Judge Jill Feeney, Case 19STCV43794 2022-08-17 Tentative Ruling

The present case arises from the following facts and circumstances. On December 7, 2018, Julian Harding (“Plaintiff”) presented to the Emergency Department at CHA Hollywood Medical Center (“Defendant CHMC”) and was seen by Shahrouz Dadfarin, M.D. (“Defendant Dadfarin”) and Byung Cheol Yoo, N.P. (“Defendant Yoo”). Plaintiff complained of extremity weakness, numbness, and difficulty with ambulation. Defendant Dadfarin and Defendant Yoo diagnosed Plaintiff with musculoskeletal pain and discharged Plaintiff. Over a month later, Plaintiff presented to Cedars-Sinai Medical Center and was diagnosed with an intracranial dural arteriovenous fistula with perimedullary spinal venous drainage. At Cedars, Plaintiff then underwent an angiography and embolization. Plaintiff alleges Defendant Dadfarin and Defendant Yoo negligently cared and treated Plaintiff when a patient at Defendant CHMC and caused Plaintiff’s medical condition to not be timely diagnosed and treated.

Defendants Dadfarin and Yoo argue that their motion for summary judgment should be granted because expert testimony shows that their treatment of Plaintiff complied with the community standard of care. Additionally, Defendants argue that their treatment of Plaintiff did not cause his alleged injuries.

Defendant CHMC also argues that expert testimony establishes CHMC acted within the standard of care and did not cause Plaintiff’s injuries. CHMC contends that it cannot be held liable for the actions and omissions of the medical staff because the staff involved were independent contractors and the hospital did not direct or supervise the professional services rendered by those physicians. Additionally, CHMC argues it cannot be held liable under the ostensible agency theory because the hospital gave Plaintiff notice that the staff were independent providers and not hospital employees.

The purpose of a motion for summary judgment “is to provide courts with a mechanism to cut through the parties’ pleadings in order to determine whether, despite their allegations, trial is in fact necessary to resolve their dispute.” (Aguilar v. Atl. Richfield Co. (2001) 25 Cal.4th 826, 843.) “Code of Civil Procedure section 437c(c), requires the trial judge to grant summary judgment if all the evidence submitted, and ‘all inferences reasonably deducible from the evidence’ and uncontradicted by other inferences or evidence, show that there is no triable issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” (Adler v. Manor Healthcare Corp. (1992) 7 Cal.App.4th 1110, 1119.)

“On a motion for summary judgment, the initial burden is always on the moving party to make a prima facie showing that there are no triable issues of material fact.” (Scalf v. D. B. Log Homes, Inc. (2005) 128 Cal.App.4th 1510, 1519.) A defendant moving for summary judgment “has met his or her burden of showing that a cause of action has no merit if the party has shown that one or more elements of the cause of action . . . cannot be established.” (Code Civ. Proc., section 437c(p)(2).) “Once the defendant . . . has met that burden, the burden shifts to the plaintiff . . . to show that a triable issue of one or more material facts exists as to the cause of action or a defense thereto.” (Ibid.) “If the plaintiff cannot do so, summary judgment should be granted.” (Avivi v. Centro Medico Urgente Med. Ctr. (2008) 159 Cal.App.4th 463, 467.)

“When deciding whether to grant summary judgment, the court must consider all of the evidence set forth in the papers (except evidence to which the court has sustained an objection), as well as all reasonable inferences that may be drawn from that evidence, in the light most favorable to the party opposing summary judgment.” (Avivi, supra, 159 Cal.App.4th at p. 467; see also Code Civ. Proc., section 437c(c).)

Defendants CHMC and Defendants Dadfarin and Yoo move for summary judgment as to Plaintiff’s medical negligence claim because expert testimony shows (1) they acted within the community standard of care and (2) their treatment of Plaintiff did not cause his injuries.

The elements of medical malpractice are: “(1) the duty of the professional to use such skill, prudence, and diligence as other members of his profession commonly possess and exercise; (2) a breach of that duty; (3) a proximate causal connection between the negligent conduct and the resulting injury; and (4) actual loss or damage resulting from the professional's negligence.”¿(Simmons v. West Covina Medical Clinic (1989) 212 Cal.App.3d 696, 701-702 (citations omitted).)¿“Both the standard of care and defendants’ breach must normally be established by expert testimony in a medical malpractice case.”¿(Avivi, supra, 159 Cal.App.4th at p. 467.)¿

Thus, in a medical malpractice case, “[w]hen a defendant moves for summary judgment and supports his motion with expert declarations that his conduct fell within the community standard of care, he is entitled to summary judgment unless the plaintiff comes forward with conflicting expert evidence.”¿(Munro v. Regents of University of California (1989) 215 Cal.App.3d 977, 984-985 (citations omitted).)¿An expert declaration, if uncontradicted, is conclusive proof as to the prevailing standard of care and the propriety of the particular conduct of the health care provider.¿(Starr v. Mooslin (1971) 14 Cal.App.3d 988, 999.)¿ Causation must be proven “within a reasonable medical probability based upon competent expert testimony.” Jones v. Ortho Pharmaceutical Corp. (1985) 163 Cal.App.3d 396, 402. “Mere possibility alone is insufficient to establish a prima facie case.” (Id.) “There can be many possible ‘causes,’ indeed, an infinite number of circumstances which can produce an injury or disease.” (Id. at 403.) “A possible cause only becomes ‘probable’ when, in the absence of other reasonable causal explanations, it becomes more likely than not that the injury was a result of its action.” (Id.)

Defendant Dadfarin and Yoo present evidence showing that on December 7, 2018, Plaintiff presented to the Emergency Department at CHMC complaining of general malaise. (UMF No.1.) Yoo evaluated Plaintiff and noted that he was well nourished and healthy. (UMF No.2.) Plaintiff complained of intermittent weakness and numbness in his left upper and bilateral lower extremities, though he reported no weakness at the time he presented to the medical center. (Id.) Plaintiff reported a history of pain in his left shoulder followed by numbness after lifting heavy weights and that the discomfort usually resolved itself. (Id.) On initial examination, Plaintiff’s vital signs, pupils, pharynx, neck, lungs, heart, back, extremities, mood, alertness, motor function, sensation, and blood all appeared normal. (UMF Nos. 3, 4.) Plaintiff was discharged with a prescription and advised about the risks of hypertension due to his high blood pressure. (UMF No. 5.)

Yoo’s examination and plan of care for Plaintiff was appropriate and within the standard of care given Plaintiff’s history and the normal findings of his examinations. (UMF No. 7; Ricci Decl., ¶12.) It is standard practice for nurse practitioners like Yoo to treat patients independently within the scope of their clinical practice. (UMF No. 8; Ricci Decl., ¶13.) Plaintiff was assigned an acuity level of 4, which was a low level of acuity, meaning Plaintiff was appropriately treated by a nurse practitioner. (UMC No. 9; Ricci Decl., ¶13.) Yoo appropriately ordered a complete blood count and performed and documented physical and neurological examinations, all of which came back normal. (UMF No. 10; Ricci Decl., ¶14.) In light of these normal results, Yoo discharged Plaintiff and there was no need to order radiological images. (UMR No. 11; Ricci Decl., ¶15.)

Dadfarin’s evidence also shows that he acted appropriately and within the standard of care. In an emergency department, the supervising physician is present for consultation or to take over from the nurse practitioner. (UMF No. 12.) There is no requirement for physicians to shadow or examine the nurse practitioner’s patient unless they are consulted. (Id.) Dadfarin was present and available to consult on Plaintiff’s case. (UMF No. 13.) Due to the normal results of Yoo’s examinations and lab work, there was no reason for Yoo to consult Dadfarin. (UMF No. 15; Ricci Decl., ¶17.)

Defendants meet their burden of showing Yoo and Dadfarin acted within the standard of care through the declaration of expert Dr. Raymond Ricci. Dr. Ricci states Defendants acted within the standard of care at all times during their treatment of Plaintiff. (Ricci Decl., ¶¶11-18.) ¿An expert declaration, if uncontradicted, is conclusive proof as to the prevailing standard of care and the propriety of the particular conduct of the health care provider.¿(Starr 14 Cal.App.3d at p. 999.) Defendants met their burden of proving Yoo and Dadfarin acted within the standard of care in ordering testing for Plaintiff and discharging him. The testimony is conclusive of the prevailing standard of care and that Yoo and Dadfarin acted within that standard of care.

Defendants Yoo and Dadfarin also argue that their treatment of Plaintiff was not the proximate cause of his injuries. Defendants’ evidence shows that Yoo ordered appropriate testing, which yielded normal results. (UMF No. 27; Ricci Decl., ¶14.) Satisfied that his physical and neurological examinations were normal, Yoo did not order radiological imaging studies. (UMF No. 28.) Plaintiff was discharged with a plan for close follow-up and strict return policy, orders that Plaintiff see his primary care physician within 1-2 days, and prescriptions for ibuprofen and cyclobenzaprine. (UMF No. 5, 30.) According to expert testimony, Defendants’ conduct was reasonable. (UMF No.33; Ricci Decl., ¶19.) To a reasonable medical probability, nothing Defendants did or failed to do caused Plaintiff’s injuries in this matter. (UMF No. 34.)

Defendants meet their burden of proving no act or admission caused Plaintiff’s injuries. The evidence shows that Defendants acted reasonably in their treatment of Plaintiff. Defendants acted reasonably when they declined to order further testing and discharged Plaintiff because his test results were normal. Expert testimony also shows that Defendants’ care and treatment were reasonable within the standard of care.

The burden shifts to Plaintiff. Plaintiff did not oppose this motion and fails his burden of proving triable issues of material fact exist over whether Yoo and Dadfarin acted within the standard of care and whether their treatment was the proximate cause of Plaintiff’s injuries. Accordingly, Defendants Yoo and Dadfarin’s motion for summary judgment is granted.

CHMC also argues that all care and treatment rendered to Plaintiff at its premises was well within the standard of care. CHMC’s evidence shows that Plaintiff presented to the medical center complaining of general malaise and extremity weakness and numbness. (UMF No. 2.) The triage nurse assigned Plaintiff an acuity level 4. (UMF No. 2.) Yoo performed physical examination and determined Plaintiff was awake, alert, and oriented, and did not have respiratory distress. (UMC No. 5.) Other testing revealed normal results, including normal speech, gait, mentation, and mood were all normal. (UMF No. 7.) Yoo assessed Plaintiff with weakness and myalgia and prescribed ibuprofen and flexeril. (UMF No. 7.) Expert testimony demonstrates the treatment Plaintiff received at the medical center was within the standard of care:

Here, the nursing staff appropriately triaged the Plaintiff by ascertaining his complaints and history of his condition, and by taking vital signs. The nursing staff assigned an acuity level which was appropriate based on Plaintiffs stated complaints. The nursing staff appropriately carried out Mr. Yoo's orders for lab work. Lastly, the nursing staff appropriately communicated Mr. Yoo' s discharge instructions to Plaintiff.

As for causation, CHMC also meets its burden of showing its treatment of Plaintiff was not the proximate cause of Plaintiff’s alleged injuries. As previously discussed, CHMC’s evidence shows its treatment of Plaintiff was within the standard of care. Additionally, expert testimony establishes that CHA’s treatment did not cause or contribute to Plaintiff’s alleged injuries:

Based on my knowledge, training, experience, and review of the materials outlined above, it is my opinion to a reasonable degree of medical probability that no act or omission to act on the part CHA Medical Center, LP., including its nurses and allied health personnel, was a substantial factor which caused or contributed to Plaintiff’s injuries and damages. Furthermore, based on my knowledge, training, experience, and review of the materials outlined above, it is my opinion to a reasonable degree of medical probability that no act or omission to act on the part of the independent physicians and mid-level providers at Hollywood Presbyterian Medical Center caused or contributed to Plaintiff's injuries and damages.

(Colby Decl., ¶30.) CHMC meets its burden of showing that its treatment of Plaintiff did not cause his alleged injuries through the expert declaration of Dr. Geoffrey Colby. To the contrary, Defendant CHMC has established that the care provided by CHMC was reasonable and within the standard of care.

The burden shifts to Plaintiff. Plaintiff did not oppose this motion and thus fails his burden of showing there are no triable issues of material fact over whether Defendant CHMC’s treatment was within the standard of care or whether the treatment was the proximate cause of Plaintiff’s injuries.

Defendant CHMC also asserts that it cannot be held liable for any negligence by Yoo and Dadfarin as they are independent contractors. Since summary judgment has been granted with respect to Defendants Yoo and Dadfarin, there is no need to reach this issue.