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Derzavis v. Bepko12/29/2000
rmed the examination. According to Dr. Bepko, he "introduced the brush until you couldn't see the last bristles attached to the handle," while the standard of care required that it be inserted "until only the bristles closest to the handle are exposed." This evidence, as well as other evidence bearing on the issue, is adequate to allow the jury to decide whether appellee deviated from the standard of care.
The adequacy of the evidence to support the third element for a medical negligence claim, while perhaps a closer question, is one which must be resolved in Derzavis' favor under our standard of review. This element was supported by expert testimony as well as other evidence properly relied upon by the expert. Dr. Kleinerman testified that, to a reasonable degree of medical certainty, appellee's breach of the standard of care caused injuries and damages to Derzavis. She testified that her opinion was based upon Derzavis' description of how she felt before and during the examination and notes and deposition testimony which included a description of how Dr. Bepko performed the Pap smear with the cytobrush. She explained the importance of the temporal connection between the use of the cytobrush and the immediacy of Derzavis' pain. Dr. Kleinerman explained that Derzavis felt fine, or not particularly uncomfortable before the examination, but felt extreme pain when the cytobrush was used. This medical expert testified that, to a reasonable degree of medical certainty, the patient should not experience this kind of pain if the taking of the Pap smear had comported with the applicable standard of care. Other evidence established the simultaneity between the Pap smear and the onset of Derzavis' symptoms. Derzavis testified that she had no symptoms when she went for the medical appointment for a Pap smear. Dr. Bepko testified initially concerning the use of the cytobrush in performing the Pap smear on Derzavis that "I inserted it. At this point she yelled and said, . . . what are you doing to me, or words to that effect." He later testified that the patient screamed either while he was going in or coming out with the cytobrush. Derzavis testified that she screamed so loudly because of the pain, the worst she had ever felt in her life, and the nurse came into the room. She also testified that she noticed that the slide Dr. Bepko took was full of blood, and she asked him about it, to which he responded, "I did that." There was also evidence that Derzavis experienced coldness, perspiration, and weakness immediately, and more profuse bleeding after the incident. This evidence was sufficient to avoid judgment as a matter of law on the issue of causation. It was for the jury to determine whether to accept or reject the expert's opinion, considering the expert's "education, experience, the reasons given for the opinion, the expert's credibility, and all the other evidence in the case." Standardized Civil Jury Instructions for the District of Columbia, No. 3-3 (Rev. Ed. 1998).
This case differs from this court's decision in Lasley v. Georgetown Univ., 688 A.2d 1381 (D.C. 1997), cert. denied, 522 U.S. 1060 (1998), cited by the majority, in which we held that " n a medically complicated case . . . contemporaneity between a medical procedure and an injury is too weak a foundation upon which to infer causation." 688 A.2d at 1387. The issue in Lasley was whether "it was fatal to Lasley's claim that none of his witnesses explicitly asserted that the embolization procedure caused his AVM [arteriovenous malformation] to rupture and hemorrhage." Id. at 1383. Since the rupture and bleeding occurred during the embolization procedure, Lasley contended that expert testimony of a causal link was not necessary. Id. In Lasley, unli
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