{ "id": 4160029, "name": "ALLEN THOMAS LORD, Plaintiff-Appellant v. PAUL J. BEERMAN, M.D.; YADKIN RIVER RADIOLOGY, P.A.; HUGH CHATHAM MEMORIAL HOSPITAL, INC.; WAKE FOREST UNIVERSITY; WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER; WAKE FOREST UNIVERSITY HEALTH SCIENCES; and NORTH CAROLINA BAPTIST HOSPITAL, Defendants-Appellees", "name_abbreviation": "Lord v. Beerman", "decision_date": "2008-07-15", "docket_number": "No. COA07-1550", "first_page": "290", "last_page": "301", "citations": [ { "type": "official", "cite": "191 N.C. App. 290" } ], "court": { "name_abbreviation": "N.C. Ct. App.", "id": 14983, "name": "North Carolina Court of Appeals" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "658 S.E.2d 272", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12640611, 12640612 ], "year": 2008, "opinion_index": 0, "case_paths": [ "/se2d/658/0272-01", "/se2d/658/0272-02" ] }, { "cite": "362 N.C. 176", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 12640552 ], "year": 2008, "opinion_index": 0, "case_paths": [ "/se2d/657/0663-04" ] }, { "cite": "645 S.E.2d 125", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12638439 ], "year": 2007, "pin_cites": [ { "page": "127" } ], "opinion_index": 0, "case_paths": [ "/se2d/645/0125-01" ] }, { "cite": "209 S.E.2d 456", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1974, "pin_cites": [ { "parenthetical": "per curiam" }, { "page": "456-57" } ], "opinion_index": 0 }, { "cite": "286 N.C. 209", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8564214 ], "year": 1974, "pin_cites": [ { "parenthetical": "per curiam" } ], "opinion_index": 0, "case_paths": [ "/nc/286/0209-01" ] }, { "cite": "203 S.E.2d 330", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1974, "opinion_index": 0 }, { "cite": "21 N.C. App. 110", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8554553 ], "year": 1974, "opinion_index": 0, "case_paths": [ "/nc-app/21/0110-01" ] }, { "cite": "183 N.C. App. 455", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8204022 ], "year": 2007, "pin_cites": [ { "page": "457-58" } ], "opinion_index": 0, "case_paths": [ "/nc-app/183/0455-01" ] }, { "cite": "580 S.E.2d 368", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2003, "opinion_index": 0 }, { "cite": "357 N.C. 164", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 491525, 491719, 491562, 491535, 491445, 491421, 491454, 491551 ], "year": 2003, "opinion_index": 0, "case_paths": [ "/nc/357/0164-03", "/nc/357/0164-06", "/nc/357/0164-07", "/nc/357/0164-05", "/nc/357/0164-01", "/nc/357/0164-08", "/nc/357/0164-04", "/nc/357/0164-02" ] }, { "cite": "564 S.E.2d 883", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "pin_cites": [ { "page": "889" } ], "opinion_index": 0 }, { "cite": "151 N.C. App. 15", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9079053 ], "year": 2002, "pin_cites": [ { "page": "24" } ], "opinion_index": 0, "case_paths": [ "/nc-app/151/0015-01" ] }, { "cite": "538 S.E.2d 912", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2000, "pin_cites": [ { "page": "916", "parenthetical": "stating that \" 'could' or 'might' expert testimony [is] insufficient to support a causal connection when there is additional evidence or testimony showing the expert's opinion to be a guess or mere speculation\"" } ], "opinion_index": 0 }, { "cite": "353 N.C. 227", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 135777 ], "year": 2000, "pin_cites": [ { "page": "233", "parenthetical": "stating that \" 'could' or 'might' expert testimony [is] insufficient to support a causal connection when there is additional evidence or testimony showing the expert's opinion to be a guess or mere speculation\"" } ], "opinion_index": 0, "case_paths": [ "/nc/353/0227-01" ] }, { "cite": "321 S.E.2d 896", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1984, "opinion_index": 0 }, { "cite": "312 N.C. 83", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 4758528, 4749866, 4748815, 4750043, 4753630 ], "year": 1984, "opinion_index": 0, "case_paths": [ "/nc/312/0083-02", "/nc/312/0083-04", "/nc/312/0083-05", "/nc/312/0083-01", "/nc/312/0083-03" ] }, { "cite": "317 S.E.2d 111", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1984, "pin_cites": [ { "page": "113" }, { "page": "113", "parenthetical": "finding sufficient evidence of proximate cause where the plaintiff's expert testified that earlier intervention \"quite likely\" would have improved the plaintiff's ultimate outcome" } ], "opinion_index": 0 }, { "cite": "69 N.C. App. 439", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8526418 ], "weight": 2, "year": 1984, "pin_cites": [ { "page": "443" }, { "page": "443" } ], "opinion_index": 0, "case_paths": [ "/nc-app/69/0439-01" ] }, { "cite": "381 S.E.2d 706", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 9, "year": 1989, "pin_cites": [ { "page": "708-09" }, { "page": "709" }, { "page": "709" }, { "page": "711" }, { "page": "711" }, { "page": "712" } ], "opinion_index": 0 }, { "cite": "325 N.C. 152", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2491380 ], "year": 1989, "opinion_index": 0, "case_paths": [ "/nc/325/0152-01" ] }, { "cite": "363 S.E.2d 203", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 6, "year": 1988, "pin_cites": [ { "page": "204" }, { "page": "205" }, { "page": "206", "parenthetical": "emphasis added" }, { "page": "206", "parenthetical": "emphasis added" } ], "opinion_index": 0 }, { "cite": "88 N.C. App. 382", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8358281 ], "weight": 2, "year": 1988, "pin_cites": [ { "page": "387" } ], "opinion_index": 0, "case_paths": [ "/nc-app/88/0382-01" ] }, { "cite": "330 S.E.2d 605", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1985, "opinion_index": 0 }, { "cite": "313 N.C. 596", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 4719396, 4721386, 4721131, 4718827, 4724383 ], "year": 1985, "opinion_index": 0, "case_paths": [ "/nc/313/0596-02", "/nc/313/0596-05", "/nc/313/0596-04", "/nc/313/0596-03", "/nc/313/0596-01" ] }, { "cite": "323 S.E.2d 372", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1984, "opinion_index": 0 }, { "cite": "72 N.C. App. 15", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8526104 ], "year": 1984, "opinion_index": 0, "case_paths": [ "/nc-app/72/0015-01" ] }, { "cite": "253 S.E.2d 304", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 7, "year": 1979, "pin_cites": [ { "page": "305" }, { "page": "306" }, { "page": "306" }, { "page": "306" }, { "page": "308" }, { "page": "308", "parenthetical": "finding insufficient evidence of proximate cause where the plaintiff introduced no evidence showing that if the defendants had intervened earlier, the plaintiff would have achieved a different ultimate medical outcome" } ], "opinion_index": 0 }, { "cite": "40 N.C. App. 456", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8551249 ], "weight": 2, "year": 1979, "pin_cites": [ { "page": "462" } ], "opinion_index": 0, "case_paths": [ "/nc-app/40/0456-01" ] }, { "cite": "311 S.E.2d 559", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1984, "pin_cites": [ { "page": "565" } ], "opinion_index": 0 }, { "cite": "310 N.C. 227", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2402972 ], "year": 1984, "pin_cites": [ { "page": "233" } ], "opinion_index": 0, "case_paths": [ "/nc/310/0227-01" ] }, { "cite": "247 S.E.2d 287", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1978, "pin_cites": [ { "page": "291" } ], "opinion_index": 0 }, { "cite": "38 N.C. App. 50", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8551832 ], "year": 1978, "pin_cites": [ { "page": "54" } ], "opinion_index": 0, "case_paths": [ "/nc-app/38/0050-01" ] }, { "cite": "513 S.E.2d 572", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1999, "pin_cites": [ { "page": "574" } ], "opinion_index": 0 }, { "cite": "132 N.C. App. 807", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 11240754 ], "year": 1999, "pin_cites": [ { "page": "809" } ], "opinion_index": 0, "case_paths": [ "/nc-app/132/0807-01" ] }, { "cite": "376 S.E.2d 425", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1989, "pin_cites": [ { "page": "427" } ], "opinion_index": 0 }, { "cite": "324 N.C. 63", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2488503 ], "year": 1989, "pin_cites": [ { "page": "66" } ], "opinion_index": 0, "case_paths": [ "/nc/324/0063-01" ] }, { "cite": "414 S.E.2d 339", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1992, "pin_cites": [ { "page": "341-42" } ], "opinion_index": 0 }, { "cite": "331 N.C. 57", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2500046 ], "year": 1992, "pin_cites": [ { "page": "62-63" } ], "opinion_index": 0, "case_paths": [ "/nc/331/0057-01" ] } ], "analysis": { "cardinality": 1047, "char_count": 27523, "ocr_confidence": 0.747, "pagerank": { "raw": 2.2733008565327874e-07, "percentile": 0.7839986037796026 }, "sha256": "c2d33e3199d0719e3db50237b939c8071795bc0c438565d460deac07c6394938", "simhash": "1:21394eaa014c05c2", "word_count": 4276 }, "last_updated": "2023-07-14T16:44:10.260573+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Judges STEELMAN and GEER concur." ], "parties": [ "ALLEN THOMAS LORD, Plaintiff-Appellant v. PAUL J. BEERMAN, M.D.; YADKIN RIVER RADIOLOGY, P.A.; HUGH CHATHAM MEMORIAL HOSPITAL, INC.; WAKE FOREST UNIVERSITY; WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER; WAKE FOREST UNIVERSITY HEALTH SCIENCES; and NORTH CAROLINA BAPTIST HOSPITAL, Defendants-Appellees" ], "opinions": [ { "text": "McGEE, Judge.\nThe record in this case shows that on or about 18 December 2002, Allen Thomas Lord (Plaintiff) began to experience cloudy and blurred vision. Plaintiff made an appointment on 20 December 2002 to see his ophthalmologist, Dr. Wells Stewart (Dr. Stewart). Dr. Stewart could not determine the reason for Plaintiffs decreasing vision, and he sent Plaintiff to have a magnetic resonance imaging (MRI) scan of his brain and optic region at Hugh Chatham Memorial Hospital (Hugh Chatham Hospital). Plaintiff underwent an MRI scan at Hugh Chatham Hospital on the afternoon of 20 December 2002.\nDr. Paul J. Beerman (Dr. Beerman) is an employee of Yadkin River Radiology. Dr. Beerman regularly reads radiology images at Hugh Chatham Hospital. Dr. Beerman read Plaintiffs MRI images and found no abnormality to account for Plaintiffs symptoms. Dr. Beerman sent a copy of his findings to Dr. Stewart. Dr. Stewart contacted Plaintiff on the evening of 20 December 2002 and informed Plaintiff that his MRI results were normal.\nDespite Plaintiffs test results, Plaintiffs vision continued to deteriorate rapidly. Dr. Stewart examined Plaintiff again on 22 December 2002 and arranged for Plaintiff to see neuro-ophthalmologist Dr. Timothy Martin (Dr. Martin) the following day at North Carolina Baptist Hospital (Baptist Hospital). However, when Plaintiff arrived at Baptist Hospital on 23 December 2002, he learned that Dr. Martin was on vacation. Plaintiff instead was seen by first-year ophthalmology resident Dr. David Gilbert (Dr. Gilbert), and third-year ophthalmology resident Dr. Gautam Mishra (Dr. Mishra). Doctors Gilbert and Mishra performed a number of tests on Plaintiff and noted that Plaintiffs previous MRI results were normal. Neither Dr. Gilbert nor Dr. Mishra could determine the cause of Plaintiffs symptoms. Dr. Mishra gave Plaintiff some eye drops and told Plaintiff that he would discuss Plaintiffs symptoms with Dr. Martin when Dr. Martin returned from vacation the following week.\nDr. Martin testified in his deposition that when he returned from vacation on 30 December 2002, he examined Plaintiffs MRI images:\n[I]n this case I wanted to look at the [optic] chiasm. That was the area that was called into question by the patient\u2019s presentation.\n. . . [T]here were some abnormalities in the [optic] chiasm.\n.... [Tjhere was certainly enough to convince me that there was some mild chiasmal enhancement, which suggests that there was a real and organic and demonstrable basis for the patient\u2019s visual field loss.\nDr. Martin immediately contacted Plaintiff and asked him to return to Baptist Hospital as soon as possible. Plaintiff returned to Baptist Hospital on 30 December 2002. Dr. Martin immediately gave Plaintiff intravenous steroids and admitted Plaintiff to Baptist Hospital for further testing. Dr. Martin ultimately diagnosed Plaintiff as having \u201can autoimmune demyelinating chiasmopathy,\u201d which Dr. Martin described as \u201can unusual problem, an unusual presentation,\u201d and \u201cso unusual and very[,] very strange.\u201d\nDr. Martin continued to treat Plaintiff with steroids over the following weeks. Plaintiff\u2019s vision improved slightly from the treatment and eventually stabilized. At present, Plaintiff is able to see some light and color, but he continues to suffer from substantial visual impairment.\nPlaintiff filed a complaint on 19 April 2006 against Dr. Beerman, Yadkin River Radiology (together, the Beerman Defendants), Baptist Hospital, Wake Forest University Baptist Medical Center, Wake Forest University, and Wake Forest University Health Sciences (together, the Wake Forest Defendants). Plaintiff first alleged that the Beerman Defendants were negligent in that on 20 December 2002, Dr. Beerman negligently misread Plaintiff\u2019s MRI images, failed to detect abnormalities in Plaintiff\u2019s optic chiasm, and reported to Dr. Stewart that Plaintiff\u2019s MRI scans were normal. Plaintiff next alleged that the Wake Forest Defendants were negligent in that on 22 December 2002, their employees failed to admit Plaintiff to the hospital or provide him steroid treatment, failed to diagnose the cause of Plaintiff\u2019s vision loss, failed to have Plaintiff examined by an ophthalmologist, and released Plaintiff without appropriate treatment or instructions. Plaintiff further alleged that the Beerman Defendants\u2019 negligence and the Wake Forest Defendants\u2019 negligence were both direct and proximate causes of his blindness. The Beerman and Wake Forest Defendants filed answers denying the allegations in Plaintiff\u2019s complaint.\nThe Beerman Defendants filed a motion for summary judgment on 18 June 2007 arguing, inter alia, that Plaintiff \u201cfailed to produce competent evidence from a qualified witness that any alleged negligence by [the Beerman Defendants] proximately caused any injury to [P]laintiff.\u201d The Wake Forest Defendants filed a motion for summary judgment on 25 June 2007 also arguing, inter alia, that \u201cPlaintiff has failed to produce competent evidence from a qualified witness that any alleged negligence by [the Wake Forest Defendants] proximately caused any injury to Plaintiff.\u201d The trial court entered orders on 2 August 2007 granting the Beerman and Wake Forest Defendants\u2019 motions, finding in each case that \u201cthere are no genuine issues of material fact and that [the respective defendants] are entitled to judgment as a matter of law[.]\u201d Plaintiff appeals.\nA trial court should grant a motion for summary judgment only \u201cif the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that any party is entitled to a judgment as a matter of law.\u201d N.C. Gen. Stat. \u00a7 1A-1, Rule 56(c) (2007). The moving party carries the burden of establishing the lack of any triable issue. Roumillat v. Simplistic Enterprises, Inc., 331 N.C. 57, 62-63, 414 S.E.2d 339, 341-42 (1992). The movant may meet his or her burden \u201cby proving that an essential element of the opposing party\u2019s claim is nonexistent, or by showing through discovery that the opposing party cannot produce evidence to support an essential element of his claim[.]\u201d Collingwood v. G.E. Real Estate Equities, 324 N.C. 63, 66, 376 S.E.2d 425, 427 (1989). All inferences of fact must be drawn against the movant and in favor of the nonmovant. Id. We review a trial court\u2019s grant of summary judgment de novo. Falk Integrated Tech., Inc. v. Stack, 132 N.C. App. 807, 809, 513 S.E.2d 572, 574 (1999).\nA.\nTo survive a motion for summary judgment in a medical malpractice action, a plaintiff must forecast evidence demonstrating \u201cthat the treatment administered by [the] defendant was in negligent violation of the accepted standard of medical care in the community[,] and that [the] defendant\u2019s treatment proximately caused the injury.\u201d Ballenger v. Crowell, 38 N.C. App. 50, 54, 247 S.E.2d 287, 291 (1978). \u201cProximate cause is a cause which in natural and continuous sequence, unbroken by any new and independent cause, produced the plaintiff\u2019s injuries, and without which the injuries would not have occurred[.]\u201d Hairston v. Alexander Tank & Equipment Co., 310 N.C. 227, 233, 311 S.E.2d 559, 565 (1984).\nOur Court\u2019s prior decisions demonstrate that where a plaintiff alleges that he or she was injured due to a physician\u2019s negligent failure to diagnose or treat the plaintiff\u2019s medical condition sooner, the plaintiff must present at least some evidence of a causal connection between the defendant\u2019s failure to intervene and the plaintiff\u2019s inability to achieve a better ultimate medical outcome. In Lindsey v. The Clinic for Women, 40 N.C. App. 456, 253 S.E.2d 304 (1979), for example, the plaintiff began to experience sharp pains, fluid leakage, and a bloody discharge in the late stages of her pregnancy. Id. at 457-58, 253 S.E.2d at 305. The defendant physicians examined the plaintiff multiple times, determined that she was having false labor, and told her to return to the clinic in one week. Id. at 458, 253 S.E.2d at 306. Plaintiff\u2019s child was later stillborn, and physicians determined the child\u2019s cause of death to be severe amnionitis and a prolapsed umbilical cord. Id. at 459, 253 S.E.2d at 306. At trial, the plaintiff\u2019s expert witness testified that \u201cthe course pursued by [the] defendant doctors . . . did not conform with approved medical practices[.]\u201d Id. at 459-60, 253 S.E.2d at 306. Our Court held that the trial court erred in denying the defendants\u2019 motion for a directed verdict:\n[Plaintiff introduced] no evidence that anything which [the] defendants did or failed to do ... either caused or could have prevented the amnionitis, which [the] plaintiff contends caused the death of her child and her own prolonged suffering. [The plaintiff\u2019s] expert witness .... never testified that had what he considered to be \u201capproved medical practices\u201d been followed by the defendants in their treatment of the plaintiff in this case, [the plaintiff\u2019s] child would not have been stillborn and her own recovery would not have been prolonged by amnionitis. . . . The evidence . . . simply fails to show that anything [the] defendants did or failed to do caused [the plaintiff\u2019s] injuries.\nId. at 462, 253 S.E.2d at 308; see also Bridges v. Shelby Women\u2019s Clinic, P.A., 72 N.C. App. 15, 323 S.E.2d 372 (1984), disc, review denied, 313 N.C. 596, 330 S.E.2d 605 (1985) (holding that where the defendant physicians negligently misdiagnosed the plaintiffs premature labor, but the plaintiff\u2019s evidence failed to establish that the defendants could have suppressed her premature labor had they correctly diagnosed the plaintiff sooner, the trial court properly granted a directed verdict against the plaintiff).\nEven where a plaintiff has introduced some evidence of a causal connection between the defendant\u2019s failure to diagnose or intervene sooner and the plaintiff\u2019s poor ultimate medical outcome, our Court has held that such evidence is insufficient if it merely speculates that a causal connection is possible. In White v. Hunsinger, 88 N.C. App. 382, 363 S.E.2d 203 (1988), for example, the plaintiff\u2019s decedent was injured in an automobile accident. Id. at 383, 363 S.E.2d at 204. The defendant physician kept the decedent at the hospital overnight and transferred him to a neurosurgeon at a different hospital the following day. The decedent died shortly thereafter. Id. The plaintiff\u2019s expert stated in an affidavit that \u201c[the decedent]\u2019s chances of survival would have been increased if he had been transferred to a neurosurgeon earlier.\u201d Id. at 384, 363 S.E.2d at 205. Our Court affirmed summary judgment for the defendant, holding that the plaintiff\u2019s evidence was speculative and insufficient to establish causation:\n[The] plaintiff could not prevail at trial by merely showing that a different course of action would have improved [the decedent]\u2019s chances of survival. Proof of proximate cause in a malpractice case requires more than a showing that a different treatment would have improved the patient\u2019s chances of recovery.\n. . . [The] plaintiff has failed ... to forecast any evidence showing that had [the defendant] referred [the decedent] to a neurosurgeon when [the decedent] was first brought to the hospital, [the decedent] would not have died. The connection or causation between the negligence and [injury] must be probable, not merely a remote possibility.\nId. at 386-87, 363 S.E.2d at 206 (emphasis added).\nIn contrast, our Courts have allowed a plaintiff\u2019s evidence to go to a jury where the plaintiff can establish a probable causal connection between the defendant\u2019s failure to diagnose or intervene sooner and the plaintiff\u2019s poor ultimate medical outcome. In Turner v. Duke University, 325 N.C. 152, 381 S.E.2d 706 (1989), for example, the plaintiff\u2019s decedent was admitted to the hospital complaining of constipation, cramping, nausea, and vomiting. Id. at 155-56, 381 S.E.2d at 708-09. The defendant physician could not determine the cause of the decedent\u2019s symptoms, and treated her for constipation. Id. The decedent\u2019s condition worsened over the following day, but doctors failed to examine her for a number of hours, at which point she was unresponsive. Id. at 156, 381 S.E.2d at 709. Exploratory surgery revealed that the decedent\u2019s colon was perforated, and the decedent died of a bacterial infection the following morning. Id. at 156-57, 381 S.E.2d at 709. The plaintiff\u2019s expert testified at trial that the defendant physician should have examined the decedent sooner, and that his failure to do so was the proximate cause of the decedent\u2019s death. Id. at 159-60, 381 S.E.2d at 711. The plaintiff\u2019s expert explained that if an examination had been performed earlier, the defendant physician should have discovered the decedent\u2019s perforated colon and could have performed a life-saving colostomy. Id. at 160, 381 S.E.2d at 711. Our Court stated that \u201c[s]uch evidence is the essence of proximate cause,\u201d id., and held that the trial court erred in granting a directed verdict against the plaintiff. Id. at 162, 381 S.E.2d at 712; see also Largent v. Acuff, 69 N.C. App. 439, 443, 317 S.E.2d 111, 113, disc. review denied, 312 N.C. 83, 321 S.E.2d 896 (1984) (holding that the plaintiff introduced sufficient causation evidence where the plaintiff\u2019s expert testified that if the defendant physician had called a neurosurgeon to examine the plaintiff three days earlier, \u201c \u2018it is quite likely that the patient may have suffered less permanent damage\u2019 \u201d (emphasis added)).\nB.\nPlaintiff\u2019s causation evidence in this case consisted of the deposition testimony of two of Plaintiff\u2019s proffered expert witnesses, Dr. Larry Frohman (Dr. Frohman) and Dr. John Leo Grady (Dr. Grady). Both experts offered opinions as to whether Plaintiff would have reached a better ultimate visual outcome had the Beerman and Wake Forest Defendants diagnosed Plaintiff earlier and initiated steroid treatment sooner.\nDr. Frohman testified in his deposition regarding medical research on the effect of steroid therapy on various optical diseases. According to Dr. Frohman, studies have shown that steroid therapy does have some effect on patients who suffer from \u201ctypical demyelinating optic neuritis.\u201d Specifically, Dr. Frohman testified that early steroid therapy may hasten a patient\u2019s recovery, but that steroid therapy has no effect on a patient\u2019s ultimate visual outcome. In other words, while a patient who undergoes steroid therapy may reach his or her ultimate visual outcome sooner, that outcome itself remains the same regardless of whether the patient receives steroids.\nDr. Frohman also testified, however, that Plaintiff did not have typical demyelinating optic neuritis, but rather suffered from autoimmune optic neuropathy. According to Dr. Frohman, autoimmune optic neuropathy is \u201ca different disease process\u201d than demyelinating optic neuritis, and is extremely rare. In fact, Dr. Frohman testified that due to the rarity of Plaintiff\u2019s disease, researchers had not been able to develop a statistical analysis regarding the effect of steroid treatment on similar patients. Dr. Frohman testified that although any treating ophthalmologist would initiate steroid treatment as soon as possible in the hopes of reaching a better or faster outcome, he was unable to determine whether immediate treatment would affect a patient\u2019s long-term prognosis.\nWith regard to Plaintiff\u2019s specific case, Dr. Frohman testified as follows:\n[DEFENSE COUNSEL]: Do you intend to offer any testimony in this case that [Plaintiff\u2019s ability to use his eyes in day-to-day life ... would have been improved in any way had he been started on treatment a day earlier, a week earlier[,] or two weeks earlier?\n[DR. FROHMAN]: .... I think that had [Plaintiff] been treated earlier, his outcome in this particular disease could have been better. I can\u2019t say that with any measure of statistical significance, because there is no series of this rare disease that can really address that question. Do I think it was standard to treat him earlier, yes. Could I say his outcome would have been better, No.\nDr. Frohman reiterated a number of times throughout his deposition that he could not determine whether earlier steroid treatment would have made a difference in Plaintiff\u2019s case, or what type of difference it would have made.\nPlaintiff correctly notes that Dr. Frohman did testify in his deposition that \u201cstarting [patients] on day one, day two, day three, day four, day five makes a difference.\u201d It is true that Dr. Frohman\u2019s statement, taken in isolation, appears to suggest that a causal connection exists between early steroid treatment and a patient\u2019s ultimate visual outcome. However, it is clear from the full context of Dr. Frohman\u2019s testimony that Plaintiff has misinterpreted Dr. Frohman\u2019s remarks:\n[DEFENSE COUNSEL]: [Is there] data which would allow [experts] to offer an opinion as to what difference, if any, treatment would have made?\n[DR. FROHMAN]: . . . [T]he disease is too small in number, too rare, for anyone to develop a series that [is] large enough to do the study and develop statistical analysis. . . . [H]ow [should we] do such a study[?] The patient is blind, in this case, in both eyes. What we\u2019re going to do is randomize a group that doesn\u2019t get sham therapy or sham studies[?] [It is] [a]n unethical study to do. When you\u2019re faced with someone who is seriously blind in both eyes, you have to treat them with what you think is best.\n[DEFENSE COUNSEL]: And some of them get better and some of them do not?\n[DR. FROHMAN]: Right. And there is not enough data to see who will.\n[DEFENSE COUNSEL]: Who will or who won\u2019t?\n[DR. FROHMAN]: And starting them on day one, day two, day three, day four, day five makes a difference.\n[DEFENSE COUNSEL]: No further questions.\nThe full text of Dr. Frohman\u2019s testimony demonstrates that Dr. Frohman was merely stating that in order to develop statistics regarding the effect of early steroid treatment, physicians involved in such research would have to administer steroid treatment to different patients at different stages of disease development. In other words, for the purposes of conducting a research study, starting treatment \u201con day one, day two, day three, day four, day five makes a difference\u201d in terms of gathering helpful data on the efficacy of early treatment. However, according to Dr. Frohman, this type of data does not exist because the disease at issue is so rare, and because a study pro-during such research would be unethical. Such testimony does not establish a causal connection between early treatment and better ultimate visual outcome.\nLike Dr. Frohman, Dr. Grady also testified in his deposition that had Plaintiff been treated earlier, there is \u201cno scientific basis to say that the long-term outcome for [Plaintiff] would be any different[.]\u201d Dr. Grady did believe that, as with typical demyelinating optic neuritis, patients with autoimmune optic neuropathy may achieve a faster recovery when treated with steroids. However, Dr. Grady also maintained that he was unable to determine whether and to what extent earlier treatment would have affected Plaintiffs final visual outcome:\n[DEFENSE COUNSEL]: In [Plaintiff\u2019s case, do you intend to offer any opinion that as of December 20, 2002, that there was treatment that would have influenced the outcome, had it been provided on that date?\n[DR. GRADY]: Well, given what we know now, probably, yeah.\n[DEFENSE COUNSEL]: You say\u2014\n[DR. GRADY]: Well, influence the outcome at least in terms of the rapidity of any improvement that may have occurred.\n[DEFENSE COUNSEL]: . . . [E]ven had treatment been rendered on December 20, 2002 . . . [Plaintiff\u2019s condition today, several years out, would not be substantially different; correct?\n[DR. GRADY]: Well, I don\u2019t think we can say that. We can\u2019t know what the outcome might have been. That is not knowable. . . .\n[DEFENSE COUNSEL]: And that\u2019s because there\u2019s no scientific proof that had [Plaintiff been treated] on December 20, 2002, that the long-term outcome would be any different than nontreatment; correct?\n[DR. GRADY]: That\u2019s correct. There\u2019s no scientific proof that treatment at that time would have made a difference in the final outcome.\nDr. Grady repeatedly stated throughout his deposition that while earlier initiation of steroid treatment may have hastened Plaintiff\u2019s recovery, there was no way to determine whether it would have improved Plaintiff\u2019s ultimate visual outcome. Dr. Grady did testify that earlier steroid intervention \u201cperhaps\u201d could have led to \u201ca fuller recovery,\u201d and that Plaintiff\u2019s eyesight \u201cmay have been improved to a better outcome.\u201d However, Dr. Grady quickly qualified his statement by admitting that \u201cany attempt to testify [as to] what improvement might have been obtained[,] and when[,] would amount to sheer speculation^]\u201d\nWe hold that Plaintiff\u2019s evidence was insufficient to establish the requisite causal connection between Defendants\u2019 alleged negligence and Plaintiff\u2019s blindness. Neither of Plaintiff\u2019s expert witnesses were able to testify that Plaintiff\u2019s vision would be better today had Defendants initiated steroid treatment sooner, nor were they able to testify that Plaintiff\u2019s vision probably would be better. Cf. Acuff, 69 N.C. App. at 443, 317 S.E.2d at 113 (finding sufficient evidence of proximate cause where the plaintiff\u2019s expert testified that earlier intervention \u201cquite likely\u201d would have improved the plaintiff\u2019s ultimate outcome). Rather, Plaintiff\u2019s expert witnesses consistently testified that they were unable to determine whether earlier treatment would have had any effect on Plaintiff\u2019s ultimate visual outcome, or what that effect might have been. Such testimony is insufficient to establish proximate cause in a medical malpractice case. See Lindsey, 40 N.C. App. at 462, 253 S.E.2d at 308 (finding insufficient evidence of proximate cause where the plaintiff introduced no evidence showing that if the defendants had intervened earlier, the plaintiff would have achieved a different ultimate medical outcome).\nAt best, Plaintiff can point to Dr. Frohman\u2019s testimony that with earlier treatment, Plaintiff\u2019s \u201coutcome in this particular disease could have been better,\u201d and Dr. Grady\u2019s testimony that earlier steroid intervention \u201cperhaps\u201d could have led to \u201ca fuller recovery.\u201d Such evidence does not establish that \u201c[t]he connection or causation between [Defendants\u2019 alleged] negligence and [Plaintiff\u2019s injury was] probable, not merely a remote possibility.\u201d White, 88 N.C. App. at 387, 363 S.E.2d at 206 (emphasis added). This is especially true given that both Dr. Frohman and Dr. Grady qualified their statements by stressing that while a different outcome might have been possible, it would be speculative to offer an opinion as to whether a different outcome could have been achieved in Plaintiff\u2019s case and what that outcome might have been. See Young v. Hickory Bus. Furn., 353 N.C. 227, 233, 538 S.E.2d 912, 916 (2000) (stating that \u201c \u2018could\u2019 or \u2018might\u2019 expert testimony [is] insufficient to support a causal connection when there is additional evidence or testimony showing the expert\u2019s opinion to be a guess or mere speculation\u201d).\nPlaintiff stresses that \u201cproximate cause is normally a question best answered by the jury.\u201d Leatherwood v. Ehlinger, 151 N.C. App. 15, 24, 564 S.E.2d 883, 889 (2002), disc. review denied, 357 N.C. 164, 580 S.E.2d 368 (2003). While we agree with Plaintiffs contention, \u201c[P]laintiff must nevertheless provide a sufficient forecast of evidence to justify presentment to the jury.\u201d Kenyon v. Gehrig, 183 N.C. App. 455, 457-58, 645 S.E.2d 125, 127 (2007), disc. review denied, 362 N.C. 176, 658 S.E.2d 272 (2008). Plaintiff has not met his burden in this case. We therefore hold that the trial court did not err in granting the Beerman and Wake Forest Defendants\u2019 motions for summary judgment.\nGiven our holding on the issues discussed above, we need not address Plaintiff\u2019s remaining assignments of error.\nAffirmed.\nJudges STEELMAN and GEER concur.\n. Plaintiff also filed suit against Hugh Chatham Hospital, which is not a party to this appeal.\n. While Plaintiffs complaint alleges that these events occurred on 22 December 2002, the record reveals that Plaintiff actually first sought treatment with the Wake Forest Defendants on 23 December 2002.\n. Defendants have also cited Sharpe v. Pugh, 21 N.C. App. 110, 203 S.E.2d 330 (1974) as controlling authority in this case. The North Carolina Supreme Court affirmed our Court\u2019s decision in Sharpe by an equally divided vote, with one justice not participating. See Sharpe v. Pugh, 286 N.C. 209, 209 S.E.2d 456 (1974) (per curiam) (Bobbitt, C.J., not participating). The Supreme Court\u2019s split vote \u201crequire[d] that the decision of the Court of Appeals be affirmed without becoming a precedent.\u201d Id. at 210, 209 S.E.2d at 456-57. Therefore, while Sharpe may be persuasive authority in this case, it does not control our decision.", "type": "majority", "author": "McGEE, Judge." } ], "attorneys": [ "The Law Offices of Robert O. Jenkins, by Robert O. Jenkins, for Plaintiff.", "McGuireWoods, L.L.P., by Mark E. Anderson and Andrew H. Nelson, for Defendants Wake Forest University, Wake Forest University Baptist Medical Center, Wake Forest University Health Sciences, and North Carolina Baptist Hospital.", "Wilson & Coffey, LLP, by Linda L. Helms and G. Gray Wilson, for Defendants Paul J. Beerman, M.D. and Yadkin River Radiology, P.A." ], "corrections": "", "head_matter": "ALLEN THOMAS LORD, Plaintiff-Appellant v. PAUL J. BEERMAN, M.D.; YADKIN RIVER RADIOLOGY, P.A.; HUGH CHATHAM MEMORIAL HOSPITAL, INC.; WAKE FOREST UNIVERSITY; WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER; WAKE FOREST UNIVERSITY HEALTH SCIENCES; and NORTH CAROLINA BAPTIST HOSPITAL, Defendants-Appellees\nNo. COA07-1550\n(Filed 15 July 2008)\nMedical Malpractice\u2014 failure to diagnose or treat sooner\u2014 proximate cause \u2014 sufficiency of evidence \u2014 summary judgment\nThe trial court did not err in a medical malpractice case by granting summary judgment in favor of defendants because: (1) to survive a motion for summary judgment in a medical malpractice action, plaintiff must forecast evidence demonstrating that the treatment administered by defendant was in negligent violation of the accepted standard of medical care in the community and that defendant\u2019s treatment proximately caused the injury; (2) where plaintiff alleges that he was injured due to a physician\u2019s negligent failure to diagnose or treat plaintiff\u2019s medical condition sooner, plaintiff must present at least some evidence of a causal connection between defendant\u2019s failure to intervene and plaintiff\u2019s inability to achieve a better ultimate medical outcome; (3) the connection or causation between the negligence and injury must be probable and not merely a remote possibility; (4) plaintiff\u2019s evidence was insufficient to establish the requisite causal connection between defendants\u2019 alleged negligence and plaintiff\u2019s blindness when neither of plaintiff\u2019s expert witnesses were able to testify that plaintiff\u2019s vision would be better today had defendants initiated steroid treatment sooner, nor were they able to testify that plaintiff\u2019s vision probably would be better; and (5) while plaintiff stresses that proximate cause is normally a question best answered by the jury, plaintiff must nevertheless provide a sufficient forecast of evidence to justify presentment to the jury.\nAppeal by Plaintiff from orders entered 2 August 2007 by Judge Ronald E. Spivey in Superior Court, Surry County. Heard in the Court of Appeals 21 May 2008.\nThe Law Offices of Robert O. Jenkins, by Robert O. Jenkins, for Plaintiff.\nMcGuireWoods, L.L.P., by Mark E. Anderson and Andrew H. Nelson, for Defendants Wake Forest University, Wake Forest University Baptist Medical Center, Wake Forest University Health Sciences, and North Carolina Baptist Hospital.\nWilson & Coffey, LLP, by Linda L. Helms and G. Gray Wilson, for Defendants Paul J. Beerman, M.D. and Yadkin River Radiology, P.A." }, "file_name": "0290-01", "first_page_order": 322, "last_page_order": 333 }