Sandoval v. Danilyants
| Decision Date | 10 May 2022 |
| Docket Number | CIVIL PJM 17-cv-1599 |
| Parties | SARAH SANDOVAL, Plaintiff, v. NATALYA DANILYANTS, M.D., et al ., Defendants. |
| Court | U.S. District Court — District of Maryland |
Sarah Sandoval sued Natalya Danilyants, M.D. and Danilyants' employer The Center for Innovative Gyn Care, PC (CIGC) for medical malpractice arising from myomectomy surgery performed by Danilyants in 2015. Following the surgery, Sandoval was found to have two perforations of the bowel, which required additional corrective surgeries.
The case went to trial beginning July 13, 2021. Sandoval's claims proceeded in two counts - one for negligence (Count I) and the other for failure to obtain informed consent (Count II). As with any medical malpractice case, Sandoval was required to support her allegations with expert testimony to the effect that, to a reasonable degree of medical probability, Danilyants breached the applicable standard of care, and that, to a reasonable degree of medical certainty the negligence caused Sandoval's injuries. At trial Sandoval offered the testimony of two physicians: Michael Hovey, M.D., her treating surgeon following the challenged surgery by Danilyants, and Steven McCarus, M.D. who offered expert opinion testimony on causation. At the end of a nine-day trial, the jury returned a verdict in favor of Sandoval on her negligence claim, but in favor of Defendants on the informed consent claim, and awarded Sandoval $1.5 million on Count I.
Following trial, Defendants filed a Renewed Motion for Judgment as a Matter of Law, ECF No. 111, as well a Motion for Remittitur/Motion to Alter or Amend the Judgment Pursuant to the Maryland Healthcare Malpractice Claims Act, ECF No. 112. In the Motions, they argue that the jury verdict must be reversed because, say Defendants, Sandoval's expert testimony failed to establish that Defendants' alleged negligence caused her injuries. Alternatively, if the verdict is upheld, Defendants seek a reduction in the amount of the damage award in order to comply with Maryland's statutory cap on noneconomic damages as well as to eliminate costs they contend were not occasioned by Danilyants' acts. Sandoval has responded, urging the Court not to disturb the verdict, agreeing, however, to some but not all, of the reductions in damages Defendants seek.
For the reasons that follow, the Court DENIES Defendants' Motion for Judgment as a Matter of Law, and GRANTS IN PART and DENIES IN PART their Motion for Remittitur.
I. Factual Background
On August 25, 2015, Sandoval underwent an MRI that showed a mass in her pelvis consistent with a subserosal fibroid on her uterus. The fibroid was over fifteen centimeters in diameter distorting Sandoval's anatomy, resulting, for instance in both ovaries being located on the same side of her body. When her doctor recommended surgery, she elected to pursue a laparoscopic assisted abdominal myomectomy (“LAAM”) at the CIGC in Maryland.[1]
After pursuing pre-surgery lab work, Sandoval underwent the surgery performed by Danilyants at CIGC on October 22, 2015. During the procedure, it was revealed that Sandoval had multiple fibroids, the largest of which was attached to the bowel. Her right ovary was also stuck to the bowel and the uterus. During the removal of the fibroids, there was significant loss of blood.
Three days after the surgery, Sandoval flew back to her home in Scottsdale Arizona. In the two weeks following the surgery, her pain initially improved, but then began to worsen. On November 5, 2015, Sandoval called CIGC and reported pain for which she was prescribed further pain medication. That same night Sandoval went to the emergency room at a hospital in Scottsdale where she reported fever, nausea, and pain. A CT scan showed evidence of infection. Sandoval therefore underwent a second surgery, this one performed by Dr. Hovey, which revealed a perforation of the cecum.[2] Though initially Sandoval's condition began to improve, within a few days another CT scan showed further infection. On November 12, 2015, she underwent surgery again, during which the surgeon found a rectal perforation. Both perforations were believed to have been caused by the surgery performed by Danilyants. After recuperating for several weeks with an ileostomy, [3] Sandoval was discharged from the hospital. In a subsequent surgery, the ileostomy was later reversed.
In this suit, Sandoval alleges that she continues to have pain in her abdomen and pelvis, and that she has been told that she likely suffered damage to her reproductive system that will make it impossible for her to become pregnant.
II. Procedural History On May 24, 2017, Sandoval filed a Statement of Claim with the Health Care Alternative Dispute Resolution Office of Maryland, naming Danilyants and CIGC as Defendants. On or about May 25, 2017, the Health Care Alternative Dispute Resolution Office issued an order transferring Sandoval's claim to this Court. Sandoval filed her Complaint here on June 12, 2017.
On March 18, 2019, the parties jointly informed the Court that they did not intend to file any dispositive motions and requested that the case be scheduled for trial. Following Covid-related delays, an in-person jury trial was held over the course of nine days, beginning on July 13, 2021. At the end of Sandoval's case on July 20, 2021, and again at the close of all evidence on July 22, 2021, Defendants moved for judgment as a matter of law. Trial Tr. vol. 5, 4-8; 17-21; Trial Tr. vol. 7, 3-4. The Court reserved ruling on the motions, taking them under advisement.
The jury returned a verdict in favor of Sandoval, see ECF No. 106, and answered special interrogatories as follows:
The jury awarded Sandoval $529, 571.04 for past medical expenses; $41, 500.00 for past lost wages, and $928, 928.96 as non-economic damages, totaling $1.5 million, which would carry post-judgment interest at the federal statutory rate. The Court also awarded Sandoval costs. ECF Nos. 106, 109.
After the Court entered judgment on the jury verdict, Defendants filed a Renewed Motion for Judgment as a Matter of Law, ECF No. 111, and Motion for Remittitur/Motion to Alter or Amend the Judgment, ECF No. 112. Sandoval responded and Defendants replied. The matters are now before the Court for resolution.
III. Discussion
A renewed motion for judgment as a matter of law under Rule 50(b) “assesses whether the claim should succeed or fail because the evidence developed at trial was insufficient as a matter of law to sustain the claim.” Belk, Inc. v. Meyer Corp., U.S., 679 F.3d 146, 155 (4th Cir. 2012), as amended (May 9, 2012). In a medical malpractice case, pursuant to Fed.R.Civ.P. 50(b) “the court may be called upon . . . to evaluate the sufficiency of the expert's testimony . . . after the jury has reached its verdict.” Samuel v. Ford Motor Co., 112 F.Supp.2d 460, 468 (D. Md. 2000), aff'd sub nom. Berger v. Ford Motor Co., 95 Fed.Appx. 520 (4th Cir. 2004). “Under Rule 50, a court should render judgment as a matter of law when ‘a party has been fully heard on an issue and there is no legally sufficient evidentiary basis for a reasonable jury to find for that party on that issue.'” Reeves v. Sanderson Plumbing Prod., Inc., 530 U.S. 133, 149, 120 S.Ct. 2097, 147 L.Ed.2d 105 (2000) (quoting Fed.R.Civ.P. 50(a)). The court views the evidence in the light most favorable to the non-movant, Gregg v. Ham, 678 F.3d 333, 341 (4th Cir. 2012), and asks whether there is “substantial evidence in the record to support the jury's findings.” See Anderson v. Russell, 247 F.3d 125, 129 (4th Cir. 2001) (citation omitted).
To prevail in a medical malpractice action, Maryland law[4] requires a plaintiff to establish “(1) the applicable standard of care, (2) that the defendants breached this standard, and (3) that her injuries were caused by the defendants' breach.” Simmons v. O'Malley, 85 Fed.Appx. 322, 2 (4th Cir. 2004), citing Weimer v. Hetrick, 309 Md. 536, 547, 525 A.2d 643, 648-49 (1987). Juries are not permitted to simply infer medical negligence in the absence of expert testimony because the determination of issues relating to breaches of standards of care and medical causation are considered to be “beyond the ken of the average layperson.” Am. Radiology Servs., LLC v. Reiss, 470 Md. 555, 580, 236 A.3d 518, 532 (2020). As such, “expert testimony is required to establish negligence and causation.” Simmons, 85 Fed.Appx. 322, citing Meda v. Brown, 318 Md. 418, 428, 569 A.2d 202, 207 (1990). See also Rodriguez v. Clarke, 400 Md. 39, 71, 926 A.2d 736 (2007). Moreover, an expert's testimony as to breach of the standard of care must be expressed to a “reasonable degree of medical probability” and causation to a reasonable degree of medical certainty to ensure that the expert's opinion is more than mere speculation or conjecture. American Radiology Services, LLC, 470 Md. at 581 (citing Kearney v. Berger, 416 Md. 628, 651-52, 7 A.3d 593 (2010)).
In the Fourth Circuit, “questions regarding the sufficiency of expert evidence offered to meet an essential element of a claimant's cause of action” are governed by federal law. See Samuel, 112 F.Supp.2d...
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