SABERS, Justice.
Patricia Koeniguer (Koeniguer) appeals a summary judgment in favor of Dakota Midland Hospital (Hospital). We reverse and remand.
Facts
Winnifred Scoblic (Scoblic) consulted Dr. Eckrich about incontinence problems. Dr. Eckrich recommended surgery and Scoblic entered Hospital on January 3, 1983. An operation was performed on January 5th. Scoblic remained hospitalized until January 16th. Hospital records indicate she had a fluctuating temperature for some time pri- or to discharge and that her temperature was 100.2 degrees Fahrenheit on the morning of the day of her discharge. Hospital records indicate that Scoblic’s temperature was recorded (if not taken) at 8:15 a.m.— after the treating physician made his rounds. Hospital and Dr. Eckrich contend that her temperature was taken prior to the physician’s arrival, at 7:30 a.m. and that the physician was aware of the elevated temperature and concluded that it was a normal reaction to surgical implants.
Scoblic was readmitted to Hospital on January 19,1988 because of severe abdominal pain and fever. The diagnosis was sepsis (infection). She was transferred to the University of Minnesota Hospital on January 21,1983 and died on March 6,1988 of multiple organ failure.
Koeniguer, as personal representative of her mother’s estate, initiated a medical malpractice action against Hospital and treating physicians, alleging departures from the appropriate standards of care. After some discovery, Hospital moved for summary judgment, which was granted.
1. WAS SUMMARY JUDGMENT TO HOSPITAL PROPER?
“Summary judgment is authorized only when the movant is entitled to judgment as a matter of law because there are no genuine issues of material fact. SDCL 15~6-56(c); Trapp v. Madera Pacific, Inc., 390 N.W.2d 558, 564 (S.D.1986) ... [citations omitted].” Bego v. Gordon, 407 N.W.2d 801, 803 (S.D.1987). The moving party has the burden of proof and the “evidence must be viewed most favorably to the nonmoving party and reasonable doubts should be resolved against the moving party.” Groseth International, Inc. v. Tenneco, Inc., 410 N.W.2d 159, 164 (S.D.1987), citing Wilson v. Great Northern Railway Co., 83 S.D. 207, 157 N.W.2d 19 (1968) and Trapp, supra. Therefore, the pleadings, affidavits, depositions, and every reasonable inference arising therefrom must be viewed most favorably toward the nonmoving party. Trapp, supra at 562. Summary judgment is an extreme remedy and is appropriate to dispose of legal, not factual issues. Trapp, supra; Bego, supra at 804. Finally, we are not bound by the factual findings of the trial court and must conduct an independent review of the record. Trapp, supra, citing Hurney v. Locke, 308 N.W.2d 764, 767 (S.D.1981).
A hospital is liable to its patients for negligence only where there is a causal connection between the hospital’s negligence and the patient’s injury. Causation, or proximate cause, depends upon proof that the plaintiff's injury was in fact caused by the hospital and that injury to the plaintiff was foreseeable. The plaintiff has the burden of proving causation in a malpractice action and generally must present expe[r]t testimony to meet this burden.
4B Personal Injury — Actions, Defenses, Damages, “Hospitals and Asylums,” § 1.02[2] (1983). “In most jurisdictions, expert testimony is required to establish the fundamental elements of the plaintiff’s malpractice action — standard of care, breach, and causation.” Id. at § 1.02[8].
[602]*602In addressing standards of care for hospitals, we have said that patients have a right to expect treatment by a hospital will be “commensurate with that available in the same or similar communities or in hospitals generally.” Fjerstad v. Knutson, 271 N.W.2d 8, 12 (S.D.1978). However, we have also cited with approval the words of the Iowa Supreme Court in Dickinson v. Mailliard, 175 N.W.2d 588 (Iowa 1970):
It is no longer justifiable, if indeed it ever was, to limit a hospital’s liability to that degree of care which is customarily practiced in its own community.... Adherence to such a rule, then, means the hospital whose conduct is assailed is to be measured only by standards which it has set for itself.
Shamburger v. Behrens, 418 N.W.2d 299, 306 (S.D.1988).
In malpractice actions against hospitals, where negligence by nursing personnel is alleged, the focus is: "Did the nurse provide reasonable care and exercise professional judgment under the circumstances?” 4B Personal Injury at § 1.03[2][a].
Referring to standards published by the American Nurses Association and various general nursing practice treatises, Koeni-guer’s expert witness, Sharon G. Van Riper, stated that in her opinion the actions of the nursing staff at Hospital did not meet acceptable standards of care for post-operative urological patients such as Scoblic. Specifically, Van Riper testified in her deposition that Hospital’s nurses failed to adequately monitor Scoblic’s condition and provide acceptable post-operative care by:
1) failing to document that Scoblic’s elevated temperature on her day of discharge was reported to the physician;
2) allowing Scoblic to be discharged with an elevated temperature;
3) failing to instruct Scoblic about monitoring her temperature; and
4) failing to document that the condition of and drainage from Scoblic’s incision was reported to the physician.
Koeniguer presented evidence of standards of care and evidence amounting to a breach of those standards. Hospital argues that Koeniguer has failed to show Hospital’s alleged negligence was the proximate cause of Scoblic’s discharge from Hospital and that any premature discharge was the proximate cause of her ultimate injuries. Hospital contends that the decision to discharge a patient is a medical determination made at the discretion of the attending physician. However, Hospital’s Director of Nursing, Mary Alice Bailey, in her deposition, stated that there are times, such as when there has been a significant change in the patient’s condition, when it is the nurse’s responsibility to question the physician’s order. She confirmed Van Riper’s assertion that the nurse has a duty to communicate changes in the patient’s condition to the physician and “go further” if her concerns are not sufficiently or appropriately answered by the physician.
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SABERS, Justice.
Patricia Koeniguer (Koeniguer) appeals a summary judgment in favor of Dakota Midland Hospital (Hospital). We reverse and remand.
Facts
Winnifred Scoblic (Scoblic) consulted Dr. Eckrich about incontinence problems. Dr. Eckrich recommended surgery and Scoblic entered Hospital on January 3, 1983. An operation was performed on January 5th. Scoblic remained hospitalized until January 16th. Hospital records indicate she had a fluctuating temperature for some time pri- or to discharge and that her temperature was 100.2 degrees Fahrenheit on the morning of the day of her discharge. Hospital records indicate that Scoblic’s temperature was recorded (if not taken) at 8:15 a.m.— after the treating physician made his rounds. Hospital and Dr. Eckrich contend that her temperature was taken prior to the physician’s arrival, at 7:30 a.m. and that the physician was aware of the elevated temperature and concluded that it was a normal reaction to surgical implants.
Scoblic was readmitted to Hospital on January 19,1988 because of severe abdominal pain and fever. The diagnosis was sepsis (infection). She was transferred to the University of Minnesota Hospital on January 21,1983 and died on March 6,1988 of multiple organ failure.
Koeniguer, as personal representative of her mother’s estate, initiated a medical malpractice action against Hospital and treating physicians, alleging departures from the appropriate standards of care. After some discovery, Hospital moved for summary judgment, which was granted.
1. WAS SUMMARY JUDGMENT TO HOSPITAL PROPER?
“Summary judgment is authorized only when the movant is entitled to judgment as a matter of law because there are no genuine issues of material fact. SDCL 15~6-56(c); Trapp v. Madera Pacific, Inc., 390 N.W.2d 558, 564 (S.D.1986) ... [citations omitted].” Bego v. Gordon, 407 N.W.2d 801, 803 (S.D.1987). The moving party has the burden of proof and the “evidence must be viewed most favorably to the nonmoving party and reasonable doubts should be resolved against the moving party.” Groseth International, Inc. v. Tenneco, Inc., 410 N.W.2d 159, 164 (S.D.1987), citing Wilson v. Great Northern Railway Co., 83 S.D. 207, 157 N.W.2d 19 (1968) and Trapp, supra. Therefore, the pleadings, affidavits, depositions, and every reasonable inference arising therefrom must be viewed most favorably toward the nonmoving party. Trapp, supra at 562. Summary judgment is an extreme remedy and is appropriate to dispose of legal, not factual issues. Trapp, supra; Bego, supra at 804. Finally, we are not bound by the factual findings of the trial court and must conduct an independent review of the record. Trapp, supra, citing Hurney v. Locke, 308 N.W.2d 764, 767 (S.D.1981).
A hospital is liable to its patients for negligence only where there is a causal connection between the hospital’s negligence and the patient’s injury. Causation, or proximate cause, depends upon proof that the plaintiff's injury was in fact caused by the hospital and that injury to the plaintiff was foreseeable. The plaintiff has the burden of proving causation in a malpractice action and generally must present expe[r]t testimony to meet this burden.
4B Personal Injury — Actions, Defenses, Damages, “Hospitals and Asylums,” § 1.02[2] (1983). “In most jurisdictions, expert testimony is required to establish the fundamental elements of the plaintiff’s malpractice action — standard of care, breach, and causation.” Id. at § 1.02[8].
[602]*602In addressing standards of care for hospitals, we have said that patients have a right to expect treatment by a hospital will be “commensurate with that available in the same or similar communities or in hospitals generally.” Fjerstad v. Knutson, 271 N.W.2d 8, 12 (S.D.1978). However, we have also cited with approval the words of the Iowa Supreme Court in Dickinson v. Mailliard, 175 N.W.2d 588 (Iowa 1970):
It is no longer justifiable, if indeed it ever was, to limit a hospital’s liability to that degree of care which is customarily practiced in its own community.... Adherence to such a rule, then, means the hospital whose conduct is assailed is to be measured only by standards which it has set for itself.
Shamburger v. Behrens, 418 N.W.2d 299, 306 (S.D.1988).
In malpractice actions against hospitals, where negligence by nursing personnel is alleged, the focus is: "Did the nurse provide reasonable care and exercise professional judgment under the circumstances?” 4B Personal Injury at § 1.03[2][a].
Referring to standards published by the American Nurses Association and various general nursing practice treatises, Koeni-guer’s expert witness, Sharon G. Van Riper, stated that in her opinion the actions of the nursing staff at Hospital did not meet acceptable standards of care for post-operative urological patients such as Scoblic. Specifically, Van Riper testified in her deposition that Hospital’s nurses failed to adequately monitor Scoblic’s condition and provide acceptable post-operative care by:
1) failing to document that Scoblic’s elevated temperature on her day of discharge was reported to the physician;
2) allowing Scoblic to be discharged with an elevated temperature;
3) failing to instruct Scoblic about monitoring her temperature; and
4) failing to document that the condition of and drainage from Scoblic’s incision was reported to the physician.
Koeniguer presented evidence of standards of care and evidence amounting to a breach of those standards. Hospital argues that Koeniguer has failed to show Hospital’s alleged negligence was the proximate cause of Scoblic’s discharge from Hospital and that any premature discharge was the proximate cause of her ultimate injuries. Hospital contends that the decision to discharge a patient is a medical determination made at the discretion of the attending physician. However, Hospital’s Director of Nursing, Mary Alice Bailey, in her deposition, stated that there are times, such as when there has been a significant change in the patient’s condition, when it is the nurse’s responsibility to question the physician’s order. She confirmed Van Riper’s assertion that the nurse has a duty to communicate changes in the patient’s condition to the physician and “go further” if her concerns are not sufficiently or appropriately answered by the physician. Hospital disputes that the standard of care for nurses requires them to independently evaluate the patient’s condition, discuss their concerns with the physician, and go to other authority if they believe the physician’s decision is in error, but expert testimony to that effect appears in the depositions. These questions are for the jury.
There is expert testimony in the record that the nurses had a duty to attempt to delay Scoblic’s discharge if her condition warranted her continued hospitalization. This advocacy role of the nurse was neglected. There is no evidence that anyone questioned or disagreed with the physician’s decision to discharge, so Scoblic was discharged. Negligence can be premised equally upon an omission to act as upon the commission of an act.
Viewing the evidence most favorably to the nonmoving party, the element of causation has been established. It can reasonably be inferred from evidence in the record that the delay in treatment resulted in Scoblic being readmitted to the hospital in a more serious condition than she would have been had she been treated three days earlier. There is contradictory expert testimony as to whether the surgery, the infection or a combination of the two resulted in Scoblic’s death. For summary judgment purposes Hospital had the burden and did [603]*603not demonstrate that the physician’s alleged negligence superceded any negligence by Hospital and was the sole proximate cause of Scoblic’s death. A jury will have to make that factual determination. Groseth, supra; Trapp, supra; Wilson, supra.
We reverse and remand for trial.
MORGAN and MILLER, JJ., concur.
HENDERSON, J., concurs specially.
WUEST, C.J., dissents.