Nurse Practitioner Expert Witness not Qualified to Testify About Medical Standards of Care and Causation

 

In Hamilton v. Pike County, Kentucky the US District Court for the Eastern District of Kentucky has ruled that a correctional system medical care expert witness was not qualified to testify about standards of care and causation because she lacked diagnostic expertise. The Court reasoned:

 

[Name of expert] is not qualified to offer an expert opinion on the standard of care required in Hamilton’s case. Hamilton had a host of medical problems while at the Pike County Detention Center including: alcohol dependency; high blood pressure; hepatitis C; head, neck, and spinal injuries; chronic back pain; a removed spleen; and blood clots. R. 44–2 at 2. It may be possible that a nurse could obtain the “knowledge, skill, experience, training, or education” required to qualify as an expert on the standard of care required of a doctor treating a patient with Hamilton’s symptoms. Fed.R.Evid. 702. One can imagine a nurse who specializes in a field (for example cardiology), reads the relevant literature, and works closely with doctors to treat patients on a regular basis. Over time, the nurse might become as qualified to opine on the standard of care her supervising physician must meet as that physician himself. See, e.g., Savage v. Three Rivers Med. Ctr., ––– S.W.3d ––––, 2012 WL 5274645, at *9 (Ky. Oct.25, 2012) (exempting a nurse with “specialized and unique training … from the usual rule that nurses will not normally be qualified to present expert testimony requiring the interpretation of an x-ray”). But [name of expert] is not that nurse. First, she has not served as a nurse in a clinical setting for over five years, and when she did she dealt with female HIV-positive inmates. It has been over eighteen years since she served as a nurse in a more general setting where she might have encountered patients like Hamilton. Second, Hamilton has a wide range of ailments, and [name of expert] has not spent a prolonged period of time specializing in any of them.

 

In response to the motion, Hamilton does not argue that [name of expert] is qualified to testify as to Dr. Waldridge’s standard of care. Instead, he argues that Dr. Waldridge admitted he violated the standard of care, so the second exception to the requirement of an expert witness applies. R. 54 at 1–3. But the issue here is not whether Hamilton needs an expert witness to establish the standard of care; it is whether [name of expert] is qualified to act as one. Hamilton’s silence as to [name of expert] qualifications speaks volumes. [name of expert] is certainly qualified in the abstract sense of the word. She has worked in the field of medicine, either as a nurse or as a consultant, for over thirty years. But she is not qualified in the specific sense required here. See Berry v. City of Detroit, 25 F.3d 1342, 1351 (6th Cir.1994) (“The issue with regard to expert testimony is … whether [a witness’s] qualifications provide a foundation for a witness to answer a specific question.”). She does not have the “knowledge, skill, experience, training, or education” required to offer an expert opinion on the standard of care required of a physician treating a patient in Hamilton’s condition. Fed.R.Evid. 702. Therefore [name of expert] testimony as to Dr. Waldridge’s standard of care is inadmissible.

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The Kentucky courts also have not directly addressed the question whether a nurse is competent to testify as an expert on causation. One court noted “[a]s an aside” that some courts have held “as a matter of law, that nurses are not qualified to give expert opinion testimony regarding medical causation in medical negligence case.” Rogers v. Integrity Healthcare Servs., Inc., 358 S.W.3d 507, 512 & n. 4 (Ky.Ct.App.2012) (finding nurse not qualified to testify as an expert on other grounds). In fact, “the majority rule [is] that nursing experts cannot opine as to medical causation and are unable to establish … proximate cause.” Vaughn v. Miss. Baptist Med. Ctr., 20 So.3d 645, 652 (Miss.2009) (citing cases from Tennessee, Washington, Indiana, Alabama, and the Eastern District of Kentucky); see also Gaines v. Comanche Cnty. Med. Hosp. ., 143 P.3d 203, 216 (Okla.2006) (allowing a nurse to testify as to the cause of bedsores but noting that the “nurse [was not] giving expert testimony against a physician”). But see Freed v. Geisinger Med. Ctr., 601 Pa. 233, 971 A.2d 1202, 1212 (Pa.2009) (“[A]n otherwise competent and properly qualified nurse [may give] expert opinion testimony regarding medical causation….”). The logic behind the rule is that nurses generally are not licensed to diagnose patients. Because nurses do not determine the medical cause of patients’ symptoms, they will not have the required expertise to testify about causation.

 

But this Court does not need to resolve that question because even if Kentucky law allows [name of expert] to testify as to causation, she is not qualified to do so. Hamilton was admitted to the Pikeville Medical Center and diagnosed with a series of problems including: kidney failure, muscle deterioration, high blood sugar, hematomas, high blood pressure, and an altered mental state. R. 44–2 at 6. [name of expert] is not qualified to testify as to the cause of these illnesses for the same reason she is not qualified to testify as to the standard of care. Hamilton has not established that she has experience, remote or recent, diagnosing these specific illnesses. Therefore Hamilton has not met—or even made any real effort to meet—his burden of proving that [name of expert] testimony as to causation is admissible.