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Waddell v. University of Iowa Community Medical Services, Inc.

Court of Appeals of Iowa

September 26, 2018

ROGER WADDELL, Administrator of the Estate of CHRISTINA WADDELL, Plaintiff-Appellant,

          Appeal from the Iowa District Court for Johnson County, Paul D. Miller, Judge.

         Plaintiff appeals the summary judgment order dismissing a medical malpractice action. AFFIRMED.

          James K. Weston II of Tom Riley Law Firm, PLC, Iowa City, for appellant.

          Desirée A. Kilburg, Constance M. Alt, and Nancy J. Penner of Shuttleworth & Ingersoll, PLC, Cedar Rapids, for appellee.

          Heard by Vaitheswaran, P.J., and Doyle and Mullins, JJ.

          MULLINS, Judge.

         The plaintiff appeals from the district court's summary judgment order dismissing the medical malpractice lawsuit against the defendant. The court concluded the plaintiff failed to establish essential elements of his claim.

         I. Background Facts and Proceedings

         On June 10, 2011, Christina Waddell sued University of Iowa Community Medical Services, Inc, (UICMS) d/b/a University of Iowa Quick Care North Liberty (Quick Care) a/k/a UI Family Care Center North Liberty (Family Care).[1] She alleged negligence in the medical care she received at Quick Care and Family Care for failing to diagnose and treat cancer in her finger during visits to two of its clinics.

         Quick Care and Family Care operate out of the same facility. Family Care offers services during normal business hours, including services dealing with long-term health care issues. Quick Care is a walk-in medical clinic providing services during evening hours and Saturday mornings, and it is geared toward more common illnesses, such as the flu or strep throat. If other or further medical care is required, Quick Care refers the individual to a primary care physician or an emergency room.

         In June 2009, Christina presented at Quick Care with a sore on the ring finger of her left hand and a rash on her face. A nurse practitioner diagnosed Christina with a fungal infection, prescribed a topical medication, and advised her to follow up with a primary care physician. Christina returned to Quick Care in July and presented to a physician's assistant with complaints that, despite using the prescribed topical medication, the sore on her ring finger had not improved, her fingernail slid off, and the rash on her face was still present. The physician's assistant removed the remaining fingernail and instructed Christina to soak the finger in Epsom salt and apply antibiotic ointment to her finger and topical creams to the facial rash. In August, Christina presented herself to Family Care for a non-healing nail bed. A physician referred Christina to the University of Iowa Hospitals and Clinics (UI) dermatology department for a possible biopsy with the concern of nail-bed cancer. An appointment was scheduled for August 11.[2] Christina was not seen on August 11 and an undated note on the referral form indicates the appointment was canceled in the system.[3]

         In December, Christina presented at the UI dermatology department to Dr. Mary Stone with a lump on her ring finger that she stated began three years prior as a pink line then darkened. Christina also presented with the development of brown spots on her fingertip, which enlarged over the prior month. Dr. Stone conducted a biopsy, diagnosed Christina with malignant melanoma, and referred Christina to the oncology department.

         On January 5, 2010, Dr. Mohammed Milhem, a UI oncologist, saw Christina for her melanoma treatment. In her history to Dr. Milhem, Christina indicated she had nail issues for the past two years, which began as a white streak that widened over time and darkened in color. She also reported that since 2008, her nail had softened in the middle. Christina told Dr. Milhem she visited Quick Care on two occasions for treatment of her fingernail. On each occasion she was prescribed a fungal cream. After neither cream worked, she stated she was then referred to the UI dermatology department. She did not mention any visit to Family Care. After his examination and discussion with the hospital tumor board, Dr. Milhem determined the best course of treatment was a wide excision of the tumor-i.e., amputation of the finger-and a biopsy of lymph nodes, which would govern decisions on further treatment.

         On January 29, doctors amputated Christina's finger. At the same time, Dr. Hisakazu Hoshi, a surgical oncologist, performed a biopsy of Christina's lymph nodes and determined her cancer was stage three as the cancer had spread to a sentinel lymph node but not to an axillary node. Despite treatment, the cancer continued to spread to her lung, bone marrow, and brain. Christina died on March 30, 2012. After her death, her father, as administrator of her estate, was substituted as plaintiff in Christina's negligence suit. The plaintiff filed a designation of four experts, naming Kim Quinn, R.N., and Drs. Hoshi, Milhem, and Stone as experts who would testify on "issues of informed consent, standard of care, causation and damages."

         In 2013, UICMS moved for summary judgment, alleging plaintiff's designated expert, Quinn, was not qualified to provide testimony on the applicable standards of care. UICMS additionally moved to strike Quinn's testimony. In the summary judgment motion, UICMS contended the plaintiff could not establish a prima facie case for medical malpractice due to a lack of causation evidence. The court denied both of the motions. In its written ruling, the court held there were genuine issues of material fact as "[r]easonable minds could draw different inferences and reach different conclusions from the facts as presented through the testimony of Drs. ...

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