2009-232, Wesley Beckles & a. v. Jennifer E. Madden, M.D. & a.

medical malpractice claims in favor of the defendants, Jennifer E. Madden, decision of the Superior Court (Barry, J.) granting summary judgment on their BRODERICK, C.J. The plaintiffs, Wesley and Maggie Beckles, appeal a

the brief and orally), for defendant Nagbhushan S. Rao, M.D. Rath, Young and Pignatelli, PC, of Nashua (Kenneth C. Bartholomew on

D.O., Foundation Medical Partners, and Foundation Neurology. brief and orally), for defendants Jennifer E. Madden, M.D., Eugene A. Lesser, Wadleigh, Starr & Peters, PLLC, of Manchester (Todd Hathaway on the

McDonough on the brief, and Benjamin R. Novotny orally), for the plaintiffs. Lubin & Meyer, P.C., of Boston, Massachusetts (Suzanne C.M. to press. Errors may be reported by E-mail at the following address:

page is: http://www.courts.state.nh.us/supreme. WESLEY BECKLES & a.

No. 2009-232 editorial errors in order that corrections may be made before the opinion goes Hillsborough-southern judicial district Hampshire, One Charles Doe Drive, Concord, New Hampshire 03301, of any Readers are requested to notify the Reporter, Supreme Court of New ___________________________

a.m. on the morning of their release. The direct address of the court's home reporter@courts.state.nh.us. Opinions are available on the Internet by 9:00

well as formal revision before publication in the New Hampshire Reports. NOTICE: This opinion is subject to motions for rehearing under Rule 22 as and his primary care physician for further diagnosis and treatment.

p. 2 secondary neurological symptoms to this.” She referred him to a neurologist difficulty such as [vitamin] B12 deficiency causing pernicious anemia with recommendations included evaluating whether Mr. Beckles had “metabolic

to have some swaying tendency.” marked difficulty with attempting to do even a partial squat,” and “appear[ed]

had “poor recollection of sequence of events or dates.” Dr. O’Dea’s

close supervision to prevent any falls.” After noting several possible causes,

times [came] close to touching the wall while trying to walk,” displayed “a

and I had to help support the patient with this.” She also documented that he

heavy things and should not be doing complicated maneuvers [and he] requires

patient still ha[d] difficulty with gait,” continued to have “balance difficulties, at

a similar difficulty with attempting to squat, started to fall backwards a bit, appeared to fall a bit against the wall to get back into upright posture. He had weakness on the left side, at times with a mild limp, and at one point [he]

on Mr. Beckles’ ability to work, Dr. Rao noted that “he should not be lifting With his feet together he has some difficulty balancing himself.” When opining he lost his balance and fell at work. The doctor’s notes reflect that “[t]he he is spastic and has ataxia. On Romberg testing he almost fell to the left. of wasting in his lower extremities,” and documented a recent episode in which location.” She also noted his “continued difficulties with the balance and sense

In his description of Mr. Beckles’ condition, he noted: “He walks almost as if

scheduled appointments with a neurologist because he could not find “the right

his body, shock-like sensations, and difficulties with balance, gait and memory numbness, a general feeling of muscle weakness, weakness to the left side of that he suffered tightness and tingling in different parts of his body,

that Mr. Beckles continued to experience difficulty with his gait and balance. neurologist Dr. Lesser co-signed Dr. Rao’s notes. Dr. Rao’s notes document appointment, and her progress notes indicate that he had recently missed two Dr. Rao was on temporary assignment at Foundation Neurology, and The following day, Mr. Beckles was examined by Dr. Rao, a neurologist.

consistent with his work injury. In particular, the medical records indicate

On March 25, Mr. Beckles again met with Dr. O’Dea for a follow-up

examined Mr. Beckles and noted symptoms that were not necessarily March 2003, Barbara O’Dea, M.D., not a named party to this lawsuit, court’s order. Plaintiff Wesley Beckles sustained a neck injury at work. In

We recite the undisputed facts provided in the record and in the trial

Neurology, and Nagbhushan S. Rao, M.D. We reverse and remand. M.D., Eugene A. Lesser, D.O., Foundation Medical Partners, Foundation walk.” p. 3 resulting in a fracture). I hope the gait training will improve his ability to and other injuries.

gait training as he had difficulty walking and was ataxic (causing his fall defendants’ negligence, and this injury ultimately led to his brain hemorrhage

normal life expectancy and resides in a nursing home.

his notes reported: “I would like him to have physical therapy especially for Dr. Rao examined Mr. Beckles at the end of April for a neurology follow-up, and to the plaintiffs, Mr. Beckles’ fall and broken ankle were a direct result of the contributing to gait disturbance which subsequently led to his fall in April.” timely initiate precautionary measures to prevent him from falling. According 12 deficiency that was causing gait and balance problems, and also failed to

will require 24-hour care for the rest of his life. He is in his mid-60s with a Beckles suffered permanent brain damage, causing numerous disabilities. He for “neurology to complete their workup,” and ordered a complete blood count. injections over the course of his lifetime. Due to the brain hemorrhage, Mr.

retrospect, the patient probably had a rather severe B12 deficiency allege that the defendants failed to diagnose Mr. Beckles’ apparent vitamin B-

partner), just this week.” Dr. Madden prescribed medication, planned to wait diagnosed and treated for vitamin B-12 deficiency, for which he will receive

foot. He could not tell me the details.” However, one medical note stated: “In negligent in the medical care they provided to Mr. Beckles. Specifically, they

mentioned to me that he had been seen by Dr. Rao of neurology (Dr. Lesser’s which ultimately caused him to suffer a brain hemorrhage. He also was through his entire history of this event and examined him and he never “associated with probable depression.” The doctor also noted that “I went medical note documented: “He also tells me that . . . he fell fracturing his right unsteady and twisted his right ankle after a fall on 04/06/03.” Another The plaintiffs filed suit against the defendants, alleging that they were medical progress note dated April 10 stated: “At home, . . . he became

lungs. He received thrombolytic therapy in order to dissolve the blood clots, discovered that blood clots had developed in one of his legs and traveled to his with numbness, coordination and gait, and concluded that his symptoms were department at Southern New Hampshire Medical Center where it was Subsequently, on June 7, Mr. Beckles was admitted to the emergency

a bone in his right leg. The circumstances surrounding the fall are unclear. A

care physician, Dr. Madden. Dr. Madden documented Mr. Beckles’ problems

The following weekend, on April 6, Mr. Beckles fell at home and fractured

Two days later, on March 28, Mr. Beckles was examined by his primary

B12 and folate levels.” Dr. Rao ordered various testing including a blood test to check his “[vitamin] the light most favorable to the non-moving party.

p. 4 affidavits and other evidence, and the inferences properly drawn from them, in We review the trial court’s grant of summary judgment by considering the facts showing that there is a genuine issue for trial.” RSA 491:8-a, IV (1997). have prevented his fall. and that the assistive device and/or the physical therapy would

plaintiffs’ burden in demonstrating causation as follows:

depositions, answers to interrogatories, or admissions, must set forth specific an assistive device or physical therapy prior to his fall on April 6

defendants’ alleged negligence caused Mr. Beckles to fall. It outlined the

denials of his pleadings, but his response, by affidavits or by reference to defendants properly treated Mr. Beckles, he would have received his fall. This means that he must demonstrate that, had the device, such as a cane, was a substantial factor in bringing about

with a sufficient level of probability that Mr. Beckles would have received The trial court concluded that the plaintiffs’ medical experts could not testify

experts were insufficient to warrant a reasonable juror’s conclusion that the

491:8-a, III (1997). “[T]he adverse party may not rest upon mere allegations or and that the moving party is entitled to judgment as a matter of law.” RSA affirm.” the affidavits filed, show that there is no genuine issue as to any material fact B-12 deficiency and provide physical therapy or an assistive Mr. Beckles must prove that the defendants’ failure to diagnose the

The trial court concluded that the opinions of the plaintiffs’ two medical

Id.

Id. We review the trial court’s application of law to the facts de novo.

and if the moving party is entitled to judgment as a matter of law, we will issues of material fact, depositions, answers to interrogatories, and admissions on file, together with i.e., facts that would affect the outcome of the litigation, of N.H., 159 N.H. 158, 160 (2009). “If this review does not reveal any genuine

for reconsideration was denied. This appeal followed. plaintiffs’ objection, the trial court granted the motion. The plaintiffs’ motion connection between their alleged negligent care and Mr. Beckles’ fall. Over the

summary judgment, deposed about two months later. Subsequently, the defendants moved for Florida. Dr. Fischer was deposed on February 15, 2008, and Dr. Singer was A moving party is entitled to summary judgment “if the pleadings,

unable to provide sufficient testimony to establish the necessary causal

hematologist from Pennsylvania, and Dr. Kenneth Fischer, a neurologist from The plaintiffs’ expert disclosure identified Dr. Barry Singer, a reasonable probability, and lacked any factual foundation. p. 5 because it was speculative, did not satisfy the necessary standard of contends that the expert testimony was insufficient to establish causation

to establish causation as a matter of law. Dr. Rao, the remaining defendant,

the time the medical care in question was rendered; and

the fact-finder, not the trial court. 5

it had sufficient factual foundation and was reliable, the expert testimony failed requirement of reliability under RSA 516:29-a. Third, they contend that even if with such standard; and to establish causation. Second, they argue that it failed to meet the threshold

medical care provider’s profession or specialty thereof, if any, at

afforded to the opinions and constitute matters that are within the province of expert testimony of a competent witness or witnesses:

in part: (b) That the medical care provider failed to act in accordance order. First, they contend that the plaintiffs’ expert testimony was insufficient

(a) The standard of reasonable professional practice in the

expert medical opinions on causation relate to the weight and credibility to be the burden of proving by affirmative evidence which must include According to the plaintiffs, the various factual assumptions underlying the I. In any action for medical injury, the plaintiff shall have care to Mr. Beckles, it is more likely than not that he would not have fallen.

governed by RSA chapter 507-E (1997 & Supp. 2009). RSA 507-E:2 provides A negligence action based upon a claim of medical malpractice is Foundation Neurology advance three arguments in support of the trial court’s

medical certainty that had the defendants immediately provided preventative

Defendants Dr. Madden, Dr. Lesser, Foundation Medical Partners and negligence on the part of the defendants caused Mr. Beckles’ fall. conclusions regarding causation which are insufficient to demonstrate that any trial court ruled that the medical experts gave conclusory statements or bald

on causation. They contend that the medical experts opined with reasonable summary judgment because the record reveals a genuine issue of material fact On appeal, the plaintiffs argue that the trial court erred in granting

received therapy and an assistive device, the fall would have been avoided. The physical therapy or an assistive device prior to his fall, or that even if he had as all reasonable inferences drawn therefrom, p. 6 in the light most favorable to the plaintiffs as the non-moving parties, as well

Mr. Beckles’ fall probably existed,

whether the summary judgment record, including the expert testimony, viewed

conclusion that the causal link between the defendants’ alleged negligence and statutory standard in order to furnish sufficient evidence to support causation. N.H. 232, 234 (2009), would be sufficient to warrant a reasonable juror’s

concluding at the time of Mr. Beckles’ fall on April 6. It is our task to review proximate cause. starting with the doctor’s appointments on March 26 and March 28 and The dispute before us centers upon a somewhat narrow time frame,

that the defendant’s conduct caused or contributed to cause the harm.” at 408. proximate cause is generally for the trier of fact. Estate of Joshua T., 150 N.H. See Bronson, 140 N.H. at 804. Ultimately, resolution of the question of

at 246. Medical experts need not use specific words or phrases that mirror the the harm would not have occurred.” Goudreault, 158 N.H. competent opinion that the defendant’s negligence ‘probably caused’ the harm engaging in idle speculation.” Id. (quotation omitted). “A medical expert’s

In medical malpractice cases, expert testimony is required to establish

sole cause of the injury, to establish proximate cause a plaintiff must prove 150 N.H. 405, 408 (2003). “Although the negligent conduct need not be the substantial factor in bringing about the harm.” Estate of Joshua T. v. State, cause requires a plaintiff to establish that the negligent conduct was a

probability, not mathematical certainty, that but for the defendant’s negligence, proximately caused the patient’s injury. 507-E:2, I(c). This standard is satisfied if the evidence shows “with reasonable existed.” Id.; see also Goudreault v. Kleeman, 158 N.H. 236, 246 (2009); RSA conclusion that the causal link between the negligence and the injury probably to support this causal link must be “sufficient to warrant a reasonable juror’s case the fall, would not have occurred without that conduct. Id. The evidence legal cause for the injury. Id. Conduct is cause-in-fact if the injury, in this The concept of proximate cause includes both the cause-in-fact and the

negligence and Mr. Beckles’ fall. Thus, our review is likewise limited. exclusively focused upon the causal connection between their alleged 140 N.H. 798, 801 (1996). Here, the defendants’ summary judgment motion

Thus, the plaintiffs must produce sufficient evidence that a doctor’s negligence

suffered injuries which would not otherwise have occurred. (c) That as a proximate result thereof, the injured person involving his physical instability.

p. 7 husband’s care to guard against falls, and to supervise him on matters

have required that Mrs. Beckles be included in the management of her doctor appointments and problems with memory, proper medical care would that given Mr. Beckles’ confused mental status and his history of missing

either the defendant doctors or a physical therapist. Additionally, they opined

have received an assistive device of some type, such as a cane or walker, from sitting, and lying down. According to the plaintiffs’ experts, Mr. Beckles should training on how to safely walk and safely navigate, including standing up,

therapy session before his fall at which he would have received instruction and

testified that Mr. Beckles would have engaged in a minimum of one physical unstable gait and balance difficulties and ordered physical therapy. They the deficiency, then counseled him and his wife on safety issues related to his

ordered by Dr. Rao to ascertain Mr. Beckles’ vitamin B-12 level and discovered

standard of care, the defendants should have followed up on the blood testing

following points. They opined that acting in accord with the proper medical plaintiffs’ experts, either collectively or individually, provided testimony on the

letter part of the summary judgment record. during Dr. Fischer’s deposition. Accordingly, we consider the expert’s opinion Indeed, defense counsel had the same opinion letter marked as an exhibit entitled to judgment as a matter of law. whether genuine issues of material fact exist and whether the moving party is

medical testimony. Rather, our task is to review We turn now to review the summary judgment record before us. The

see Canney v. Travelers Insurance Co., 110 N.H. 304, 305 (1970). circumstances that are supported by evidence and resemble the case at bar, N.H. at 408, and that experts are permitted to opine on hypothetical causation is generally a matter for the trier of fact, see Estate of Joshua T., 150 conducting this review, we are mindful that the question of proximate and they did not move to strike it or otherwise seek to have it excluded. See Smith, 159 N.H. at 160. In

judgment record in the light most favorable to the plaintiffs to determine

trial court’s summary judgment ruling regarding the sufficiency of the expert the unsworn disclosure is inappropriate.” erroneous or unsustainable exercise of discretion standard in reviewing the considered part of the summary judgment record, arguing that “[r]eliance on We also reject defendant Rao’s argument that we should apply a clearly opinion letter authored by one plaintiff expert, Dr. Fischer, should be

expert’s letter was part of the summary judgment record before the trial court however, because the defendants acknowledged at oral argument that the requirement under RSA 491:8-a, II). We decline to consider this argument, Corp., 135 N.H. 298, 301-02 (1992) (deposition sufficient to satisfy affidavit

Foundation Medical Partners and Foundation Neurology contest whether an As an initial matter, we note that defendants Dr. Madden, Dr. Lesser, exam with Dr. Rao earlier that week.

p. 8 failed to tell Dr. Madden that Mr. Beckles had just undergone a neurology

location of the doctor’s office. Dr. Madden’s notes document that Mr. Beckles had recently missed two neurology appointments because he could not find the remarked that he had “poor recollection of sequence of events or dates,” and he

how to use it properly in different situations, he fell and fractured his ankle. measures to provide physical therapy and prevent the fall. The defendant,

raise a genuine factual dispute regarding his mental confusion. Dr. O’Dea

Mr. Beckles, including providing him with an assistive device and training him missing for at least several days,” leaving insufficient time for him to take the defendants’ failure to implement proper precautionary measures to protect not would have prevented Mr. Beckles from falling, and, as a direct result of have ensured that he received it immediately.” Further, the medical records

successfully.” dictates that Dr. Rao would not [have] follow[ed] up . . . and notice[d] they were March 26 were returned mistakenly to the wrong doctor, and “[c]ommon sense directly or inferentially, that proper precautionary measures more likely than of the Doctors recommended gait training or physical therapy to help, I would Beckles’ fall. He contends that the results of the blood tests he ordered on medical affairs. In her affidavit, however, Mrs. Beckles averred that, “Had any husband’s fall and that Mr. Beckles lacked mental capacity to handle his own

they probably would have told him to stay in bed, if he couldn’t get around

Mr. Beckles’ history of gait and balance problems. Finally, they opined, either speculative on whether his purported negligence proximately caused Mr.

foundation, that Mrs. Beckles’ involvement would have prevented her

necessary to provide for his safety, stating: “I mean, if the man couldn’t walk session, a physical therapist would have given Mr. Beckles whatever was as how to stand up, sit, and lie down. Dr. Singer testified that at the first care was warranted, even without detecting the vitamin B-12 deficiency, given Dr. Rao also argues that the plaintiffs’ expert testimony was particularly from the doctors. Moreover, both experts opined that proper precautionary that the situation was urgent and should have prompted immediate attention insufficient to establish causation because they opined, without any factual

the training includes instructing the patient on how to use the device, as well

fall was relatively short, Dr. Singer’s deposition testimony suggests he believed Defendant Rao argues that the plaintiffs’ expert opinions were

patient a proper assistive device “right at the first visit.” He also testified that evaluates the patient’s gait and potential problems for safety, and gives the typical training session as including “safety first,” in which the therapist Although the time frame between the alleged negligence and Mr. Beckles’

has seen physical therapy sessions with patients many times. He described a With respect to physical therapy training, Dr. Fischer testified that he measures were required given Mr. Beckles’ physical and mental symptoms.

p. 9 opined that even without the vitamin B-12 deficiency, the same precautionary beginning physical therapy training before Mr. Beckles fell. Moreover, they and his wife almost immediately upon securing the test results, and (3) and that Mrs. Beckles would have supervised her husband.

and the circumstances of the case are issues of fact for the jury to resolve.

week, (2) communicating the diagnosis and safety counseling to Mr. Beckles likelihood that Mr. Beckles would have complied with physical therapy training

more likely than not to have occurred given the particular individuals involved

end of the week that Mr. Beckles was seen by the doctors, or early the following established through lay testimony rather than expert testimony, such as the In this case, however, several factual issues relevant to causation can be negligence and Mr. Beckles’ fall in order to recover on their negligence claims.

argues that a causal link cannot be established because “there is so little

scheduling of physical therapy. Whether or not these underlying events were depended upon timely blood testing, follow-up appointments, and appropriate procedure would likely have resulted in (1) securing blood test results by the instructions. They also acknowledged that timely preventative care partly rendered proper medical care, the normal and expected time line and letter viewed as a whole reveal that the experts opined that had the defendants 9 necessary step in the causal connection between the defendants’ alleged

factual circumstances surrounding Mr. Beckles’s fall,” and defendant Rao

physicians, in engaging in physical therapy, and in complying with safety

prevented the fall. However, the deposition testimony and Dr. Fischer’s opinion defendants correctly assert that the plaintiffs must demonstrate each

The trial court noted that “there is no concrete evidence regarding the

depended, in part, upon Mr. Beckles’ cooperation in meeting with the

whether proper precautionary instruction and an assistive device would have another assistive device from the doctors or from the physical therapist; and (5) supported by the evidence and resemble the case before the jury). The drawing appointments; (4) whether Mr. Beckles would have received a cane or id. (facts assumed in hypothetical scenario opined upon by an expert must be

Both of the plaintiffs’ experts acknowledged that timely preventative care

Mr. Beckles would have been available for any physical therapy or blood

deficiency. precautionary care was required even absent detecting the vitamin B-12

(2) whether physical therapy would have occurred prior to the fall; (3) whether about: (1) how long it would take to have blood drawn for a vitamin B-12 test; demonstrate causation because they collectively or individually speculated The trial court concluded that the experts’ opinions were insufficient to

situation was urgent and required immediate attention; and (2) immediate however, fails to account for the expert testimony opining that: (1) the to resolve. p. 10 proximate cause element involve issues of fact that are properly left to the jury

We conclude that the circumstances surrounding the fall as relevant to the

contributing to gait disturbance which subsequently led to his fall in April.”

“[i]n retrospect, the patient probably had a rather severe B12 deficiency improve his ability to walk.” Additionally, a transfer summary note states that was ataxic (causing his fall resulting in a fracture). I hope the gait training will

experts’ opinions rest should be left to the jury in this case. apparently poor memory. The existence of the ultimate facts upon which the

physical therapy especially for gait training as he had difficulty walking and

Beckles would have promptly attended a follow-up appointment given his

Specifically, Dr. Rao’s April 22 notes state that: “I would like him to have appear to directly attribute Mr. Beckles’ fall to his unstable walking gait. he fell that week when he was trying to get out of bed.” Two medical notes

factual assumptions underlying the experts’ opinions, such as whether Mr. not be applied to foreclose the plaintiffs from submitting evidence on the therapy evaluation, but not five days.” Moreover, summary judgment should 10

defense counsel stated that Mrs. Beckles had “testified [during deposition] that

gait training “would probably have prevented

he answered, “It doesn’t take five days. It may take a day or so to get physical

favorable to the plaintiffs, it appears that the plaintiffs’ experts did not vacillate In addition, when the deposition testimony is read in the light most

deposition testimony suggests that he fell while trying to get out of bed, and he fell fracturing his right foot. He could not tell me the details.” Dr. Singer’s certain foundational facts, ( medical note authored by Dr. Rao documents that: “He also tells me that . . .

one point, Dr. Singer testified that he “can’t say one way or the other” whether

received physical therapy, gait training and an assistive device before his fall, Dr. Fischer was asked the basis for stating that Mr. Beckles would have However, the experts also gave definitive answers. For example, when

have occurred in a timely manner), the doctors responded indecisively.

(Emphases added.) Further, at times when pressed on the likely occurrence of unsteady and twisted his right ankle after a fall on 04/06/03.” Yet, another this fall in this particular case.”

experts qualified their answers, stating that they would be “speculating.” At occasions when faced with different scenarios offered by defense counsel, the used by the experts at different times during their depositions. On several The trial court also was troubled by some of the indecisive phraseology

example, one medical progress note states: “At home, he states he became the fall and their relationship to the purported negligence in this case. For genuine issue of material fact exists regarding the circumstances surrounding

However, viewing the record in the light most favorable to the plaintiffs, a information as to how the fall actually occurred and the reasons for his falling.” therefrom, when viewed in the light most favorable to the plaintiffs, would be

p. 11 more likely than not [the fall] would have been prevented. followed, Mr. Beckles probably would not have fallen. diagnosed and immediately treated her condition). ensure Mr. Beckles’ safety, and opined that had these procedures been time line and the procedures for providing proper precautionary measures to

testimony and opinion letter, as well as all reasonable inferences drawn

had some training and had an assistive device. So the answer is injury that she otherwise would not have suffered had physician properly

statements. Rather, the plaintiffs’ experts explained the normal and expected

recommended by the plaintiff’s expert, the deceased would not have otherwise testimony to demonstrate that if the defendant had taken the additional steps contributed to the suicide, the plaintiff offered no specific lay or expert We conclude that the summary judgment record, including the expert

device. That all would have been prevented had he had therapy, functioning while at the emergency room, and that plaintiff ultimately suffered show that “chances are” at least 50 percent of plaintiff’s optic nerve was still defendants that the expert opinions consist of bald conclusions and conclusory (2001) (causation sufficiently shown by expert testimony that medical records

fall.” When asked whether proper physical therapy training would have fall to the defendants’ alleged substandard medical care. gait training and counseling, more likely than not would have prevented the foreseeable event and that defendant’s deviations caused or substantially Benton, 147 N.H. 786, 790 (2002) (while expert testified that the suicide was a

he was clumsy. He was unsupervised. He didn’t have an assistive

We disagree with the characterization by the trial court and the

Moreover, in his opinion letter, Dr. Fischer clearly attributed Mr. Beckles’ timely, and doing the other aspect of that, of providing the physical therapy,

fall would have been prevented. . . . [P]reventative as far as Again, looking at Dr. Rao’s report on [April] 22nd, he fell because I can’t say with certainty, but I think with the medical probability.

Dr. Fischer stated: “But the diagnosis being made by Dr. Rao correctly and

have allowed better precautionary care of the patient such as the My opinion is that diagnosing the Vitamin B-12 deficiency would

Dr. Singer stated: as to what they ultimately opined likely happened in this case. For example, the trial court’s ruling, we decline to reach the merits of their argument.

p. 12 causation under New Hampshire law.” Because the defendants/ misconstrue happening in a single case “is just too unforeseeable to amount to legal leading to the final result] is incredibly small” such that the risk of each event

speculative leaps of faith” and “[t]he individual risk of each [precipitating event

(2007), that, even if the expert testimony was sufficient as to causation of the fall, it

B-12 deficiency leading to Mr. Beckles’ brain hemorrhage involve “far too many

did not address the reliability of the expert testimony under RSA 516:29-a Singer and Dr. Fischer in relation to Mr. Beckles’ fall. It did not render a ruling experts’ testimony would not be admissible at trial. The trial court, however, argue that the trial court properly discounted such evidence because the of events starting from the defendants’ alleged failure to diagnose the vitamin Dr. Singer’s testimony plaintiffs’ expert testimony is sufficient and reliable. They argue that the chain notes that, even after considering the testimonies of facts of this case do not establish causation as a matter of law even if the

on the issue of causation. reverse the trial court’s ruling granting summary judgment to the defendants simply summarizes its conclusion regarding the expert testimony of both Dr. defendants and Mr. Beckles’s fall.” (Emphases added.) The trial court’s ruling lacking any “scientific or other methodology.” Relying upon RSA 516:29-a, they insufficient facts to demonstrate a causal link between any negligence of the

insufficient to demonstrate causation,” ruled that: “Additionally, the Court Medical Partners and Foundation Neurology, the trial court concluded that the The trial court, after concluding that “is

causation could be resolved as a matter of law in this case. Accordingly, we

not reliable and were merely “speculation dressed-up as expert analysis,”

Finally, according to defendants Dr. Lesser, Dr. Madden, Foundation

properly before us. see Goudreault, 158 N.H. at 246-47, and, therefore, that issue is not

the experts’ testimony did not render their opinions insufficient such that defendant’s medical failure). The particular factual uncertainties underlying plaintiff’s infection in her uterus was “instigated and started by” the Foundation Neurology argue that the expert medical opinions in this case were Defendants Dr. Lesser, Dr. Madden, Foundation Medical Partners and Beckles would not have fallen on April 6. probability that had the defendants provided proper precautionary care, Mr. IV

where he testified that there was a “reasonable medical probability” that the 624 (2000) (expert testimony sufficient to withstand motion for directed verdict

seen by the defendants on March 26 and on March 28, there was a reasonable sufficient for a reasonable juror to conclude that from the time Mr. Beckles was p. 13 13

DALIANIS, DUGGAN, HICKS and CONBOY, JJ., concurred.

brain hemorrhage and resulting disabilities. was insufficient to establish causation of all the alleged injuries, including the