Tousignant v. ST. LOUIS COUNTY, MN
| Decision Date | 27 July 2000 |
| Docket Number | No. C8-99-826.,C8-99-826. |
| Citation | 615 N.W.2d 53 |
| Parties | Violet TOUSIGNANT, petitioner, Appellant, v. ST. LOUIS COUNTY, MINNESOTA, et al., Respondents. |
| Court | Minnesota Supreme Court |
David L. Weidt, Duluth, for appellant.
Alan L. Mitchell, St. Louis County Atty., Amy H. Kuronen, Asst. County Atty., Duluth, for respondents.
Wilbur W. Fluegel, Minneapolis, for amicus curiae Minn. Trial Lawyers Assn.
Considered and decided by the court en banc without oral argument.
Appellant Violet Tousignant brought an action against respondents Chris Jensen Nursing Home and its owner St. Louis County, alleging negligence by the Jensen Home's nursing staff. The St. Louis County District Court dismissed Tousignant's action for her failure to submit an affidavit of expert disclosure in compliance with Minn.Stat. § 145.682 (1998). The Minnesota Court of Appeals affirmed the dismissal. We reverse and remand to the district court.
The facts giving rise to this appeal are undisputed. Appellant Violet Tousignant was admitted to Chris Jensen Nursing Home (Jensen Home) at 11:30 a.m. on February 6, 1995. The Jensen Home is owned and operated by St. Louis County and the two are hereinafter referred to as respondents. Tousignant was 86 years old and recovering from surgery for a fractured right hip and wrist when she was admitted to the Jensen Home.
The interagency referral form that accompanied Tousignant from the hospital as her admission orders to the Jensen Home authorized the use of a vest "prn" (as needed) due to her confusion and risk of re-injury. The referral form's "Patient Care Plan" stated that Tousignant was "alert, but pleasantly confused" and that she was to have a "vest restraint on at all times." While a registered nurse signed this referral form, Tousignant submitted evidence showing that the referral form was considered by the Jensen Home staff as admission orders from the physician. Tousignant also submitted evidence that the Jensen Home staff was aware that Tousignant would likely attempt to walk unassisted if left unrestrained and unattended. Tousignant's family members also stated that they informed the Jensen Home staff "at least five to six times" that Tousignant needed to be restrained because of her confusion, even if she appeared "ok."
Tousignant was left unattended in her room after admission, unrestrained, and in a wheelchair. Approximately three hours after her admission, Tousignant was found on the floor of her room. She had fallen and sustained another fracture to her right hip.
Tousignant brought a medical malpractice action in St. Louis County District Court naming respondents as defendants. Respondents initially moved for summary judgment based on official immunity, the denial of which they appealed. See Tousignant v. St. Louis County, No. C0-98-907, 1998 WL 846581 *1 (Minn.App.1998). The court of appeals affirmed the district court's denial of summary judgment for respondents. See id.
On remand, respondents moved to dismiss, arguing that Tousignant had failed to meet the expert disclosure requirements of Minn.Stat. § 145.682. Tousignant responded with a motion for the district court to determine whether expert testimony was required to establish a prima facie case of negligence.1 Respondents argued that dismissal was mandated by the fact that Tousignant had not filed the expert affidavit required by Minn.Stat. § 145.682, subd. 4, and that Tousignant's claim required expert testimony. Tousignant responded that because the issues in her case were neither complicated nor beyond the understanding of lay persons, expert testimony was not required to establish a prima facie case of medical malpractice.
The district court ruled that because medical judgment was required by the Jensen Home staff concerning the treatment and care of Tousignant, expert testimony was required to establish a prima facie case. The court also concluded that the statute had required interpretation by the court on this issue and that there had been a lengthy delay due to the earlier appeal. Accordingly, the court found that Tousignant's delay in filing the required expert affidavit was excusable and granted Tousignant a 30-day extension to file the requisite expert affidavit.
On February 10, 1999, Tousignant provided respondents with an affidavit that purported to be the expert disclosures required by Minn.Stat. § 145.682. Tousignant's affidavit was not signed by any of her identified experts and it contained only brief conclusory summaries of the proposed expert testimony. Respondents renewed their motion to dismiss and the district court granted the motion, dismissing Tousignant's action with prejudice. When it dismissed Tousignant's action, the district court found that her affidavit did not comply in form or substance with the requirements of Minn.Stat. § 145.682 "although she has had substantial and sufficient opportunity to do so * * *." Specifically, the court found the affidavit insufficient because it was not signed by the experts and because the affidavit did not set forth the standard of care and a factual delineation of how the Jensen Home failed to comport to that standard. The court also found that Tousignant failed to provide the required expert discovery responses under Minn. R. Civ. P. 26.02(d)(1) which would have satisfied the requirements of section 145.682, subd. 4, if they were signed by the experts. See id. The court stated that it was "left with the firm conviction [that Tousignant] simply has failed to carry the obligations imposed upon her by the statute as interpreted by case law." The court then concluded that dismissal with prejudice was "mandated by the statute."
Tousignant appealed, arguing that the district court erred in dismissing her claim or in the alternative by not granting her a further extension so that she could bring her affidavit into compliance with the statute. The court of appeals affirmed the district court, holding that the affidavit was clearly deficient on the grounds the district court articulated. See Tousignant v. St. Louis County, 602 N.W.2d 882 (Minn.App.1999). In its decision, the court of appeals rejected Tousignant's argument that the district court should have considered the affidavit in connection with the Vulnerable Adults Act report, prepared by an identified expert witness and submitted to the court on summary judgment. See id. at 886. To support its conclusion, the court of appeals cited Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 578 (Minn. 1999), and its prohibition on the use of nonaffidavit materials to supplement the required affidavit. See Tousignant, 602 N.W.2d at 886.
Finally, the court of appeals rejected Tousignant's claim that the district court erred in not granting a second extension, noting that no further extension was requested in the district court and that there was no discernable "reasonable excuse" on which to base such an extension. See id. at 886-87. The court of appeals observed that Tousignant had over two years to obtain a sufficient affidavit and had already been granted one extension by the district court. See id. at 887. Although the court referred to its decision as "unquestionably harsh," observing that Tousignant's claims were not frivolous and that her failures caused "no identifiable prejudice to Jensen and St. Louis County," it nonetheless affirmed the district court's dismissal with prejudice. See id.
Tousignant petitioned this court for review, arguing only that the court of appeals erred in holding that Minn.Stat. § 145.682 as interpreted by this court mandates dismissal and that such an interpretation of section 145.682 deprived her of a legitimate lawsuit. In her brief, however, Tousignant also argues that the district court erred in requiring an affidavit. In their brief, respondents object to this argument, asserting that it is beyond the scope of the petition for review and was not presented to the court of appeals.
Tousignant presents two questions on appeal: first, whether the district court erred in concluding that an expert affidavit was required to establish a prima facie case2; and second, whether she substantially complied with the requirements of Minn.Stat. § 145.682.
We have stated that we will not reverse a dismissal for failure to comply with the requirements of section 145.682 absent a showing that the district court abused its discretion. See Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188, 190 (Minn.1990). However, interpretation of the requirements of section 145.682 requires statutory interpretation, a question of law, which this court reviews de novo. See Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 555 (Minn.1996). As we observed in Sorenson, section 145.682, subd. 2, specifically limits its application to those medical malpractice actions "as to which expert testimony is necessary to establish a prima facie case." 457 N.W.2d at 191. Thus, the threshold question in this matter is whether Tousignant's claim required expert testimony to establish a prima facie case. Because there are no issues of fact to be resolved, we review this issue as a question of law. Our analysis therefore necessarily turns to case law that determines when such expert testimony is required to establish a prima facie case.
We have stated that expert testimony is generally required to establish the standard of care and the departure from that standard for the conduct of physicians. See id. "The purpose of expert testimony is to interpret the facts and connect the facts to conduct which constitutes [medical] malpractice and causation." Id. at 192. This is based on the assumption that most medical malpractice cases involve complex issues of science or technology, requiring expert testimony to assist the jury in determining liability.
We have stated an exception to the expert affidavit requirement—that when "the acts or omissions complained of are within the general knowledge...
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