Medical malpractice; Elher v. Misra; Proximate causation; Teal v. Prasad; Lockridge v. Oakwood Hosp.; Kalaj v. Khan; Ray v. Swager; Standard of care (SOC)

Holding that plaintiff presented evidence creating a genuine issue of material fact as to causation, the court reversed the grant of partial summary disposition and remanded. Plaintiff argued that the trial court, relying on the expert testimony of his causation expert, Dr. V, erroneously held that there was no genuine issue of material fact as to the issue of proximate causation. The court held that defendants’ position failed because plaintiff’s SOC expert, Dr. S, did not limit his testimony to requiring an MRI of the lumbar spine. S testified that the SOC for “a patient with Marfan syndrome with the specific symptoms plaintiff had, which included ‘pain inferior to the right scapula,’ ‘pain in the right flank,’ ‘pain in the lumbosacral area,’ ‘pain in the thoracic vertebrae area,’ pain that ‘moves around’ but ‘[a]ll related to the back’ called for ‘an MRI or a CT of the chest, abdomen, pelvis, and spine,’ and that a ‘focused spine radiological study’ was necessary ‘to see dural ectasia.’” S testified that “they didn’t do the proper radiological evaluation of the spine.” V’s remarks were based on a hypothetical scenario that did not match S’s SOC testimony, and he clarified before responding that the question at issue was whether “an MRI of the lumbar spine” would “image the mid thoracic spine.” S did “not opine that an MRI of the chest or a focused spine radiological study would fail to reveal plaintiff’s presenting condition.” To the extent V gave any opinion testimony as to what tests he would order, it was irrelevant and inadmissible, as it was undisputed that he was not qualified under MCL 600.2169 to render SOC opinions as to ER physicians. The essence of S’s opinion was not that the defendants-doctors breached the SOC by “failing to diagnose a dural ectasia per se. Rather, it was failing to perform the evaluation for dural ectasia called for by the [SOC] based on plaintiff’s presentation at the emergency room, because those tests—even if they did not show dural ectasia—would have revealed” his spinal epidural abscess. Nothing in S’s testimony indicated that he considered the “‘proper radiological evaluation of the spine’ to be an evaluation of the lumbar spine only, especially given the awareness that plaintiff’s pain ‘kind of moved around’ and could have radiated from a spinal disorder in the thoracic vertebra area.” S testified to a SOC that “called for the proper evaluation of the entire spine, not just that part of the spine where dural ectasia most likely occurs statistically.” S’s claim that ER doctors practice medicine based on clinical presentation, not on statistics, also supported such an inference.