Supreme Court of Washington Finds Advanced Registered Nurse Practitioners Can Testify Regarding Medical Causation

Washington Rule of Evidence 702 provides that

If scientific, technical, or other specialized knowledge willassist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.

Under this standard, can an advanced registered nurse practitioner (ARNP) testify regarding the medical cause of a particular condition? In its recent opinion in Frausto v. Yakima HMA, LLC, 2017 WL 1533247 (Wash. 2017), the Supreme Court of Washington answered this question in the affirmative. 

In Frausto,

Rudy Frausto, a 70-year-old quadriplegic man, checked in to Yakima HMA LLC for pneumonia. While there, the nurses allegedly failed to provide proper care in the form of moving him, turning him, and providing him with an appropriate bed. As a result, Frausto developed pressure ulcers and filed suit against the medical center.

In response to the Yakima's motion for summary judgment, Frausto submitted the affidavit of Karen Wilkinson, an ARNP with more than 30 years of experience; Wilkinson stated her "professional objective medical opinion, on a more probable than not basis," that the treating nurses breached the applicable standard of care and that this breach proximately caused Frausto's pressure ulcers. The trial court found that "while Wilkinson was certainly qualified as an expert and could speak to the applicable standard of care, the law did not permit Wilkinson to testify on the issue of proximate cause."

The Supreme Court of Washington disagreed. The court began by noting that there is a sharp divide among courts that have decided the issue. Specifically, eight states expressly permit such testimony: Idaho, Kansas, Nevada, New York, North Carolina, Ohio, Oklahoma, and Pennsylvania. And six more states contain case law arguably permitting such testimony: Arizona, Michigan, New Hampshire, Rhode Island, South Carolina, and Virginia.

Conversely, severn states expressly forbid such testimony: Alabama, Georgia, Illinois, Indiana, Mississippi, Tennessee, and Texas. And two more states arguably exclude such testimony: Minnesota and Kentucky.

The Supreme Court of Washington sided with those courts allowing such testimony for two reasons: "First, Washington's nursing statutes differ from statutes in other states in that our legislature has empowered ARNPs to diagnose illnesses and injuries to at least a limited degree." Second, "ARNPs in Washington State receive substantially more education, training, and diagnostic authority than registered nurses."

-CM