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You can search the entire site. or go to the recent opinions, or the chronological or subject indices. Kimberly and Jonathon Goodwin v. Mat-Su Midwifery, Inc., et al (12/6/2024) sp-7733

Kimberly and Jonathon Goodwin v. Mat-Su Midwifery, Inc., et al (12/6/2024) sp-7733

        Notice:  This opinion is subject to correction before publication in the PACIFIC REPORTER.   

        Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts,  

        303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email  

        corrections@akcourts.gov.  

  

  

                  THE SUPREME COURT OF THE STATE OF ALASKA  



  



KIMBERLY WALLACE GOODWIN,                                 )     

and JONATHON GOODWIN,                                     )   Supreme Court Nos.: S-18401/18411  

individually and as the parents of                        )     

JACKSON WALLACE GOODWIN,                                  )   Superior Court No.: 3AN-14-10649 CI  

                                                          )     

         Appellants and Cross-Appellees,                  )   O P I N I O N  

                                                          )     

         v.                                               )   No. 7733 - December 6, 2024  

                                                          )  

MAT-SU MIDWIFERY, INC., d/b/a                             )  

MAT-SU MIDWIFERY AND                                      )  

FAMILY HEALTH, JUDI                                       )  

DAVIDSON, and DARCY LUCEY,                                )  

                                                          )  

         Appellees and Cross-Appellants.                  )  

                                                          )  

                   

                 Appeal from the Superior Court of the State of Alaska, Third  

                 Judicial District, Anchorage, Gregory Miller, Judge.  

  

                 Appearances:  Ted Stepovich, Law Office of Ted Stepovich,  

                 Anchorage,  and Kenneth  P.  Jacobus,  Kenneth  P.  Jacobus,  

                 P.C., Anchorage, for Appellants and Cross-Appellees.  John  

                 J.  Tiemessen,  Clapp Peterson  Tiemessen  Thorsness,  LLC,  

                 Fairbanks, for Appellees and Cross-Appellants.  

  

                 Before:  Maassen, Chief Justice, and Carney, Borghesan, and  

                 Pate, Justices. [Henderson, Justice, not participating.]  

                   

                 BORGHESAN, Justice.  

                   


----------------------- Page 2-----------------------

        INTRODUCTION  



               This  appeal  arises  from  a  medical  malpractice  suit.    The  parents  of  a  



stillborn child sued the midwives attending the birth for malpractice.  The plaintiffs  



alleged, among other things, that the midwives failed to obtain informed consent for  



delivery by midwife at a birth center, instead of delivery by physician at a hospital.  The  



plaintiffs alleged that the midwives did not disclose the risks of midwife delivery for  



expectant mothers like the plaintiff:  a woman of advanced maternal age with a history  



of miscarriage.  The superior court granted summary judgment in favor of the midwives,  



ruling that the plaintiffs failed to present evidence that midwife delivery caused the  



child to be stillborn.    



               The key issue in this appeal concerns the element of proximate cause in  



informed consent claims.  The plaintiffs argue that they presented sufficient evidence  



of causation to survive summary judgment because they showed they would not have  



opted  for  midwife  delivery  had  they  been  properly  informed  of  the  risks.    But  this  



evidence was not enough.  To prevail on a claim of informed consent, a plaintiff must  



prove two aspects of proximate cause:  first, that the plaintiff would not have consented  



to  the treatment or course of care had the risks been disclosed; and second, that the  



treatment or course of care caused the plaintiff's injury.  The midwives presented expert  



opinion indicating that their care did not cause the stillbirth, and the plaintiffs did not  



meet their burden to present evidence that the midwives' care did  cause the stillbirth.   



Therefore, we affirm summary judgment in the midwives' favor.  We also affirm the  



superior court's award of enhanced attorney's fees based on the plaintiffs' vexatious  



litigation conduct.     



        FACTS AND PROCEEDINGS  



        A.     Facts 



               Kimberly  Wallace  Goodwin  became  pregnant  in  2012.    She  and  her 



husband, Jonathon Goodwin, named the unborn child Jackson.  Kimberly was 39 years  



old at the time of this pregnancy and had previously suffered several miscarriages.   



                                                 -2-                                          7733  


----------------------- Page 3-----------------------

                After  Kimberly  became  pregnant,  the  Goodwins  engaged  a  doctor  for  



obstetrical care.   In October 2012 the doctor transferred Kimberly's care to Mat-Su  



Midwifery,   Inc.   ("Midwifery")   for   delivery   of   the   child.      On   November   21,  



approximately 40 weeks into her pregnancy, Kimberly attended an appointment at the  



Midwifery.  She was cared for by a direct entry midwife, Judi Davidson, and a certified  

nurse midwife, Darcy Lucey.1  Kimberly expressed concerns in that appointment that  



she was overdue.2  According to the Goodwins, Davidson and Lucey told Kimberly to  



return in one week.   



                Kimberly returned to the clinic on November 28 and was again told to  



return in one week.  She returned on December 3, nearly 42 weeks into her pregnancy.   



A test was performed, which indicated that the fetus was "reactive."  Kimberly was told  



to return in two days.   She returned on December 5, and then again on December 6  



when she was in active labor.     



                Lucey  initially monitored Kimberly.   The Midwifery's records indicate  



that at 11:00 a.m., Jackson's fetal heart rate was 130-140 and that at 11:30 a.m. his fetal  



heart  rate was 120.    Lucey  announced at this time that she was not sure if she was  



detecting Jackson's heartrate or Kimberly's.  Davidson joined  Lucey at 12:15 p.m. and  



checked  the  fetal  heartrate.    At  12:15  p.m.  and  12:25  p.m.,  the  fetal  heartrate  was  



                                                                                                             

        1        There are statutes and regulations governing direct entry midwives, but  

they  do  not  appear  to  define  what  a  direct  entry  midwife  is.    See  AS 08.65.010  -  

08.65.190; 12 Alaska Administrative Code (AAC)  14.110 -  14.990.  According to the  

parties' briefing below and the superior court's order, a direct entry midwife operates  

independently  of  a  hospital  setting,  while  a  certified  nurse  midwife  has  additional  

training and certifications.  See also  12 AAC 14.500(b)-(c) (describing duties of direct  

entry midwife toward "home-birth client").  The precise definition of a direct entry  

midwife is not central to this opinion.    

        2       A pregnancy is considered full-term from 39 weeks through 40 weeks and  

6  days.    Nat'l  Child  &  Maternal  Health  Educ.  Program,  Nat'l  Inst.  of  Health,  

https://www.nichd.nih.gov/ncmhep/initiatives/know-your-terms/moms (June 2, 2022).    



                                                     -3-                                               7733  


----------------------- Page 4-----------------------

recorded at 70-80.  Shortly thereafter, Davidson and Lucey transported Kimberly to the  



hospital, where Jackson was delivered stillborn via caesarian section.   



                 Following the stillbirth, the Goodwins lobbied the  legislature to pass a  



statute  creating  a  cause  of  action  for  the  wrongful  death  of  an  unborn  child.  Their  



testimony to the legislature implied that Alaska law did not recognize such an action.    



                 The resulting statute was codified as Alaska Statute 09.55.585 and named  

"Jackson's Law."3  The uncodified portion of the law provides:  "This Act applies to  



actions arising from a wrongful act or omission that takes place on or after the effective  

date  of  this Act."4    The  effective date  was  in  October  2014,  nearly  two years  after  



                         5 

Jackson's stillbirth.   



         B.      Proceedings  



                 In  December  2014  the  Goodwins,  "individually  and  as  the  parents  of  



Jackson,"  filed  suit  against  the  Midwifery,  Lucey,  and  Davidson  (collectively  "the  



                                                                                       6 

Midwifery"), on claims of negligence and lack of informed consent.     



                 In  February  2017  the  Goodwins  filed  a  list  identifying  their  expert  



witnesses.    This  list  named  Dr.  Donald  Rogers,  the  forensic  pathologist  who  had  



performed the autopsy on Jackson.  However, by this time Dr. Rogers' medical license  



had lapsed.  He died in 2019 without ever having been deposed.  The Goodwins also  



named Kathryn Osborne, a certified nurse midwife, as their expert.   



                 In March 2017 the Midwifery moved for summary judgment.  It argued  



that (1) there was no cause of action for the death of an unborn child under the general  



wrongful death statute, AS 09.55.580, and (2) quasi-estoppel barred the Goodwins from  



utilizing this statute due to their testimony before the legislature that no cause of action  



                                                                                                                

         3       Ch. 77, SLA 2014.  



         4       Id.  



         5       Id.  



         6       The Goodwins also brought several other claims that are not relevant to  

this appeal.   



                                                       -4-                                                7733  


----------------------- Page 5-----------------------

existed under that law.  Opposing the motion, the Goodwins argued that a majority of  



states  allow  wrongful  death  claims  for  viable  unborn  children  and  that  the  same  



approach should be adopted in Alaska.  They also disputed that quasi-estoppel applied  



to them.   



                 The superior court denied this motion for summary judgment.  The court  



held that the general  wrongful death statute provided the Goodwins with a cause of  

action.7  And it concluded that the Goodwins' claims were not barred by quasi-estoppel.     



                 In  December  2018  the  Midwifery  moved  to  exclude  Osborne's  expert  



testimony, arguing that her experience and knowledge as a certified nurse midwife did  



not qualify her to testify on the standard of care applicable to Davidson, a direct entry  

midwife.8  The Goodwins opposed this motion.    



                 The superior court did not immediately rule on this motion.   The delay  



was a result of a trial continuance, granted due to the Goodwins' divorce, uncertainty  



regarding whether their counsel could continue with the representation, and questions  



about Kimberly's capacity for trial.  Due to this delay, the Midwifery moved for costs  



incurred in preparing for the continued trial.  The superior court granted the request in  



part.   



                 Over the next few months, the superior court expressed frustration with  



the Goodwins' behavior.  After Kimberly failed to verify her discovery requests, despite  



numerous orders, the court imposed sanctions. After the Goodwins failed to pay those  



sanctions  more than a year and a half later, the court found that the Goodwins were  



willfully  disobedient.  In  July  2020  the  court  denied  the  Goodwins'  motion  for  



                                                                                                             

        7        The superior court cited an Oregon case, Libbee v. Permanente Clinic, 518  

P.2d 636, 637-40 (Or. 1974), which held that a viable unborn child is a "person" under  

Oregon's  similar  wrongful  death  statute.    The  superior  court  also  noted  that,  as  a  

remedial statute, AS 09.55.580(a) should be interpreted liberally to avoid unjust results.     

        8        In cases of professional negligence an expert witness must be "trained and  

experienced in the same discipline or school of practice as the defendant or in an area  

directly related to a matter at issue."  AS 09.20.185(a)(2).   



                                                      -5-                                              7733  


----------------------- Page 6-----------------------

reconsideration of the court's willful disobedience finding, stating that the case was  



being "stalled in a way [it had] never seen in a case before.  Motions having to be filed.   



Fees having to be incurred."   



                  Eventually,       in   September        2020,     the    superior     court     granted     the  



Midwifery's motion to exclude Osborne as an expert witness.  The court concluded that  



Osborne, "as a certified nurse midwife who has practiced exclusively in hospitals, has  



an insufficient basis for testifying about the standard of care ordinarily exercised by  



direct entry midwives."   The court gave the Goodwins until January 2021 to file an  



updated witness list.  The court then extended the deadline to April 2021.   



                  In April 2021 Kimberly provided an affidavit from a new expert on the  



standard  of  care,  Elizabeth  Cook,  a  certified  professional  midwife.    In  the  body  of  



Cook's  expert  report,  she  alleged  that  the  Midwifery  "failed  to  meet  applicable  



standards of care" in ten different ways.   She opined that the Midwifery's failure "to  



meet applicable standards of care . . . contributed to the demise of" Jackson.     



                  The Midwifery deposed Cook.  The Midwifery's counsel questioned Cook  



on the cause of the stillbirth:   



                  Q. Okay.  And you will agree with me in your 15 April 2021  

                  affidavit  report  you  don't  state  what  medical  condition  

                  Jackson Goodwin died from?  

                    

                  A. I don't give a medical diagnosis . . . for the demise.  I give  

                  contributing factors.  

                    

                  Q. Have you ever made a determination of cause of death on  

                  a death certificate?  

                    

                  A. I have not.  

                    

                  Q.  And  in  your  practice,  would  you  typically  defer  to  

                  pathologists for determination of causes of death?  

                    

                  A. I would defer to the neonatology experts in collaboration  

                  with pathology, potentially in collaboration with obstetrical  



                                                         -6-                                                  7733  


----------------------- Page 7-----------------------

                 experts as to cause of death, but I may contribute . . . events  

                 leading to that or contributing factors to a cause of death.  

                 . . .  

                 Q. Are you able to say on a more-likely-than-not basis that  

                 any of the deficits that you identified in your report more  

                 likely than not caused the fetal demise.  

                   

                 A. What I can say is that, as I pointed out in my report, that  

                 failure to provide fully informed consent for shared decision  

                 making as to all options for care and current evidence on  

                 recommendations for care based on the individual factors of  

                 Kimberly      Goodwin's        situation,    particularly     AMA,       or  

                 advanced maternal age, and post-term or late-term gestation  

                 potentially contributed to the demise of this baby . . . .  And  

                 as  I  also  pointed  out,  that  failure  to  respond  in  a  timely  

                 manner when heart tones dropped in labor also potentially  

                 contributed to the death of this baby.   And overall, we see  

                 significant  failure  on  the  part  of  Mat-Su  Midwifery  to  

                 provide a quality care to this patient.   



When pressed, Cook stated that either inadequate record keeping prevented a definitive  



diagnosis  or  that  a  specialist  would  ultimately  need  to  weigh  in  on  the  cause  of  



Jackson's death.   



                 In January 2022 the Midwifery moved for summary judgment again.  The  



Midwifery submitted an affidavit from its own causation expert, Dr. Judy Melinek, a  



forensic  pathologist.    Dr.  Melinek  concluded  that  the   stillbirth  was  caused  by  



"intrauterine fetal demise due to chorioamnionitis and funisitis."  Dr. Melinek asserted  



that this diagnosis meant "that the placenta and umbilical cord supplying blood to the  



infant were damaged by an infection prior to delivery."   According to Dr. Melinek,  



"[c]horioamnionitis and funisitis are well-described natural causes for intrauterine fetal  



demise  regardless  of  type  of  delivery  and  type  of  obstetrical  care."    The  affidavit  



concluded that there was no pathologic evidence to support the claim that the midwives'  



care and treatment during delivery caused Jackson's demise.    



                 In its motion, the Midwifery quoted from Cook's deposition and argued  



that she had failed to state an opinion on the cause of death.  The Midwifery argued that  



                                                       -7-                                               7733  


----------------------- Page 8-----------------------

the Goodwins could not rebut Dr. Melinek's explanation for the cause of death and  



therefore failed to establish a dispute of material fact as to whether the Midwifery's care  



caused  Jackson's  death.    The  Goodwins  did  not  oppose  this  motion  for  summary  



judgment.   



                 The superior court granted the motion for summary judgment in February  



2022.  The superior court noted that "whether a plaintiff must present expert testimony  



on causation depends on the nature of the injury and the plaintiff's causation theory,"  



but the Goodwins had "not filed any opposition - and thus no theory of causation or  



supporting evidence."   The court  also  observed that Cook had been "retained on the  



standard of care issue, but not causation."  Thus, the court concluded that it "need not  



determine whether now at issue is a 'technical' or 'non-technical' theory of causation"  



and granted summary judgment.  The court requested briefing on whether its ruling on  



causation disposed of all claims.    



                 The Midwifery filed a motion for final judgment arguing that both the  



negligence  claim  and  the  informed  consent  claim  hinged  on  causation.  Jonathon  



opposed this motion, asserting that (1) Cook was qualified to testify on causation, and  



(2) expert testimony is not required to prove causation in an informed consent claim.   



With  respect  to  the  second  argument,  Jonathon  relied  on  our  decision  in  Poulin  v.  



Zartman  to  argue  that  establishing  proximate  cause  in  an  informed  consent  claim  



merely requires evidence that the plaintiff would have declined the procedure or chosen  

a different course if  adequately informed.9   The court entered final judgment against  



the Goodwins and dismissed all claims.    



                 Jonathon moved for reconsideration.   He argued that the superior court  



failed  to  consider  Cook's  report.    The  superior  court  denied  reconsideration.  It  



                                                                                                             

         9       Poulin v. Zartman, 542 P.2d 251, 275 (Alaska 1975) (concluding plaintiff  

failed to prove proximate cause because "[t]he record fail[ed] to establish that, had he  

known of the alternative, he would have declined the procedure which was employed"),  

overruled on other grounds by State v. Alex, 646 P.2d 203, 208 n.4 (Alaska 1982).  



                                                      -8-                                              7733  


----------------------- Page 9-----------------------

explained  that  it  had  considered  Cook's  affidavit  and  deposition  when  granting  



summary judgment, but she had not expressed an opinion on the cause of death.  The  



court also explained that proximate causation is an element of an informed consent  



cause  of  action.    The  court  concluded  that  because  "Cook's  affidavit  contains  no  



reference to . . . whether . . . failure to inform proximately caused any harm," summary  



judgment against the Goodwins was warranted.    



                 The  Midwifery  moved  for  enhanced  fees  under  Alaska  Civil  Rules  

82(b)(3) and 95.10   The Midwifery argued that the Goodwins had engaged in "seven  



years  of  stop  and  start  litigation,"  ignoring  deadlines,  procedures,  and  discovery  



requirements.  At oral argument,  the Goodwins ' former  counsel  stated  that  "from the  



very  beginning  . . . there  was no  case here  and  that  has  not  changed."    The  former  



counsel added that the Goodwins had difficulty retaining an expert on causation; "it did  



evolve into a point where getting that expert . . . was close to impossible."   



                 The  court  granted  the  motion  and  awarded  $295,923.61  in  fees  and  



$35,653.63 in costs jointly and severally against the Goodwins.  The court made several  



findings:  (1) the case was uniquely complicated; (2) the case twice came to the eve of  



trial, causing the Midwifery to incur trial preparation costs twice; (3) the Midwifery's  



attorney's  fees  were  reasonable;  (4)  the  Midwifery  used  a  reasonable  number  of  



attorneys; (5) the Midwifery's attorney tried to minimize fees; (6) around April 2019  



the   Goodwins'   responsiveness   began   to   deteriorate   and   their   claims   became  



unreasonable; (7) the Goodwins' actions after April 21, 2019, were vexatious and  in  



bad  faith;  and  (8)  the  Midwifery  litigated  the  case  in  a  proper  manner  while  the  



Goodwins did not, which drove up fees.    



                 The  parties  now  appeal.    The  Goodwins  appeal  the  superior  court's  



summary  judgment  ruling  in  the  Midwifery's  favor  and  the  award  of  enhanced  



                                                                                                              

         10      Alaska R. Civ. P. 82(b)(3) (allowing court to vary standard attorney's fee  

award upon consideration of listed factors); Alaska R. Civ. P. 95 (allowing  court to  

withhold or assess attorney's fees to penalize infraction of Civil Rules).  



                                                      -9-                                               7733  


----------------------- Page 10-----------------------

attorney's fees.  The Midwifery cross-appeals, arguing that the superior court erred in  



construing  the  wrongful  death  statute  and  in  declining  to  estop  the  Goodwins'  



                                         11 

arguments related to that statute.            



         STANDARD OF REVIEW  



                 "We  review  a  grant  of  summary  judgment  de  novo,  applying  our  

independent judgment."12   "We affirm a grant of summary judgment if there are no  



genuine  issues of material fact and the movant is entitled to judgment as a matter of  

law."13  "Whether the evidence presented a genuine issue of material fact is a question  



of  law  that  we  independently  review."14    "When  applying  the  de  novo  standard  of  



review, we apply our 'independent judgment to questions of law, adopting the rule of  



                                                                               15 

law most persuasive in light of precedent, reason, and policy.' "                  



                 "We  review  the  denial  of  a  motion  for  reconsideration  for  abuse  of  

discretion."16    "The  abuse  of  discretion  standard  asks  'whether  the  reasons  for  the  



                                                                                                             

         11      The Midwifery was not required to cross-appeal to raise these arguments  

in support of the judgment.  "[A]n appellee may urge . . . in defense of a decree or  

judgment any matter appearing in the record, even if rejected below and even if [the]  

appellee's argument may involve an attack upon the reasoning of the lower court or an  

insistence upon [a] matter overlooked or ignored by it."  Nicolos v. N. Slope Borough,  

424 P.3d 318, 325 (Alaska 2018) (quoting Ransom v. Haner, 362 P.2d 282, 285 (Alaska  

 1961)).  

         12      Kalenka v. Infinity Ins.  Cos., 262 P.3d 602, 607 (Alaska 2011).  



         13      Ball v. Birch, Horton, Bittner & Cherot, 58 P.3d 481, 485 (Alaska 2002).  



         14      ConocoPhillips Alaska, Inc. v. Williams Alaska Petroleum, Inc., 322 P.3d  

 114, 122  (Alaska 2014) (quoting Kalenka v. Jadon, Inc., 305  P.3d 346, 349 (Alaska  

2013)).  

         15      Id.  (quoting Russell  ex  rel.  J.N.  v.  Virg-In ,  258  P.3d 795, 802  (Alaska  

2011)).  

         16      Szabo v. Mun. of Anchorage, 320 P.3d 809, 813 (Alaska 2014)  (quoting  

Alaskan Adventure Tours, Inc. v. City & Borough of Yakutat, 307 P.3d 955, 959 (Alaska  

2013)).  



                                                      -10-                                             7733  


----------------------- Page 11-----------------------

exercise  of  discretion  are  clearly  untenable  or  unreasonable'  and  fall  outside  the  

boundaries of reasonable responses."17  



                We review an award of attorney's fees for abuse of discretion.18  Abuse  



of discretion exists if the award is "arbitrary, capricious, manifestly unreasonable, or  

improperly motivated."19   "Because an enhanced fee award under  Rule 82(b)(3)(G)  



calls into question a party's litigation conduct and the potential merits of the party's  



arguments and defenses, we assess de novo the legal and factual viability of the party's  

claims and review relevant findings of fact for clear error."20  



        DISCUSSION  



                The parties have presented many issues for our consideration on appeal,  



but  the key  issue  is causation.   The  superior  court  ruled  that  the  Goodwins did not  



present  evidence  rebutting  the  Midwifery's  evidence  that  its  conduct  did  not  cause  



Jackson  to  be  stillborn,  so  the  Goodwins'  negligence  and  informed  consent  claims  



failed.  Because we agree with the superior court that the Goodwins needed to present  



this evidence and did not, we agree with the court's conclusion that their claims could  



not survive summary judgment.  Therefore, the issues occupying most of the parties'  



briefing  are  beside  the  point:    whether  the  superior  court  erred  in  deciding  that  the  



Goodwins' first expert was not qualified to opine on the applicable standard of care;  



whether the court correctly interpreted the wrongful death statute prior to the enactment  



of "Jackson's Law" to permit recovery for the death of an unborn person; and whether  



                                                                                                           

        17      Buchholdt v. Nelson, 534 P.3d 91, 93 (Alaska 2023)  (quoting Moore v.  

Moore , 349 P.3d 1076, 1084 (Alaska 2015)).  

        18      Nautilus Marine Enters., Inc. v. Exxon Mobile Corp. , 332 P.3d 554, 557  

(Alaska 2014).  

        19      Roderer v. Dash, 233 P.3d 1101, 1106 (Alaska 2010) (quoting Rhodes v.  

Erion, 189 P.3d 1051, 1053 (Alaska 2008)).  

        20      Keenan v. Meyer, 424 P.3d 351, 356 (Alaska 2018) (internal quotation  

marks and brackets omitted) (quoting Herring v. Herring, 373 P.3d 521, 528 (Alaska  

2016)).  



                                                     -11-                                            7733  


----------------------- Page 12-----------------------

the court should have estopped the Goodwins from arguing that the law permitted their  



claim  for  wrongful  death  when  they  suggested  to  the  legislature  that  it  did  not.   



However, we do address and affirm the superior court's award of enhanced attorney's  



fees to the Midwifery.        



        A.       The Superior Court Did Not Err In Granting Summary Judgment To  

                 The  Midwifery  Because  The  Goodwins  Did  Not  Present  Evidence  

                 That The Midwifery's Treatment Caused Jackson To Be Stillborn.     

                 An essential element of any tort claim is causation.21  The plaintiff must  



show that the defendant caused the harm that the plaintiff has suffered.22  The Goodwins  



do  not  dispute  that  their  medical  malpractice  claim  requires  them  to  prove  that  the  

Midwifery's negligence caused Jackson to be stillborn.23  But they appear to argue that  



their informed consent claim requires proving only that, had the Midwifery properly  



informed them of the risks of midwife delivery, they would not have opted for midwife  



delivery and would have opted for delivery in a hospital instead.  Implicit in this position  



is  the  argument  that  the  Midwifery's  failure  to  obtain  informed  consent  makes  the  



Midwifery liable for any harm that occurred to the mother or child, even if there is no  



evidence that those harms were caused by having a midwife-assisted delivery.  This is  



not the law.    



                 Rather, establishing causation for an informed consent claim  entails two  



distinct showings.  The plaintiff must show that she would not have gotten the treatment  

or course of care if she had been properly informed of the risk.24  And the plaintiff must  



                                                                                                             

        21       See, e.g., RESTATEMENT (SECOND) OF TORTS § 281 (AM. L. INST .  1965).  



        22       See id. §§ 431, 432.  



        23       See id. § 433B.  



        24       See Canesi ex rel. Canesi v. Wilson, 730 A.2d 805, 812 (N.J. 1999).  



                                                      -12-                                             7733  


----------------------- Page 13-----------------------

also show that the harm she suffered was actually caused by the treatment or course of  

care she received.25  The second showing may be referred to as "medical causation."26    



                At common law, medical causation is a necessary element of informed  

consent  claims.27    The  Alaska  statute  governing  informed  consent  claims  does  not  



mention  medical  causation,  but  the  text  and  legislative  history  of  the  medical  



malpractice statutes do not reveal a clear intent to change the common law elements of  

this tort.28  Therefore, we conclude that under Alaska law, a plaintiff must show medical  



causation to prevail on a claim of informed consent.   



                 The Goodwins failed to present evidence of medical causation in this case,  



and this failure is fatal to their claim.  "[A] party seeking summary judgment has the  



initial  burden  of  proving,  through  admissible  evidence,  that  there  are  no  [genuine]  



disputed issues of material fact and that the moving party is entitled to judgment as a  

matter  of  law."29    The  Midwifery  moved  for  summary  judgment,  presenting  Dr.  



Melinek's opinion that the stillbirth was caused by an infection independent of any act  



or omission by the Midwifery.   



                 Once  the  Midwifery  made  this  showing,  the  burden  shifted  to  the  



Goodwins  "to  set  forth  specific  facts  showing  that  [they]  could  produce  evidence  



                                                                                                             

        25      See id. at 812-13.  



        26      See id. at 812.  



        27      See generally STUART M. SPEISER ET. AL., 4A AMERICAN LAW OF TORTS  

§ 15:73 n.1 (2024).  See also Poulin v. Zartman, 542 P.2d 251, 275 (Alaska 1975) ("It  

is a "seemingly undisputed principle that proximate cause must be shown in order to  

recover for lack of informed consent." (citing Patrick v. Sedwick, 391 P.2d 453, 458  

(Alaska 1964))), overruled on other grounds by State v. Alex, 646 P.2d 203, 208 n.4  

(Alaska 1982).  

        28      Knolmayer v. McCollum , 520 P.3d 634, 647  (Alaska 2022)  ("[S]tatutes  

will not be interpreted as changing the common law unless they effect the change with  

clarity."  (alteration  in  original)  (quoting  ANTONIN  SCALIA  &  BRYAN  A.  GARNER,  

READING LAW : THE INTERPRETATION OF LEGAL TEXTS 318 (West 2012))).  

        29      Mitchell v. Teck Cominco Alaska Inc. , 193 P.3d 751, 760 n.25 (Alaska  

2008).  



                                                      -13-                                             7733  


----------------------- Page 14-----------------------

reasonably tending to dispute or contradict the movant's evidence and thus demonstrate  

that  a  material  issue  of  fact  exists."  30      But  the  Goodwins'  experts  did  not  rebut  



Dr. Melinek's  opinion  about  the  cause  of  Jackson's  death.    And  contrary  to  the  



Goodwins' assertion, expert evidence was required to establish medical causation in  

this case.31   Whether  the  midwives' actions were a substantial factor in causing the  



stillbirth of a child is not the kind of inference that lay people can reliably determine  

based  on  their  everyday  experience.32    Therefore,  the  "complete  lack  of  evidence  



establishing   causation   [was]   grounds   for   summary   judgment"   in   favor   of   the  



              33 

Midwifery.                  



                 1.      At common law, a claim for failure to obtain informed consent  

                         requires  the  plaintiff  to  prove  that  the  treatment  obtained  

                         caused the injury.   



                 At  common  law,  a  claim  of  malpractice  based  on  a  lack  of  informed  



consent generally required three elements:  (1) that the practitioner failed to disclose the  



risks of and alternatives to a course of treatment when a reasonable practitioner would  



have;  (2)  "that  a  reasonably  prudent  patient  in  the  same  position  would  not  have  



undergone the treatment if he or she had been fully informed"; and (3) "that the actual  



                                                                                                               

        30       Christensen  v.  Alaska  Sales  &  Serv.,  Inc.,  335  P.3d  514,  517  (Alaska  

2014) (quoting  State, Dep't of Highways v. Green, 586 P.2d 595, 606 n.32 (Alaska  

1978)).   

        31       See Culliton v. Hope Cmty. Res. Inc., 491 P.3d 1088, 1097 (Alaska 2021).   

("If the connection between the defendant's conduct and the plaintiff's injury is not  

readily  apparent  to  a  lay  person  relying  on  'everyday  experience,'  the  opinion  of  a  

medical expert is required to establish this connection.").    

        32       Compare  Choi  v.  Anvil,  32  P.3d  1,  4  (Alaska  2001)  (For  "a  rear-end  

automobile collision causing relatively common injuries . . . like pain, stiffness, and  

loss of strength . . . the jury, using everyday experience, could readily find a causal  

relationship  without  []  expert  assistance."),  with   Culliton,  491  P.3d  at   1096-97  

("Without the aid of medical expertise, a lay person cannot reliably decide whether one  

particular  aspiration  event  was  a  substantial  cause  of  [pneumonia  and  eventually]  

death.").  

        33       Culliton, 491 P.3d at 1096.  



                                                       -14-                                              7733  


----------------------- Page 15-----------------------

procedure performed for which there was no informed consent was the proximate cause  

of  the  injury."34    As  we  stated  in  1975,  before  the  legislature  codified  the  tort  of  



informed consent in statute, it was a "seemingly undisputed principle that proximate  



                                                                                          35 

cause must be shown in order to recover for lack of informed consent."                        



                 Proximate cause can be difficult to define.  One treatise observes that "the  



consequences of an act go forward to eternity, and the causes of an event go back to the  



dawn of human events, and beyond.  But any attempt to impose responsibility upon  

such a basis would result in indefinite liability for all wrongful acts."36  Therefore, "[a]s  



a practical matter, legal responsibility must be limited to those causes  which are so  



closely connected with the result and of such significance that the law is justified in  

imposing liability."37  The Restatement (Second) of Torts echoes this sentiment when  



describing negligence claims generally:  "In order to be a legal cause of another's harm,  



it is not enough that the harm would not have occurred had the actor not been negligent.  



. . . The negligence must also be a substantial factor in bringing about the plaintiff's  

harm."38   "If, without the actor's negligent conduct, the  other would have sustained  



harm,  the  same  in  character  and  extent  as  that  which  he  receives,  the  actor's  



                                                                                                               

         34      STUART M. SPEISER ET. AL., 4A AMERICAN LAW OF TORTS  § 15:73 n.1  

(2024).  

         35      Poulin v. Zartman, 542 P.2d 251, 275 (Alaska 1975)  (citing Patrick v.  

Sedwick, 391 P.2d 453, 458 (Alaska 1964)), overruled on other grounds by State v.  

Alex , 646 P.2d 203, 208 n.4 (Alaska 1982).    

         36      W. PAGE KEETON ET. AL., PROSSER AND KEETON ON THE LAW OF TORTS  

§ 41, at 264 (5th ed. 1984).  

         37      Id.   



         38      RESTATEMENT (SECOND) OF TORTS § 431 cmt. a (AM. L. INST . 1965); see  

also  id.  §  433  (describing  factors  important  in  determining  if  actor's  conduct  is  a  

substantial factor in bringing about harm to another).  



                                                       -15-                                              7733  


----------------------- Page 16-----------------------

conduct . . . is not even its necessary antecedent, and so is not a substantial factor in  

bringing it about."39  



                 When the concept of proximate cause is applied to an informed consent  



claim,  it  requires  two  causal  showings:    that  the  patient  received  a  treatment  she  



otherwise would not have consented to if properly informed, and that the treatment was  



a  substantial  factor  in  bringing  about  the  injury.    The  New  Jersey  Supreme  Court  



explained this point in a case similar to the Goodwins' case,  Canesi ex rel. Canesi v.  

Wilson.40  In that case, parents brought an informed consent claim against a physician  



for failing to properly inform them of the side effects of taking a medication in early  

pregnancy,  seeking  damages  for  their  child's  congenital  limb  defects.41    The  court  



explained that "[i]n informed  consent  cases, proximate  cause requires  the plaintiff  to  



prove that a reasonably prudent patient in the plaintiff's position would have declined  



to undergo the treatment if apprised of the risks that the defendant negligently failed to  

disclose."42   "In  addition," the  court went  on,  "because  damages  in  informed  consent  



cases include the harm or physical injury to the patient, there must be medical causation,  



that  is,  a  causal  connection  between  the  undisclosed  risk  and  the  injury  ultimately  

sustained."43  The court affirmed summary judgment in favor of the physician because  



the parents "presented insufficient proof of a causal relationship between the drug and  

the  defect  that  afflicts  their  son."44   Other  courts have reached  similar  conclusions.45   



                                                                                                                   

         39      Id.  § 432 cmt. a (emphasis added).  



         40       730 A.2d 805 (N.J.  1999).  



         41      Id. at 809-10.  



         42      Id. at 812.  



         43      Id.   



         44      Id. at 814.   



         45      See,  e.g., Looney  v.  Moore,  886  F.3d  1058,  1062-70  (11th  Cir.  2018)  

(describing Alabama law as requiring informed consent plaintiff to prove they were  

  



                                                         -16-                                                7733  


----------------------- Page 17-----------------------

These authorities confirm that medical causation is an essential element of the common  



law tort of informed consent.   



                 2.      Alaska's   informed   consent   statute   does   not   abrogate   the  

                         common law element of medical causation.  



                 The     Goodwins       suggest     that    Alaska's      informed      consent     statute,  



AS 09.55.556(a), requires a plaintiff to show only that she would not have chosen the  



treatment in question had she been properly informed of the risks.  They imply that the  



statute does not require a showing of medical causation.  Although the statutory text  



does  not  mention  medical  causation,  we  see  no  clear  indication  that  the  legislature  



intended  to  abrogate  this  element  of  the  common  law  when  it  codified  the  tort  of  



informed  consent.    The  legislative  history  supports  this  conclusion:   the  legislature  



drafted the statute as part of  a wholesale review of medical malpractice  law  to  limit  



lawsuits  and  damage  recoveries.    Therefore,  proving  medical  causation  remains  



necessary to prevail on a claim of informed consent under Alaska law.  



                 We applied the informed consent statute in Parker v. Tomera, but did not  

squarely address the need to present evidence of medical causation.46   In Parker, we  



partially  reversed  a  grant  of  summary  judgment  to  the  defendants  on  an  informed  

consent  claim.47    We  held  that  the  plaintiff's  failure  to  present  expert  testimony  to  



support  his  claim  that  it  was  possible  for  the  procedure  to  have  caused  his  sexual  



dysfunction was grounds for summary judgment in favor of the defendants as to that  

injury.48  However, because the defendant's expert did not offer an opinion about the  



other symptoms the plaintiff claimed to have suffered, there was "no expert testimony  



                                                                                                               



"injured as a result of the particular treatment" and concluding that plaintiff provided  

insufficient evidence of such causation); Andersen v. Khanna , 913 N.W.2d 526, 544- 

48 (Iowa 2018)  (recognizing that injury caused by procedure is essential element to  

informed consent claims).   

        46       89 P.3d 761 (Alaska 2004).  



        47       Id. at 769.  



        48       Id.  



                                                       -17-                                              7733  


----------------------- Page 18-----------------------

for [the plaintiff] to rebut" regarding those injuries, so the lack of expert testimony was  

not a proper basis for summary judgment as to those injuries.49  But while we addressed  



the sufficiency of an informed consent claim under AS 09.55.556, we discussed the  



need for expert testimony in the context of the risks that had to be disclosed, which  

pertains to the standard of care rather than to medical causation.50  Therefore, we do not  



read Parker  as conclusively establishing the need for medical causation in informed  



consent  claims.    For  that  reason  we  review  the  text  and  legislative  history  of  the  



informed consent statute.  



                 "Whether  the  legislature  intended  to  preserve,  eliminate,  or  otherwise  

modify  [common  law  rules]  is  an  issue  of  statutory  interpretation."51    We  interpret  



statutes "according to reason, practicality, and common sense, taking into account the  

plain meaning and purpose of the law as well as the intent of the drafters."52   "When  



we engage in statutory construction, we must, whenever possible, 'interpret[ ] each part  



or section of a statute with every other part or section, so as to create a harmonious  

whole.' "53  "[S]tatutes will not be interpreted as changing the common law unless they  



                                       54 

effect the change with clarity."             



                                                                                                               

         49      Id .  



         50      Id.  ("Because [defense expert's] affidavit did not address whether these  

were potential side effects there was no expert testimony for [plaintiff] to rebut.  If  

infection  and  prostatitis  are  common  risks  of  catheterization,  then  [plaintiff]  was  

entitled to full information in deciding whether to consent to this procedure.").  

         51      Knolmayer v. McCollum, 520 P.3d 634, 643 (Alaska 2022).  



         52      Cox v. Est. of Cooper, 426 P.3d 1032, 1035 (Alaska 2018) (quoting In re  

Est. of Baker, 386 P.3d 1228, 1231 (Alaska 2016)).  

         53      Kodiak Island Borough v. Exxon Corp., 991 P.2d 757, 761 (Alaska 1999)  

(alteration in original)  (quoting Rydwell v. Anchorage Sch. Dist., 864 P.2d 526, 528  

(Alaska 1993)).  

         54      Knolmayer,  520  P.3d  at  647  (alteration  in  original)  (quoting  ANTONIN  

SCALIA & BRYAN A. GARNER, READING LAW : THE INTERPRETATION OF LEGAL TEXTS  

318 (West 2012)).  



                                                       -18-                                              7733  


----------------------- Page 19-----------------------

                 The informed consent statute was enacted in 1976 as part of a package of  



medical   malpractice   reforms   suggested  by   an   expert   commission  convened  by  



Governor  Jay  Hammond.    The  Commission  had  been  created  to  "study  and  make  



recommendations concerning the problem of adequate professional liability insurance  

availability     for   the    medical      profession."55         The    Commission         published      its  



recommendations  and  drafted  legislation  to  effectuate  them.56    The  draft  legislation  



included  a  provision  on  informed  consent.    The  legislature  ultimately  enacted  the  



following statute:  



                 A  health  care  provider  is  liable  for  failure  to  obtain  the  

                 informed consent of a patient if the claimant establishes by  

                 a preponderance of the evidence that the provider has failed  

                 to inform the patient of the common risks and reasonable  

                 alternatives to the proposed treatment or procedure, and that  

                 but for that failure the claimant would not have consented to  

                                                                [57]  

                 the proposed treatment or procedure.                  



                 Notably,  the  statute  does  not  mention  injury  or  damages  at  all.    This  



silence is in contrast to the general medical malpractice statute, AS 09.55.540, which  



provides :  



                 In a malpractice action based on the negligence or willful  

                 misconduct of a health care  provider, the plaintiff has the  

                 burden      of     proving      by     a    preponderance         of    the  

                 evidence . . . that, as a proximate result of [the defendant's]  

                 lack  of  knowledge  or  skill  or  the  failure  to  exercise  [the  

                 applicable] degree of care, the plaintiff suffered injuries that  

                                                                     [58]   

                 would not have otherwise been incurred.                   



                                                                                                                

         55      Report of the Governor's Medical Malpractice Insurance Commission, at  

2, 13 (Oct. 1, 1975).  

         56      Id.  at  5-10;  Report  of  the  Governor's  Medical  Malpractice  Insurance  

Commission,         Supplement        (Oct.    31,    1975)      (hereinafter      Commission         Report  

Supplement) (containing draft legislation).  

         57      Ch. 102, § 37, SLA 1976; AS 09.55.556(a).  



         58      Ch. 102, § 34, SLA 1976; AS 09.55.540(a)(4).  



                                                       -19-                                               7733  


----------------------- Page 20-----------------------

The contrast between the way the two statutes discuss causation could be read to suggest  



that an informed consent claim under AS 09.55.556(a) requires the plaintiff to prove  



only that she would not have consented to the procedure if fully informed.  Interpreted  



that  way,  AS  09.55.556(a)  would  abrogate  the  medical  causation  element  in  the  



common law tort of informed consent.   



                 But   there   is   ample   reason   to   doubt   that   interpretation.      Reading  



AS 09.55.556  as  eliminating  the  medical  causation  element  would  lead  to  absurd  



results.  For example, a physician's failure to obtain informed consent to vaccinate a  



child would make the physician liable for any illness the child later suffered, even if  



there was no evidence the vaccine caused the illness.  It seems doubtful the legislature  



intended to create such open-ended liability without saying so expressly.  The more  



plausible reading of the statue is that the legislature intended only to define certain  



elements  of  the  informed  consent  tort,  not  to  eliminate  the  common  law's  medical  

causation requirement.59  Under this reading, the legislature did not vastly expand tort  



liability to include any post-treatment injury regardless of a causal link to the treatment.   



                 Another  indication  that  the  legislature  did  not  intend  to  abrogate  the  



common law's medical causation requirement is found in the legislation's provision for  



expert advisory panels.  The legislature provided for an expert advisory panel to be  

appointed in malpractice actions, including those for informed consent.60  The panel of  



                                                                                                               

         59      See  Spencer  v.  Goodill,  17  A.3d  552,  554-57  (Del.  2011)  (rejecting  

argument that  Delaware's  informed consent statute  silently eliminated  common law  

causation requirement).   

         60      See  Ch. 102, § 33, SLA 1976  (codified as amended at AS 09.55.536(a))  



("In an action for  damages due to personal  injury or death based upon the provision  of  

professional  services by a health care provider , including a person providing services  

on behalf of a governmental entity, when the parties have not agreed to arbitration of  

the claim under AS 09.55.535, the court shall appoint within 20 days after the filing of  

an answer to a summons and complaint a three-person expert advisory panel unless the  

  



                                                       -20-                                              7733  


----------------------- Page 21-----------------------

experts must make a written report answering questions primarily relevant to causation,  



including:  "What would have been the probable outcome without medical care?"; "Did  



an injury arise from the medical care?"; "What specifically caused the medical injury?";  

and "Was the medical injury caused by unskillful care?"61  Because the legislature did  



not exempt informed consent claims from the  expert advisory panel statute, we infer  



that the legislature understood informed consent claims to require a showing of medical  



causation, notwithstanding the statute's silence on that point.    



                 The  legislative  history  of  AS  09.55.556  does  not  evince  any  intent  to  



abrogate the common law requirement of medical causation.  Rather, it is focused on  



defining what informed consent means and when it must be obtained.  In its report, the  



Medical  Malpractice  Commission  identified  the  common  law  cause  of  action  for  



informed consent:  "Cases have been brought elsewhere against doctors, not because  



they  performed  a  procedure  negligently,  but  because  they  performed  it  without  the  



permission of the patient, or allegedly obtained consent without properly explaining the  

consequences of the procedure to the patient."62  The Commission then highlighted that  



"[p]hysicians frequently find it necessary to perform surgery or other procedures under  



circumstances where an informed consent cannot be obtained or where . . . it would be  



ill advised to be overly graphic in informing the patient of all the consequences of a  



                        63 

needed procedure."          



                                                                                                              



court decides that an expert advisory opinion is not necessary for a decision in the case."  

(emphasis added)).     



                 We have explained that the appointment of an expert advisory panel is  

discretionary.  See, e.g., Parker v. Tomera, 89 P.3d 761, 767-68 (Alaska 2004).  

        61       Ch. 102, § 33, SLA 1976 (codified as amended at AS 09.55.536(c)).   



        62       Report of the Governor's Medical Malpractice Insurance Commission, at  

59 (Oct. 1, 1975).   

        63       Id.   

                                                      -21-                                              7733  


----------------------- Page 22-----------------------

                 In response to this issue, the Commission recommended  "a  legislatively  



prescribed procedure for informing the patient of the consequences of a procedure and  



obtaining the consent to perform it and also setting forth the conditions pursuant to  

which  consent  is  implied  or  not  required."64    The  Commission  drafted  legislation  



                                65 

effectuating this purpose.          



                 None  of  the  other  legislative  history  materials  suggest  an  intent  to  



eliminate the medical causation element of the common law tort.  Doing so would have  



been contrary to the overall purpose of the medical malpractice reforms:  to lower the  



                                                                                                          66 

cost  of  professional  liability  insurance  by  limiting  medical  malpractice  litigation.                  



Given this overall purpose, it is not plausible that the legislature intended to abrogate  



the medical causation element of informed consent claims so as to expand liability to  



injuries  or  illnesses  that  were  not  causally  connected  to  the  treatment  in  question.   



Rather, the legislature intended to expressly define the standard of informed consent  



without  eliminating  the  plaintiff's  need  to  show  that  the  injury  was  caused  by  the  



unconsented-to treatment.    



                 3.      The Goodwins did not present admissible evidence to dispute  

                         the opinion of the Midwifery's expert that the stillbirth was not  

                         caused by any act or omission of the Midwifery.  



                 When  moving  for  summary  judgment  on  causation,  the  Midwifery  



provided expert testimony from Dr. Melinek concluding that Jackson died from a kind  



of  infection  known  to  cause  stillbirth  "regardless  of  type  of  delivery  and  type  of  



obstetrical care."  Dr. Melinek opined that there was no pathologic evidence to support  



                                                                                                              

        64       Id.   



        65       Commission Report Supplement, supra note 56, at 23-24.   



        66       See    Report      of   the    Governor's       Medical      Malpractice       Insurance  

Commission,  at  12  (Oct.  1,  1975)  (explaining  that  "throughout  the  whole  country,  

malpractice  carrier  insolvency,  retrenching  insurance  markets,  extraordinary  rate  

increases, growing malpractice judgments and rapidly increasing frequency of litigation  

[were] precipitating crises").  



                                                      -22-                                              7733  


----------------------- Page 23-----------------------

the  claim  that  the  midwives'  care  and  treatment  during  delivery  caused  Jackson's  



demise.  With the Midwifery's proffer, "the burden shift[ed] to the non-moving party  



'to  set  forth  specific  facts  showing  that  [they]  could  produce  evidence  reasonably  

tending to dispute or contradict the movant's evidence.' "67  But the Goodwins did not  



oppose the Midwifery's motion for summary judgment and therefore failed to rebut Dr.  



Melinek's theory of causation.  Nevertheless, the court "extensively consider[ed]" their  



expert's  affidavit  and  concluded  that  she  "never  expressed  an  opinion  on  cause  of  



death."   



                 The Goodwins argue that the court erred in granting summary judgment  



in favor of the Midwifery and denying their motion for reconsideration because Cook  



gave  sufficient testimony to rebut Dr. Melinek's theory of causation.   They highlight  



Cook's  statement  that  "the  care  rendered  .  .  .  by  the  [Midwifery]  failed  to  meet  



applicable standards of care, and thus contributed to the [stillbirth]."  This statement did  



not satisfy the Goodwins' burden.                   



                 As discussed above, tort claims for both negligence and lack of informed  



consent require the alleged wrongful act or omission to have proximately caused the  



alleged  injury.    To  show  medical  causation,  the  Goodwins  had  to  show  that  the  



                                                                                                         68 

Midwifery's treatment was a "substantial factor" in causing Jackson to be stillborn.                           



                 Cook's affidavit discussed the risks particular to an expectant mother "of  



advanced maternal age" who "has never previously carried a pregnancy past 20 weeks  



                                                                                                               

        67       Christensen  v.  Alaska  Sales  &  Serv.,  Inc.,  335  P.3d  514,  517  (Alaska  

2014) (quoting  State, Dep't of Highways v. Green, 586 P.2d 595, 606 n.32 (Alaska  

1978)).  

        68       Winschel v. Brown, 171 P.3d 142, 148 (Alaska 2007) ("Alaska follows the  

'substantial factor test' of causation, which generally requires the plaintiff to show that  

the accident would not have happened 'but for' the defendant's negligence and that the  

negligent act was so important in bringing about the injury that reasonable individuals  

would  regard  it  as  a  cause  and  attach responsibility  to  it.");  see  also  Canterbury  v.  

Spence, 464 F.2d 772, 790 (D.C. Cir. 1972); Canesi ex rel. Canesi v. Wilson 730 A.2d  

805, 812 (N.J.  1999).  



                                                       -23-                                              7733  


----------------------- Page 24-----------------------

gestation"  and  concluded  that  "[t]he  most  significant  fetal  risk  in  this  situation  is  



stillbirth."  Cook's affidavit did go on to state that had Kimberly been informed of the  



risks specific to her situation "it is very possible she would have opted for an induction  



earlier in her pregnancy, an in-hospital delivery with greater antenatal and intrapartum  



fetal  surveillance,  and/or  a  c[a]esarean  delivery."    Accordingly  Cook's  affidavit  



established one aspect of proximate cause:  that the Goodwins would have opted for  



different treatment had they been properly informed of the risks.  



                 But Cook's statements  are not  sufficient evidence of medical causation.   



Nothing in Cook's testimony rebuts Dr. Melinek's expert opinion that the stillbirth was  



caused  by  an  infection  unassociated  with  the  conduct  of  the  Midwifery.    Cook's  



testimony provided her expert opinion that the Midwifery "failed to meet applicable  



standards of care, and thus contributed to the [stillbirth]."  Yet she repeatedly declined  



to state a medical diagnosis or cause of death.  Cook also indicated that she could not  



give a cause of death due to inadequate records and would defer to specialists on that  



determination.    Therefore,  her  statements  are  not  evidence  that  opting  for  midwife  



                                                                    69 

delivery was a "substantial factor" in Jackson's death.                 



                 The  evidence  provided  by  the  Goodwin's  earlier  expert,  Osborne,  is  



similarly  lacking.    Osborne's  affidavit  stated  that  the  Midwifery  "failed  to  meet  



expected standards of care" in several respects, which "were substantial contributing  



                                                                                                              

        69       See  RESTATEMENT  (SECOND)  OF  TORTS  §  432(1)  (AM.  L.  INST .  1965)  

("[T]he actor's negligent conduct is not a substantial factor in bringing about harm to  

another  if  the  harm  would  have  been  sustained  even  if  the  actor  had  not  been  

negligent."); id. cmt. a ("If, without the actor's negligent conduct, the other would have  

sustained harm, the same in character and extent as that which he receives, the actor's  

conduct . . . is not even its necessary antecedent, and so is not a substantial factor in  

bringing it about." (emphasis added)); id. cmt. b ("[T]his Subsection is . . . applicable  

where the actor's tortious conduct consists in a failure to take some precautions which  

are required for the protection of another's person . . . .  In such case, if the same harm,  

both in character and extent, would have been sustained even had the actor taken the  

required precautions, his failure to do so is not even a perceptible factor in bringing it  

about and cannot be a substantial factor in producing it.").  



                                                      -24-                                              7733  


----------------------- Page 25-----------------------

factors in the [stillbirth]."  But the affidavit did not opine on the medical condition that  



caused Jackson to stop breathing.  It suggested only that some earlier action should have  



been taken.  And at her deposition Osborne stated that she did not know what caused  



Kimberly's  placenta  to  stop  oxygenating  Jackson;  when  asked  whether  that  sort  of  



analysis was beyond what she was asked to perform for this case, she agreed.  Osborne  



stated she was "curious" about the diagnosis of chorioamnionitis but conceded that this  



was "not [her] area of expertise."  In discussing evidence relevant to the timing of the  



injury Jackson suffered, she conceded again that it was "not [her] area of expertise at  



all."   



                 Therefore, Osborne's statements do not dispute Dr. Melinek's opinion that  



(1) the cause of Jackson's death was "that the placenta and umbilical cord supplying  



blood    to   the   infant    were     damaged   by       an   infection    prior    to   delivery";    (2)  



"[c]horioamnionitis and funisitis are well-described natural causes for intrauterine fetal  



demise regardless of type of delivery and type of obstetrical care"; and (3) there is "no  



pathologic evidence that supports the claim" that the Midwifery "caused the demise of  



Jackson  Goodwin  in  their  care  and  treatment"  of  Kimberly  during  delivery.    The  



Goodwins simply failed to present expert evidence that created a dispute of fact about  



medical causation.  



                 The  Goodwins  also  argue  that  expert  evidence  was  unnecessary  to  



establish causation.  They suggest that the causal link between the Midwifery's course  



of treatment and Jackson's death can be inferred from the sequence of events described  



in the record.  We disagree.    



                 We explained in Culliton v. Hope Community Resources, Inc. that "expert  



testimony is not required 'in non-technical situations where negligence is evident to lay  

people.' "70  But "[i]f the connection between the defendant's conduct and the plaintiff's  



                                                                                                              

        70       491 P.3d 1088, 1094 (Alaska 2021) (quoting D.P. v. Wrangell Gen. Hosp.,  

5 P.3d 225, 228 (Alaska 2000)).  



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----------------------- Page 26-----------------------

injury  is  not  readily apparent  to  a  lay  person  relying on  'everyday  experience,'  the  

opinion of a medical expert is required to establish this connection."71    



                 In   this   case   medical   expertise   is   essential   to   establishing   medical  



causation.  Lay people's ordinary experience does not allow them to reliably decide  



whether  opting  for  delivery  by  midwife  care,  as  opposed  to  hospital  care,  was  a  



substantial factor in Jackson being stillborn.  The Midwifery's expert, Dr. Melinek,  



opined that the stillbirth was caused by an infection that damaged "the placenta and  



umbilical cord supplying blood to the infant."  But it is unknown when this infection  



began or when it became fatal  to Jackson.  We do not know whether Jackson would  



have been born alive had Kimberly been under the care of an obstetrician or had opted  



not to obtain pregnancy care under the direction of midwives.  This question involves  



the  interplay  between  obstetrical  practice  and  the  nature  of  Jackson's  underlying  



condition, which lay people cannot reliably answer without the help of an expert.     



                 Without  expert testimony to rebut Dr. Melinek's opinion that Jackson's  



death was caused by an infection and that there was no evidence the Midwifery's care  



contributed to his death, the Goodwins could not prove that the Midwifery is liable for  

the  stillbirth  under  either  a  negligence  or  informed  consent  theory.72    We  therefore  



affirm the superior court's summary judgment in favor of the Midwifery and its denial  



of reconsideration.    



                                                                                                               

        71       Id. at 1097.   



        72       See  id.  at  1096  ("A complete lack  of evidence establishing causation is  

grounds  for  summary  judgment  in  favor  of  the  defendant.");  see  also  Greywolf  v.  

Carroll, 151 P.3d 1234, 1241 (Alaska 2007) ("[A] complete failure of proof concerning  

an essential element of the nonmoving party's case necessarily renders all other facts  

immaterial."  (alteration in original)  (quoting  Celotex Corp. v. Catrett, 477 U.S. 317,  

323 (1986))).  



                                                       -26-                                              7733  


----------------------- Page 27-----------------------

        B.       The  Superior  Court  Did  Not  Abuse  Its  Discretion  In  Awarding  

                 Enhanced Attorney's Fees.     



                 The Goodwins challenge the superior court's award of enhanced costs and  



fees.  "[I]n general, a trial court has broad discretion to award Rule 82 attorney's fees  



in amounts exceeding those prescribed by the schedule of the rule, so long as the court  

specifies in the record its reasons for departing from the schedule."73   Although "[a]  



Rule 82(b)(3) award of full fees is manifestly unreasonable absent a finding of bad faith  

or  vexatious  conduct,"74  we  have  previously  held  that  a  75%  fee  award  "does  not  



constitute a 'substantially full award' and thus does not require vexatious or bad faith  

conduct."75   "[M]ere evasiveness in responding, contentiousness over difficult issues,  



or delay in completing testimony do not, in themselves, constitute bad faith or vexatious  

conduct."76   Instead, "[c]onduct justifying an increased award must be such that the  



                                                                                   77 

parties are prevented from litigating the action on an equal plane."                   



                 The  superior  court  awarded  enhanced  fees  under  Rule  82(b)(3)  at  a  



cumulative total of 64.5%.  To support its award, the court made detailed findings of  



fact relevant to Rule 82(b)(3)(A)-(K):  (1) this case was extremely complicated; (2) the  



parties  were  "diametrically  opposed"  in  their  view  of  liability;  (3)  the  Goodwins'  



theories of liability changed over the course of litigation as they retained new experts;  



and (4) the Goodwins had trouble retaining experts and were not candid regarding why  



they were having these problems.  The court also found that over the course of the case  



the Goodwins' claims became "unsupported and unsupportable," which they "couldn't  



or wouldn't" acknowledge, as shown by routinely missed deadlines.   



                                                                                                              

        73       Johnson v. Johnson , 239 P.3d 393, 400 (Alaska 2010)  (quoting  United  

Servs. Auto. Ass 'n v. Pruitt ex rel. Pruitt, 38 P.3d 528, 535 (Alaska 2001)).  

        74       Id. (internal quotation marks omitted).  



        75       Cole v. Bartels, 4 P.3d 956, 961 (Alaska 2000).  



        76       Kowalski v. Kowalski, 806 P.2d 1368, 1373 (Alaska 1991).  



        77       Id.  



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----------------------- Page 28-----------------------

                 The  court  also  found  that  the  Goodwins  engaged  in  "vexatious  or  bad  



faith" conduct beginning in April 2019 because the Goodwins "knew they no longer  



could meet their causation burden of proof, yet they hid that for two years as they tried  



to get 'something' for settlement."   The court relied on  statements by the Goodwins'  



                           78 

own former attorney.            



                 This  award  was  not  an  abuse  of  discretion.    The  court  calculated  the  



amount of fees by awarding full fees for certain time periods, but the cumulative award  



itself - 64.5% of reasonable, actual fees - falls below the threshold of  "substantially  

full."79  Therefore, findings of vexatious or bad faith conduct were not required.  Even  



so, the court provided detailed factual support for its findings of vexatious and bad faith  



conduct.   



                 The Goodwins also challenge the court's reliance on Alaska  Civil Rule  



95(a), which permits the court to assess attorney's fees or costs as a penalty for violation  



of the Civil Rules.   "[W]hen assessing attorney's fees under Rule 95(a), the superior  



court must provide an explanation of its reasons for assessing the fees, and the preferred  

practice is to cite a specific rule that has been violated."80   The Goodwins argue that  



"the  trial  court  did  not  specify  what  rules  the  Goodwins  had  violated  and  how  the  



alleged conduct of the Goodwins justified the enhanced award of fees."   



                 The superior court's order was adequate.  Citing to a specific rule is the  

"preferred practice,"81 but failure to do so is not always reversible error.  The superior  



court stated that the Rule 95(a)  award was justified  for  "the reasons stated above" -  



                                                                                                               

         78      The Goodwins argue that the Alaska  superior court erred by making an  

award of attorney's fees permissible only under Civil Rule 68, pertaining to offers of  

judgment, even though the Midwifery did not make a valid offer of judgment.    We  

disagree.  The court clearly explained that Rule 82, not Rule 68, served as the basis for  

enhanced fees, and the court's analysis tracks the requirements of Rule 82.    

         79      Cole, 4 P.3d at 961.  



         80      In re Schmidt, 114 P.3d 816, 826 (Alaska 2005).  



         81      Id.  



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----------------------- Page 29-----------------------

i.e.,  its  discussion  of  factors  under  Rule  82(b)(3).    There  the  court  noted  that  the  



Goodwins "fail[ed] to provide even the most basic discovery, including taking literally  



years and multiple motions and orders to get [the Goodwins] to sign their interrogatories  



under oath."   The court also noted that the Goodwins missed deadlines and failed to  



litigate the case.  These comments adequately describe violations of the Civil Rules and  



therefore provide a sufficient basis for the Rule 95(a) award.  



                 Finally, the Goodwins argue that the superior court erred by awarding the  



Midwifery the cost of experts who did not testify.  They cite Alaska Civil Rule 79(f)(7),  

which limits expert  costs  to the time spent  testifying.82   However, the superior court  



                                                                                                           83 

awarded the expert  costs  under  Rule 95(a), which is not limited in the same way.                             



Therefore, the superior court made no error in awarding these costs.  



         CONCLUSION  



                 We AFFIRM the judgement of the  superior court.  

  



                                                                                                               

        82       Alaska  R.  Civ.  P.  79(f)(7)  (allowing  witness  fees  described  in  Alaska  

Admin. R. 7); Alaska Admin. R. 7(c) ("Recovery of costs for a witness called to testify  

as an expert is limited to the time when the expert is employed and testifying and shall  

not exceed $150.00 per hour, except as otherwise provided in these rules.").  

        83       Alaska R. Civ. P. 95(a) (permitting allocation of costs for "infraction" of  

Civil Rules "as the circumstances of the case and discouragement of like conduct in the  

future may require").  



                                                       -29-                                              7733  

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