## Facts

- During Susan Oswald’s third pregnancy, just before a scheduled five-month checkup, she experienced vaginal bleeding and painful cramping.
- Dr. Larry R. LeGrand examined Susan and sent her home to rest.
- Later that day, Susan was taken by ambulance to Mercy Health Center for continued bleeding; she was again sent home and told to take it easy.
- The next day, Susan’s cramping and bleeding worsened; her husband, Larry Oswald, drove her to Mercy’s emergency room.
- Dr. Christopher Clark examined Susan and told her she should go home, but Larry insisted on admission; Susan was transferred to the labor ward.
- On the ward, a nurse scolded Susan for coming in after being told to rest, and another nurse told her that if she miscarried it would not be a baby but a “blob of blood.”
- The next day, Susan heard Clark yelling outside her room that he did not want her as a patient and that he was tired of Dr. Barry Smith (Susan’s family physician) “dumping” patients on him; Clark later apologized and said he would care for Susan until he left for vacation later that day.
- Susan developed intense pain, became hysterical, and insisted she was about to deliver; after examining her and reviewing a sonogram, Clark ordered further monitoring and left before the end of his scheduled duty.
- Shortly after, Susan delivered a premature infant; a nurse observed no heartbeat or respiratory activity, declared the baby stillborn, and placed the baby on an instrument tray.
- LeGrand delivered the placenta and, assuming the infant was stillborn, did not examine the infant beyond identifying the sex.
- After Larry felt the infant grasp his finger, the nurse determined the infant was alive and rushed the infant to the neonatal care unit; the infant died about 12 hours later.
- The Oswalds sued Mercy, LeGrand, Clark, and Smith for negligent care of Susan and the infant and for severe emotional distress from both the care provided and what they witnessed around the delivery.
- The district court barred the Oswalds’ expert witnesses for untimely designation under Iowa Code § 668.11(2) and granted summary judgment for defendants on all claims; the Oswalds appealed.

## Issues

1. Whether the district court properly excluded the Oswalds’ untimely designated expert witnesses under Iowa Code § 668.11(2).
2. Whether, without expert testimony, summary judgment was proper on all claims, or whether some claims could be tried under the “common knowledge” exception.
3. Whether claims seeking emotional-distress damages based on statements and conduct by hospital staff (and related implied-contract theories) could proceed without expert testimony.

## Decision

- The court upheld the exclusion of late-designated expert testimony under Iowa Code § 668.11(2).
- The court affirmed summary judgment on claims that depended on medical judgments and causation questions outside lay understanding (including diagnosis, treatment, monitoring decisions, and causation tied to the pregnancy outcome and infant’s death).
- The court reversed summary judgment on claims that did not necessarily require expert testimony, including claims focused on nontechnical conduct and communications in the hospital setting that a jury could assess using common knowledge, and that were tied to claimed emotional distress.
- The court affirmed in part, reversed in part, and remanded for further proceedings on the surviving claims.

## Legal Principles

- In Iowa, a prima facie medical-malpractice claim requires proof of the applicable standard of care, breach, and causal connection between breach and injury; expert testimony is generally required to prove these elements.
- A narrow exception applies when the lack of due care is so obvious that lay jurors can evaluate it using common knowledge and experience (including the related situation where a doctor injures a body part not being treated).
- When a valid procedural ruling prevents the use of expert testimony, summary judgment is proper only for claims that cannot be proved without expert evidence; courts must separate claims that require medical proof from those that do not.
- Emotional-distress damages may be recoverable where the claim rests on conduct and communications that can be judged by ordinary community standards without medical testimony, and where the nature of the services involved makes serious emotional disturbance a foreseeable result of negligent performance.

## Conclusion

Oswald held that the plaintiffs’ failure to timely designate experts justified exclusion of expert testimony and defeated claims based on technical medical care and causation, but it did not require dismissal of every theory in the case; the Iowa Supreme Court sent back for trial those claims grounded in nontechnical statements and conduct surrounding the hospitalization and delivery that a lay jury could assess without medical expert testimony, including associated emotional-distress theories.


Oswald v. LeGrand, 453 N.W.2d 634 (1990)