Susan R. Hamilton v. Dr. D. B. Allen, M.D., Individually, and Dr. Ken Taylor, M.D., Individually

 Annotate this Case
Download PDF
DIVISIONS I & II  CA06­1051  NOVEMBER 7, 2007  SUSAN R. HAMILTON  APPELLANT  V. DR. D.B. ALLEN, M.D., Individuallyand DR.  KEN TAYLOR, M.D., Individually  APPELLEES  APPEAL FROM THE PULASKI COUNTY  CIRCUIT COURT,  THIRD DIVISION  [NO. CV02­920]  HON. JAY MOODY,  JUDGE  AFFIRMED  In this medical­malpractice case Susan R. Hamilton appeals the circuit court’s order granting  summary judgment in favor of appellees, Dr. D.B. Allen and Dr. Ken Taylor.  Hamilton raises four  points on appeal: (1) that appellees’ motion for summary judgment did not demonstrate a prima facie  case and was improperly granted; (2) that the trial court erred in striking her response to appellees’  motion for summary judgment on the basis of untimeliness; (3) that the trial court erred in failing to  allow  her  to  supplement  the  affidavit  of her  expert  witness;  and  (4)  that  the  trial  court  erred  in  dismissing her oral motion for a continuance.  We find no error by the trial court in granting summary  judgment in favor of appellees, and we affirm.  Hamilton underwent  gynecological surgery by Dr. Allen on the afternoon of February 10,  2000.  Several  hours  after  the  surgery  Hamilton’s  blood  pressure  decreased  and  her    pulse  rate  increased,  suspected  to  be  the  result  of  post­operative,  intra­abdominal  bleeding.  Consequently,  exploratory surgery was performed that same evening by Dr. Allen and Dr. Taylor, and two oozing  vessels were identified and ligated.  A third surgery was required two days later for additional intra­ abdominal  bleeding:  a  third  bleeding  vessel  was  found  and  ligated  in  this  surgery,  which  was  performed by Dr. Allen and Dr. Michael Pollock.  Hamilton was discharged from the hospital eight  days  after  what  had  been  originally  scheduled  as  a  “day  surgery.”    Her  allegations  of  medical  negligence regarded Dr. Allen and Dr. Taylor’s treatment of her initial post­operative bleeding.  Procedural History  Before addressing the merits of appellant’s argument, we briefly summarize the development  of this case before the circuit court.  Appellant initially filed suit in February 2002, just before the  expiration of the statute of limitations.  Appellees took the deposition of Dr. Joseph Hume, who had  been identified  by  appellant as the only medical expert she intended to call as a witness at trial.  Appellees filed a motion for summary judgment on January 26, 2005, alleging that Hamilton could  not meet her burden of proof through the testimony of her expert witness.  At a hearing on February  4, 2005, the trial court treated appellees’ motion as a motion in limine because it had been filed after  a court­imposed deadline for the filing of dispositive motions.  The court denied the motion in limine,  ruling that Hamilton could call Dr. Hume to testify at trial, that the court would deal at that time with  any objections by appellees to Dr. Hume’s opinions, and that the court was reserving the right to  grant a directed verdict, depending on the evidence presented at trial.  The court stated, “So to the  extent that the motion for summary judgment can be considered a motion to exclude the testimony  of Dr. Hume or some motion in limine to that effect as excluding that portion of the testimony, that  motion  will  be  denied.”    On  the  same  day,  Hamilton  voluntarily  non­suited  her  case  as  to  all  defendants.  On July 13, 2005 Hamilton re­filed her complaint against Drs. Allen and Taylor, making  essentially the same allegations of negligence on their part  as  were made in the first suit.  After ­2­  CA06­1051  answering and denying all allegations of negligence, appellees filed a motion for summary judgment  on October 6, 2005, based upon the same grounds as their motion for summary judgment in the first  lawsuit, i.e., that because Dr. Hume’s testimony was speculative, it was insufficient as a matter of law  to establish the existence of an essential element of her claim of negligence on the part of appellees.  On November  2,  2005  Hamilton filed  a  paper  entitled  “Plaintiff’s  Designation  of  Expert  Witness,” which identified Dr. Harold J. Miller as her only expert witness in the case. Attached to the  document  was  Dr.  Miller’s  affidavit:  it  set  forth  the  standard  of  care  applicable  to  the  surgical  procedures  performed  on  Hamilton  by  appellees,  it  stated  that  appellees  had  deviated  from  the  standard of care, and it described the nature of such deviation. On December 1, 2005 Hamilton filed  her response to the motion for summary judgment.  She  argued, among other things, that appellees’  motion was ill­founded to  the extent  that  it  relied upon the deposition of Dr. Hume because his  deposition was taken in connection with the earlier case that Hamilton had voluntarily non­suited and,  therefore, it was not evidence that could be used as a basis for summary judgment in Hamilton’s re­  filed lawsuit.  Appellees moved to strike Hamilton’s response, arguing that its filing was not timely and that,  even if timely, Dr. Miller’s affidavit did not establish that he was familiar with the applicable standard  of care and, like Dr. Hume’s testimony, his opinions were based solely upon speculation. Thereafter,  Hamilton moved for leave to supplement Dr. Miller’s affidavit and appellees responded in opposition  to it.  Following a hearing on May 12, 2006, during which Hamilton orally moved that the hearing  be continued until after discovery was completed, the trial court announced its findings: that the ­3­  CA06­1051  doctors’ motion to strike Hamilton’s response to the motion for summary judgment should be granted  because the response was not timely filed, that Hamilton’s motion to file a supplemental affidavit of  Dr. Miller should be denied because the filing of Dr. Miller’s initial affidavit was not timely, that  Hamilton’s oral motion for a continuance should be denied, and that the appellee/doctors’ motion for  summary judgment should be granted.  The court also reiterated that, at the February 2005 hearing  on appellees’ motion in limine in the first case, it had reserved the right to grant a motion for directed  verdict by appellees and that “the reason they didn’t get their motion for summary judgment is they  waited too close to trial to get it heard.” The court’s decision was memorialized in an order entered  on June 1, 2006.  Hamilton now appeals, arguing the four points set forth in the first paragraph  above.  Grant of Summary Judgment  Summary judgment is proper when a claiming party fails to show that there is a genuine issue  as to a material fact and the moving party is entitled to judgment as a matter of law.  Skaggs v.  Johnson, 323 Ark. 320, 915 S.W.2d 253 (1996) (citing Ark. R. Civ. P. 56(c) and Celotex ex Corp.  v. Catrett, 477 U.S. 317 (1986)).  Once the moving party has established a prima facie case showing  entitlement to summary judgment, the opposing party must meet proof with proof and demonstrate  the existence of a material issue of fact.  Mitchell v. Lincoln, 366 Ark. 592, 598 S.W.3d ___ (2006).  The appellate court determines if summary judgment was appropriate based on whether the evidence  presented by the moving party in support of its motion leaves a material fact unanswered.  Id.  The ­4­  CA06­1051  evidence is reviewed in a light most favorable to the party against whom the motion was filed, with  1  all doubts and inferences resolved against the moving party.  Id.  In a medical­malpractice action, the plaintiff must prove: (1) the applicable standard of care;  (2) that the medical provider failed to act in accordance with that standard; and (3) that such failure  was a proximate cause of the plaintiff’s injuries.  Webb v. Bouton, 350 Ark. 254, 264, 85 S.W.3d 885,  891 (2002).  A medical­malpractice complaint is subject to a motion for summary judgment when the  plaintiff fails to present expert evidence of those three elements and the defending party demonstrates  that the plaintiff lacks proof on one or more of these essential elements.  Robbins v. Johnson, 367 1  The dissent does not acknowledge that the purpose of summary judgment is to avoid the  waste of time, work, and money involved in requiring the trial of a case when a party cannot  produce evidence supporting the existence of a fact necessary to establish his claim or defense.  Joey Brown Interest, Inc. v. Merchants Nat’l Bank of Fort Smith, 284 Ark. 418, 683 S.W.2d 601  (1985).  The well­recited standard to be applied in summary­judgment cases is whether there is  evidence sufficient to raise a fact issue.  See Wallace v. Broyles, 331 Ark. 58, 66, 961 S.W.2d  712, 715 (1998) (citing Caplener v. Bluebonnet Milling Co., 322 Ark. 751, 911 S.W.2d 586  (1995)).  Rather, the dissenting opinion seems to suggest that even though Hamilton’s expert  doctor could not, without speculation, testify that the appellee doctors had violated any standard  of care, she should, nonetheless, be given a chance to present that proof at trial because the  appellees have not, in their motion for summary judgment, presented affirmative proof that they  did not violate any standard of care. The dissent’s position ignores Ark. Code Ann. § 16­114­206,  which places the burden on the plaintiff to produce expert evidence establishing the essential  elements of his or her claim, and Ark. R. Civ. P. 56(c), which mandates the grant of summary  judgment where the pleadings, discovery, and affidavits, if any, show that there is no genuine  issue as to any material fact.  In any case, medical­malpractice or otherwise, summary judgment is appropriate where the  moving party demonstrates that the opposing party will be unable, at trial, to prove an essential  element of his or her claim.  See Celotex Corp. v. Catrett, supra (stating that summary judgment is  mandated against a party who fails to make a showing sufficient to establish the existence of an  element essential to that party’s case, and on which that party will bear the burden of proof at  trial); Cantrell­Waind & Associates, Inc. v. Guillaume Motorsports, Inc., 62 Ark. App. 66, 968  S.W.2d 72 (1998) (stating that the role of summary judgment is simply to decide whether material  questions of fact exist to be resolved at trial).  ­5­  CA06­1051  2  Ark. 506, ___ S.W.3d ___ (2006); Parkerson v. Arthur, 83 Ark. App. 240, 125 S.W.3d 825 (2003).  Here,  Hamilton  had  the  statutory  burden  of  proving  these  three  essential  elements  by  expert  testimony.  See Ark. Code Ann. §16­114­206(a) (Repl. 2006); Dodd v. Sparks Reg’l Med. Ctr., 90  3  Ark. App. 191, 204 S.W.3d 579 (2005).  In order to demonstrate a genuine issue of material fact, the plaintiff’s medical expert must  state “within a reasonable degree of medical certainty” that the defendant breached the standard of  care and that the alleged breach was a proximate cause of the injury.  Mitchell v. Lincoln, supra;  Fryar v. Touchstone Physical Therapy, Inc., 365 Ark. 295, 229 S.W.3d 7 (2006).  A party against 2  The dissenting judge cites Wolner v. Bogaev, 290 Ark. 299, 718 S.W.2d 942 (1986) and  Cash v. Lim,  322 Ark. 359, 908 S.W.2d 655 (1995) for the proposition that the  defendant/movants had to prove the requisite standard of care and that they had conformed to  that standard.  However, in Wolner, unlike the present case, the defendant doctor/movant filed a  motion for summary judgment and attached his affidavit and the affidavit of his consulting  physician stating merely that the doctor had not been negligent. Describing these affidavits as  mere “conclusory assertions,” the supreme court stated, “When that is virtually all the supporting  strength of a motion for summary judgment then the movant has failed to make a prima facie  showing of entitlement to summary judgment and the burden of going forward does not shift to  the opposing party.”  290 Ark. at 303, 718 S.W.2d at 944 (emphasis added).  Likewise, in Cash,  the proof offered by the defendant/movant in support of his motion for summary judgment was  found by the supreme court to be lacking where the deposition testimony of the consulting doctor  failed to establish a prima facie case of lack of causation.  Unlike the movant/defendants in Wolner and Cash, supra, here the movants have  established in their motion for summary judgment that the deposition testimony of Hamilton’s  expert medical witness demonstrated that Hamilton lacked proof on an essential element of her  claim because Dr. Hume could not state, without speculating, that a third bleeding site existed  during the second surgery that Drs. Allen and Taylor should have discovered.  Neither Wolner nor  Cash involved a summary judgment in which the movant demonstrated an inability on the part of  the plaintiff to prove one of the essential elements required to be proved in a medical­malpractice  case.  3  However, expert testimony is not required when the asserted negligence lies within the  comprehension of a jury of laymen, such as a surgeon’s failure to sterilize instruments or failure to  remove a sponge from the incision before closing it.  Mitchell v. Lincoln, 366 Ark. at 592, 598  S.W.3d at ___ (citing Lanier v. Trammell, 207 Ark. 372, 180 S.W.2d 818 (1944)).  ­6­  CA06­1051  whom a claim is asserted “may move with or without supporting affidavits for a summary judgment  in his favor as to all or any part thereof.”  Ark. R. Civ. P. 56(c).  Burdens of proof for the parties to  summary judgment are as follows:  Rule 56(c) [of the Federal Rules of Civil Procedure] mandates the entry of summary  judgment ... against a party who fails to make a showing sufficient to establish the  existence of an element essential to that party’s case, and on which that party will bear  the burden of proof at trial. In such a situation, there can be “no genuine issue as to  any material fact,” since a complete failure of proof concerning an essential element  of the  nonmoving  party’s  case  necessarily renders  all other  facts  immaterial.  The  moving party is “entitled to a judgment as a matter of law” because the nonmoving  party has failed to make a sufficient showing on an essential element of her case with  respect to which she has the burden of proof. ...  Of  course,  a  party  seeking  summary  judgment  always  bears  the  initial  responsibility of informing the district court of the basis for its motion, and identifying  those  portions  of  “the  pleadings,  depositions,  answers  to  interrogatories,  and  admissions on file, together with the affidavits, if any,” which it believes demonstrate  the absence of a genuine issue of material fact. But ... we find no express or implied  requirement in Rule 56 that the moving party support its motion with affidavits or  other similar materials negating the opponent’s claim. On the contrary, Rule 56(c),  which refers to “the affidavits, if any” ... suggests the absence of such a requirement.  And if there were any doubt about the meaning of Rule 5(c) in this regard, such doubt  is  clearly  removed  by  Rules  56(a)  and  (b),  which  provide  that  claimants  and  defendants,  respectively,  may  move  for  summary  judgment  “with  or  without  supporting affidavits[.]”  Celotex, 477 U.S. at 322­23.  Our Rule 56 tracks the federal rule and is to be construed in accordance  with federal decisions.  Reporter’s Notes to Ark. R. Civ. P. 56; Caplener v. Bluebonnet Milling Co.,  322 Ark. 751, 911 S.W.2d 586 (1995).  In their motion for summary judgment, appellees alleged that Hamilton could not meet her  burden of proving the elements of negligence and causation because her only expert witness, Dr.  Joseph  Hume,  admitted  that  speculation  was  the  basis  of  his  opinions  regarding  the  alleged  negligence.  Appellees attached excerpts from his deposition  to their motion.  In the deposition Dr. ­7­  CA06­1051  Hume stated that, had there not been a third bleeder at the time of the second surgery, he would have  had no criticisms of either appellee.  Dr. Hume said that he had no specific criticisms of appellee Dr.  Taylor and did not feel “that he had deviated below any standard of care” with which Dr. Hume was  familiar.  Dr. Hume’s criticism of appellee  Dr. Allen was that he did not adequately explore the  bleeding in the second surgery and had deviated below the standard of care; this was based upon Dr.  Hume’s opinion that there was a third bleeding site that was not identified.  Dr. Hume admitted,  however, that he did not know whether there had been a third bleeder at the time of the second  surgery and that it would require speculation on his part to say so.  The  circuit  court  based  its  order  of  summary  judgment  upon  the  following  finding:  “Defendants have demonstrated that there exists no genuine issue of material fact and that they are  entitled to judgment as a matter of law.  Plaintiff has failed to meet proof with proof.”  The trial court  did not err in this ruling.  Appellees demonstrated their prima facie entitlement to summary judgment  by attaching to their motion portions of Dr. Hume’s deposition demonstrating that his opinion of  negligence on the part of appellees was speculative, thus rendering his opinion insufficient to satisfy  4  Hamilton’s burden of proof.  4  In affirming the order of summary judgment, we also reject The dissenting judge misconstrues today’s majority opinion as assigning to a plaintiff in a  medical­malpractice case a higher burden of proof at the summary­judgment stage than is  assigned to a plaintiff in any other type of case.  To the contrary, we make no such distinction.  Quite simply, in a medical­malpractice case, as in any other type of case, when a party cannot  present proof on an essential element of his or her claim, there is no remaining genuine issue of  material fact and the party moving for a summary judgment is entitled to judgment as a matter of  law.  Irvin v. Jones, 310 Ark. 114, 832 S.W.2d 827 (1992) (citing Short v. Little Rock Dodge,  Inc., 297 Ark. 104, 106, 759 S.W.2d 553, 554 (1988), and Celotex, supra).  See Sundeen v.  Kroger, 355 Ark. 138, 133 S.W.3d 393 (2003) (affirming summary judgment where plaintiff  offered no proof of coercive actions or efforts to extort anything from him in abuse­of­process  case against grocery store and its security officer); Irvin v. Jones, supra (affirming summary  judgment because plaintiffs presented no proof of delivery, an essential element of their claim that  certificates of deposit were gifts inter vivos); Short v. Little Rock Dodge, Inc., supra (affirming  summary judgment where plaintiffs claiming  negligence and strict liability for manufacture and  ­8­  CA06­1051  Hamilton’s argument that the trial court’s granting of summary judgment in her second lawsuit was  in error because, prior to the non­suit of her first lawsuit, the court had denied appellees’ motion in  limine and had ruled that Dr. Hume could testify at trial. Hamilton refers us to no authority for her  argument, and we are aware of none. As appellees note, the trial court never addressed the merits of  the summary­judgment motion in the first lawsuit because the motion was not timely filed; rather, the  court treated it as a motion in limine and stated that the court would rule on the merits of appellees’  argument after Dr. Hume testified at trial.  However, Hamilton non­suited her first lawsuit and it  never went to trial.  We are unaware of any authority that would preclude a party from filing a motion  for summary judgment in a second lawsuit and relying upon the same evidence as was relied upon in  a previously non­suited lawsuit, especially where, as here, the allegations in the second lawsuit are  the same as those in the first lawsuit.  We  take  this  opportunity  to  review  and  clarify  the  parties’  burdens  of  proof  regarding  summary judgment when the movant is the defendant in a medical­malpractice action.  In Skaggs v.  Johnson, supra, and in Robson v. Tinnin, supra, the movants met their burden of proving a prima  facie case for summary judgment by showing that the plaintiffs had no expert to testify as to the  breach of the applicable standard of care.  In Brumley v. Naples, 320 Ark. 310, 896 S.W.2d 860  (1995), where the appellant’s expert on the issue of informed consent could not offer an opinion as  to the proper standard of care, the appellant did not meet her burden of proof and no material issue  of  fact  existed.  In  Dodd  v.  Sparks  Regional  Medical  Center,  supra,  summary  judgment  was sale of a defective product were unable to produce evidence that a defect in the car or the dealer’s  negligence in failing to repair it caused the fatal automobile accident; when the summary judgment  motion was made, the trial court had before it depositions and responses to requests for  admissions and interrogatories).  ­9­  CA06­1051  appropriate  where  the  affidavit,  which  offered  only  a  statement  of  what  care  should  have  been  provided  and  an  opinion  that  the  health­care  providers  had  failed  to  exercise  due  care,  did  not  establish the applicable standard of care.  When the defendant demonstrates the plaintiff’s failure to  produce the requisite expert testimony, the defendant has demonstrated that no genuine issues of  material fact exist and is therefore entitled to summary judgment as a matter of law.  Id.; Skaggs v.  Johnson, supra;  Robson v. Tinnin, supra; Brumley v. Naples, supra; Reagan v. City of Piggott, 305  Ark. 77, 805 S.W.2d 636 (1991).  The moving party is not required to  support its motion with  affidavits or other materials further negating the plaintiff’s claim.  See Ark. R. Civ. P. 56 and Celotex,  supra.  In McAdams v. Curnayn, 96 Ark. App. 118, ___ S.W.3d ___ (2006), a medical­malpractice  action against a veterinary clinic and its employees, this court correctly affirmed an order of summary  judgment but incorrectlyaddressed the summary­judgment movants’ burden of proof.  We summarily,  and incorrectly, disposed of their argument that appellant McAdams, the nonmoving party and the  plaintiff below, had failed through his expert witness to demonstrate the standard of care and a breach  of the standard.  Reviewing the proof presented by appellees (the defendant/movants) in their motion  for summary judgment, we stated in dicta:  Appellees did not present affirmative proof of the applicable standard of care required  of  a  veterinarian  in  the  February  14,  2000  visit  or  affirmative  proof  that  the  veterinarian complied with the standard of care. ...  Without proof supporting the  motion for summary judgment on the applicable standard or breach thereof, appellant  was under no duty to rebut those two aspects of medical negligence.  96 Ark. App. at  ___, ___ S.W.3d  at   ___ (citations omitted).  By the opinion we issue today, we  acknowledge that insofar as McAdams appears to say that a defendant/summary­judgment movant  in a medical malpractice case is required to present affirmative proof of the standard of care and that ­10­  CA06­1051  the defendant’s conduct conformed to that standard, McAdams is an incorrect statement of the law  where the basis of the summary­judgment motion is the plaintiff’s failure to produce evidence to  establish an essential element of the plaintiff’s case.  Timeliness of Response to the Motion for Summary Judgment  Hamilton contends in her second point on appeal that her response to appellees’ motion for  summary judgment was timely and, thus, that appellees’ motion to strike on the basis of untimeliness  should have been denied.  In their motion to strike Hamilton’s response to the motion for summary  judgment, appellees asserted that it was untimely and, further, that Dr. Miller’s affidavit failed to  establish an issue of material fact.  The circuit court found that Hamilton had not responded to the  summary­judgment motion within the time prescribed by the Arkansas Rules of Civil Procedure; the  court further stated that, had it considered Dr. Miller’s affidavit, the court would have found the  affidavit insufficient to meet proof with proof.  The adverse party to a motion for summary judgment shall serve a response and supporting  materials, if any, within twenty­one days after the motion is served.  Ark. R. Civ. P. 56(c)(1).  Under  Rule 6(d), “Whenever a party has the right . . . to do some act or take some proceedings within a  prescribed period after the service of a notice or other paper upon him and the notice or paper is  served  upon him by mail or  commercial delivery company,  three  (3)  days  shall  be  added  to  the  prescribed period.”  Hamilton was served with appellees’ motion for summary judgment on October 4, 2005.  She  argues on appeal that she timely responded within the time prescribed by our rules when she sent  appellees’ counsel a copy of her “Plaintiff’s Designation of Expert Witness” designating Dr. Harold  Miller as her only expert witness and attaching his affidavit to the notice.  Appellees assert that this ­11­  CA06­1051  paper was wholly insufficient as “a response” to the summary­judgment motion as contemplated by  our  Rules  of  Civil  Procedure.  They  note  that  on  November  28,  2005  they  were  served  with  Hamilton’s formal response, entitled “Plaintiff Susan R. Hamilton’s Response to Defendant’s Motion  for Summary Judgment,” which addressed the merits of their motion for summary judgment.  They  contend that this response was untimely and that the court’s striking of it was proper because of  untimeliness.  We reject Hamilton’s argument that the document designating Dr. Miller as her expert witness  was a response to the motion for summary judgment.  Neither the document nor the attached affidavit  addressed the merits of the motion, and nothing in the record indicates that either party treated this  paper as a response to the motion before Hamilton served her actual response on November 28, 2005.  Appellees’ summary­judgment motion was served on Hamilton on October 4, 2005, and, without  requesting an extension of time within which to file her response, she did not serve her response until  almost eight weeks later.  The trial court did not err in finding that Hamilton did not respond within  the time allowed by our Rules of Civil Procedure; therefore, there was no error in the striking of her  5  response on the basis of untimeliness.  Supplementation of Dr. Miller’s Affidavit  As her third point on appeal, Hamilton contends that the circuit court erred in denying her  motion to file a supplemental affidavit of her designated expert witness, Dr. Harold Miller.  This 5  The designation of witness was served on October 27, 2005, twenty­three days after  Hamilton was served the summary­judgment motion on October 4.  Hamilton argues that,  because the motion was served by both fax and mail, Rule 6(d) allowed three days for mailing in  addition to the twenty­one days prescribed by Rule 56(c)(1), for a total of twenty­four days.  Appellees argue that Hamilton had only twenty­one days from October 4 to serve her  response. Because we agree with the trial court that the designation of witness is not a response  to the motion, we need not decide this issue.  ­12­  CA06­1051  motion was submitted to  the trial court  approximately a month before the scheduled date of the  summary­judgment hearing on May 12, 2006.  The court denied the motion to supplement at the  conclusion of the May 12 hearing.  Hamilton argues that the denial of her motion to supplement Dr. Miller’s affidavit was error  because service of his original affidavit was timely and appellees would suffer no surprise or prejudice  by supplementation of the affidavit.  She points out that, under Ark. R. Civ. P. 56(e), the circuit court  may  permit  affidavits  to  be  supplemented  by  further  affidavits.  However,  as  we  noted  in  our  discussion of Hamilton’s second point on appeal, the paper designating Dr. Miller as Hamilton’s  expert witness was not a response to appellees’ motion for summary judgment.  Thus, we need not  address any argument regarding supplementation of Dr. Miller’s affidavit.  Hamilton also argues that a written order of the circuit court, marked with a file date of May  10,  2006,  granted  “leave  to  submit  supplemental  affidavit  of  Dr.  Harold  Miller.”    The  order,  submitted to the court by Hamilton as a proposed order, was entered without any of the other parties’  knowledge, and no mention was made of it at the hearing two days later.  At the hearing on May 12,  2006, the court denied Hamilton’s motion to supplement Dr. Miller’s affidavit, and an order to that  effect was entered on June 1, 2006.  By written order of June 26, 2006, the court vacated the order  of May 10,  2006  and  left  its  order  of June  1,  2006  undisturbed.    The  denial  of  the  motion  to ­13­  CA06­1051  supplement was within the discretion given to the trial court by Rule 56(e).  Further, Hamilton has  demonstrated no prejudice from the mistaken granting of her motion.  Oral Motion for a Continuance  Hamilton contends in her final point on appeal that the trial court erred by denying her oral  motion for a continuance at the hearing on May 12, 2006.  She argues on appeal, as she did to the  trial court, that sufficient discovery had not taken place and that she had not been able to schedule  depositions with appellees.  Rule 56(f) allows a party opposing a motion for summary judgment to request a continuance:  Should it appear from the affidavits of a party opposing the motion that he cannot for  reasons stated present by affidavit facts essential to justify his opposition, the court  may . . . order a continuance to permit affidavits to be obtained or depositions to be  taken or discovery to be had or may make such other order as is just.  Ark. R. Civ. P. 56(f).  Under this rule, the decision on whether to grant a continuance is a matter of  discretion with the trial court.  Jenkins v. Int’l Paper Co., 318 Ark. 663, 887 S.W.2d 300 (1994).  Hamilton did not submit an affidavit stating the reasons that the trial court should order a  continuance to allow further discovery, as is required by Rule 56(f).  From her counsel’s comments  to the trial court during the hearing, it appears that the additional discovery Hamilton desired was for  appellees to take the deposition of Dr. Miller, an offer that appellees’ attorney had earlier declined.  The trial court acted well within its discretion in denying Hamilton’s oral motion for a continuance.  Affirmed.  GLADWIN, MARSHALL, VAUGHT, and MILLER, JJ., agree.  BAKER, J., dissents.  KAREN R. BAKER, Judge, dissenting. If our standard on review of summary judgment is that ­14­  CA06­1051  we actively work to prevent a medical malpractice case from going to trial, then we should clearly  state that goal. The reality is that we are not far from that practice now. One study conducted by the  U.S. Department of Health and Human Services revealed that only 1.53% of those injured by medical  malpractice file a claim. See Kimberly J. Frazier, Arkansas’s Civil Justice Reform Act of 2003: Who’s  Cheating Who?, 57 Ark. L. Rev. 651, 655 & n 28 (2004).  The same study indicated that a mere 8­  13% of the claims filed by these injured patients or their survivors proceeded to trial; “and of these  only 1.2­1.9% ended with a verdict favorable to the plaintiff.” Id. nn 29­30. See also Examining the  Work of State Courts, 2005, A National Perspective from the Court Statistics Project (2006) at 29  (concluding that in 2004, medical malpractice cases accounted for an average of only four percent  of tort cases in 13 states reporting).  Eliminating the threat  of a jury trial would  have  an  enormous impact on the handling of  malpractice claims. As Neil Vidmar, a professor with Duke University known for his extensive study  of  medical  malpractice  litigation,  recently  explained  in  testimony  to  the  U.S.  Senate,  “Without  question the threat of a jury trial is what forces parties to settle cases. The presence of the jury as an  ultimate arbiter provides the incentive to settle but the effects are more subtle than just negotiating  around a figure. The threat causes defense lawyers and the liability insurers to focus on the acts that  led to the claims of negligence.” Testimony of Neil Vidmar, Professor of Law, Duke Law School  before  The  Senate  Committee  on Health,  Education,  Labor  and  Pensions,  “Hearing  on  Medical  Liability:  New  Ideas  for  Making  the  System  Work  Better  for  Patients,”  June  22,  2006  at  21.  (Citations omitted).  As Professor Vidmar opined, the threat of the jury trial forces those defending to actually  examine the acts of the medical care providers. Ordinarily, one might anticipate that a system of  justice would encourage the participants to focus on the facts and circumstances surrounding the ­15­  CA06­1051  allegations of harm. Given that just fractions of a percentage of claims ever come to trial in a medical  malpractice case, the courts should be particularly vigilant in adhering to our procedural safeguards.  Instead of adhering to precedents that safeguard these procedures, the majority states the  following in its opinion: “We take this opportunity to review and clarify the parties’ burdens of proof  regarding summary judgment when the movant is the defendant in a medical­malpractice action.” The  five judges in the majority on this panel then purport to, for lack of a better term, “correct” the five  judges in the majority on McAdams v. Curnayn, 96 Ark. App. 118, ___ S.W.3d ___ (2006). While  I dissented on other grounds in McAdams, the majority in McAdams did accurately state our supreme  court’s precedents regarding the standard of review for summary judgment in medical malpractice  cases.  My dissent in this case is based upon two premises: (1) We have no authority to overrule our  supreme court’s mandates on the standard of review for summary judgment cases; (2) Our supreme  court applies the same standards of proof in a summary judgment case involving medical malpractice  as it does in any other case disposed of by summary judgment.  The majority disagrees with each of those premises as it further decrees: "By the opinion we  issue today, we acknowledge that insofar as McAdams appears to say that a defendant/summary­  judgment movant in a medical malpractice case is required to present affirmative proof of the standard  of care  and  that  the  defendant’s  conduct  conformed  to  that  standard,  McAdams  is  an  incorrect  statement of the law where the basis of the summary­judgment motion is the plaintiff’s failure to  produce evidence to establish an essential element of the plaintiff’s case." 1  Perhaps the majority has adopted the general premise of the legislature’s enactment of The 1  The statement in McAdams to which the majority refers reads as follows: “Without proof  supporting the motion for summary judgment on the applicable standard or breach thereof,  appellant was under no duty to rebut those two aspects of medical negligence.”  96 Ark. App. at  ___ , ___S.W.3d ___ (2007).  ­16­  CA06­1051  Civil Justice Reform Act  of 2003: “The Civil Justice Reform Act  of 2003 (hereinafter  ‘Act 649'  transforms the manner in which Arkansas courts must conduct business.” Frazier, supra. One author,  Kimberly Frazier, applied Act 649 to Advocat Inc. v. Sauer, ___ Ark. ___, ___ S.W.3d ___ (2005),  a case involving negligence of a nursing home, to explain the effect the Act had upon the court’s  practices:  Under Act 649, a cause of action with the same facts would have had higher burdens of proof  for  punitive  damages,  diminished  venue  option,  no  possibility  of  joint  liability,  different  pleading requirements and a maximum jury award of $1 million dollars (in stark contrast with  the $63 million in punitive damages initially awarded in Sauer).  Of course, I believe that where the Act infringes upon the court’s rules and procedures, our  supreme court will reject any such infringement. One example of such a rejection is our supreme  court’s  finding  as  unconstitutional  Act  649's  requirement  that  a  trial  court  dismiss  a  plaintiff’s  malpractice case if a plaintiff fails to file an affidavit of reasonable cause within thirty days of filing  her complaint, now codified at Ark. Code Ann. § 16­114­209(b) (Repl. 2006). See Summerville v.  Thrower, 369 Ark. 231, ___ S.W.3d ___ (2007). Our supreme court concluded that the mandatory  thirty­day  requirement  for  the  affidavit  of  reasonable  cause  after  filing  the  complaint  directly  conflicted with Rule 3 of our Rules of Civil Procedure regarding commencement of litigation. Id.  Accordingly, they reversed and remanded the case for further proceedings.  Id.  In explaining its  reasoning, our supreme court quoted with approval a sister court’s striking of a similar provision:  The Oklahoma legislature implemented the Affordable Access to Health Care Act ... for the  purpose  of  implementing  reasonable,  comprehensive  reforms  designed  to  improve  the  availability of health care services while lowering the cost of medical liability insurance and  ensuring that persons with meritorious injury claims receive fair and adequate compensation.  Although statutory schemes  similar  to  Oklahoma’s  Health Care  Act  do  help  screen  out  meritless  suits,  the  additional  certification  costs  have  produced  a  substantial  and  disproportionate  reduction  in  the  number  of  claims  filed  by  low­income  plaintiffs.  the  affidavit of merit provisions front­load litigation costs and result in the creation of cottage  industries  of  firms  offering  affidavits  from  physicians  for  a  price.  They  also  prevent ­17­  CA06­1051  meritorious medical malpractice actions from being filed. the affidavits of merit requirement  obligates plaintiffs to engage in extensive pre­trial discovery to obtain the facts necessary for  an expert to render an opinion resulting in most medical malpractice causes being out of  court  during  discovery.  Rather  than  reducing  the  problems  associated  with  malpractice  litigation, these provisions have resulted in the dismissal of legitimately injured plaintiffs’  claims based solely on procedural, rather than substantive grounds.  Summerville, 369 Ark. at ___, ___ S.W.3d at ___ (quoting Zeir v. Zimmer, Inc. ___ P.3d ___, ____  (Okla. Dec. 9, 2006)) (emphasis added).  Our supreme court’s rejection of this legislative infringement upon court procedures in the  management of a medical malpractice action reaffirms the premise that we do not have a different  standard of review for orders granting summary judgment in a medical malpractice case.  Nor should  we.  Despite much discussion to the contrary, litigation and the threat of jury trials improves health  care in much the same way that litigation in other contexts protects the safety of the citizens of this  country: In the absence of a comprehensive social insurance system, the patient’s right to safety can be  enforced only by a legal claim against the hospital. … [M]ore liability suits against hospitals  may  be  necessary  to  motivate  hospital  boards  to  take  patient  safety  more  seriously.…  Anesthesiologists  were  motivated  by  litigation  to  improve  patient  safety.  As  a  result,  this  profession implemented 25­years­ago a program to make anesthesia safer for patients and as  a result, the risk of death from anesthesia dropped from 1 in 5000 to about 1 in 250,000.  George  J.  Annas,  J.D.,  M.P.H.,  “The  Patient’s  Right  to  Safety –  Improving  the  Quality  of  Care  through Litigation against Hospitals,” New England Journal of Medicine, May 11, 2006.  Under the majority’s analysis, a plaintiff in a medical malpractice case has a higher burden of  proof at the summary judgment stage of a proceeding than a plaintiff in any other type of case.  A  plaintiff has to establish through expert testimony that the defendant committed malpractice before a  plaintiff is allowed to present that proof to the fact­finder.  According to the majority, all a defendant ­18­  CA06­1051  in a medical malpractice case need allege in a motion for summary judgment is that the plaintiff has  not yet met, by expert testimony, his burden of proof pursuant to the statutes.  No provision in the  medical malpractice statutes requires that a plaintiff  meet his or her burden of proof prior to trial.  Neither has our supreme court adopted that standard:  Summary judgment is to be granted by a trial court only when it is clear that there are no  genuine issues of material fact to be litigated, and the party is entitled to judgment as a matter  of law. Once the moving party has established a prima facie entitlement to summary judgment,  the opposing party must meet proof with proof and demonstrate the existence of a material  issue of fact. On appellate review, we determine if summary judgment was appropriate based  on whether the evidentiary items presented by the moving party in support of its motion leave  a material fact unanswered. This court views evidence in a light most favorable to the party  against whom the motion was filed, resolving all doubts and inferences against the moving  party. Our review is not limited to the pleadings, as we also focus on the affidavits and other  documents filed by the parties. After reviewing undisputed facts, summary judgment should  be denied if, under the evidence, reasonable persons might reach different conclusions from  those undisputed facts.  Rice v. Tanner, 363 Ark. 79, 82, 210 S.W.3d 860, 863 (2005) (citations omitted) (holding that once  a movant in a medical malpractice case presents evidence in a summary judgment context establishing  the standard of care and that the standard of care was met by the defendant, the nonmoving party must  present evidence to create a fact question).  In the context of summary judgment, our duty as a reviewing court is to determine, first and  foremost,  whether  the  moving  party  has  presented  evidence  that  establishes  that  the  facts  are  undisputed and that the only conclusion from the undisputed facts is that the movant’s actions cannot  be the legal basis for recovery. See id.  The majority’s confabulation of our standard by inserting a  sufficiency determination in a medical malpractice summary judgment is perplexing.  What is even  more confusing is the majority’s citation to federal procedure and precedent to support this perversion.  Not only is our supreme court not bound by federal case law interpreting federal procedural rules ­19­  CA06­1051  regarding summary judgment, but our supreme court has specifically rejected the premise that a trial  court considering a summary judgment motion should determine whether the evidence presented at  summary judgment is sufficient to sustain a burden of proof at trial:  Also cited by the petitioners is Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505,  91  L.Ed.2d  202  (1986),  in  which  the  Supreme  Court  stated  that  the  summary­judgment  standard “mirrors the standard for a directed verdict.”  That statement was repeated by the  Supreme Court, although it was not the basis of the holding, in Celotex Corp. v. Catrett, 477  U.S.  317,  106  S.Ct.  2548,  91  L.Ed.2d  265  (1986),  a  case  we  have  cited  often  for  other  language concerning summary­judgment law but not for the "mirror" concept.  If it has not been clear heretofore, we hope this opinion clarifies that, although we follow  federal courts’ interpretation of the parallel rule, F.R.C.P. 56(c) when possible for the sake of  uniformity,  we  have  never  gone  so  far  as  to  say,  much  less  hold,  that  we  will  make  a  “sufficiency of the evidence” determination when a summary­judgment motion is at issue. We  regard that directed­verdict standard, used in ruling on motions made pursuant to Ark. R. Civ.  P. 50, as being somewhat different from the summary­judgment standard.  We have ceased referring to summary judgment as “drastic” remedy. We now regard it simply  as one of the tools in a trial court’s efficiency arsenal; however, we only approve the granting  of  the  motion  when  the  state  of  the  evidence  as  portrayed  by  the  pleadings,  affidavits,  discovery responses, and admissions on file is such that the nonmoving party is not entitled to  a day in court, i.e., when there is not any genuine remaining issue of material fact and the  moving party is entitled to judgment as a matter of law.  Wallace v. Broyles, 331 Ark. 58, 194­195, 961 S.W.2d 712,723­724 (1998) (emphasis added).  Our supreme court admonishes that a “sufficiency of the evidence” determination is not the  appropriate standard when a summary­judgment motion is at issue. That specific admonition alone  requires reversal of the case before us.  In direct contradiction with our supreme court’s instruction  that sufficiency of the evidence is not our determination, the majority opines: “Appellees demonstrated  their prima facie entitlement to summary judgment by attaching to their motion portions of Dr. Hume’s  deposition demonstrating that his opinion of negligence on the part of appellee was speculative, thus ­20­  CA06­1051  rendering his opinion insufficient to satisfy Hamilton’s burden of proof.” 2  Not only does the majority err by applying a sufficiency of the evidence standard to hold that  the  expert’s  opinion was  insufficient  to  satisfy Hamilton’s  burden of proof,  but  the  majority also  further  compounds  that  error  by  completely  ignoring  the  fact  that  the  medical  expert  is  legally  incapable of admitting that his testimonyis impermissibly speculative. Examining the appellees’ motion  for summary judgment makes the majority’s error painfully clear.  Paragraph two of appellees’ motion for summary judgment reads as follows: “Expert testimony  is  inadmissible  if  based  upon  speculation.”  Paragraph  three  states  the  following:  “Plaintiff’s  only  liability expert witness, Dr. Joseph Hume, admitted during his deposition that he bases his opinions  regarding the issue of negligence (and therefore on the issue of causation) on speculation.” Paragraph  four continues with this conclusion: “Because plaintiff’s theories of negligence and causation are based  upon speculation, testimony regarding those theories is inadmissible and thus plaintiff cannot satisfy  her burden of proof against Dr. Allen and Dr. Taylor. Where a plaintiff cannot meet her burden of  proof on an essential element of her claim, the defendant is entitled to summary judgment.”  Appellees’ motion for summary judgment  characterized the medical expert’s testimony as 2  When evaluating an expert opinion regarding the causation aspect of the negligence  claim, a trial court should be mindful of the following admonition emphasizing that proximate  cause is a jury question: “Arkansas does not require any specific “magic words” with respect to  expert opinions, and they are to be judged upon the entirety of the opinion, not validated or  invalidated on the presence or lack of ‘magic words.’ See Wackenhut Corp. v. Jones, 73 Ark.  App. 158, 40 S.W.3d 333 (2001). Even in medical malpractice cases, proximate cause may be  shown from circumstantial evidence, and such evidence is sufficient to show proximate cause if  the facts proved are of such a nature and are so connected and related to each other that the  conclusion may be fairly inferred. See Stecker v. First Commercial Trust Co., 331 Ark. 452, 962  S.W.2d 792 (1998).”  Wal­Mart Stores, Inc. v. Kilgore, 85 Ark. App. 231, 148 S.W.3d 754  (2004)).  ­21­  CA06­1051  speculation.  In their brief in support, appellees cite three cases and proclaim that “the Supreme Court  affirmed directed verdicts in favor of medical care providers where plaintiffs failed to present expert  medical  testimony  to  support  their  allegations  of  negligence  against  medical  care  providers.”  (Emphasis added).  Motions for directed verdict and judgment notwithstanding the verdict as to proof  of negligence and resulting damages are challenges to the sufficiency of the evidence. See Callahan  v. Clark, 321 Ark. 376, 386, 901 S.W.2d 842, 847 (1995); see Conagra, Inc. v. Strother, 340 Ark.  672, 676, 13 S.W.3d 150, 153 (2000) “motion for JNOV is technically only a renewal of the motion  for a directed verdict made at the close of the evidence).  Appellees’ entire motion is based upon their claim that Dr. Hume admitted that his opinions  were based upon speculation.  While that argument may be appropriate in the context of analyzing  whether or not a trial court properly directed a verdict in a jury trial, it is inapplicable to our analysis  regarding the propriety of an order granting summary judgment.  As convenient as the argument may  be, it is understandable why appellees failed to include any legal authority regarding any admission by  Dr. Hume that his opinion was impermissibly speculative as a matter of law. While there is nothing in  the  record  to  indicate  that  Dr.  Hume  would  have  had  any  insight  into  the  legal  significance  of  impermissible theorizing to reach a conclusion, even if he had testified that he was the foremost legal  authority in the country on evidentiary matters with an emphasis on impermissible speculation, his legal  opinion as to the admissibility of his testimony would be completely irrelevant. Evidentiary matters  regarding the admissibility of evidence are left to the sound discretion of the trial court and rulings in  this  regard will not be reversed absent an abuse of discretion. White v. State, 330 Ark. 813, 958 ­22­  CA06­1051  3  S.W.2d 519 (1997).  Nothing Dr. Hume might  have  said could relieve the trial court of its duty to review the  “evidence” presented to it to determine whether a factual matter was presented.  It was the trial court’s  duty, not a party’s nor a witness’s, to determine whether the appellees had established a prima facie  case  that  they  were  entitled  to  judgment  as  a  matter  of  law.  The  duty  of  a  plaintiff,  even  in  a  malpractice case, to present proof prior to trial only arises when the moving party first establishes a  prima facie case that judgment is warranted as a matter of law. When the proof supporting a motion  for summary judgment is insufficient, there is no duty on the part of the opposing party to meet proof  with proof.  See Robson v. Tinnin, 322 Ark. 605, 911 S.W.2d 246 (1995);  Wolner v. Bogaev, 290  Ark. 299, 718 S.W.2d 942 (1986).  Our supreme court has explained the application of this principle  in previous malpractice cases:  In Wolner, the plaintiff was in the hospital for prostatic surgery, and following surgery,  he rose from a chair, fell, and broke his arm. He sued the hospital and his urologist, and the  circuit court granted summary judgment in favor of both. Our supreme court reversed with  respect to the urologist and stated that it was the responsibility of the urologist, as the moving  party, to prove the requisite standard of care and that he had conformed to that standard of  care before the opposing party was required to present proof of the contrary. This he failed  to do.  Similarly, in Collyard v. American Home Assur. Co., supra, the issue was whether  proof  was  sufficient  to  sustain  summary  judgment  in  a  slip  and  fall  case.  The  plaintiff  (Collyard) gave a deposition in which she stated that she did not know how the water causing  her fall got on the floor or how long it had been there. The defendant business (YMCA) where  the plaintiff fell moved for summary judgment and attached the plaintiff’s deposition in support  of the motion. The circuit court granted the motion in favor of the defendant because the  plaintiff had not responded to the motion by countervailing proof. This court reversed and  stated: 3  Even  Rule 701 of the Arkansas Rules of Evidence allowing the opinion of lay persons,  rather than experts,  has been recognized  not as a rule against opinions, but as a rule that  conditionally favors them. Bridges v. State, 327 Ark. 392, 938 S.W.2d 561 (1997).  ­23­  CA06­1051  The appellant [Collyard] alleged negligence on the part of the YMCA. The appellee [YMCA]  never controverted this allegation by affidavit or other proof. It simply offered the deposition  of Collyard that she did not know how the water got there or how long it had been there. The  appellee and trial judge mistakenly presumed that the burden was on Collyard to come forward  with additional proof on this issue. The burden in a summary judgment proceeding is on the  moving party; it cannot be shifted when there is no offer of proof on a controverted issue. The  object of a summary judgment is not to try the issues but to determine if there are issues of  fact. Ashley v. Eisele, 247 Ark. 281, 445 S.W.2d 76 (1967).  Whether the YMCA was negligent remained a fact in issue. If appellant had offered  proof that the YMCA was not negligent, then Collyard would have had to produce a counter­  affidavit or proof refuting the offer. But that was not the case. The appellee based its motion  only on the deposition of Collyard, the plaintiff.  The allegation in the complaint remained  uncontroverted  and  Collyard  should  be  permitted  to  present  other  evidence  on  that  fact.  Collyard, 271 Ark. at 229­230, 607 S.W.2d at 668.  Cash  v.  Lim,  322  Ark.  359,  365­66,  908  S.W.2d  655,  658­59  (1995)  (reversing  and  remanding  summary judgment  award  holding  that  surgeon’s  deposition,  which  was  attached  to  defendants’  motion  for  summary  judgment,  did  not  constitute  proof  of  lack  of  causation  that  required  countervailing proof from plaintiffs).  Applying the principles discussed in Wolner, supra, and Cash, supra, appellees as the moving  party had to prove the requisite standard of care and that they had conformed to that standard of care  before appellant was required to present proof to the contrary. Appellees’ failure to provide proof that  they had met the standard of care precluded the entry of summary judgment and requires reversal in  this case. It may seem axiomatic, from reading our supreme court precedents and our reiteration of those  precedents in McAdams, that appellees failed to make a prima facie case by failing to first establish  conformity with the standard of care. Yet, appellees’ based their argument and the majority renders its  opinion upon the assumption that appellees only needed to prove that appellant had not yet presented ­24­  CA06­1051  the requisite expert testimony. Rather than presenting evidence that established the standard of care and  compliance with that standard, appellees presented evidence that appellant’s expert witness had not  demonstrated the standard of care and violation of that standard that proximately caused damages to  appellant. The argument is convenient for appellees who conducted the deposition of appellant’s expert  witness and were under no obligation to inquire as to the standard of care and compliance with the  standard in questioning appellant’s expert.  Even  with  their  complete  control of the  questioning  of appellant’s  expert,  Dr.  Hume,  the  statements by Dr. Hume were not as impermissibly speculative as the majority contends.  Dr. Hume  testified that the deviation from the standard of care in this case came from the failure to properly  identify  the  cause  of  the  excessive  bleeding  which  would  have  been  identified  if  Dr.  Allen  had  adequately opened the incision area.  Appellees’ counsel questioned, “If I understand your testimony,  your opinion in this case that Dr. Allen deviated below the standard of care is based upon your opinion  that there was a third bleeding site that was not identified?” It is clear from the context that the third  site was not identified by Dr. Allen because he did not extend the incision enough to visualize the area  in question. When appellees’ counsel asked, “And it would be speculation to say they would have found  anything, correct?”, Dr. Hume responded, “Well, no, I still think that there was a bleeder from the first  surgery that they didn’t get or they tamponaded it just enough when they put those sutures in for the  oozers and then it reopened up.”  Ironically, the testimony that the appellees and the majority apparently rely so heavily upon  regarding  speculation  surrounds  the  attempts  by counsel  to  commit  Dr.  Hume  to  saying  that  the  excessive bleeding was caused by the two sources of bleeding identified by appellees but that appellees  just failed to adequately address the bleeding: ­25­  CA06­1051  Q:  And  you  don’t  have  any reason  to  doubt,  as  we  sit  here  today,  Dr.  Allen’s  testimony  concerning how far he opened that up?  A:  No.  I  don’t  have  any  ­­  he  just  didn’t  go  all  the  way  up  in  the  infundibulopelvic  retroperitoneal space of the ligament.  Q: So am I correct, do you believe that there was a third bleeding site?  A: Probably.  It was artery.  And we know he didn't get it because the surgeon found it on the  12th.  ...  Q: Just to make sure I understand. During the second surgery, meaning the first exploratory  surgery, from your review of the records and Dr. Allen’s deposition, it’s your opinion that there was  a third bleeding site?  A: That’s correct.  Q: What in your opinion caused that third bleeding site?  A: I think that the vessell retracted.  Q: When did the vessel retract?  A: At the initial surgery, he lost it in the clamp, pulled back. Or it could have torn, depending  upon how much tension was placed on it.  Q: Did you see in looking at the operative note from the second surgery, any evidence of  continuing bleeding after Dr. Allen had sutured the two bleeding sites he identified?  A: He sutured the two oozing and he didn’t feel he saw any other sites. But I think that it was  probably tamponaded for a bit and then it opened back up. Since its arterial it will go through spasms.  Q: So in other words, you don't know whether this third bleeding site was actually bleeding  at the time of the second surgery?  A: That's correct.  Q: It would be speculation on your part to say that it was bleeding?  A: It would be speculation. But for the amount of blood that she had there, it probably had  bled on and off to make the volume up so great.  ...  A: I feel that the amount of blood there was not ­­ was more than what the two oozes would  cause. ­26­  CA06­1051  Q: Is that based upon your opinion that the sites were both oozing at the time of the second  surgery?  A: Right.  Q: So as far as whether they had been bleeding more vigorously before ­­­  A: I have no opinion on that.  Q: So in other words, when you saw the oozing of the two sites Dr. Allen identified during the  second surgery, you can't say without speculating that those two sites, or one or the other, wasn’t  bleeding more vigorously before?  A: I can't say for sure that one of those was bleeding heavy.  Q: So  as far as the blood that  was actually found  during the second surgery, it would be  speculation to say that it didn't come from one or both of the two bleeding sites ­­  A: That's true.  ...  Q: Is it possible that the bleeding could have started after the second surgery?  A: I doubt it.  Q: But is it possible?  A: It could be possible.  ...  Q: I take it, if there was not a third bleeder at the time of the second surgery, you would not  have had any criticisms of Dr. Allen or Dr. Taylor?  A: No.  Q: Is that correct?  A: That's correct.  Q: As we sit here today ­­  A: There wouldn't be a second surgery.  ... ­27­  CA06­1051  Q: ­­­again, if there was not a bleeding site during that second surgery, that would have served  no purpose to go up and look for it further?  A: It would have made sure that there wasn't anything that we were ­­ that he was missing. It's  what you do when you have to go back in.  These exchanges show that Dr. Hume examined the surgical notes from the procedures and  the deposition of one defendant surgeon to conclude that  the standard of care required that the  surgeon  determine  the  source  of  the  excessive  bleeding  by  making  a  longer  incision  than  that  performed  by  appellees  to  adequately  examine  the  area.  After  pages  and  pages  of  this  type  of  questioning about matters other than appellees' failure to properly examine the patient, and only pages  94 through 117 of Dr. Hume’s deposition were attached to the motion, Dr. Hume’s somewhat sharp  response in reiterating his criticism is understandable:  A: Well, no. My criticism is that he didn't open that whole space up so that he could visualize  what he was clamping. I mean, when you do that, you basically have skeletonized the vessels so that  you know damn good and well that you're grabbing onto the vessel and not a lot of tissue with it.  The majority does not explain how this testimony demonstrates that appellees were entitled  to judgment as a matter of law. By their reasoning, an examination of the evidence is unnecessary  because once appellees alleged that the evidence was insufficient, appellant had to provide evidence  sufficient to meet her statutory burden of proof or her medical malpractice case would be dismissed  on summary judgment. Until our supreme court holds that we have a different standard for summary  judgment in medical malpractice cases, the majority's approach is not the law. Because the majority's  approach clearly violates that standard, this case should be reversed and remanded on appellant's first  argument rendering the remaining arguments moot.  Accordingly, I dissent. ­28­  CA06­1051 

Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.