national standard in District of Columbia

2010Although our adoption of a rule requiring reference to a national standard of care was based in part on the medical profession’s practice of national certification in certain recognized areas such as general surgery, see Morrison, 407 A.2d at 564-65 , we have never defined the permissible scope of the expert testimony itself to include only testimony about what would be done by a physician holding a particular Board certification without regard to specialization within the certified area.

2007In order to establish a national standard, “the plaintiff must establish through expert testimony the course of action that a reasonably prudent doctor with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland v. Pinder, 899 A.2d 770, 773 (D.C.2006) (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984) (citing Morrison v. MacNamara, 407 A.2d 555, 560-65 (D.C.1979))).

2013We have often held that an expert’s opinion must include “some evidence of a national standard, such as attendance at national seminars or meetings or conventions, or reference to published, materials, when evaluating a medical course of action or treatment.” Hawes v. Chua, 769 A.2d 797, 806 (D.C.2001) (emphasis added); see also Hill v. Medlantic Health Care Grp., 933 A.2d 314, 326-27 (D.C.2007) (foundation for expert’s testimony inadequate where expert did not “provide an independent basis” for concluding “that his opinion ... was based upon literature, speaking with other doctors around the

2010In Hawes we summarized the minimum requirements for expert testimony on the national standard of care as follows: “(1) it is insufficient for an expert’s standard of care testimony to merely recite the words ‘national standard of care’;[ 4 ] (2) such testimony may not be based upon the expert’s personal opinion, nor mere speculation or conjecture; and (3) such testimony must reflect some evidence of a national standard.” 769 A.2d at 806 .

2010To overcome a challenge to the sufficiency of his or her evidence under Rule 50 (judgment as a matter of law), therefore, a plaintiff is required to show that a reasonable juror could fairly conclude that the expert testimony about the national standard established by a preponderance of the evidence “the course of action that a reasonably prudent doctor "with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland, 899 A.2d at 773 (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984)); see Hill, 933 A.2d at 325 and Nwaneri, 931 A.2d at 470 (quoting Stri

2007In order to establish a national standard, “the plaintiff must establish through expert testimony the course of action that a reasonably prudent doctor with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland v. Pinder, 899 A.2d 770, 773 (D.C.2006) (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984) (citing Morrison v. MacNamara, 407 A.2d 555, 560-65 (D.C.1979))).

2013We have often held that an expert’s opinion must include “some evidence of a national standard, such as attendance at national seminars or meetings or conventions, or reference to published, materials, when evaluating a medical course of action or treatment.” Hawes v. Chua, 769 A.2d 797, 806 (D.C.2001) (emphasis added); see also Hill v. Medlantic Health Care Grp., 933 A.2d 314, 326-27 (D.C.2007) (foundation for expert’s testimony inadequate where expert did not “provide an independent basis” for concluding “that his opinion ... was based upon literature, speaking with other doctors around the

2011Extensive expert testimony supports the court’s findings, in compliance with the words of a recent decision of this court, that the “expert must explicitly indicate the basis for his or her knowledge of the national standard of care, state what the national standard of care is, and provide a basis for his or her opinion testimony that another doctor has deviated from that standard.” Hill v. Medlantic Health Care Group, 933 A.2d 314, 328 (D.C.2007).

1998Capitol Hill Hosp. v. Jones, 532 A.2d 89, 93 (D.C.1987); Watkins, supra, 684 A.2d at 401 .

1990With respect to institutions such as hospitals, this court has rejected the “locality” rule, which refers to the standard of conduct expected of other similarly situated members of the profession in the same locality or community, see Capitol Hill Hosp. v. Jones, 532 A.2d 89, 93-94 (D.C.1987), in favor of a national standard.

2010To overcome a challenge to the sufficiency of his or her evidence under Rule 50 (judgment as a matter of law), therefore, a plaintiff is required to show that a reasonable juror could fairly conclude that the expert testimony about the national standard established by a preponderance of the evidence “the course of action that a reasonably prudent doctor "with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland, 899 A.2d at 773 (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984)); see Hill, 933 A.2d at 325 and Nwaneri, 931 A.2d at 470 (quoting Stri

2010To overcome a challenge to the sufficiency of his or her evidence under Rule 50 (judgment as a matter of law), therefore, a plaintiff is required to show that a reasonable juror could fairly conclude that the expert testimony about the national standard established by a preponderance of the evidence “the course of action that a reasonably prudent doctor "with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland, 899 A.2d at 773 (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984)); see Hill, 933 A.2d at 325 and Nwaneri, 931 A.2d at 470 (quoting Stri

2010See Snyder, 890 A.2d at 246 (noting that during voir dire, plaintiff’s expert "indicated that any subsequent testimony regarding the standard of care ... would reflect a national standard”). .

2009Rather, the testifying expert must establish that the relevant standard of care is followed nationally, “either through reference to a published standard, discussion of the described course of treatment with practitioners outside the District at seminars or conventions, or through presentation of relevant data.” Strickland, supra, 899 A.2d at 773-74 (internal punctuation and citations omitted); Snyder v. George Washington Univ., 890 A.2d 237 , 241 n. 3 (D.C.2006) (standard-of-care “testimony must reflect some evidence of a national standard, such as attendance at national seminars or meetings

2006See, e.g., Battle v. Thornton, 646 A.2d 315 , 322 n. 8 (D.C.1994); In re Melton, 597 A.2d 892, 897-98 (D.C.1991) (en banc); District of Columbia v. Anderson, 597 A.2d 1295, 1299 (D.C.1991); Ornoff v. Kuhn and Kogan Chartered, 549 A.2d 728, 732 (D.C.1988).

2001ANALYSIS We turn first to appellants’ argument that the testimony of Dr. Charles F. Hill, Jr., appellees’ expert witness regarding the standard of care owed to Mrs. Hawes, should have been struck by the trial court, because he failed “to provide any basis for his opinion as to the national standard of care.” Appellees argue that the trial court did not abuse its discretion in deciding not to strike Dr. Hill’s testimony, because, “[a]s the [trial] [e]ourt ... noted, there was no need to recite the mantra of ‘national’ in each and every question and answer. ...” “ ‘The trial judge has wide latit

2010To overcome a challenge to the sufficiency of his or her evidence under Rule 50 (judgment as a matter of law), therefore, a plaintiff is required to show that a reasonable juror could fairly conclude that the expert testimony about the national standard established by a preponderance of the evidence “the course of action that a reasonably prudent doctor "with the defendant’s specialty would have taken under the same or similar circumstances.” Strickland, 899 A.2d at 773 (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984)); see Hill, 933 A.2d at 325 and Nwaneri, 931 A.2d at 470 (quoting Stri

2007Ctr., 579 A.2d 177, 182 (D.C.1990), we concluded that there was sufficient evidence to establish a national standard of care.

2013In finding the expert’s testimony in that case inadequate to establish a foundation for an opinion on the national standard of care, this court wrote that, despite the expert’s repeated reference to published materials, “there [was] no evidence that the journals [the expert] received ... contained information about the national standard of care, or revealed what that standard was.” Id.

2013The expert had also failed to provide “any testimony indicating whether these journals, or his published article, were national, peer-reviewed publications that recognized a national standard of care for vascular surgeons.” Id.

2007See District of Columbia v. Carmichael, 577 A.2d 312, 316 (D.C.1990).

1998Without addressing or even citing Mitchell or Watkins , the District relies on a line of cases such as Phillips, supra, 714 A.2d at 773-74 , Clark, supra, 708 A.2d at 635-36; District of Columbia v. Moreno, 647 A.2d 396, 399 (D.C.1994); District of Columbia v. Carmichael, 577 A.2d 312, 314-16 (D.C.1990); and Toy v. District of Columbia, 549 A.2d 1, 6-8 (D.C.1988), in which we have been especially “demanding in requiring proof of a national standard of care.” Clark, supra, 708 A.2d at 635 (citations omitted).

2003See Phillips, 714 A.2d at 773 (reference to American Correctional Association (ACA) standards was insufficient when no specific standard was identified; “the expert must testify as to specific ACA standards ... and must relate them to the defendant’s conduct” (emphasis in original) (citing Moreno, 647 A.2d at 401 )); Clark, 708 A.2d at 635 n. 3 (passing reference to an ACA standard not sufficient).

1998Without addressing or even citing Mitchell or Watkins , the District relies on a line of cases such as Phillips, supra, 714 A.2d at 773-74 , Clark, supra, 708 A.2d at 635-36; District of Columbia v. Moreno, 647 A.2d 396, 399 (D.C.1994); District of Columbia v. Carmichael, 577 A.2d 312, 314-16 (D.C.1990); and Toy v. District of Columbia, 549 A.2d 1, 6-8 (D.C.1988), in which we have been especially “demanding in requiring proof of a national standard of care.” Clark, supra, 708 A.2d at 635 (citations omitted).

2006Standard of Review "In a medical malpractice action, there are three elements a plaintiff must show to establish a prima facie case: `(1) the applicable standard of care; (2) a deviation from that standard of care by the defendant; and (3) a causal relationship between that deviation and the plaintiff's injury.'" Burke v. Scaggs, 867 A.2d 213, 217 (D.C.2005) (emphasis in original) (quoting Talley v. Varma, 689 A.2d 547, 552 (D.C.1997)). "[I]n view of the uniform standards of proficiency established by national board certification," the standard of care for board-certified physicians "is to be

2006Burke v. Scaggs, 867 A.2d 213, 217 (D.C.2005) (emphasis in original) (quoting Talley v. Varma, 689 A.2d 547, 552 (D.C.1997)). “[I]n view of the uniform standards of proficiency established by national board certification,” the standard of care for board-certified physicians “is to be measured by the national standard.” Morrison v. MacNamara, 407 A.2d 555, 565 (D.C.1979).

2010See Strickland, 899 A.2d at 773 (“The personal opinion of the testifying expert as to what he or she would do in a particular case ... is insufficient to prove the applicable standard of care.” (quoting Travers, 672 A.2d at 568 )); Coulter, 964 A.2d at 189 (“Further, an expert’s educational and professional background is not sufficient to demonstrate that he is familiar with the national standard of care.”); id. (“[T]he testifying expert must establish that the relevant standard of care is followed nationally, ‘either through reference to a published standard, discussion of the described cours

2010See Strickland, 899 A.2d at 773 (“The personal opinion of the testifying expert as to what he or she would do in a particular case ... is insufficient to prove the applicable standard of care.” (quoting Travers, 672 A.2d at 568 )); Coulter, 964 A.2d at 189 (“Further, an expert’s educational and professional background is not sufficient to demonstrate that he is familiar with the national standard of care.”); id. (“[T]he testifying expert must establish that the relevant standard of care is followed nationally, ‘either through reference to a published standard, discussion of the described cours

2010E.g., Evans-Reid v. District of Columbia, 930 A.2d 930, 936 (D.C.2007) (opinion relating to use of deadly force by police officer when conducting routine traffic stop); District of Columbia v. Wilson, 721 A.2d 591, 597 (D.C.1998) (opinion relating to standard of care in medical malpractice case); Messina v. District of Columbia, 663 A.2d 535, 539 (D.C.1995) (opinion relating to safe construction of playground equipment). 6 However, in other contexts the specific language we have used has called this general requirement into ques tion.

1997See Messina, supra, 663 A.2d at 538-40 ; Moreno, supra, 647 A.2d at 399-401 ; Carmichael, supra, 577 A.2d at 314-16 ; Toy, supra, 549 A.2d at 7-8 .

2010See Aikman v. Kanda, 975 A.2d 152, 160-62 (D.C.2009).

2010See Aikman, 975 A.2d at 161 . 2 *500 Dr. Bieligk’s medical studies and practice had taken him to Oklahoma, Louisiana, New York, and Maryland.

2006Moreover, "the use of expert testimony is required since the subject is `not likely to be within the common knowledge of the average layman.'" Allen v. Hill, 626 A.2d 875, 877 (D.C.1993) (quoting District of Columbia v. Barriteau, 399 A.2d 563, 569 (D.C.1979)).

2006Moreover, “the use of expert testimony is required since the subject is ‘not likely to be within the common knowledge of the average layman.’ ” Allen v. Hill, 626 A.2d 875, 877 (D.C.1993) (quoting District of Columbia v. Barriteau, 399 A.2d 563, 569 (D.C.1979)).

2006Moreover, "the use of expert testimony is required since the subject is `not likely to be within the common knowledge of the average layman.'" Allen v. Hill, 626 A.2d 875, 877 (D.C.1993) (quoting District of Columbia v. Barriteau, 399 A.2d 563, 569 (D.C.1979)).

2006Moreover, “the use of expert testimony is required since the subject is ‘not likely to be within the common knowledge of the average layman.’ ” Allen v. Hill, 626 A.2d 875, 877 (D.C.1993) (quoting District of Columbia v. Barriteau, 399 A.2d 563, 569 (D.C.1979)).

1987We also held in Noble v. Worthy, supra, that “[architects are held to a standard of performance which requires them to employ that degree of skill and care ordinarily used by their colleagues,” 378 A.2d at 676 (citations and footnote omitted), and in Morrison we declared, citing Noble , that “[architects are not held to a standard of conduct exercised by other architects in the District or a similar locality ... [but are] held to a national standard of care.” 407 A.2d at 564 .

1987We also held in Noble v. Worthy, supra, that “[architects are held to a standard of performance which requires them to employ that degree of skill and care ordinarily used by their colleagues,” 378 A.2d at 676 (citations and footnote omitted), and in Morrison we declared, citing Noble , that “[architects are not held to a standard of conduct exercised by other architects in the District or a similar locality ... [but are] held to a national standard of care.” 407 A.2d at 564 .

1987See Shilkret v. Annapolis Emergency Hospital Ass’n, 276 Md. 187, 198 , 349 A.2d 245, 252 (1975); Douglas v. Bussabarger, 73 Wash.2d 476, 488-90 , 438 P.2d 829, 837-38 (1968); Brune v. Belinkoff, 354 Mass. 102 , 235 N.E.2d 793 (1968); Blair v. Eblen, 461 S.W.2d 370, 372-73 (Ky.1970); Shier v. Freedman, 58 Wis.2d 269 , 206 N.W.2d 166 (1973). 17 .

1979E. g., Robbins v. Footer supra (applying national standard of care to board certified specialist in the federal courts of this jurisdiction); Kronke v. Danielson, 108 Ariz. 400, 403 , 499 P.2d 156, 159 (1972) (specialist); Blair v. Eblen, 461 S.W.2d 370, 372-73 (Ky.1970) (general practitioners); Ardoin v. Hartford Accident & Indemnity Co., 360 So.2d 1331, 1340 (La.1978) (specialist); Brune v. Belinkoff, supra (specialist, dictum general practitioners); Naccarato v. Grob, 384 Mich. 248, 254 , 180 N.W.2d 788, 791 (1970) (specialist); Belk v. Sweizer, 268 N.C. 50, 56 , 149 S.E.2d 565, 569 (1966)

2010See Coulter, 964 A.2d at 191 (noting that “nothing in [the proposed expert’s] testimony established that he attended national conferences, or kept current with pertinent medical literature, from which he could be familiar with the national standard of care”); see also Travers, 672 A.2d at 569-70 (rejecting the testimony of an expert as to the national standard of care where “the expert expressed a personal opinion rather than a national standard of care”).

2010See Strickland, 899 A.2d at 773 (“The personal opinion of the testifying expert as to what he or she would do in a particular case ... is insufficient to prove the applicable standard of care.” (quoting Travers, 672 A.2d at 568 )); Coulter, 964 A.2d at 189 (“Further, an expert’s educational and professional background is not sufficient to demonstrate that he is familiar with the national standard of care.”); id. (“[T]he testifying expert must establish that the relevant standard of care is followed nationally, ‘either through reference to a published standard, discussion of the described cours

2001As she put it: “As long as you say there’s a national standard of care, that’s sufficient, and he has done that.” But, Travers, Wilson and Phillips, supra, stand for the proposition that something more than mere utterance of the words “national standard of care” is required of experts in medical malpractice cases.

2000Since the trial court relied on the testimony of Mr. Cochran and Mr. Papadopoulos to establish the applicable standard of care, and that testimony is inadequate given the principles governing the presentation of expert testimony, see Clark, supra; Phillips, supra, and given the testimony of Mr. Colanzi, which arguably may be sufficient, together with other evidence of record, to establish the applicable national standard of care governing this case, we are constrained to remand this matter to Judge Braman for further proceedings regarding the District’s liability, with instructions to address

1998Without addressing or even citing Mitchell or Watkins , the District relies on a line of cases such as Phillips, supra, 714 A.2d at 773-74 , Clark, supra, 708 A.2d at 635-36; District of Columbia v. Moreno, 647 A.2d 396, 399 (D.C.1994); District of Columbia v. Carmichael, 577 A.2d 312, 314-16 (D.C.1990); and Toy v. District of Columbia, 549 A.2d 1, 6-8 (D.C.1988), in which we have been especially “demanding in requiring proof of a national standard of care.” Clark, supra, 708 A.2d at 635 (citations omitted).

1995However, the expert “gave no indication of how many police departments throughout the country have this type of emergency equipment available,” and the court specifically noted that “[o]ne instance of a police department with [such] emergency equipment is plainly insufficient to provide a factual basis for an expert opinion that the national standard of care requires police departments to maintain resuscitation equipment.” Id. at 8 .

2010E.g., Evans-Reid v. District of Columbia, 930 A.2d 930, 936 (D.C.2007) (opinion relating to use of deadly force by police officer when conducting routine traffic stop); District of Columbia v. Wilson, 721 A.2d 591, 597 (D.C.1998) (opinion relating to standard of care in medical malpractice case); Messina v. District of Columbia, 663 A.2d 535, 539 (D.C.1995) (opinion relating to safe construction of playground equipment). 6 However, in other contexts the specific language we have used has called this general requirement into ques tion.

2001In applying these principles to Dr. Hill, appellees’ national standard of care expert, we are mindful that our opinions concerning a plaintiffs national standard of care expert testimony, by which this panel as well as the trial judges are bound, have ranged from requiring a minimal or modest showing of adherence to a national standard, see Phillips and Wilson, supra, to a more extensive and substantial showing, see Travers, supra. 8 However, we do not understand any of our opinions, read in their totality, to declare that, in a medical malpractice case, a mere recitation of the words “nationa

1987See Shilkret v. Annapolis Emergency Hospital Ass’n, 276 Md. 187, 198 , 349 A.2d 245, 252 (1975); Douglas v. Bussabarger, 73 Wash.2d 476, 488-90 , 438 P.2d 829, 837-38 (1968); Brune v. Belinkoff, 354 Mass. 102 , 235 N.E.2d 793 (1968); Blair v. Eblen, 461 S.W.2d 370, 372-73 (Ky.1970); Shier v. Freedman, 58 Wis.2d 269 , 206 N.W.2d 166 (1973). 17 .

1987See Shilkret v. Annapolis Emergency Hospital Ass’n, 276 Md. 187, 198 , 349 A.2d 245, 252 (1975); Douglas v. Bussabarger, 73 Wash.2d 476, 488-90 , 438 P.2d 829, 837-38 (1968); Brune v. Belinkoff, 354 Mass. 102 , 235 N.E.2d 793 (1968); Blair v. Eblen, 461 S.W.2d 370, 372-73 (Ky.1970); Shier v. Freedman, 58 Wis.2d 269 , 206 N.W.2d 166 (1973). 17 .

2023In District of Columbia v. Arnold & Porter, 756 A.2d 427, 429 (D.C. 2000), we held that “expert testimony is required to establish the national standard of care for the operation and maintenance of a municipal water system and the handling of leaks in that system.” At issue in that case was whether the District’s response to a ruptured water main pipe, which it resolved in four to five hours, was unreasonably delayed when “the task could have been accomplished in one to two hours.” Id. at 430 .

2023In District of Columbia v. Arnold & Porter, 756 A.2d 427, 429 (D.C. 2000), we held that “expert testimony is required to establish the national standard of care for the operation and maintenance of a municipal water system and the handling of leaks in that system.” At issue in that case was whether the District’s response to a ruptured water main pipe, which it resolved in four to five hours, was unreasonably delayed when “the task could have been accomplished in one to two hours.” Id. at 430 .

2019E.g., Montano, 800 F.3d at 186 (factual issue regarding whether 1 This tipping standard is a national standard that also accounts for local variation.