Background
Sheri Hartman visited the emergency department at Portneuf Medical Center in Pocatello in November 2019 for severe back pain. Physician assistant Amber Schroeder administered a transdermal fentanyl patch and discharged her. Two days later, orthopedic surgeon Dr. Stephen Hansen prescribed eight additional fentanyl patches to manage her pain until surgery. Mrs. Hartman’s husband applied the patches every 72 hours as instructed. She died on November 25, 2019, from respiratory depression and acute fentanyl intoxication.
Her family filed medical malpractice and informed consent claims against the emergency providers, the orthopedic surgeon, and Portneuf Medical Center. The Hartmans retained out-of-state liability experts to testify about the standard of care but refused to disclose the identities of the local, non-testifying physicians their experts had consulted to learn about the standard of care in Pocatello. The district court struck the Hartmans’ liability experts as a discovery sanction and then granted summary judgment to all defendants—both on the discovery violation and on causation grounds.
The Court’s Holding
The Idaho Supreme Court unanimously affirmed in part, reversed in part, and remanded. On the discovery question, the Court held that the district court did not abuse its discretion in striking the Hartmans’ expert witnesses. Under Quigley v. Kemp, 162 Idaho 408 (2017), the identity of a non-testifying local standard-of-care expert must be disclosed under Idaho Rule of Civil Procedure 26(b)(4)(A)(i) as part of the “basis and reasons” and “data or other information” underlying the testifying expert’s opinion. The Court rejected the Hartmans’ argument that disclosure was unnecessary because their experts “primarily” relied on the defendant’s deposition testimony rather than the local consultants—the rule draws no distinction between primary and secondary sources.
On causation, however, the Court reversed. The district court had required the Hartmans to prove that fentanyl molecules from the first patch remained in Mrs. Hartman’s body at the time of her death—effectively applying a but-for test. The Supreme Court held this was error. In a multiple-cause case, the correct inquiry is the substantial-factor test for actual causation and, for proximate causation, whether the defendant’s conduct created a foreseeable “general risk of harm,” not whether the specific pharmacokinetic mechanism was foreseeable. Relying on Orthman v. Idaho Power Co., 130 Idaho 597 (1997), the Court held that the correct question was whether dispensing a potent opioid to a patient already taking an antidepressant created a general risk of opioid-related harm—an issue for the jury.
Because the expert-striking sanction eliminated the malpractice claims against the emergency providers and the orthopedic surgeon, the causation reversal resulted only in remand of the claim against Portneuf Medical Center based on its pharmacist’s alleged negligence in dispensing the fentanyl patch. The Court also awarded partial attorney fees against the Hartmans, finding their appeal of the discovery sanction to be frivolous and without foundation.
Key Takeaways
- Idaho medical malpractice plaintiffs must disclose the identity of every non-testifying local standard-of-care expert their testifying experts consult, regardless of whether that consultant was a “primary” or “secondary” source—failure to do so risks exclusion of the expert’s testimony under Rules 16(e), 26(b)(4), and 37(c).
- In cases involving multiple potential causes, Idaho courts must apply the substantial-factor test for actual causation rather than the but-for test, and plaintiffs need only demonstrate a foreseeable general risk of harm for proximate causation—not the specific mechanism of injury.
- Pursuing an appeal grounded in a misreading of settled precedent can result in an attorney fee award under Idaho Code § 12-121, even when the appellant prevails on other issues in the same case.
Why It Matters
This opinion reinforces the strict expert-disclosure regime that governs Idaho medical malpractice litigation. Practitioners relying on out-of-state experts should treat the identity of every local consultant as mandatory disclosure from the earliest expert-witness deadline, regardless of how tangential the consultant’s input may appear. The fear of local-physician retaliation—an argument the Hartmans raised—did not excuse non-disclosure, though the Court left open the possibility that a sufficiently supported protective-order motion might succeed in a future case.
At the same time, the causation holding is a significant win for plaintiffs in multi-provider malpractice cases. By reaffirming that foreseeability turns on the general risk of harm rather than the precise mechanism of injury, the Court prevented hospitals and emergency providers from escaping liability simply by showing that another provider’s later conduct was the more immediate cause of death. Idaho practitioners handling opioid-related malpractice claims should take note: the substantial-factor test preserves the plaintiff’s path to a jury when multiple providers each contributed to a patient’s cumulative drug exposure.