Background
Nolan Spires was born via Cesarean section at 37 weeks’ gestation in October 2017 and was transferred to the neonatal intensive care unit at St. Francis Medical Center in Monroe, Louisiana after developing respiratory distress and a pneumothorax. He subsequently suffered seizure-like symptoms and was treated with multiple anticonvulsant medications, including Cerebyx (Fosphenytoin), which metabolizes into Dilantin (phenytoin). Plaintiffs alleged that the treating neonatologist, Dr. Marc De Soler, administered a bolus dose of Cerebyx before receiving the results of a previously drawn Dilantin level, and that pharmacy staff at St. Francis improperly prepared and delivered the dose. Nolan suffered a cardiac and respiratory arrest and was ultimately transferred to Children’s Hospital of New Orleans, where Dilantin toxicity was confirmed. He required extracorporeal membrane oxygenation (ECMO) and remained hospitalized until December 2017.
Plaintiffs brought suit against St. Francis, Dr. De Soler, and nurse practitioners Amanda Carnes and Kathleen Lirette, alleging the defendants’ conduct fell below the applicable standard of care and caused Nolan’s permanent developmental, cognitive, motor, and behavioral deficits. A medical review panel (MRP) found that St. Francis pharmacy staff had failed to meet the standard of care in preparing and delivering the Cerebyx dose, but unanimously concluded that Dr. De Soler and the nurse practitioners had acted appropriately and within the standard of care. Based on the MRP opinion favoring the individual clinicians, Dr. De Soler and the nurse practitioners moved for summary judgment, arguing that plaintiffs lacked an expert witness to counter the MRP’s findings.
The trial court granted summary judgment in favor of the individual defendants in September 2023, finding that plaintiffs had not produced expert testimony on the standard of care. After procedural skirmishing that included a motion for reconsideration, a premature appeal that was dismissed, and a rehearing on the motions, the trial court again affirmed the summary judgments in May 2025. Plaintiffs appealed to the Second Circuit.
The Court’s Holding
The Second Circuit affirmed the summary judgments in favor of Dr. De Soler, Carnes, and Lirette, applying a de novo standard of review. The court held that in a medical malpractice action, a plaintiff bears the burden of establishing the applicable standard of care, a breach of that standard, and causation of damages. Expert testimony is generally required to meet that burden, and becomes especially critical when the defendants have supported their summary judgment motions with favorable expert opinion evidence — here, the unanimous MRP opinion finding no breach by the individual clinicians.
The court rejected plaintiffs’ argument that this case fell within the narrow exception permitting lay-person inference of negligence without expert guidance. The court found that neonatal management of anticonvulsant drug dosing and toxicity — including the timing of medication boluses in relation to laboratory results and the complex physiological cascade that followed — presented issues far beyond the comprehension of an ordinary layperson. Because plaintiffs failed to identify or produce any expert witness to counter the MRP’s unanimous exoneration of the individual defendants, there was no genuine issue of material fact, and summary judgment was proper as a matter of law.
Costs of the appeal were assessed to plaintiffs.
Key Takeaways
- A favorable medical review panel opinion is admissible at summary judgment and, when unrebutted by a plaintiff’s expert, is sufficient to support dismissal of a medical malpractice claim against individual health care providers.
- Louisiana’s narrow “layperson inference” exception to the expert testimony requirement does not extend to complex neonatal pharmacology and medication management; such cases require qualified expert testimony to establish the standard of care and its breach.
- Once a defendant-movant points to the absence of expert support for an essential element of the plaintiff’s claim, the burden shifts to the plaintiff to produce factual support demonstrating they can satisfy their evidentiary burden at trial — failure to do so is fatal to the claim.
- A split MRP result — finding a breach by institutional pharmacy staff but not by individual clinicians — can insulate non-breaching defendants at summary judgment even while litigation against the institution continues.
Why It Matters
This decision reinforces the high evidentiary bar plaintiffs face in Louisiana medical malpractice cases involving sophisticated clinical judgments. For plaintiffs’ counsel, the case is a cautionary reminder that a favorable MRP finding against one defendant (here, the hospital’s pharmacy) does not carry over to exonerate individual clinicians from the expert-witness requirement — each defendant’s conduct must be independently supported by expert proof. The absence of a retained expert at summary judgment, particularly in a case involving neonatal intensive care and drug toxicology, will almost certainly be dispositive.
For defense practitioners and health systems, the decision illustrates the strategic value of the medical review panel process: a unanimous MRP opinion finding no breach by individual providers, introduced at summary judgment before plaintiffs have secured a counter-expert, creates a nearly insurmountable barrier to trial. The case also underscores that Louisiana courts will not readily invoke the layperson-inference exception in highly technical clinical contexts, limiting that doctrine to scenarios involving obvious, patent negligence.