(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

UMH DID NOT BREACH ITS DUTY OF CARE TO PLAINTIFFS DECEDENTS
A hospital such as UMH owes its patients a duty of reasonable care. In a wrongful death action that is based on medical malpractice, the evidence must be sufficient to allow the jury to infer that in the absence of defendant's negligence, there was a reasonable probability that the plaintiff would have obtained a better result. (Espinoza v. Little Company of Mary (1995) 31 Cal.App.4th 1304, 1315.) The measure of such duty is the degree of care and skill ordinarily used by hospitals generally in the community, according to what the undertaking to treat the particular patient requires in each instance. (Contreras v. St. Luke's Hospital (1978) 78 Cal.3d 919,927.)

The declaration of Sandy Singer, RN, establishes that she has sufficient credentials to qualify as an expert witnesses with regard to the care and treatment provided to plaintiff Joan White and plaintiffs decedents by UMH's nursing staff. She has opined, based upon a review of the relevant documents, that UMH did not breach its duty of care to plaintiff and plaintiffs decedents as the staff properly followed doctors' orders, properly monitored, observed and reported the condition of Joan White and the twins to the doctors and cared for Ms.. White and the twins appropriately. Nurse Singer has also stated that it is a physician function, rather than a nursing function, to order treatment for patients.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

As is evidenced by the attached declaration of Sandy Singer, UMH provided care and treatment to plaintiff Joan White, and plaintiff decedents (Owen and Tomas White), which met the standard of care. Ms. Singer has opined that the nurses the nurses properly observed and reported Ms. White's condition and progress to her treating physician. The nurses appropriately monitored Ms.. White during her early labor, and followed the doctor's orders regarding treatment. The nurses appropriately observed and reported on the condition and progress of the fetuses's based on the fetal monitor. The nurses appropriately recorded their observations in Ms.. White's chart and on the fetal monitoring strips.

The nurses followed the appropriate protocols for medication administration during early labor, as well as the protocols for early labor, and for the labor and delivery of extremely premature infants. In addition, Ms. Singer has opined that UMH did everything possible for the twins, but due to their extreme prematurity, nothing could be done to save their lives. Accordingly, plaintiffs cannot establish that UMH breached its duty of care, and UMH's motion for summary judgment should be granted.

A PARTY SUBMITTING UNCONTRADICTED EXPERT EVIDENCE MUST PREVAIL

California courts have held that where a defendant's expert testimony is uncontradicted, no triable issue of fact remains for the jury to consider, and the defendant must prevail as a matter of law. (Willard v. Hagemeister (1981) 121 Cal.App.3d 406.) The Willard opinion describes the preemptive weight of expert testimony in a malpractice action as follows:

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

THE ISSUE OF NEGLIGENCE CAN ONLY BE RESOLVED BY EXPERT TESTIMONY IN THIS CASE

Based on the allegations of the complaint, plaintiffs contend that the twins died because of the alleged professional negligence of the hospital. Generally speaking, actions for professional negligence center on an allegation that the professional breached the applicable standard of care. Proving what the applicable standard of care is, under most circumstances, requires testimony of a properly qualified expert. In Jambazian v. Borden, (1994) 25 Cal.App.4th 836, 844, the court stated:

The standard of skill, knowledge and care prevailing in a medical community is ordinarily a matter within the knowledge of experts. Whether the standard of care in the community has been breached presents the basic issue in a malpractice action and can only be proved by opinion testimony unless the medical question is within the common knowledge of lay persons.

In Evans v. Ohanesian (1974) 39 Cal.App.3d 121, at 128, the court set forth the standards to be met when one offers the testimony of a medical expert:

To qualify a witness as a medical expert, it must be shown that the witness (1) has the required professional knowledge, learning, and skill of the subject under inquiry sufficient to qualify him to speak with authority on that subject; and (2) is familiar with the standard required...under similar circumstances...

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

ARGUMENT

SUMMARY JUDGMENT MUST BE GRANTED WHEN MOVING PARTY DEMONSTRATES THAT THE ACTION IS WITHOUT MERIT

A defendant may move for summary judgment in any action or proceeding if it contends the cause of action has no merit. (Code Civ. Proc., § 437c, subd. (a).) The cause of action has no merit if:

1. One or more of the elements of the cause of action cannot be separately established, even if that element is separately pleaded, or

2. A defendant establishes an affirmative defense to the cause of action. (Code Civ. Proc., § 437c, subd. (n).)

The motion shall be granted if all of the papers submitted show there is no triable issue as to any material fact and the defendant is entitled to summary judgment as a matter of law. (Code Civ. Proc., § 437c, subd. (c).) Any alleged disputes must concern material facts.
... [O]nce a party bears the initial burden of demonstrating an entitlement to judgment as a matter of law, the opposing party may not defeat summary judgment by attempting to generate a factual dispute as to immaterial issues ... (Romero v. American President Lines, Ltd. (1995 38 Cal.App.4th 1199, 1203.)

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

STATEMENT OF FACTS

Joan White was a 26-year-old G2, P1 who was under the obstetrical care of Dr. Cindy Brown. Ms. White had previously been under the care of Dr. Brown for the delivery of her first child only 11 months before this incident. At the time of this incident, Ms. White was pregnant with diamnaiotic, dichorionic twins. Dr. Brown's notes indicate that Ms. White had been without significant complaints until she was admitted to Universal Memorial Hospital at 23 weeks, two days gestation for tocolysis due to premature labor.

Ms. White underwent tocolytic therapy for two days at the hospital before it became apparent that the drugs were not working. She continued to go into labor and became fully dilated. At that point, Dr. Brown had discussions with Ms. and Mr. White about the poor prognosis for babies at such an early gestation. Dr. Greene, a neonatologist, also discussed the poor prognosis for babies born with such extreme prematurity.

The babies were delivered by cesarean section on XX/XX/2005. Baby A had APGARs of 2, 6 and 8, with a birth weight of 532 grams. Baby B had APGARs of 5 and 7 (no value reported for 10 minutes), with a birth weight of 560. Both babies were admitted to the NICU with a multitude of system problems, as would be expected of such premature infants.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

PLEASE TAKE NOTICE that defendant Universal Memorial Hospital of (hereinafter "UMH" ) will, and hereby does, move this court for an order that no substantial controversy or triable issue of material fact exists as to said defendant, and for entry of judgment in favor of said defendant and against plaintiffs.

This motion is made pursuant to Code of Civil Procedure section 437c of the on the ground that no triable issue of material fact exists as to UMH, in that said defendant breached no duty of care to plaintiff.

The motion will be based on this notice, the separate statement of undisputed facts filed concurrently herewith, the accompanying memorandum of points and authorities, the declaration of Sandy Singer, RN, Mary Black, Daniella Jones, the exhibits , and all pleadings, papers and other documents on file with this Court and, on such other evidence, oral or documentary, as may be presented at the hearing of this motion.

MEMORANDUM OF POINTS AND AUTHORITIES
STATEMENT OF THE CASE

This is a medical malpractice/wrongful death action arising out of allegations that plaintiffs' decedents were negligently examined, diagnosed and/or treated while they were patients of Universal Memorial Hospital. Ms. White was pregnant with twins when she was admitted to Universal Memorial Hospital at 23 weeks, two days gestation for tocolysis due to premature labor.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Plaintiff Signed the Conditions of Services Agreement and is Bound by Its Provisions.

The Conditions of Services form was signed and dated November 3, 2003, prior to the bulk of the treatment provided at UMC and by Dr. Cruz, and two days prior to the subject surgery. California law uniformly holds that one who signs an instrument may not avoid the impact of its terms on the grounds that she failed to read it before signing. In Hoffman v. Sports Car Club of America (1986) 180 Cal.App.3d 119, the plaintiff, a driver injured while participating in a sports car race, sought to avoid the impact of a release agreement on the ground that he failed to read it before signing. In affirming the trial court's grant of defendants' motion for summary judgment, the Court of Appeal stated:

[M]istake, as plaintiff has argued it, is not a viable ground for not enforcing the release. His position on this point we liken to a person who comments upon leaving the movie, Had I known what it was about, I never would have bought a ticket. In sum, plaintiff cannot now claim he was mistaken about what was in the release when he failed to read it before signing [Citation]. Id. at 126.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Dr. Cruz is Not the Ostensible Agent of UMC.

Pursuant to Mejia v. Community Hospital (2002) 99 Cal.App.4th 1448, in order to establish ostensible agency plaintiffs must prove all of the following three elements: (1) the plaintiff believed that the physician was an agent of the hospital, and this belief was reasonable; (2) plaintiff's belief must be generated by some act or neglect of UMC; and (3) the plaintiff must not be guilty of negligence. (Mejia, supra 99 Cal.App.4th 1456 -1457.) Herein, plaintiffs cannot establish these elements because the Conditions of Services form, signed by the patient and dated November 3, 2003, prior to the subject surgery by Dr. Cruz, clearly states under paragraph 4 that all physicians and surgeons furnishing services to the patient ... are independent contractors with the patient and are not employees or agents of the hospital.

Plaintiff was Given Actual Notice of the Independent Contractor Relationship between Physicians and UMC.

Ostensible agency may not be inferred when the hospital gave the patient actual notice of the true relationship between the hospital and the physician, and in the instant case, such notice was given to plaintiff, who acknowledged his signature on the Conditions of Admissions form dated November 3, 2003, signed by the plaintiff within 24 hours of his presentation to UMC, and a full day before the subject surgery by Dr. Cruz. Since plaintiff was provided with actual, written notice of the relationship between UMC and physicians, there can be no finding of an ostensible agency relationship between Dr. Cruz and UMC.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Further, plaintiff was given actual notice of the relationship between physicians and UMC in the Conditions of Services form. The physicians are independent contractors and not employees or agents of UMC. Moreover, plaintiffs signature appears on the Conditions of Services form. UMC cannot be liable for any physician negligence (i.e., diagnosis and treatment) alleged by plaintiffs.

Any assertion that UMC breached a duty in the diagnosis and treatment of the decedent's condition is also a legal impossibility--diagnosis and treatment are the sine qua non of practicing medicine and only a licensed physician may perform such acts. UMC does not have a license to practice medicine, and it does not practice medicine. (Bus. & Prof. Code § 2052 [ Any person who practices or attempts to practice ... any system or mode of treating the sick, or afflicted in the state... without having at the time of doing so, a valid, unrevoked, or unsuspended certificate... is guilty of a misdemeanor. )

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Universal Medical Center's Opposition to Plaintiffs' Motion for Summary Adjudication

Defendant, UNIVERSAL MEDICAL CENTER ("UMC") hereby opposes plaintiffs motion for summary adjudication. Plaintiffs have failed to meet their burden because UMC is not liable for the acts of an independent contractor physician; plaintiffs' moving papers fail to establish ostensible agency pursuant to the three prong test set forth by Mejia and plaintiffs were given actual notice that Dr. Cruz was an independent contractor, and Dr. Cruz was not a UMC employee or agent. Thus, summary adjudication must be denied.

MEMORANDUM OF POINTS AND AUTHORITIES

Summary adjudication must be denied because (1) UMC is not liable for the acts of an independent contractor physician; (2) plaintiffs' moving papers fail to establish ostensible agency pursuant to the three prong test set forth by Mejia and plaintiffs were given actual notice that Dr. Cruz was an independent contractor, and (3) Dr. Cruz was not a UMC employee or agent.

UMC is Not Liable for Independent Contractor Physicians.

If a doctor is an independent contractor at a hospital, the hospital is not liable for a doctor's alleged negligence. (Mayers v. Litow (1957) 154 Cal.App.2d 413; Konoff v. Fraser (1944) 62 Cal.App.2d 788.)

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

DR. BLACK'S DECLARATION OMITS VITAL FACTS

Dr. Black's declaration, through careful wording, attempts to create the picture that when any patient presents to XYZ Hospital and they are seen by a nurse practitioner, a supervising physician is automatically involved every time, working hands-on with that patient, second-guessing the nurse practitioner, and fully handling and managing that patient's care. Nothing can be further from the truth. Nurse practitioners, by their special status as mid-level practitioners are allowed (and even expected) to have a certain degree of autonomy in rendering care to patients. In fact, page 1 of the Frequently Asked Questions Regarding Nurse Practitioner Practice states that a nurse practitioner is still practicing legally when the supervising physician is 50 miles away.

Further, XYZ Medical Center's Standardized Procedures for Nurse Practitioners, that Dr. Black has mis-cited in his declaration, in actuality goes to great lengths to describe the degree and type of autonomy that nurse practitioners have. On page 4 of the Standardized Procedures, at the very onset of the General Policies, the first sentence states it is the intent of this document to authorize nurse practitioners at XYZ Medical Center Emergency Department to implement the Standardized Procedures without the immediate supervision or approval of a physician. (Emphasis added.) Page 6 of the General Policies provides that the nurse practitioner will be responsible for the preparation of a complete medical record for each patient contact per existing office policies. Moreso, under the "Supervision" heading, the nurse practitioner is authorized to implement the Standardized Procedures in this document without the direct or immediate observation, supervision or approval of a physician, except as may be specified on individual healthcare management standardized procedures.

Under the "Consultation" heading, the rules regarding when a nurse practitioner must consult with a physician clearly state on page 7 the situations wherein a physician must be consulted. These requirements are mandatory for nurse practitioners only. Thus, it is up to the nurse practitioner to seek out the physician for a consultation, if such is required under these guidelines, not the other way around. It is not a physician's duty to seek out a nurse practitioner and provide an unasked-for consultation. Physicians are not required to wander the halls, looking for patients whose very existence they are unaware of, seeking to provide consultations every time a nurse practitioner treats a patient.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Dr. White was never an attending physician and merely signed Paul Brown's chart, fulfilling his administrative duties to the hospital. Dr. White in his declaration in support of his moving papers, at 2:6, states quite plainly I am required to sign charts of a number of patients who were seen and treated by mid-level practitioners, who I did not see or treat myself. There is no requirement that the chart be reviewed in detail by the physician or that the physician make an independent evaluation of the patient's diagnosis and treatment. Thus, Dr. White's signature does not create a duty to see the patient or direct the medical treatment, all of which has already occurred. More so, page 1 of the Frequently Ask Questions Regarding Nurse Practitioner Practice states that "The Nursing Practice Act (NPA) does not require physician countersignature of nurse practitioner charts."

However, other statutes or regulations, such as those for third party reimbursement, may require the physician countersignature. Additionally, some malpractice insurance carriers require physicians to sign NP charts as a condition of participation. Standardized procedures may also be written to require physicians to countersign charts.

Dr. Black sums up his opinions at 5:11-21, stating that plaintiff's injuries "could have been avoided if appropriate nursing triage had occurred ..." and "if Nurse Brown had accurately completed the history and physical..." These two portions of Black's declaration are utterly irrelevant to Dr. White in this matter. Black then posits a hypothetical that "if Dr. White had read, critically reviewed, and appropriately responded, (as required by the emergency department supervisory procedures) to the submitted patient chart, the patient's care would have met the standard of care ..." Plaintiff was never at any point in time Dr. White's patient, as the triage nurse directed plaintiff to nurse practitioner Paul Brown, and nurse Brown never consulted with Dr. White regarding plaintiffs care. Dr. White in his declaration at 1:25-2:3 describes that patients coming to the emergency room at XYZ Medical Center at that time (and now) are typically screened by a triage nurse, whose role includes determining the acuity (severity) of the patient.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Dr. Black states in his declaration that plaintiffs injuries represented complex, if not major, trauma. Black goes on to state at 3:26-4:4 that complex or major trauma requires immediate involvement of an emergency department physician, for documentation, diagnosis, initial treatment and stabilization, and referral. Only minor trauma may be initially evaluated by a nurse practitioner ... Dr. Black in his declaration has the benefit of 20/20 hindsight in that the true extent of plaintiff's injury is now known. Upon plaintiffs initial presentation to XYZ Hospital, it may have been impossible to instantaneously recognize her injury as complex and/or major trauma. Here, plaintiff was ambulatory and brought herself voluntarily to the hospital, the day after falling at her home, with a complaint of neck pain.

The real crux of Black's declaration begins at 4:5 wherein he chastises the inappropriate triage decision of placing plaintiff in urgent care, accompanied by the incomplete and inaccurate evaluation performed by nurse practitioner Paul Brown. This information is totally irrelevant to the potential liability of Dr. White. A decision by the triage nurse to send a patient to either a nurse practitioner or a physician is utterly out of Dr. White's hands. Despite this lack of responsibility on Dr. White's part, Black attempts to overcome this by citing to XYZ Medical Center's Nurse Practitioner Standardized Procedures.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

LEGAL STANDARD

SUMMARY JUDGMENT IS APPROPRIATE BECAUSE PLAINTIFF HAS FAILED TO ESTABLISH THAT A TRIABLE ISSUE OF ONE OR MORE FACTS EXISTS

In a summary judgment motion, the opposing party has the burden of showing the existence of a triable issue of material fact. (Churn v. Bank of America (1976) 15 Cal.3d 866, at 873; Marilla v. Right Stuff Food, Inc. (1998) 65 Cal.App.4th 833, at 841). The motion for summary judgment shall be granted if all the papers submitted show that there is no triable issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. (Code of Civil Procedure §437(c)(7)(c)). The defendant need only show the plaintiff cannot establish at least one element of the cause of action. (Aguilar v. Atlantic Richfield Company (2001) 25 Cal.4th 826, at 853.) Once the defendant has met its burden, the burden shifts to the plaintiff to show that a triable issue of one or more facts exists as to that cause of action. (Id.) Information and expert opinion that is utterly irrelevant to the moving party is not sufficient to create an issue of fact.

ARGUMENT

THE OPINIONS EXPRESSED BY DR. BLACK ARE IRRELEVANT TO DR. WHITE

Dr. Black states in his declaration that "a standard trauma evaluation was required, with emergency attending physician evaluation..." Black goes on to further state at 3:18 that "early emergency department attending physician evaluation ... could have prevented the subsequent cervical spine deformity..." While this may or may not be the case, this opinion assumes that when plaintiff presented, the patient was actually seen by Dr. White. As is well documented, and even admitted in plaintiffs opposition brief, Dr. White neither saw, nor cared for, plaintiff at any point in time through no fault of his own.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)

Steve White, M.D.’s (hereinafter "White") Reply to Plaintiff’s Opposition to Summary Judgment Motion by Defendant Steve White, M.D.

INTRODUCTION
The following facts were established in the moving papers in this medical malpractice action, and remain without dispute. Plaintiff Cindy Smith went to the emergency room the day after she fell at her Sacramento home, and she complained of neck pain. The patient was directed to a nurse practitioner (Paul Brown) and was never seen by Dr. White.

Plaintiff's opposition to this motion is misdirected. Plaintiff's essential contention is that she should have been seen by a medical doctor and not a nurse practitioner. But, this was a decision made by the triage nurse. Plaintiff argues that Dr. White is "personally and vicariously liable for nurse Paul Brown's failure ..." But, there is no legal basis for vicarious liability on the part of a physician, who simply happens to be in the emergency department at the same time that a patient is treated by a nurse practitioner and discharged.

Beyond expressing an opinion that the patient had a serious condition that warranted evaluation by a medical doctor, not a nurse practitioner, plaintiffs expert provides nothing to the court of legal significance. He attempts to offer an interpretation of Standardized Procedures under which nurse practitioner Wonder operates but such opinion is argumentative, lacks foundation, and is outside the scope of the expertise of a medical expert.