Day on Torts
Plaintiff’s HCLA claim that defendant medical facility failed to advise a transportation service of his mobility issues required expert medical proof.
In Dickerson v. United Medical Transportation LLC, No. W2023-01084-COA-R3-CV (Tenn. Ct. App. Oct. 23, 2024), plaintiff had been a patient at defendant medical facility. Upon plaintiff’s discharge, defendant arranged for transportation for plaintiff with a transport service. The service did not assist plaintiff when he was getting out of the car, and he fell, injuring himself.
Plaintiff filed this HCLA claim asserting that defendant “failed to inform [the transport service] of his medical conditions, including his fall risk status, while arranging for his transportation.” Defendant moved for summary judgment based on a lack of duty and the assertion that plaintiff had no ambulatory issues, and plaintiff responded by filing the affidavit of an expert with a background in transportation. Notably, this expert had no medical training or licensure. The trial court granted summary judgment to the defendant, ruling that plaintiff would need expert testimony to support his claim, and the Court of Appeals affirmed.
An HCLA plaintiff is generally “required to prove his or her claim through expert testimony.” (internal citation omitted). Plaintiff argued on appeal that the common knowledge exception applied here, meaning that no medical expert was required. “Tennessee law provides that expert testimony is not required where the act of alleged wrongful conduct lies within the common knowledge of a layperson.” (internal citation and quotation omitted). To determine whether the common knowledge exception applies, courts look at “whether the alleged negligent conduct involved technical or specialized knowledge of a medical procedure or a patient’s medical condition or whether the alleged negligent conduct involved medical decision-making.” (internal citation omitted).
Plaintiff argued that the negligent conduct here was defendant’s failure to tell the transport service that plaintiff was a fall risk. Defendant asserted, however, that there was an issue of fact regarding plaintiff’s ambulatory needs, and that the actual conduct complained of included plaintiff’s therapist reviewing his record and making an informed decision about what information needed to be shared with the transport service. The Court agreed with defendant. While the Court wrote that the need to share relevant information with the transport service was evident without expert testimony, it also wrote that it was “clear that the determination of the patient’s limitations requires the exercise of medical judgment.” The Court defined the allegedly negligent conduct as “less the failure to provide information, and more the determination that certain information was not medically relevant[.]”
The Court reasoned:
While no medical knowledge may be required to understand the importance of communicating a patient’s ambulation needs to the entity in charge of transporting the patient, the determination of the level of assistance a patient requires is not so obvious as to be within the knowledge of the average layperson. … The decision to not communicate that [plaintiff] needed assistance was therefore the result of the exercise of uniquely professional medical skills, a deliberate balancing of medical risks and benefits, or the exercise of therapeutic judgment.
(internal citation and quotation omitted). The Court therefore agreed that plaintiff needed expert proof to support his claim.
Plaintiff next argued that the trial court erred in finding that the expert he offered was not qualified under the HCLA. Plaintiff’s expert was an expert in ground transportation with no medical training. Plaintiff asserted that because ground transportation does not require licensure in Tennessee, his expert’s lack of a license should not be a basis for disqualification.
Like the common knowledge exception analysis, though, the Court found that the allegedly negligent act in this case involved medical judgment. The Court wrote:
However, as we concluded in relation to the common knowledge exception, the issue before us actually requires the assessment of [plaintiff’s] physical condition at the time of his discharge from Lakeside. The expert proof provided by [defendant] opined that [plaintiff’s therapist] was not required to inform the medical transportation company that [plaintiff] required assistance with mobility because his medical assessment was that [plaintiff] did not require any assistance with mobility. We are unwilling to assume that [the expert’s] experience with arranging ground transportation makes him suitably knowledgeable about whether a patient does or does not need help to walk, and we have not been provided with any evidence to establish otherwise.
While “there is no express requirement that an expert witness in a health care liability be a medical doctor,” the Court found that plaintiff’s proffered expert was not qualified to testify on the contested issue of what plaintiff’s ambulatory needs were. Because an expert was needed, and because plaintiff’s expert was not qualified to testify about the medical judgment used to determine what information to share with a transport service, summary judgment was affirmed.
This opinion is a reminder that very few HCLA cases fall within the common knowledge exception. When planning to file an HCLA case, the safest option is to have a relevant medical expert to support your claim.
This opinion was released four months after oral arguments in this case.