Background
On June 23, 2022, Dr. Charles Sherry performed a total right knee replacement on Nancy Marguerite Torres, closing the wound with metal staples. Torres had a complex medical history that included prior strokes, heart surgery, and ambulatory difficulties. She was discharged two days later to a skilled nursing facility, Regency at Fremont. By July 1, 2022, a Regency physician believed Torres had developed an infection and began antibiotic treatment — but did not notify Dr. Sherry. Torres’s family reported concerns about inadequate wound care and a failure to communicate the infection to the treating surgeon. In early November 2022, Torres was hospitalized presenting signs of a stroke, with no indication of sepsis or multi-organ failure at admission. She died on November 26, 2022; the death certificate listed diastolic congestive heart failure and ischemic cardiomyopathy as causes of death, with sepsis secondary to the infected knee prosthesis noted as one of three other significant contributing conditions.
Teresa Lynn Castro, as personal representative of the estate, filed a medical malpractice action on April 1, 2024. The parties stipulated to a narrow standard-of-care issue: whether Dr. Sherry breached the standard of care by using metal staples rather than sutures to close the surgical wound. Plaintiff retained Dr. Ronald Lederman as her sole expert on that question. Following discovery and Dr. Lederman’s deposition, defendants moved for summary disposition under MCR 2.116(C)(10), arguing plaintiff had failed to establish proximate causation. The Kent County Circuit Court agreed and granted the motion on April 16, 2025. Plaintiff appealed.
On appeal, plaintiff pointed to two medical records in which Torres reported an allergy to both metal and sutures, and to the death certificate notation referencing sepsis secondary to the infected knee prosthesis. Plaintiff argued these items created a genuine issue of material fact sufficient to survive summary disposition.
The Court’s Holding
The Michigan Court of Appeals affirmed, holding that plaintiff failed to raise a genuine issue of material fact on the element of proximate causation. The court applied the standard under MCR 2.116(C)(10), which required plaintiff — once defendants met their initial burden — to go beyond the pleadings and present specific facts showing that it was more probable than not that Dr. Sherry’s use of metal staples caused Torres’s infection and, ultimately, her death. The court found the record evidence fell short of that threshold.
The court emphasized several undisputed points from Dr. Lederman’s own deposition: Torres was never diagnosed with or tested for a true metal allergy; her medical records prior to this surgery showed no notation of such an allergy; she had previously tolerated metal implants without incident; and any metal-allergy reaction would typically manifest within 72 hours of surgery, whereas Torres’s symptoms did not appear until several weeks later. Dr. Lederman also acknowledged he had not reviewed the nursing facility’s records to assess whether Regency’s wound-care failures or its failure to notify Dr. Sherry of the infection contributed to the outcome. The court further noted that Dr. Lederman himself conceded that Torres’s entire post-surgical course could be explained without reference to a metal allergy.
The medical records showing Torres’s self-reported allergy to both metal and sutures did not help plaintiff’s case. Because Dr. Lederman testified that sutures would have been the appropriate alternative to staples, the fact that Torres also reported a suture allergy undermined any claim that an alternative closure method would have prevented her injury. The death certificate notation, standing alone and without supporting expert testimony connecting it to the staple-closure decision, likewise failed to establish but-for causation by a preponderance of the evidence.
Key Takeaways
- In a Michigan medical malpractice action, a plaintiff must prove by a preponderance of the evidence that the defendant’s breach was the but-for cause of the injury; showing that a physician “should not have” taken a particular action is insufficient without expert testimony linking that breach to the harm.
- A death certificate notation identifying a condition as a “significant contributing factor” does not, by itself, establish proximate causation — particularly where the certified causes of death are distinct conditions and the plaintiff’s own expert cannot connect the alleged breach to the outcome.
- An expert’s failure to review records from a third-party care provider whose conduct may have independently caused or contributed to the patient’s injury can fatally undermine the causation element of a malpractice claim.
- Where a plaintiff’s proposed alternative treatment (sutures) is itself something the patient reportedly had an allergy to, that alternative cannot support a causation theory that the breach led to the injury.
Why It Matters
This unpublished decision illustrates the demanding causation standard plaintiffs face in Michigan medical malpractice cases, particularly when the chain of events between an alleged surgical misstep and a patient’s death runs through intervening care providers. The court’s analysis makes clear that a stipulated breach issue — here, whether metal staples were appropriate — does not relieve a plaintiff of the obligation to marshal specific, expert-supported evidence connecting that breach to the ultimate injury. Gaps in an expert’s review of the full medical record, especially records from post-acute or nursing facility care, can prove dispositive at the summary disposition stage.
The decision also highlights the evidentiary pitfalls of relying on a death certificate’s secondary notations as a substitute for expert causation testimony. For practitioners, the case underscores the importance of ensuring retained experts have reviewed all relevant records — including those from third-party facilities whose care may have been a contributing or superseding cause — before the close of discovery.