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Miller v. Christiana Care Health, Services, Inc.

Superior Court of Delaware

September 28, 2018

KAREN I. MILLER, Individually and as Representative of the Estate of LOIS V. CARD, KRISTI WRIGHT, and ERKKIM. AKKOLA, Plaintiffs,
v.
CHRISTIANA CARE HEALTH, SERVICES, INC., IPC HEALTHCARE, INC., and MEGHANA DHAMDHERE, M.D., Ph.D., Defendants. v.

          Submitted: June 21, 2018

          David G. Culley, Esquire Richard Galperin, Esquire Joshua Meyeroff, Esquire

         JURY TRIAL OF 12 DEMANDED

         Upon CCHS's Motion for Partial Summary Judgment: DENIED

          ABIGAIL M. LEGROW JUDGE

         1. This medical negligence action arises from treatment a patient received in the emergency room after experiencing severe chest pain. Among other claims not at issue in this motion, Plaintiffs contend the two emergency room doctors who treated the patient negligently failed to diagnose her aortic dissection. The hospital has moved for summary judgment as to the negligence claims against the emergency room doctors, arguing Plaintiffs' experts are not qualified to testify regarding the standard of care applicable to emergency room physicians. The issue presented in the pending motion is whether Plaintiffs may rely on the expert opinions of two doctors who are not experienced in emergency medicine. Those doctors have testified that the standard of care for diagnosing aortic dissection is the same regardless of the treating doctor's specialty or the setting in which care is administered. Because I find Plaintiffs have shown that their experts are qualified to testify regarding the standard of care, I deny the motion for partial summary judgment.

         FACTUAL & PROCEDURAL BACKGROUND

         2. The following facts are drawn from the complaint. Lois Card was admitted to the Emergency Room at Christiana Care Health Services' Wilmington Hospital on the morning of March 1, 2015, after experiencing severe chest pain and difficulty breathing. The receiving nurse noted Card continued to experience chest pain, headache, and non-radiating bilateral pain in her arms. After evaluation by an emergency physician, an EKG showed Card had an irregular heart rate. A chest x-ray showed mild vascular congestion, and a cardiac enzyme test showed a negative troponin reading. At noon that day, Card's care was transferred to IPC Healthcare and Dr. Dhamdhere, where Card was diagnosed with chest discomfort and a trial fibrillation. The same day, at approximately 5:00 p.m., Card came under the care of Dr. Kathryn Groner, who determined Card needed to be transferred to the hospital's heart unit.[1] Before Card could be transferred, however, she became unresponsive. Card's condition deteriorated and she was pronounced dead at approximately 7:30 p.m. Card is survived by her children, Karen Miller, Kristi Wright, and Erkki Akkola, who are Plaintiffs in this action.

         3. On September 14, 2016, Plaintiffs brought a medical negligence claim against CCHS, Dr. Dhamdhere, and IPC Healthcare. As part of their case, Plaintiffs alleged that Card's treating emergency physicians, Drs. Leonard Nitowski and Kathryn Groner, failed to identify and diagnose Card's aortic dissection.[2] In support of these allegations, Plaintiffs offer the testimony of Dr. Thomas Berger, a former thoracic surgeon, and Dr. Donald Marks, a hospitalist. After discovery, CCHS filed a motion for partial summary judgment as to all direct negligence claims against CCHS's emergency medicine staff.

         THE PARTIES' CONTENTIONS

         4. In its motion for summary judgment, CCHS argues Plaintiffs' witnesses are not qualified to testify to the standard of care for emergency medicine. CCHS contends 18 Del. C. § 6854 requires Plaintiffs' experts to be familiar with the degree of skill ordinarily employed in the field of medicine on which they will testify. Because Plaintiffs' experts are not familiar with emergency medicine, CCHS argues they cannot testify as to whether Card's emergency physicians breached the standard of care, and Plaintiffs therefore cannot maintain any direct medical negligence claims against CCHS's emergency staff.

         5. In response, Plaintiffs first argue CCHS's motion should be raised as a motion in limine, not a dispositive motion. Second, Plaintiffs argue the alleged negligence involves the failure to diagnose an aortic dissection, which Plaintiffs contend is a field that intersects multiple medical specialties. Because their experts are familiar with diagnosing and treating aortic dissections, Plaintiffs argue their experts are qualified to testify to the standard of care applicable to making that diagnosis, whether the setting of care is an emergency room, urgent care, or primary care office.

         ANALYSIS

         6. Summary judgment should be awarded if "the pleadings, depositions, answers to interrogatories and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law."[3] When considering a motion for summary judgment, the evidence and the inferences drawn from the evidence are to be viewed in the light most favorable to the nonmoving party.[4] The Court will accept "as established all undisputed factual assertions . . . and accept the non-movant's version of any disputed facts. From those accepted facts[, ] the [C]ourt will draw all rational inferences which favor the non-moving party."[5]

         7. Plaintiffs first argue Drs. Berger's and Marks' qualifications should be analyzed under the Daubert standard on a motion in limine as opposed to a dispositive motion. Courts in Delaware, however, repeatedly have resolved dispositive motions on the basis of expert medical witnesses' qualifications under Section 6854.[6] CCHS's motion for summary judgment is a proper vehicle to examine the experts' qualifications and determine whether Plaintiffs may rely on those experts' opinions to establish their claims against CCHS.

         8. CCHS argues summary judgment is appropriate because Plaintiffs cannot meet their burden of proof at trial. Apart from several limited exceptions not applicable here, Delaware law requires a plaintiff in a medical negligence action to support her claim with expert medical testimony as to both the alleged deviation from the standard of care and the causal connection between the wrongful conduct and the alleged injury.[7] If the plaintiff fails to support her allegations with expert medical testimony, the defendant is entitled to judgment as a matter of law.[8] Title 18, Section 6854 of the Delaware Code requires a medical expert opining as to standard of care to be "familiar with the degree of skill ordinarily employed in the field of medicine on which he or she ...


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