Stokes v. Baker
| Citation | 248 Cal.Rptr.3d 174,35 Cal.App.5th 946 |
| Decision Date | 30 May 2019 |
| Docket Number | B279241 |
| Court | California Court of Appeals |
| Parties | Clara STOKES et al., Plaintiffs and Appellants, v. Ellen M. BAKER, Defendant and Respondent. |
Hodes Milman Liebeck, T. Gabe Houston, Daniel M. Hodes, Irvine, Lee M. Weiss ; Newmeyer & Dillion, Charles S. Krolikowski and Jason Moberly Caruso, Newport Beach, for Plaintiffs and Appellants.
Haight Brown & Bonesteel, Angela S. Haskins, Vangi M. Johnson, Los Angeles; Cole Pedroza, Curtis A. Cole, Fresno, Kenneth R. Pedroza and Danica-Joyce Lam for Defendant and Respondent.
Health and Safety Code section 1799.110, subdivision (c) states: "In any action for damages involving a claim of negligence against a physician and surgeon providing emergency medical coverage for a general acute care hospital emergency department, the court shall admit expert medical testimony only from physicians and surgeons who have had substantial professional experience within the last five years while assigned to provide emergency medical coverage in a general acute care hospital emergency department."1 In this appeal, we must decide whether this expert qualification requirement applies to all expert medical testimony in a negligence action against an emergency room doctor, or whether it applies only to medical testimony regarding the standard of care.
Plaintiffs Clara and Vaughn Stokes sued defendant Ellen Baker, M.D., alleging Dr. Baker negligently failed to diagnose a subarachnoid hemorrhage
afflicting Ms. Stokes when she presented to Dr. Baker's emergency department. They alleged Dr. Baker's negligence caused Ms. Stokes's aneurysm to go untreated until it ruptured, resulting in the cognitive and neurological difficulties Ms. Stokes now experiences.
The trial court granted Dr. Baker's motion for summary judgment, concluding plaintiffs' causation expert—a board-certified neurointerventional surgeon—was not qualified to offer medical testimony under section 1799.110 because he did not have substantial professional experience working in an emergency department. We conclude this was error. As we will discuss, section 1799.110's structure and legislative history confirm the Legislature intended the expert qualification provision to ensure only that emergency physicians are subject to a fair and practical appraisal of the applicable standard of care. Although the trial court's interpretation is consistent with the strict letter of the isolated clause, its literal construction would generate needless conflicts with Evidence Code section 720 and absurd consequences in cases where causation and damages implicate medical issues outside the experience and expertise of emergency room physicians. We reverse.
Consistent with the applicable standard of review, we state the facts established by the parties' evidence in the light most favorable to plaintiffs as the nonmoving parties, drawing all reasonable inferences and resolving all evidentiary conflicts, doubts or ambiguities in plaintiffs' favor. ( Jacks v. City of Santa Barbara (2017) 3 Cal.5th 248, 273, 219 Cal.Rptr.3d 859, 397 P.3d 210 ( Jacks ); Saelzler v. Advanced Group 400 (2001) 25 Cal.4th 763, 768, 107 Cal.Rptr.2d 617, 23 P.3d 1143 ( Saelzler ).)
Ms. Stokes presented to Torrance Memorial's emergency department on May 25, 2014, complaining of sudden pain on the back of her head radiating to her neck. She told Dr. Baker she had experienced pain in her neck and a migraine headache since twisting her neck two days earlier, and she reported a recent increase in the frequency of migraines. Ms. Stokes said she was suffering from the worst headache she had ever experienced and described her primary pain intensity as "10/10." She also reported vomiting the prior evening, and complained of right sciatic nerve pain.
Dr. Baker's physical examination of Ms. Stokes found neck tenderness, no neurologic deficit, and full strength in both arms and legs. A computerized tomography
scan of Ms. Stokes's head and brain was "negative" for injury, and an x-ray of her lumbar spine was "unremarkable." An x-ray of her cervical spine revealed a congenital fusion abnormality and degenerative changes at various vertebrate. Dr. Baker contacted the on-call neurologist, who indicated he could see Ms. Stokes in two or three days. Dr. Baker did not order further testing.
Dr. Baker concluded that Ms. Stokes had an acute migraine headache, dehydration secondary to vomiting, and severe degenerative changes to her cervical spine. She prescribed Ms. Stokes pain medication and advised her to contact the neurologist for a follow-up visit. Ms. Stokes was discharged with instructions to follow up with the neurologist and to return to the emergency department if her condition worsened or if she developed new symptoms. Ms. Stokes followed up with the neurologist on May 28, 2014.
On June 4, 2014, Ms. Stokes suffered an intracranial bleed secondary to a ruptured aneurysm
. She was admitted to the hospital and underwent a craniotomy and clipping. She remained intubated after the surgery and required high levels of sedation. Her hospital treatment was complicated by healthcare-associated pneumonia and staph infection. Following the ruptured aneurysm and surgery, Ms. Stokes has had persistent cognitive and physical impairments that prevent her from performing full-time work in a normal working environment.
Plaintiffs sued Dr. Baker, Torrance Memorial, and other medical professionals who had participated in Ms. Stokes's treatment, asserting causes of action for medical negligence and loss of consortium. They alleged Dr. Baker breached the standard of care by "fail[ing] to identify, diagnose, and treat, an intraventricular and subarachnoid hemorrhage
in" Ms. Stokes, and by "fail[ing] to order and perform a lumbar puncture, thereby permitting the hemorrhage to progress untreated." And they alleged Dr. Baker's failure to diagnose the hemorrhage allowed it to go untreated until Ms. Stokes's aneurysm ruptured, which caused Ms. Stokes to suffer serious personal injuries.
Dr. Baker moved for summary judgment on the grounds that her care and treatment of Ms. Stokes were consistent with the standard of care and nothing she did or failed to do caused Ms. Stokes's alleged injuries.
In support of the motion, Dr. Baker proffered the declaration of Jonathan Lawrence, M.D., a board-certified physician in emergency medicine with "extensive experience dealing with patients presenting to the Emergency Department with the complaints and symptoms such as those experienced by [Ms. Stokes] on May 25, 2014." Dr. Lawrence opined that Dr. Baker's care and treatment of Ms. Stokes "conformed with the standard of care required under the circumstances." He explained: "[T]he presentation of plaintiff [Ms. Stokes] to the [Torrance Memorial] Emergency Department on May 25, 2014 was not suspicious for subarachnoid hemorrhage
.... The radiologic imaging ordered by Dr. BAKER was appropriate for following up on the patient's complaints of neck pain and it confirmed that plaintiff [Ms. Stokes] suffers from degenerative disk disease in the cervical spine. In addition, Dr. BAKER consulted with a Neurologist who advised that he would follow [up with] the patient in his office in two to three days. Accordingly, the index of suspicion for subarachnoid hemorrhage was low and did not require any further work-up such as a lumbar puncture."
As for causation, Dr. Lawrence opined: "It is further my opinion, to a reasonable degree of medical probability that no negligent act or omission by defendant ELLEN BAKER, M.D. caused or contributed to any injury, harm or damages as alleged by plaintiffs."
In opposition to Dr. Baker's motion, plaintiffs proffered the declarations of emergency medicine physician Michael Ritter, M.D., and neurointerventional surgeon George Rappard, M.D.
Dr. Ritter opined that Dr. Baker fell below accepted standards of care for emergency medicine in her diagnosis, care, and treatment of Ms. Stokes. According to Dr. Ritter, Dr. Baker's impression that Ms. Stokes had an acute migraine headache, dehydration secondary to vomiting, and severe degenerative changes to her cervical spine did not account for Ms. Stokes's new pattern of headaches or her sudden onset of head pain radiating to the neck. Rather, these symptoms were consistent with a subarachnoid hemorrhage
, which causes "severe headaches as well as neck pain and stiffness," and therefore "the standard of care required Dr. Baker to order all necessary testing to completely rule out a subarachnoid hemorrhage." Dr. Ritter further explained that "[s]maller hemorrhages may not show up on a normal CT scan." Thus, when Ms. Stokes's CT scan came back negative, "the standard of care required Dr. Baker to order a lumbar puncture," which would have "revealed blood in Ms. Stokes'[s] cerebral spinal fluid" and "confirm[ed] a subarachnoid hemorrhage." At that point, "the standard of care would have required Dr. Baker to refer Ms. Stokes to a specialist such as a neurosurgeon or neurointerventional surgeon to address the subarachnoid hemorrhage." By failing to order the lumbar puncture, Dr. Ritter opined Dr. Baker breached the standard of care in treating Ms. Stokes.
Dr. Rappard opined that Dr. Baker's actions were a substantial factor in causing Ms. Stokes to suffer greater injuries than she would have suffered had Dr. Baker diagnosed the subarachnoid hemorrhage
when Ms. Stokes presented to the emergency department on May 25, 2014. Based on his experience as a board-certified neurointerventional surgeon and his review of Ms. Stokes's medical records, Dr. Rappard determined Ms. Stokes's subarachnoid hemorrhage was "a small ‘sentinel’ or ‘early warning’ bleed, which denotes an aneurysm that has yet to fully rupture but will likely rupture in the near future."...
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