Knowledge, Not Title, Qualified Gastroenterologist as Causation Expert

A man suffered from dysphagia (difficulty swallowing). A gastroenterologist treated his dysphagia by inserting a percutaneous endoscopic gastrostomy (PEG) feeding tube. The PEG feeding tube perforated the man's small bowel. Following the procedure, the man experienced severe abdominal pain and a distended abdomen. Without timely treatment, the man developed sepsis, suffered multi-organ failure and, ultimately, died.


The man’s estate sued the gastroenterologist and his practice for medical malpractice. During discovery, the estate identified a board certified gastroenterologist, as an expert witness who would testify at trial as to the gastroenterologist's deviation from the standard of care and causation. At his deposition, the estate’s gastroenterologist opined that, following the insertion of the PEG feeding tube, the treating gastroenterologist failed to recognize a perforation of the bowel, and that this failure to recognize the perforation ultimately caused the man's death. He testified that if the treating gastroenterologist had examined the man within a couple of hours after the procedure, he would have noticed the complication, and the patient could have been treated.


The gastroenterologist filed a motion in limine seeking to preclude the estate’s expert from testifying on the issue of causation on the ground that he was not qualified to testify on that subject in this case because only a surgeon could competently testify as to the man's likely surgical outcome. The New Haven Superior Court granted the motion in limine to preclude the estate’s expert from testifying as to causation and issued a written order stating: “The plaintiff has provided no evidence that [the gastroenterologist] is qualified to testify as to proximate cause, which, under the facts of this case, requires the expert testimony of a surgeon.” The gastroenterologist moved for summary judgment on the ground that the estate could not make out a prima facie case because it did not have an expert witness to testify as to proximate causation of the man's death. The court granted their motion for summary judgment.


The Appellate Court of Connecticut reversed and remanded with direction to deny the motions to preclude the estate's expert testimony and for summary judgment and for further proceedings according to law. The court held that no law sets forth specific requirements as to the qualifications of experts who testify as to causation in a medical malpractice case. It is not the artificial classification of a witness by title that governs the admissibility of the expert medical testimony, but the scope of the witness' knowledge of the particular condition. The court noted that medical specialties overlap, and it is within a court's discretion to consider that fact in exercising its discretion to deem the expert medical witness qualified to testify in a medical malpractice action. The estate’s gastroenterologist was qualified to render expert testimony even though he was not a surgeon, because he was a board certified gastroenterologist, and knew, was able to recognize, and was trained to carefully monitor his patients for signs and symptoms of bowel perforation to ensure timely diagnosis of bowel perforation and appropriate surgical intervention.


Instead of treating his lack of that credential as dispositive, the court should have examined the full range of the estate’s gastroenterologist's professional familiarity with the cause of, proper treatment for, and likely prognosis of patients timely diagnosed with perforated bowels to determine if he was competent to offer expert testimony. Had it done so on the basis of the record before it, where undisputed evidence of the estate’s gastroenterologist's professional familiarity with these matters as a board certified gastroenterologist was substantial, the court should have denied the treating gastroenterologist's motion to preclude, and, accordingly, the subsequent motion for summary judgment in ruling that only a surgeon would be qualified to testify as to causation in this case.


See: Ward v. Ramsey, 146 Conn.App. 485, 2013 WL 5716164 (Conn.App., October 29, 2013) (not designated for publication).