Judge: Salvatore Sirna, Case: 20STCV31783, Date: 2023-02-07 Tentative Ruling

The Court may change tentative rulings at any time. Therefore, counsel are advised to check this website periodically to determine whether any changes or updates have been made to the tentative ruling. Counsel may submit on the tentative rulings by calling the clerk in Department G at (909) 802-1104 prior to 8:30 a.m. the morning of the hearing.

Case Number: 20STCV31783    Hearing Date: February 7, 2023    Dept: G

Defendants Zouhair Hakak, M.D.; Ralph E. Conner, D.O.; and Emergent Medical Associates’ Motion for Summary Judgment

Respondent: Plaintiff Steven Anthony Montoya

TENTATIVE RULING

Defendants Zouhair Hakak, M.D.; Ralph E. Conner, D.O.; and Emergent Medical Associates’ Motion for Summary Judgment is GRANTED IN PART as to Zouhair Hakak, M.D. and DENIED IN PART as to Ralph E. Conner, D.O. and Emergent Medical Associates.

BACKGROUND

This is a medical malpractice and personal injury action. In the early morning on August 30, 2019, Plaintiff Steven Anthony Montoya was exercising at a Crunch Fitness gym in San Dimas when Plaintiff began to exhibit symptoms of an ischemic stroke, including slurred speech and disorientation. Upon observing Plaintiff’s symptoms, Crunch Fitness staff and others mistakenly believed Plaintiff was intoxicated and contacted law enforcement. Subsequently, deputies of the Los Angeles County Sheriff’s Department (LASD) arrived and detained Plaintiff by handcuffing Plaintiff and placing Plaintiff in the back of a patrol vehicle. After questioning Plaintiff, LASD deputies believed Plaintiff to be under the influence and had Plaintiff transported to San Dimas Community Hospital.

When Plaintiff was admitted to the emergency room of San Dimas Community Hospital, Plaintiff was admitted as a “John Doe” and was unable to communicate with hospital staff due to the symptoms of Plaintiff’s stroke. Zouhair Hakak, M.D. (Dr. Hakak) gave Plaintiff an initial diagnosis of “acute psychosis” and ordered a neurological consultation. The next day on August 31, 2019, another physician examined Plaintiff and suspected Plaintiff had a stroke. Plaintiff was then transported to the Pomona Valley Hospital where Plaintiff was diagnosed with an acute parietal ischemic infarct and placed on non-TPA stroke protocol.

On August 20, 2020, Plaintiff filed a complaint against San Dimas Community Hospital; Ralph E. Conner, D.O. (Dr. Connor); Emergent Medical Associates (Emergent); Dr. Hakak; Crunch Fitness; County of Los Angeles; LASD; and Does 1-200, alleging the following causes of action: (1) medical negligence (against San Dimas Community Hospital, Dr. Conner, Emergent, Dr. Hakak, and Does 1-50); (2) negligence (against Crunch Fitness and Does 51-100); (3) false imprisonment (against County of Los Angeles, LASD, and Does 101-150); (4) deprivation of right under color of state law pursuant to 42 U.S.C. §§ 1983, 1988 (against County of Los Angeles, LASD, and Does 101-150); (5) deprivation of right under Article I, Section 13 of the California Constitution (against County of Los Angeles, LASD, and Does 101-150); and (6) negligence pursuant to Government Code section 820 and California common law (against County of Los Angeles, LASD, and Does 101-150).

On June 23, 2021, the court sustained a demurrer by the County of Los Angeles and LASD to Plaintiff’s third, fourth, fifth, and sixth causes of action. On July 26, the court entered a judgment of dismissal in favor of both defendants after Plaintiff failed to amend the complaint.

On November 18, 2022, Dr. Hakak filed the present motion for summary judgment on Plaintiff’s first cause of action for medical negligence, with Dr. Conner and Emergent filing notices of joinder to the motion. Plaintiff filed oppositions to the joinders of Dr. Conner and Emergent but submitted a notice of non-opposition as to Dr. Hakak’s motion.

A hearing on the motions and case management conference are set for February 7, 2023.

ANALYSIS

Dr. Hakak, Dr. Conner, and Emergent (collectively, Defendants) move for summary judgment on Plaintiff’s first cause of action for medical negligence on the grounds that (1) Defendants complied with the applicable standard of care and (2) Defendant did not cause or contribute to Plaintiff’s alleged injuries. For the following reasons, the motion for summary judgment is GRANTED IN PART, DENIED IN PART.  Defendants’ motion is GRANTED as to Dr. Hakak and DENIED as to Defendants Conner and Emergent.

Legal Standard

The function of a motion for summary judgment or adjudication is to allow a determination as to whether an opposing party cannot show evidentiary support for a pleading or claim and to enable an order of summary dismissal without the need for trial. (Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, 843.) Code of Civil Procedure section 437c, subdivision (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, quoting Code Civ. Proc., § 437c, subd. (c).) “The function of the pleadings in a motion for summary judgment is to delimit the scope of the issues[;] the function of the affidavits or declarations is to disclose whether there is any triable issue of fact within the issues delimited by the pleadings.”  (Juge v. County of Sacramento (1993) 12 Cal.App.4th 59, 67, quoting FPI Development, Inc. v. Nakashima (1991) 231 Cal. App.3d 367, 381-382.) 

“A plaintiff or cross-complainant has met his or her burden of showing that there is no defense to a cause of action if that party has proved each element of the cause of action entitling the party to judgment on¿the¿cause of action.” (Code Civ. Proc., § 437c, subd. (p)(1).) Then, “the burden shifts to the defendant or cross-defendant to show that a triable issue of one or more material facts exists as to¿the¿cause of action or a defense thereto.” (Code Civ. Proc., § 437c, subd. (p)(1).) To establish a triable issue of material fact, the party opposing the motion must produce substantial responsive evidence. (Sangster v. Paetkau (1998) 68 Cal.App.4th 151, 166.) Courts “liberally construe the evidence in support of the party opposing summary judgment and resolve doubts concerning the evidence in favor of that party.”  (Dore v. Arnold Worldwide, Inc. (2006) 39 Cal.4th 384, 389.)

To succeed on a cause of action for medical negligence, Plaintiff must establish “(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.” (Turpin v. Sortini (1982) 31 Cal.3d 220, 229-230, quoting 4 Witkin, Summary of Cal. Law (8th ed. 1974) Torts, § 488 et seq., p. 2749.) 

Discussion

Defendants argue it is undisputed that Defendants’ care and treatment did not fall below the appropriate standard of care and cause Plaintiff’s injuries. The court agrees with regard to Dr. Hakak, but disagrees as to Dr. Conner and Emergent.  

“In professional malpractice cases, expert opinion testimony is required to prove or disprove that the defendant performed in accordance with the prevailing standard of care [citation], except in cases where the negligence is obvious to laymen.” (Ryan v. Real Estate of the Pacific, Inc. (2019) 32 Cal.App.5th 637, 644-645, quoting Kelley v. Trunk (1998) 66 Cal.App.4th 519, 523.) “When 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.” (Webster v. Claremont Yoga (2018) 26 Cal.App.5th 284, 288-289, quoting Hanson v. Grode (1999) 76 Cal.App.4th 601, 607.)

Similarly, “[w]here the complexity of the causation issue is beyond common experience, expert testimony is required to establish causation.” (Garbell v. Conejo Hardwoods, Inc. (2011) 193 Cal.App.4th 1563, 1569.) Plaintiff must establish “that defendants' breach of the standard of care was the cause, within a reasonable medical probability, of his injury.” (Bushling v. Fremont Medical Center (2004) 117 Cal.App.4th 493, 509.)

In this case, Defendants rely on the expert opinions of two doctors: Peter Glassman, MBBS, MSc, FACP (Dr. Glassman), and Nerses Sanossian, M.D. (Dr. Sanossian). In opposition, Plaintiff relies on the expert opinion of Christopher Ho, M.D. (Dr. Ho).

Dr. Conner

On August 30, 2019, at 8:08 AM, Plaintiff arrived at San Dimas Community Hospital’s emergency department. (Plaintiff’s Response to Separate Statement of Undisputed Material Facts (PRSSUMF), ¶ 3.) At 8:10 AM, Dr. Conner evaluated Plaintiff. (PRSSUMF, ¶ 5.) After running lab tests and a CT scan, Dr. Conner diagnosed Plaintiff with acute psychosis and admitted Plaintiff to see Dr. Hakak. (DeFalco Decl., Ex. B., p. 0008.) Neither one of Defendant’s experts provided any opinion on Dr. Conner’s treatment. (Glassman Decl., ¶ 8-10; Sanossian Decl., ¶ 7-9.)

However, Dr. Ho opined that Dr. Conner’s treatment fell below the acceptable standard of care because Dr. Conner did not seriously consider the possibility of acute stroke as a diagnosis. (Ho Decl., ¶ 7(a).) If Dr. Conner had performed an appropriate stroke assessment, Dr. Ho opined it is more likely than not that Plaintiff would have been properly diagnosed with ischemic stroke soon after admission. (Ho Decl., ¶ 7(b).) Also, Dr. Ho stated Dr. Conner’s failure to properly and timely diagnose Plaintiff prevented Plaintiff from receiving TPA treatment that could have broken up the clot causing Plaintiff’s stroke and improved Plaintiff’s outcome. (Ho Decl., ¶ 8.) Dr. Ho’s opinion is also supported by Dr. Sanossian, who stated the window to provide TPA treatment was 4 ½ hours after the onset of symptoms and would have closed at 11:00 AM. (Sanossian Decl., ¶ 8.)

Thus, because Plaintiff had provided expert opinion evidence that suggests (1) Dr. Conner’s errant diagnosis fell below the acceptable standard of care and (2) caused Plaintiff’s injury by denying Plaintiff timely TPA treatment, the court finds triable issues of material fact as to Dr. Conner and Emergent. 

As a result, the court denies the motion for summary judgment as to Dr. Conner and Emergent on Plaintiff’s medical negligence claim.

Dr. Hakak

At 12:30 PM, Plaintiff was transferred from San Dimas Community Hospital’s emergency department to Room 120A under the care of Dr. Hakak. (DeFalco Decl., Ex. B., p. 0001, 0016.) According to Dr. Glassman, Dr. Hakak’s treatment of Plaintiff was within the standard of care and no act or omission by Dr. Hakak caused or contributed to Plaintiff’s injuries. (Dr. Glassman Decl., ¶ 9-10.) Dr. Sanossian also agreed that Dr. Hakak did not cause or contribute to Plaintiff’s injuries. (Sanossian Decl., ¶ 7-9.) In particular, Dr. Sanossian opined that the window to provide TPA treatment had closed at 11:10 AM before Plaintiff was transferred to Dr. Hakak’s care. (Sanossian Decl., ¶ 8-9.)

Plaintiff’s expert does not provide any opinion on Dr. Hakak’s treatment. Furthermore, Plaintiff had submitted a notice of non-opposition with respect to Dr. Hakak’s motion for summary judgment. Thus, because Defendant has provided uncontroverted evidence that establishes (1) Dr. Hakak’s treatment did not fall below the acceptable standard of care and (2) did not cause Plaintiff’s injury, Dr. Hakak is entitled to summary judgment on Plaintiff’s medical negligence claim.

CONCLUSION

Based on the foregoing, Defendants’ motion for summary judgment is GRANTED IN PART as to Dr. Hakak and DENIED IN PART as to Dr. Conner and Emergent.