Munda Forbort, et al., Appellants,

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A25-1293

Munda Forbort, et al.,
Appellants,

vs.

St. Mary’s Medical Center,
Respondent.

Filed May 4, 2026
Affirmed
Jesson, Judge*

St. Louis County District Court
File No. 69DU-CV-23-2561

William D. Paul, William D. Paul Law Office, Duluth, Minnesota (for appellants)

Tracy A. Schramm, Geraghty O’Loughlin & Kenney, P.A., Duluth, Minnesota (for
respondent)

Considered and decided by Reyes, Presiding Judge; Connolly, Judge; and Jesson,
Judge.
NONPRECEDENTIAL OPINION
JESSON, Judge
Appellant Munda Forbort sued respondent St. Mary’s Medical Center (SMMC) for
medical malpractice, claiming nursing staff broke her spine while she was recovering from

* Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to
Minn. Const. art. VI, § 10.
2
surgery and rendered her paraplegic. The district court dismissed the complaint for failure
to meet the expert-affidavit requirements set forth in Minnesota Statute section 145.682
(2024). Forbort argues that because the allegations in her complaint are within the “general
knowledge or experience of laypersons,” the district court erred by determining that she
was required to submit expert affidavits pursuant to the statute. Alternatively, Forbort
contends that the court erred in concluding that her expert affidavit failed to establish a
prima facie case of medical malpractice. Because we conclude that an expert affidavit was
required and Forbort’s expert affidavit is insufficient because it does not outline the chain
of causation, we affirm.
FACTS
Forbort, who was 65- years old during the events of this case, has a history of
degenerative disc disease, scoliosis, sagittal imbalance, stenosis, radiculopathy, and
neurogenic claudication. 1 On September 11, 2019, Forbort underwent elective spinal
surgery at SMMC in an attempt to alleviate her chronic back pain. The surgery fused her
T10 vertebra to her ilium, and Forbort was discharged from SMMC a week later. But after
experiencing recurrent back pain, Forbort came to the SMMC emergency room on
September 25. The surgical area had become infected, and testing revealed that Forbort
had possible fluid collection and a new fracture of the T10 vertebra. Forbort was admitted
to SMMC and had another surgery on September 25, which extended the spinal fusion to

1 The facts are derived from the records submitted alongside the parties’ motions for and
against dismissal.
3
her T9 vertebra. She remained at SMMC while she recovered. The alleged injury took
place overnight on October 4.
On the evening of October 4, Forbort was able to stand unassisted and walk to and
from bed with the assistance of two staff which was “no differen[t] from previous shifts.”
Although Forbort looked “exhausted,” and reported feeling progressively worse, her
extremities tested at a 4 out of 5 for strength. Forbort’s husband was concerned that she
had not napped that day and that she was experiencing a recent change in pain medication.
The nurse noted these concerns in Forbort’s medical chart at 7:50 p.m. and left Forbort to
rest.
According to Forbort, sometime that night nursing staff repositioned her in such a
way that she felt an acute increase in pain in her back. At the same time, she felt the
“energy” leaving her legs. Immediately afterward, nursing staff assisted Forbort to and
from the bathroom. Walking back into the room, Forbort felt her “legs buckling,” and
nursing staff had to “drag” her across the floor with her “limp legs . . . dragging behind
[her].”
At 6:00 a.m. the next morning, Forbort called a nurse for assistance going to the
bathroom because she felt too weak to get out of bed. Forbort stated that she was
“paralyzed,” and unable to move or feel her legs. The nurse observed that Forbort was
moving her legs independently at that time and discussed the difference between weakness
and paralysis. Another nurse reported that Forbort was “very focused on a bad experience
she encountered last night with decreased function.”
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Later that morning, Forbort reported to her physician’s assistant that she
experienced “total loss of function of her [legs], starting last night after sitting on bedside
commode.” She stated that she felt “pops” in her back and was concerned she had broken
something. As the physician’s assistant observed Forbort, he noted that she could move
her toes and knees and could react to sensation. He scheduled her for a CT scan at around
10:30 a.m. The CT scan revealed additional swelling, a worsening fracture of Forbort’s
T10 vertebra, and a new fracture in her T9 vertebra. To address this, Forbort had another
spinal-fusion surgery one day later and was ultimately discharged on October 18. Medical
records indicate that at that time, Forbort could move both legs and respond to sensations
in each foot.
Forbort sued SMMC for medical malpractice. Her complaint alleged that SMMC
nursing staff “repositioned [Forbort] with such excessive force and in such a manner that
[Forbort’s] lower back was fractured.” She alleged that due to this injury, she was rendered
paraplegic and sought damages in excess of $10 million. Forbort subsequently filed three
medical-expert affidavits in support of her claim. SMMC moved to dismiss the complaint,
arguing that Forbort failed to comply with the affidavit requirements of
Minn. Stat. §145.682, subd. 4(a). In response, Forbort argued that expert testimony is not
required in this case, and alternatively, that her expert affidavits are legally sufficient.
The district court granted SMMC’s motion to dismiss. It concluded that expert
testimony was required and that none of Forbort’s expert affidavits established a prima
facie case of medical malpractice. The case was dismissed with prejudice. See id., subd. 6.
Forbort appeals.
5
DECISION
To succeed in a medical-malpractice case, plaintiffs must prove “(1) the standard of
care recognized by the medical community as applicable to the particular defendant’s
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 patient’s injuries.”
Dickhoff ex rel. Dickhoff v. Green, 836 N.W.2d 321, 329 (Minn. 2013) (quotation omitted).
Early in a medical-malpractice action, plaintiffs are generally required to submit an expert
affidavit which states, with respect to 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.” Minn. Stat. § 145.682, subd. 4(a). Unless an exception applies,
failure to submit a compliant affidavit results in mandatory dismissal. Id., subd. 6(c). On
review of a district court’s dismissal for failure to comply with the affidavit requirements,
we will not reverse absent a showing that the district court abused its discretion.
Tousigant v. St. Louis County, 615 N.W.2d 53, 58 (Minn. 2000). But interpretation of the
requirements of section 145.682 is a question of law which we review de novo. Id.
Here, the district court concluded that no exception applied and Forbort was
required to provide expert affidavits. It further determined that none of Forbort’s expert
affidavits complied with section 145.682 such that dismissal was required. Forbort
challenges each determination, which we address in turn.
I. Expert testimony is required to prove Forbort’s claim.
Generally, proving all three elements in a medical-malpractice claim requires an
expert to assist the jury in understanding “complex issues of science or technology.”
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Id. at 59. An exception applies for those “rare” cases when “the alleged negligent acts are
within the general knowledge or experience of laypersons.” Id. at 58 (quotation omitted);
Mercer v. Andersen, 715 N.W.2d 114, 122 (Minn. App. 2006). To determine whether this
exception applies, we consider whether the rational inferences following a proved sequence
of events are sufficient to “establish causal connection without any supporting medical
testimony.” Rygwall v. ACR Homes, Inc., 6 N.W.3d 416, 43 0 (Minn. 2024) (quotation
omitted); see also Tousignant, 615 N.W.2d at 58 (stating that whether section 145.682
applies is a legal question we review de novo).
The district court concluded that this is not an exceptionally rare case where expert
testimony is not required to establish a prima facie medical -malpractice case. We agree.
A plaintiff must support their claim with expert testimony “[ i]f a layperson could not
reasonably understand and make inferences concerning the connection between the breach
of duty and injury.” Rygwall, 6 N.W.3d at 435. Forbort’s diagnosis includes several
medical conditions which led to chronic back pain and an initial spinal-fusion surgery on
September 11. After experiencing an unexplained fracture to the T10 vertebra, a second
surgery extended the spinal fusion to the T9 vertebra. Forbort claims that during her post-
operative recovery, SMMC staff caused an additional fracture to her T9 vertebra which
rendered her paraplegic. We cannot conclude that a layperson would understand the
interplay between Forbort’s medical history, multiple spinal surgeries, and post -operative
recovery to make the necessary inferences between SMMC’s conduct on October 4 and
Forbort’s alleged injuries. Nor could a layperson reasonably understand how an injury to
the T9 vertebra could cause paralysis. Finally, it is exceptionally unlikely that a layperson
7
could reasonably understand why Forbort’s earlier spinal fractures did not cause paralysis,
but her alleged injury did. This requires expert testimony.
To persuade us otherwise, Forbort compares her circumstances to Tousignant,
arguing that it is “common sense” that medical staff should not reposition a patient in such
a violent manner that would fracture their spine. We are not persuaded. In Tousignant,
the plaintiff was admitted to a nursing home while she was recovering from hip surgery.
Tousignant, 615 N.W.2d at 55-56. The plaintiff’s patient form specifically advised staff
that the plaintiff needed to have a “vest restraint on at all times” to prevent her from
falling. Id. at 56. She was subsequently left unattended and unrestrained, and as a result,
fell and re-fractured her hip. Id. In concluding that expert testimony was unnecessary to
establish a prima facie case of medical malpractice, the court reasoned that “[i]t is a matter
of common knowledge and experience that an elderly person, confused and recovering
from a fractured hip, who was likely to attempt to walk without assistance if left
unattended, also likely would fall” and “[t]hat a fall by such a person would result in . . .
injuries.” Id. at 61.
But unlike in Tousignant, Forbort’s allegations are highly disputed. Generally,
when expert testimony is not required, it is because “breach and causation are undisputed
and are a matter of common knowledge and experience.” See
Daulton v. TMS Treatment Ctr., Inc., 2 N.W.3d 331, 339 (Minn. App. 2024) (quotation
omitted). But here, medical records indicate that Forbort’s new spinal fracture may have
been caused by her already existing spinal infection, poor bone quality, the nature of the
first surgery, her preferred sitting position, or a traumatic incident. The average layperson
8
is not adequately equipped to assess these factors and determine that Forbort’s injuries
were caused by SMMC’s actions on October 4. Thus, unlike Tousignant, this is not the
“rare” case where expert testimony is not required.2 615 N.W.2d at 58 (quotation omitted).
In sum, the district court did not err in concluding that Forbort’s claim was subject
to the expert-affidavit requirements pursuant to Minn. Stat. § 145.682.
II. Because Forbort’s expert affidavit failed to establish a prima facie case as to
the element of causation, the district court did not abuse its discretion by
dismissing her claims.

A plaintiff’s expert affidavit must “[a]t a minimum . . . disclose specific details
concerning their experts’ expected testimony, including the applicable standard of care, the
acts or omissions that plaintiff alleges violated the standard of care and an outline of the
chain of causation between the violation of the standard of care and the plaintiff’s
damages.” Lindberg v. Health Partners, Inc., 599 N.W.2d 572, 577 (Minn.
1999) (quotation omitted). As recently discussed by the supreme court, the chain of
causation must include “reference to specific facts in the record connecting the conduct of

2 Alternatively, Forbort argues that res ipsa loquitur applies in this case. We disagree. Res
ipsa loquitur, or “the thing or situation speaks for itself,” is available in a medical-
malpractice action to infer negligence when the plaintiff can prove three things: “(1) that
ordinarily the injury would not occur in the absence of negligence; (2) that the cause of the
injury was in the exclusive control of the defendant; and (3) that the injury was not due to
plaintiff’s conduct.” Hoven v. Rice Mem’l Hosp., 396 N.W.2d 569, 572 (Minn. 1986); see
also Hestbeck v. Hennepin County, 212 N.W.2d 361, 365 (Minn. 1973). Forbort does not
address any of these prongs on appeal. Even so, there is no evidence that the circumstances
of this case support res ipsa loquitur. Cf. Hestbeck, 212 N.W.2d at 365 (concluding that
“[w]hen an operation leaves a sponge in the patient’s interior, the thing speaks for itself
without the aid of any expert’s advice” (quotation omitted)). As discussed, the
complexities of Forbort’s injury require expert testimony. Res ipsa loquitur does not apply.

9
the defendant provider to the injury suffered by the harmed patient.” Rygwall, 6 N.W.3d
at 434. “ [B]road and conclusory statements as to causation” are insufficient.
Teffeteller v. Univ. of Minn., 645 N.W.2d 420, 428 (Minn. 2002).
But a district court need not reach these expert-affidavit requirements unless the
witness is qualified to give an expert opinion. Id. at 427. Here, the district court determined
that of Forbort’s three experts, two were unqualified to provide relevant expert testimony.
It reasoned that these experts, while physicians, did not have any experience in spinal-
fusion surgery and were thus unqualified to testify as to the standard of care or causation.
Forbort does not challenge these determinations on appeal, and we do not address them.
Forbort’s remaining expert, Nurse Hoppenrath, is a critical-care nurse with
experience providing post-operative care in a neurological recovery setting. The district
court determined that Nurse Hoppenrath was qualified to provide expert testimony as to
the standard of care for “post-operative nursing.” But significantly, the district court did
not state that Nurse Hoppenrath was qualified to testify as to causation. As previously
discussed, expert testimony is required to establish each element of a prima facie case of
medical malpractice. See Rygwall, 6 N.W.3d at 431. Given the district court’s conclusions
as to expert qualifications—which Forbort does not challenge—we are not persuaded that
Forbort provided any qualified expert as to causation. See Minn. Stat. § 145.682, subd. 3(1)
(requiring an expert to be qualified to opine as to how “defendants deviated from the
applicable standard of care and by that action caused injury to the plaintiff” (emphasis
added)).
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Nonetheless, the district court proceeded to find that Nurse Hoppenrath’s affidavit
failed to establish causation. 3 We discern no abuse of discretion in this determination.
See Teffeteller, 645 N.W.2d at 426 (holding that we will only reverse a district court’s
dismissal for failure to comply with the affidavit requirements for an abuse of discretion).
In relevant part, the affidavit states that “the attending critical care nurses breached the
applicable standard of care in repositioning Ms. Forbort in such a rough and careless
manner as to cause a fracture in her spine.” It continues that after this repositioning, “two
nurses dragged [Forbort] to the bathroom without putting her in her back brace,” and that
“[i]f a stat CT had been completed, that would have shown the presence of a new fracture
and an expeditious decompression and stabilization surgery could have been performed.”
It ultimately concludes that these “acts and omissions were . . . the sole, direct and
proximate cause both of [Forbort’s] spinal injury on October 4, 2019 and her present
permanent paralysis for failure to obtain treatment of the new fracture as soon as possible.”
These broad and conclusory statements —while they may have articulated a prima facie
case for breach of a nursing standard of care —are insufficient to establish that the breach
caused Forbort’s injuries.
In reaching this conclusion, we turn first to Lindberg. There, a plaintiff alleged that
medical staff failed to instruct her to seek an immediate physical examination after she

3 The district court also concluded that Nurse Hoppenrath’s affidavit failed to articulate the
applicable standard of care or how SMMC’s actions reflect a breach of the standard of care.
Because we conclude that Forbort’s expert affidavit is insufficient to establish a prima facie
case for causation, we do not address whether it sufficiently delineates the standard of care
or breach.
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reported concerning pregnancy symptoms, and that this failure caused her to have a
stillbirth. 599 N.W.2d at 574. As to causation, her expert affidavit opined:
[I]t is more probable than not, that if, among other things, [the
plaintiff] had been instructed to seek medical treatment at the
time of her phone call on the morning of March 28, 1994,
[decedent] would not have died.

[Decedent] died as a result of the negligent and careless
conduct of the Defendants and/or their agents and employees,
including [the midwives].

Id. at 575. The supreme court concluded that these statements fell short of the affidavit
requirements, reasoning that the affidavit did not connect the “failure to instruct [the
plaintiff] to seek immediate medical attention with the stillbirth of the decedent and it fails
to even identify the medical condition for which [the plaintiff] allegedly was not given
attention.” Id. at 578.
Similarly, Nurse Hoppenrath’s affidavit states that Forbort’s spine was fractured
when she was repositioned in a “rough and careless manner,” but fails to explain the nature
of the fracture, how it was caused through “repositioning,” or, most fundamentally, how
this fracture—as opposed to the previous fractures —caused her paralysis.
See Teffeteller, 645 N.W.2d at 429 n. 4 (stating that the purpose of the expert-affidavit
requirement is to illustrate “how” and “why” the alleged malpractice caused the plaintiff’s
injuries).
4 And while the nurse’s affidavit opines that Forbort’s paralysis was caused by

4 Moreover, while Nurse Hoppenrath’s affidavit states that Forbort was dragged across the
floor without her back brace, it makes no attempt to connect this act to any injury.
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failure to receive earlier treatment, precedent supports our conclusion that this statement is
insufficient to establish causation.
In Maudsley, an expert affidavit opined:
It is more likely than not that if treatment had been initiated on
June 27, rather than June 28, [plaintiff] would not have lost the
vision in her right eye. She may have suffered some
impairment to that vision, but she would not have lost it totally.
When infections are present, it is generally true that better
outcomes are the result of earlier treatment; in fact, every hour
counts.

Maudsley v. Pederson , 676 N.W.2d 8, 10 (Minn. App. 2004). We held that these
statements were insufficient, reasoning that they “fail[ed] to outline specific details
explaining how and why [the staff’s] . . . delay in treatment caused [the plaintiff’s]
blindness.” Id. at 14. By comparison, Forbort’s affidavit contains even fewer details— it
alleges that an earlier CT scan would have prompted an “expeditious” surgery but does not
explain how the delay in treatment caused Forbort’s ongoing paralysis. And further, unlike
Maudsley where the expert was a qualified physician, Forbort’s affidavit is provided by a
nurse who the district court concluded was not qualified to address the causation issue. But
even if the witness was qualified, the affidavit itself only contains the kind of “empty
conclusions” that are insufficient to outline the chain of causation. See Rygwall, 6 N.W.3d
at 432.
We acknowledge that an expert affidavit does not need to be overly detailed. See id.
(explaining that an expert need not make a “detailed disclosure” to establish a prima facie
case (quotation omitted)). But it must provide enough information that a jury will not
speculate as to the cause of the plaintiff’s injury. See id. at 435. And it must be provided
13
by a qualified expert. See Teffeteller, 645 N.W.2d at 427; Minn. Stat. § 145.692, subd. 4.
Given the exclusion of Forbort’s two proposed experts on causation, which she does not
challenge on appeal, and the inadequacy of Nurse Hoppenrath’s affidavit with regard to
the causation element, we cannot conclude that a jury will have sufficient information to
draw a connection — without speculating— between SMMC’s conduct and Forbort’s
injuries. See Rygwall, 6 N.W.3d at 435.
In sum, the district court did not abuse its discretion in dismissing Forbort’s claim
with prejudice for failure to comply with the affidavit requirements pursuant to
Minn. Stat. § 145.682.
Affirmed.