This opinion will be unpublished and

may not be cited except as provided by

Minn. Stat. § 480A.08, subd. 3 (2004).






Phyllis L. Lawrence, as Trustee for the heirs and next of kin

of Caleb Keown Lawrence, decedent,





Silver Lake Clinic, P.A., et al.,



Filed October 10, 2006

Reversed and remanded

Shumaker, Judge


Hennepin County District Court

File No. WC 03-018950


Anthony J. Nemo, Meshbesher & Spence, Ltd., 1616 Park Avenue, Minneapolis, MN 55404 (for appellant)


William M. Hart, Melissa Dosick Riethof, Meagher & Geer, P.L.L.P., 33 South Sixth Street, Suite 4400, Minneapolis, MN 55402 (for respondents)


            Considered and decided by Shumaker, Presiding Judge; Kalitowski, Judge; and Worke, Judge.

U N P U B L I S H E D   O P I N I O N


            In this medical-negligence action, the district court determined that another physician’s negligent acts or omissions superseded the omissions of the respondents and granted summary judgment in respondents’ favor.  Appellant contends that the court improperly decided disputed material facts.  Because we find that there exist genuine issues of material fact for trial, we reverse and remand.


            Eleven-year-old Caleb Lawrence visited respondent Silver Lake Clinic on January 12, 2000, after experiencing lightheadedness and a feeling of the lights dimming while playing basketball on three occasions since the previous November.  Respondent Patrick Loew, P.A. examined him, concluded that it was possible that Caleb was “having some exertional vaso-syncope episodes or near episodes,” and referred him for an echocardiogram.

            Caleb had a transthoracic echocardiogram on January 12, 2000.  Cardiologist John Bass interpreted the recording and reported “[n]ormal cardiac anatomy and function.  The left main coronary artery takes an unusual course from the right coronary cusp passing between the ascending aorta and main pulmonary artery.”

            Loew received Dr. Bass’s report on January 24, 2000, reviewed it with respondent Gerald Jensen, M.D., and advised Caleb’s mother, appellant Phyllis L. Lawrence, that Caleb could resume playing basketball but should return for further tests if the symptoms persisted.  This was the last contact Caleb or Lawrence had with any of the respondents.

            Caleb and his family then moved to Texas.  During a school physical examination in Texas on December 10, 2001, Caleb told Kamna Kapil, M.D., that he experienced loss of breath and dizziness while playing basketball and that he passed out for a few seconds on one occasion.  Caleb or Lawrence apparently told Dr. Kapil that the echocardiogram in Minnesota was normal.  Dr. Kapil performed tests and then referred Caleb to cardiologist Sandra Clapp.

            Dr. Clapp obtained a history from Caleb, performed an echocardiogram, among other tests, and reported that “[t]he echocardiogram shows the presence of a structurally and functionally normal heart.  There is no evidence of hypertrophic or dilated cardiomyopathy.  There is no mitral prolapse.  There are no intracardiac shunts.”  Dr. Clapp did not advise further cardiac evaluation and did not restrict Caleb’s basketball playing.

            While playing basketball on April 3, 2002, Caleb collapsed and died a short time later.  A postmortem examination on April 4, 2002, revealed the cause of death to have been “an anomalous origin of the left main coronary artery from the right sinus of Valsalva.”

            Contending that the respondents’ negligence caused or contributed to Caleb’s wrongful death, Lawrence brought this lawsuit for damages.  Among the particular negligent omissions Lawrence alleged were respondents’ failure to prescribe additional testing, to refer Caleb to a cardiac specialist, and to restrict Caleb’s physical activity.

            The district court granted respondents’ motion for summary judgment, determining that respondents’ acts or omissions were not the proximate cause of Caleb’s death, but rather that Dr. Clapp misdiagnosed Caleb’s condition and her negligence acted as an intervening, superseding cause of Caleb’s death.  This appeal followed.


            On appeal from summary judgment, this court must ascertain whether any genuine issue of material fact exists for trial and whether the district court erred in its application of the law.  Fabio v. Bellomo, 504 N.W.2d 758, 761 (Minn. 1993).  Although the district court may properly determine whether or not fact questions exist, it may not resolve those questions.  Nord v. Herreid, 305 N.W.2d. 337, 339 (Minn. 1981).  Factual inferences, credibility assessments, and weighing evidence are all factual issues for the trier of fact and are inappropriate on summary judgment.  Foley v. WCCO Television, Inc., 449 N.W.2d 497, 506 (Minn. App. 1989), review denied (Minn. Feb. 9, 1990).  Considering the definitive nature of the summary judgment, genuine doubts as to fact issues compel denial of the motion.

Summary judgment is a “blunt instrument” and should not be employed to determine issues which suggest that questions be answered before the rights of the parties can be fairly passed upon.  It should be employed only where it is perfectly clear that no issue of fact is involved, and that it is not desirable nor necessary to inquire into facts which might clarify the application of the law.


Donnay v. Boulware, 275 Minn. 37, 45, 144 N.W.2d 711, 716 (1966) (quoting 3 Barron & Holtzoff, Federal Practice and Procedure (Rules ed.) § 1234).

            Although no type of case and no dispositive issue is insulated from summary determination, “[c]ausation is generally a question of fact left to the finder of fact that only becomes a question of law where different minds can reasonably arrive at only one result.”  Paidar v. Hughes, 615 N.W.2d 276, 281 (Minn. 2000) (quotation omitted).

            If it appears that there exists a genuine issue of material fact for trial, summary judgment will be inappropriate even if the evidence perhaps might not withstand a motion for directed verdict.  Carl v. Pennington, 364 N.W.2d 455, 457 (Minn. App. 1985). Finally, in applying the summary-judgment rule, a court’s task is to determine whether a genuine material fact exists, as demonstrated by admissible evidence. 

            Citing dictum from Fabio v. Bellomo, Lawrence argues that we are to accept her factual allegations as true.  See Fabio, 504 N.W.2d at 761 (stating that “[f]or purposes of this case . . . we must accept as true the factual allegations made by the party against whom judgment was granted”).  We reject the notion that the summary-judgment standard requires a court to accept the nonmoving party’s facts as true.  The court’s task is to determine whether a fact exists.  If the court is to assume the truth of allegations, then it must necessarily assume the existence of the facts underlying the allegations.  This approach contradicts the summary-judgment standard and is an example of the logical fallacy of begging the question.

            The issue the district court found dispositive, at least for summary judgment, was that of causation.  The court held that the undisputed facts show that Dr. Clapp’s failure to consult with respondents and her negligent interpretation of Caleb’s Texas echocardiogram superseded any causal negligence by the respondents.

            The court reached its conclusion after analyzing the law of intervening, superseding cause, but in doing so the court necessarily made factual determinations.

            An intervening cause is also a superseding cause if (1) its harmful effects occur after the original negligence, (2) it has not been brought about by the original negligence, (3) it actively worked to bring about a result that otherwise would not have followed from the original negligence, and (4) it must not have been foreseeable by the original wrongdoer.  Wartnick v. Moss & Barnett, 490 N.W.2d 108, 113 (Minn. 1992).

            Unlike the district court, we find genuine fact issues as to all the elements of intervening, superseding cause.

            We begin with the proposition, as to which there is a genuine fact issue, that the respondents were negligent in failing to refer Caleb for further cardiac testing and treatment and in failing to restrict his physical activity in the interim.  In the record there is expert evidence that Dr. Bass’s description of the “unusual” course of Caleb’s left main coronary artery signaled a congenital cardiac anomaly which, if not repaired surgically, could cause sudden death.  There is expert evidence that the applicable standard of care required the respondents to restrict and refer.  The respondents did neither, an omission the district court took to be negligent.  The proper analysis next requires us to ascertain if there are genuine fact issues as to whether that original negligence continued in an unbroken chain of causation to the ultimate conclusion, or whether the chain was broken at some point by another causative act or omission that superseded the original negligence.

            The respondents contend that Lawrence’s “experts do not allege liability beyond the lack of a referral to a specialist” and they argue that the chain of causation was broken when a referral was made to Dr. Clapp.  If the original negligence was merely a failure to refer, the respondents’ argument has merit.  But the original negligence, if any, had three vital components: (1) the failure to restrict Caleb’s physical activity, (2) the failure to refer Caleb to a specialist, and (3) the failure to disclose and pass on to the specialist Dr. Bass’s finding on the Minnesota echocardiogram.

            According to the record, after Caleb left Minnesota, the next medical encounter was with Dr. Kapil.  The respondents’ negligence persisted through this event because Dr. Kapil did not learn of Caleb’s cardiac anomaly.

            Caleb then saw Dr. Clapp.  At this point a referral to a specialist had occurred, but at the outset of her examination the specialist was unaware of Caleb’s cardiac anomaly.  The respondents’ negligence persisted through at least the early stages of Dr. Clapp’s examination because it was not merely the lack of referral that was negligent but rather it was the failure to pass on the critical finding of the anomaly through the referral that was the essence of the negligent omission.

            Dr. Clapp obtained Caleb’s medical history and learned that “[h]is symptoms occurred 2 years ago in Minneapolis, and he was evaluated there as well by a cardiologist.  At the time of that evaluation, he was thought to have a normal heart.”  The doctor then performed a physical examination, an electrocardiogram, and an echocardiogram, the latter test revealing “the presence of a structurally and functionally normal heart.”

            The district court concluded that Dr. Clapp’s negligence was twofold.  First, upon learning of Caleb’s previous heart studies, she failed to “contact or consult with” the respondents.  Second, she was “negligent in interpreting the echocardiogram.”  These two failures led to Dr. Clapp’s faulty diagnosis and her failure to learn of the anomaly that led to Caleb’s death.  To reach its conclusions, the district court had to make assumptions that in turn required resolution of fact issues.  For example, considering Caleb’s history, prior “normal” heart tests, normal electrocardiogram, and normal echocardiogram, was contact with the respondents necessary?  It appeared to Dr. Clapp that her findings were consistent with the prior findings.  Did she improperly conduct the echocardiogram so that it did not detect the anomaly?  Did she misread the echocardiogram and just miss the anomaly?  There is evidence in the record that another specialist failed to see the anomaly on the echocardiogram.  The answers to these questions depend either on facts in dispute or inferences to be drawn from disputed or undisputed facts.  The basic issue is whether Dr. Clapp did, or failed to do, anything that was a contributing cause of Caleb’s death.  If not, the original negligence continued in an unbroken chain.  If so, perhaps her conduct broke that chain and superseded the respondents’ negligence.  The resolution of the basic issue is the prerogative of the trier of fact and not of the court by way of granting summary judgment.

            In terms of the specific elements of superseding cause as indicated in Wartnick, treating the respondents’ omissions as the original negligence, Dr. Clapp’s conduct occurred afterward, but there is a fact issue as to whether that conduct produced any harmful effects.  There is a fact issue as to whether Dr. Clapp’s omissions were causally connected with the original negligence.  There is a fact issue as to whether Dr. Clapp’s conduct brought about a result that otherwise would not have followed from the original negligence.  In other words, it remains to be determined whether anything Dr. Clapp did or failed to do broke the chain of causal negligence that began with the respondents, who were the only providers who knew of Caleb’s cardiac anomaly.  And there is a fact issue as to whether the original wrongdoers might reasonably have foreseen that a subsequent medical provider might not detect the anomaly and might not restrict Caleb’s physical activity.  On this record, there is enough evidence to support an inference that Caleb’s condition was not one that was readily detectable.  Dr. Clapp and another expert failed to see the anomaly on the Texas echocardiogram, suggesting that either the test was faulty or the test was accurate and both physicians misinterpreted it, or that it is a condition that does not necessarily show up on such a test.  Whichever proposition is correct depends on the development of an appropriate factual context.  We refer back to Donnay v. Boulware and emphasize that summary judgment should not be granted when it is not perfectly clear that there are no fact issues for trial and when it is “necessary to inquire into facts which might clarify the application of the law.”  275 Minn. at 45, 144 N.W.2d at 716.  This is a case in which it is necessary to determine facts that will clarify the application of the law of intervening, superseding cause.

            Reversed and remanded.