§ 145.682

Judith Rygwall, as Trustee for the Heirs and Next of Kin of Amy Rygwall v. ACR Homes, Inc. d/b/a ... · 2024 15 citations

+ 15 more citations in this opinion.

Melinda M. Binkley, Trustee on behalf of the heirs and next of kin of Kirk T. Lloyd, II v. Allina Health System · 2016 4 citations

+ 4 more citations in this opinion.

Guzick v. Kimball · 2015 3 citations [Concurrence]

+ 3 more citations in this opinion.

Dickhoff ex rel. Dickhoff v. Green · 2013 1 citation

+ 1 more citation in this opinion.

Wesely v. Flor · 2011 15 citations

+ 15 more citations in this opinion.

Brown-Wilbert, Inc. v. Copeland Buhl & Co. · 2007 8 citations

+ 8 more citations in this opinion.

Broehm v. Mayo Clinic Rochester · 2005 59 citations

OPINION ANDERSON, Russell A., Justice. Appellant brought a medical malpractice action in connection with injury incurred during post-operative care following tracheal resection surgery. The district court granted defendant’s motion to dismiss on grounds that appellant had failed to comply with the expert witness disclosure requirements of Minn. Stat. § 145.682 (2004). The court of appeals affirmed, and we granted further review. Concluding that appellant’s expert disclosure was sufficient to preclude mandatory dismissal of a nursing malpractice cause of action, we affirm in part, reverse in part, and remand to the district court for further proceedings. *724On December 17, 1999, appellant Amy-Marie Broehm underwent tracheal resection surgery, performed by Dr. Peter Pair-olero, thoracic surgeon and chief of surgery at respondent Mayo Clinic Rochester, for a congenital narrowing of her trachea. The surgery involved removing a one and a half inch section of the trachea where the narrowing had occurred and reconnecting the two sections of the trachea with sutures. Following tracheal resection surgery, the patient’s head and neck must be immobilized for two to three days as hy-perextension of the neck could cause the separation of the tracheal sutures, resulting in suffocation. One method used by thoracic surgeons to immobilize the head and neck area is to suture the patient’s chin to the chest. As an alternative, Dr. Pairolero designed a head restraint and has employed this method “dozens of times” for over 28 years. The restraint consists of a surgical towel placed against the patient’s forehead and secured by two strips of 2-inch-wide surgical tape attached to a headboard. Paul Holland, a physician assistant who worked with Dr. Pairolero and helped in developing the restraint, constructed the device used on Broehm. The usual practice was for Dr. Pairolero’s “team” or “service” to manage the care of the device. On December 19, as Broehm began to recover from sedation, she complained of a headache and pain in her forehead. According to Broehm’s medical chart, at noon the “primary s[ervice]” removed the restraint and observed an abraded area on Broehm’s forehead. Triple antibiotic medication ointment was applied to the abraded area and the restraint was “redone to remove pressure from [the] site.” A plastic surgeon was consulted who recommended additional ointments and gels for the wound, noting that it would heal without difficulty. The wound, however, did not heal properly and left a permanent scar on Broehm’s forehead. Broehm commenced an action against Mayo on July 31, 2001, alleging medical malpractice. As required under Minn. Stat. § 145.682, subds. 2, 3 (2004), Broehm served Mayo with an affidavit of expert review on the day that the suit was filed. Additionally, on January 21, 2002, within the 180-day period required under Minn. Stat. § 145.682, subd. 4 (2004), Broehm served Mayo with an expert witness disclosure signed by Linda Wick, R.N., C.N.P. On January 28, 2002, the last day of the 180-day time period, Broehm filed a motion to extend the 180-day deadline. Mayo opposed the motion for extension and moved to dismiss Broehm’s claim. The extension and dismissal motions came on for hearing on March 20, 2002. On April 9, 2002, without the district court’s permission, Broehm submitted a “supplemental memorandum,” seeking to preserve the position that expert disclosure was not required because Broehm would be entitled to a res ipsa loquitur jury instruction. In an attachment to the memorandum, Broehm submitted an expert disclosure identifying a plastic surgeon and summarizing his opinion. The district court, without considering the newly filed submissions, denied Broehm’s motion for an extension and granted Mayo’s motion to dismiss. The court found that Broehm had failed to demonstrate good cause for an extension and had failed to comply with the requirements of Minn. Stat. § 145.682. On appeal, the court of appeals affirmed by panel majority. The court of appeals initially considered and rejected Broehm’s claim that no expert testimony was required. The court then affirmed the procedural dismissal, concluding that Wick was not qualified to provide expert opinion as to the applicable standards of care as *725required by Minn. Stat. § 145.682. The court affirmed the denial of an extension, concluding that Broehm had adequate time to comply with the expert-disclosure deadline and failed to show good cause for the requested extension. The dissenting panel member believed that while expert testimony would likely be necessary at trial, it was not required at the preliminary stage to show a prima facie case of medical malpractice. I. In a medical malpractice action, Minn. Stat. § 145.682 requires that with service of the summons and complaint, plaintiffs attorney must also serve an affidavit stating that the case has been reviewed with an expert “whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff.” Id., subds. 2, 3. Within 180 days of commencement of suit, plaintiff must serve upon defendant affidavits signed by each expert that plaintiff expects to call at trial stating, with respect to issues of malpractice or causation, the substance of the facts and opinions to which the expert expects to testify and a summary of the grounds for each opinion. Id., subd. 4(a). Interrogatory answers may be used in lieu of affidavits so long as they are signed by the expert and plaintiffs attorney. Id. Noncompliance with the statutory requirements re-suits in dismissal with prejudice. Minn. Stat. § 145.682, subd. 6 (2004).1 Here, in dismissing Broehm’s complaint for failure to comply with expert disclosure, the district court determined that a nurse practitioner was not qualified to provide expert opinion as to the standard of care of a thoracic surgeon. We will reverse a district court’s dismissal of a malpractice claim for noncompliance with expert disclosure only if the district court abused its discretion. Teffeteller v. Univ. of Minn., 645 N.W.2d 420, 427 (Minn.2002). In an effort to reduce the costs associat-. ed with malpractice litigation as a means to increase the availability of reasonably priced medical insurance, nearly every state has enacted some measure of medical malpractice litigation reform. Mitchell J. Nathanson, It’s the Economy (and Combined Ratio) Stupid: Examining the Medical Malpractice Litigation Myth and the Factors Critical to Reform, 108 Penn. St. L.Rev.. 1077, 1077 n. 1 (2004). The Minnesota legislature enacted expert-review and expert-disclosure requirements as a means of readily identifying meritless lawsuits at an early stage of the litigation. Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188, 190-91 (Minn.1990) (noting that “the legislature contemplated procedural reform directed at elimination of ‘frivolous cases’ ” in adopting the statute). “[N]otice of claim and certificate of merit provisions are not as intrusive as more elaborate malpractice [screening] panels seen in other states * * *.” Thomas J. Hurney, Jr., *726Medical Professional Liability in West Virginia, 105 W. Va. L.Rev. 369, 385 n. 115 (2003). Certificate of merit requirements have proven more effective than other malpractice reform mechanisms, such as arbitration panels and. capping of damages, in “reducing insurers’ litigation costs without significant social costs.” Nathanson, supra at 1079. So as not to undermine the legislative aim of expert review and disclosure, we have stressed that plaintiffs must adhere to strict compliance with the requirements of Minn. Stat. § 145.682. See Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 577-78 (Minn.1999) (statutory requirements are “uncomplicated and unambiguous” and contemplate strict compliance). Plaintiffs are “expected to set forth, by affidavit or answers to interrogatories, specific details concerning their experts’ expected testimony, including the applicable standard of care, the acts or omissions that plaintiffs allege violated the standard of care and an outline of the chain of causation that allegedly resulted in damage to them.” Sorenson, 457 N.W.2d at 193. We have made plain that “broad and conclusory statements as to causation” and “empty conclusions” are insufficient. Anderson v. Rengachary, 608 N.W.2d 843, 847-48 (Minn.2000) (expert affidavit failed to set forth standard of care, did not identify acts or omissions that violated standard of care and made no attempt to outline chain of causation resulting in injury); Lindberg, 599 N.W.2d at 578 (expert affidavit failed to state how health care providers departed from standard of care, failed to recite facts upon which expert would rely as a basis for expert opinion and failed to outline a chain of causation); Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 556 (Minn.1996) (expert affidavit provided only broad, conclusory statements as to causation and did not provide outline of chain of causation between alleged violations of standard of care and claimed damages, merely opining that delay in diagnosis resulted in complicated hospital stay). The expert disclosure requirements cannot be met by a witness who is not qualified to give an expert opinion. Teffeteller, 645 N.W.2d at 427 (expert not specialized in field of pediatric oncology or experienced with bone marrow transplants not qualified to submit expert affidavit as to customary response for physicians treating pediatric bone marrow transplant patients); Wall v. Fairview Hosp. and Healthcare Servs., 584 N.W.2d 395, 405 (Minn.1998) (psychologist and psychotherapist not qualified to provide expert opinion about the appropriate standard of care for a psychiatric nurse); cf. Cornfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (expert medical witnesses must have both sufficient scientific knowledge and practical experience with respect to subject matter of the offered testimony). We have been firm in holding that failure by the plaintiff to strictly satisfy the requirements under Minn. Stat. § 145.682, subd. 4(a) results in dismissal of the claim with prejudice. Teffeteller, 645 N.W.2d at 430-31 (dismissal of malpractice action mandated where expert disclosure contained only broad and conclusory statements); Anderson, 608 N.W.2d at 848 (dismissal mandated where expert disclosure clearly failed to fulfill the statutory requirements); Lindberg, 599 N.W.2d at 578 (dismissal mandated where expert disclosure falls short of the substantive disclosure requirements). Here, the district court found that Broehm’s expert disclosure did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standards of care. The Wick disclosure *727set forth four duties that Mayo allegedly owed Broehm and that Wick claimed were breached: 1. Obtain her informed consent to the use of a head restraint device that had a foreseeable risk of causing a permanent wound and scarring to her forehead if, such was a known or foreseeable risk. 2. Construct a head restraint device that did not cause a wound injury or, alternatively, employ an alternative technique to immobilize the head. 3. Inspect skin integrity and the restraint device as though it were a dressing at regular intervals, no less often than once each 8 hour nursing shift or more often if medically indicated. 4. Seek appropriate specialty care to diagnose and treat the patient’s forehead wound immediately upon discovery of the wound. Wick received her baccalaureate degree in nursing in 1984 and earned a master’s degree in 1995. She is a certified geriatric nurse practitioner and is currently employed at St. Mary’s Duluth Clinic, principally in the nephrology department. As the lower courts concluded, Wick has neither the training nor the practical experience necessary to offer opinions regarding postoperative care following tracheal resection surgery in support of claims based on the first two asserted duties; and the expert disclosure does not indicate that Wick has sufficient practical experience to qualify her as an expert in support of a claim based on the asserted duty to seek appropriate specialty care. The dismissal of those claims was not an abuse of discretion. Wick does, however, appear to have sufficient training and practical experience with respect to general nursing care duties and duties of a nurse practitioner sufficient to qualify her as an expert in support of a claim based on a nursing standard of care. Thus, while the claims of failure to obtain informed consent, failure to construct an appropriate head restraint, and failure to seek appropriate specialty care upon discovery of the wound were properly dismissed by the district court, we reverse the dismissal of the remaining nursing malpractice claim and remand for further proceedings. II. Broehm also argues that the district court abused its discretion in denying her motion to extend the 180-day expert-disclosure deadline. We review the denial of an extension of the disclosure deadline for an abuse of discretion. See, e.g., Lindberg, 599 N.W.2d at 578-79. A plaintiff is allowed to extend the expert-disclosure deadline past the 180-day statutory time limit “by order of the court for good cause.” Minn. Stat. § 145.682, subd. 4(b) (2004). Broehm sought an extension to obtain opinions from physicians with expertise in plastic surgery and dermatology. Broehm had copies of her medical records well in advance of commencing the medical malpractice action. She had taken depositions of both Dr. Pairolero and physician assistant Holland a full two months prior to the deadline. As grounds for an extension, Broehm asserted that she had expected Mayo to offer an opinion concerning the cause of the injury to her forehead and that she needed additional information related to the head restraint. In denying the extension, the district court noted that Mayo had no obligation to provide opinions on causation beyond those provided in discovery and that all obtainable information concerning the restraint had long since been available. In affirming, the court of appeals observed that as of the time of the hearing on the extension-request motion, Broehm “had been in possession of the *728relevant medical records for more than a year. The medical treatment that appellant alleges was negligently provided occurred two years before the date of the. hearing.” Broehm v. Mayo Clinic Rochester, No. C0-02-959, 2003 WL 951886, at *5 (Minn.App. Mar. 11, 2003). In that Broehm had sufficient information from which to obtain a qualified expert well before expiration of the 180-day deadline and otherwise failed to show good cause for an extension, the denial of an extension was not an abuse of discretion. III. Finally, Broehm asserts _ that expert disclosure was unnecessary because the determination of Mayo’s negligence was within the common knowledge of laypeople, citing Tousignant v. St. Louis County, 615 N.W.2d 53 (Minn.2000). Tousignant involved a claim that a nursing home breached a standard of care by failing to follow physician’s orders to restrain a resident. Id. at 58. The claim did not involve medical care that required professional judgment. Rather, it involved non-medical, administrative, custodial or routine nursing home care. Id. at 59-60. By contrast, as the court of appeals observed, Broehm’s claim alleged medical malpractice “arising from negligent postoperative care.” Broehm, 2003 WL 951886, at *3. The claim required a medical expert. Broehm also asserts that the doctrine of res ipsa loquitur excuses her from expert-disclosure requirements. This issue was neither timely presented before the district court nor adequately briefed on appeal. Generally, we decline to review issues under these circumstances. See, e.g., Dep’t of Labor & Indus. v. Wintz Parcel Drivers, Inc., 558 N.W.2d 480, 480 (Minn.1997) (issue not adequately briefed on appeal); Thiele v. Stich, 425 N.W.2d 580, 582-83 (Minn.1988) (issue not raised in district court). Affirmed in part, reversed in part, and remanded for further proceedings. ANDERSON, G. Barry, J., not having been a member of this court at the time of the argument and submission, took no part in the consideration or decision of this case.

OPINION ANDERSON, Russell A., Justice. Appellant brought a medical malpractice action in connection with injury incurred during post-operative care following tracheal resection surgery. The district court granted defendant’s motion to dismiss on grounds that appellant had failed to comply with the expert witness disclosure requirements of Minn. Stat. § 145.682 (2004). The court of appeals affirmed, and we granted further review. Concluding that appellant’s expert disclosure was sufficient to preclude mandatory dismissal of a nursing malpractice cause of action, we affirm in part, reverse in part, and remand to the district court for further proceedings. *724On December 17, 1999, appellant Amy-Marie Broehm underwent tracheal resection surgery, performed by Dr. Peter Pair-olero, thoracic surgeon and chief of surgery at respondent Mayo Clinic Rochester, for a congenital narrowing of her trachea. The surgery involved removing a one and a half inch section of the trachea where the narrowing had occurred and reconnecting the two sections of the trachea with sutures. Following tracheal resection surgery, the patient’s head and neck must be immobilized for two to three days as hy-perextension of the neck could cause the separation of the tracheal sutures, resulting in suffocation. One method used by thoracic surgeons to immobilize the head and neck area is to suture the patient’s chin to the chest. As an alternative, Dr. Pairolero designed a head restraint and has employed this method “dozens of times” for over 28 years. The restraint consists of a surgical towel placed against the patient’s forehead and secured by two strips of 2-inch-wide surgical tape attached to a headboard. Paul Holland, a physician assistant who worked with Dr. Pairolero and helped in developing the restraint, constructed the device used on Broehm. The usual practice was for Dr. Pairolero’s “team” or “service” to manage the care of the device. On December 19, as Broehm began to recover from sedation, she complained of a headache and pain in her forehead. According to Broehm’s medical chart, at noon the “primary s[ervice]” removed the restraint and observed an abraded area on Broehm’s forehead. Triple antibiotic medication ointment was applied to the abraded area and the restraint was “redone to remove pressure from [the] site.” A plastic surgeon was consulted who recommended additional ointments and gels for the wound, noting that it would heal without difficulty. The wound, however, did not heal properly and left a permanent scar on Broehm’s forehead. Broehm commenced an action against Mayo on July 31, 2001, alleging medical malpractice. As required under Minn. Stat. § 145.682, subds. 2, 3 (2004), Broehm served Mayo with an affidavit of expert review on the day that the suit was filed. Additionally, on January 21, 2002, within the 180-day period required under Minn. Stat. § 145.682, subd. 4 (2004), Broehm served Mayo with an expert witness disclosure signed by Linda Wick, R.N., C.N.P. On January 28, 2002, the last day of the 180-day time period, Broehm filed a motion to extend the 180-day deadline. Mayo opposed the motion for extension and moved to dismiss Broehm’s claim. The extension and dismissal motions came on for hearing on March 20, 2002. On April 9, 2002, without the district court’s permission, Broehm submitted a “supplemental memorandum,” seeking to preserve the position that expert disclosure was not required because Broehm would be entitled to a res ipsa loquitur jury instruction. In an attachment to the memorandum, Broehm submitted an expert disclosure identifying a plastic surgeon and summarizing his opinion. The district court, without considering the newly filed submissions, denied Broehm’s motion for an extension and granted Mayo’s motion to dismiss. The court found that Broehm had failed to demonstrate good cause for an extension and had failed to comply with the requirements of Minn. Stat. § 145.682. On appeal, the court of appeals affirmed by panel majority. The court of appeals initially considered and rejected Broehm’s claim that no expert testimony was required. The court then affirmed the procedural dismissal, concluding that Wick was not qualified to provide expert opinion as to the applicable standards of care as *725required by Minn. Stat. § 145.682. The court affirmed the denial of an extension, concluding that Broehm had adequate time to comply with the expert-disclosure deadline and failed to show good cause for the requested extension. The dissenting panel member believed that while expert testimony would likely be necessary at trial, it was not required at the preliminary stage to show a prima facie case of medical malpractice. I. In a medical malpractice action, Minn. Stat. § 145.682 requires that with service of the summons and complaint, plaintiffs attorney must also serve an affidavit stating that the case has been reviewed with an expert “whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff.” Id., subds. 2, 3. Within 180 days of commencement of suit, plaintiff must serve upon defendant affidavits signed by each expert that plaintiff expects to call at trial stating, with respect to issues of malpractice or causation, the substance of the facts and opinions to which the expert expects to testify and a summary of the grounds for each opinion. Id., subd. 4(a). Interrogatory answers may be used in lieu of affidavits so long as they are signed by the expert and plaintiffs attorney. Id. Noncompliance with the statutory requirements re-suits in dismissal with prejudice. Minn. Stat. § 145.682, subd. 6 (2004).1 Here, in dismissing Broehm’s complaint for failure to comply with expert disclosure, the district court determined that a nurse practitioner was not qualified to provide expert opinion as to the standard of care of a thoracic surgeon. We will reverse a district court’s dismissal of a malpractice claim for noncompliance with expert disclosure only if the district court abused its discretion. Teffeteller v. Univ. of Minn., 645 N.W.2d 420, 427 (Minn.2002). In an effort to reduce the costs associat-. ed with malpractice litigation as a means to increase the availability of reasonably priced medical insurance, nearly every state has enacted some measure of medical malpractice litigation reform. Mitchell J. Nathanson, It’s the Economy (and Combined Ratio) Stupid: Examining the Medical Malpractice Litigation Myth and the Factors Critical to Reform, 108 Penn. St. L.Rev.. 1077, 1077 n. 1 (2004). The Minnesota legislature enacted expert-review and expert-disclosure requirements as a means of readily identifying meritless lawsuits at an early stage of the litigation. Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188, 190-91 (Minn.1990) (noting that “the legislature contemplated procedural reform directed at elimination of ‘frivolous cases’ ” in adopting the statute). “[N]otice of claim and certificate of merit provisions are not as intrusive as more elaborate malpractice [screening] panels seen in other states * * *.” Thomas J. Hurney, Jr., *726Medical Professional Liability in West Virginia, 105 W. Va. L.Rev. 369, 385 n. 115 (2003). Certificate of merit requirements have proven more effective than other malpractice reform mechanisms, such as arbitration panels and. capping of damages, in “reducing insurers’ litigation costs without significant social costs.” Nathanson, supra at 1079. So as not to undermine the legislative aim of expert review and disclosure, we have stressed that plaintiffs must adhere to strict compliance with the requirements of Minn. Stat. § 145.682. See Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 577-78 (Minn.1999) (statutory requirements are “uncomplicated and unambiguous” and contemplate strict compliance). Plaintiffs are “expected to set forth, by affidavit or answers to interrogatories, specific details concerning their experts’ expected testimony, including the applicable standard of care, the acts or omissions that plaintiffs allege violated the standard of care and an outline of the chain of causation that allegedly resulted in damage to them.” Sorenson, 457 N.W.2d at 193. We have made plain that “broad and conclusory statements as to causation” and “empty conclusions” are insufficient. Anderson v. Rengachary, 608 N.W.2d 843, 847-48 (Minn.2000) (expert affidavit failed to set forth standard of care, did not identify acts or omissions that violated standard of care and made no attempt to outline chain of causation resulting in injury); Lindberg, 599 N.W.2d at 578 (expert affidavit failed to state how health care providers departed from standard of care, failed to recite facts upon which expert would rely as a basis for expert opinion and failed to outline a chain of causation); Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 556 (Minn.1996) (expert affidavit provided only broad, conclusory statements as to causation and did not provide outline of chain of causation between alleged violations of standard of care and claimed damages, merely opining that delay in diagnosis resulted in complicated hospital stay). The expert disclosure requirements cannot be met by a witness who is not qualified to give an expert opinion. Teffeteller, 645 N.W.2d at 427 (expert not specialized in field of pediatric oncology or experienced with bone marrow transplants not qualified to submit expert affidavit as to customary response for physicians treating pediatric bone marrow transplant patients); Wall v. Fairview Hosp. and Healthcare Servs., 584 N.W.2d 395, 405 (Minn.1998) (psychologist and psychotherapist not qualified to provide expert opinion about the appropriate standard of care for a psychiatric nurse); cf. Cornfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (expert medical witnesses must have both sufficient scientific knowledge and practical experience with respect to subject matter of the offered testimony). We have been firm in holding that failure by the plaintiff to strictly satisfy the requirements under Minn. Stat. § 145.682, subd. 4(a) results in dismissal of the claim with prejudice. Teffeteller, 645 N.W.2d at 430-31 (dismissal of malpractice action mandated where expert disclosure contained only broad and conclusory statements); Anderson, 608 N.W.2d at 848 (dismissal mandated where expert disclosure clearly failed to fulfill the statutory requirements); Lindberg, 599 N.W.2d at 578 (dismissal mandated where expert disclosure falls short of the substantive disclosure requirements). Here, the district court found that Broehm’s expert disclosure did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standards of care. The Wick disclosure *727set forth four duties that Mayo allegedly owed Broehm and that Wick claimed were breached: 1. Obtain her informed consent to the use of a head restraint device that had a foreseeable risk of causing a permanent wound and scarring to her forehead if, such was a known or foreseeable risk. 2. Construct a head restraint device that did not cause a wound injury or, alternatively, employ an alternative technique to immobilize the head. 3. Inspect skin integrity and the restraint device as though it were a dressing at regular intervals, no less often than once each 8 hour nursing shift or more often if medically indicated. 4. Seek appropriate specialty care to diagnose and treat the patient’s forehead wound immediately upon discovery of the wound. Wick received her baccalaureate degree in nursing in 1984 and earned a master’s degree in 1995. She is a certified geriatric nurse practitioner and is currently employed at St. Mary’s Duluth Clinic, principally in the nephrology department. As the lower courts concluded, Wick has neither the training nor the practical experience necessary to offer opinions regarding postoperative care following tracheal resection surgery in support of claims based on the first two asserted duties; and the expert disclosure does not indicate that Wick has sufficient practical experience to qualify her as an expert in support of a claim based on the asserted duty to seek appropriate specialty care. The dismissal of those claims was not an abuse of discretion. Wick does, however, appear to have sufficient training and practical experience with respect to general nursing care duties and duties of a nurse practitioner sufficient to qualify her as an expert in support of a claim based on a nursing standard of care. Thus, while the claims of failure to obtain informed consent, failure to construct an appropriate head restraint, and failure to seek appropriate specialty care upon discovery of the wound were properly dismissed by the district court, we reverse the dismissal of the remaining nursing malpractice claim and remand for further proceedings. II. Broehm also argues that the district court abused its discretion in denying her motion to extend the 180-day expert-disclosure deadline. We review the denial of an extension of the disclosure deadline for an abuse of discretion. See, e.g., Lindberg, 599 N.W.2d at 578-79. A plaintiff is allowed to extend the expert-disclosure deadline past the 180-day statutory time limit “by order of the court for good cause.” Minn. Stat. § 145.682, subd. 4(b) (2004). Broehm sought an extension to obtain opinions from physicians with expertise in plastic surgery and dermatology. Broehm had copies of her medical records well in advance of commencing the medical malpractice action. She had taken depositions of both Dr. Pairolero and physician assistant Holland a full two months prior to the deadline. As grounds for an extension, Broehm asserted that she had expected Mayo to offer an opinion concerning the cause of the injury to her forehead and that she needed additional information related to the head restraint. In denying the extension, the district court noted that Mayo had no obligation to provide opinions on causation beyond those provided in discovery and that all obtainable information concerning the restraint had long since been available. In affirming, the court of appeals observed that as of the time of the hearing on the extension-request motion, Broehm “had been in possession of the *728relevant medical records for more than a year. The medical treatment that appellant alleges was negligently provided occurred two years before the date of the. hearing.” Broehm v. Mayo Clinic Rochester, No. C0-02-959, 2003 WL 951886, at *5 (Minn.App. Mar. 11, 2003). In that Broehm had sufficient information from which to obtain a qualified expert well before expiration of the 180-day deadline and otherwise failed to show good cause for an extension, the denial of an extension was not an abuse of discretion. III. Finally, Broehm asserts _ that expert disclosure was unnecessary because the determination of Mayo’s negligence was within the common knowledge of laypeople, citing Tousignant v. St. Louis County, 615 N.W.2d 53 (Minn.2000). Tousignant involved a claim that a nursing home breached a standard of care by failing to follow physician’s orders to restrain a resident. Id. at 58. The claim did not involve medical care that required professional judgment. Rather, it involved non-medical, administrative, custodial or routine nursing home care. Id. at 59-60. By contrast, as the court of appeals observed, Broehm’s claim alleged medical malpractice “arising from negligent postoperative care.” Broehm, 2003 WL 951886, at *3. The claim required a medical expert. Broehm also asserts that the doctrine of res ipsa loquitur excuses her from expert-disclosure requirements. This issue was neither timely presented before the district court nor adequately briefed on appeal. Generally, we decline to review issues under these circumstances. See, e.g., Dep’t of Labor & Indus. v. Wintz Parcel Drivers, Inc., 558 N.W.2d 480, 480 (Minn.1997) (issue not adequately briefed on appeal); Thiele v. Stich, 425 N.W.2d 580, 582-83 (Minn.1988) (issue not raised in district court). Affirmed in part, reversed in part, and remanded for further proceedings. ANDERSON, G. Barry, J., not having been a member of this court at the time of the argument and submission, took no part in the consideration or decision of this case.

OPINION ANDERSON, Russell A., Justice. Appellant brought a medical malpractice action in connection with injury incurred during post-operative care following tracheal resection surgery. The district court granted defendant’s motion to dismiss on grounds that appellant had failed to comply with the expert witness disclosure requirements of Minn. Stat. § 145.682 (2004). The court of appeals affirmed, and we granted further review. Concluding that appellant’s expert disclosure was sufficient to preclude mandatory dismissal of a nursing malpractice cause of action, we affirm in part, reverse in part, and remand to the district court for further proceedings. *724On December 17, 1999, appellant Amy-Marie Broehm underwent tracheal resection surgery, performed by Dr. Peter Pair-olero, thoracic surgeon and chief of surgery at respondent Mayo Clinic Rochester, for a congenital narrowing of her trachea. The surgery involved removing a one and a half inch section of the trachea where the narrowing had occurred and reconnecting the two sections of the trachea with sutures. Following tracheal resection surgery, the patient’s head and neck must be immobilized for two to three days as hy-perextension of the neck could cause the separation of the tracheal sutures, resulting in suffocation. One method used by thoracic surgeons to immobilize the head and neck area is to suture the patient’s chin to the chest. As an alternative, Dr. Pairolero designed a head restraint and has employed this method “dozens of times” for over 28 years. The restraint consists of a surgical towel placed against the patient’s forehead and secured by two strips of 2-inch-wide surgical tape attached to a headboard. Paul Holland, a physician assistant who worked with Dr. Pairolero and helped in developing the restraint, constructed the device used on Broehm. The usual practice was for Dr. Pairolero’s “team” or “service” to manage the care of the device. On December 19, as Broehm began to recover from sedation, she complained of a headache and pain in her forehead. According to Broehm’s medical chart, at noon the “primary s[ervice]” removed the restraint and observed an abraded area on Broehm’s forehead. Triple antibiotic medication ointment was applied to the abraded area and the restraint was “redone to remove pressure from [the] site.” A plastic surgeon was consulted who recommended additional ointments and gels for the wound, noting that it would heal without difficulty. The wound, however, did not heal properly and left a permanent scar on Broehm’s forehead. Broehm commenced an action against Mayo on July 31, 2001, alleging medical malpractice. As required under Minn. Stat. § 145.682, subds. 2, 3 (2004), Broehm served Mayo with an affidavit of expert review on the day that the suit was filed. Additionally, on January 21, 2002, within the 180-day period required under Minn. Stat. § 145.682, subd. 4 (2004), Broehm served Mayo with an expert witness disclosure signed by Linda Wick, R.N., C.N.P. On January 28, 2002, the last day of the 180-day time period, Broehm filed a motion to extend the 180-day deadline. Mayo opposed the motion for extension and moved to dismiss Broehm’s claim. The extension and dismissal motions came on for hearing on March 20, 2002. On April 9, 2002, without the district court’s permission, Broehm submitted a “supplemental memorandum,” seeking to preserve the position that expert disclosure was not required because Broehm would be entitled to a res ipsa loquitur jury instruction. In an attachment to the memorandum, Broehm submitted an expert disclosure identifying a plastic surgeon and summarizing his opinion. The district court, without considering the newly filed submissions, denied Broehm’s motion for an extension and granted Mayo’s motion to dismiss. The court found that Broehm had failed to demonstrate good cause for an extension and had failed to comply with the requirements of Minn. Stat. § 145.682. On appeal, the court of appeals affirmed by panel majority. The court of appeals initially considered and rejected Broehm’s claim that no expert testimony was required. The court then affirmed the procedural dismissal, concluding that Wick was not qualified to provide expert opinion as to the applicable standards of care as *725required by Minn. Stat. § 145.682. The court affirmed the denial of an extension, concluding that Broehm had adequate time to comply with the expert-disclosure deadline and failed to show good cause for the requested extension. The dissenting panel member believed that while expert testimony would likely be necessary at trial, it was not required at the preliminary stage to show a prima facie case of medical malpractice. I. In a medical malpractice action, Minn. Stat. § 145.682 requires that with service of the summons and complaint, plaintiffs attorney must also serve an affidavit stating that the case has been reviewed with an expert “whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff.” Id., subds. 2, 3. Within 180 days of commencement of suit, plaintiff must serve upon defendant affidavits signed by each expert that plaintiff expects to call at trial stating, with respect to issues of malpractice or causation, the substance of the facts and opinions to which the expert expects to testify and a summary of the grounds for each opinion. Id., subd. 4(a). Interrogatory answers may be used in lieu of affidavits so long as they are signed by the expert and plaintiffs attorney. Id. Noncompliance with the statutory requirements re-suits in dismissal with prejudice. Minn. Stat. § 145.682, subd. 6 (2004).1 Here, in dismissing Broehm’s complaint for failure to comply with expert disclosure, the district court determined that a nurse practitioner was not qualified to provide expert opinion as to the standard of care of a thoracic surgeon. We will reverse a district court’s dismissal of a malpractice claim for noncompliance with expert disclosure only if the district court abused its discretion. Teffeteller v. Univ. of Minn., 645 N.W.2d 420, 427 (Minn.2002). In an effort to reduce the costs associat-. ed with malpractice litigation as a means to increase the availability of reasonably priced medical insurance, nearly every state has enacted some measure of medical malpractice litigation reform. Mitchell J. Nathanson, It’s the Economy (and Combined Ratio) Stupid: Examining the Medical Malpractice Litigation Myth and the Factors Critical to Reform, 108 Penn. St. L.Rev.. 1077, 1077 n. 1 (2004). The Minnesota legislature enacted expert-review and expert-disclosure requirements as a means of readily identifying meritless lawsuits at an early stage of the litigation. Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188, 190-91 (Minn.1990) (noting that “the legislature contemplated procedural reform directed at elimination of ‘frivolous cases’ ” in adopting the statute). “[N]otice of claim and certificate of merit provisions are not as intrusive as more elaborate malpractice [screening] panels seen in other states * * *.” Thomas J. Hurney, Jr., *726Medical Professional Liability in West Virginia, 105 W. Va. L.Rev. 369, 385 n. 115 (2003). Certificate of merit requirements have proven more effective than other malpractice reform mechanisms, such as arbitration panels and. capping of damages, in “reducing insurers’ litigation costs without significant social costs.” Nathanson, supra at 1079. So as not to undermine the legislative aim of expert review and disclosure, we have stressed that plaintiffs must adhere to strict compliance with the requirements of Minn. Stat. § 145.682. See Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 577-78 (Minn.1999) (statutory requirements are “uncomplicated and unambiguous” and contemplate strict compliance). Plaintiffs are “expected to set forth, by affidavit or answers to interrogatories, specific details concerning their experts’ expected testimony, including the applicable standard of care, the acts or omissions that plaintiffs allege violated the standard of care and an outline of the chain of causation that allegedly resulted in damage to them.” Sorenson, 457 N.W.2d at 193. We have made plain that “broad and conclusory statements as to causation” and “empty conclusions” are insufficient. Anderson v. Rengachary, 608 N.W.2d 843, 847-48 (Minn.2000) (expert affidavit failed to set forth standard of care, did not identify acts or omissions that violated standard of care and made no attempt to outline chain of causation resulting in injury); Lindberg, 599 N.W.2d at 578 (expert affidavit failed to state how health care providers departed from standard of care, failed to recite facts upon which expert would rely as a basis for expert opinion and failed to outline a chain of causation); Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 556 (Minn.1996) (expert affidavit provided only broad, conclusory statements as to causation and did not provide outline of chain of causation between alleged violations of standard of care and claimed damages, merely opining that delay in diagnosis resulted in complicated hospital stay). The expert disclosure requirements cannot be met by a witness who is not qualified to give an expert opinion. Teffeteller, 645 N.W.2d at 427 (expert not specialized in field of pediatric oncology or experienced with bone marrow transplants not qualified to submit expert affidavit as to customary response for physicians treating pediatric bone marrow transplant patients); Wall v. Fairview Hosp. and Healthcare Servs., 584 N.W.2d 395, 405 (Minn.1998) (psychologist and psychotherapist not qualified to provide expert opinion about the appropriate standard of care for a psychiatric nurse); cf. Cornfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (expert medical witnesses must have both sufficient scientific knowledge and practical experience with respect to subject matter of the offered testimony). We have been firm in holding that failure by the plaintiff to strictly satisfy the requirements under Minn. Stat. § 145.682, subd. 4(a) results in dismissal of the claim with prejudice. Teffeteller, 645 N.W.2d at 430-31 (dismissal of malpractice action mandated where expert disclosure contained only broad and conclusory statements); Anderson, 608 N.W.2d at 848 (dismissal mandated where expert disclosure clearly failed to fulfill the statutory requirements); Lindberg, 599 N.W.2d at 578 (dismissal mandated where expert disclosure falls short of the substantive disclosure requirements). Here, the district court found that Broehm’s expert disclosure did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standards of care. The Wick disclosure *727set forth four duties that Mayo allegedly owed Broehm and that Wick claimed were breached: 1. Obtain her informed consent to the use of a head restraint device that had a foreseeable risk of causing a permanent wound and scarring to her forehead if, such was a known or foreseeable risk. 2. Construct a head restraint device that did not cause a wound injury or, alternatively, employ an alternative technique to immobilize the head. 3. Inspect skin integrity and the restraint device as though it were a dressing at regular intervals, no less often than once each 8 hour nursing shift or more often if medically indicated. 4. Seek appropriate specialty care to diagnose and treat the patient’s forehead wound immediately upon discovery of the wound. Wick received her baccalaureate degree in nursing in 1984 and earned a master’s degree in 1995. She is a certified geriatric nurse practitioner and is currently employed at St. Mary’s Duluth Clinic, principally in the nephrology department. As the lower courts concluded, Wick has neither the training nor the practical experience necessary to offer opinions regarding postoperative care following tracheal resection surgery in support of claims based on the first two asserted duties; and the expert disclosure does not indicate that Wick has sufficient practical experience to qualify her as an expert in support of a claim based on the asserted duty to seek appropriate specialty care. The dismissal of those claims was not an abuse of discretion. Wick does, however, appear to have sufficient training and practical experience with respect to general nursing care duties and duties of a nurse practitioner sufficient to qualify her as an expert in support of a claim based on a nursing standard of care. Thus, while the claims of failure to obtain informed consent, failure to construct an appropriate head restraint, and failure to seek appropriate specialty care upon discovery of the wound were properly dismissed by the district court, we reverse the dismissal of the remaining nursing malpractice claim and remand for further proceedings. II. Broehm also argues that the district court abused its discretion in denying her motion to extend the 180-day expert-disclosure deadline. We review the denial of an extension of the disclosure deadline for an abuse of discretion. See, e.g., Lindberg, 599 N.W.2d at 578-79. A plaintiff is allowed to extend the expert-disclosure deadline past the 180-day statutory time limit “by order of the court for good cause.” Minn. Stat. § 145.682, subd. 4(b) (2004). Broehm sought an extension to obtain opinions from physicians with expertise in plastic surgery and dermatology. Broehm had copies of her medical records well in advance of commencing the medical malpractice action. She had taken depositions of both Dr. Pairolero and physician assistant Holland a full two months prior to the deadline. As grounds for an extension, Broehm asserted that she had expected Mayo to offer an opinion concerning the cause of the injury to her forehead and that she needed additional information related to the head restraint. In denying the extension, the district court noted that Mayo had no obligation to provide opinions on causation beyond those provided in discovery and that all obtainable information concerning the restraint had long since been available. In affirming, the court of appeals observed that as of the time of the hearing on the extension-request motion, Broehm “had been in possession of the *728relevant medical records for more than a year. The medical treatment that appellant alleges was negligently provided occurred two years before the date of the. hearing.” Broehm v. Mayo Clinic Rochester, No. C0-02-959, 2003 WL 951886, at *5 (Minn.App. Mar. 11, 2003). In that Broehm had sufficient information from which to obtain a qualified expert well before expiration of the 180-day deadline and otherwise failed to show good cause for an extension, the denial of an extension was not an abuse of discretion. III. Finally, Broehm asserts _ that expert disclosure was unnecessary because the determination of Mayo’s negligence was within the common knowledge of laypeople, citing Tousignant v. St. Louis County, 615 N.W.2d 53 (Minn.2000). Tousignant involved a claim that a nursing home breached a standard of care by failing to follow physician’s orders to restrain a resident. Id. at 58. The claim did not involve medical care that required professional judgment. Rather, it involved non-medical, administrative, custodial or routine nursing home care. Id. at 59-60. By contrast, as the court of appeals observed, Broehm’s claim alleged medical malpractice “arising from negligent postoperative care.” Broehm, 2003 WL 951886, at *3. The claim required a medical expert. Broehm also asserts that the doctrine of res ipsa loquitur excuses her from expert-disclosure requirements. This issue was neither timely presented before the district court nor adequately briefed on appeal. Generally, we decline to review issues under these circumstances. See, e.g., Dep’t of Labor & Indus. v. Wintz Parcel Drivers, Inc., 558 N.W.2d 480, 480 (Minn.1997) (issue not adequately briefed on appeal); Thiele v. Stich, 425 N.W.2d 580, 582-83 (Minn.1988) (issue not raised in district court). Affirmed in part, reversed in part, and remanded for further proceedings. ANDERSON, G. Barry, J., not having been a member of this court at the time of the argument and submission, took no part in the consideration or decision of this case.

+ 56 more citations in this opinion.

Teffeteller v. University of Minnesota · 2002 58 citations

OPINION STRINGER, Justice. Respondent Jean Teffeteller, as trustee for the heirs of Thad Roddy, commenced this medical malpractice action against appellant University of Minnesota, doing business as University of Minnesota Hospital and Clinics, and appellant Pediatric Research and Education Foundation (PREF) alleging that both appellants negligently failed to recognize signs of morphine toxicity, and faded to appropriately treat morphine toxicity resulting in Rod-dy’s death. The district court granted appellants’ motions for dismissal ruling that respondent’s expert was not qualified to testify as to the applicable standard of care and that, even if the expert had the appropriate qualifications, the expert affidavit submitted by respondent failed to meet the requirements of Minn. Stat. § 145.682 (2000).1 The court of appeals reversed and remanded. We reverse the court of appeals and reinstate the ruling of the district court. In November 1995, 14-year-old Thad Roddy was diagnosed with leukemia. He was admitted to the University of Minnesota Hospital on December 4, 1996 and underwent a bone marrow transplant on December 12,1996. In the week following the transplant, Roddy received morphine to help manage his pain. The morphine dosage was increased on December 18, 1996 in an attempt to reduce his worsening throat pain. At approximately 7:05 a.m. on December 19, 1996, members of the University of Minnesota nursing staff and Dr. Cynthia Wetmore, a medical resident employed by the University of Minnesota, checked on Roddy and found him to be alert, oriented, and responsive. Around 8:30 a.m., Sima Perry, a nurse employed by the University *423of Minnesota, checked on Roddy and found him to be unresponsive. Specifically, Nurse Perry wrote in her progress notes that she was unable to arouse Roddy with “verbal, vigorous tactile stimulation as well as sternal pressure.” She also noted that Roddy’s pupils were sluggish and that he had “dusky nailbeds.” Nurse Perry notified Dr. Wetmore who immediately went to Roddy’s bedside. Dr. Wetmore found that while Roddy was not completely unresponsive and did arouse some, he was not in his normal state of arousal. Dr. Wet-more also found that Roddy was respirat-ing, that his blood pressure and heart rate were fine, and that his nailbeds were not in fact dusky. At approximately 8:45 a.m., Dr. Wet-more called the intensive care unit and spoke with Dr. Kenneth Tegtmeyer, a fellow in pediatric intensive care employed by the University of Minnesota. Dr. Wet-more presented Roddy’s condition to Dr. Tegtmeyer and the two discussed the possible reasons for Roddy’s change in condition, including sepsis, a head bleed, and morphine toxicity. Dr. Wetmore believed that morphine toxicity was an unlikely cause of Roddy’s change in condition because he had been doing fine for the preceding nine hours when he had been on a continuous morphine drip. Dr. Wetmore discussed the possibility of morphine toxicity with Dr. Tegtmeyer, recognizing that toxicity must always be considered when a patient is on morphine. In their discussion, Dr. Wetmore and Dr. Tegtmeyer agreed that they had four different options: (1) give a dose of Narcan (also known as naloxone), (2) give a dose of Nubain, (3) turn off the morphine drip completely, or (4) wait, watch, and do nothing. Dr. Wetmore and Dr. Tegtmeyer ultimately agreed that Dr. Wetmore would order a small test dose of 0.5 milligrams of Nubain be given to Roddy in an effort to assess whether a component of morphine toxicity was present. Dr. Wetmore preferred to order Nubain rather than Narcan, because she believed that administering Nubain was a more conservative diagnostic test for determining whether morphine was playing a role in Roddy’s condition, while Narcan would have immediately and abruptly reversed any morphine toxicity. Dr. Wetmore feared that any such immediate reversal of morphine toxicity caused by administering Narcan could lead to a number of undesirable side effects, including a sudden increase in in-tracranial pressure, a sudden rise in blood pressure, a sudden onset of extreme pain, or vomiting. Dr. Wetmore testified at her deposition that she then called Dr. Michael Shannon, an attending physician in the pediatric intensive care unit employed by PREF, at approximately 9:00 a.m. She presented Roddy’s condition to Dr. Shannon and explained the decision she and Dr. Tegtmeyer had reached about administering Nu-bain instead of Narcan. According to Dr. Wetmore, Dr. Shannon agreed with her assessment that, given the fact Roddy’s vital signs were still stable, as well as the potential side effects of Narcan, ordering a small test dose of Nubain was reasonable and also a more compassionate and conservative approach than administering Nar-can. Dr. Shannon testified in deposition that he did not recall any of this discussion with Dr. Wetmore and that he was not consulted about Roddy’s care until shortly before he arrived at Roddy’s room later that morning. He also testified that he was unfamiliar with the use of Nubain under the circumstances of this case. In any event, Roddy’s morphine drip was stopped and 0.5 milligrams of Nubain were administered around 9:15 or 9:20 a.m. Dr. Bruce Blazar, a pediatric pulmonary transplant staff physician employed by PREF, and Dr. Brenda Weigel, a pediatric *424bone marrow transplant fellow employed by the University of Minnesota, were getting ready to begin their rounds when they were called into Roddy’s room between 9:25 and 9:30 a.m. Dr. Blazar testified in deposition that either he or Dr. Weigel ordered the first dose of Narcan to be administered shortly after assessing Rod-dy’s condition. A total of two or three doses of Narcan were administered between 9:30 and 10:23 a.m. Dr. Shannon testified that he arrived with Dr. Tegtmeyer at Roddy’s room sometime between 10:00 and 10:15 a.m. to assist in Roddy’s care. According to the nurses’ progress notes, Roddy began deteriorating shortly after Dr. Shannon arrived, during the administration of a dose of Narcan. At approximately 10:23 a.m., Roddy experienced a respiratory arrest and a code was called. Roddy was immediately intubated and two or three more doses of Narcan were administered between 10:25 and 11:30 a.m. Roddy never regained consciousness. He was placed on mechanical ventilation but died on January 3, 1997 after being removed from life support. Roddy’s autopsy report indicated that he died as a result of multi-organ system failure, but that his decreased respiratory state before his arrest on December 19,1996 was caused by the administration of morphine. Respondent commenced this lawsuit on or about December 1, 1998. With the summons and complaint, respondent served an affidavit of respondent’s attorney as required by Minn. Stat. § 145.682, subds. 2, 3 (2000), stating that the facts in the case had been reviewed by respondent’s attorney with a medical expert whose qualifications provided a reasonable expectation that the expert’s opinion could be admissible at trial and, in the opinion of the expert, the appellants’ deviations from the applicable standard of care caused injury to respondent. There is no contention that this affidavit failed to meet the statutory requirements of Minn. Stat. § 145.682, subd. 3. In February 1999, respondent and both appellants entered into a stipulation that the 180-day deadline for meeting the expert affidavit requirements of Minn. Stat. § 145.682, subd. 4 (2000) was extended to 90 days following the completion of certain discovery depositions. The last of these depositions occurred on June 17, 1999. On or about August 25, 1999, respondent served appellants with an affidavit of the expected testimony of respondent’s expert, Dr. William Perloff. Dr. Perloffs curriculum vitae indicated that (1) he has been board certified in pediatrics and pediatric critical care, (2) he has held numerous teaching positions related to pediatric care, (3) he served as the medical director of the pediatric intensive care unit at the University of Wisconsin Children’s Hospital in Madison, Wisconsin from 1982 to 1998, (4) he has served on multiple pediatric and critical care committees, and (5) he has published articles and given presentations on various aspects of pediatric care. The affidavit stated, in part: Dr. Perloff is expected to testify that the medical and nursing care provided by the defendants fell below acceptable levels of care practiced by reasonably prudent physicians and nurses, under the circumstances of this case. It is Dr. Perloffs opinion that it was below accepted standards of care for the defendants to fail to timely recognize that Thad Roddy was experiencing Morphine toxicity on the morning of December 19, 1996. At 8:30 a.m., when the nurses noted that they were unable to rouse him with verbal, vigorous or tactile stimulation, or with sternal pressure, and Thad had pinpoint and sluggish pupils, the applicable standard of care would *425require recognition that Thad was in a state of Morphine toxicity. * * * An acceptable level of care between 8:30 and 9:25 would have required frequent boluses or a continuous infusion of naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of narcotic toxicity * * *. It was below accepted standards of care for the defendants to administer Nubain, as ordered by Cynthia Wet-more, M.D., which may well have exacerbated the effects of the Morphine. Further, it is Dr. Perloffs opinion that had Thad Roddy’s clinical status [been] appreciated as Morphine toxicity at about 8:30 a.m., and had appropriate treatment measures been utilized, i.e. frequent boluses or a continuous infusion of naloxone continuously monitored by a physician, Thad Roddy, to a reasonable degree of medical probability would have been revived successfully. Finally, it is Dr. Perloffs opinion that the departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death. Over 7 months later, on or about April 5, 2000, respondent served appellants with an affidavit supplementing Dr. Perloffs opinions, this time pertaining to Dr. Shannon and Dr. Blazar. The supplemental affidavit stated, in part: It is Dr. Perloffs opinion that Drs. Shannon and Blazar, in their involvement in Thad Roddy’s care, departed from an acceptable level of care expected of specialists in the practice of pediatric care. Specifically, it was below the acceptable standard of care to approve the administration of Nubain in this case. * * * An acceptable level of care at about 8:30 a.m., would have required frequent boluses of or continuous infusion of Naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of the narcotic toxicity * * *. [A]t about 8:30 a.m. up until the time of the arrest, all of the physicians caring for or providing medical input to the care of Thad Roddy, should have recognized that Thad Roddy was experiencing Morphine toxicity. As such, the applicable standard of care would have required the administration of Naxolone as above described. In addition, had Thad Roddy’s clinical status been appreciated as Morphine toxicity at about 8:30 a.m. and thereafter, and had appropriate treatment measures been utilized as above outlined, Thad Roddy’s death would have, to a reasonable degree of medical probability, have [sic] been avoided. Both appellants moved for dismissal in June of 2000, arguing that respondent’s expert affidavit and supplemental affidavit were insufficient as to negligence and causation, thereby failing to meet the requirements of Minn. Stat. § 145.682. The University of Minnesota also argued that Dr. Perloffs supplemental affidavit was untimely and that he was not qualified to render an opinion about the standard of care for treating Roddy. The district court, applying a summary judgment standard, granted both appellants’ motions to dismiss. The court held that appellants were entitled to dismissal with prejudice under Minn. Stat. § 145.682 because of respondent’s “failure to identify an expert qualified to testify to the applicable standard of care,” noting that Dr. Perloff lacked practical and clinical experience in treating bone marrow transplant patients. Relying in part on deposition testimony from Dr. Blazar, a physician experienced in bone marrow transplant procedures, the court concluded that this specific experience was necessary to state an opinion because following a high risk procedure of this nature a physician would have several *426additional factors to consider when diagnosing complications. The court also held that even if Dr. Perloff were qualified to render an opinion in this case, both appellants were entitled to have the case dismissed with prejudice because Dr. Perloff failed to detail a chain of causation between appellants’ alleged malpractice and Roddy’s death. Finally, the court concluded that Dr. Perloffs affidavits were “wholly deficient” under Minn. Stat. § 145.682 as they related to appellant PREF. The court of appeals reversed, holding that Dr. Perloff was qualified to testify about the standards of care related to morphine toxicity in pediatric patients and that Dr. Perloffs first affidavit satisfied the requirements of Minn. Stat. § 145.682 for both appellants. Tejfeteller v. Univ. of Minn., 626 N.W.2d 201, 208 (Minn.App. 2001). This appeal followed. I. We will reverse a district court’s dismissal of a claim pursuant to Minn. Stat. § 145.682 only if we find that the district court abused its discretion. Anderson v. Rengachary, 608 N.W.2d 843, 846 (Minn. 2000). At the same time, statutory construction is a question of law and subject to de novo review. Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 555 (Minn.1996). In a medical malpractice case where expert testimony is necessary to establish a prima facie case, the plaintiff must satisfy two requirements provided in Minn. Stat. § 145.682. Anderson, 608 N.W.2d at 846; Minn. Stat. § 145.682, subds. 2-4. First, the plaintiff must serve the defendant with the summons and complaint accompanied by an affidavit of the plaintiffs attorney stating: [T]he facts of the case have been reviewed by the plaintiffs attorney with an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff [[Image here]] Minn. Stat. § 145.682, subd. 3. Then, within 180 days after commencement of the suit, the plaintiff must serve upon the defendant a second affidavit setting forth: [T]he identity of each person whom plaintiff expects to call as an expert witness at trial to testify with respect to the issues of malpractice or causation, the substance of the facts and opinions to which the expert is expected to testify, and a summary of the grounds for each opinion. Id., subd. 4. Failure to comply with these requirements results, upon motion, in mandatory dismissal with prejudice of each cause of action as to which expert testimony is required to establish a prima facie case. Id., subd. 6; see also Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 578 (Minn.1999). The district court found that respondent’s affidavit did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standard of care. Accepting the evidence in a light most favorable to the nonmoving party, the district court ruled that although Dr. Perloff had extensive experience in general pediatrics, he was not qualified to testify as an expert on the medical issue before the court because there was nothing in his affidavit or accompanying curriculum vitae indicating he had treated cancer patients or patients who have undergone bone marrow transplants. As a result, the district court concluded that Dr. Perloffs opinion *427was not based upon knowledge of the customary response for physicians treating bone marrow transplant patients when they have decreased respiratory levels. The dissent claims that in reaching its conclusion the district court erroneously imported language from subdivision 3 of Minn. Stat. § 145.682 when discussing the expert affidavit required by subdivision 4. According to the dissent, section 145.682 does not require that the expert affidavit be submitted by “ 'an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial,’ ” as the court of appeals ruled. Teffeteller, 626 N.W.2d at 205 (quoting Minn. Stat. § 145.682, subd. 3). We disagree. The affidavit requirement simply cannot be met by a witness not reasonably expected to provide an admissible expert opinion at trial. The statutory structure of section 145.682, subd. 2 provides that where a malpractice claim requires “expert testimony * * * to establish a prima facie case” the expert affidavit in subdivision 4 is required. Expert testimony cannot be given by a witness who is not an expert— that is, someone who is not qualified or competent to give an expert opinion. See Comfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (indicating that in order for a medical witness to be competent to testify as an expert, the witness must have both sufficient scientific knowledge of and practical experience with the subject matter of the offered testimony); Swanson v. Ckat-terton, 281 Minn. 129,140,160 N.W.2d 662, 669 (Minn.1968) (noting that notwithstanding other impressive credentials, an expert witness in a malpractice case must make a substantial showing of qualification in the particular area necessary to support the claims at issue in the suit). Both the district court and the court of appeals appropriately considered Dr. Perloff s qualifications according to the standards articulated in Comfeldt, but the court of appeals concluded that the district court erred in holding that Dr. Perloff was not qualified. Teffeteller, 626 N.W.2d at 206. We disagree. Our case law makes clear that we are to apply “a very deferential standard” to the district court when reviewing a determination as to expert qualification, reversing only if there has been a clear abuse of discretion. Gross v. Victoria Station Farms, Inc., 578 N.W.2d 757, 761 (Minn.1998); see also Benson v. N. Gopher Enters., Inc., 455 N.W.2d 444, 445-46 (Minn.1990). Although Gross arose in the context of a summary judgment motion, and Benson in the context of whether there was sufficient foundation for an expert opinion at trial, the distinction is immaterial because the discretion accorded the district court in determining whether a witness has the qualifications necessary to provide an expert affidavit pursuant to Minn. Stat. § 145.682 is the same. The district court did precisely that here based upon Dr. PerlofPs affidavit with attachments and significant discovery. It did not abuse its discretion in concluding that a doctor who is not specialized in the field of pediatric oncology, or experienced with the highly sophisticated procedure of bone marrow transplants, is not competent to testify as to this claim of medical malpractice.2 To hold otherwise ignores the very deferential standard we accord the trial court as well as the purpose served by the *428expert affidavit statute. Accordingly, we reverse the decision of the court of appeals on this issue. II. We next consider the district court’s finding that even if Dr. Perloff had the appropriate qualifications, his affidavit failed to meet the substantive requirements of section 145.682. Our medical malpractice jurisprudence has clearly defined a number of essential elements that must be included in the affidavit to avoid dismissal. Since 1990, we have reviewed four cases involving claims where expert testimony was necessary to establish a prima facie case. See Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188 (Minn.1990); Stroud, 556 N.W.2d 552; Lindberg, 599 N.W.2d 572; Anderson, 608 N.W.2d 843. In Sorenson, we first established what plaintiffs would be expected to set forth in the expert affidavit in order to comply with the requirements of subdivision 4. 457 N.W.2d at 190. The expert affidavit must (1) disclose specific details concerning the expert’s expected testimony, including the applicable standard of care, (2) identify the acts or omissions that the plaintiff alleges violated the standard of care, and (3) include an outline of the chain of causation between the violation of the standard of care and the plaintiffs damages. Id. In Sorenson, we concluded that the expert affidavit contained “empty conclusions” as to causation which could mask a frivolous claim in the absence of a showing as to how the defendant’s alleged failure to properly diagnose the illness of the decedent’s mother led to decedent’s death. Id. at 192-93. Specifically, we held that the expert affidavit stating that the defendants “failed to properly evaluate” or “failed to properly diagnose” the patient did not set out how the expert will use the facts in the hospital record to arrive at opinions of malpractice and causation. Id. at 192-93. Later, in Stroud, we ruled that it is not enough for the expert affidavit to simply repeat the facts in the hospital record; rather, “ ‘[t]he affidavit should set out how the expert will use those facts to arrive at opinions of malpractice and causation.’ ” 556 N.W.2d at 555 (quoting Sorenson, 457 N.W.2d at 192). In Stroud, a case alleging malpractice based on the defendants’ failure to timely diagnose and treat a sub-arachnoid hemorrhage, we concluded that the expert affidavit provided only broad and conclusory statements as to causation. 556 N.W.2d at 556. The expert affidavit failed to connect the decedent’s cause of death to the defendant’s alleged delay in properly diagnosing and treating the decedent. Id. Then in Lindberg, a case alleging malpractice based on the defendant’s failure to advise the pregnant plaintiff to seek medical treatment, the expert affidavit failed to state what the standard of care was and how the defendants departed from it. 599 N.W.2d at 577-78. It stated that the plaintiffs baby died as a result of the negligent and careless conduct of the defendants. Id. at at 575. We concluded that the expert affidavit, as in Stroud, contained no more than a broad and con-clusory statement as to causation. Lindberg, 599 N.W.2d at 578. Finally, in Anderson, a case in which the plaintiff alleged that the defendant’s negligence caused a severed vagus nerve and swelling of her esophagus and thyroid, we concluded that the expert affidavit failed to state what the standard of care was and how the defendant allegedly violated it; the affidavit even suggested that the cause of the plaintiffs injury was perhaps unrelated to defendant’s acts. 608 N.W.2d at 848. Therefore, as to causation, we held that the affidavit failed to adequately de*429scribe the alleged negligence on the part of the defendant and its relationship to the plaintiffs injury. Id. Applying the standards set forth in Sorenson, Stroud, Lindberg, and Anderson, and comparing the language of the affidavits in these cases to the first affidavit submitted by respondent’s expert, we conclude that the district court did not abuse its discretion in holding that the affidavit failed to detail a chain of causation between the University of Minnesota’s alleged negligence and Roddy’s death.3 Although Dr. Perloffs affidavit states that defendants should have immediately recognized that Roddy was experiencing morphine toxicity and outlines what should have been done to comply with an acceptable level of care thereafter, the affidavit treats the cause of death summarily: [T]he departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death.4 This statement is remarkably similar to the statement of causation found in the affidavit deemed insufficient in Stroud: [A]s a result of the breach of the standard of care [previously identified], there was a failure to diagnose and treat a subarachnoid hemorrhage which ultimately resulted in * * * death of the Plaintiff. 556 N.W.2d at 554. As in Stroud, the expert affidavit submitted by respondent here contains only broad, conclusory statements regarding causation and fails to set forth the chain of causation connecting the failure to treat Roddy for morphine toxicity and his death, as required by the statute. Id. at 556; Sorenson, 457 N.W.2d at 192-93. We therefore reverse the court of appeals and hold that the affidavits failed to meet the requirements of Minn. Stat. § 145.682, subd. 4.5 We take this opportunity to correct the analysis in the opinion of the court of appeals. The court held that the statements contained in Dr. Perloffs affidavit “were sufficient to put the respondents on notice of appellant’s proposed expert testimony.” Teffeteller, 626 N.W.2d at 208 (citing Demgen v. Fairview Hosp., 621 N.W.2d 259, 265-66 (Minn.App.), rev. denied (Minn. Apr. 17, 2001)). The court *430cited Demgen for the erroneous proposition that an expert affidavit is sufficient under Minn. Stat. § 145.682, subd. 4 if it specifies the facts and circumstances of the defendant’s alleged negligence in such a manner as to give defendants a “sneak preview” of the expert’s testimony. 626 N.W.2d at 208. The affidavit required in the statute must provide more than a sneak preview, as noted clearly and repeatedly in Sorenson, Stroud, Lindberg, and Anderson. “The statute requires far more information than simply identification of the expert intended to be called at trial or a ‘general disclosure’ * * Lindberg, 599 N.W.2d at 578. At a minimum, a “meaningful disclosure” is required setting forth the standard of care, the act or omissions violating that standard, and the chain of causation. Anderson, 608 N.W.2d at 849; see also Lindberg, 599 N.W.2d at 577; Stroud, 556 N.W.2d at 555-56; Sorenson, 457 N.W.2d at 198. III. Finally, while we find Dr. Perloff s affidavits deficient as to both appellants on the issue of causation, we address as a separate matter the district court’s conclusion that they were “wholly deficient” as to Dr. Shannon and Dr. Blazar, both employed by PREF. The district court concluded that it was a factual impossibility for either of Dr. Perloff s affidavits to satisfy the requirements of the statute as they relate to PREF. Its holding was based on the fact that both of Dr. Perloff s affidavits stated that the applicable standard of care would have required a continuous infusion of naloxone beginning at 8:30 a.m. and the evidence suggested that neither PREF doctors were involved with Roddy’s care until about 9:30 a.m. The record is unclear as to what time Dr. Shannon became involved in Roddy’s care. Dr. Shannon contends that he was not involved until sometime between 10:00 and 10:15 a.m. Dr. Wetmore stated, however, that she spoke with Dr. Shannon at around 9:00 a.m. about his thoughts on whether or not to administer Nubain. Dr. Wetmore also claimed that she and Dr. Shannon discussed using Narcan instead of Nubain. Dr. Shannon does not recall this conversation. As for Dr. Blazar, the record indicates that he was not involved in Roddy’s care until 9:25 to 9:30 a.m. Dr. Perloff s first affidavit fails to identify what the standard of care for either Dr. Shannon or Dr. Blazar was, what they did to violate that standard, or even what their relation was to Roddy’s care or to care provided by the treating physicians. The applicable standard of care identified in Dr. Perloff s first affidavit relates to recognizing the morphine toxicity at 8:30 a.m. and administering naloxone between 8:30 and 9:25 a.m. The acts allegedly falling below this standard were failing to timely recognize the morphine toxicity, administering Nubain, and failing to infuse nalox-one between 8:30 and 9:25 a.m. There are no allegations that Dr. Shannon should have recognized the morphine toxicity based on the information presented to him during his telephone conversation with Dr. Wetmore, nor is there anything to indicate why either Dr. Shannon or Dr. Blazar should have been involved with Roddy’s care between 8:30 and 9:25 a.m. Finally, even if Dr. Shannon did approve the administering of Nubain, respondent’s theory is not that the administration of the Nu-bain caused Roddy’s death. Therefore, the district court properly concluded that Dr. Perloff s first affidavit failed to articulate the statutory requirements as to PREF. Dr. Perloff s second affidavit also fails to comply with the statutory requirements as to PREF. In it he again asserts that it was *431below the acceptable standard of care to approve the administration of Nubain, but as noted above, no causal link is identified. The second affidavit also indicates that all of the physicians caring for or providing medical input to the care of Roddy should have administered naloxone starting at 8:30 a.m. until there was evidence of ongoing reversal of the narcotic toxicity. But Dr. Blazar was not present in Roddy’s room until about 9:20 a.m. and Dr. Shannon did not arrive until 10:00 a.m. or shortly thereafter. There is nothing in Dr. Perloffs second affidavit indicating what these doctors could have done before they arrived in Roddy’s room to satisfy the standard of care or that their care after arriving in Roddy’s room caused his death. In fact, this second affidavit, like the first, seems to indicate that naloxone needed to be administered starting at 8:30 a.m. or shortly thereafter in order to have reversed the effects of morphine toxicity. Thus, we conclude that both of Dr. Per-loffs affidavits fail to provide any meaningful disclosure regarding what the standard of care required of PREF’s doctors was or how they violated it. Furthermore, neither of Dr. Perloffs affidavits detail a chain of causation between any alleged acts or omissions of PREF’s doctors and Roddy’s death. Accordingly, we hold that dismissal with prejudice as to the claim against appellant PREF was not an abuse of the district court’s discretion and that the court of appeals erred by concluding that the initial affidavit was sufficient to satisfy the statute as to appellant PREF. Reversed.6 BLATZ, C.J., and PAGE, J. took no part in the consideration or decision of this case. GILBERT, J., files an opinion concurring in part and dissenting in part, in which PAUL H. ANDERSON, J., joins.

OPINION STRINGER, Justice. Respondent Jean Teffeteller, as trustee for the heirs of Thad Roddy, commenced this medical malpractice action against appellant University of Minnesota, doing business as University of Minnesota Hospital and Clinics, and appellant Pediatric Research and Education Foundation (PREF) alleging that both appellants negligently failed to recognize signs of morphine toxicity, and faded to appropriately treat morphine toxicity resulting in Rod-dy’s death. The district court granted appellants’ motions for dismissal ruling that respondent’s expert was not qualified to testify as to the applicable standard of care and that, even if the expert had the appropriate qualifications, the expert affidavit submitted by respondent failed to meet the requirements of Minn. Stat. § 145.682 (2000).1 The court of appeals reversed and remanded. We reverse the court of appeals and reinstate the ruling of the district court. In November 1995, 14-year-old Thad Roddy was diagnosed with leukemia. He was admitted to the University of Minnesota Hospital on December 4, 1996 and underwent a bone marrow transplant on December 12,1996. In the week following the transplant, Roddy received morphine to help manage his pain. The morphine dosage was increased on December 18, 1996 in an attempt to reduce his worsening throat pain. At approximately 7:05 a.m. on December 19, 1996, members of the University of Minnesota nursing staff and Dr. Cynthia Wetmore, a medical resident employed by the University of Minnesota, checked on Roddy and found him to be alert, oriented, and responsive. Around 8:30 a.m., Sima Perry, a nurse employed by the University *423of Minnesota, checked on Roddy and found him to be unresponsive. Specifically, Nurse Perry wrote in her progress notes that she was unable to arouse Roddy with “verbal, vigorous tactile stimulation as well as sternal pressure.” She also noted that Roddy’s pupils were sluggish and that he had “dusky nailbeds.” Nurse Perry notified Dr. Wetmore who immediately went to Roddy’s bedside. Dr. Wetmore found that while Roddy was not completely unresponsive and did arouse some, he was not in his normal state of arousal. Dr. Wet-more also found that Roddy was respirat-ing, that his blood pressure and heart rate were fine, and that his nailbeds were not in fact dusky. At approximately 8:45 a.m., Dr. Wet-more called the intensive care unit and spoke with Dr. Kenneth Tegtmeyer, a fellow in pediatric intensive care employed by the University of Minnesota. Dr. Wet-more presented Roddy’s condition to Dr. Tegtmeyer and the two discussed the possible reasons for Roddy’s change in condition, including sepsis, a head bleed, and morphine toxicity. Dr. Wetmore believed that morphine toxicity was an unlikely cause of Roddy’s change in condition because he had been doing fine for the preceding nine hours when he had been on a continuous morphine drip. Dr. Wetmore discussed the possibility of morphine toxicity with Dr. Tegtmeyer, recognizing that toxicity must always be considered when a patient is on morphine. In their discussion, Dr. Wetmore and Dr. Tegtmeyer agreed that they had four different options: (1) give a dose of Narcan (also known as naloxone), (2) give a dose of Nubain, (3) turn off the morphine drip completely, or (4) wait, watch, and do nothing. Dr. Wetmore and Dr. Tegtmeyer ultimately agreed that Dr. Wetmore would order a small test dose of 0.5 milligrams of Nubain be given to Roddy in an effort to assess whether a component of morphine toxicity was present. Dr. Wetmore preferred to order Nubain rather than Narcan, because she believed that administering Nubain was a more conservative diagnostic test for determining whether morphine was playing a role in Roddy’s condition, while Narcan would have immediately and abruptly reversed any morphine toxicity. Dr. Wetmore feared that any such immediate reversal of morphine toxicity caused by administering Narcan could lead to a number of undesirable side effects, including a sudden increase in in-tracranial pressure, a sudden rise in blood pressure, a sudden onset of extreme pain, or vomiting. Dr. Wetmore testified at her deposition that she then called Dr. Michael Shannon, an attending physician in the pediatric intensive care unit employed by PREF, at approximately 9:00 a.m. She presented Roddy’s condition to Dr. Shannon and explained the decision she and Dr. Tegtmeyer had reached about administering Nu-bain instead of Narcan. According to Dr. Wetmore, Dr. Shannon agreed with her assessment that, given the fact Roddy’s vital signs were still stable, as well as the potential side effects of Narcan, ordering a small test dose of Nubain was reasonable and also a more compassionate and conservative approach than administering Nar-can. Dr. Shannon testified in deposition that he did not recall any of this discussion with Dr. Wetmore and that he was not consulted about Roddy’s care until shortly before he arrived at Roddy’s room later that morning. He also testified that he was unfamiliar with the use of Nubain under the circumstances of this case. In any event, Roddy’s morphine drip was stopped and 0.5 milligrams of Nubain were administered around 9:15 or 9:20 a.m. Dr. Bruce Blazar, a pediatric pulmonary transplant staff physician employed by PREF, and Dr. Brenda Weigel, a pediatric *424bone marrow transplant fellow employed by the University of Minnesota, were getting ready to begin their rounds when they were called into Roddy’s room between 9:25 and 9:30 a.m. Dr. Blazar testified in deposition that either he or Dr. Weigel ordered the first dose of Narcan to be administered shortly after assessing Rod-dy’s condition. A total of two or three doses of Narcan were administered between 9:30 and 10:23 a.m. Dr. Shannon testified that he arrived with Dr. Tegtmeyer at Roddy’s room sometime between 10:00 and 10:15 a.m. to assist in Roddy’s care. According to the nurses’ progress notes, Roddy began deteriorating shortly after Dr. Shannon arrived, during the administration of a dose of Narcan. At approximately 10:23 a.m., Roddy experienced a respiratory arrest and a code was called. Roddy was immediately intubated and two or three more doses of Narcan were administered between 10:25 and 11:30 a.m. Roddy never regained consciousness. He was placed on mechanical ventilation but died on January 3, 1997 after being removed from life support. Roddy’s autopsy report indicated that he died as a result of multi-organ system failure, but that his decreased respiratory state before his arrest on December 19,1996 was caused by the administration of morphine. Respondent commenced this lawsuit on or about December 1, 1998. With the summons and complaint, respondent served an affidavit of respondent’s attorney as required by Minn. Stat. § 145.682, subds. 2, 3 (2000), stating that the facts in the case had been reviewed by respondent’s attorney with a medical expert whose qualifications provided a reasonable expectation that the expert’s opinion could be admissible at trial and, in the opinion of the expert, the appellants’ deviations from the applicable standard of care caused injury to respondent. There is no contention that this affidavit failed to meet the statutory requirements of Minn. Stat. § 145.682, subd. 3. In February 1999, respondent and both appellants entered into a stipulation that the 180-day deadline for meeting the expert affidavit requirements of Minn. Stat. § 145.682, subd. 4 (2000) was extended to 90 days following the completion of certain discovery depositions. The last of these depositions occurred on June 17, 1999. On or about August 25, 1999, respondent served appellants with an affidavit of the expected testimony of respondent’s expert, Dr. William Perloff. Dr. Perloffs curriculum vitae indicated that (1) he has been board certified in pediatrics and pediatric critical care, (2) he has held numerous teaching positions related to pediatric care, (3) he served as the medical director of the pediatric intensive care unit at the University of Wisconsin Children’s Hospital in Madison, Wisconsin from 1982 to 1998, (4) he has served on multiple pediatric and critical care committees, and (5) he has published articles and given presentations on various aspects of pediatric care. The affidavit stated, in part: Dr. Perloff is expected to testify that the medical and nursing care provided by the defendants fell below acceptable levels of care practiced by reasonably prudent physicians and nurses, under the circumstances of this case. It is Dr. Perloffs opinion that it was below accepted standards of care for the defendants to fail to timely recognize that Thad Roddy was experiencing Morphine toxicity on the morning of December 19, 1996. At 8:30 a.m., when the nurses noted that they were unable to rouse him with verbal, vigorous or tactile stimulation, or with sternal pressure, and Thad had pinpoint and sluggish pupils, the applicable standard of care would *425require recognition that Thad was in a state of Morphine toxicity. * * * An acceptable level of care between 8:30 and 9:25 would have required frequent boluses or a continuous infusion of naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of narcotic toxicity * * *. It was below accepted standards of care for the defendants to administer Nubain, as ordered by Cynthia Wet-more, M.D., which may well have exacerbated the effects of the Morphine. Further, it is Dr. Perloffs opinion that had Thad Roddy’s clinical status [been] appreciated as Morphine toxicity at about 8:30 a.m., and had appropriate treatment measures been utilized, i.e. frequent boluses or a continuous infusion of naloxone continuously monitored by a physician, Thad Roddy, to a reasonable degree of medical probability would have been revived successfully. Finally, it is Dr. Perloffs opinion that the departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death. Over 7 months later, on or about April 5, 2000, respondent served appellants with an affidavit supplementing Dr. Perloffs opinions, this time pertaining to Dr. Shannon and Dr. Blazar. The supplemental affidavit stated, in part: It is Dr. Perloffs opinion that Drs. Shannon and Blazar, in their involvement in Thad Roddy’s care, departed from an acceptable level of care expected of specialists in the practice of pediatric care. Specifically, it was below the acceptable standard of care to approve the administration of Nubain in this case. * * * An acceptable level of care at about 8:30 a.m., would have required frequent boluses of or continuous infusion of Naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of the narcotic toxicity * * *. [A]t about 8:30 a.m. up until the time of the arrest, all of the physicians caring for or providing medical input to the care of Thad Roddy, should have recognized that Thad Roddy was experiencing Morphine toxicity. As such, the applicable standard of care would have required the administration of Naxolone as above described. In addition, had Thad Roddy’s clinical status been appreciated as Morphine toxicity at about 8:30 a.m. and thereafter, and had appropriate treatment measures been utilized as above outlined, Thad Roddy’s death would have, to a reasonable degree of medical probability, have [sic] been avoided. Both appellants moved for dismissal in June of 2000, arguing that respondent’s expert affidavit and supplemental affidavit were insufficient as to negligence and causation, thereby failing to meet the requirements of Minn. Stat. § 145.682. The University of Minnesota also argued that Dr. Perloffs supplemental affidavit was untimely and that he was not qualified to render an opinion about the standard of care for treating Roddy. The district court, applying a summary judgment standard, granted both appellants’ motions to dismiss. The court held that appellants were entitled to dismissal with prejudice under Minn. Stat. § 145.682 because of respondent’s “failure to identify an expert qualified to testify to the applicable standard of care,” noting that Dr. Perloff lacked practical and clinical experience in treating bone marrow transplant patients. Relying in part on deposition testimony from Dr. Blazar, a physician experienced in bone marrow transplant procedures, the court concluded that this specific experience was necessary to state an opinion because following a high risk procedure of this nature a physician would have several *426additional factors to consider when diagnosing complications. The court also held that even if Dr. Perloff were qualified to render an opinion in this case, both appellants were entitled to have the case dismissed with prejudice because Dr. Perloff failed to detail a chain of causation between appellants’ alleged malpractice and Roddy’s death. Finally, the court concluded that Dr. Perloffs affidavits were “wholly deficient” under Minn. Stat. § 145.682 as they related to appellant PREF. The court of appeals reversed, holding that Dr. Perloff was qualified to testify about the standards of care related to morphine toxicity in pediatric patients and that Dr. Perloffs first affidavit satisfied the requirements of Minn. Stat. § 145.682 for both appellants. Tejfeteller v. Univ. of Minn., 626 N.W.2d 201, 208 (Minn.App. 2001). This appeal followed. I. We will reverse a district court’s dismissal of a claim pursuant to Minn. Stat. § 145.682 only if we find that the district court abused its discretion. Anderson v. Rengachary, 608 N.W.2d 843, 846 (Minn. 2000). At the same time, statutory construction is a question of law and subject to de novo review. Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 555 (Minn.1996). In a medical malpractice case where expert testimony is necessary to establish a prima facie case, the plaintiff must satisfy two requirements provided in Minn. Stat. § 145.682. Anderson, 608 N.W.2d at 846; Minn. Stat. § 145.682, subds. 2-4. First, the plaintiff must serve the defendant with the summons and complaint accompanied by an affidavit of the plaintiffs attorney stating: [T]he facts of the case have been reviewed by the plaintiffs attorney with an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff [[Image here]] Minn. Stat. § 145.682, subd. 3. Then, within 180 days after commencement of the suit, the plaintiff must serve upon the defendant a second affidavit setting forth: [T]he identity of each person whom plaintiff expects to call as an expert witness at trial to testify with respect to the issues of malpractice or causation, the substance of the facts and opinions to which the expert is expected to testify, and a summary of the grounds for each opinion. Id., subd. 4. Failure to comply with these requirements results, upon motion, in mandatory dismissal with prejudice of each cause of action as to which expert testimony is required to establish a prima facie case. Id., subd. 6; see also Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 578 (Minn.1999). The district court found that respondent’s affidavit did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standard of care. Accepting the evidence in a light most favorable to the nonmoving party, the district court ruled that although Dr. Perloff had extensive experience in general pediatrics, he was not qualified to testify as an expert on the medical issue before the court because there was nothing in his affidavit or accompanying curriculum vitae indicating he had treated cancer patients or patients who have undergone bone marrow transplants. As a result, the district court concluded that Dr. Perloffs opinion *427was not based upon knowledge of the customary response for physicians treating bone marrow transplant patients when they have decreased respiratory levels. The dissent claims that in reaching its conclusion the district court erroneously imported language from subdivision 3 of Minn. Stat. § 145.682 when discussing the expert affidavit required by subdivision 4. According to the dissent, section 145.682 does not require that the expert affidavit be submitted by “ 'an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial,’ ” as the court of appeals ruled. Teffeteller, 626 N.W.2d at 205 (quoting Minn. Stat. § 145.682, subd. 3). We disagree. The affidavit requirement simply cannot be met by a witness not reasonably expected to provide an admissible expert opinion at trial. The statutory structure of section 145.682, subd. 2 provides that where a malpractice claim requires “expert testimony * * * to establish a prima facie case” the expert affidavit in subdivision 4 is required. Expert testimony cannot be given by a witness who is not an expert— that is, someone who is not qualified or competent to give an expert opinion. See Comfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (indicating that in order for a medical witness to be competent to testify as an expert, the witness must have both sufficient scientific knowledge of and practical experience with the subject matter of the offered testimony); Swanson v. Ckat-terton, 281 Minn. 129,140,160 N.W.2d 662, 669 (Minn.1968) (noting that notwithstanding other impressive credentials, an expert witness in a malpractice case must make a substantial showing of qualification in the particular area necessary to support the claims at issue in the suit). Both the district court and the court of appeals appropriately considered Dr. Perloff s qualifications according to the standards articulated in Comfeldt, but the court of appeals concluded that the district court erred in holding that Dr. Perloff was not qualified. Teffeteller, 626 N.W.2d at 206. We disagree. Our case law makes clear that we are to apply “a very deferential standard” to the district court when reviewing a determination as to expert qualification, reversing only if there has been a clear abuse of discretion. Gross v. Victoria Station Farms, Inc., 578 N.W.2d 757, 761 (Minn.1998); see also Benson v. N. Gopher Enters., Inc., 455 N.W.2d 444, 445-46 (Minn.1990). Although Gross arose in the context of a summary judgment motion, and Benson in the context of whether there was sufficient foundation for an expert opinion at trial, the distinction is immaterial because the discretion accorded the district court in determining whether a witness has the qualifications necessary to provide an expert affidavit pursuant to Minn. Stat. § 145.682 is the same. The district court did precisely that here based upon Dr. PerlofPs affidavit with attachments and significant discovery. It did not abuse its discretion in concluding that a doctor who is not specialized in the field of pediatric oncology, or experienced with the highly sophisticated procedure of bone marrow transplants, is not competent to testify as to this claim of medical malpractice.2 To hold otherwise ignores the very deferential standard we accord the trial court as well as the purpose served by the *428expert affidavit statute. Accordingly, we reverse the decision of the court of appeals on this issue. II. We next consider the district court’s finding that even if Dr. Perloff had the appropriate qualifications, his affidavit failed to meet the substantive requirements of section 145.682. Our medical malpractice jurisprudence has clearly defined a number of essential elements that must be included in the affidavit to avoid dismissal. Since 1990, we have reviewed four cases involving claims where expert testimony was necessary to establish a prima facie case. See Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188 (Minn.1990); Stroud, 556 N.W.2d 552; Lindberg, 599 N.W.2d 572; Anderson, 608 N.W.2d 843. In Sorenson, we first established what plaintiffs would be expected to set forth in the expert affidavit in order to comply with the requirements of subdivision 4. 457 N.W.2d at 190. The expert affidavit must (1) disclose specific details concerning the expert’s expected testimony, including the applicable standard of care, (2) identify the acts or omissions that the plaintiff alleges violated the standard of care, and (3) include an outline of the chain of causation between the violation of the standard of care and the plaintiffs damages. Id. In Sorenson, we concluded that the expert affidavit contained “empty conclusions” as to causation which could mask a frivolous claim in the absence of a showing as to how the defendant’s alleged failure to properly diagnose the illness of the decedent’s mother led to decedent’s death. Id. at 192-93. Specifically, we held that the expert affidavit stating that the defendants “failed to properly evaluate” or “failed to properly diagnose” the patient did not set out how the expert will use the facts in the hospital record to arrive at opinions of malpractice and causation. Id. at 192-93. Later, in Stroud, we ruled that it is not enough for the expert affidavit to simply repeat the facts in the hospital record; rather, “ ‘[t]he affidavit should set out how the expert will use those facts to arrive at opinions of malpractice and causation.’ ” 556 N.W.2d at 555 (quoting Sorenson, 457 N.W.2d at 192). In Stroud, a case alleging malpractice based on the defendants’ failure to timely diagnose and treat a sub-arachnoid hemorrhage, we concluded that the expert affidavit provided only broad and conclusory statements as to causation. 556 N.W.2d at 556. The expert affidavit failed to connect the decedent’s cause of death to the defendant’s alleged delay in properly diagnosing and treating the decedent. Id. Then in Lindberg, a case alleging malpractice based on the defendant’s failure to advise the pregnant plaintiff to seek medical treatment, the expert affidavit failed to state what the standard of care was and how the defendants departed from it. 599 N.W.2d at 577-78. It stated that the plaintiffs baby died as a result of the negligent and careless conduct of the defendants. Id. at at 575. We concluded that the expert affidavit, as in Stroud, contained no more than a broad and con-clusory statement as to causation. Lindberg, 599 N.W.2d at 578. Finally, in Anderson, a case in which the plaintiff alleged that the defendant’s negligence caused a severed vagus nerve and swelling of her esophagus and thyroid, we concluded that the expert affidavit failed to state what the standard of care was and how the defendant allegedly violated it; the affidavit even suggested that the cause of the plaintiffs injury was perhaps unrelated to defendant’s acts. 608 N.W.2d at 848. Therefore, as to causation, we held that the affidavit failed to adequately de*429scribe the alleged negligence on the part of the defendant and its relationship to the plaintiffs injury. Id. Applying the standards set forth in Sorenson, Stroud, Lindberg, and Anderson, and comparing the language of the affidavits in these cases to the first affidavit submitted by respondent’s expert, we conclude that the district court did not abuse its discretion in holding that the affidavit failed to detail a chain of causation between the University of Minnesota’s alleged negligence and Roddy’s death.3 Although Dr. Perloffs affidavit states that defendants should have immediately recognized that Roddy was experiencing morphine toxicity and outlines what should have been done to comply with an acceptable level of care thereafter, the affidavit treats the cause of death summarily: [T]he departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death.4 This statement is remarkably similar to the statement of causation found in the affidavit deemed insufficient in Stroud: [A]s a result of the breach of the standard of care [previously identified], there was a failure to diagnose and treat a subarachnoid hemorrhage which ultimately resulted in * * * death of the Plaintiff. 556 N.W.2d at 554. As in Stroud, the expert affidavit submitted by respondent here contains only broad, conclusory statements regarding causation and fails to set forth the chain of causation connecting the failure to treat Roddy for morphine toxicity and his death, as required by the statute. Id. at 556; Sorenson, 457 N.W.2d at 192-93. We therefore reverse the court of appeals and hold that the affidavits failed to meet the requirements of Minn. Stat. § 145.682, subd. 4.5 We take this opportunity to correct the analysis in the opinion of the court of appeals. The court held that the statements contained in Dr. Perloffs affidavit “were sufficient to put the respondents on notice of appellant’s proposed expert testimony.” Teffeteller, 626 N.W.2d at 208 (citing Demgen v. Fairview Hosp., 621 N.W.2d 259, 265-66 (Minn.App.), rev. denied (Minn. Apr. 17, 2001)). The court *430cited Demgen for the erroneous proposition that an expert affidavit is sufficient under Minn. Stat. § 145.682, subd. 4 if it specifies the facts and circumstances of the defendant’s alleged negligence in such a manner as to give defendants a “sneak preview” of the expert’s testimony. 626 N.W.2d at 208. The affidavit required in the statute must provide more than a sneak preview, as noted clearly and repeatedly in Sorenson, Stroud, Lindberg, and Anderson. “The statute requires far more information than simply identification of the expert intended to be called at trial or a ‘general disclosure’ * * Lindberg, 599 N.W.2d at 578. At a minimum, a “meaningful disclosure” is required setting forth the standard of care, the act or omissions violating that standard, and the chain of causation. Anderson, 608 N.W.2d at 849; see also Lindberg, 599 N.W.2d at 577; Stroud, 556 N.W.2d at 555-56; Sorenson, 457 N.W.2d at 198. III. Finally, while we find Dr. Perloff s affidavits deficient as to both appellants on the issue of causation, we address as a separate matter the district court’s conclusion that they were “wholly deficient” as to Dr. Shannon and Dr. Blazar, both employed by PREF. The district court concluded that it was a factual impossibility for either of Dr. Perloff s affidavits to satisfy the requirements of the statute as they relate to PREF. Its holding was based on the fact that both of Dr. Perloff s affidavits stated that the applicable standard of care would have required a continuous infusion of naloxone beginning at 8:30 a.m. and the evidence suggested that neither PREF doctors were involved with Roddy’s care until about 9:30 a.m. The record is unclear as to what time Dr. Shannon became involved in Roddy’s care. Dr. Shannon contends that he was not involved until sometime between 10:00 and 10:15 a.m. Dr. Wetmore stated, however, that she spoke with Dr. Shannon at around 9:00 a.m. about his thoughts on whether or not to administer Nubain. Dr. Wetmore also claimed that she and Dr. Shannon discussed using Narcan instead of Nubain. Dr. Shannon does not recall this conversation. As for Dr. Blazar, the record indicates that he was not involved in Roddy’s care until 9:25 to 9:30 a.m. Dr. Perloff s first affidavit fails to identify what the standard of care for either Dr. Shannon or Dr. Blazar was, what they did to violate that standard, or even what their relation was to Roddy’s care or to care provided by the treating physicians. The applicable standard of care identified in Dr. Perloff s first affidavit relates to recognizing the morphine toxicity at 8:30 a.m. and administering naloxone between 8:30 and 9:25 a.m. The acts allegedly falling below this standard were failing to timely recognize the morphine toxicity, administering Nubain, and failing to infuse nalox-one between 8:30 and 9:25 a.m. There are no allegations that Dr. Shannon should have recognized the morphine toxicity based on the information presented to him during his telephone conversation with Dr. Wetmore, nor is there anything to indicate why either Dr. Shannon or Dr. Blazar should have been involved with Roddy’s care between 8:30 and 9:25 a.m. Finally, even if Dr. Shannon did approve the administering of Nubain, respondent’s theory is not that the administration of the Nu-bain caused Roddy’s death. Therefore, the district court properly concluded that Dr. Perloff s first affidavit failed to articulate the statutory requirements as to PREF. Dr. Perloff s second affidavit also fails to comply with the statutory requirements as to PREF. In it he again asserts that it was *431below the acceptable standard of care to approve the administration of Nubain, but as noted above, no causal link is identified. The second affidavit also indicates that all of the physicians caring for or providing medical input to the care of Roddy should have administered naloxone starting at 8:30 a.m. until there was evidence of ongoing reversal of the narcotic toxicity. But Dr. Blazar was not present in Roddy’s room until about 9:20 a.m. and Dr. Shannon did not arrive until 10:00 a.m. or shortly thereafter. There is nothing in Dr. Perloffs second affidavit indicating what these doctors could have done before they arrived in Roddy’s room to satisfy the standard of care or that their care after arriving in Roddy’s room caused his death. In fact, this second affidavit, like the first, seems to indicate that naloxone needed to be administered starting at 8:30 a.m. or shortly thereafter in order to have reversed the effects of morphine toxicity. Thus, we conclude that both of Dr. Per-loffs affidavits fail to provide any meaningful disclosure regarding what the standard of care required of PREF’s doctors was or how they violated it. Furthermore, neither of Dr. Perloffs affidavits detail a chain of causation between any alleged acts or omissions of PREF’s doctors and Roddy’s death. Accordingly, we hold that dismissal with prejudice as to the claim against appellant PREF was not an abuse of the district court’s discretion and that the court of appeals erred by concluding that the initial affidavit was sufficient to satisfy the statute as to appellant PREF. Reversed.6 BLATZ, C.J., and PAGE, J. took no part in the consideration or decision of this case. GILBERT, J., files an opinion concurring in part and dissenting in part, in which PAUL H. ANDERSON, J., joins.

OPINION STRINGER, Justice. Respondent Jean Teffeteller, as trustee for the heirs of Thad Roddy, commenced this medical malpractice action against appellant University of Minnesota, doing business as University of Minnesota Hospital and Clinics, and appellant Pediatric Research and Education Foundation (PREF) alleging that both appellants negligently failed to recognize signs of morphine toxicity, and faded to appropriately treat morphine toxicity resulting in Rod-dy’s death. The district court granted appellants’ motions for dismissal ruling that respondent’s expert was not qualified to testify as to the applicable standard of care and that, even if the expert had the appropriate qualifications, the expert affidavit submitted by respondent failed to meet the requirements of Minn. Stat. § 145.682 (2000).1 The court of appeals reversed and remanded. We reverse the court of appeals and reinstate the ruling of the district court. In November 1995, 14-year-old Thad Roddy was diagnosed with leukemia. He was admitted to the University of Minnesota Hospital on December 4, 1996 and underwent a bone marrow transplant on December 12,1996. In the week following the transplant, Roddy received morphine to help manage his pain. The morphine dosage was increased on December 18, 1996 in an attempt to reduce his worsening throat pain. At approximately 7:05 a.m. on December 19, 1996, members of the University of Minnesota nursing staff and Dr. Cynthia Wetmore, a medical resident employed by the University of Minnesota, checked on Roddy and found him to be alert, oriented, and responsive. Around 8:30 a.m., Sima Perry, a nurse employed by the University *423of Minnesota, checked on Roddy and found him to be unresponsive. Specifically, Nurse Perry wrote in her progress notes that she was unable to arouse Roddy with “verbal, vigorous tactile stimulation as well as sternal pressure.” She also noted that Roddy’s pupils were sluggish and that he had “dusky nailbeds.” Nurse Perry notified Dr. Wetmore who immediately went to Roddy’s bedside. Dr. Wetmore found that while Roddy was not completely unresponsive and did arouse some, he was not in his normal state of arousal. Dr. Wet-more also found that Roddy was respirat-ing, that his blood pressure and heart rate were fine, and that his nailbeds were not in fact dusky. At approximately 8:45 a.m., Dr. Wet-more called the intensive care unit and spoke with Dr. Kenneth Tegtmeyer, a fellow in pediatric intensive care employed by the University of Minnesota. Dr. Wet-more presented Roddy’s condition to Dr. Tegtmeyer and the two discussed the possible reasons for Roddy’s change in condition, including sepsis, a head bleed, and morphine toxicity. Dr. Wetmore believed that morphine toxicity was an unlikely cause of Roddy’s change in condition because he had been doing fine for the preceding nine hours when he had been on a continuous morphine drip. Dr. Wetmore discussed the possibility of morphine toxicity with Dr. Tegtmeyer, recognizing that toxicity must always be considered when a patient is on morphine. In their discussion, Dr. Wetmore and Dr. Tegtmeyer agreed that they had four different options: (1) give a dose of Narcan (also known as naloxone), (2) give a dose of Nubain, (3) turn off the morphine drip completely, or (4) wait, watch, and do nothing. Dr. Wetmore and Dr. Tegtmeyer ultimately agreed that Dr. Wetmore would order a small test dose of 0.5 milligrams of Nubain be given to Roddy in an effort to assess whether a component of morphine toxicity was present. Dr. Wetmore preferred to order Nubain rather than Narcan, because she believed that administering Nubain was a more conservative diagnostic test for determining whether morphine was playing a role in Roddy’s condition, while Narcan would have immediately and abruptly reversed any morphine toxicity. Dr. Wetmore feared that any such immediate reversal of morphine toxicity caused by administering Narcan could lead to a number of undesirable side effects, including a sudden increase in in-tracranial pressure, a sudden rise in blood pressure, a sudden onset of extreme pain, or vomiting. Dr. Wetmore testified at her deposition that she then called Dr. Michael Shannon, an attending physician in the pediatric intensive care unit employed by PREF, at approximately 9:00 a.m. She presented Roddy’s condition to Dr. Shannon and explained the decision she and Dr. Tegtmeyer had reached about administering Nu-bain instead of Narcan. According to Dr. Wetmore, Dr. Shannon agreed with her assessment that, given the fact Roddy’s vital signs were still stable, as well as the potential side effects of Narcan, ordering a small test dose of Nubain was reasonable and also a more compassionate and conservative approach than administering Nar-can. Dr. Shannon testified in deposition that he did not recall any of this discussion with Dr. Wetmore and that he was not consulted about Roddy’s care until shortly before he arrived at Roddy’s room later that morning. He also testified that he was unfamiliar with the use of Nubain under the circumstances of this case. In any event, Roddy’s morphine drip was stopped and 0.5 milligrams of Nubain were administered around 9:15 or 9:20 a.m. Dr. Bruce Blazar, a pediatric pulmonary transplant staff physician employed by PREF, and Dr. Brenda Weigel, a pediatric *424bone marrow transplant fellow employed by the University of Minnesota, were getting ready to begin their rounds when they were called into Roddy’s room between 9:25 and 9:30 a.m. Dr. Blazar testified in deposition that either he or Dr. Weigel ordered the first dose of Narcan to be administered shortly after assessing Rod-dy’s condition. A total of two or three doses of Narcan were administered between 9:30 and 10:23 a.m. Dr. Shannon testified that he arrived with Dr. Tegtmeyer at Roddy’s room sometime between 10:00 and 10:15 a.m. to assist in Roddy’s care. According to the nurses’ progress notes, Roddy began deteriorating shortly after Dr. Shannon arrived, during the administration of a dose of Narcan. At approximately 10:23 a.m., Roddy experienced a respiratory arrest and a code was called. Roddy was immediately intubated and two or three more doses of Narcan were administered between 10:25 and 11:30 a.m. Roddy never regained consciousness. He was placed on mechanical ventilation but died on January 3, 1997 after being removed from life support. Roddy’s autopsy report indicated that he died as a result of multi-organ system failure, but that his decreased respiratory state before his arrest on December 19,1996 was caused by the administration of morphine. Respondent commenced this lawsuit on or about December 1, 1998. With the summons and complaint, respondent served an affidavit of respondent’s attorney as required by Minn. Stat. § 145.682, subds. 2, 3 (2000), stating that the facts in the case had been reviewed by respondent’s attorney with a medical expert whose qualifications provided a reasonable expectation that the expert’s opinion could be admissible at trial and, in the opinion of the expert, the appellants’ deviations from the applicable standard of care caused injury to respondent. There is no contention that this affidavit failed to meet the statutory requirements of Minn. Stat. § 145.682, subd. 3. In February 1999, respondent and both appellants entered into a stipulation that the 180-day deadline for meeting the expert affidavit requirements of Minn. Stat. § 145.682, subd. 4 (2000) was extended to 90 days following the completion of certain discovery depositions. The last of these depositions occurred on June 17, 1999. On or about August 25, 1999, respondent served appellants with an affidavit of the expected testimony of respondent’s expert, Dr. William Perloff. Dr. Perloffs curriculum vitae indicated that (1) he has been board certified in pediatrics and pediatric critical care, (2) he has held numerous teaching positions related to pediatric care, (3) he served as the medical director of the pediatric intensive care unit at the University of Wisconsin Children’s Hospital in Madison, Wisconsin from 1982 to 1998, (4) he has served on multiple pediatric and critical care committees, and (5) he has published articles and given presentations on various aspects of pediatric care. The affidavit stated, in part: Dr. Perloff is expected to testify that the medical and nursing care provided by the defendants fell below acceptable levels of care practiced by reasonably prudent physicians and nurses, under the circumstances of this case. It is Dr. Perloffs opinion that it was below accepted standards of care for the defendants to fail to timely recognize that Thad Roddy was experiencing Morphine toxicity on the morning of December 19, 1996. At 8:30 a.m., when the nurses noted that they were unable to rouse him with verbal, vigorous or tactile stimulation, or with sternal pressure, and Thad had pinpoint and sluggish pupils, the applicable standard of care would *425require recognition that Thad was in a state of Morphine toxicity. * * * An acceptable level of care between 8:30 and 9:25 would have required frequent boluses or a continuous infusion of naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of narcotic toxicity * * *. It was below accepted standards of care for the defendants to administer Nubain, as ordered by Cynthia Wet-more, M.D., which may well have exacerbated the effects of the Morphine. Further, it is Dr. Perloffs opinion that had Thad Roddy’s clinical status [been] appreciated as Morphine toxicity at about 8:30 a.m., and had appropriate treatment measures been utilized, i.e. frequent boluses or a continuous infusion of naloxone continuously monitored by a physician, Thad Roddy, to a reasonable degree of medical probability would have been revived successfully. Finally, it is Dr. Perloffs opinion that the departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death. Over 7 months later, on or about April 5, 2000, respondent served appellants with an affidavit supplementing Dr. Perloffs opinions, this time pertaining to Dr. Shannon and Dr. Blazar. The supplemental affidavit stated, in part: It is Dr. Perloffs opinion that Drs. Shannon and Blazar, in their involvement in Thad Roddy’s care, departed from an acceptable level of care expected of specialists in the practice of pediatric care. Specifically, it was below the acceptable standard of care to approve the administration of Nubain in this case. * * * An acceptable level of care at about 8:30 a.m., would have required frequent boluses of or continuous infusion of Naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of the narcotic toxicity * * *. [A]t about 8:30 a.m. up until the time of the arrest, all of the physicians caring for or providing medical input to the care of Thad Roddy, should have recognized that Thad Roddy was experiencing Morphine toxicity. As such, the applicable standard of care would have required the administration of Naxolone as above described. In addition, had Thad Roddy’s clinical status been appreciated as Morphine toxicity at about 8:30 a.m. and thereafter, and had appropriate treatment measures been utilized as above outlined, Thad Roddy’s death would have, to a reasonable degree of medical probability, have [sic] been avoided. Both appellants moved for dismissal in June of 2000, arguing that respondent’s expert affidavit and supplemental affidavit were insufficient as to negligence and causation, thereby failing to meet the requirements of Minn. Stat. § 145.682. The University of Minnesota also argued that Dr. Perloffs supplemental affidavit was untimely and that he was not qualified to render an opinion about the standard of care for treating Roddy. The district court, applying a summary judgment standard, granted both appellants’ motions to dismiss. The court held that appellants were entitled to dismissal with prejudice under Minn. Stat. § 145.682 because of respondent’s “failure to identify an expert qualified to testify to the applicable standard of care,” noting that Dr. Perloff lacked practical and clinical experience in treating bone marrow transplant patients. Relying in part on deposition testimony from Dr. Blazar, a physician experienced in bone marrow transplant procedures, the court concluded that this specific experience was necessary to state an opinion because following a high risk procedure of this nature a physician would have several *426additional factors to consider when diagnosing complications. The court also held that even if Dr. Perloff were qualified to render an opinion in this case, both appellants were entitled to have the case dismissed with prejudice because Dr. Perloff failed to detail a chain of causation between appellants’ alleged malpractice and Roddy’s death. Finally, the court concluded that Dr. Perloffs affidavits were “wholly deficient” under Minn. Stat. § 145.682 as they related to appellant PREF. The court of appeals reversed, holding that Dr. Perloff was qualified to testify about the standards of care related to morphine toxicity in pediatric patients and that Dr. Perloffs first affidavit satisfied the requirements of Minn. Stat. § 145.682 for both appellants. Tejfeteller v. Univ. of Minn., 626 N.W.2d 201, 208 (Minn.App. 2001). This appeal followed. I. We will reverse a district court’s dismissal of a claim pursuant to Minn. Stat. § 145.682 only if we find that the district court abused its discretion. Anderson v. Rengachary, 608 N.W.2d 843, 846 (Minn. 2000). At the same time, statutory construction is a question of law and subject to de novo review. Stroud v. Hennepin County Med. Ctr., 556 N.W.2d 552, 555 (Minn.1996). In a medical malpractice case where expert testimony is necessary to establish a prima facie case, the plaintiff must satisfy two requirements provided in Minn. Stat. § 145.682. Anderson, 608 N.W.2d at 846; Minn. Stat. § 145.682, subds. 2-4. First, the plaintiff must serve the defendant with the summons and complaint accompanied by an affidavit of the plaintiffs attorney stating: [T]he facts of the case have been reviewed by the plaintiffs attorney with an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial and that, in the opinion of this expert, one or more defendants deviated from the applicable standard of care and by that action caused injury to the plaintiff [[Image here]] Minn. Stat. § 145.682, subd. 3. Then, within 180 days after commencement of the suit, the plaintiff must serve upon the defendant a second affidavit setting forth: [T]he identity of each person whom plaintiff expects to call as an expert witness at trial to testify with respect to the issues of malpractice or causation, the substance of the facts and opinions to which the expert is expected to testify, and a summary of the grounds for each opinion. Id., subd. 4. Failure to comply with these requirements results, upon motion, in mandatory dismissal with prejudice of each cause of action as to which expert testimony is required to establish a prima facie case. Id., subd. 6; see also Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 578 (Minn.1999). The district court found that respondent’s affidavit did not satisfy the requirements of Minn. Stat. § 145.682 because it failed to identify an expert qualified to testify to the applicable standard of care. Accepting the evidence in a light most favorable to the nonmoving party, the district court ruled that although Dr. Perloff had extensive experience in general pediatrics, he was not qualified to testify as an expert on the medical issue before the court because there was nothing in his affidavit or accompanying curriculum vitae indicating he had treated cancer patients or patients who have undergone bone marrow transplants. As a result, the district court concluded that Dr. Perloffs opinion *427was not based upon knowledge of the customary response for physicians treating bone marrow transplant patients when they have decreased respiratory levels. The dissent claims that in reaching its conclusion the district court erroneously imported language from subdivision 3 of Minn. Stat. § 145.682 when discussing the expert affidavit required by subdivision 4. According to the dissent, section 145.682 does not require that the expert affidavit be submitted by “ 'an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial,’ ” as the court of appeals ruled. Teffeteller, 626 N.W.2d at 205 (quoting Minn. Stat. § 145.682, subd. 3). We disagree. The affidavit requirement simply cannot be met by a witness not reasonably expected to provide an admissible expert opinion at trial. The statutory structure of section 145.682, subd. 2 provides that where a malpractice claim requires “expert testimony * * * to establish a prima facie case” the expert affidavit in subdivision 4 is required. Expert testimony cannot be given by a witness who is not an expert— that is, someone who is not qualified or competent to give an expert opinion. See Comfeldt v. Tongen, 262 N.W.2d 684, 692 (Minn.1977) (indicating that in order for a medical witness to be competent to testify as an expert, the witness must have both sufficient scientific knowledge of and practical experience with the subject matter of the offered testimony); Swanson v. Ckat-terton, 281 Minn. 129,140,160 N.W.2d 662, 669 (Minn.1968) (noting that notwithstanding other impressive credentials, an expert witness in a malpractice case must make a substantial showing of qualification in the particular area necessary to support the claims at issue in the suit). Both the district court and the court of appeals appropriately considered Dr. Perloff s qualifications according to the standards articulated in Comfeldt, but the court of appeals concluded that the district court erred in holding that Dr. Perloff was not qualified. Teffeteller, 626 N.W.2d at 206. We disagree. Our case law makes clear that we are to apply “a very deferential standard” to the district court when reviewing a determination as to expert qualification, reversing only if there has been a clear abuse of discretion. Gross v. Victoria Station Farms, Inc., 578 N.W.2d 757, 761 (Minn.1998); see also Benson v. N. Gopher Enters., Inc., 455 N.W.2d 444, 445-46 (Minn.1990). Although Gross arose in the context of a summary judgment motion, and Benson in the context of whether there was sufficient foundation for an expert opinion at trial, the distinction is immaterial because the discretion accorded the district court in determining whether a witness has the qualifications necessary to provide an expert affidavit pursuant to Minn. Stat. § 145.682 is the same. The district court did precisely that here based upon Dr. PerlofPs affidavit with attachments and significant discovery. It did not abuse its discretion in concluding that a doctor who is not specialized in the field of pediatric oncology, or experienced with the highly sophisticated procedure of bone marrow transplants, is not competent to testify as to this claim of medical malpractice.2 To hold otherwise ignores the very deferential standard we accord the trial court as well as the purpose served by the *428expert affidavit statute. Accordingly, we reverse the decision of the court of appeals on this issue. II. We next consider the district court’s finding that even if Dr. Perloff had the appropriate qualifications, his affidavit failed to meet the substantive requirements of section 145.682. Our medical malpractice jurisprudence has clearly defined a number of essential elements that must be included in the affidavit to avoid dismissal. Since 1990, we have reviewed four cases involving claims where expert testimony was necessary to establish a prima facie case. See Sorenson v. St. Paul Ramsey Med. Ctr., 457 N.W.2d 188 (Minn.1990); Stroud, 556 N.W.2d 552; Lindberg, 599 N.W.2d 572; Anderson, 608 N.W.2d 843. In Sorenson, we first established what plaintiffs would be expected to set forth in the expert affidavit in order to comply with the requirements of subdivision 4. 457 N.W.2d at 190. The expert affidavit must (1) disclose specific details concerning the expert’s expected testimony, including the applicable standard of care, (2) identify the acts or omissions that the plaintiff alleges violated the standard of care, and (3) include an outline of the chain of causation between the violation of the standard of care and the plaintiffs damages. Id. In Sorenson, we concluded that the expert affidavit contained “empty conclusions” as to causation which could mask a frivolous claim in the absence of a showing as to how the defendant’s alleged failure to properly diagnose the illness of the decedent’s mother led to decedent’s death. Id. at 192-93. Specifically, we held that the expert affidavit stating that the defendants “failed to properly evaluate” or “failed to properly diagnose” the patient did not set out how the expert will use the facts in the hospital record to arrive at opinions of malpractice and causation. Id. at 192-93. Later, in Stroud, we ruled that it is not enough for the expert affidavit to simply repeat the facts in the hospital record; rather, “ ‘[t]he affidavit should set out how the expert will use those facts to arrive at opinions of malpractice and causation.’ ” 556 N.W.2d at 555 (quoting Sorenson, 457 N.W.2d at 192). In Stroud, a case alleging malpractice based on the defendants’ failure to timely diagnose and treat a sub-arachnoid hemorrhage, we concluded that the expert affidavit provided only broad and conclusory statements as to causation. 556 N.W.2d at 556. The expert affidavit failed to connect the decedent’s cause of death to the defendant’s alleged delay in properly diagnosing and treating the decedent. Id. Then in Lindberg, a case alleging malpractice based on the defendant’s failure to advise the pregnant plaintiff to seek medical treatment, the expert affidavit failed to state what the standard of care was and how the defendants departed from it. 599 N.W.2d at 577-78. It stated that the plaintiffs baby died as a result of the negligent and careless conduct of the defendants. Id. at at 575. We concluded that the expert affidavit, as in Stroud, contained no more than a broad and con-clusory statement as to causation. Lindberg, 599 N.W.2d at 578. Finally, in Anderson, a case in which the plaintiff alleged that the defendant’s negligence caused a severed vagus nerve and swelling of her esophagus and thyroid, we concluded that the expert affidavit failed to state what the standard of care was and how the defendant allegedly violated it; the affidavit even suggested that the cause of the plaintiffs injury was perhaps unrelated to defendant’s acts. 608 N.W.2d at 848. Therefore, as to causation, we held that the affidavit failed to adequately de*429scribe the alleged negligence on the part of the defendant and its relationship to the plaintiffs injury. Id. Applying the standards set forth in Sorenson, Stroud, Lindberg, and Anderson, and comparing the language of the affidavits in these cases to the first affidavit submitted by respondent’s expert, we conclude that the district court did not abuse its discretion in holding that the affidavit failed to detail a chain of causation between the University of Minnesota’s alleged negligence and Roddy’s death.3 Although Dr. Perloffs affidavit states that defendants should have immediately recognized that Roddy was experiencing morphine toxicity and outlines what should have been done to comply with an acceptable level of care thereafter, the affidavit treats the cause of death summarily: [T]he departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death.4 This statement is remarkably similar to the statement of causation found in the affidavit deemed insufficient in Stroud: [A]s a result of the breach of the standard of care [previously identified], there was a failure to diagnose and treat a subarachnoid hemorrhage which ultimately resulted in * * * death of the Plaintiff. 556 N.W.2d at 554. As in Stroud, the expert affidavit submitted by respondent here contains only broad, conclusory statements regarding causation and fails to set forth the chain of causation connecting the failure to treat Roddy for morphine toxicity and his death, as required by the statute. Id. at 556; Sorenson, 457 N.W.2d at 192-93. We therefore reverse the court of appeals and hold that the affidavits failed to meet the requirements of Minn. Stat. § 145.682, subd. 4.5 We take this opportunity to correct the analysis in the opinion of the court of appeals. The court held that the statements contained in Dr. Perloffs affidavit “were sufficient to put the respondents on notice of appellant’s proposed expert testimony.” Teffeteller, 626 N.W.2d at 208 (citing Demgen v. Fairview Hosp., 621 N.W.2d 259, 265-66 (Minn.App.), rev. denied (Minn. Apr. 17, 2001)). The court *430cited Demgen for the erroneous proposition that an expert affidavit is sufficient under Minn. Stat. § 145.682, subd. 4 if it specifies the facts and circumstances of the defendant’s alleged negligence in such a manner as to give defendants a “sneak preview” of the expert’s testimony. 626 N.W.2d at 208. The affidavit required in the statute must provide more than a sneak preview, as noted clearly and repeatedly in Sorenson, Stroud, Lindberg, and Anderson. “The statute requires far more information than simply identification of the expert intended to be called at trial or a ‘general disclosure’ * * Lindberg, 599 N.W.2d at 578. At a minimum, a “meaningful disclosure” is required setting forth the standard of care, the act or omissions violating that standard, and the chain of causation. Anderson, 608 N.W.2d at 849; see also Lindberg, 599 N.W.2d at 577; Stroud, 556 N.W.2d at 555-56; Sorenson, 457 N.W.2d at 198. III. Finally, while we find Dr. Perloff s affidavits deficient as to both appellants on the issue of causation, we address as a separate matter the district court’s conclusion that they were “wholly deficient” as to Dr. Shannon and Dr. Blazar, both employed by PREF. The district court concluded that it was a factual impossibility for either of Dr. Perloff s affidavits to satisfy the requirements of the statute as they relate to PREF. Its holding was based on the fact that both of Dr. Perloff s affidavits stated that the applicable standard of care would have required a continuous infusion of naloxone beginning at 8:30 a.m. and the evidence suggested that neither PREF doctors were involved with Roddy’s care until about 9:30 a.m. The record is unclear as to what time Dr. Shannon became involved in Roddy’s care. Dr. Shannon contends that he was not involved until sometime between 10:00 and 10:15 a.m. Dr. Wetmore stated, however, that she spoke with Dr. Shannon at around 9:00 a.m. about his thoughts on whether or not to administer Nubain. Dr. Wetmore also claimed that she and Dr. Shannon discussed using Narcan instead of Nubain. Dr. Shannon does not recall this conversation. As for Dr. Blazar, the record indicates that he was not involved in Roddy’s care until 9:25 to 9:30 a.m. Dr. Perloff s first affidavit fails to identify what the standard of care for either Dr. Shannon or Dr. Blazar was, what they did to violate that standard, or even what their relation was to Roddy’s care or to care provided by the treating physicians. The applicable standard of care identified in Dr. Perloff s first affidavit relates to recognizing the morphine toxicity at 8:30 a.m. and administering naloxone between 8:30 and 9:25 a.m. The acts allegedly falling below this standard were failing to timely recognize the morphine toxicity, administering Nubain, and failing to infuse nalox-one between 8:30 and 9:25 a.m. There are no allegations that Dr. Shannon should have recognized the morphine toxicity based on the information presented to him during his telephone conversation with Dr. Wetmore, nor is there anything to indicate why either Dr. Shannon or Dr. Blazar should have been involved with Roddy’s care between 8:30 and 9:25 a.m. Finally, even if Dr. Shannon did approve the administering of Nubain, respondent’s theory is not that the administration of the Nu-bain caused Roddy’s death. Therefore, the district court properly concluded that Dr. Perloff s first affidavit failed to articulate the statutory requirements as to PREF. Dr. Perloff s second affidavit also fails to comply with the statutory requirements as to PREF. In it he again asserts that it was *431below the acceptable standard of care to approve the administration of Nubain, but as noted above, no causal link is identified. The second affidavit also indicates that all of the physicians caring for or providing medical input to the care of Roddy should have administered naloxone starting at 8:30 a.m. until there was evidence of ongoing reversal of the narcotic toxicity. But Dr. Blazar was not present in Roddy’s room until about 9:20 a.m. and Dr. Shannon did not arrive until 10:00 a.m. or shortly thereafter. There is nothing in Dr. Perloffs second affidavit indicating what these doctors could have done before they arrived in Roddy’s room to satisfy the standard of care or that their care after arriving in Roddy’s room caused his death. In fact, this second affidavit, like the first, seems to indicate that naloxone needed to be administered starting at 8:30 a.m. or shortly thereafter in order to have reversed the effects of morphine toxicity. Thus, we conclude that both of Dr. Per-loffs affidavits fail to provide any meaningful disclosure regarding what the standard of care required of PREF’s doctors was or how they violated it. Furthermore, neither of Dr. Perloffs affidavits detail a chain of causation between any alleged acts or omissions of PREF’s doctors and Roddy’s death. Accordingly, we hold that dismissal with prejudice as to the claim against appellant PREF was not an abuse of the district court’s discretion and that the court of appeals erred by concluding that the initial affidavit was sufficient to satisfy the statute as to appellant PREF. Reversed.6 BLATZ, C.J., and PAGE, J. took no part in the consideration or decision of this case. GILBERT, J., files an opinion concurring in part and dissenting in part, in which PAUL H. ANDERSON, J., joins.

+ 55 more citations in this opinion.

Mellett v. Fairview Health Services · 2001 3 citations

+ 3 more citations in this opinion.

Tousignant v. ST. LOUIS COUNTY, MN · 2000 10 citations

+ 10 more citations in this opinion.

Anderson v. Rengachary · 2000 69 citations

+ 69 more citations in this opinion.

Lindberg v. Health Partners, Inc. · 1999 66 citations

+ 66 more citations in this opinion.

Wall v. Fairview Hospital & Healthcare Services · 1998 2 citations

+ 2 more citations in this opinion.

Stroud v. Hennepin County Medical Center · 1996 16 citations

+ 16 more citations in this opinion.

Sorenson v. St. Paul Ramsey Medical Center · 1990 15 citations

+ 15 more citations in this opinion.

Moen v. Mikhail · 1990 1 citation

+ 1 more citation in this opinion.

Stern v. Dill · 1989 4 citations

+ 4 more citations in this opinion.

Thorson v. Rice County District One Hospital · 1989 14 citations

+ 14 more citations in this opinion.

Sandmann v. Petron · 1987 8 citations

+ 8 more citations in this opinion.

Jane Doe v. Gavin Patrick Meany, Marie Olseth MD LLC d/b/a West End Consultation Group, ... · 2024 1 citation

+ 1 more citation in this opinion.

Dennis J. Daulton, trustee for the next of kin of Brady Joel Daulton v. TMS Treatment Center, ... · 2024 129 citations

+ 129 more citations in this opinion.

Andrew Joseph Haman v. Seth Tyberg · 2023 9 citations

+ 9 more citations in this opinion.

Firkus v. Harms · 2018 10 citations

+ 10 more citations in this opinion.

Sharon Schirmer, trustee for the next of kin of Cary F. Schirmer v. The Duluth Clinic, Ltd., d/b/a �Essentia Health - Hibbing Clinic,Ž · 2016 13 citations

+ 13 more citations in this opinion.

· 2015 1 citation

+ 1 more citation in this opinion.

Roseland v. Wentzell · 2015 1 citation

+ 1 more citation in this opinion.

Jerry Expose, Jr. v. Thad Wilderson & Associates, P. A., Nina Mattson · 2015 6 citations

+ 6 more citations in this opinion.

Johnny L. Moore v. Park Nicollet Methodist Hospital · 2015 1 citation

+ 1 more citation in this opinion.

Gary Cyril Jenco v. Paul James Crowe, M.D., John Y. Hendricks, M.D., North Memorial Health Care, d/b/a North Memorial Medical Center · 2015 4 citations

+ 4 more citations in this opinion.

Mary Beth Davidson v. North Memorial Health Care, d/b/a North Memorial Medical Center, and d/b/a North Memorial Ambulance Service · 2015 12 citations

+ 12 more citations in this opinion.

Kimberly Shierts, Trustee for the Heirs of Jodie Shierts v. University of Minnesota Physicians, Regents of the University of Minnesota · 2014 10 citations

+ 10 more citations in this opinion.

Curtis Anderson v. Bradly J. Donabauer · 2014 4 citations

+ 4 more citations in this opinion.

Robert Bonczek v. Donald Erickson, DDS, Mark Wilson, Periodontist, Mayo Clinic - Rochester, University of Minnesota - Minneapolis, City of Minneapolis · 2014 6 citations

+ 6 more citations in this opinion.

· 2014 27 citations

+ 27 more citations in this opinion.

Pfeiffer ex rel. Pfeiffer v. Allina Health System · 2014 19 citations

+ 19 more citations in this opinion.

Dickhoff ex rel. Dickhoff v. Green · 2012 1 citation

+ 1 more citation in this opinion.

Wesely v. Flor · 2010 21 citations

+ 21 more citations in this opinion.

Juetten v. LCA-Vision, Inc. · 2010 5 citations

+ 5 more citations in this opinion.

Fontaine v. Steen · 2009 2 citations

+ 2 more citations in this opinion.

Mercer v. Andersen · 2006 8 citations

+ 8 more citations in this opinion.

Lake Superior Center Authority v. Hammel, Green & Abrahamson, Inc. · 2006 4 citations

+ 4 more citations in this opinion.

Middle River-Snake River Watershed District v. Dennis Drewes, Inc. · 2005 2 citations

+ 2 more citations in this opinion.

Maudsley v. Pederson · 2004 20 citations

+ 20 more citations in this opinion.

Teffeteller v. University of Minnesota · 2001 5 citations

+ 5 more citations in this opinion.

Demgen v. Fairview Hospital · 2001 22 citations

+ 22 more citations in this opinion.

Canfield v. Grinnell Mutual Reinsurance Co. · 2000 13 citations

Appellant Henry Canfield sued respondent Dr. Donald Starzinski for negligence, battery, medical malpractice, and negligent *691 nondisclosure, claiming that he was injured while respondent was performing an independent medical examination. The district court granted statutory dismissal to Star-zinski on the ground that Canfield’s claims were not supported by a sufficient expert affidavit as required by Minn. Stat. § 145.682 (1996). Canfield contends that section 145.682 applies only to malpractice claims, and not to his negligence and battery claims for injuries that occurred during an independent medical evaluation, that no disclosure was needed here in any event, and that the affidavit he submitted was sufficient.

Canfield brought this lawsuit against Dr. Starzinski, Grinnell, Value Medical, and others, alleging negligence, battery, negligent nondisclosure, and medical malpractice. He submitted, an expert affidavit by Dr. D.M. VanNostrand. Dr. Starzinski moved for summary judgement or statutory dismissal, arguing that the expert affidavit was insufficient under Minn. Stat § 145.682 (1996). The trial court dismissed all of Canfield’s claims against Starzinski for failure to submit- sufficient expert affidavits. The parties stipulated to dismissal of all claims against Grinnell (pursuant to Pierringer Release) and Value Medical (without prejudice under Minn. R. Civ. P. 41.01(a)), and the trial court dismissed all remaining parties. Canfield appeals the trial court’s dismissal of all claims against Starzinski.

Appellant Henry Canfield sued respondent Dr. Donald Starzinski for negligence, battery, medical malpractice, and negligent *691 nondisclosure, claiming that he was injured while respondent was performing an independent medical examination. The district court granted statutory dismissal to Star-zinski on the ground that Canfield’s claims were not supported by a sufficient expert affidavit as required by Minn. Stat. § 145.682 (1996). Canfield contends that section 145.682 applies only to malpractice claims, and not to his negligence and battery claims for injuries that occurred during an independent medical evaluation, that no disclosure was needed here in any event, and that the affidavit he submitted was sufficient.

+ 10 more citations in this opinion.

Tousignant v. St. Louis County · 2000 5 citations

+ 5 more citations in this opinion.

Haile v. Sutherland · 1999 19 citations

+ 19 more citations in this opinion.

Paulos v. Johnson · 1999 1 citation

+ 1 more citation in this opinion.

Anderson v. Rengachary · 1999 13 citations

+ 13 more citations in this opinion.

Bjorke v. Mayo Clinic of Rochester · 1998 14 citations

+ 14 more citations in this opinion.

Femrite v. Abbott Northwestern Hospital · 1997 2 citations

+ 2 more citations in this opinion.

Stroud v. Hennepin County Medical Center · 1996 21 citations

+ 21 more citations in this opinion.

Kay v. Fairview Riverside Hospital · 1995 1 citation

+ 1 more citation in this opinion.

Lombardo v. Seydow-Weber · 1995 21 citations

+ 21 more citations in this opinion.

Hempel v. Fairview Hospitals & Healthcare Services, Inc. · 1993 14 citations

+ 14 more citations in this opinion.

Paulos v. Johnson · 1993 9 citations

+ 9 more citations in this opinion.

Leubner v. Sterner · 1992 1 citation

+ 1 more citation in this opinion.

Myers Through Myers v. Price · 1990 1 citation

+ 1 more citation in this opinion.

Maloney v. Fairview Community Hospital · 1990 13 citations

The Hospital answered and served interrogatories asking for, among other things, identification of expert witnesses. The Doctors served separate answers, a “Demand for Affidavit from Expert,” which requested compliance with Minn. Stat. § 145.682, and interrogatories upon appellant.

The Hospital answered and served interrogatories asking for, among other things, identification of expert witnesses. The Doctors served separate answers, a “Demand for Affidavit from Expert,” which requested compliance with Minn. Stat. § 145.682, and interrogatories upon appellant.

The Hospital answered and served interrogatories asking for, among other things, identification of expert witnesses. The Doctors served separate answers, a “Demand for Affidavit from Expert,” which requested compliance with Minn. Stat. § 145.682, and interrogatories upon appellant.

+ 10 more citations in this opinion.

Henke v. Dunham · 1990 16 citations

+ 16 more citations in this opinion.

Moen v. Mikhail · 1989 11 citations

+ 11 more citations in this opinion.

Sorenson v. St. Paul Ramsey Medical Center · 1989 65 citations

+ 65 more citations in this opinion.

Stern v. Dill · 1988 2 citations

+ 2 more citations in this opinion.

Chizmadia v. Smiley's Point Clinic · 1988 7 citations

+ 7 more citations in this opinion.

Parker v. O'PHELAN · 1987 14 citations

+ 14 more citations in this opinion.

Pratt Ex Rel. Pratt v. University of Minnesota Affiliated Hospitals & Clinics · 1987 1 citation

+ 1 more citation in this opinion.

· 2025 2 citations

+ 2 more citations in this opinion.

Fiorito v. United States · 2025 2 citations

+ 2 more citations in this opinion.

Larson v. Minnesota Department of Human Services · 2025 2 citations

+ 2 more citations in this opinion.

Anderson v. United States of America, The · 2024 2 citations

+ 2 more citations in this opinion.

Mullins v. Morgan · 2024 24 citations

+ 24 more citations in this opinion.

Kamal v. Baker Tilly Virchow Krause, LLC · 2024 2 citations

+ 2 more citations in this opinion.

Mancini v. United States of America, The · 2024 16 citations

+ 16 more citations in this opinion.

Hollie v. Essentia Health Moose Lake Clinic · 2023 2 citations

+ 2 more citations in this opinion.

Everest Stables, Inc. v. Porter, Wright, Morris, & Arthur LLP · 2023 2 citations

B. Choice of Law and the Erie Doctrine In this case brought pursuant to diversity jurisdiction, the application of Minnesota Statutes Section 544.42 to Plaintiffs’ claims is warranted. Because Section 544.42 does not directly conflict with a Federal Rule of Civil Procedure and the application of Section 544.42 significantly affects the outcome of the litigation, federal courts consistently consider Minn. Stat. § 145.682, and by extension Section 544.42, as substantive in the

B. Choice of Law and the Erie Doctrine In this case brought pursuant to diversity jurisdiction, the application of Minnesota Statutes Section 544.42 to Plaintiffs’ claims is warranted. Because Section 544.42 does not directly conflict with a Federal Rule of Civil Procedure and the application of Section 544.42 significantly affects the outcome of the litigation, federal courts consistently consider Minn. Stat. § 145.682, and by extension Section 544.42, as substantive in the

Parson v. Barney · 2023 2 citations

Count 2 also claims Defendant Barney was negligent in denying him proper medical treatment. (See ECF No. 31 at 7-9.) To prevail on a claim of medical negligence under Minnesota law, a plaintiff must establish: “(1) the standard of care recognized by the medical community as applicable to the particular defendant conduct, (2) that the defendant in fact departed from that standard, and (3) that the defendant’s departure from the standard was a direct cause of [the plaintiffs] injuries.” Plutshack v. Univ. of Minn. Hosps., 316 N.W.2d 1, 5 (Minn.1982). In addition, a plaintiff must serve, along with the summons and complaint, an affidavit verifying that: (1) an expert has reviewed the facts underlying the medical negligence claim and opines that the defendant deviated from the applicable standard of care; or (2) expert review could not reasonably be obtained before the action was commenced due to the applicable statute of limitations. Minn. Stat. § 145.682, subds. 2-4. “[M]andatory dismissal with prejudice” results when the plaintiff does not provide the expert review affidavit “within 60 days after demand for the affidavit[.]” Id. § 145.682, subd. 6(a). Here, Mr. Parson fails to plead the necessary elements to establish a medical negligence

Count 2 also claims Defendant Barney was negligent in denying him proper medical treatment. (See ECF No. 31 at 7-9.) To prevail on a claim of medical negligence under Minnesota law, a plaintiff must establish: “(1) the standard of care recognized by the medical community as applicable to the particular defendant conduct, (2) that the defendant in fact departed from that standard, and (3) that the defendant’s departure from the standard was a direct cause of [the plaintiffs] injuries.” Plutshack v. Univ. of Minn. Hosps., 316 N.W.2d 1, 5 (Minn.1982). In addition, a plaintiff must serve, along with the summons and complaint, an affidavit verifying that: (1) an expert has reviewed the facts underlying the medical negligence claim and opines that the defendant deviated from the applicable standard of care; or (2) expert review could not reasonably be obtained before the action was commenced due to the applicable statute of limitations. Minn. Stat. § 145.682, subds. 2-4. “[M]andatory dismissal with prejudice” results when the plaintiff does not provide the expert review affidavit “within 60 days after demand for the affidavit[.]” Id. § 145.682, subd. 6(a). Here, Mr. Parson fails to plead the necessary elements to establish a medical negligence

Fiorito v. United States · 2023 6 citations

+ 6 more citations in this opinion.

Fiorito v. United States · 2023 2 citations

+ 2 more citations in this opinion.

Brennan v. Minnesota Department of Human Services · 2023 4 citations

+ 4 more citations in this opinion.

Hollie v. Essentia Health Moose Lake Clinic · 2022 8 citations

+ 8 more citations in this opinion.

Andrews v. Brott · 2022 4 citations

+ 4 more citations in this opinion.

Martin v. Larson · 2022 4 citations

+ 4 more citations in this opinion.

Judah v. Ovsak · 2021 4 citations

+ 4 more citations in this opinion.

Mills v. Mayo Clinic · 2020 6 citations

+ 6 more citations in this opinion.

Robinson v. Minnesota, State of · 2019 4 citations

+ 4 more citations in this opinion.

Perkins v. Stanton · 2019 2 citations

+ 2 more citations in this opinion.

Dutton v. St. Louis County · 2018 4 citations

+ 4 more citations in this opinion.

Kaplan v. Mayo Clinic · 2013 2 citations

MEMORANDUM OPINION AND ORDER ON DEFENDANTS’ MOTIONS IN LIMINE JOHN R. TUNHEIM, District Judge. This case arises out of a surgery performed on Elliot Kaplan (“Kaplan”) by a surgeon at Mayo Clinic to treat pancreatic cancer, a condition which post-surgery testing revealed that Kaplan never had. Kaplan and has wife Jeanne Kaplan (collectively, “the Kaplans”) filed lawsuit against Mayo Clinic and its affiliated entities (collectively, “Mayo”), as well as Dr. David Nagorney (“Dr. Nagorney”), the doctor who performed Kaplan’s surgery, and Dr. Lawrence J. Burgart (“Dr. Bur-gart”), the doctor who erroneously diagnosed Kaplan with pancreatic cancer. The Court granted summary judgment in favor of Dr. Nagorney. The case proceeded to trial against the other defendants on the Kaplans’ claims of breach of contract and negligent failure to diagnose. At the close of the Kaplans’ case, the Court granted judgment as a matter of law against them on their breach of contract claim. The jury returned a verdict for Mayo and Bur-*1004gart on the Kaplans’ claim for negligent failure to diagnose, and the Court entered judgment on that verdict. On appeal, the Eighth Circuit reversed as to the breach of contract claim concluding that a reasonable jury could find that Nagorney, on behalf of Mayo, formed a contract with Kaplan when Nagorney told Kaplan that he would perform an intraop-erative biopsy to confirm the cancer diagnosis before proceeding with the surgery. The Eighth Circuit found that Nagorney breached this contract when he failed to perform the promised biopsy. The Eighth Circuit remanded for further proceedings on the breach of contract claim. The case is now before the Court on Mayo’s motions in limine regarding the presentation of damages evidence at the remand trial on the Kaplans’ breach of contract claim. Mayo requests that the Court (1) preclude the Kaplans from presenting evidence of pain and suffering and emotional damages in support of their breach of contract claim; (2) dismiss Mrs. Kaplan’s loss of consortium claim; and (3) limit the Kaplans’ evidence of damages to documents and information disclosed prior to the December 30, 2012 disclosure deadline. For the reasons explained below, the Court will grant Mayo’s motion to exclude evidence of pain and suffering and emotional damages and will dismiss Mrs. Kap-lan’s loss of consortium claim. The Court will deny Mayo’s motion to limit the Kap-lans’ evidence to damages information disclosed prior to December 30, 2012. BACKGROUND I. THE WHIPPLE PROCEDURE In July 2003, Kaplan was hospitalized in Missouri after experiencing severe abdominal pain. A CT scan showed that Kaplan had an enlarged pancreas, and doctors in Missouri proceeded to perform a needle biopsy on the pancreas. A pathologist affiliated with the Missouri hospital reviewed the biopsy and, based on that review, Kap-lan was diagnosed with pancreatic cancer. In August 2003, Kaplan sought a second opinion from Mayo, and sent Mayo the pathology slides that the Missouri doctors had prepared in conjunction with the needle biopsy. Dr. Burgart, a Mayo pathologist, reviewed the pathology slides and diagnosed Kaplan with grade 2 infiltrating pancreatic cancer. Another Mayo doctor made an independent diagnosis of pancreatic cancer based on the slides. Given Dr. Burgart’s diagnosis, Dr. Nagorney, a Mayo surgeon, recommended that Kaplan undergo a pancreatoduodenectomy, or “Whipple” procedure, which involves excising portions of the pancreas and stomach as well as the entire pylorus and duodenum. Kaplan was concerned about the validity of the cancer diagnosis, and expressed this concern to Dr. Nagorney. When asked if he could confirm the diagnosis during the surgery, Dr. Nagorney allegedly replied that he would do a biopsy of the mass to verify that it was cancer, and if there was no cancer, Dr. Nagorney would not complete the procedure. On August 14, 2003, Dr. Nagorney performed the Whipple procedure on Kaplan. Dr. Nagorney did not perform an intraoperative biopsy on Kap-lan’s pancreatic tissue, and completed the Whipple procedure. After examining the pancreatic tissue postoperatively, Mayo pathologists concluded that Kaplan did not have pancreatic cancer. II. PROCEDURAL HISTORY In 2007, the Kaplans filed a complaint against Mayo, Dr. Nagorney, and Dr. Bur-gart, alleging claims for medical malpractice, negligent nondisclosure, breach of contract, and loss of consortium. {See Am. Compl., Sept. 17, 2007, Docket No. 4.) *1005A. Summary Judgment and Trial In 2008, the Court granted summary judgment in favor of Dr. Nagorney, finding that the Kaplans’ expert affidavit opined only on medical negligence with respect to Kaplan’s medical diagnosis, and not with respect to the surgical procedure performed on Kaplan: (Order at 14-15, Oct. 27, 2008, Docket No. 87, 2008 WL 4755797.) Consequently, the Court dismissed all of the Kaplans’ claims against Dr. Nagorney with prejudice. (Id. at 15.) The case proceeded to trial against the other defendants on claims of breach of contract and negligent failure to diagnose. (See Pl.’s Statement of the Case at 5, Mar. 23, 2009, Docket No. 116.) ' Before conclusion of the trial, the Court granted defendants’ motion for judgment as a matter of law on the breach of contract claims. (Minute Entry, Apr. 14, 2009, Docket No. 165.) The Court determined that the breach of contract claim, which arose “out of the diagnosis, care and treatment of [Kaplan],” failed because the Kaplans had not presented expert testimony relating to the standard of care to determine whether there had been a breach. (Tr. at 986-87, July 15, 2010, Docket No. 202.) After the evidence was presented, the jury returned a verdict for Mayo and Dr. Burgart on the Kaplans’ claims for negligent misdiagnosis. (Special Verdict Form at 1, Apr. 15, 2009, Docket No. 166.) Because the jury found that neither Mayo nor Dr. Burgart was negligent in the care or treatment of Kaplan, the jury did not answer any questions regarding damages. (Id. at 1-2.) The Court entered judgment on the verdict. (J., Apr. 17, 2009, Docket No. 169.) The Court then denied the Kap-lans’ motion for a new trial, and the Kap-lans appealed. (Order, Apr. 20, 2010, Docket No. 184, 2010 WL 1576784; Notice of Appeal, May 20, 2010, Docket No. 190.) B. Appeal On appeal, the Eighth Circuit denied the Kaplans’ request for a new trial on their claim for negligent failure to diagnose, and affirmed the Court’s judgment with respect to that claim. Kaplan v. Mayo Clinic, 653 F.3d 720, 724-26 (8th Cir.2011). The Eighth Circuit also affirmed the Court’s grant of judgment in favor of Dr. Burgart on the Kaplans’ breach of contract claim. Id. at 727. But the Eight Circuit concluded that the Court erred in granting judgment as a matter of law to Mayo on the Kaplans’ breach of contract claim. Id. at 729. Viewing the evidence in the light most favorable to the Kaplans, the Eighth Circuit reviewed the Court’s grant of judgment as a matter of law to determine whether any reasonable jury could have found in favor of the Kaplans on their breach of contract claim. Id. at 727. To establish a claim for breach of contract the Kaplans were required to show formation of a contract, breach, and resulting damages. Id. at 726 (citing Briggs Transp. Co. v. Ranzenberger, 299 Minn. 127, 217 N.W.2d 198, 200 (1974)). The Eighth Circuit first determined that a reasonable jury could have found that Dr. Nagorney, acting on behalf of Mayo, formed a contract when he allegedly told Kaplan that Dr. Nagorney would perform an intraoperative biopsy to confirm the cancer diagnosis. Id. at 727. As consideration “Mr. Kaplan authorized Dr. Nagor-ney and his colleagues to perform the Whipple procedure and paid them for that surgery.” Id. Although Dr. Nagorney testified that he never made such a promise, the Eighth Circuit determined that “this testimony merely raises factual question for the jury as to whether there was an agreement.” Id. The Eighth Circuit also determined that a jury could conclude the contract was breached, because it “is un*1006disputed” that Dr. Nagorney failed to perform an intraoperative biopsy. Id. at 728. With respect to damages, the Eighth Circuit concluded that a reasonable jury could have made the requisite finding of damages. To recover on a breach of contract the damages must have resulted from the breach. Id. The Eighth Circuit determined that the Kaplans needed to demonstrate two different steps to show causation as to damages. Id. First, the Kaplans “had to offer evidence to support a finding that the intraoperative biopsy results would have been negative for cancer,” and the Eighth Circuit concluded the Kaplans had made such a showing. Id. Second, the Kaplans would have to establish that “Dr. Nagorney would not have performed the Whipple procedure if the promised biopsy was negative.” Id. Finally, the Eighth Circuit determined that the Kaplans had “provided sufficient evidence of economic damages resulting from that procedure— though the amount was greatly disputed'—■ to meet the final requirement for making out their contract claim.” Id. The Eighth Circuit also found that the Kaplans’ breach of contract claim did not simply restate a medical malpractice claim—a claim that would require expert testimony. Id. at 729. The Eighth Circuit noted that “Minnesota law requires plaintiffs to file an expert-witness affidavit in any action against a health care provider for ‘malpractice, error, mistake, or failure to cure, whether based on contract or tort,’ if ‘expert testimony is necessary to establish a prima facie case’ in that action.” Id. at 728-29 (quoting Minn. Stat. § 145.682). The court concluded that expert testimony was unnecessary to support the Kaplans’ “perfectly ordinary, garden-variety contract claim,” and characterized the claim as “simply that a physician promised to perform a certain procedure and did not do it, resulting in damages to [the Kap-lans].” Id. at 729. Finally, the Eighth Circuit remanded for further proceedings on the Kaplans’ breach of contract claim. Id.1 In doing so, the court noted that “[t]he parties’ briefs do not discuss the question of whether Ms. Kaplan’s loss-of-consortium damages are recoverable in a contract action. This is a matter for exploration on remand should it arise.” Id. at 729 n. 1. C. Post-Remand Discovery Issues During an October 2, 2012 phone conference, the Court granted Mayo’s request to pursue limited additional discovery into the Kaplans’ damages, and set a February 1, 2013 deadline for such discovery. (Minutes, Oct. 2, 2012, Docket No. 239.) On October 11, 2012, Mayo served the Kaplans with interrogatories and document requests regarding damages. (See Defs.’ Mem. in Supp. of Mot. for Sanctions at 1, Jan. 4, 2013, Docket No. 256.) After receiving no response, Mayo brought a motion to compel that discovery. (Mot. to Compel, Nov. 30, 2012, Docket No. 244.) United States Magistrate Judge Jeffrey Keyes granted the motion to compel and ordered the Kaplans to respond to the discovery requests by December 30, 2012. (Order, Dec. 11, 2012, Docket No. 250.) The Magistrate Judge also awarded Mayo its fees and costs incurred in bringing the motion to compel, which order this Court affirmed. (Id. at 3; Order, Jan. 3, 2013, Docket No. 252; Order, Feb. 8, 2013, Docket No. 279.) *1007The Kaplans then twice produced responses to Mayo’s October 11, 2012 discovery request. (See Eighth Decl. of Heather M. McCann, Exs. K-L, Jan. 4, 2013, Docket No. 257.) The Kaplans responses were incomplete, and did not contain all of the updated information requested by Mayo. (See id., Ex. M.) Due to the inadequacy of the responses, on January 8, 2013, Mayo brought a motion for sanctions and a motion to compel. (Mot. to Compel, Jan. 8, 2013, Docket No. 259.) In the motion, Mayo sought an order, among other things, compelling complete responses and “prohibiting Plaintiffs from introducing into evidence or relying on evidence or argument based on evidence not disclosed or produced prior to the Court’s December 30, 2012 deadline.” (Id. at 1.) Mayo also asked the Court to extend the February 1, 2013 discovery deadline for defendants only. (Id.) The Magistrate Judge granted in part and denied in part Mayo’s motion to compel. (Order, Feb. 7, 2013, Docket No. 277.) Of relevance to the present motions, the Magistrate Judge denied Mayo’s request that the Kaplans be prohibited from introducing at trial any evidence not disclosed before December 30, 2012. (Order, Feb. 7, 2013, Docket No. 277.) This denial was, however, without prejudice because the Magistrate Judge concluded he was “not going to make that type of evidentia-ry ruling with respect to the trial of this case,” and specifically stated he was not “precluding Judge Tunheim from deciding the issue at the appropriate motion that’s made at the time of trial.” (Tr. at 34, Feb. 12, 2013, Docket No. 281.) The Magistrate Judge granted Mayo’s motion to compel the production of signed tax returns, supplemental answers to interrogatories, and a blank authorization for the release of Kaplan’s medical records. (Order, Feb. 7, 2013, Docket No. 277.) With respect to the extension of time for discovery the Magistrate Judge treated the request as one to continue the trial date, and declined to do so, determining that issue was best left to “counsel to work ... out between themselves and with ... Judge Tunheim to determine whether or not any delay of the trial is warranted with respect to that matter.” (Tr. at 37.) ANALYSIS I. CONTRACTUAL DAMAGES EVIDENCE The Court begins by determining whether the Kaplans may present evidence of pain and suffering and emotional distress to prove damages in relation to their breach of contract claim. A damage award in a breach of contract action is intended to place the nonbreaching party “in the position in which he would be if the contract were performed.” Lesmeister v. Lilly, 330 N.W.2d 95, 102 (Minn.1983); see also Jepson v. Gen. Cas. Co. of Wis., 513 N.W.2d 467, 472 (Minn.1994) (“[P]eople should get the benefit of the contracts they enter into, nothing less and nothing more.”). Therefore, a plaintiff may recover those “damages sustained by reason of the breach which arose naturally from the breach or could reasonably be supposed to have been contemplated by the parties when making the contract as the probable result of the breach.” Lesmeister, 330 N.W.2d at 103; see also Franklin Mfg. Co. v. Union Pac. R.R. Co., 311 Minn. 296, 248 N.W.2d 324, 325 (1976) (“When the damages are assessed as those which it is reasonable to suppose that the parties had in mind, what is really meant is that the law, aiming at compensation, considers it fair to hold a defendant for damages which as a reasonable man he ought to have foreseen as likely to follow from a breach. What he in fact foresaw or contemplated is immateri*1008al.” (internal quotation marks and alterations omitted)). Whether damages were reasonably foreseeable at the time of contracting is a question of fact. See Franklin Mfg. Co., 248 N.W.2d at 326. “Liability for breach of contract requires proof that damages resulted from or were caused by the breach.” Border State Bank of Greenbush v. Bagley Livestock Exch., Inc., 690 N.W.2d 326, 336 (Minn.Ct.App.2004). Whether a particular damage resulted from or was caused by a breach of contract is a question for the jury. See id.; see also Cashman v. Allied Prods. Corp., 761 F.2d 1250, 1254 (8th Cir.1985) (finding that “the jury could reasonably infer from the evidence presented” that the plaintiff had suffered lost profits due to the breach). Extra-contractual damages, on the other hand, are those which do not flow naturally from the breach and are not reasonably anticipated by the parties to the contract. See Wild v. Rang, 302 Minn. 419, 234 N.W.2d 775, 789 (1975). In Minnesota, extracontractual damages “are not recoverable for breach of contract except in exceptional cases where the breach is accompanied by an independent tort.” Haagenson v. Nat’l Farmers Union Prop. & Cas. Co., 277 N.W.2d 648, 652 (Minn. 1979). “The accompanying independent tort must be willful.” Lickteig v. Alderson, Ondov, Leonard & Sween, P.A., 556 N.W.2d 557, 561 (Minn.1996). The rule disallowing extra-contractual damages is designed “to insure that contract law is not swallowed by tort law.” Deli v. Univ. of Minn., 578 N.W.2d 779, 782 (Minn.Ct.App. 1998). A jury found in favor of the defendants on all of the Kaplans’ tort claims and the Eighth Circuit -affirmed the verdict. Therefore, there is no independent tort in the present case and the Kaplans cannot recover any extra-contractual damages. The difficulty, however, is determining whether pain and suffering and emotional distress damages constitute extra-contractual damages in the context of the alleged contract between Mayo and the Kaplans. Although pain and suffering and emotional distress damages might seem to be the natural proximate cause of a breach in certain types of contracts, Minnesota courts have expanded the prohibition on recovering such damages in a breach of contract action, even where those damages could be reasonably within the contemplation of the parties based on the nature of the contract. See Lickteig, 556 N.W.2d at 561 (categorically defining emotional distress . damages as “extra-contractual”); Francis v. W. Union Tel. Co., 58 Minn. 252, 59 N.W. 1078, 1081 (1894) (denying recovery of emotional distress damages even after recognizing that a contract to send a sensitive telegram relates “wholly to matters of sentiment or feeling” and therefore breach of such a contract could reasonably be expected to result in mental anxiety); Deli, 578 N.W.2d at 781-82 (finding emotional distress damages could not be awarded on a claim for an athletic director’s breach of an oral promise not to view a videotape that contained footage of the plaintiffs sexual encounter with her husband, despite the “inherently personal nature” of the contract); Bom v. Medico Ufe Ins. Co., 428 N.W.2d 585, 587, 590 (Minn.Ct.App.1988) (stating that pain and suffering were extra-contractual damages even though the breach alleged was for a contract to provide medical-insurance). Instead of examining solely the foreseeability of certain damages to determine whether such damages may be extra-contractual, Minnesota law appears to restrict recoverable contractual damages more generally to those that are pecuniary in nature. The Minnesota Supreme Court *1009has long held that regardless of the “nature of the contract ... [t]he law looks only to the pecuniary value of the contract, and for its breach awards only pecuniary damages.” Francis, 59 N.W. at 1081; see also Beaulieu v. Great N. Ry. Co., 103 Minn. 47, 114 N.W. 353, 356 (1907) (explaining that in the absence of an independent tort, damages for breach, of contract “must be limited to the actual pecuniary loss naturally and necessarily flowing from the breach”). Therefore, in addition to requiring that contractual damages be those which flow directly from the breach and were within the contemplation of the parties, the Minnesota Supreme Court has held that contractual damages are those which “may be measured and determined by some definite rule or standard of compensation.” Beaulieu, 114 N.W. at 355. Thus damages that are “incapable of definite calculation” and “must necessarily rest in the discretion of the jury” are extra-contractual and are recoverable only in tort actions. Id. It does not appear that the Minnesota Supreme Court has ever precisely addressed whether pain and suffering and emotional distress damages are recoverable for breach of a contract between a physician and his patient. Where the Court is faced with an undecided question of Minnesota law, its role is to predict how the Minnesota Supreme Court would resolve the question. See Spine Imaging MRI, L.L.C. v. Country Cas. Ins. Co., Civ. No. KM80, 2011 WL 379100, at *6 (D.Minn. Feb. 1, 2011) (citing Midwest Oil-seeds, Inc. v. Limagrain Genetics Corp., 387 F.3d 705, 715 (8th Cir.2004)). Although many courts have recognized that “a surviving patient can maintain a cause of action for breach of an express or implied promise against a physician,” Zostautas v. St. Anthony De Padua Hosp., 23 Ill.2d 326, 178 N.E.2d 303, 307 (1961), courts have disagreed about whether those surviving patients can recover damages for pain and suffering ■ or emotional distress. Some courts have held that where “liability is predicated on the failure to perform an agreed undertaking rather than upon negligence ... the damages are restricted to the payments made, the expenditure for nurses and medicines, or other damages that flow naturally from the breach (thereof), and do not include the patient’s pain and. suffering as in malpractice actions.” Id. at 305 (citations and internal quotation marks omitted).2 Courts limiting recoverable damages for breach of a contract by a physician have done so in part to maintain a clear distinction between tort and contract claims, emphasizing that “[a]lthough ... actions of malpractice and breach of contract may arise out of the same transaction, they are distinct as to theory, proof and damages.” Id. at 304. Other courts, however, when faced with a contract between a physician and patient have applied the general rule of contract law that a plaintiff may recover damages that were within the contemplation of the *1010contracting parties. In Stewart v. Rudner, for example, the court allowed the plaintiff to recover mental anguish and pain and suffering damages in a contract in which a physician had agreed, but failed to perform a Caesarean section, causing the death of the plaintiffs unborn child. 349 Mich. 459, 84 N.W.2d 816, 821, 824 (1957). The court focused on the underlying subject matter of the parties’ agreement, reasoning that this particular contract was “concerned not with trade and commerce but with life and death,” a breach of which would “inevitably and necessarily result in mental anguish, pain and suffering.” Id. at 824. Therefore, the court held that “[i]n such cases the parties may reasonably be said to have contracted with reference to the payment of damages [for mental anguish and pain and suffering] in the event of breach. Far from being outside the contemplation of the parties they are an integral and inseparable part of it.” Id.; see also Sullivan v. O’Connor, 363 Mass. 579, 296 N.E.2d 183, 188-89 (1973) (“It is all a question of the subject matter and background of the contract, and when the contract calls for an operation on the person of the plaintiff, psychological as well as physical injury may be expected to figure somewhere in the recovery, depending on the particular circumstances.”). Based upon Minnesota’s general law governing contractual damages, the Court concludes that the Minnesota Supreme Court would likely follow the Zostautas court’s approach, and preclude the Kaplans from recovering pain and suffering and emotional distress damages based upon the breach of any contract formed with Mayo. Although it is possible that pain and suffering and emotional distress could have reasonably been within the contemplation of Mayo and the Kaplans based upon the nature of the contract at issue, the Minnesota Supreme Court has expressly rejected the approach used in Stewart and Sullivan of examining the underlying nature of the contract to determine whether damages such as those for mental anguish and pain and suffering are recoverable. See Francis, 59 N.W. at 1081 (refusing to “allow damages for injury to the feelings resulting from a breach of contract—even one [relating wholly to matters of sentiment or feeling]”). Instead Minnesota law appears to limit damages in a contract action to those capable of measurement by “some definite rule or standard of compensation,” and “to the actual pecuniary loss naturally and necessarily flowing from the breach.” Beaulieu, 114 N.W. at 356.3 The Kaplans’ pain and suffering as well as any emotional distress they may have suffered are damages that, although recoverable in tort, do not appear to be recoverable in a breach of contract action under Minnesota law.4 Therefore, *1011the Court will preclude the Kaplans from presenting evidence of pain and suffering or emotional distress at trial to support their breach of contract action.5 The Court’s conclusion that the Kaplans may not recover damages for pain and suffering or emotional distress is further supported by the Eighth Circuit’s opinion in this case. The Eighth Circuit specifically determined that the Kaplans had “provided sufficient evidence of economic damages resulting from [the Whipple] to meet the final requirement for making out their contract claim.” Kaplan, 653 F.3d at 728 (emphasis added). Furthermore, the Court notes that its conclusion is in keeping with the purpose of limiting extracon-tractual damages, to wit: preserving the boundary between contract and tort law. See Deli 578 N.W.2d at 782. The Kaplans already brought tort claims against the defendants in this case. The jury rejected those claims, and the Eighth Circuit affirmed. The Kaplans cannot use their remaining breach of contract claim to attempt to recover all of the damages that may have been recoverable in those tort claims. Although allegedly based on some of the same conduct, the Kaplans’ breach of contract action is distinct “as to theory, proof and damages,” Zostautas, 178 N.E.2d at 304, and therefore the Kaplans may not recover damages for pain and suffering and emotional distress. II. LOSS OF CONSORTIUM Under Minnesota law, a spouse of a person “injured as a direct result of the negligence of another shall have a right of action against that same person for her loss of consortium,” provided the injured person recovers against the tortfeasor and the spouse joins his or her claim in the same action as the injured person. Thill v. Modem Erecting Co., 284 Minn. 508, 170 N.W.2d 865, 869 (1969). “Loss of consortium is a derivative claim, failure of the tort claims underlying the loss of consortium claim will preclude recovery.” Schanhaar v. EF Techs., Inc., Civ. No. 08-5382, 2010 WL 4056045, at *4 (D.Minn. Oct. 14, 2010); see also Peters v. Bodin, 242 Minn. 489, 65 N.W.2d 917, 922 (1954). Although it does not appear that Minnesota courts have explicitly rejected a claim for consortium brought as a derivative to a breach of contract claim, the Kaplans have not cited to, nor has the Court found any Minnesota cases that *1012have allowed such a claim.6 The majority of other jurisdictions have concluded that a loss of consortium claim cannot derive from a breach of contract action, and the Court can identify no reason why the Minnesota Supreme Court would hold differently. See, e.g., Riley v. Champion Int’l Corp., 973 F.Supp. 634, 651 (E.D.Tex. 1997) (“[A] spouse’s derivative claims may not rest upon a simple breach of contract claim.”); Perrin v. Hilton Int’l Inc., 797 F.Supp. 296, 302 (S.D.N.Y.1992) (“[A] claim for loss of consortium cannot be derived from a spouse’s breach of contract claim.”); Covert v. Allen Grp., Inc., 597 F.Supp. 1268, 1270 (D.Colo.1984) (“A cause of action for loss of consortium cannot arise out of a cause of action for breach of contract or the ancillary theory of promissory estoppel.”). Because loss of consortium is a claim that is derivative of a tort, the Court concludes that Mrs. Kaplan cannot maintain a loss of consortium claim based upon the breach of contract claim remaining in this matter. In its motion, Mayo appears to be requesting dismissal of Mrs. Kaplan’s claim rather than simply the exclusion of evidence in support of that claim. Normally “motions in limine are not proper procedural devices for the wholesale disposition of theories or defenses.” In re Levaquin Prods. Liab. Litig., Civ. No. OS-5743, 2010 WL 4676973, at *3 (D.Minn. Nov. 9, 2010) (internal quotation marks omitted); see also CardioVention, Inc. v. Medtronic, Inc., 483 F.Supp.2d 830, 842 (D.Minn.2007) (declining to decide a dis-positive motion contained within a motion in limine). However, the Court finds that it is proper to dismiss Mrs. Kaplan’s claim at this time because requiring Mayo to file a separate motion to dismiss would “only prolong a meritless position,” and would require the parties to reargue the validity of the loss of consortium claim, which has been fully briefed in connection with the motion in limine. See SPX Corp. v. Bartec USA LLC, No. 06-14888, 2008 WL 3850770, at *3 (E.D.Mich. Aug. 12, 2008) (deciding whether summary judgment should be granted on a claim, even though the issue was raised in a motion in limine).7 *1013Moreover, given the unique procedural posture of this case on remand, it does not appear that Mayo is attempting to use a motion in limine to circumvent a disposi-tive motion deadline. Therefore, the Court will dismiss Mrs. Kaplan’s claim for loss of consortium, and preclude the Kap-lans from presenting evidence in support of this claim at trial. III. EVIDENCE NOT PRODUCED BEFORE DECEMBER 30, 2012 Mayo also requests that the Court exclude all evidence of damages not produced by the Kaplans prior to the December 30, 2012 deadline set by the Magistrate Judge. Although this argument was presented to the Magistrate Judge, the Magistrate Judge specifically declined to rule, and left this determination for this Court. Federal Rule of Civil Procedure 37 provides that where a party “fails to obey an order to provide or permit discovery” a court is permitted to “prohibit! ] the disobedient party from supporting or opposing designated claims or defenses, or from introducing designated matters in evidence.” Fed.R.Civ.P. 37(b)(2)(A). “The district court is afforded great latitude in imposing sanctions for failure to comply with discovery ordersf.]” Hazen v. Pasley, 768 F.2d 226, 229 (8th Cir.1985). Mayo confirmed at oral argument on the present motion that it has received all requested discovery regarding the Kap-lans’ claimed damages. The trial is not set to begin until this fall, giving Mayo ample time to review the Kaplans’ relatively small amount of new damages information. Although this information is undoubtedly important, it cannot be that the slight delay in receiving this information from the Kaplans will or has seriously hampered Mayo’s ability to prepare for this trial. The Court concludes that precluding the Kaplans from presenting updated evidence of damages would be an overly harsh sanction given the nature of the information and the timeline of this case. Thus, the Court will allow evidence produced after December 30, 2012, to be used at trial, and the Court cautions counsel to comply with the Federal Rules and the Court’s orders in the future.8 ORDER Based on the foregoing, and all the files, records, and proceedings- herein, IT IS HEREBY ORDERED that: 1. Defendants’ Motion in Limine [Docket No. 269] is GRANTED in part and DENIED in part as follows: a. To the extent Defendants’ motion seeks to preclude Plaintiffs from presenting evidence at trial of pain and suffering or mental anguish in support of their claim for breach of contract, the motion is GRANTED; *1014b. To the extent Defendants’ motion seeks to preclude Plaintiffs from presenting evidence at trial in support of their claim for loss of consortium, the motion is GRANTED; c. Plaintiffs’ claim for loss of consortium (Count II) is DISMISSED with prejudice; and d. To the extent Defendants’ motion seeks to preclude Plaintiffs from present evidence at trial that was disclosed to Defendants after the December 30, 2012 deadline, the motion is DENIED. 2. Defendants’ Motion to Strike Pleading [Docket No. 300] is DENIED.

MEMORANDUM OPINION AND ORDER ON DEFENDANTS’ MOTIONS IN LIMINE JOHN R. TUNHEIM, District Judge. This case arises out of a surgery performed on Elliot Kaplan (“Kaplan”) by a surgeon at Mayo Clinic to treat pancreatic cancer, a condition which post-surgery testing revealed that Kaplan never had. Kaplan and has wife Jeanne Kaplan (collectively, “the Kaplans”) filed lawsuit against Mayo Clinic and its affiliated entities (collectively, “Mayo”), as well as Dr. David Nagorney (“Dr. Nagorney”), the doctor who performed Kaplan’s surgery, and Dr. Lawrence J. Burgart (“Dr. Bur-gart”), the doctor who erroneously diagnosed Kaplan with pancreatic cancer. The Court granted summary judgment in favor of Dr. Nagorney. The case proceeded to trial against the other defendants on the Kaplans’ claims of breach of contract and negligent failure to diagnose. At the close of the Kaplans’ case, the Court granted judgment as a matter of law against them on their breach of contract claim. The jury returned a verdict for Mayo and Bur-*1004gart on the Kaplans’ claim for negligent failure to diagnose, and the Court entered judgment on that verdict. On appeal, the Eighth Circuit reversed as to the breach of contract claim concluding that a reasonable jury could find that Nagorney, on behalf of Mayo, formed a contract with Kaplan when Nagorney told Kaplan that he would perform an intraop-erative biopsy to confirm the cancer diagnosis before proceeding with the surgery. The Eighth Circuit found that Nagorney breached this contract when he failed to perform the promised biopsy. The Eighth Circuit remanded for further proceedings on the breach of contract claim. The case is now before the Court on Mayo’s motions in limine regarding the presentation of damages evidence at the remand trial on the Kaplans’ breach of contract claim. Mayo requests that the Court (1) preclude the Kaplans from presenting evidence of pain and suffering and emotional damages in support of their breach of contract claim; (2) dismiss Mrs. Kaplan’s loss of consortium claim; and (3) limit the Kaplans’ evidence of damages to documents and information disclosed prior to the December 30, 2012 disclosure deadline. For the reasons explained below, the Court will grant Mayo’s motion to exclude evidence of pain and suffering and emotional damages and will dismiss Mrs. Kap-lan’s loss of consortium claim. The Court will deny Mayo’s motion to limit the Kap-lans’ evidence to damages information disclosed prior to December 30, 2012. BACKGROUND I. THE WHIPPLE PROCEDURE In July 2003, Kaplan was hospitalized in Missouri after experiencing severe abdominal pain. A CT scan showed that Kaplan had an enlarged pancreas, and doctors in Missouri proceeded to perform a needle biopsy on the pancreas. A pathologist affiliated with the Missouri hospital reviewed the biopsy and, based on that review, Kap-lan was diagnosed with pancreatic cancer. In August 2003, Kaplan sought a second opinion from Mayo, and sent Mayo the pathology slides that the Missouri doctors had prepared in conjunction with the needle biopsy. Dr. Burgart, a Mayo pathologist, reviewed the pathology slides and diagnosed Kaplan with grade 2 infiltrating pancreatic cancer. Another Mayo doctor made an independent diagnosis of pancreatic cancer based on the slides. Given Dr. Burgart’s diagnosis, Dr. Nagorney, a Mayo surgeon, recommended that Kaplan undergo a pancreatoduodenectomy, or “Whipple” procedure, which involves excising portions of the pancreas and stomach as well as the entire pylorus and duodenum. Kaplan was concerned about the validity of the cancer diagnosis, and expressed this concern to Dr. Nagorney. When asked if he could confirm the diagnosis during the surgery, Dr. Nagorney allegedly replied that he would do a biopsy of the mass to verify that it was cancer, and if there was no cancer, Dr. Nagorney would not complete the procedure. On August 14, 2003, Dr. Nagorney performed the Whipple procedure on Kaplan. Dr. Nagorney did not perform an intraoperative biopsy on Kap-lan’s pancreatic tissue, and completed the Whipple procedure. After examining the pancreatic tissue postoperatively, Mayo pathologists concluded that Kaplan did not have pancreatic cancer. II. PROCEDURAL HISTORY In 2007, the Kaplans filed a complaint against Mayo, Dr. Nagorney, and Dr. Bur-gart, alleging claims for medical malpractice, negligent nondisclosure, breach of contract, and loss of consortium. {See Am. Compl., Sept. 17, 2007, Docket No. 4.) *1005A. Summary Judgment and Trial In 2008, the Court granted summary judgment in favor of Dr. Nagorney, finding that the Kaplans’ expert affidavit opined only on medical negligence with respect to Kaplan’s medical diagnosis, and not with respect to the surgical procedure performed on Kaplan: (Order at 14-15, Oct. 27, 2008, Docket No. 87, 2008 WL 4755797.) Consequently, the Court dismissed all of the Kaplans’ claims against Dr. Nagorney with prejudice. (Id. at 15.) The case proceeded to trial against the other defendants on claims of breach of contract and negligent failure to diagnose. (See Pl.’s Statement of the Case at 5, Mar. 23, 2009, Docket No. 116.) ' Before conclusion of the trial, the Court granted defendants’ motion for judgment as a matter of law on the breach of contract claims. (Minute Entry, Apr. 14, 2009, Docket No. 165.) The Court determined that the breach of contract claim, which arose “out of the diagnosis, care and treatment of [Kaplan],” failed because the Kaplans had not presented expert testimony relating to the standard of care to determine whether there had been a breach. (Tr. at 986-87, July 15, 2010, Docket No. 202.) After the evidence was presented, the jury returned a verdict for Mayo and Dr. Burgart on the Kaplans’ claims for negligent misdiagnosis. (Special Verdict Form at 1, Apr. 15, 2009, Docket No. 166.) Because the jury found that neither Mayo nor Dr. Burgart was negligent in the care or treatment of Kaplan, the jury did not answer any questions regarding damages. (Id. at 1-2.) The Court entered judgment on the verdict. (J., Apr. 17, 2009, Docket No. 169.) The Court then denied the Kap-lans’ motion for a new trial, and the Kap-lans appealed. (Order, Apr. 20, 2010, Docket No. 184, 2010 WL 1576784; Notice of Appeal, May 20, 2010, Docket No. 190.) B. Appeal On appeal, the Eighth Circuit denied the Kaplans’ request for a new trial on their claim for negligent failure to diagnose, and affirmed the Court’s judgment with respect to that claim. Kaplan v. Mayo Clinic, 653 F.3d 720, 724-26 (8th Cir.2011). The Eighth Circuit also affirmed the Court’s grant of judgment in favor of Dr. Burgart on the Kaplans’ breach of contract claim. Id. at 727. But the Eight Circuit concluded that the Court erred in granting judgment as a matter of law to Mayo on the Kaplans’ breach of contract claim. Id. at 729. Viewing the evidence in the light most favorable to the Kaplans, the Eighth Circuit reviewed the Court’s grant of judgment as a matter of law to determine whether any reasonable jury could have found in favor of the Kaplans on their breach of contract claim. Id. at 727. To establish a claim for breach of contract the Kaplans were required to show formation of a contract, breach, and resulting damages. Id. at 726 (citing Briggs Transp. Co. v. Ranzenberger, 299 Minn. 127, 217 N.W.2d 198, 200 (1974)). The Eighth Circuit first determined that a reasonable jury could have found that Dr. Nagorney, acting on behalf of Mayo, formed a contract when he allegedly told Kaplan that Dr. Nagorney would perform an intraoperative biopsy to confirm the cancer diagnosis. Id. at 727. As consideration “Mr. Kaplan authorized Dr. Nagor-ney and his colleagues to perform the Whipple procedure and paid them for that surgery.” Id. Although Dr. Nagorney testified that he never made such a promise, the Eighth Circuit determined that “this testimony merely raises factual question for the jury as to whether there was an agreement.” Id. The Eighth Circuit also determined that a jury could conclude the contract was breached, because it “is un*1006disputed” that Dr. Nagorney failed to perform an intraoperative biopsy. Id. at 728. With respect to damages, the Eighth Circuit concluded that a reasonable jury could have made the requisite finding of damages. To recover on a breach of contract the damages must have resulted from the breach. Id. The Eighth Circuit determined that the Kaplans needed to demonstrate two different steps to show causation as to damages. Id. First, the Kaplans “had to offer evidence to support a finding that the intraoperative biopsy results would have been negative for cancer,” and the Eighth Circuit concluded the Kaplans had made such a showing. Id. Second, the Kaplans would have to establish that “Dr. Nagorney would not have performed the Whipple procedure if the promised biopsy was negative.” Id. Finally, the Eighth Circuit determined that the Kaplans had “provided sufficient evidence of economic damages resulting from that procedure— though the amount was greatly disputed'—■ to meet the final requirement for making out their contract claim.” Id. The Eighth Circuit also found that the Kaplans’ breach of contract claim did not simply restate a medical malpractice claim—a claim that would require expert testimony. Id. at 729. The Eighth Circuit noted that “Minnesota law requires plaintiffs to file an expert-witness affidavit in any action against a health care provider for ‘malpractice, error, mistake, or failure to cure, whether based on contract or tort,’ if ‘expert testimony is necessary to establish a prima facie case’ in that action.” Id. at 728-29 (quoting Minn. Stat. § 145.682). The court concluded that expert testimony was unnecessary to support the Kaplans’ “perfectly ordinary, garden-variety contract claim,” and characterized the claim as “simply that a physician promised to perform a certain procedure and did not do it, resulting in damages to [the Kap-lans].” Id. at 729. Finally, the Eighth Circuit remanded for further proceedings on the Kaplans’ breach of contract claim. Id.1 In doing so, the court noted that “[t]he parties’ briefs do not discuss the question of whether Ms. Kaplan’s loss-of-consortium damages are recoverable in a contract action. This is a matter for exploration on remand should it arise.” Id. at 729 n. 1. C. Post-Remand Discovery Issues During an October 2, 2012 phone conference, the Court granted Mayo’s request to pursue limited additional discovery into the Kaplans’ damages, and set a February 1, 2013 deadline for such discovery. (Minutes, Oct. 2, 2012, Docket No. 239.) On October 11, 2012, Mayo served the Kaplans with interrogatories and document requests regarding damages. (See Defs.’ Mem. in Supp. of Mot. for Sanctions at 1, Jan. 4, 2013, Docket No. 256.) After receiving no response, Mayo brought a motion to compel that discovery. (Mot. to Compel, Nov. 30, 2012, Docket No. 244.) United States Magistrate Judge Jeffrey Keyes granted the motion to compel and ordered the Kaplans to respond to the discovery requests by December 30, 2012. (Order, Dec. 11, 2012, Docket No. 250.) The Magistrate Judge also awarded Mayo its fees and costs incurred in bringing the motion to compel, which order this Court affirmed. (Id. at 3; Order, Jan. 3, 2013, Docket No. 252; Order, Feb. 8, 2013, Docket No. 279.) *1007The Kaplans then twice produced responses to Mayo’s October 11, 2012 discovery request. (See Eighth Decl. of Heather M. McCann, Exs. K-L, Jan. 4, 2013, Docket No. 257.) The Kaplans responses were incomplete, and did not contain all of the updated information requested by Mayo. (See id., Ex. M.) Due to the inadequacy of the responses, on January 8, 2013, Mayo brought a motion for sanctions and a motion to compel. (Mot. to Compel, Jan. 8, 2013, Docket No. 259.) In the motion, Mayo sought an order, among other things, compelling complete responses and “prohibiting Plaintiffs from introducing into evidence or relying on evidence or argument based on evidence not disclosed or produced prior to the Court’s December 30, 2012 deadline.” (Id. at 1.) Mayo also asked the Court to extend the February 1, 2013 discovery deadline for defendants only. (Id.) The Magistrate Judge granted in part and denied in part Mayo’s motion to compel. (Order, Feb. 7, 2013, Docket No. 277.) Of relevance to the present motions, the Magistrate Judge denied Mayo’s request that the Kaplans be prohibited from introducing at trial any evidence not disclosed before December 30, 2012. (Order, Feb. 7, 2013, Docket No. 277.) This denial was, however, without prejudice because the Magistrate Judge concluded he was “not going to make that type of evidentia-ry ruling with respect to the trial of this case,” and specifically stated he was not “precluding Judge Tunheim from deciding the issue at the appropriate motion that’s made at the time of trial.” (Tr. at 34, Feb. 12, 2013, Docket No. 281.) The Magistrate Judge granted Mayo’s motion to compel the production of signed tax returns, supplemental answers to interrogatories, and a blank authorization for the release of Kaplan’s medical records. (Order, Feb. 7, 2013, Docket No. 277.) With respect to the extension of time for discovery the Magistrate Judge treated the request as one to continue the trial date, and declined to do so, determining that issue was best left to “counsel to work ... out between themselves and with ... Judge Tunheim to determine whether or not any delay of the trial is warranted with respect to that matter.” (Tr. at 37.) ANALYSIS I. CONTRACTUAL DAMAGES EVIDENCE The Court begins by determining whether the Kaplans may present evidence of pain and suffering and emotional distress to prove damages in relation to their breach of contract claim. A damage award in a breach of contract action is intended to place the nonbreaching party “in the position in which he would be if the contract were performed.” Lesmeister v. Lilly, 330 N.W.2d 95, 102 (Minn.1983); see also Jepson v. Gen. Cas. Co. of Wis., 513 N.W.2d 467, 472 (Minn.1994) (“[P]eople should get the benefit of the contracts they enter into, nothing less and nothing more.”). Therefore, a plaintiff may recover those “damages sustained by reason of the breach which arose naturally from the breach or could reasonably be supposed to have been contemplated by the parties when making the contract as the probable result of the breach.” Lesmeister, 330 N.W.2d at 103; see also Franklin Mfg. Co. v. Union Pac. R.R. Co., 311 Minn. 296, 248 N.W.2d 324, 325 (1976) (“When the damages are assessed as those which it is reasonable to suppose that the parties had in mind, what is really meant is that the law, aiming at compensation, considers it fair to hold a defendant for damages which as a reasonable man he ought to have foreseen as likely to follow from a breach. What he in fact foresaw or contemplated is immateri*1008al.” (internal quotation marks and alterations omitted)). Whether damages were reasonably foreseeable at the time of contracting is a question of fact. See Franklin Mfg. Co., 248 N.W.2d at 326. “Liability for breach of contract requires proof that damages resulted from or were caused by the breach.” Border State Bank of Greenbush v. Bagley Livestock Exch., Inc., 690 N.W.2d 326, 336 (Minn.Ct.App.2004). Whether a particular damage resulted from or was caused by a breach of contract is a question for the jury. See id.; see also Cashman v. Allied Prods. Corp., 761 F.2d 1250, 1254 (8th Cir.1985) (finding that “the jury could reasonably infer from the evidence presented” that the plaintiff had suffered lost profits due to the breach). Extra-contractual damages, on the other hand, are those which do not flow naturally from the breach and are not reasonably anticipated by the parties to the contract. See Wild v. Rang, 302 Minn. 419, 234 N.W.2d 775, 789 (1975). In Minnesota, extracontractual damages “are not recoverable for breach of contract except in exceptional cases where the breach is accompanied by an independent tort.” Haagenson v. Nat’l Farmers Union Prop. & Cas. Co., 277 N.W.2d 648, 652 (Minn. 1979). “The accompanying independent tort must be willful.” Lickteig v. Alderson, Ondov, Leonard & Sween, P.A., 556 N.W.2d 557, 561 (Minn.1996). The rule disallowing extra-contractual damages is designed “to insure that contract law is not swallowed by tort law.” Deli v. Univ. of Minn., 578 N.W.2d 779, 782 (Minn.Ct.App. 1998). A jury found in favor of the defendants on all of the Kaplans’ tort claims and the Eighth Circuit -affirmed the verdict. Therefore, there is no independent tort in the present case and the Kaplans cannot recover any extra-contractual damages. The difficulty, however, is determining whether pain and suffering and emotional distress damages constitute extra-contractual damages in the context of the alleged contract between Mayo and the Kaplans. Although pain and suffering and emotional distress damages might seem to be the natural proximate cause of a breach in certain types of contracts, Minnesota courts have expanded the prohibition on recovering such damages in a breach of contract action, even where those damages could be reasonably within the contemplation of the parties based on the nature of the contract. See Lickteig, 556 N.W.2d at 561 (categorically defining emotional distress . damages as “extra-contractual”); Francis v. W. Union Tel. Co., 58 Minn. 252, 59 N.W. 1078, 1081 (1894) (denying recovery of emotional distress damages even after recognizing that a contract to send a sensitive telegram relates “wholly to matters of sentiment or feeling” and therefore breach of such a contract could reasonably be expected to result in mental anxiety); Deli, 578 N.W.2d at 781-82 (finding emotional distress damages could not be awarded on a claim for an athletic director’s breach of an oral promise not to view a videotape that contained footage of the plaintiffs sexual encounter with her husband, despite the “inherently personal nature” of the contract); Bom v. Medico Ufe Ins. Co., 428 N.W.2d 585, 587, 590 (Minn.Ct.App.1988) (stating that pain and suffering were extra-contractual damages even though the breach alleged was for a contract to provide medical-insurance). Instead of examining solely the foreseeability of certain damages to determine whether such damages may be extra-contractual, Minnesota law appears to restrict recoverable contractual damages more generally to those that are pecuniary in nature. The Minnesota Supreme Court *1009has long held that regardless of the “nature of the contract ... [t]he law looks only to the pecuniary value of the contract, and for its breach awards only pecuniary damages.” Francis, 59 N.W. at 1081; see also Beaulieu v. Great N. Ry. Co., 103 Minn. 47, 114 N.W. 353, 356 (1907) (explaining that in the absence of an independent tort, damages for breach, of contract “must be limited to the actual pecuniary loss naturally and necessarily flowing from the breach”). Therefore, in addition to requiring that contractual damages be those which flow directly from the breach and were within the contemplation of the parties, the Minnesota Supreme Court has held that contractual damages are those which “may be measured and determined by some definite rule or standard of compensation.” Beaulieu, 114 N.W. at 355. Thus damages that are “incapable of definite calculation” and “must necessarily rest in the discretion of the jury” are extra-contractual and are recoverable only in tort actions. Id. It does not appear that the Minnesota Supreme Court has ever precisely addressed whether pain and suffering and emotional distress damages are recoverable for breach of a contract between a physician and his patient. Where the Court is faced with an undecided question of Minnesota law, its role is to predict how the Minnesota Supreme Court would resolve the question. See Spine Imaging MRI, L.L.C. v. Country Cas. Ins. Co., Civ. No. KM80, 2011 WL 379100, at *6 (D.Minn. Feb. 1, 2011) (citing Midwest Oil-seeds, Inc. v. Limagrain Genetics Corp., 387 F.3d 705, 715 (8th Cir.2004)). Although many courts have recognized that “a surviving patient can maintain a cause of action for breach of an express or implied promise against a physician,” Zostautas v. St. Anthony De Padua Hosp., 23 Ill.2d 326, 178 N.E.2d 303, 307 (1961), courts have disagreed about whether those surviving patients can recover damages for pain and suffering ■ or emotional distress. Some courts have held that where “liability is predicated on the failure to perform an agreed undertaking rather than upon negligence ... the damages are restricted to the payments made, the expenditure for nurses and medicines, or other damages that flow naturally from the breach (thereof), and do not include the patient’s pain and. suffering as in malpractice actions.” Id. at 305 (citations and internal quotation marks omitted).2 Courts limiting recoverable damages for breach of a contract by a physician have done so in part to maintain a clear distinction between tort and contract claims, emphasizing that “[a]lthough ... actions of malpractice and breach of contract may arise out of the same transaction, they are distinct as to theory, proof and damages.” Id. at 304. Other courts, however, when faced with a contract between a physician and patient have applied the general rule of contract law that a plaintiff may recover damages that were within the contemplation of the *1010contracting parties. In Stewart v. Rudner, for example, the court allowed the plaintiff to recover mental anguish and pain and suffering damages in a contract in which a physician had agreed, but failed to perform a Caesarean section, causing the death of the plaintiffs unborn child. 349 Mich. 459, 84 N.W.2d 816, 821, 824 (1957). The court focused on the underlying subject matter of the parties’ agreement, reasoning that this particular contract was “concerned not with trade and commerce but with life and death,” a breach of which would “inevitably and necessarily result in mental anguish, pain and suffering.” Id. at 824. Therefore, the court held that “[i]n such cases the parties may reasonably be said to have contracted with reference to the payment of damages [for mental anguish and pain and suffering] in the event of breach. Far from being outside the contemplation of the parties they are an integral and inseparable part of it.” Id.; see also Sullivan v. O’Connor, 363 Mass. 579, 296 N.E.2d 183, 188-89 (1973) (“It is all a question of the subject matter and background of the contract, and when the contract calls for an operation on the person of the plaintiff, psychological as well as physical injury may be expected to figure somewhere in the recovery, depending on the particular circumstances.”). Based upon Minnesota’s general law governing contractual damages, the Court concludes that the Minnesota Supreme Court would likely follow the Zostautas court’s approach, and preclude the Kaplans from recovering pain and suffering and emotional distress damages based upon the breach of any contract formed with Mayo. Although it is possible that pain and suffering and emotional distress could have reasonably been within the contemplation of Mayo and the Kaplans based upon the nature of the contract at issue, the Minnesota Supreme Court has expressly rejected the approach used in Stewart and Sullivan of examining the underlying nature of the contract to determine whether damages such as those for mental anguish and pain and suffering are recoverable. See Francis, 59 N.W. at 1081 (refusing to “allow damages for injury to the feelings resulting from a breach of contract—even one [relating wholly to matters of sentiment or feeling]”). Instead Minnesota law appears to limit damages in a contract action to those capable of measurement by “some definite rule or standard of compensation,” and “to the actual pecuniary loss naturally and necessarily flowing from the breach.” Beaulieu, 114 N.W. at 356.3 The Kaplans’ pain and suffering as well as any emotional distress they may have suffered are damages that, although recoverable in tort, do not appear to be recoverable in a breach of contract action under Minnesota law.4 Therefore, *1011the Court will preclude the Kaplans from presenting evidence of pain and suffering or emotional distress at trial to support their breach of contract action.5 The Court’s conclusion that the Kaplans may not recover damages for pain and suffering or emotional distress is further supported by the Eighth Circuit’s opinion in this case. The Eighth Circuit specifically determined that the Kaplans had “provided sufficient evidence of economic damages resulting from [the Whipple] to meet the final requirement for making out their contract claim.” Kaplan, 653 F.3d at 728 (emphasis added). Furthermore, the Court notes that its conclusion is in keeping with the purpose of limiting extracon-tractual damages, to wit: preserving the boundary between contract and tort law. See Deli 578 N.W.2d at 782. The Kaplans already brought tort claims against the defendants in this case. The jury rejected those claims, and the Eighth Circuit affirmed. The Kaplans cannot use their remaining breach of contract claim to attempt to recover all of the damages that may have been recoverable in those tort claims. Although allegedly based on some of the same conduct, the Kaplans’ breach of contract action is distinct “as to theory, proof and damages,” Zostautas, 178 N.E.2d at 304, and therefore the Kaplans may not recover damages for pain and suffering and emotional distress. II. LOSS OF CONSORTIUM Under Minnesota law, a spouse of a person “injured as a direct result of the negligence of another shall have a right of action against that same person for her loss of consortium,” provided the injured person recovers against the tortfeasor and the spouse joins his or her claim in the same action as the injured person. Thill v. Modem Erecting Co., 284 Minn. 508, 170 N.W.2d 865, 869 (1969). “Loss of consortium is a derivative claim, failure of the tort claims underlying the loss of consortium claim will preclude recovery.” Schanhaar v. EF Techs., Inc., Civ. No. 08-5382, 2010 WL 4056045, at *4 (D.Minn. Oct. 14, 2010); see also Peters v. Bodin, 242 Minn. 489, 65 N.W.2d 917, 922 (1954). Although it does not appear that Minnesota courts have explicitly rejected a claim for consortium brought as a derivative to a breach of contract claim, the Kaplans have not cited to, nor has the Court found any Minnesota cases that *1012have allowed such a claim.6 The majority of other jurisdictions have concluded that a loss of consortium claim cannot derive from a breach of contract action, and the Court can identify no reason why the Minnesota Supreme Court would hold differently. See, e.g., Riley v. Champion Int’l Corp., 973 F.Supp. 634, 651 (E.D.Tex. 1997) (“[A] spouse’s derivative claims may not rest upon a simple breach of contract claim.”); Perrin v. Hilton Int’l Inc., 797 F.Supp. 296, 302 (S.D.N.Y.1992) (“[A] claim for loss of consortium cannot be derived from a spouse’s breach of contract claim.”); Covert v. Allen Grp., Inc., 597 F.Supp. 1268, 1270 (D.Colo.1984) (“A cause of action for loss of consortium cannot arise out of a cause of action for breach of contract or the ancillary theory of promissory estoppel.”). Because loss of consortium is a claim that is derivative of a tort, the Court concludes that Mrs. Kaplan cannot maintain a loss of consortium claim based upon the breach of contract claim remaining in this matter. In its motion, Mayo appears to be requesting dismissal of Mrs. Kaplan’s claim rather than simply the exclusion of evidence in support of that claim. Normally “motions in limine are not proper procedural devices for the wholesale disposition of theories or defenses.” In re Levaquin Prods. Liab. Litig., Civ. No. OS-5743, 2010 WL 4676973, at *3 (D.Minn. Nov. 9, 2010) (internal quotation marks omitted); see also CardioVention, Inc. v. Medtronic, Inc., 483 F.Supp.2d 830, 842 (D.Minn.2007) (declining to decide a dis-positive motion contained within a motion in limine). However, the Court finds that it is proper to dismiss Mrs. Kaplan’s claim at this time because requiring Mayo to file a separate motion to dismiss would “only prolong a meritless position,” and would require the parties to reargue the validity of the loss of consortium claim, which has been fully briefed in connection with the motion in limine. See SPX Corp. v. Bartec USA LLC, No. 06-14888, 2008 WL 3850770, at *3 (E.D.Mich. Aug. 12, 2008) (deciding whether summary judgment should be granted on a claim, even though the issue was raised in a motion in limine).7 *1013Moreover, given the unique procedural posture of this case on remand, it does not appear that Mayo is attempting to use a motion in limine to circumvent a disposi-tive motion deadline. Therefore, the Court will dismiss Mrs. Kaplan’s claim for loss of consortium, and preclude the Kap-lans from presenting evidence in support of this claim at trial. III. EVIDENCE NOT PRODUCED BEFORE DECEMBER 30, 2012 Mayo also requests that the Court exclude all evidence of damages not produced by the Kaplans prior to the December 30, 2012 deadline set by the Magistrate Judge. Although this argument was presented to the Magistrate Judge, the Magistrate Judge specifically declined to rule, and left this determination for this Court. Federal Rule of Civil Procedure 37 provides that where a party “fails to obey an order to provide or permit discovery” a court is permitted to “prohibit! ] the disobedient party from supporting or opposing designated claims or defenses, or from introducing designated matters in evidence.” Fed.R.Civ.P. 37(b)(2)(A). “The district court is afforded great latitude in imposing sanctions for failure to comply with discovery ordersf.]” Hazen v. Pasley, 768 F.2d 226, 229 (8th Cir.1985). Mayo confirmed at oral argument on the present motion that it has received all requested discovery regarding the Kap-lans’ claimed damages. The trial is not set to begin until this fall, giving Mayo ample time to review the Kaplans’ relatively small amount of new damages information. Although this information is undoubtedly important, it cannot be that the slight delay in receiving this information from the Kaplans will or has seriously hampered Mayo’s ability to prepare for this trial. The Court concludes that precluding the Kaplans from presenting updated evidence of damages would be an overly harsh sanction given the nature of the information and the timeline of this case. Thus, the Court will allow evidence produced after December 30, 2012, to be used at trial, and the Court cautions counsel to comply with the Federal Rules and the Court’s orders in the future.8 ORDER Based on the foregoing, and all the files, records, and proceedings- herein, IT IS HEREBY ORDERED that: 1. Defendants’ Motion in Limine [Docket No. 269] is GRANTED in part and DENIED in part as follows: a. To the extent Defendants’ motion seeks to preclude Plaintiffs from presenting evidence at trial of pain and suffering or mental anguish in support of their claim for breach of contract, the motion is GRANTED; *1014b. To the extent Defendants’ motion seeks to preclude Plaintiffs from presenting evidence at trial in support of their claim for loss of consortium, the motion is GRANTED; c. Plaintiffs’ claim for loss of consortium (Count II) is DISMISSED with prejudice; and d. To the extent Defendants’ motion seeks to preclude Plaintiffs from present evidence at trial that was disclosed to Defendants after the December 30, 2012 deadline, the motion is DENIED. 2. Defendants’ Motion to Strike Pleading [Docket No. 300] is DENIED.

Adolphson v. United States · 2008 10 citations

+ 10 more citations in this opinion.

Meyer v. Dygert · 2001 2 citations

+ 2 more citations in this opinion.

House v. Kelbel · 2000 14 citations

+ 14 more citations in this opinion.

Ellingson v. Walgreen Co. · 1999 30 citations

+ 30 more citations in this opinion.

Bellecourt v. United States · 1992 24 citations

+ 24 more citations in this opinion.

Chizmadia v. Smiley's Point Clinic · 1991 14 citations

+ 14 more citations in this opinion.

Chizmadia v. Smiley's Point Clinic · 1989 6 citations

+ 6 more citations in this opinion.

Oslund v. United States · 1988 16 citations

+ 16 more citations in this opinion.