Sampson et al v. The Medical Center, Inc. et al

Georgia Court of Appeals Confirms That Absolute Certainty Is Not the Legal Standard for Admissibility of Expert Causation Opinions


The Plaintiff gave birth to her son at Columbia Regional Health Midtown Medical Center on September 9, 2016. The Defendants recognized Plaintiff’s knowledge deficits regarding taking care of her newborn. Despite that recognition, there was evidence in the record that the Defendants failed to educate Plaintiff about newborn safety and warn against “co-sleeping.” Defendants also failed to provide Plaintiff with a bassinet and other baby equipment that should have been given to her as a Medicaid recipient. 

Plaintiff brought her newborn home on September 11, 2016, and co-slept with him in her bed because she did not have a crib or bassinet for him. Plaintiff stated that she did not recall waking up on top of her newborn and that rolling over on top of her newborn was impossible because of the space between them in her bed. Nonetheless, Plaintiff’s newborn began making odd grunting noises while sleeping and exhibiting symptoms of reflux after being fed. On September 17, 2016, Plaintiff was awakened by her newborn—who lay next to her—making awkward noises while struggling to breathe. Plaintiff brought her newborn to the emergency room where it was determined that the newborn showed significant acidosis, consistent with asphyxia. After seeking further medical treatment, the newborn was diagnosed with a brain injury that caused cerebral palsy and developmental delays. 

Plaintiff filed a medical malpractice suit against Midtown Medical Center and its medical providers for failing to instruct Plaintiff on infant sleep safety and the dangers of co-sleeping. Plaintiff claimed that the failure to instruct her on infant sleep safety and the dangers of co-sleeping caused Plaintiff to co-sleep with her newborn, and that co-sleeping was the cause of her newborn’s injuries. 

To support her causation argument, Plaintiff provided expert testimony that her newborn’s condition was “most likely” the result of Plaintiff laying over her newborn without realizing it and that Plaintiff’s co-sleeping was “more likely than not” the cause of her newborn’s injuries. The Defendants contended that Plaintiff’s experts’ inability to provide more concrete evidence of the cause of her infant child’s injuries meant that the experts’ opinions should be excluded and summary judgment granted in their favor.

The trial court agreed with Defendants and granted Defendants’ motion for summary judgment. The trial court determined that the experts’ opinions were speculative because they did not have any “concrete evidence” as to what occurred to cause the injuries to Plaintiff’s son. Plaintiff appealed the court’s rulings. 

Issues & Holdings

The issue in this case was the standard for the admissibility of an expert’s causation opinions.  

The Georgia Court of Appeals held that the trial court incorrectly granted summary judgment to the Defendants because it applied the wrong standard for establishing causation. 


In medical malpractice cases, causation must be established through expert testimony that presents a realistic assessment of the likelihood that the defendant’s negligence caused the plaintiff’s injuries. The expert must provide the basis for how the conclusions were reached, and the probability that they are accurate. Swint v. Mae, 340 Ga. App. 480 (2017). Georgia law requires that the probability of an expert’s opinion being correct be more than a medical possibility. See, e.g., Evans v. Med. Ctr. of Cent. Ga., 359 Ga. App. 797, 800 (2021). Courts have used the phrases“reasonable medical probability” or “reasonable medical certainty” to describe the correct standard. Id.; see also Zwiren v. Thompson, 276 Ga. 498, 503 (2003). 

In this case, the Court of Appeals stated that Plaintiff’s experts had employed a proper methodology in reviewing all the pertinent medical records and tests, and by ruling out other potential causes of the newborn’s injuries. The experts also provided the likelihood that their opinions were correct–one stated that his onions were to a reasonable degree of medical certainty and the other stated that they were “more likely than not” correct. 

Because the trial court did not apply the correct standard in granting summary judgment, the Court of Appeals reversed the trial court’s decision. 


This case re-emphasizes that absolute certainty is not the standard of admissibility for expert opinions in general, or causation opinions in particular. Expert witnesses must state the basis for their opinions, and the probability that they are correct. 

When testifying about the probability that their opinions are correct, the threshold is higher than a mere possibility but it is not as high as absolute certainty. There are no magic words that have to be utilized, but an expert who can state that their opinions are to a reasonable degree of medical probability, or more likely than not, has met the standard. 

When preparing your experts for their depositions or trial testimony, it is important that you ensure they can adequately explain the basis for their opinions and that their opinions are true and accurate to a reasonable degree of medical probability or are more likely than not correct.

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Citation: Sampson et al. v. The Medical Center, Inc. et al, 
No. A23A1014 (Ga. Ct. App. October 23, 2023)

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