This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (2004).
IN COURT OF APPEALS
Phyllis L. Lawrence, as Trustee for the heirs and next of kin
of Caleb Keown Lawrence, decedent,
Filed October 10, 2006
Reversed and remanded
Hennepin County District Court
File No. WC 03-018950
Nemo, Meshbesher & Spence, Ltd.,
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In this medical-negligence action, the district court determined that another physician’s negligent acts or omissions superseded the omissions of the respondents and granted summary judgment in respondents’ favor.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
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,
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.
D E C I S I O N
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 (
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
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 (
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 (
Citing dictum from Fabio
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
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 (
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
According to the record, after Caleb left
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
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
Reversed and remanded.