Medical malpractice; Standard of care; Expert testimony; Elher v Misra; Proximate causation; MCL 600.2912a(2); Cause in fact; Taylor v Kent Radiology; Circumstantial evidence; Reasonable inference of causation; Robins v Garg

The court held that plaintiff’s expert testimony created a genuine issue of material fact as to causation in this medical-malpractice action arising from the decedent’s death after an elective abortion and IUD placement. Plaintiff alleged defendants failed to timely recognize and treat a uterine perforation and thrombotic complications that led to a fatal pulmonary embolism. The trial court granted summary disposition for all defendants, reasoning that causation could not be established because no expert could definitively identify whether the fatal emboli originated in the decedent’s uterine veins or lower extremities. On appeal, the court held that plaintiff did not have to identify and trace “a particular clot” through the decedent’s body. Rather, plaintiff only had to show “a reasonable likelihood of probability” and “a fair amount of certainty.” Viewed in plaintiff’s favor, the testimony allowed a reasonable jury to find that timely recognition and treatment of the uterine perforation “more probably than not would have prevented the fatal pulmonary embolism, regardless of the precise origin of the thrombi.” The court emphasized expert testimony that surgery could have addressed the uterine-vein thrombosis, heparin would have prevented a pulmonary embolus, the perforation caused the thrombi and emboli, and timely diagnosis would have led to referral or surgical care. Thus, the trial court improperly weighed uncertainty about the clot’s source rather than recognizing a triable causation issue. Reversed and remanded.