from the Iowa District Court for Scott County, Paul L. Macek,
Carter appeals the district court's ruling granting
summary judgment in favor of Genesis Health System d/b/a
Genesis Medical Center on his medical malpractice action.
William J. Bribriesco of Bribriesco Law Firm, P.L.L.C.,
Bettendorf, for appellant.
M. Reinsch of Lane & Waterman L.L.P., Davenport, for
Considered by Vaitheswaran, P.J., and Doyle and Bower, JJ.
VAITHESWARAN, PRESIDING JUDGE.
Carter sued Genesis Medical Center for negligence in
connection with a nurse's insertion of an indwelling
catheter and the subsequent erosion of his penile implant.
Genesis moved for summary judgment. Carter conceded the
motion was appropriate on all but one of his claims: whether
the nurse's failure to consult a physician about the use
of a condom catheter instead of an indwelling catheter
amounted to negligence. The district court granted
Genesis' motion on that claim after concluding Carter
lacked a causation expert. See Kennis v. Mercy Hosp. Med.
Ctr., 491 N.W.2d 161, 165 (Iowa 1992) (noting in a
medical malpractice action, a "plaintiff must show
evidence which establishes the applicable standard of care,
demonstrate this standard has been violated, and develop a
causal relationship between the violation and the alleged
harm"); see also Phillips v. Covenant Clinic,
625 N.W.2d 714, 718 (Iowa 2001) ("Expert testimony is
nearly always required to establish each of these elements .
. . . [P]roximate cause, like the other elements, cannot be
based upon mere speculation."). Carter appealed.
reviewing a summary judgment in a medical malpractice action,
the 'task is to determine whether any evidence in the
summary judgment record enables plaintiffs to establish the
applicable standards of care, and defendant's breach of
those standards.'" Kennis, 491 N.W.2d at
164 (citation omitted). Summary judgment is appropriate
"when the party can demonstrate that the proof of the
other party is deficient as to a material element of that
party's case." Thompson v. Embassy
Rehab. & Care Ctr., 604 N.W.2d 643, 646
(Iowa 2000); see also Welte v. Bello, 482
N.W.2d 437, 440 (Iowa 1992) ("If expert testimony is
required to establish general negligence or the foundational
facts and expert testimony is unavailable, then summary
judgment is appropriate."); Oswald v. LeGrand,
453 N.W.2d 634, 635 (Iowa 1990) (stating "where
plaintiffs are limited in the presentation of expert
testimony, the issue becomes not whether there was
negligence in the actions of the defendant but
whether there was evidence upon which liability
could be found").
does not argue a causation expert was unnecessary. See
Kennis 491 N.W.2d at 165 (stating negligence could be
established in three ways, including "through expert
testimony" or "through evidence showing the
[healthcare professional's] lack of care so obvious as to
be within comprehension of a" layperson). To the
contrary, he named and proffered the opinions of two experts.
In his view, these experts generated an issue of material
fact on the element of causation. Carter points to a report
of his nurse expert, who opined "there was a breach in
the standard of care when the patient condition and the
potential for likelihood of penile implant complication were
not addressed by the nursing and physician staff of Genesis
Medical Center." He also cites the same expert's
deposition testimony opining the standard of care required
the nurse, who inserted the indwelling catheter, to
"have [a] conversation with the physician" about
the use of a condom catheter instead of an indwelling
catheter. Finally, he refers to the deposition testimony of
his physician expert, who opined, "[I]f [Carter] had not
had an indwelling catheter, he probably would not have had a
penile-or an erosion of his prosthesis, so in that sense, it
was probably a contributing cause." Based on these
portions of the summary judgment record, Carter contends
"an inference can be drawn that if a discussion had
occurred between [the] nurse . . . and the ordering physician
regarding condom v. indwelling catheter; the ordering
physician would have used a condom catheter."
district court concluded this expert testimony failed to
establish causation. The court conceded Carter had
"expert testimony that [the nurse] breached the standard
of care in not questioning the order" but stated there
was no opinion that "the failure to question the order
caused the penile erosion." The court explained:
Plaintiffs claim fails because a jury would have to infer
that when [the nurse] asked the ordering physician if a
condom catheter was required, that the physician would have
said yes and changed her order. If the ordering physician
does not change the order, then [the nurse's] failure to
question the order would not have caused Plaintiffs injury,
because an indwelling catheter would have been placed in
spite of [the nurse] questioning the order. In other words,
[the physician's] testimony on causation relates to the
placement of an indwelling catheter and not to the factual
circumstance of [the nurse's] failure to ask the ordering
physician if a condom catheter should be used.
district court did not err in reaching this conclusion.
See McKee v. Isle of Capri Casinos, Inc., 864 N.W.2d
518, 525 (Iowa 2015) (setting forth standard of review).
Without expert testimony that the claimed breach of the
standard of care was the cause of his harm, Carter could not
establish a prima facie case of medical negligence. See
Oswald, 453 N.W.2d at 635.
affirm the district court's summary judgment ruling ...