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COURT OF APPEALS DIV I
STATE OF WASHINGTON
2018 JUL 1 6 AM 8:31
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
CHELSEA KRICH and MICHAEL KRICH, )
husband and wife; WILLOW KRICH, a ) No. 76775-5-1
minor child; PAISLEY KRICH, a minor )
child; and TANNER KRICH, a minor child, ) DIVISION ONE
)
Appellants, ) UNPUBLISHED OPINION
)
v. )
)
MARY B. WITTMAN, M.D. and JOHN )
DOE WITTMAN, individually and their )
marital community comprised thereof; and )
EASTSIDE OB/GYN, PLLC, a Washington )
Corporation, )
)
Respondents. ) FILED: July 16, 2018
)
APPELWICK, C.J. — Krich appeals from summary judgment dismissing her
medical malpractice and lack of consent action against her doctor and the doctor's
medical group. She argues that she did not consent to continued labor after she
consented to a cesarean section delivery, and that the continued labor caused
injury to her daughter. Krich did not provide expert testimony establishing that the
continued labor caused temporary or permanent injuries. We affirm.
FACTS
Chelsea Krich's pregnancy with daughter Willow was complicated by
hypertension. Krich signed a consent form indicating that her doctor, Shannon
Bailey, recommended inducing labor because of the hypertension. The consent
form authorized the doctor to break Krich's water and to use the medications
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Oxytocin (Pitocin) and Cervidil. Dr. Mary Wittman assumed care of Krich and
induced her labor on June 26, 2014.
In the morning of June 26, Krich was put on Pitocin, and later that morning
Dr. Wittman ruptured Krich's membranes as part of the inducement process.
Around 1:00 p.m. that day, there was an abrupt drop in the baby's heart rate. The
baby's heart rate had recovered, but Dr. Wittman inserted an intrauterine pressure
catheter to put extra fluid around the baby, in an attempt to prevent future drops in
heart rate. Dr. Wittman raised the potential need for a cesarean section (C-
section) with Krich. Krich signed a consent form for a C-section. Dr. Wittman
allowed the induced labor to proceed.
Around 10:00 p.m. the baby's heart rate dropped again, and Dr. Wittman
recommended amnio infusion and to prepare for a C-section. Dr. Wittman was
unable to find the baby's "heart tones," and called a "crash C-section." The baby,
Willow, was admitted at Swedish Medical Center six days later due to neurological
complications.
In a suit against Wittman and Eastside OB/GYN PLLC(hereafter collectively
referred to as Wittman), Krich alleged that the continued labor was without her
consent. She further alleged that Willow suffered severe and permanent injuries
because of the continued labor. Wittman moved for summary judgment. She
argued that Krich did not produce expert testimony establishing that a breach of
the doctor's standard of care caused the alleged injuries. Asserting that Krich
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No. 76775-5-1/3
could not establish this link, Wittman also argued that her informed consent claim
failed.
The trial court granted Wittman's motion for summary judgment. It found
on Krich's medical malpractice claim,
There is no witness who is expert in this case who is willing to
testify that Dr. Wittman fell below the standard of care. And more
importantly, there is no medical witness at all, including Dr. Wittman
herself, that her standard of care violation more likely than not cause
the damage to the plaintiff.
On the informed consent claim, the trial court found,
[I]t seems to be an argument that informed consent had been
withdrawn and nonetheless that the labor continued, the question is
whether or not that treatment, the continued labor, again, as opposed
to what the plaintiff -- patient consented to, proximately caused injury
to her. And here again, I have a complete gap in the testimony.
Yes, there is testimony from Dr. Wittman, and it's pretty
categorical, that there was a placental abruption here that she saw
signs of at the time of the emergency C-section, but when did it
happen and is that the cause of any of the plaintiffs' damage?
Certainly, there's no evidence at all that it's cause of permanent
injury here because there's a real absence of even clear evidence
here of permanent injury such as cerebral palsy. All three doctors
have opined otherwise.
But also, there's a complete absence of testimony from Dr.
Wittman or anybody else that the labor that continued until the
emergency C-section caused the temporary injuries either.
The court denied Krich's motion for reconsideration. Krich appeals.
DISCUSSION
Krich's sole argument on appeal is that she received treatment to which she
did not consent, and that this treatment proximately caused injury.
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No. 76775-5-1/4
We review summary judgment orders de novo, considering the evidence
and all reasonable inferences from the evidence in the light most favorable to the
nonmoving party. Keck v. Collins, 184 Wn.2d 358, 370, 357 P.3d 1080 (2015).
Summary judgment is appropriate only when no genuine issue exists as to any
material fact and the moving party is entitled to judgment as a matter of law. Id.
Krich contends that she did not consent to continued labor. She argues that
the continued labor caused three types of harm:(1) her emotional distress,(2) her
husband's bystander emotional distress, and (3) injuries to Willow, resulting in
medical bills around $160,000.
The relevant statute provides,
No award shall be made in any action or arbitration for damages for
injury occurring as the result of health care which is provided after
June 25, 1976, unless the plaintiff establishes one or more of the
following propositions:
(1) That injury resulted from the failure of a health care
provider to follow the accepted standard of care;
(2) That a health care provider promised the patient or his or
her representative that the injury suffered would not occur;
(3) That injury resulted from health care to which the patient
or his or her representative did not consent.
Unless otherwise provided in this chapter, the plaintiff shall
have the burden of proving each fact essential to an award by a
preponderance of the evidence.
ROW 7.70.030.
Under the statute, not only must Krich establish that she did not consent to
the treatment she received, but also that injury resulted from that treatment. ROW
7.70.030(3). In general, expert testimony is required when an essential element
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in the case is best established by an opinion which is beyond the expertise of a
layperson. Harris v. Robert C. Groth, M.D., Inc., 99 Wn.2d 438,449,663 P.2d 113
(1983). Medical facts in particular must be proven by expert testimony unless they
are observable by a layperson's senses and describable without medical training.
Id. Expert testimony is generally necessary to establish most aspects of causation.
Id.
Krich asserts that she did not consent to the continued labor, and
differentiates this claim from a claim of lack of informed consent. Krich relies on
Bundrick v. Stewart, 128 Wn. App. 11, 114 P.3d 1204 (2005).
In Bundrick, this court explained that an action for total lack of consent is a
claim of battery, while a claim for lack of informed consent is a medical malpractice
action of negligence. Id. at 17. Informed consent protects the patient's right to
know the risks of the decisions she makes about her care, whereas the cause of
action for battery protects an individual's right to privacy and bodily integrity. Id.
Battery is an intentional tort, and the plaintiffs burden is to show that the defendant
intended to and caused either harm or offense. Id. at 18. The burden ordinarily
requires the plaintiff to show that she did not consent. Id. And, when she
consented to a surgical procedure, but contends she limited her consent to certain
participants, she must demonstrate she communicated that limitation. Id.
Here, Krich argues that the consent form she signed early in the afternoon
establishes that she sought a C-section at that time, and therefore did not consent
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No. 76775-5-1/6
to the continued labor that caused injury) The consent form she signed states, in
part,
I recognize that, during the course of the operation, post-operative
care, medical treatment, anesthesia or other procedure, unforeseen
conditions may necessitate additional or different procedures than
those set forth above. I therefore authorize my above-named
physician, and his or her assistants or designees, to perform such
surgical or other procedures as are in the exercise of their
professional judgment necessary and desirable. The authority
granted under this paragraph shall extend to the treatment of all
conditions that require treatment and are not known to my physician
at the time the medical or surgical procedure is commenced.
The consent form does not dictate a time for the C-section delivery. But, Krich's
deposition testimony does,
Q. So when she left, you understood from her perspective
that you weren't going to have the C-section at that point?
A. Yes, 1-- we stopped her. 1 stopped her at the door saying,
"I don't want to continue on with labor. I want to have a C-section. I
want to have a C-section now."
In the light most favorable to Krich, Krich communicated that she no longer
consented to the continued labor. But, even if Krich did not consent to the
continued labor, statutorily she must prove that the continued labor caused injury.
See RCW 7.70.030(3). A plaintiff who seeks recovery for injuries resulting from
medical treatment must, except under unusual circumstances, offer expert
testimony to establish"the essential elements of her claim. See Groth, 99 Wn.2d
at 449.
Krich does not cite to any case law to support her assertion that a doctor
not performing a type of procedure immediately is a medical battery.
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No. 76775-5-1/7
In Krich's motion for reconsideration, she conceded that "no expert testified
directly that [a] C-section earlier in the day would have avoided the neurologic
depression that put Willow in the NICU [(neonatal intensive care unit)] for the
weeks following her birth." Krich also stated,
Indeed, though the treating neonatologist Dr. Menezes
declined to connect Willow's current problems to the events of her
birth, his note and deposition testimony seem to unambiguously
support that fetal distress "20-30 minutes prior to delivery" were the
direct cause of the "cooling protocol" that was initiated.
Plaintiff's expert Dr. Lin likewise declined to connect Willow's
current issues with the events of her birth, but he gave no testimony
on whether earlier C-section would, or would not have prevented the
"cooling protocol", defense counsel being (quite understandably)
more concerned with Dr. Lin's opinions on Willow's long-term
problems.
After acknowledging the lack of expert testimony, Krich asked the trial court
to reconsider summary judgment, arguing that "a jury could reasonably infer" from
the evidence that an earlier C-section would have avoided injury. Krich relied on
Douglas v. Freeman, 117 Wn.2d 242, 814 P.2d 1160 (1991). There, the Court
recognized,
Expert testimony usually is required to establish proximate cause in
medical malpractice cases. It is not always necessary, however, to
prove every element of causation by medical testimony. If, from the
facts and circumstances and the medical testimony given, a
reasonable person can infer that the causal connection exists, the
evidence is sufficient.
Id. at 252(footnotes omitted).
Douglas is distinguishable from this case. In Douglas, the plaintiff charged
her doctor with negligence in extracting her teeth, and the clinic with negligence in
supervising him. Id. at 253. The doctor who performed the plaintiff's procedure
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No. 76775-5-1/8
stated that wisdom tooth extractions require an assistant. Id. at 253-54. And, two
expert witnesses testified that the lingual nerve could be damaged at stages where
the doctor stated he required an assistant. Id. at 254. Our Supreme Court held
that a jury could reasonably infer from the evidence that the assistant's absence
and the clinic's negligence in supervising the doctor proximately caused the
plaintiffs injuries. Id. at 254-55.
Here, in Krich's motion for reconsideration, she pointed to Dr. Wittman's
statement,
"You know, in the earlier part of the day, she had the
deceleration, the baby recovered, the baby did well, the baby was
having accelerations and good variability, and then, at the end, the
baby just wasn't tolerating labor at all, which is why we did the urgent
C-section, crash C-section."
Krich argues that had a C-section been performed when the baby recovered, the
injuries would have been avoided. Unlike Douglas, Krich did not provide any
expert testimony from which a jury could reasonably infer that allowing the labor to
continue from the early interventions until the C-section proximately caused injury.
And, the statements the experts made declined to connect the injuries to the birth.
The temporal inference that the injuries occurred before the C-section is not
sufficient standing alone to allow the jury to infer any injury occurred after consent
to the C-Section. The jury would have had to speculate about what caused any
injuries and when they were caused.
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We find that the trial court did not err in concluding that Krich did not present
evidence that the continued labor caused injury. The summary judgment was
properly granted.
We affirm.
WE CONCUR:
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