Medical malpractice elements; Craig v Oakwood Hosp; Cause in fact/“but for” causation; MCL 600.2912a(2); Expert testimony; Kalaj v Khan; Specialty mismatch; Halloran v Bhan; National Institute of Health (NIH); Middle cerebral artery (MCA)

The court held that plaintiff created a genuine issue of material fact on causation through expert testimony that earlier imaging and a code stroke in the ER would have altered monitoring and treatment and avoided death. Thus, summary disposition for defendant-ER physician and her employer was improper. The patient presented to the ER with facial droop, a low NIH Stroke Scale score, and a negative non-contrast CT. The ER physician diagnosed suspected stroke, noted she was outside the tPA window, gave aspirin, and admitted her without ordering a CT angiogram or calling a code stroke. The patient’s condition deteriorated overnight, imaging later showed a left MCA occlusion, consultants ultimately declined thrombectomy, and she later died after multiple worsening strokes. On appeal, the court held the trial court erred by treating the causation experts’ testimony as insufficient “but for” evidence and by failing to consider it in full. It emphasized plaintiff needed evidence permitting a “reasonable inference of a logical sequence of cause and effect.” It cited testimony that a CT angiogram “when she presented on the 10th” would have shown an MCA occlusion with distal flow and collaterals, prompting admission to “a highly monitored setting . . . with frequent neuro checks,” ensuring hydration and avoiding blood-pressure drops, and initiation of dual antiplatelet therapy, and that with proper early management she “would not have died.” It also cited testimony that early CT angiogram and stroke-team activation would have placed her in neuro critical care so deterioration would be recognized promptly and she would have been a candidate for mechanical intervention on the morning of 4/11, with “a significant chance of recovery of function.” The court rejected arguments that later consults declining intervention broke causation, noting expert testimony that earlier imaging and monitoring would have changed the treatment pathway and candidacy timing, creating a triable fact question. Reversed and remanded.