Filed 7/2/26 Karkera v. Redlands Community Hospital CA4/1
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for
publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication
or ordered published for purposes of rule 8.1115.
COURT OF APPEAL, FOURTH APPELLATE DISTRICT
DIVISION ONE
STATE OF CALIFORNIA
REVATHI KARKERA, as Conservator, D087437
etc. et al.,
Plaintiffs and Appellants, (Super. Ct. No. CIVSB2215317)
v.
ORDER MODIFYING
REDLANDS COMMUNITY HOSPITAL, OPINION AND DENYING
INC., REHEARING
Defendant and Respondent. NO CHANGE IN JUDGMENT
THE COURT:
It is ordered that the opinion filed herein on June 15, 2026, be modified
as follows:
1. Footnote 4 on page 11 is deleted.
2. A new section III is inserted on page 16 immediately before the
Disposition as follows:
III
After we filed our original opinion, Karkera filed a
petition for rehearing raising multiple issues. We address
them as follows:
First, Karkera argues that section 70701(a)(7)
establishes the standard of care for her negligence per se
claim independent of any community standard of care. But
Karkera did not assert that Dr. Jackson’s opinions were
admissible to establish a violation of section 70701(a)(7) in
her argument on the evidentiary issue in the opening brief.
“Arguments cannot be raised for the first time in a petition
for rehearing.” (Shapell Socal Rental Properties, LLC v.
Chico’s FAS, Inc. (2022) 85 Cal.App.5th 198, 216.)
Moreover, Dr. Jackson did not mention this regulation in
her declaration; she only offered an opinion that Redlands
“fell below the standard of care of a reasonably careful
hospital facility in granting Drs. Schiraldi and Cortez
privileges to perform ETSP surgery under the
circumstances.” (Italics added.) The admitted evidence did
not create a triable issue of material fact on Karkera’s
theory that Redlands violated section 70701(a)(7) by
granting Dr. Schiraldi and Dr. Cortez privileges to perform
ETSP surgery.
Second, Karkera asserts that the “core procedure”
premise was never established by Redlands in its moving
papers. We disagree. Dr. Tung’s declaration stated: “The
procedure in question, an [ETSP], is a procedure within the
core skills of any neurosurgeon that has successfully
completed their residency from an accredited program.
This is a procedure that residents from an accredited
residency program will have to perform numerous times
before being able to graduate from residency.” Moreover,
Karkera herself submitted deposition testimony from Cathi
Bell confirming that the hospital’s “core privileges match
up with the ACGME, a group that actually provides the
structure and what is taught in a residency program” and
“that [the ETSP] procedure must be part of that core that
every neurosurgeon would be trained on.” In Karkera’s
opening brief, she did not contest the trial court’s
conclusion that ACGME “treats the procedure as a core
procedure.” We disregard Karkera’s reliance on new
evidence she submitted in support of her motion for new
trial because she did not challenge the trial court’s ruling
on the motion for new trial in this appeal.
2
Third, Karkera asserts that Dr. Jackson’s declaration
“could not be held to a higher foundational standard than
the declaration [of Christina Andrews] it was offered to
oppose.” Karkera overlooks the fact that she did not object
to the Andrews declaration. Neither the trial court nor this
court had occasion to decide any issue regarding the
foundation for Andrews’s opinions.
Finally, Karkera cites Dr. Jackson’s personal opinion
that Redlands did not have the necessary infrastructure to
conduct ETSP surgeries, including a neurological ICU with
trained staff, neurosurgeons with extensive experience at
ETSP surgeries, and an endocrinologist on staff. But
Dr. Jackson never offered an opinion that this violated the
applicable standard of care for hospitals. Her standard of
care opinion was limited to Redland’s decision to grant
Dr. Schiraldi and Dr. Cortez privileges to perform ETSP
surgery.
There is no change in judgment.
The petition for rehearing is denied.
_________________________
BUCHANAN, Acting P. J.
Copies to: All parties
3
Filed 6/15/26 Karkera v. Redlands Community Hospital CA4/1 (unmodified opinion)
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for
publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication
or ordered published for purposes of rule 8.1115.
COURT OF APPEAL, FOURTH APPELLATE DISTRICT
DIVISION ONE
STATE OF CALIFORNIA
REVATHI KARKERA, as Conservator, D087437
etc. et al.,
Plaintiffs and Appellants,
(Super. Ct. No. CIVSB2215317)
v.
REDLANDS COMMUNITY HOSPITAL,
INC.,
Defendant and Respondent.
APPEAL from a judgment of the Superior Court of San Bernardino
County, Donald Alvarez, Judge. Affirmed.
Burch & Cracchiolo, Susan G. Dana-Kobey, Daryl Manhart, Bryan F.
Murphy; Law Offices of Merel Grey Nissenberg and Merel Grey Nissenberg
for Plaintiffs and Appellants.
Lewis Brisbois Bisgaard & Smith, Jeffry A. Miller, Corinne C.
Bertsche, Bryan R. Reid, and Dean H. McVay, for Defendant and
Respondent.
Revathi Karkera and Anchal Karkera (plaintiffs), as conservators for
Dr. Suchal Karkera (Dr. Karkera), appeal from a judgment entered in favor
of Redlands Community Hospital, Inc. (Redlands) after the trial court
granted the hospital’s motion for summary judgment in their medical
malpractice action. Plaintiffs’ primary argument on appeal is that the court
erred by excluding portions of an expert opinion which they contend
demonstrate the existence of a material factual dispute. We disagree and
affirm.
FACTUAL AND PROCEDURAL BACKGROUND
A. The Surgery
In April 2021, Dr. Karkera, a 34-year-old family medicine physician,
was admitted to Redlands with nausea, vomiting, headache, and visual
deficits from a tumor in her brain. In May 2021, Dr. Michael Schiraldi,
a neurosurgeon at Redlands, performed an endoscopic endonasal
transsphenoidal resection surgery (ETSP) on Dr. Karkera, with assistance
from Dr. Vladamir Cortez, Dr. John Kiessling, Dr. Ajay Ramnot, and
Dr. Louis Reier. After the surgery, Dr. Karkera experienced complications
requiring emergency placement of external ventricular drains and intubation.
Her mental status worsened, and she needed additional interventions and
hourly checks in the intensive care unit. Dr. Karkera’s family eventually
decided to transfer her to another hospital in June 2021 for further
treatment.
Dr. Karkera now suffers from persisting right hemiparesis and third
cranial nerve palsy, which has led to right-side paralysis and blindness in her
left eye, rendering her permanently disabled.
B. The Complaint
In July 2022, plaintiffs filed suit as Dr. Karkera’s co-conservators
against Dr. Schiraldi, his medical group, Redlands, corporate entities
associated with the hospital, and other physicians who provided Dr. Karkera
2
with healthcare services in connection with the surgery. The complaint
alleges professional negligence, breach of fiduciary duty, and battery against
Dr. Schiraldi and other neurosurgeons involved in the surgery (cause of
action one, two, and five); professional negligence against the anesthesia
providers (cause of action three); lack of informed consent and battery against
the neurosurgeons (causes of action four and five); and “statutory”1 and
professional negligence against Redlands (causes of action six and seven).
The sixth cause of action alleged, among other things, that Redlands
failed to comply with California Code of Regulations (CCR) title 22, section
70701, subdivision (a)(7) (section 70701(a)(7)) requiring that a hospital’s
governing body “establish controls that are designed to ensure the
achievement and maintenance of high standards of professional ethical
practices including provision that all members of the medical staff be
required to demonstrate their ability to perform surgical and/or other
procedures competently and to the satisfaction of an appropriate committee
1 Plaintiffs have based their “statutory negligence” claim on Evidence
Code section 669, which provides that a rebuttable presumption of negligence
may arise in certain circumstances, including when a person violates “a
statute, ordinance, or regulation of a public entity.” (Evid. Code, § 669, subd.
(a)(1).) This is properly referred to as “negligence per se” rather than
“statutory negligence” and is merely an evidentiary rule, not the basis for a
separate cause of action. (See McKenna v. Beesley (2021) 67 Cal.App.5th 552,
574, fn. 26 [doctrine of negligence per se is not a separate cause of action, but
creates an evidentiary presumption that affects the standard of care in a
cause of action for negligence].)
3
or committees of the staff, at the time of original application for appointment
to the staff and at least every two years thereafter.”2
The seventh cause of action alleged, in relevant part, that Redlands
breached its duty of care, including in investigating its neurosurgeons’
competency, evaluating the quality and adequacy of the medical care they
rendered to patients, establishing credentialing procedures and standards to
ensure their continued competence, and having “appropriate contingency
planning” to avoid subjecting patients to unreasonable risk of harm and
inadequate medical care.
C. Redlands’ Summary Judgment Motion
In July 2024, Redlands moved for summary judgment or summary
adjudication of issues on the only causes of action asserted against it in the
complaint: the sixth and seventh causes of action.
In their respective statements of undisputed facts, the parties
admitted that the following facts about Redlands’ credentialing process
were undisputed. Redlands grants staff privileges to physicians if their
application for privileges is approved, and Redlands will only approve an
application if a physician meets certain qualifications established to ensure
competency. The medical staff services office at Redlands reviews
applications and verifies each physician’s initial qualifications and other
evidence submitted in support of the application. The relevant department
2 Plaintiffs also alleged in their complaint that Redlands violated CCR
title 22, section 70703, subdivisions (f) and (h), and section 70433, subdivision
(a)(2). Plaintiffs do not argue on appeal that the trial court erred in ruling
that they had failed to raise a triable issue of material fact as to whether
Redlands violated those statutes to support their negligence per se claim.
Accordingly, we limit our review to section 70701(a)(7).
4
chair then reviews each file, and if they approve the application, the
credentials chair or committee reviews the supporting information and
documentation. The credentials chair or committee then makes a
recommendation to the medical executive committee, which reviews the
recommendation and decides what to recommend to the hospital’s board of
directors. The board ultimately decides whether to appoint the physician
to Redlands’ medical staff and grant the physician staff privileges.
When Redlands grants privileges to a surgeon, the surgeon must have
their initial four procedures at the hospital proctored to ensure they are
providing quality treatment. A physician’s appointment to hospital staff, and
its accompanying privileges, are only valid for two years, after which each
applicant must request reappointment.
Redlands followed this review procedure in granting Dr. Karkera staff
privileges as a neurosurgeon. Once credentialed, Redlands does not control
or supervise the manner in which physicians with staff privileges provide
services to patients, and Redlands does not exercise control over the
physicians’ clinical judgment or medical decisions.
The parties disagree about whether Redlands’ credentialing process
was sufficient to ensure the competency of its neurosurgeons. In support of
its motion, Redlands submitted a declaration from Christina Andrews, the
manager of medical staff services at Redlands, and an expert declaration
from Dr. Howard Tung, a neurosurgeon. Andrews stated in her declaration
that Redlands’ credentialing procedures comply with the applicable standard
of care and all statutory requirements because the process requires that new
applicants “must have performed within the last 12 months at least fifty
(50) neurological surgical procedures reflective of the scope of privileges
requested, or successful completion within the past 12 months of an
5
Accreditation Council for Graduate Medical Education [ACGME] or American
Osteopathic Association accredited residency or clinical fellowship.”
In addition to opining on whether hospital staff adhered to the
applicable standard of care in treating Dr. Karkera, Dr. Tung also opined
that because ETSP surgery “is a procedure that is within the core skills of
any neurosurgeon that has successfully completed their residency from an
accredited program,” and because residents will have had to perform the
procedure numerous times before graduating from residency, “Dr. Schiraldi,
as a credentialed neurosurgeon having completed his residency, was fully
and appropriately qualified to perform such a procedure[.]” Relying on these
affidavits, Redlands argued that there was no need for Dr. Schiraldi to make
an additional showing of specific competence to perform ETSP surgery,
beyond what is required for credentialing, for the hospital to fulfill its duty
of care.
Plaintiffs submitted declarations from four experts in opposition
to Redlands’ motion: (1) Dr. Andrew Little, a neurosurgeon; (2) Dr. Gary
Reese, a neurologist; (3) Dr. Harold Pretorius, an endocrinologist; and
(4) Dr. Stephanie Jackson, a hospital administrator with experience in
hospital credentialing. Plaintiffs acknowledged that Dr. Schiraldi had
assisted in 29 ETSP surgeries during his neurosurgical residency, and
that the minimum required for certification by the American Board of
Neurological Surgery is 20. Relying primarily on Dr. Jackson’s opinion,
plaintiffs argued that just because neurosurgery residents are required to
assist in a minimum of 20 ETSP procedures before graduating does not mean
they are competent to perform the procedure as the chief neurosurgeon upon
completing residency. Plaintiffs contended that Dr. Schiraldi, who had not
assisted with an ETSP surgery since March 2018 during his residency, was
6
not competent to perform the surgery as chief neurosurgeon more than three
years later in May 2021. According to plaintiffs, the fact that Redlands
granted core privileges to all its neurosurgeons which allowed them to
perform ETSP surgeries without any “specific demonstration of their
competence” to do so, and without monitoring, constituted a violation of the
hospital’s duty to ensure its credentialed physicians are competent to perform
the surgical procedures for which they are granted privileges.
Plaintiffs also argued, relying on Dr. Pretorius’s opinion, that Redlands
was negligent in allowing Dr. Karkera’s ETSP surgery to proceed without a
preoperative evaluation by an endocrinologist. Dr. Pretorious opined that
such an evaluation would have revealed comorbidities and anomalies “which
mandated transfer to a hospital facility with a higher level of care.”
D. Redlands’ Evidentiary Objections
Redlands objected to portions of Dr. Jackson’s declaration in which she
opined that the hospital “failed to perform their fiduciary duty to adequately
supervise the medical staff credentialing process respecting performance of
ETSP surgeries” because Redlands did not require “any demonstration of
specific training or experience necessary” beyond what it required in granting
core privileges. Redlands also objected to Dr. Jackson’s opinion that
Redlands did not meet the standard of care “of a reasonably careful hospital
facility in granting Drs. Schiraldi and Cortez privileges to perform ETSP
surgery” because:
“[d]espite the complexity of the ETSP surgery and the
risks that surgical errors create for the patients there
was no specific demonstration of competency required
before Dr. Schiraldi was granted privileges to perform
ETSP surgery, which was treated as part of the
neurosurgery staff’s core privileges. There was no
monitoring requirement specific to that procedure
7
although Dr. Schiraldi had never been the chief surgeon
in an ETSP surgery. There was no apparent process for
reevaluation of Dr. Schiraldi’s competence at this procedure
although he had last assisted in an ETSP surgery in 2018,
or any reevaluation of Dr. Cortez’s ongoing competence.
Further investigation was also necessary due to the fact
that, since finishing his residency at Cedars Sinai Medical
Center in 2019, Dr. Schiraldi had settled two prior medical
malpractice claims.”
Redlands further objected to Dr. Jackson’s opinion stating that the
hospital “caused or contributed” to Dr. Karkera’s injuries because “Dr. Little’s
declaration confirms the important role of a neurosurgeon’s experience in
preventing complications from ETSP surgery,” and Redlands’ “credentialing
of Drs. Schiraldi and Cortez despite their inexperience enabled them to
conduct a surgical procedure which more appropriately should have been
entrusted to a more experienced practitioner at another hospital facility with
more experience at treating pituitary lesions.”
Plaintiffs made no objections to Redlands’ evidence in support of its
motion.
E. Trial Court’s Ruling
After considering the parties’ briefs, supporting documents, and oral
arguments at the motion hearing, the trial court issued a written order
granting summary judgment to Redlands. The court began by overruling all
of Redlands’ objections to plaintiffs’ evidence, except for the objections to
Dr. Jackson’s declaration described above. The court sustained those
objections on “insufficient foundation” grounds.
The court then found that plaintiffs had failed to demonstrate triable
issues of material fact exist for the sixth cause of action regarding whether
Redlands breached its duty under section 70701(a)(7). The court explained
8
that plaintiffs’ admissible evidence did not establish a dispute over the fact
that ETSP surgery is treated as a “core procedure” by the ACGME, and that
even if liberally construed, Dr. Jackson’s affidavit “provides insufficient
foundation to support the conclusion that to meet competency requirements,
all core procedures must be performed as part of [Redlands’] proctor
requirement before granting staff privileges.” The court further found
that plaintiffs did not present any expert testimony demonstrating that
“it does not meet the hospital community standard of care to include the
ETSP procedure as part of a core neurosurgery function or to approve it as
a core procedure without requiring proctoring of that specific procedure.”
Although plaintiffs relied on Dr. Little’s testimony, the court determined that
Dr. Little’s opinion was insufficient to create a triable issue of material fact
as to whether Redlands met community standards because the purpose of his
opinion was to address whether Drs. Schiraldi and Cortez provided treatment
meeting the standard of care applicable to neurosurgeons operating in
similar circumstances. The court noted that Dr. Little did “not provide any
discussion that other hospitals require special credentialing with respect to
privileges that include the ETSP procedure in relation to the hospital
community standard of care.”
As for the seventh cause of action for professional negligence, the court
first found that plaintiffs had demonstrated the existence of triable issues of
fact regarding whether Dr. Schiraldi breached his duty of care. But the court
went on to find that for the reasons it described regarding the sixth cause of
action, plaintiffs had not submitted admissible evidence addressing the
hospital’s standard of care when it comes to credentialing and granting
privileges to neurosurgeons to perform ETSP surgeries. And although
plaintiffs had relied on Dr. Pretorius’s opinion that the proper standard of
9
care required that Dr. Karkera see an endocrinologist before undergoing
ETSP surgery, the court found that Dr. Pretorious’s opinion did not create a
triable issue of fact as to whether Redlands breached its duty of care by not
having an endocrinologist on staff. Whether Dr. Schiraldi should have
referred Dr. Karkera to an endocrinologist, the court reasoned, “is a different
issue.”
After the court granted Redlands’ summary judgment motion, it
entered judgment in Redlands’ favor and dismissed the hospital from the case
with prejudice. Plaintiffs moved for a new trial, which the court denied.
DISCUSSION
I
Plaintiffs argue that the trial court abused its discretion when it
sustained Redlands’ objections to Dr. Jackson’s expert opinions, and that the
trial court should have found her opinions sufficient to create a triable issue
of fact against Redlands.3 Because we discern no error in the court’s decision
to sustain Redlands’ objections, we conclude that ruling is not grounds for
reversal.
A. Governing Law
We review the trial court’s evidentiary rulings regarding Dr. Jackson’s
expert opinion for abuse of discretion. (See Sargon Enterprises, Inc. v.
University of Southern California (2012) 55 Cal.4th 747, 773 [“[e]xcept to the
extent the trial court bases its ruling on a conclusion of law (which we review
3 Because plaintiffs offer no separate argument addressing why the
denial of their motion for new trial was improper, we do not address it here.
10
de novo), we review its ruling excluding or admitting expert testimony for
abuse of discretion.”].)4
A motion for summary judgment “must be decided upon admissible
evidence in the form of affidavits, declarations, admissions, answers to
interrogatories, depositions and matters of which judicial notice shall or
may be taken. Personal knowledge and competency must be shown in the
supporting and opposing affidavits and declarations. The affidavits must cite
evidentiary facts, not legal conclusions or ‘ultimate’ facts.” (Hayman v. Block
(1986) 176 Cal.App.3d 629, 638–639 [cleaned up].) “A properly qualified
expert may offer an opinion relating to a subject that is beyond common
experience, if that expert’s opinion will assist the trier of fact. Even so, the
expert opinion may not be based on assumptions of fact that are without
evidentiary support or based on factors that are speculative or conjectural,
for then the opinion has no evidentiary value and does not assist the trier of
fact.” (Bushling v. Fremont Medical Center (2004) 117 Cal.App.4th 493, 510
[cleaned up].)
In determining the admissibility of expert testimony, “a court may
inquire into, not only the type of material on which an expert relies, but also
whether that material actually supports the expert’s reasoning. ‘A court may
conclude that there is simply too great an analytical gap between the data
4 At oral argument, Karkera argued for the first time that we should
review the trial court’s evidentiary rulings de novo because they deprived her
of essential evidence on her claims against Redlands. In her opening brief,
however, Karkera conceded that these evidentiary rulings were subject to
review for abuse of discretion. Moreover, the case law her counsel referred to
at oral argument applies to dispositive in limine rulings on expert testimony,
not evidentiary rulings on summary judgment. (See San Francisco Print
Media Co. v. The Hearst Corp. (2020) 44 Cal.App.5th 952, 962, fn. 7.)
11
and the opinion proffered.’ ” (Sargon Enterprises, Inc. v. University of
Southern California (2012) 55 Cal.4th 747, 771 (Sargon).) “An expert’s
opinion rendered without a reasoned explanation of why the underlying facts
lead to the ultimate conclusion has no evidentiary value because an expert
opinion is worth no more than the reasons and facts on which it is based.
Thus, in order to defeat summary adjudication, plaintiffs cannot rely on
assertions that are conclusionary, argumentative or based on conjecture and
speculation, but rather are required to make an independent showing by a
proper declaration or by reference to a deposition or another discovery
product that there is sufficient proof of the matters alleged to raise a triable
question of fact.” (Brown v. Ransweiler (2009) 171 Cal.App.4th 516, 530
[cleaned up].)
B. Analysis
Plaintiffs contend that Dr. Jackson’s conclusions have “more than
adequate foundation” and are “based on evidence the trial court held
admissible[,] including declarations from other experts.” But as the court
observed, Dr. Jackson’s declaration did not provide a reasoned explanation,
with reference to any established guidelines or standards or her own personal
experience, for why she concluded Redlands’ credentialing failed to meet the
applicable standard of care for hospitals. In other words, Dr. Jackson’s
declaration did not explain why Redlands fell short in its reliance on the
standard set by the ACGME, which includes ETSP surgery as a core
neurosurgery skill that a physician has obtained by the time they graduate
from residency. Instead, Dr. Jackson’s declaration made the conclusory
assertion that the hospital should have required that its neurosurgeons do
more to demonstrate competence in ETSP surgery, without identifying
what—in her own personal experience with credentialing—led her to
12
conclude that this is the standard of care ordinarily exercised by hospitals
under similar circumstances. (See Powell v. Kleinman (2007) 151
Cal.App.4th 112, 122 [“Medical providers must exercise that degree of skill,
knowledge, and care ordinarily possessed and exercised by members of their
profession under similar circumstances”].)
Dr. Jackson did not, for example, state that other hospitals where she
had worked required additional showings of competence for ETSP surgery,
or that some hospitals used guidelines other than ACGME that are more
exacting. Dr. Jackson explained that she had served on numerous hospital
credentialing committees, she was a member of the quality committee of the
board at two hospitals, and she had served as the medical executive support
for the board’s quality committee at two major health systems. Yet she did
not declare that any of these hospitals or health systems (1) required
additional showings of competence for ETSP surgery beyond the minimum
required for board certification, or (2) treated ETSP surgery as being beyond
the core skills of any neurosurgeon who has successfully completed their
residency from an accredited program, or (3) required any monitoring or
reevaluation specific to the ETSP surgery. In these circumstances, the trial
court did not abuse its discretion by excluding Dr. Jackson’s standard of care
opinions for lack of foundation. On summary judgment, “evidentiary
objections based on lack of foundation, qualification of experts, and
conclusory and speculative testimony are traditionally left to the sound
discretion of the trial court.” (Alexander v. Scripps Memorial Hospital La
Jolla (2018) 23 Cal.App.5th 206, 226.)
Plaintiffs’ reliance on the fact that Dr. Jackson referenced other
admissible expert opinions is also misplaced. The mere fact that other
experts’ opinions were admissible does not mean they formed a sufficient
13
basis for conclusions regarding the credentialing standard of care for
hospitals. For example, Dr. Jackson relied on Dr. Little’s statements that
ETSP is a “complex surgical procedure” requiring that neurosurgeons be
well-trained to reduce the risk of complications, and that completing
residency does not necessarily indicate “all” neurosurgeons’ competency to
“independently perform ETSP.” As an initial matter, Dr. Little did not
define “independently,” and it is unclear whether that term would apply to
Dr. Schiraldi’s performance of Dr. Karkera’s surgery given that Dr. Cortez
and other physicians assisted him. More importantly, Dr. Little’s personal
opinions on ETSP training did not shed any light on the standard of care
hospitals commonly follow for credentialing. Dr. Little was not even retained
to opine on credentialing. According to Dr. Little, the purpose of his expert
opinion was to address whether Drs. Schiraldi and Cortez “complied with
the standard of care expected of reasonably careful neurosurgeons under
similar circumstances.” There is no indication Dr. Little was qualified to
opine on credentialing, nor did he address what other hospitals require
when it comes to ensuring neurosurgeons are competent to perform ETSP
surgery. Moreover, even when taking Dr. Little’s statements into account,
Dr. Jackson’s declaration still did not adequately provide a reasoned
explanation for why Redlands’ credentialing process failed to meet that
standard—even if ETSP surgery is complex and Drs. Schiraldi and Cortez
would have benefited from additional practice, as Dr. Little opined.
In these circumstances, we cannot conclude that the trial court abused
its discretion by concluding that Dr. Jackson’s statements had insufficient
foundation to be admissible. The trial court reasonably concluded that there
was “ ‘too great an analytical gap’ ” between Dr. Jackson’s standard of care
opinions and the supporting foundational material she cited in reaching those
14
opinions. (Sargon, supra, 55 Cal.4th at p. 771.) Accordingly, we affirm the
court’s decision to sustain Redlands’ objections.
This requires us to affirm summary judgment on the negligent
credentialing theory. Plaintiffs do not dispute that Redlands met its initial
summary judgment burden on the negligent credentialing theory, nor do they
contend that they established a triable issue of material fact on this theory
without the inadmissible portions of Dr. Jackson’s declaration. A breach of
the standard of care is an essential element of a malpractice claim and can
only be established with expert testimony, unless the circumstances are such
that the required conduct is within the layperson’s common knowledge. (San
Antonio Regional Hospital v. Superior Court (2024) 102 Cal.App.5th 346, 350;
see also McAlpine v. Norman (2020) 51 Cal.App.5th 933, 938 [“Because this is
a matter peculiarly within the knowledge of experts, expert opinion
testimony normally is required to prove or disprove that the defendant
breached the standard of care”].) Without Dr. Jackson’s excluded expert
opinions on the standard of care for credentialing—which is not something
within a layperson’s common knowledge—plaintiffs’ opposing evidence was
legally insufficient to create a triable issue of fact on this theory. Thus, the
court properly found no triable issues of material fact on the negligent
credentialing theory. To the extent plaintiffs argue that Dr. Jackson’s
excluded opinions would have created triable issues of material fact if they
had been admitted, we need not and do not address those arguments.
II
We turn next to plaintiffs’ argument that they demonstrated the
existence of a triable issue of material fact as to the seventh cause of action
for professional negligence because they presented evidence that Redlands
allowed its neurosurgeons to perform ETSP surgeries “although it did not
15
have the necessary health care infrastructure to support such surgery.”
Plaintiffs cite Dr. Pretorious’s testimony as an endocrinologist that given
Dr. Karkera’s comorbidities, the standard of care required referring
Dr. Karkera to a qualified endocrinologist for preoperative evaluation.
But again, Dr. Pretorious’s opinion addressed the standard of care applicable
to physicians, not Redlands. To the extent Dr. Pretorious made conclusory
statements about what hospitals should or “must” do in terms of maintaining
trained staff, there was no evidence he is qualified to provide testimony on
the standard of care applicable to hospitals when credentialing its physicians
or making staffing decisions. As with Dr. Little, moreover, his own personal
opinions did not supply evidence of the standard of care hospitals commonly
follow in staffing or credentialing. For these reasons, we are not persuaded
that plaintiffs’ evidence was sufficient to create a triable issue of material
fact as to Redlands’ alleged breach of the standard of care for hospitals.
DISPOSITION
The judgment is affirmed. Respondent may recover its costs on appeal.
BUCHANAN, Acting P. J.
WE CONCUR:
KELETY, J.
CASTILLO, J.
16