Casey Slaydon Versus River Oaks, Inc. D/B/A River Oaks Hospital

CASEY SLAYDON NO. 23-CA-452

VERSUS FIFTH CIRCUIT

RIVER OAKS, INC. D/B/A RIVER OAKS COURT OF APPEAL
HOSPITAL
STATE OF LOUISIANA

ON APPEAL FROM THE TWENTY-FOURTH JUDICIAL DISTRICT COURT
PARISH OF JEFFERSON, STATE OF LOUISIANA
NO. 822-060, DIVISION "O"
HONORABLE DANYELLE M. TAYLOR, JUDGE PRESIDING

April 24, 2024

SCOTT U. SCHLEGEL
JUDGE

Panel composed of Judges Fredericka Homberg Wicker,
Stephen J. Windhorst, and Scott U. Schlegel

AFFIRMED
SUS
FHW

WINDHORST, J., DISSENTS WITH REASONS
SJW

COUNSEL FOR PLAINTIFF/APPELLANT,
CASEY SLAYDON
Pierre F. Gremillion
Vincent J. DeSalvo

COUNSEL FOR DEFENDANT/APPELLEE,
RIVER OAKS, INC. D/B/A RIVER OAKS HOSPITAL
Zachary R. Christiansen

SCHLEGEL, J.

Plaintiff/Appellant, Casey Slaydon, appeals the trial court’s June 20, 2023

judgment, which granted a motion for summary judgment filed by defendant, River

Oaks, Inc. d/b/a River Oaks Hospital (“River Oaks”), and dismissed all of Mr.

Slaydon’s claims against River Oaks with prejudice. Mr. Slaydon contends that

River Oaks’ nursing staff failed to provide prompt treatment for an infection in his

left leg/knee, resulting in the amputation of his left leg above his knee. The trial

court found that Mr. Slaydon failed to meet his burden to prove that a genuine

issue of material fact existed on the issue of causation because he did not present

any expert testimony on this issue. Due to Mr. Slaydon’s complex medical history

and condition, expert testimony is necessary to establish causation in this matter.

Therefore, we affirm the judgment under review.

FACTS AND PROCEDURAL BACKGROUND

Mr. Slaydon filed a petition for damages against River Oaks on October 21,

2021. In his petition, Mr. Slaydon explains that he admitted himself into River

Oaks for “detox services” on October 1, 2020. Prior to his stay at River Oaks, he

had undergone a recent surgery to insert a rod in his left leg. He alleged that River

Oaks failed to timely diagnose and treat an infection in his left knee/leg during his

detox treatment even though he had experienced prior infections following the

surgery. He further alleged that River Oaks’ negligence caused him to sustain

injuries and damages, including the above the knee amputation of his left leg.

River Oaks filed an answer to the petition on November 12, 2021.

Over six months later, on May 16, 2022, River Oaks filed a motion for

summary judgment asserting that Mr. Slaydon could not prevail at trial because he

failed to identify an expert to testify to the elements necessary to meet his burden

of proof in a medical malpractice action ‒ the standard of care, breach of the

standard of care, and causation. River Oaks explained that it sent Mr. Slaydon

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interrogatories asking him to identify any individual who would testify as an expert

witness in this matter. Mr. Slaydon responded that he had “[n]one at this time,

other than medical providers listed herein.” Mr. Slaydon did not identify any

individual medical providers who treated his leg in his discovery responses.

River Oaks’ summary judgment motion was originally set for hearing on

July 7, 2022. The parties agreed to continue the hearing to allow Mr. Slaydon time

to depose Dr. Mack Holdiness, a physician who treated Mr. Slaydon at River Oaks.

The hearing date was eventually reset to March 16, 2023.

On March 1, 2023, Mr. Slaydon filed a one-page opposition to the summary

judgment motion. In his opposition, Mr. Slaydon agreed that he would “need to

call a medical expert to opine as to applicable standards of medical care and to the

Defendant’s breach thereof with causation of damages,” to meet his burden of

proof at trial. Mr. Slaydon attached his own affidavit, as well as an affidavit from

a nursing expert ‒ a licensed registered nurse ‒ Kimberly Stonecypher, and argued

that the affidavits provided “genuine issues of material fact.”

River Oaks filed a reply memorandum arguing that Mr. Slaydon failed to

offer any expert evidence regarding the causation element. River Oaks asserted

that while the Ms. Stonecypher’s affidavit contained numerous statements with

respect to alleged deviations from the nursing standard of care, she failed to offer

any opinions or conclusions that the damages suffered by Mr. Slaydon were

causally related to the alleged deviations. River Oaks further argued that as a

nursing expert, Ms. Stonecypher was not qualified to testify regarding medical

causation because this was outside of the realm of nursing care.

The matter came for hearing on March 16, 2023. Following oral argument,

the trial court granted summary judgment, finding that Mr. Slaydon did not

produce expert testimony to meet his burden of proof with respect to the causation

element. On June 20, 2023, the trial court signed a written judgement, which

23-CA-452 2

granted River Oaks’ summary judgment motion and dismissed Mr. Slaydon’s

claims with prejudice. The judgment stated that Mr. Slaydon “did not create

genuine issues of material fact as to causation.” On August 7, 2023, Mr. Slaydon

filed a motion for devolutive appeal, which the trial court granted the same day.

LAW AND ANALYSIS

On appeal, Mr. Slaydon argues that the trial court erred by finding that no

genuine issues of material fact existed regarding the cause of his damages. Mr.

Slaydon specifically argues that he did not need to provide expert testimony on the

issue of causation based on the “common knowledge” exception. He argues that

the breach of the nursing standards of care by River Oaks’ nursing staff caused a

delay in the assessment and treatment of his left knee/leg and that it is common

knowledge that the delayed treatment caused him additional harm.

River Oaks argues in response that expert testimony is required because

wound healing is a complex medical issue and Mr. Slaydon has a complex medical

history. River Oaks contends that the trial court properly granted summary

judgment due to the absence of any expert testimony to link any alleged deviations

in the nursing standard of care to an alleged change in Mr. Slaydon’s outcome.

The summary judgment procedure is favored and is designed to secure the

just, speedy, and inexpensive determination of every action. La. C.C.P. art.

966(A)(2). A motion for summary judgment shall be granted if the motion,

memorandum, and supporting documents show that there is no genuine issue as to

material fact and that the mover is entitled to judgment as a matter of law. La.

C.C.P. art. 966(A)(3). The burden of proof rests with the mover. La. C.C.P. art.

966(D)(1). However, if the mover will not bear the burden of proof at trial on the

issue before the trial court on the motion for summary judgment, the mover is not

required to negate all essential elements of the plaintiff’s claim, but is only

required to point out the absence of factual support for one or more elements

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essential to the plaintiff’s claim. Id. The burden then shifts to the plaintiff to

produce factual support sufficient to show the existence of a genuine issue of

material fact or that the mover is not entitled to judgment as a matter of law. Id.

Appellate courts review summary judgments de novo using the same criteria

that govern the trial court’s determination of whether summary judgment is

appropriate. Reed v. Landry, 21-589 (La. App. 5 Cir. 6/3/22), 343 So.3d 874, 880.

To establish a claim for medical malpractice, a plaintiff must prove by a

preponderance of evidence: 1) the standard of care applicable to the defendant; (2)

the defendant breached that standard of care; and (3) there was a causal connection

between the breach and the resulting injury. La. R.S. 9:2794. With respect to

causation, a plaintiff must prove that “as a proximate result of [the] lack of

knowledge or skill or the failure to exercise [the] degree of care the plaintiff

suffered injuries that would not otherwise have been incurred.” La. R.S.

9:2794(A)(3). Nurses who perform medical services are subject to the same

standards of care and liability as physicians. Cangelosi v. Our Lady of the Lake

Regional Medical Center, 564 So.2d 654, 661 (La. 1989).

Generally, because of the complex medical and factual issues involved, a

plaintiff will likely fail to sustain his burden of proving his claim under La. R.S.

9:2794’s requirements without expert testimony. Pfiffner v. Correa, 94-924, 94-

963, 94-992 (La. 10/17/94), 643 So.2d 1228, 1234. Further, except for cases

where the causal connection between a defendant’s fault and the injury alleged is

obvious, such as “where a seriously injured patient is left to bleed to death in an

emergency room,” expert medical testimony is also necessary to establish

causation. Id.; Henry v. Weishaupt, 17-26 (La. App. 5 Cir. 5/31/17), 221 So.3d

299, 304, writ denied, 17-1066 (La. 10/9/17), 228 So.3d 746.

Normally, in cases involving patients with complicated medical histories or

complex medical conditions, causation is simply beyond the domain of lay persons

23-CA-452 4

to assess without the assistance of expert medical testimony. See Pfiffner, 643

So.2d at 1234 (causal connection between patient’s death and an unreasonable

delay in neurosurgeon’s diagnosis and treatment of patient in circumstances

involving complex medical history and condition required expert testimony);

Henry, 221 So.3d at 304; Ladart v. Harahan Living Center, Inc., 13-923 (La. App.

5 Cir. 5/14/14), 142 So.3d 103, 108, writ denied, 14-1147 (La. 9/19/14), 149 So.3d

243 (finding that in light of plaintiff’s medical history and condition, expert

testimony was required to establish a connection between the nursing staff’s failure

to regularly reposition plaintiff and the development of pressure ulcers).

Further, in Moss v. Stokes, 21-40 (La. App. 5 Cir. 10/20/21), 329 So.3d

1100, 1103, writ denied, 21-1740 (La. 1/26/22), 332 So.3d 83, this Court

determined that a surgical cite infection presented a complex medical condition

that required expert testimony to satisfy the burden of proof. In Moss, the plaintiff

injured his wrist while playing football. Following surgery, the plaintiff developed

a bacterial infection that progressed to a severe state necessitating further surgical

interventions and causing severe, permanent and disabling injuries including

permanent damage to the bones in the wrist. The plaintiff filed a petition for

damages against his doctor, the medical clinic, and surgical center alleging, among

other things, that the doctor failed to timely diagnose and treat the infection. The

plaintiff alleged that he repeatedly advised the doctor during post-operation visits

that he believed he had an infection, but claimed his doctor ignored his concerns

and failed to perform necessary testing to diagnose the infection.

The defendants filed a summary judgment motion arguing that the plaintiff

failed to produce proper expert testimony to meet his burden of proof to establish a

medical malpractice claim. The trial court granted summary judgment and

dismissed the plaintiff’s claims. On appeal, this Court affirmed based on its

finding that “the prevention, diagnosis, and treatment of surgical site infections

23-CA-452 5

present complex medical and factual issues which require the testimony of an

expert witness to meet the evidentiary burden set forth in La. R.S. 9:2794(A).” Id.

at 1103.

In the present matter, Mr. Slaydon argues that based on the “common-

knowledge” exception, expert testimony is not required to establish causation in

this matter. However, following our de novo review of the affidavits Mr. Slaydon

attached to his opposition brief, we find that due to Mr. Slaydon’s complex

medical history and the complex medical condition presented by his surgical

wound, Mr. Slaydon cannot meet his burden on the issue of causation without

expert testimony.

In her affidavit, Ms. Stonecypher began by summarizing Mr. Slaydon’s

complex medical history and numerous conditions contained in the River Oaks’

medical records.1 She noted that on October 1, 2020, Mr. Slaydon admitted

himself into River Oaks for treatment for a heroin addiction he described as

ongoing for three to four years. He also disclosed that he had been using “meth

and THC.” The intake assessment noted that Mr. Slaydon had scars all over his

arms and that he “was picking his sores during his assessment.” In addition to his

drug addiction, Ms. Stonecypher explained that the assessment and nursing notes

listed other medical issues and conditions, including 1) multiple healing wounds on

his lower left leg; 2) asthma; 3) Hepatitis C positive; and 4) a closed head injury.

She also referenced that the assessment included a “written note that the client is to

have a BKA soon.”2 Mr. Slaydon also explains in his affidavit that he informed

the nurses that he had recently undergone a surgery to place a rod in his left leg and

1
Ms. Stonecypher did not attach any of the River Oaks’ medical records that she cited to in her affidavit.
2
Ms. Stonecypher did not explain what the initials “BKA” meant in her affidavit. According to the
Attorneys Medical Deskbook 4th, §5:4, Dan J. Tennenhouse, MD, JD, FLCM, “BKA” means below the
knee amputation. Appellate courts may take judicial notice of medical terms and definitions. See La.
C.E. art. 201; see also Veras v. Jacobson, No. 18-CV-6724 (S.D.N.Y. June 14, 2022), 2022 WL 2133842,
p. 2, fn.4.

23-CA-452 6

had “a history of infections in this leg which required immediate medical

attention.”

Ms. Stonecypher contends that the River Oaks’ nursing staff breached the

standard of care by failing to properly assess and document the wound when Mr.

Slaydon was initially admitted to River Oaks, by failing to document a plan of care

for the wound, and by failing to update his treatment plan when he was

experiencing drainage and pain on October 4, 2020. She further states that Mr.

Slaydon indicated that he reported swelling and pain in his leg as early as October

2, 2020, and that the nursing staff breached the standard of care by failing to

advocate for the patient and escalating the issue to a nursing supervisor or

physician.3 However, Ms. Stonecypher’s affidavit does not include any findings

that these alleged deviations in the standard of care caused the amputation.

Mr. Slaydon argues for the first time on appeal that the trial court should

have concluded that the alleged delay in treatment caused some unspecified

“additional harm.” If Mr. Slaydon is attempting to transform his claim into one for

the alleged loss of the chance to save his leg, such a claim would certainly require

expert testimony from a physician this case. His argument that it is “common

sense” that any delay caused “additional harm” is contrary to the Louisiana

Supreme Court’s instruction in Pfiffner, 643 So.2d at 1234, that expert testimony is

required when a patient has a complex medical history or complex medical

condition. The connection between the alleged deviations and the subsequent

amputation in light of Mr. Slaydon’s complex medical history and condition is

beyond the province of a layperson to assess. Mr. Slaydon’s own expert noted Mr.

Slaydon’s extremely complicated medical history that included years of drug

3
Mr. Slaydon states in his affidavit that on October 2, 2020, he advised the nurses that he was
experiencing swelling, redness, and severe pain in his left leg/knee. He claimed that the “first medical
attention [he] received was on October 5, 2020,” and that on October, 6, 2020, the wound burst open.

23-CA-452 7

addiction. Mr. Slaydon further explained that he had a recent surgery on his left

leg that involved a history of prior infections. Thus, we find Mr. Slaydon cannot

prove an essential element of his claim without providing expert evidence as to

causation. After River Oaks pointed out an absence of factual support for the

causation element of malpractice, Mr. Slaydon was required to produce expert

testimony regarding causation in order to defeat summary judgment. He has failed

to do so.4

CONCLUSION

For the forgoing reasons, we find that trial court properly granted summary

judgment and dismissed Mr. Slaydon’s suit against River Oaks with prejudice.

Accordingly, the judgment of the district court is affirmed.

AFFIRMED

4
We further observe that in his petition for damages, Mr. Slaydon alleged that the negligence of River
Oaks’ “employees” caused his injuries. Ms. Stonecypher refers primarily to breaches of the nursing
standard of care in her affidavit, though she does refer to the hospital standard of care several times.
Regardless, this Court has previously recognized that pursuant to La. R.S. 9:2794(D), registered nurses
are not qualified to provide expert testimony regarding the applicable standard of care provided by
physicians. Moss, 329 So.3d at 1105. Therefore, to the extent that Mr. Slaydon intended to allege that
any physicians employed by River Oaks caused his injuries, the trial court properly dismissed such claims
due to the lack of proper expert testimony.

23-CA-452 8

CASEY SLAYDON NO. 23-CA-452

VERSUS FIFTH CIRCUIT

RIVER OAKS, INC. D/B/A RIVER OAKS COURT OF APPEAL
HOSPITAL
STATE OF LOUISIANA

WINDHORST, J., DISSENTS WITH REASONS

I respectfully dissent from the majority opinion. I believe Nurse

Stonecypher’s affidavit is sufficient to create a genuine issue of material fact on

causation. I also think the “common knowledge” exception should apply here.

Nurse Stonecypher’s affidavit outlines in detail several breaches in the

standard of care and violations of hospital policy and procedure. First, the

affidavit states that a body check is required upon admission and that nursing

personnel are responsible for the initial assessment for all wounds. Nurse

Stonecypher found that Mr. Slaydon’s wounds were not assessed and findings

were not documented upon admission or during each shift at River Oaks.1 Nurse

Stonecypher opined that this failure to follow policy and procedure is a breach in

the nursing and hospital standards of care.

Second, Nurse Stonecypher stated that River Oak’s policy required the

nursing staff to initiate precautions for existing medical conditions during a

patient’s hospitalization. She found that Mr. Slaydon’s master care plan did not

include a plan of care to address his left knee wound, which also constitutes a

breach in the nursing and hospital standard of care.

1 Mr. Slaydon states in his affidavit that on October 2, 2020, he advised the nurses that he was

experiencing swelling, redness, and severe pain in his left leg/knee. He further states that he did
not receive medical attention until October 5, 2020, and that on October 6, 2020, the wound burst
open.

23-CA-452 1

Third, Nurse Stonecypher recognized in her affidavit that on October 4,

2020, the nursing staff noted a small seeping hole in Mr. Slaydon’s left leg/knee

area and his complaints of pain. She opined that a more aggressive and advocating

approach should have been taken and that his condition should have been reported

to a nursing supervisor or manager. She stated that the nursing staff’s failure to

advocate for a patient so that they receive medication attention timely is a breach

of nursing and hospital standards of care.

Nurse Stonecypher’s affidavit states:

It is my opinion that the aforementioned breaches in the nursing
standard of care reached a level of gross negligence due to the fact that
no actions were taken by the nursing staff to appropriately or accurately
provide an assessment of the wounds to Mr. Slaydon’s leg during upon
his admission to River Oaks Hospital. It is also gross negligence to not
provide the care and treatment for a patient that is guided by a hospital’s
policy and procedure that is specific in the determination of information
required and the process to follow after the information is obtained. ***
To not respond to a patient’s complaint’s and to not monitor a patient
through interventions such as a physical assessment of the left leg and
then to report to the key individuals such as the physician and nursing
leadership is gross negligence.

Although her affidavit may not include the specific terms related to causation, I

believe a reading of the affidavit in its entirety clearly creates a genuine issue of

material fact as to whether River Oaks potential gross negligence caused Mr.

Slaydon some harm. Nurse Stonecypher repeatedly states that the nursing standard

of care reached a level of gross negligence. In addition, considering Mr. Slaydon’s

poor condition at the time of admission, the nursing staff clearly should have been

alerted that he would likely need additional medical attention and/or close attention.

Taking in consideration the above, as well as the “common knowledge”

exception, I do not think Mr. Slaydon should be deprived of his right to present

his case to a jury. In medical malpractice claims, Louisiana jurisprudence has

23-CA-452 2

recognized that expert testimony is not always necessary in order for a plaintiff to

meet his burden of proof. Pfiffner v. Correa, 94-924 (La. 10/17/94), 643 So.2d 1228,

1233. Expert testimony is not required where the physician does an obviously

careless act, from which a layperson can infer negligence. Id.; See also, Hastings v.

Baton Rouge Gen. Hosp., 498 So.2d 713, 719 (La. 1986). The Pfiffner court held

that obvious negligence may be inferred by a layperson from the failure to attend to

a patient when the circumstances demonstrate the serious consequences of this

failure, and the failure of an on-call physician to respond to an emergency when he

knows or should know that his presence is necessary. Pfiffner, 643 So.2d at 1234.

The “common-knowledge” exception does not give the members of the medical

profession a monopoly on common sense. Breaux v. Ochsner Clinic, LLC, 23-62

(La. App. 4 Cir. 9/29/23), writ denied, 23-01436 (La. 1/10/24), 376 So.3d 847. The

facts of this case fall within the common knowledge exception or the definition of

obvious negligence, which may be inferred by a layperson.

Causation is a question of fact generally decided at the trial on the merits.

Estate of Adams v. Home Healthcare of Louisiana, 00-2494 (La. 12/15/00), 775

So.2d 1064; Breaux, supra. Once a breach of duty constituting malpractice is

established, the question of whether the malpractice contributed to the damage is a

question of fact for the jury. Hastings v. Baton Rouge Gen. Hosp., 498 So.2d 713,

720 (La. 1986). Defendant’s conduct must increase the risk of a patient’s harm to

the extent of being a substantial factor in causing the result but need not be the only

cause. Id.

In Estate of Adams, plaintiff alleged that defendant, Home Health Care

of Louisiana (“HH”), was negligent in failing to properly care for her at home

after an extensive hospitalization and in failing to call the attending doctor

when the plaintiff’s condition worsened. In its summary judgment motion,

23-CA-452 3

HH did not contest its negligence, but argued that the amputation of the plaintiff’s

foot would have been required regardless of its negligence. HH relied on plaintiff’s

lack of an expert witness to prove the causal connection between its negligence and

the amputation. The trial court granted HH’s summary judgment motion; the

appellate court, with one dissent, affirmed. Granting writs and reversing the lower

courts, the Supreme Court observed:

the admitted negligence clearly caused some damages, even if it merely
hastened the amputation by one day. Plaintiff’s damages for pain and
suffering during the period of negligence, for aggravation of her
medical condition, and for loss of any chance of saving her foot or of
delaying the amputation is more appropriately decided by trial on the
merits, even if plaintiff’s case regarding the amount of damages is
considerably weakened by the dearth of expert testimony.

Estate of Adams, 00-2494, 775 So.2d at 1064-65.

In Breaux, plaintiff averred that during a thirteen-day period of misdiagnosis,

he suffered “continued and progressive pain”; the misdiagnosis “caused him to

continue with a physically demanding and strenuous practice regimen, causing

severe pain, grievous injuries and damages”; and the misdiagnosis “caused a delay

in petitioner receiving the appropriate treatment and care.” Plaintiff also Mr. Breaux

asserted the loss of a chance of a more favorable outcome doctrine.

The trial court granted defendant physicians’ summary judgment, agreeing

with their argument, that the lack of expert testimony to establish a causal connection

between the assumed misdiagnosis and any injury to Mr. Breaux was dispositive.

Plaintiff countered that the causal connection between the misdiagnosis and his

increased leg pain falls within the “common-knowledge” exception to the expert

testimony rule.

On appeal, the appellate court concluded that a lay person could attribute Mr.

Breaux’s alleged injury to the wrongful conduct without the aid of expert testimony.

23-CA-452 4

As a result, the appellate court reversed the trial court’s granting of summary

judgment.

Considering the foregoing, particularly Nurse Stonecypher’s affidavit, the

obvious delayed treatment in this case, and Mr. Slaydon’s apparent medical

problems upon admission, I believe the record supports allowing Mr. Slaydon to

present his claim to a jury. See Estate of Adams, supra; Breaux, supra. In my view,

a jury should determine whether River Oaks’ delay in providing Mr. Slayton

treatment for his wound caused him any additional damages. As recognized in

Pfiffner, the issue of whether the delayed treatment caused Mr. Slaydon additional

damages is a determination capable of a layperson’s reasonable inference. In

addition, when considering summary judgment motions, factual inferences

reasonably drawn from the evidence must be construed in favor of the party opposing

the motion. Indep. Fire Ins. Co. v. Sunbeam Corp., 99-2181 (La. 2/29/00), 755 So.2d

226, 236. If a party submits expert opinion evidence in opposition to a motion for

summary judgment that would be admissible, and is sufficient to allow a reasonable

juror to conclude that the expert’s opinion on a material fact more likely than not is

true, the court should deny the motion and let the issue be decided at trial. Id.

Accordingly, I would reverse the trial court’s judgment granting River Oaks’

motion for summary judgment and deny the motion.

23-CA-452 5

SUSAN M. CHEHARDY CURTIS B. PURSELL

CHIEF JUDGE CLERK OF COURT

SUSAN S. BUCHHOLZ
FREDERICKA H. WICKER
CHIEF DEPUTY CLERK
JUDE G. GRAVOIS
MARC E. JOHNSON
STEPHEN J. WINDHORST LINDA M. WISEMAN
JOHN J. MOLAISON, JR.
FIRST DEPUTY CLERK
SCOTT U. SCHLEGEL
TIMOTHY S. MARCEL FIFTH CIRCUIT
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23-CA-452
E-NOTIFIED
24TH JUDICIAL DISTRICT COURT (CLERK)
HONORABLE DANYELLE M. TAYLOR (DISTRICT JUDGE)
PIERRE F. GREMILLION (APPELLANT) VINCENT J. DESALVO (APPELLANT) ZACHARY R. CHRISTIANSEN
(APPELLEE)

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