Expert Witness Profiler

Tag: Medical Community

  • Emergency Medicine Expert Allowed to Testify Because of His Familiarity with Springfield’s Medical Community

    Emergency Medicine Expert Allowed to Testify Because of His Familiarity with Springfield’s Medical Community

    Plaintiff, Ashley Huddleston was born with a genetic condition called muscular dystrophy, which required her to be in a wheelchair and utilize a tracheostomy since age 11.

    On December, 2021, at around 2:36 p.m., Plaintiff presented to the Tristar Northcrest Medical Center ED with low oxygen, shortness of breath, and a history of muscular dystrophy requiring tracheostomy. Approximately an hour later, Plaintiff had a chest x-ray taken, which was normal.

    At some point, Plaintiff complained of low back pain. A physician’s assistant in the emergency room, Defendant Samantha Stephens, ordered and administered 0.5 milligrams of Dilaudid to Plaintiff for her back pain. Five minutes later, Plaintiff was in cardiac arrest and CPR was initiated. Emergency room physician and supervising physician of Stephens, Defendant James Nell, ordered Narcan, and Plaintiff was alert soon thereafter.

    Chest x-rays taken after Plaintiff received CPR showed a pneumothorax (collapsed lung). Plaintiff had a chest tube inserted and was flown by helicopter to St. Thomas Hospital, where she stayed until January 22, 2022. She was transferred to a different hospital, where she stayed until March 3, 2022, after which she received treatment at home until April 4, 2022.

    Plaintiff brought this case against Defendants Samantha Stephens, P.A., and James Nell, M.D. for their alleged negligence in providing her medical care on December 25, 2021.

    Specifically, Plaintiff claimed Defendants negligently ordered and administered Dilaudid, which proximately caused her respiratory arrest, cardiac arrest and subsequent pneumothorax, pain/suffering, and long-term hospitalization.

    Defendants sought to exclude Dr. David Wiggins for failure to comply with the “locality requirement” of subsection (a)(1) of Tennessee Code Annotated Section 29-26-115.

    Emergency Medicine Expert Witness

    David Wiggins is a residency trained, board certified emergency physician with over 31 years of continuous full-time emergency medicine experience.

    Get the full story on challenges to David Wiggins’ expert opinions and testimony with an in-depth Challenge Study. 

    Discussion by the Court

    Locality Requirement

     To satisfy this “locality requirement,” an expert witness may show either that they are “familiar” with the relevant medical community or that they are familiar with a “similar” medical community:

    “A claimant is required to prove the “[t]he recognized standard of acceptable professional practice … in the community in which the defendant practices or in a similar community.”  The medical expert or experts used by the claimant to satisfy this requirement must demonstrate some familiarity with the medical community in which the defendant practices, or a similar community, in order for the expert’s testimony to be admissible under Rules 702 and 703.

    Generally, a competent expert’s testimony that he or she has reviewed and is familiar with pertinent statistical information such as community size, hospital size, the number and type of medical facilities in the community, and medical services or specialized practices available in the area; has had discussions with other medical providers in the pertinent community or a neighboring one regarding the applicable standard of care relevant to the issues presented; or has visited the community or hospital where the Defendant practices, will be sufficient to establish the expert’s testimony as admissible.”

    Thus, a competent expert may demonstrate familiarity with the medical community in which the Defendant practices – here Springfield, Tennessee – or a similar community by:

    1. testifying that they have reviewed and become familiar with pertinent information, such as the size of Springfield’s community and hospital, the number and type of medical facilities in Springfield, and the medical services available in the Springfield area;

    2. testifying that they have had discussions regarding the applicable standard of care relevant to the issues presented with other medical providers in the Springfield community or a neighboring community; or

    3. testifying that they have visited Springfield, Tennessee or the Hospital.

    Analysis

    Wiggins has: (1) reviewed and become familiar with the size of Springfield’s community and the medical services available there; and (2) had discussions regarding the applicable standard of care relevant to the issues in this case with another medical provider in a neighboring community who also frequently visits the Hospital and Springfield, Tennessee.

    He testified that, in 2021, the Hospital was similar in bed-size and services offered to other medical facilities he had worked in and that he was aware that the Hospital was a 109-bed hospital that offered services such as 24-hour emergency room, cardiac, and orthopedic care.

    Wiggins has also testified that his home practice is in Thomasville, North Carolina, a community with a population of approximately 27,000 people, which is similar in size to Springfield, Tennessee. Additionally, Wiggins has provided sworn testimony that he has had discussions regarding the Springfield, Tennessee medical community and local standard of care with Dr. George Thomas, a medical provider in Bowling Green, Kentucky who has visited the Hospital and is familiar with the Springfield community. 

    The Court found that Wiggins has demonstrated familiarity with the medical community of Springfield, Tennessee and a similar community, such that he satisfies the “locality requirement” of subsection (a) of Section 29-26-115.

    Moreover, Wiggins has not provided contradictory testimony as to his professional experience or the information he has learned about the Springfield, Tennessee medical community and population size. Plaintiff disclosed Dr. Wiggins as an expert who would be offering his opinions on the standard of care, which necessarily includes his opinions on the locality rule under Tennessee law. Thus, this is not a situation where Defendants can claim surprise that Wiggins would be offering such opinions. 

    Held

    The Court denied the Defendants’ motion to exclude testimony of Plaintiff’s expert David Wiggins, M.D. As only standard of care opinions are subject to the locality rule, the Court held that the Defendants’ motion will be denied to the extent they seek to exclude causation opinions based on a failure to comply with subsection (a)(1).

    Key Takeaway:

    Because Wiggins has shown familiarity with the Springfield, Tennessee medical community and a similar one, he fulfills the locality requirement under Section 29-26-115(a). His testimony about his professional background and knowledge of Springfield’s medical environment and demographics has been consistent.

    Case Details:

    Case Caption: Huddleston V. Tristar Northcrest Medical Center Et Al
    Docket Number: 3:22cv718
    Court: United States District Court, Tennessee Middle
    Order Date: April 3, 2025
  • Emergency Medicine Expert Witness Testimony Excluded Due to Lack of Familiarity with the Memphis Medical Community

    Emergency Medicine Expert Witness Testimony Excluded Due to Lack of Familiarity with the Memphis Medical Community

    Plaintiff, Mikhaila Lenoir filed this healthcare liability action on March 15, 2023, regarding care that occurred at Regional One Health from October 8, 2021 through January 21, 2022. Plaintiff alleged that Regional One Health and its nurses, nurses’ assistants, and other employees allegedly breached the applicable standards of care by:

     . . . failing to properly turn Plaintiff in her bed, failing to restrain and attend to plaintiff while sitting in a chair, failing to properly clean and treat Plaintiff’s bed/pressure sores, failing to place Plaintiff’s call device, performing medical procedures on Plaintiff without her informed consent and in blatant disregard for her clearly expressed non-consent, and by severely limiting Plaintiff’s family visitation.

    Plaintiff designated Dr. Richisa Salazar as her expert witness. She was responsible for establishing the relevant standard of care. Defendant Shelby County Health Care Corporation filed a motion to exclude the opinions of Plaintiff’s medical expert witness Salazar.

    Emergency Medicine Expert Witness

    Richisa Salazar is a licensed physician in Mississippi, Texas, Florida and Georgia. She is currently practicing as an emergency room physician with multiple hospitals including several in the Atlanta, Georgia area.

    Get the full story on challenges to Richisa Salazar’s expert opinions and testimony with an in-depth Challenge Study. 

    Discussion by the Court

    Defendant argued that Salazar’s testimony should be excluded because she (1) is not licensed in a profession or specialty that would make her testimony relevant; (2) does not satisfy Tennessee’s locality rule; and (3) improperly relies on a national standard of care. 

    A. Whether Salazar is Licensed in a Profession or Specialty that Would Make Her Testimony Relevant

    Defendant contended that Salazar’s license in emergency medicine does not amount to a license in a practice or specialty that makes her testimony relevant. Apparently, the issue is that Salazar is not a “wound care specialist.” Defendant insists that Salazar’s experience in the emergency room is irrelevant because the complaint’s allegations pertain to events that occurred while Plaintiff was under continuous care. As they see it, “the issue in this case is the prevention, development and appropriate treatment of pressure injuries.”

    The Court finds that Salazar is licensed in a profession or specialty that would make her testimony relevant. The Tennessee Supreme Court has made clear that Tenn. Code. Ann. § 29-26-115 does not require that an expert witness practice the same specialty as the Defendant. Instead, courts must “look carefully at the particular issues presented in the case to determine if an expert practices a profession or specialty that would make the expert’s testimony relevant to those issues.”

    The Court finds there to be little reason to require that any medical expert witness in this case be licensed as a wound-care specialist; this case turns on whether Defendant’s medical personnel failed to follow basic patient-care protocols as opposed to wound care specialist-specific standards. To that end, Salazar’s license in emergency medicine, her training in Geriatrics, and her experience with pressure ulcers all demonstrate that she is licensed to practice in a profession or specialty that makes her testimony relevant.

    B. Whether Salazar Satisfies the Locality Rule

    Defendant contended that Salazar failed to establish that she is familiar with the Memphis medical community, or that she practices medicine in a medical community similar to Memphis, and she has not testified as to the Memphis medical community’s standard of care.

    i. Whether Salazar’s Deposition Testimony Satisfies the Locality Rule

    It is given that Salazar does not practice medicine in Memphis. Defendant argued that the only basis Salazar gave for her conclusion that she practiced medicine in a similar community was her statement that she was familiar with the standard of care in Memphis because it seemed very similar to Jackson, Mississippi where she grew up.

    Defendant, however, noted that Salazar never practiced medicine in Jackson, Mississippi. Specifically, Plaintiff acknowledged that Salazar did not know the specific population of the Memphis area, its demographic or socioeconomic makeup, or the exact number of hospitals.

    Plaintiff insisted that Salazar’s testimony reflects that she did know that the University of Tennessee Medical School was in the Memphis area and that Regional One Health was Level 1 trauma center which offered a wide range of specialties.

    Based on a review of the deposition transcript, the Court held that it would be quite charitable to conclude that Salazar knew either of these facts. Nowhere in this response did Salazar affirm that she “knows” that there are medical schools in Memphis. To the contrary, her response reflects that she is uncertain. Moreover, all of Salazar’s purported knowledge regarding Regional One Health appears to have been derived from a string of assumptions she made because the hospital was treating Plaintiff.

    The Court held that Salazar’s deposition testimony does not establish that she is familiar with the Memphis medical community or its standard of care.

    ii. Whether Salazar Satisfies the Locality Rule with the Addition of her Affidavit

    Plaintiff included a supplemental affidavit, in seeming acknowledgment of the inadequacy of Salazar’s testimony on this matter. Here, Salazar’s familiarity with the Memphis medical community and its standard of care turns on two facts: (1) that she earned her Master’s Degree in Public Health with a concentration in Health services and Doctorate of Medicine from Meharry Medical College in Nashville, and (2) that Memphis is very similar to Atlanta—where she has practiced medicine since 2018—with respect to size, population, medical facilities, and access to medical information.

    Concerning (1), Salazar appears to be suggesting that she became familiar with the Memphis standard of care via her “Tennessee medical education.” She also mentions that she frequently visits her family in Memphis. Defendant argued that Plaintiff’s attempt to connect Salazar’s time in medical school in Nashville, Tennessee still fails to satisfy the locality rule because Salazar was in medical school 13 years before the time that the events in this case took place, and her history in Nashville still does not establish her familiarity with Memphis’s medical community.

    The Court is not persuaded that Salazar satisfies the locality rule even with the additional information from her affidavit. She fails to explain how her Nashville education provided her with any insight into the Memphis medical community and provides a hazy rationale on why she believes that Atlanta’s medical community is similar to Memphis’s. She also conceded that she was applying a national standard of care when she was testifying.

    Held

    The Court granted the Defendant’s motion to exclude the opinions of Plaintiff’s medical expert witness Richisa Salazar, M.D. 

    Key Takeaway:

    Given Plaintiff’s concession that Salazar did not know the specific population of the Memphis area, its demographic or socioeconomic makeup, or the exact number of hospitals and the Court’s finding that Salazar has failed to make a strong enough affirmative showing that she has any familiarity with the Memphis medical community and standard of care, the Court concluded that Salazar did not satisfy the locality rule.

    Case Details:

    Case Caption: Lenoir V. Shelby County Health Care Corporation
    Docket Number: 2:23cv2138
    Court: United States District Court, Tennessee Western
    Order Date: December 16, 2024