Karyn D. Rasor and Donald Miller, wife and husband, Plaintiffs/Appellants/Cross-Appellees,
Northwest Hospital LLC dba Northwest Medical Center, Defendant/Appellee/Cross-Appellant.
from the Superior Court in Pima County No. C20133700 The
Honorable Leslie Miller, Judge.
& Wilson LPC, Tucson By Kevin E. Miniat Counsel for
Campbell, Yost, Clare & Norell P.C., Phoenix By Kari B.
Zangerle and Mary G. Isban Counsel for
Espinosa authored the opinion of the Court, in which
Presiding Judge Staring and Judge Eppich concurred.
In January 2015, the trial court entered summary judgment in
favor of Northwest Medical Center (Northwest or the hospital)
in the medical malpractice action filed by Karyn Rasor and
her husband (the Rasors). They appealed, and in an opinion
filed on May 17, 2016, we concluded the Rasors' proffered
expert witness was unqualified to give standard-of-care
testimony; however, we reversed the trial court's denial
of the Rasors' request for additional time to secure a
new expert and vacated its summary judgment order. Rasor
v. Nw. Hosp., LLC (Rasor I), 239 Ariz. 546, ¶¶
15, 38 (App. 2016).
Upon review, our supreme court agreed that the Rasors'
expert did not qualify as a standard-of-care expert but
remanded the case to us to determine two additional issues:
whether the expert was qualified to testify to causation, or
if expert testimony on causation was not required. Rasor
v. Nw. Hosp., LLC (Rasor II), 243 Ariz. 160,
¶¶ 3, 29, 32-33 (2017). We conclude the case does
call for expert causation testimony and although the
Rasors' expert witness was not qualified on the standard
of care, she was competent to testify about causation. We
therefore remand to the trial court to provide the Rasors an
opportunity to file a motion to obtain additional evidence
pursuant to Rule 56(d), Ariz. R. Civ. P., and for any other
and Procedural Background
On appeal from summary judgment, we view the facts in the
light most favorable to the party against whom summary
judgment was entered. See Wilson v. Playa de
Serrano, 211 Ariz. 511, ¶ 2 (App. 2005). The
underlying facts describing Karyn's critical care
hospitalization at Northwest are detailed in Rasor
I, 239 Ariz. 546, ¶¶ 2-4. For present
purposes, we note that in July 2011, Karyn underwent
open-heart surgery at Northwest, after which she received an
intra-aortic balloon pump (IABP) threaded through her femoral
artery and requiring the immobilization of her leg. Following
surgery, Karyn spent several days in the intensive care unit
(ICU), where the nurses eventually discovered a pressure
ulcer on her coccyx that ultimately reached "stage
IV" and required thirty-one debridement procedures.
Based on Karyn's allegedly permanent pain and other
symptoms, the Rasors brought a medical malpractice action
against Northwest in July 2013, alleging the hospital had
"breached its professional duties . . ., proximately
causing the development of a decubitus ulcer" by failing
to "appropriately off-load" Karyn and
"negligently fail[ing] to timely discover" the
ulcer during her intensive care. In support of their claim,
the Rasors retained a single expert, a board-certified
wound-care nurse, Julie Ho, R.N. In Ho's opinion,
Northwest had not adequately repositioned Karyn during
recovery, causing the development of a pressure ulcer, which
worsened because of the hospital's failure to respond
appropriately after discovering it. The Rasors filed a motion
to qualify Ho as an expert on the standard of care,
causation, and prognosis, or, in the alternative, to be
permitted to identify a new expert.
subsequently filed a motion for summary judgment, asserting
that Nurse Ho "d[id] not qualify under Arizona Rule of
Evidence, Rule 702, A.R.S. § 12-2603, and A.R.S. §
12-2604" to render opinions in this matter such that the
Rasors "[we]re unable to establish that [the hospital]
breached the applicable standard of care and [the] Complaint
should be dismissed." At the hearing on the Rasors'
motion, the trial court found that Ho could testify to the
standard of care and stated, "I'm going to let you
go with a wound care witness rather than an ICU nurse. You
can take that to the bank, okay?" However, the court
also said, "[W]hat I'm concerned about is whether or
not she could testify as to causation, " ultimately
concluding that the Rasors could introduce her expert opinion
"regarding wound care."
¶6 At the oral argument on
Northwest's summary judgment motion, the Rasors again
asked that they be permitted to find a new expert witness if
the trial court determined that Nurse Ho was unqualified. The
court, however, denied that request and granted summary
judgment without explanation.  The Rasors appealed, and as noted
above, we concluded that Ho was unqualified as a
standard-of-care expert. Our supreme court agreed, but
remanded the case for this court to determine whether Ho
might nevertheless be qualified to provide expert testimony
on causation, or whether this case does not require a
causation expert as a matter of law. See Rasor II,
243 Ariz. 160, ¶¶ 8, 29, 32. On remand, we ordered
supplemental briefing on "the requisite qualifications
for causation experts in medical malpractice cases under
Arizona law, " and the parties filed simultaneous
Before addressing whether Nurse Ho was qualified to testify
to causation in this case, we must determine whether the
Rasors needed to provide a causation expert at all. See
id. ¶¶ 32-33. "'[U]nless a causal
relationship is readily apparent to the trier of fact, '
expert medical testimony normally is required to establish
proximate cause in a medical negligence case."
Salica v. Tucson Heart Hosp.-Carondelet, L.L.C., 224
Ariz. 414, ¶ 16 (App. 2010), quoting Gregg v.
Nat'l Med. Health Care Servs., Inc.,145 Ariz. 51,
54 (App. 1985) (alteration in Salica). In their
opening brief before this court, the Rasors asserted
"the nature of the risk from the failure to relieve
pressure over Ms. ...