Berger v. Ogden Regional Medical Center , 2020 UT App 85 ( 2020 )


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    2020 UT App 85
    THE UTAH COURT OF APPEALS
    ROBERT BERGER, JACK BERGER, AND THE ESTATE OF BONNIE BERGER,
    Appellants,
    v.
    OGDEN REGIONAL MEDICAL CENTER, MOUNTAINSTAR HEALTH
    CARE, MOUNTAINSTAR CARDIOVASCULAR, JOSEPH GRAHAM,
    DANIEL J. GREENBERG, AND D. SCOTT STANLEY,
    Appellees.
    Opinion
    No. 20190206-CA
    Filed June 4, 2020
    Second District Court, Ogden Department
    The Honorable Ernest W. Jones
    No. 140904377
    Brett D. Cragun, Attorney for Appellants
    Eric P. Schoonveld, and Justin W. Pendleton,
    Attorneys for Appellees Ogden Regional Medical
    Center, and Mountainstar Health Care
    Christian W. Nelson, Brandon B. Hobbs, and Sean C.
    Miller, Attorneys for Appellees Joseph Graham, and
    Mountainstar Cardiovascular
    Brian P. Miller, Christopher W. Droubay, and
    Nathanael J. Mitchell, Attorneys for Appellees Daniel
    J. Greenberg and D. Scott Stanley
    JUDGE JILL M. POHLMAN authored this Opinion, in which
    JUDGES GREGORY K. ORME and RYAN M. HARRIS concurred.
    POHLMAN, Judge:
    ¶1    In this medical malpractice case, Robert Berger, Jack
    Berger, and the Estate of Bonnie Berger (collectively, the Bergers)
    appeal the district court’s summary judgment in favor of Ogden
    Berger v. Ogden Regional Medical Center
    Regional Medical Center, Mountainstar Health Care,
    Mountainstar Cardiovascular, Joseph Graham, Daniel J.
    Greenberg, and D. Scott Stanley (collectively, Defendants). The
    Bergers contend that the district court erred in rejecting their
    effort to rely on the doctrine of res ipsa loquitur, in denying their
    request to extend the expert discovery deadlines, and in granting
    summary judgment to Defendants on the ground that they had
    not designated any expert witnesses and thus could not establish
    their medical malpractice claim. We affirm.
    BACKGROUND 1
    ¶2     On May 31, 2011, Bonnie Berger underwent robotic lung
    surgery at Ogden Regional Medical Center under Defendants’
    care. The purpose of the surgery was to evaluate her for
    non-small cell carcinoma and to remove the lower lobe of one
    lung. During the surgery, Bonnie 2 developed possible arterial
    bleeding, became hypotensive, and suffered an anoxic brain
    injury. She emerged from surgery unresponsive and died a week
    later.
    ¶3     The Bergers filed a medical malpractice lawsuit against
    Defendants in 2014. In their complaint, the Bergers alleged that
    Defendants had deviated from the standard of care in the
    following ways:
    1. When reviewing the grant of summary judgment, “this court
    views the facts in a light most favorable to the losing part[ies]
    below”—here, the Bergers. See Goodnow v. Sullivan, 
    2002 UT 21
    ,
    ¶ 7, 
    44 P.3d 704
     (cleaned up).
    2. Where relevant individuals share the same last name, we refer
    to them by their first names, with no disrespect intended by the
    apparent informality.
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    a. Improper preparation took place prior to
    surgery;
    b. Surgical and anesthetic management were not
    properly attentive and responsive to changes in
    [Bonnie’s] hemodynamic status;
    c. The resuscitation efforts were not timely given
    the significant loss of blood volume from the
    bleeding artery, there was a lack of readily
    available replacement blood, and there was not
    proper intravenous access to reestablish the
    patient’s blood volume.
    d. There is [a] question regarding the continuity of
    care regarding whether the primary anesthesia
    provider was present in the operating room at the
    time [Bonnie] began to decline and/or whether
    there was proper transfer of care of the patient
    from the primary anesthesia provider to his
    replacement; and
    e. Other deficiencies which may be noted after
    proper discovery.
    ¶4     Over the course of the next three years, the parties
    stipulated to extending the discovery deadlines seven times,
    which the district court allowed in each instance. Fact discovery
    finally closed on February 22, 2018. The Bergers’ deadline to
    disclose the identity of any expert witnesses was one week later,
    on March 1, 2018.
    ¶5     The day before the deadline, the Bergers moved for more
    time to disclose their expert witnesses. In support of their
    motion, the Bergers asserted that, as a result of fact discovery,
    they “believe[d] the injury sustained by Bonnie Berger . . . was of
    a type that did not occur in the absence of negligence and
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    Berger v. Ogden Regional Medical Center
    therefore expert testimony may not be necessary in this case
    under the doctrine of res ipsa loquitur.” The Bergers stated their
    intention to file a separate motion asking the court to determine
    whether res ipsa loquitur applied to the facts of the case, and
    they urged the court to extend the expert deadlines “until the
    determination regarding the applicability of res ipsa loquitur is
    reached.” If res ipsa loquitur applied, the Bergers asserted, the
    parties could “avoid the time and expense” of unnecessary
    discovery. On the other hand, if res ipsa loquitur did not apply,
    the parties could “proceed with expert discovery in the normal
    course.”
    ¶6     On March 7, 2018, the Bergers filed a motion asking the
    court to determine whether there was adequate foundation for a
    jury instruction on the doctrine of res ipsa loquitur. See generally
    Model Utah Jury Instructions 2d CV327 (2018). In so doing, the
    Bergers moved from the specific theories set out in their
    complaint to a much more generalized theory premised on the
    doctrine. According to the Bergers, res ipsa loquitur applied to
    the facts of the case because Bonnie’s injury “was of a kind
    which in the ordinary course of events, would not have
    happened had [Defendants] used due care,” and the jury
    therefore could infer Defendants’ fault without the need for
    expert testimony. The Bergers argued that “it is within the
    knowledge and experience of laypersons that a person with a
    healthy brain does not usually go into the operating room for
    lung surgery and emerge with a brain injury without some
    occurrence of negligence.” They further argued that “[t]here is
    no need for an expert to explain what is readily within the
    knowledge of laypersons” and that the burden should shift to
    Defendants to show that they were not negligent.
    ¶7      Defendants opposed the Bergers’ request for a res ipsa
    loquitur jury instruction. Disagreeing with the Bergers’ position
    that it would be common knowledge that Bonnie’s injury would
    not have occurred absent negligence, Defendants asserted that
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    “[n]one of the issues in this case are within the common
    knowledge of lay jurors,” including “non-small cell carcinoma,
    robotic surgery, anesthesia techniques, and hospital blood
    procedures and administration.” As a result, Defendants
    asserted, res ipsa loquitur had no application to the case and the
    Bergers were subject to the general rule that expert testimony is
    required to establish a medical malpractice claim. In the
    meantime, Defendants disclosed their own experts.
    ¶8      Defendants also opposed the Bergers’ motion to extend
    the expert discovery deadlines, arguing that no good cause
    existed to justify an extension. Defendants asserted that the
    Bergers had known the facts underlying the motion “for months,
    if not years,” and that the Bergers “should have either
    designated experts or simply expressed their intention to rely on
    the doctrine of res ipsa loquitur.” Noting that “designating
    experts would not necessarily preclude them from relying on the
    doctrine,” Defendants characterized the Bergers’ motion as an
    attempt to have the court “decide for them if they should
    designate experts” and asserted that the Bergers “should not get
    an extension just in case they are wrong” about the applicability
    of res ipsa loquitur.
    ¶9     After hearing oral argument on the issue of res ipsa
    loquitur, the district court denied the Bergers’ motion for a jury
    instruction on the doctrine. The court agreed with Defendants,
    ruling that “this is not the type of case where a layman could
    determine whether the event causing the damage is of a type
    that ordinarily would not happen except for someone’s
    negligence” and that the doctrine of res ipsa loquitur therefore
    was inapplicable. (Cleaned up.)
    ¶10 Thereafter, Defendants moved for summary judgment,
    asserting they were entitled to judgment as a matter of law. They
    argued that because the Bergers had not timely disclosed any
    experts, the Bergers would be unable to meet their burden at
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    Berger v. Ogden Regional Medical Center
    trial to establish, by expert testimony, the elements of their
    claim, including the applicable standard of care, a breach of that
    standard, and causation.
    ¶11 In opposing Defendants’ motion, the Bergers countered
    that they had timely moved to extend the discovery deadlines
    before their expert designations were due and that their motion
    remained pending. The Bergers also explained that, while not
    seeking to delay the case, they had pursued their res ipsa
    loquitur theory to see if it could “eliminate or refine the need for
    expert discovery . . . and potentially expedite the disposition” of
    the case. They further argued that Defendants had not been
    harmed by, and the Bergers had not gained advantage from, the
    fact that Defendants were the first to designate expert witnesses.
    The Bergers also maintained that good cause existed to extend
    the expert discovery deadlines. Yet they conceded that if the
    court did not allow them additional time to designate expert
    witnesses, they would be without expert testimony and
    Defendants would be entitled to summary judgment.
    ¶12 The court heard oral argument on the pending motions
    and entered rulings. First, it denied the Bergers’ motion to
    extend the discovery deadlines, explaining that rule 26 of the
    Utah Rules of Civil Procedure requires that “if a party fails to
    designate a witness by the appropriate deadline, that party may
    not be permitted to use that witness at trial.” The court then
    found that the Bergers’ undisputed failure to designate experts
    by the March 1, 2018 deadline was “not harmless because it
    precipitated Defendants disclosing their expert information out
    of sequence, and without the benefit of the information to which
    they are entitled under Rule 26(a)(4)(C).” It also found that the
    Bergers’ failure to disclose experts “was not the result of good
    cause.” According to the court, the Bergers “had every
    opportunity to designate their experts and they simply failed to
    do so.” Bonnie’s surgery “happened seven years” before, the
    lawsuit itself had been “pending for over four years,” and there
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    Berger v. Ogden Regional Medical Center
    had been “a number of extensions for discovery deadlines.”
    Although the Bergers elected to proceed under a res ipsa
    loquitur theory of liability, the court reasoned that their
    “decision to proceed in such a manner did not obviate the
    requirement to designate expert witnesses by the appointed
    deadline.” Under these circumstances, the court decided that
    rule 26 “mandate[d] the exclusion of [the Bergers’] experts at this
    point in the case.”
    ¶13 The court then granted Defendants’ motion for summary
    judgment. It explained that because it had previously ruled that
    res ipsa loquitur was inapplicable, the Bergers “must present
    their case to the jury via qualified medical experts to opine on
    the applicable standard of care, a breach of that standard and
    causation.” Because the Bergers could not “present any disputed
    issue of material fact as to any element of their prima facie case
    in the absence of expert testimony,” Defendants were entitled to
    summary judgment. The Bergers appeal.
    ISSUES AND STANDARDS OF REVIEW
    ¶14 The Bergers advance three issues on appeal. First, they
    contend that the district court erred when it ruled that they
    failed to establish a prima facie case of res ipsa loquitur and
    declined to instruct the jury on the doctrine. “[W]hether a
    plaintiff has established the requisite foundation for a res ipsa
    loquitur instruction is a question of law.” Walker v. Parish Chem.
    Co., 
    914 P.2d 1157
    , 1161 (Utah Ct. App. 1996). We review a
    district court’s resolution of a question of law for correctness. See
    Pilot v. Hill, 
    2019 UT 10
    , ¶ 9, 
    437 P.3d 362
    .
    ¶15 Second, the Bergers contend that the district court erred in
    denying their motion to extend the expert discovery deadlines.
    “Trial courts have broad discretion in managing the cases before
    them and we will not interfere with their decisions absent an
    abuse of discretion. When reviewing a district court’s exercise of
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    Berger v. Ogden Regional Medical Center
    discretion, we will reverse only if there is no reasonable basis for
    the district court’s decision.” Callister v. Snowbird Corp., 
    2014 UT App 243
    , ¶ 9, 
    337 P.3d 1044
     (cleaned up).
    ¶16 Third, the Bergers contend that the district court erred in
    granting summary judgment to Defendants. Summary judgment
    is appropriate “if the moving party shows that there is no
    genuine dispute as to any material fact and the moving party is
    entitled to judgment as a matter of law.” Utah R. Civ. P. 56(a).
    We review the district court’s decision to grant summary
    judgment for correctness. Ruiz v. Killebrew, 
    2020 UT 6
    , ¶ 7, 
    459 P.3d 1005
    .
    ANALYSIS
    I. Res Ipsa Loquitur
    ¶17 The Bergers contend that the district court erred when it
    ruled that they “did not establish a prima facie case for res ipsa
    loquitur and further erred when it failed to approve the
    proposed jury instruction.” The Bergers’ contention hinges on
    their assertion that Bonnie’s injury “was of a kind that, in the
    ordinary course of events, would not have happened if due care
    had been observed.” This assertion, in turn, rests on the premise
    that “it is within the knowledge and experience of laypersons
    that a person with a healthy brain does not usually go into the
    operating room for routine lung surgery and emerge with a
    brain injury that causes death without some occurrence of
    negligence.” For the reasons below, we reject the Bergers’
    position and conclude that the district court correctly ruled that
    res ipsa loquitur is inapplicable to this case.
    ¶18 To prevail on a claim of medical malpractice, “a plaintiff
    must prove four elements: (1) the standard of care required
    of health care providers under the circumstances; (2) breach
    of that standard by the defendant; (3) injury proximately
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    caused by the breach; and (4) damages.” Morgan v. Intermountain
    Health Care, Inc., 
    2011 UT App 253
    , ¶ 8, 
    263 P.3d 405
    . “To
    establish the standard of care required of a physician in
    a particular field, breach of that standard, and proximate
    cause, the plaintiff is generally required to produce an expert
    witness who is acquainted with the standards of care in the
    same or a similar field as the defendant doctor.” Dalley v. Utah
    Valley Reg’l Med. Center, 
    791 P.2d 193
    , 195–96 (Utah 1990). The
    reason for this general rule is that “the nature of the [medical]
    profession removes the particularities of its practice from the
    knowledge and understanding of the average citizen.” Nixdorf v.
    Hicken, 
    612 P.2d 348
    , 352 (Utah 1980). The doctrine of res
    ipsa loquitur is an exception to this general rule. Dalley, 791 P.2d
    at 196.
    ¶19 Through the doctrine of res ipsa loquitur, a plaintiff may
    establish “a prima facie case of negligence using circumstantial
    evidence.” Id. When the doctrine comes into play, it is often
    because “a plaintiff may be unconscious or incapacitated during
    surgery, and therefore unable to identify a defendant’s specific
    negligent acts.” Baczuk v. Salt Lake Reg’l Med. Center, 
    2000 UT App 225
    , ¶ 6, 
    8 P.3d 1037
    . Res ipsa loquitur thus “allows an
    inference of negligence to be drawn when human experience
    provides a reasonable basis for concluding that an injury
    probably would not have happened if due care had been
    exercised.” King v. Searle Pharm., Inc., 
    832 P.2d 858
    , 861 (Utah
    1992). This inference of negligence is “rebuttable,” putting “the
    burden of going forward with the evidence” on the defendants.
    Dalley, 791 P.2d at 200. And “[s]ince res ipsa loquitur generally
    raises only an inference and not a presumption of negligence, the
    fact finder may choose either to accept or reject that inference.”
    King, 832 P.2d at 861.
    ¶20 To rely on the doctrine of res ipsa loquitur, a “plaintiff
    must establish an evidentiary foundation from which a finder of
    fact could logically conclude that an injury was probably caused
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    by negligence.” Baczuk, 
    2000 UT App 225
    , ¶ 6. A plaintiff does so
    by showing three elements:
    (1) The accident was of a kind which, in the
    ordinary course of events, would not have
    happened had the defendant[s] used due care,
    (2) the instrument or thing causing the injury was
    at the time of the accident under the management
    and control of the defendant[s], and (3) the
    accident happened irrespective of any participation
    at the time by the plaintiff.
    Nixdorf, 612 P.2d at 352–53 (cleaned up). Only the first element is
    disputed on appeal.
    ¶21 Establishing an evidentiary foundation that a plaintiff’s
    injury “was of a kind which, in the ordinary course of events,
    would not have happened had the defendant[s] used due care”
    “presents a peculiar problem to a plaintiff in a medical
    malpractice case because of the necessity of showing what the
    usual outcome of a medical procedure would be when the
    required due care is employed.” Id. (cleaned up). A plaintiff may
    take one of two paths for laying the required evidentiary
    foundation. One path is for the plaintiff to introduce “expert
    medical testimony to establish the fact the outcome is more
    likely the result of negligence than some other cause.” Id. at 353;
    see also King, 832 P.2d at 862; Baczuk, 
    2000 UT App 225
    , ¶ 7. The
    other path is for the plaintiff to “rely on the common knowledge
    and understanding” of laypersons. Nixdorf, 612 P.2d at 353; see
    also King, 832 P.2d at 862–63. This is because the Utah Supreme
    Court has recognized that “in certain situations, the medical
    procedure is so common or the outcome so affronts our notions
    of medical propriety that expert testimony is not required to
    establish what would occur in the ordinary course of events.”
    Nixdorf, 612 P.2d at 353. “A classic example” of this type of
    situation is “leaving a foreign object in a patient’s body during
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    Berger v. Ogden Regional Medical Center
    surgery.” King, 832 P.2d at 862; accord Pete v. Youngblood, 
    2006 UT App 303
    , ¶¶ 23–24, 30, 
    141 P.3d 629
    . 3
    ¶22 Here, because the Bergers maintain “there is no need for
    an expert to explain what is readily within the knowledge of
    laypersons,” they thus are relying on the “common knowledge”
    path for establishing that Bonnie’s injury “was of a kind which,
    in the ordinary course of events,” would not have happened but
    for Defendants’ negligence. See Nixdorf, 612 P.2d at 352–53
    (cleaned up). The Bergers’ theory is as follows: “[Bonnie’s] brain
    was injured during lung surgery. She died from that injury. This
    is not a common occurrence. As such, it is reasonable to infer
    that negligence occurred (subject to [Defendants] being given the
    opportunity to prove otherwise).” In so arguing, the Bergers
    liken this case to two cases in which res ipsa loquitur applied to
    surgical patients who suffered injuries to unrelated parts of their
    bodies.
    ¶23 First, in Dalley v. Utah Valley Regional Medical Center, 
    791 P.2d 193
     (Utah 1990), the plaintiff underwent a caesarean section
    and returned from the operating room with a burn on the calf of
    her right leg. 
    Id. at 195
    . The Utah Supreme Court held that “it is
    within the knowledge and experience of laypersons that a
    woman with a healthy leg does not usually go into an operating
    room for a caesarean section operation and emerge with a burn
    on her leg without some occurrence of negligence.” 
    Id. at 196
    .
    Concluding that “[t]his type of inference does not require expert
    testimony concerning the standard of care and breach of that
    3. Other examples in non-medical contexts include “a barrel of
    flour falling from a warehouse window onto a pedestrian,” “a
    falling elevator,” a “sudden slamming of automatic doors in an
    airport,” and “glass particles found in a loaf of bread.” Walker v.
    Parish Chem. Co., 
    914 P.2d 1157
    , 1162 (Utah Ct. App. 1996)
    (collecting cases).
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    Berger v. Ogden Regional Medical Center
    standard,” 
    id.,
     the court further explained that when “a plaintiff
    receives an injury to a healthy part of the body not involved in
    the operation in an operating room controlled by known
    defendants, res ipsa loquitur establishes a rebuttable inference of
    negligence and causation that puts the burden of going forward
    with the evidence upon [the defendants],” 
    id. at 200
    .
    ¶24 Second, in Baczuk v. Salt Lake Regional Medical Center, 
    2000 UT App 225
    , 
    8 P.3d 1037
    , the plaintiff underwent hand surgery.
    Id. ¶ 2. An anesthesiologist “had used a heating pad to prevent
    vasoconstriction during the surgery,” and after surgery, the
    plaintiff discovered “a pressure injury and/or a burn to his
    buttocks.” Id. On appeal, this court agreed with the plaintiff that
    “it is within the understanding of laypersons that his burn
    and/or pressure injury on an originally uninjured part of his
    body not involved in the surgery more probably than not
    resulted from negligence.” Id. ¶ 8. This court reasoned, “It
    requires no medical or technical expertise to understand that a
    person may suffer a burn and/or a pressure injury from lying in
    the same position for too long on a heating pad. Nor does it
    require medical expertise to understand the steps that must be
    taken to avoid such injuries.” Id. ¶ 11. Accordingly, this court
    concluded that the plaintiff was “justified in relying on the
    understanding of laypersons” to set forth the evidentiary
    foundation for res ipsa loquitur. Id. ¶¶ 7–8, 11.
    ¶25 Relying on Dalley and Baczuk, the Bergers argue that “it
    would also appear that it is within the knowledge and
    experience of laypersons that a person with a healthy brain does
    not usually go into the operating room for routine lung surgery
    and emerge with a brain injury that causes death without some
    occurrence of negligence.” We disagree.
    ¶26 This case is dissimilar to Dalley and Baczuk. Dalley turned
    on the existence of a simple injury (a burn on the leg) that would
    clearly not occur during the specific type of procedure (a
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    Berger v. Ogden Regional Medical Center
    caesarean section), see Dalley, 791 P.2d at 196, 200, and Baczuk
    turned primarily on the simplicity of the injury (burn and/or
    pressure injury on the buttocks) and its lack of connection to the
    procedure (hand surgery), see Baczuk, 
    2000 UT App 225
    , ¶¶ 7–8,
    11. In contrast, this case presents more complex questions about
    the procedure and injury that non-medically trained persons
    would be unable to evaluate without assistance. Laypersons
    would be unable to assess whether an anoxic brain injury clearly
    would not occur during a robotic lung surgery and whether that
    injury had any connection to the procedure. Indeed, whether
    and how an anoxic brain injury could occur during a robotic
    procedure on a patient’s lung do not fall within the common
    understanding of laypersons. This injury is not an obvious one
    that a non-medically trained person could automatically
    associate with negligence, like “leaving a foreign object in a
    patient’s body during surgery.” See King, 832 P.2d at 862.
    Moreover, laypersons likely do not understand “the steps that
    must be taken to avoid” injuries like Bonnie’s. See Baczuk, 
    2000 UT App 225
    , ¶ 11.
    ¶27 Although the Bergers claim that, like Dalley and Baczuk,
    this case involves an injury to an otherwise healthy part of the
    body that is uninvolved with the procedure, we cannot agree.
    Defendants point out—and the Bergers do not dispute—that a
    procedure removing the lower lobe of a lung necessarily
    involves the respiratory and circulatory systems, which supply
    oxygen to the brain, and that, as a matter of biology, the proper
    functioning of the lungs is crucial to the health of the brain.
    Thus, unlike the procedures and sites of injury in Dalley and
    Baczuk, the brain is not a remote, uninvolved part of the body
    when a patient is undergoing lung surgery.
    ¶28 We thus agree with the district court that this is “a
    medically complicated malpractice case” and that the issues “are
    not within the common knowledge of lay jurors.” The medical
    and standard of care questions are complex and involve a
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    number of subjects “with which a lay juror would have no
    familiarity or expertise,” including “non-small cell carcinoma,
    robotic surgery, anesthesia techniques, and hospital blood
    procedures and administration.” We agree that it is not within
    the common understanding of laypersons to determine
    “whether a surgeon correctly performed the robotic evaluation
    and removal of non-small cell carcinoma,” whether “anesthesia
    techniques used during the surgery were appropriate and within
    the standard of care,” and whether a patient was adequately and
    appropriately “monitored during a procedure.” It is also not
    within the common understanding of laypersons to evaluate
    “hospital policies regarding availability of blood product in
    procedures such as this, including blood bank procedures and
    the use of a cell saver machine.”
    ¶29 In short, the district court correctly ruled that “this is not
    the type of case where a layman could determine whether the
    event causing the damage is of a type that ordinarily would not
    happen except for someone’s negligence.” (Cleaned up.) The
    situation surrounding Bonnie’s injury is not one in which the
    Bergers “can rely on the common knowledge and understanding
    of laymen to establish” that Bonnie’s injury was probably caused
    by negligence. See Nixdorf, 612 P.2d at 353. Therefore, the Bergers
    cannot rely on the doctrine of res ipsa loquitur to exempt them
    from the general rule that expert testimony is required to
    support their medical malpractice claim. 4 Accordingly, we affirm
    the district court’s ruling on the issue of res ipsa loquitur.
    4. In arguing that they should have been able to rely on res ipsa
    loquitur without expert testimony, the Bergers emphasize that
    evidence was conflicting at the end of fact discovery, “there were
    still questions about what actually caused [Bonnie’s] injury,” and
    those facts “are only known by [Defendants].” Because of these
    circumstances, the Bergers suggest that their potential experts
    (continued…)
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    II. Expert Disclosure Deadlines
    ¶30 Next, the Bergers contend that the district court erred in
    denying their motion to extend the expert discovery deadlines.
    They assert that their motion was justified by good cause
    because, as a matter of “fairness, a plaintiff should be able to
    obtain a ruling on invocation of the doctrine of res ipsa loquitur
    before expert discovery is required.” According to the Bergers,
    the doctrine of res ipsa loquitur “cannot be effectively invoked
    before the close of fact discovery (because facts may be learned
    which make the doctrine inappropriate) and logically should be
    invoked before expert discovery begins (to allow expert
    discovery to proceed effectively).” They also assert that
    extending the discovery deadlines would have “maintain[ed] the
    status quo,” resulted in only a “short delay,” and caused no
    prejudice to any party.
    ¶31 District courts generally may extend deadlines “for good
    cause.” 5 Utah R. Civ. P. 6(b)(1). In exercising its discretion to
    (…continued)
    “would only be able to speculate and infer what happened to
    [Bonnie]” and therefore “it is only reasonable that [Defendants]
    be required to explain how [Bonnie’s] injury occurred in a
    non-negligent way.” We are not persuaded. Instead, we agree
    with Defendants that “experts reach opinions based on
    conflicting facts as a matter of course” and that, specific to this
    case, “the possibility of conflicting opinions supports the
    argument that the procedure and injuries in this case could be
    explained by multiple potential causes,” underscoring the extent
    to which “the medical issues fall outside the realm of common
    knowledge or experience.”
    5. In their opening brief, the Bergers claim that the district court
    “applied the wrong standards in denying the motion to extend
    (continued…)
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    Berger v. Ogden Regional Medical Center
    deny the Bergers’ motion to extend the discovery deadlines,
    the district court articulated reasonable bases to support its
    decision that the Bergers’ failure to disclose experts “was not
    the result of good cause.” The court determined that the
    Bergers “had every opportunity to designate their experts and
    they simply failed to do so.” See Townhomes at Pointe Meadows
    Owners Ass’n v. Pointe Meadows Townhomes, LLC, 
    2014 UT App 52
    , ¶ 12, 
    329 P.3d 815
     (affirming the denial of a motion to
    extend the discovery deadlines when the district court
    determined, among other things, that “the discovery period in
    [the] case ha[d] afforded the parties a fair and reasonable
    opportunity to prepare for trial” (cleaned up)), superseded on
    other grounds by rule as stated in Ghidotti v. Waldron, 
    2019 UT App 67
    , 
    442 P.3d 1237
    . Indeed, the events in question “happened
    seven years” earlier, the parties had been litigating “for over
    four years,” and there had already been “a number of extensions
    for discovery deadlines.” Additionally, the court determined
    that the Bergers’ undisputed failure to designate experts by
    the March 1, 2018 deadline was “not harmless” given that
    it forced Defendants to make their expert disclosures “out of
    sequence” and “without the benefit of” the Bergers’ expert
    disclosures.
    ¶32 Likewise, the district court rejected the notion that
    the Bergers’ motion on their res ipsa loquitur theory provided
    good cause for extending the disclosure deadlines. The court
    reasoned that the “decision to proceed in such a manner did not
    obviate the requirement to designate expert witnesses by the
    appointed deadline.” It explained that while the Bergers could
    have avoided calling an expert at trial if they had prevailed on
    (…continued)
    expert discovery deadlines.” But in oral argument before this
    court, the Bergers conceded that the district court applied the
    correct standard in deciding the motion.
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    Berger v. Ogden Regional Medical Center
    the res ipsa loquitur motion, they could have “at least
    designated an expert to comply with the discovery rules,”
    especially when medical malpractice cases commonly “end up
    being a battle of experts.” But where the Bergers “roll[ed] the
    dice and wait[ed] to see” whether they prevailed on their res
    ipsa loquitur motion before designating experts, the court did
    not see “any wiggle room” to “give [them] more time to come up
    with an expert.”
    ¶33 We appreciate the Bergers’ perceived dilemma concerning
    their attempt to rely on res ipsa loquitur and their impending
    expert disclosure deadlines. These considerations might have
    weighed in favor of extending the deadlines in this case
    and might have provided a reasonable basis for doing so. Yet
    the district court’s decision on the matter was “a discretionary
    call,” reviewed only for abuse of discretion. See Gunn Hill Dairy
    Props., LLC v. Los Angeles Dep’t of Water & Power, 
    2015 UT App 261
    , ¶ 24, 
    361 P.3d 703
     (Orme, J., concurring) (opining that
    the district court “made the wrong call” on a motion to
    change venue but that “it was, in its essence, a discretionary
    call—and one that was within the broad range of discretion
    entrusted to [it]”). While we cannot say that we necessarily
    would have denied the Bergers’ motion had we been in the
    district court judge’s position considering it in the first instance,
    we affirm the district court’s decision under the deferential
    standard of review that we are obliged to apply. See id. ¶ 21
    (emphasizing that “standards of review really do matter”).
    Under that standard, “we will reverse only if there is no
    reasonable basis for the district court’s decision.” See Townhomes,
    
    2014 UT App 52
    , ¶ 9. Here, the district court articulated
    reasonable bases for its decision, including that the case had
    been pending “for over four years” and the Bergers “had every
    opportunity to designate their experts.” We thus conclude that
    the district court did not exceed the bounds of its discretion
    when it denied the Bergers’ motion to extend the expert
    discovery deadlines.
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    Berger v. Ogden Regional Medical Center
    III. Summary Judgment
    ¶34 Finally, the Bergers challenge the district court’s grant of
    summary judgment to Defendants, making their challenge
    contingent on their success on the first issue raised on appeal.
    They assert that “if this court determines that the Bergers have
    established the requisite foundation to invoke the doctrine of res
    ipsa loquitur then the trial court’s determination that summary
    judgment for lack of designation of an expert should be
    reversed.”
    ¶35 As discussed, a plaintiff must prove four elements to
    prevail on a medical malpractice claim. Morgan v. Intermountain
    Health Care, Inc., 
    2011 UT App 253
    , ¶ 8, 
    263 P.3d 405
    . “A
    plaintiff’s failure to present evidence that, if believed by the trier
    of fact, would establish any one of the elements of the prima
    facie case justifies a grant of summary judgment to the
    defendant.” 
    Id.
     (cleaned up). In light of our affirmance of the
    district court’s decision that the res ipsa loquitur theory is
    unavailable to the Bergers, and in light of our affirmance of its
    decision denying the Bergers further opportunity to designate
    expert witnesses, we also affirm the district court’s decision
    granting summary judgment to Defendants.
    CONCLUSION
    ¶36 We conclude that the district court correctly determined
    that the Bergers could not rely on the doctrine of res ipsa
    loquitur. We also conclude that the court did not exceed its
    discretion in denying the Bergers’ motion to extend the expert
    discovery deadlines. Given the Bergers’ need for expert
    testimony and their failure to designate any expert witnesses, the
    district court correctly granted summary judgment in favor of
    Defendants. Accordingly, we affirm the district court in all
    respects.
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