Background
On October 12, 2016, Alice Clark, a 70-year-old patient, underwent outpatient surgery at St. Francis Medical Center (“SFMC”) in Monroe, Louisiana. During and after the procedure, she received Propofol, fentanyl, and Dilaudid. Upon transfer to the Ambulatory Surgery Unit to await discharge, Clark asked to use the restroom. Nurse Teresa Massey assisted her to the restroom, assessed her as alert and oriented, instructed her not to get up unassisted and to pull the call cord for help, and then stepped away to phone a family member. Clark subsequently attempted to pull up her clothing, felt sleepy and dizzy, fell off the commode, and fractured her left hip.
Clark filed a Medical Review Panel (“MRP”) complaint, and a unanimous panel found that SFMC’s nurses acted within the standard of care, noting that Clark was alert and that leaving her seated on the toilet with instructions and a call cord was appropriate. The MRP’s written opinion addressed Propofol but did not explicitly discuss fentanyl or Dilaudid. Clark then filed a medical malpractice lawsuit in the Fourth Judicial District Court, Parish of Ouachita, alleging SFMC was negligent in, among other things, leaving her unattended after surgery and failing to maintain fall-risk precautions.
A four-day jury trial was held in October 2024. Plaintiff’s expert, Dr. Stella Fitzgibbons, testified that the fentanyl and Dilaudid Clark received would likely have still been impairing her balance and judgment at the time of the fall. Defense witnesses — including the two MRP panelists, Dr. Russell Lolley and Dr. Jonathan Hunter, who testified as SFMC’s trial experts — countered that the drugs’ duration of action was under an hour and that Clark’s medical records consistently showed she was alert, oriented, and denying dizziness. The jury found that Clark failed to prove SFMC breached the standard of care, and the trial court entered judgment accordingly and denied Clark’s motions for JNOV and new trial.
The Court’s Holding
The Louisiana Second Circuit affirmed the jury verdict and the trial court’s denial of post-trial relief. On the primary evidentiary issue — whether the trial court abused its discretion by permitting MRP panelists Dr. Lolley and Dr. Hunter to testify as defense experts at trial — the court held there was no abuse of discretion. Relying on the Louisiana Supreme Court’s decision in Medine v. Roniger, 879 So. 2d 706 (La. 2004), the appellate court reiterated that no statutory provision restricts a panelist’s testimony once the MRP’s written opinion has been rendered. The panelists were free to respond to and refute the plaintiff’s expert’s trial opinions, including opinions on drugs not expressly addressed in the MRP’s written findings.
The court further found that SFMC had disclosed Dr. Lolley and Dr. Hunter on its witness lists as early as August 2023 and again in October 2024, in compliance with the trial court’s pretrial order. Critically, the plaintiff herself had listed both doctors as witnesses she intended to cross-examine, and she failed to object at trial when they testified about fentanyl and Dilaudid — waiving that challenge on appeal under La. C.E. art. 103(A)(1). The same waiver rationale disposed of the challenge to Nurse Allbritton’s standard-of-care opinion, which plaintiff likewise did not object to at trial.
On the JNOV and new trial motions, the court held that the evidence — particularly the medical records consistently documenting Clark’s alert and oriented status, the absence of documented dizziness or confusion, and the testimony of Nurse Massey and both MRP panelists — was of sufficient quality and weight that reasonable jurors could reach the verdict they did. The mere occurrence of an injury does not raise a presumption of negligence in Louisiana medical malpractice cases, and the jury was entitled to credit the defense experts over plaintiff’s expert.
Key Takeaways
- Under Louisiana law, a physician who served on a Medical Review Panel may testify as an expert witness for a party at trial; once the MRP’s written opinion issues, no statute limits the panelist’s trial testimony, including the ability to rebut a plaintiff’s expert on issues the MRP opinion did not expressly address.
- A plaintiff who fails to object at trial to expert testimony on the grounds of inadequate discovery disclosure waives that objection and cannot raise it for the first time on appeal.
- To defeat a JNOV motion, a defendant need only show evidence of sufficient quality and weight that reasonable jurors could reach different conclusions — competing expert testimony on drug pharmacokinetics and a consistent medical record showing the patient was alert and oriented satisfied that standard.
- In Louisiana medical malpractice cases, a plaintiff bears the burden of proving by a preponderance of the evidence both that the defendant breached the standard of care and that the breach caused the injury; the mere fact that a post-surgical fall occurred raises no presumption of negligence.
Why It Matters
This decision reinforces that MRP panelists in Louisiana are a potent and flexible resource for defendants in medical malpractice litigation. Because panelists have already reviewed the full medical record as part of the MRP process, they arrive at trial with substantial institutional knowledge of the case — and, as this opinion confirms, they may go beyond the four corners of the MRP’s written opinion to respond to new theories advanced by the plaintiff’s experts at trial. Defense counsel can leverage this without being bound by the narrow language of the panel’s written findings.
The case also serves as a practical reminder about preservation of error in Louisiana trial practice. Plaintiff’s failure to object contemporaneously to the testimony of Dr. Lolley, Dr. Hunter, and Nurse Allbritton effectively forfeited all three evidentiary challenges on appeal. For plaintiffs’ attorneys in Louisiana medical malpractice cases, the decision underscores the importance of vigilant trial objections whenever a defense witness offers opinions that were not disclosed during discovery — silence at trial is silence on appeal.