Christopher Spires and Laura Lively, Individually and on Behalf of Nolan Spires, A Minor v. St. Francis Medical Center, Marc De Soler, M.D. Amanda Carnes, NNP, and Kathlee Lirette, NNP

• Court: Louisiana Court of Appeal
• Decided: April 8, 2026
• Docket: 56,803-CA
• Status: Published
• Author: Pitman

Opinion

Judgment rendered April 8, 2026. Application for rehearing may be filed within the delay allowed by Art. 2166, La. C.C.P.

No. 56,803-CA

COURT OF APPEAL SECOND CIRCUIT STATE OF LOUISIANA

*****

CHRISTOPHER SPIRES AND Plaintiffs-Appellants LAURA LIVELY, INDIVIDUALLY AND ON BEHALF OF NOLAN SPIRES, A MINOR versus

ST. FRANCIS MEDICAL CENTER, Defendants-Appellees MARC DE SOLER, M.D. AMANDA CARNES, NNP, AND KATHLEEN LIRETTE, NNP *****

Appealed from the Fourth Judicial District Court for the Parish of Ouachita, Louisiana Trial Court No. 2022-0562

Honorable Frederick D. Jones, Judge

KARL BERNARD LAW, LLC Counsel for Appellants By: G. Karl Bernard

NELSON, ZENTNER, SARTOR, & Counsel for Appellees, SNELLINGS, LLC Amanda Carnes, NNP, By: David H. Nelson and Kathleen Lirette, NNP

HUDSON, POTTS & BERNSTEIN, LLP Counsel for Appellee, By: Gordon L. James Marc de Soler, M.D. Donald H. Zeigler, III

BREAZEALE, SACHSE & WILSON, LLP Counsel for Appellee, By: Thomas Richard Temple, Jr. St. Francis Medical Center Alexa Nicole Candelora

Before PITMAN, STEPHENS, and ROBINSON, JJ. PITMAN, C. J.

Plaintiffs Christopher Spires and Laura Lively, individually and on

behalf of their minor child, Nolan Spires, appeal the summary judgments

granted in this medical malpractice suit in favor of Defendants Marc

De Soler, M.D., Amanda Carnes, NNP, and Kathleen Lirette, NNP. For the

following reasons, we affirm the granting of the summary judgments.

FACTS

Plaintiffs filed suit for medical malpractice against St. Francis

Medical Center (“St. Francis”), Dr. Marc De Soler and nurse practitioners

Amanda Carnes and Kathleen Lirette.

Nolan was born at University Health-Monroe via Cesarean-section at

37 weeks’ gestation on October 11, 2017. His APGAR scores (a rapid, 10-

point assessment of a newborn’s health, calculated at one and five minutes

after birth) were good, 9 and 9 (normal is 7-10), but he subsequently began

developing signs of respiratory distress. He was originally placed on a

Continuous Positive Airway Pressure (CPAP) machine and had acceptable

oxygen saturations, but his distress worsened. He was transferred to the

neonatal intensive care unit at St. Francis.

At St. Francis, Nolan was intubated, and it was discovered that he had

developed a right-sided pneumothorax requiring placement of a chest tube.

His respiratory acidosis eventually resolved, and his blood gases improved.

His distress was diagnosed as a condition called transient tachypnea of the

newborn. On October 12, 2017, Nolan began having seizure-like symptoms,

which lasted for 30 to 45 minutes and continued intermittently. Nurse

practitioner Carnes notified Dr. De Soler, the neonatal medical specialist and

lead physician on his case. Nolan was given Ativan; Cerebyx (Dilantin) and phenobarbital to control the seizure symptoms. He was administered these

drugs at certain intervals with Dr. De Soler testing his toxicity levels several

times. The doctor noted in the discharge summary:

The infant had a phenobarbital level of 33 on 10/14 at 5:30 and had a Dilantin level of 55 on 10/14 at 5:30 a.m., after the infant received a bolus of Cerebyx at 0555 hours, just before obtaining the level. I repeated the Dilantin level at 1300 hours on 10/14, about 8 hours after the bolus was given and it was 69.

Plaintiffs alleged that Dr. De Soler administered the bolus of Cerebyx

prior to receiving the results of the level that had been taken at 5:30 a.m. and

that this mistake caused their son’s resulting damages.1 They claim that

almost immediately after the Cerebyx was administered at 5:55 a.m., Nolan

experienced a sudden hemodynamic deterioration, which resulted in heart

rate readings in the 60s. A Code Blue was called, he was intubated and

required chest compressions, and a needle was inserted into his left chest

without return of air. He was very hypotensive and an EKG was performed,

which revealed a stiff heart with poor relaxation and contraction of the heart.

Bilateral pneumothorax was identified by chest X-ray and tubes were placed.

Plaintiffs claimed that after more than two days of steady decline and failure

of the physician and staff to stabilize him, plans were made to transfer Nolan

to Children’s Hospital of New Orleans, a facility which could provide a

higher level of care. However, when the crew arrived to transfer him, Nolan

was too unstable to be immediately transported.

1 The results of the test were not available until 7:14 a.m. The medical review panel addressed this issue in its report, noted the time of the testing and the administration of the bolus of Cerebyx, and stated, “To expect the lab work report on Dilantin to be returned quickly is unreasonable. The Dilantin level of 55.8 was reported at 7:14 am. The evidence indicates Dr. De Soler was notified promptly and discontinued the Cerebyx. Prior to this, the infant had a cardiac respiratory arrest, which was managed appropriately. Subsequent Dilantin level showed an increase to 69.8. The evidence supports Dr. De Soler’s efforts to determine the etiology of the high rise of levels, including metabolism disorder.” 2 When he ultimately arrived in New Orleans on October 15, 2017, it

was discovered that Nolan was suffering from Dilantin toxicity, and

appropriate treatment began. Nolan remained in New Orleans until

December 2, 2017. During his stay, he required several interventions,

including an extracorporeal membrane oxygenation (ECMO) procedure to

serve as a bypass for a poorly functioning circulatory and respiratory system.

Plaintiffs assert that Nolan now suffers with developmental, cognitive,

motor, speech and social/behavioral delays. He cannot understand

nonverbal communications, walk or use the restroom independently and has

bouts of emotional distress and other deficits.

Following the filing of Plaintiffs’ original medical malpractice claim

against Defendants, the medical review panel (“MRP”) published its opinion

entitled, “Opinion and Written Reasons for Conclusion.” A case report

attached to the MRP’s written reasons is in the original record of this suit

and is entitled, “Cardia Collapse Secondary to Phenytoin Toxicity in a

Neonate Treated with Extracorporeal Membrane Oxygenation Support.”

Plaintiffs alleged that this report is based on Nolan’s medical history and

was published in the Journal of Medical Toxicology in November 2019.2 It

found that although medication overdose and toxicity are uncommon in

neonates, some medications pose a risk. One of those is Fosphenytoin,

which is sold under the name Cerebyx.

The MRP found that the evidence presented supported the conclusion

that St. Francis and its staff, particularly the pharmacy staff, failed to meet

2 Defendants alleged that the case study, while attached to the MRP’s written opinion and seeming to be exactly descriptive of Nolan’s case, never mentions him by name. This was not an issue until the case was later appealed to this court after rendition of the reconsideration of the summary judgment at issue in this appeal. 3 the applicable standard of care as charged in the complaint and that the

conduct complained of was a factor in the resulting damages. Specifically,

the MRP stated that the pharmacy staff of St. Francis failed particularly in

the preparation of the dose and delivery of the Cerebyx, which was

“inappropriate and incorrect, leading to the Dilantin toxicity and level

increases[.]” Based on this finding, Plaintiffs filed a timely suit against all

Defendants on February 22, 2022, and alleged all of their actions fell below

the standard of care.

Dr. De Soler answered and denied all allegations, except he admitted

that the MRP’s findings as to St. Francis were as recited above. He also

alleged that the findings as to him were not included by counsel and that the

MRP found unanimously that his actions were appropriate and within the

standard of care for a neonatologist. He further alleged that the MRP had

issued a unanimous opinion that the evidence did not support the conclusion

that he had breached any applicable standard of care in Nolan’s treatment.

Nurse practitioners Lirette and Carnes answered together and alleged

that the MRP resulted in a unanimous written opinion in their favor, which

would be presented at trial.

After the answers were filed, Dr. De Soler filed a motion for summary

judgment and sought dismissal of Plaintiffs’ suit because (1) they could not

meet their burden of proof that he had breached any applicable standard of

care, (2) this medical malpractice claim involved issues outside the realm of

a layperson’s understanding and (3) Plaintiffs did not have a medical expert

who could testify that his conduct had breached an applicable standard of

care. On this basis, he sought dismissal of the suit against him.

4 Nurse practitioners Carnes and Lirette collectively filed a motion for

summary judgment on the same basis, i.e., that Plaintiffs lacked an expert

witness to contradict the findings of the MRP that they had not breached the

appropriate standard of care; and, thus, the case against them should be

dismissed.

A hearing on the motions for summary judgment was held on July 28,

2023, and the matter was taken under advisement.

On August 1, 2023, the trial court found that summary judgment

should be granted and issued reasons, stating that Plaintiffs are required to

provide expert witness testimony on the matters at issue and none was

presented. On September 11, 2023, the trial court granted both motions for

summary judgment and dismissed all of Plaintiffs’ claims against

Defendants.

On September 20, 2023, Plaintiffs filed a motion for reconsideration

of the trial court’s granting of Defendants’ motions for summary judgment,

which was granted, effectively allowing Plaintiffs a new trial on those

motions.

Some procedural confusion ensued when Plaintiffs filed a notice for a

devolutive appeal, which the trial court granted. The record was filed with

this court but was dismissed as being prematurely before our court since the

reconsideration of the motions for summary judgment was still outstanding.

On March 11, 2025, the trial court held a hearing to reconsider the

granting of the previous motions for summary judgment. Also at issue was

whether Plaintiffs were required to produce expert testimony to provide

proof of the necessary standard of care, or whether this was a case in which

5 a lay person could infer without it that the medical personnel had committed

malpractice.

On May 6, 2025, a judgment was entered denying Plaintiffs’ motion

for reconsideration and affirming the judgment on the motions for summary

judgment previously entered into the record. Reasons for judgment issued

indicated the trial court found expert testimony was required in this case and

that no such expert had been identified. Plaintiffs appeal the granting of the

motions for summary judgment and the dismissal of their suit against

DISCUSSION

Plaintiffs argue the trial court erred in finding that Defendants were

entitled to summary judgment because it found that they had failed to

produce an expert witness to support their claims in the medical malpractice

case. They contend that expert testimony is not always necessary in order

for a plaintiff to meet his burden of proof in establishing a medical

malpractice claim. Further, they assert that there are instances in which the

medical and factual issues are such that a lay jury can perceive negligence in

the charged physician’s conduct as well as any expert, or in which the

physician testifies as to the standard of care and there is objective evidence

which demonstrates a breach thereof.

Plaintiffs also argue that Defendants’ conduct in this matter was not

complex or complicated but, instead, involved medical and factual issues

that a lay jury could perceive as negligence just as readily as an expert.

They claim that their charges against Defendants are simply that they failed

to monitor the levels of Dilantin administered to Nolan, and that if they had

6 properly done so, he would not now suffer with permanent developmental

delays and related damages.

Defendants argue that summary judgment is appropriate because after

an opportunity for adequate discovery, summary judgment shall be granted

if the motion, memorandum and supporting documents show that there is no

genuine issue as to material fact and that mover is entitled to judgment as a

matter of law. They contend that a claimant in the medical malpractice

action has the burden of proving the degree of knowledge or skill possessed

or ordinarily exercised by physicians, that the defendant either lacked this

degree of knowledge or skill or failed to use reasonable care and diligence

along with his best judgment in application of the skill, and that as a

proximate result of his lack of knowledge or skill or the failure to exercise it,

the plaintiff suffered injuries that otherwise would not have been incurred.

They assert that because Plaintiffs failed to meet their burden of proof,

summary judgment is appropriate in this case.

A summary judgment is reviewed on appeal de novo, with the

appellate court using the same criteria that govern the trial court’s

determination of whether summary judgment is appropriate, i.e., whether

there is any genuine issue of material fact and whether the movant is entitled

to judgment as a matter of law. Samaha v. Rau, 07-1726 (La. 2/26/08),

977 So. 2d 880; Logan v. Richland Par. Hosp., 56,127 (La. App. 2 Cir.

4/9/25), 408 So. 3d 1208, reh’g denied (5/15/25), writ denied, 25-00760 (La.

10/1/25), 417 So. 3d 570. A motion for summary judgment shall be granted

if the motion, memorandum and supporting documents show that there is no

genuine issue as to a material fact and that the mover is entitled to judgment

7 as a matter of law. La. C.C.P. art. 966(A)(3); Staten v. Glenwood Reg’l

Med. Ctr., 53,220 (La. App. 2 Cir. 1/29/20), 290 So. 3d 280, writ denied,

20-00591 (La. 9/23/20), 301 So. 3d 1184. The burden of proof on a

summary judgment motion remains with the mover. La. C.C.P.

art. 966(D)(1). However, if the moving party will not bear the burden of

proof on the issue at trial and points out that there is an absence of factual

support for one or more elements essential to the adverse party’s claim,

action, or defense, then the nonmoving party must produce factual support

sufficient to establish that he will be able to satisfy his evidentiary burden of

proof at trial. Id.; Staten, supra. If the opponent of the motion fails to do so,

there is no genuine issue of material fact and summary judgment should be

granted. Staten, supra.

In a medical malpractice action, the plaintiff has the burden of

proving: (1) the applicable standard of care, (2) that the standard of care was

breached and (3) that as a proximate result of the breach, the plaintiff

sustained injuries that would not otherwise have been incurred. La.

R.S. 9:2794(A); Staten, supra. Expert testimony is generally required to

establish the applicable standard of care and whether that standard was

breached, except where the negligence is so obvious that a lay person can

infer negligence without the guidance of expert testimony. Samaha v. Rau,

supra; Staten, supra. The requirement of producing expert medical

testimony is especially apt when the defendants have filed summary

judgment motions and supported such motions with expert opinion evidence

that their treatment met the applicable standard of care. Staten, supra.

8 In Samaha, supra, the Louisiana Supreme Court observed that “by

law, the report of the expert opinion reached by the medical review panel is

admissible as evidence in any action subsequently brought by the claimant in

a court of law” and that “[t]his undoubtedly includes a summary judgment

proceeding in a medical malpractice lawsuit.” It is well settled that a

defendant-health care provider can use the medical review panel’s favorable

opinion to support a summary judgment motion. Staten, supra.

The only documents that may be filed or referenced in support of or in

opposition to the motion are pleadings, memoranda, affidavits, depositions,

answers to interrogatories, certified medical records, certified copies of

public documents or public records, certified copies of insurance policies,

authentic acts, private acts duly acknowledged, promissory notes and

assignments thereof, written stipulations and admissions. La. C.C.P.

art. 966(A)(4).

Plaintiffs failed to obtain any expert witness to support their

contention that Defendants breached the applicable standard of care and that

the breach caused the damages alleged. This is a very complicated medical

malpractice case and does not present facts from which a layperson could

infer negligence without the guidance of an expert in the field of

neonatology. Plaintiffs have failed to meet their burden of proof to show

that genuine issues of material fact remain; and, therefore, summary

judgment is appropriate. For these reasons, this assignment of error is

without merit.

CONCLUSION

For the foregoing reasons, we affirm the granting of the motions for

summary judgment in favor of Defendants Marc De Soler, M.D., Amanda 9 Carnes, NNP, and Kathleen Lirette, NNP. Costs of the appeal are assessed

to Plaintiffs Christopher Spires and Laura Lively.

AFFIRMED.