Expert Witness Blog
In the landmark case of Smith v. Medical Center East, Supreme Court of Alabama 1991, the role and admissibility of an Emergency Medical Services Expert Witness became central to the court’s analysis of alleged medical negligence and causation in the context of emergency trauma care and inter-hospital transfer protocols.
Background and Facts
The case arose from the tragic death of Scott Smith following a motor vehicle accident. Smith was initially treated at the scene by emergency medical technicians (EMTs) and subsequently transported to Medical Center East (MCE) rather than Carraway, a designated Level I trauma center. The plaintiff, Calvin Smith, alleged that multiple defendants—including Carraway, MCE, Southeastern Emergency Physicians, and Cardio-Thoracic Surgeons—were negligent in failing to ensure Scott Smith was transported and transferred to the most appropriate facility for his injuries.
Parties and Claims
The plaintiff asserted that Carraway’s on-call emergency physician, Dr. Berry, should have overridden Scott Smith’s stated preference and directed EMTs to transport him to Carraway, given the severity of his injuries. Additional claims were made against MCE and its staff for failing to transfer Smith to Carraway after initial evaluation, and against the on-call cardiothoracic surgeon for not ordering a transfer upon learning of Smith’s condition.
Role and Methods of the Emergency Medical Services Expert Witness
The plaintiff’s case relied heavily on the testimony of Dr. Jonathan Alexander, who was qualified as an Emergency Medical Services Expert Witness. Dr. Alexander provided detailed testimony regarding the standards of care applicable to trauma triage and inter-hospital transfer decisions. He opined that, in light of Smith’s injuries and the resources available at a Level I trauma center, the standard of care required immediate transport to Carraway, regardless of the patient’s stated preference. Dr. Alexander’s analysis was grounded in his knowledge of regional EMS protocols and trauma system guidelines, including those promulgated by the Birmingham Regional Emergency Medical Services System (BREMSS).
Court’s Reliability and Daubert Analysis
The court carefully examined the admissibility and sufficiency of Dr. Alexander’s expert testimony under Alabama’s standards for medical malpractice cases. The court reiterated that, except in cases where negligence is obvious to a layperson, expert testimony is required to establish both the standard of care and causation. The court found that Dr. Alexander’s qualifications and experience were sufficient to opine on EMS protocols and the standard of care for trauma triage.
However, the court scrutinized the reliability of Dr. Alexander’s causation testimony. The defense presented evidence, including the testimony of Dr. Berry and the EMTs, that established BREMSS protocols required transport to the hospital of the patient’s choice if the patient was conscious and capable of making decisions. The court noted that Dr. Alexander could not state with reasonable medical probability that the alleged breaches in the standard of care proximately caused Smith’s death. The defense further demonstrated that all actions taken by the EMTs and physicians were consistent with established regional EMS procedures.
Impact of the Expert Testimony on the Outcome
The court ultimately held that, while Dr. Alexander’s testimony was admissible and relevant to the standard of care, it was insufficient to create a genuine issue of material fact on the element of causation. The court emphasized that expert testimony must establish not only a deviation from the standard of care but also that such deviation probably caused the injury or death in question. Because Dr. Alexander could not meet this burden, and the defense’s evidence regarding EMS protocols was undisputed, summary judgment was entered in favor of all defendants.
This case underscores the critical importance of both the qualifications and the substantive content of Emergency Medical Services Expert Witness testimony in medical negligence litigation. The court’s rigorous analysis of expert reliability and causation remains a touchstone for future cases involving EMS protocols and trauma care standards.