Montgomery v. Gardiner

2025 UT App 146

THE UTAH COURT OF APPEALS

AMBER MONTGOMERY,
Appellant and Cross-appellee,
v.
JEFFREY P. GARDINER AND UTAH VALLEY EYE CENTER, INC.,
Appellees and Cross-appellants.

Opinion
No. 20230415-CA
Filed October 9, 2025

Fourth District Court, Provo Department
The Honorable Robert A. Lund
No. 190400226

Justin D. Heideman and Justin R. Elswick,
Attorneys for Appellant
Kirk G. Gibbs and Devin H. Geier,
Attorneys for Appellees

JUDGE JOHN D. LUTHY authored this Opinion, in which
JUDGES RYAN M. HARRIS and AMY J. OLIVER concurred.

LUTHY, Judge:

¶1 Dr. Jeffrey P. Gardiner, an ophthalmologist employed by
Utah Valley Eye Center, Inc., performed cataract surgery on
Amber Montgomery’s left eye. After the surgery, Montgomery
experienced poor eyesight and other increasingly troubling vision
problems in that eye. She repeatedly reported these to Gardiner
during her post-operative visits, and he repeatedly informed her
that he saw nothing concerning. Nearly three months after the
surgery, an on-call ophthalmologist diagnosed Montgomery with
multiple retinal tears and retinal detachment, and Montgomery
had corrective surgery the next day. Montgomery has not
regained vision in her left eye. After learning of Montgomery’s
retinal detachment, Gardiner reviewed a scan he took at one of
Montgomery v. Gardiner

Montgomery’s post-operative appointments and determined that
a retinal detachment was visible in that scan.

¶2 Montgomery sued Gardiner and Utah Valley Eye Center
(collectively, UVEC), alleging that Gardiner’s delay in diagnosing
her retinal detachment caused her vision loss. UVEC filed a
motion in limine seeking to prevent Montgomery’s expert
witness, an ophthalmologist, from testifying about the cause of
Montgomery’s vision loss, asserting that the expert was
unqualified to do so because he was not a retina specialist. The
court denied the motion and permitted the expert to testify at trial.
After Montgomery presented her case-in-chief, UVEC moved for
judgment as a matter of law, arguing that Montgomery had
provided no evidence of causation. The court agreed and granted
the motion.

¶3 Montgomery appeals, contending that the district court
erred in granting UVEC’s motion for judgment as a matter of law.
UVEC cross-appeals, arguing that the court erred in denying its
motion in limine and permitting the expert to testify on causation.
We conclude that the expert was qualified to testify as to causation
and that Montgomery did put on evidence of causation from
which a jury could find in her favor. Therefore, we reverse the
district court’s judgment as a matter of law and remand this
matter for retrial or other appropriate proceedings consistent with
this opinion.

BACKGROUND

Montgomery’s Ocular History

¶4 When Montgomery was five years old, she was diagnosed
with type 1 diabetes. She later developed diabetic retinopathy, 1

1. “Diabetic retinopathy is a complication of diabetes that affects
the eyes. It is caused by damage to the blood vessels in the light-
(continued…)

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Montgomery v. Gardiner

and she had laser treatments in both eyes to address this
condition. She also had successful cataract surgery on her right
eye in 2009.

¶5 In August 2017, Montgomery saw Gardiner for a
consultation regarding cataract surgery for her left eye. During
that visit, he recorded her distance vision in her left eye as 20/30.
Gardiner performed cataract surgery on Montgomery’s left eye on
September 18, 2017.

¶6 After the surgery, Montgomery noticed that her eyesight
had not come back right away, as it had following her right-eye
cataract surgery, and that her eye was “uncomfortable,” her
vision was “blurry,” and it “[f]elt like maybe something was in
[her] eye.” The day after the surgery, she met with Gardiner for a
postoperative appointment. He told her that it was normal for her
vision to be a little blurry and that it could take up to three weeks
to clear up. He recorded her distance vision as 20/50-3, meaning
she could read the 20/50 line but missed three letters on that line.
She had another postoperative appointment with Gardiner ten
days after the cataract surgery. At that appointment, her vision
was measured at 20/50-2. She expressed to Gardiner that she still
had blurry vision and was experiencing discomfort, flashes of
light, and floaters, which symptoms were causing headaches.
Gardiner told her that she had dry eyes and that she needed to
drink more water. He also recommended contact lenses and eye
drops to correct the blurry vision.

¶7 Two weeks later, on October 12, Montgomery went in for
another follow-up appointment and reported that she was still
experiencing “[b]lurred vision,” that she “[c]ouldn’t focus,” that
she saw “flashing lights,” and that “black spots were becoming

sensitive tissue at the back of the eye . . . .” Diabetic retinopathy,
Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/
diabetic-retinopathy/symptoms-causes/syc-20371611 [https://per
ma.cc/X7ES-E7U6].

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Montgomery v. Gardiner

more frequent.” Gardiner told Montgomery that “everything
looked normal,” and he recorded her vision as 20/50. A scan of her
eye was also taken to look closer at the retina 2 and the inner part
of her eye. When Gardiner reviewed the scan that day, he did not
notice any retinal detachment. He again recommended an
increase in Montgomery’s water intake, and he ordered her new
contact lenses. He also said she may want to see a retina specialist
if the problems she described were still bothering her in a few
weeks.

¶8 Two weeks later, Montgomery had her last follow-up
appointment with Gardiner, and her vision was recorded as
20/30+. Montgomery reported that she felt like something was in
her left eye and that her contact would fog over after she wore it
for ten to fifteen minutes. Gardiner told her that her symptoms
were normal and that he did not see anything wrong with her eye.
He, again, ordered her a new contact lens to try.

¶9 By December 7, Montgomery started to lose all functional
use of her left eye. The next day, she developed a bad headache,
was nauseous, and had black spots in her vision. The day after
that, she noticed that “the black on the side of [her] vision was
getting worse, moving towards [her] center of vision,” and that
the black spot at the bottom of her vision was moving up. When
she awoke on December 10, “it was blatantly obvious that it was
worse”: the black area was “all the way over,” and she “could not
see out [of her] left eye.” She called the on-call doctor (Doctor) for
Utah Valley Eye Center and told him what she was experiencing.
She went in for an exam that day, and Doctor told her she had a
detached retina. Specifically, he said there was a “retinal
detachment with multiple breaks.” He recorded her vision as
20/30 and told her she needed surgery right away. The next

2. “The retina is the light-sensitive layer of tissue at the back of the
eyeball. Images that come through the eye’s lens are focused on
the retina.” Retina, MedlinePlus, https://medlineplus.gov/ency/
article/002291.htm [https://perma.cc/KMX4-SDVR].

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Montgomery v. Gardiner

morning, the on-call retina specialist (Surgeon) performed
surgery to reattach Montgomery’s retina. Because the retina was
almost “completely detached and folded” or “wrinkled,” “the
surgery took longer than [anticipated].”

¶10 At her post-operative appointment with Surgeon a few
days after the surgery, Montgomery had “no vision” out of her
left eye—“[i]t was just black.” Since then, her eyesight has never
returned to what it was before her cataract surgery, and she “can’t
see much out of [her] left eye.” Because of this, Montgomery sued
UVEC in February 2019, alleging medical malpractice and
respondeat superior. Montgomery claimed that UVEC breached
its duty to provide her with care and treatment “within the
professional standard of care” by “failing to properly examine,
evaluate, workup, refer, treat, . . . obtain specialist consultations
[for], and/or properly diagnose [her]” and that because of this
breach, she “suffered from an undiagnosed retinal detachment,
which led to permanent blindness in her left eye.”

¶11 After Gardiner learned of Montgomery’s claims, he
reassessed the scan from her appointment with him on October
12 and, after changing some of the scan settings, saw that a
peripheral retinal detachment had been visible at the time of that
appointment.

UVEC’s Motion in Limine and the Rule 702 Hearing

¶12 Before trial, UVEC filed a “motion in limine to exclude
causation testimony from [Montgomery’s] expert” (Expert).
UVEC argued that Expert was unqualified to opine about
causation because, although he was a board-certified
ophthalmologist, he did “not treat diabetic retinopathy” and did
not “perform surgery to repair detached retinas.” After receiving
written arguments from both sides, the district court conducted a
rule 702 hearing at the beginning of trial, outside the presence of
the jury. See generally Utah R. Evid. 702 advisory committee’s
original note (stating that trial judges have “a ‘gatekeeper’
responsibility to screen out unreliable expert testimony” and that

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“it is not contemplated that evidentiary hearings will be routinely
required in order for the trial judge to fulfill [that gatekeeper]
role,” but implying that such hearings may be employed).

¶13 During that hearing, Expert reviewed his background and
training, indicating that he graduated from medical school,
completed an internship in internal medicine, and fulfilled a
three-year residency in ophthalmology. He did not go on to
become a retina specialist (which is accomplished by completing
a two-year fellowship after residency) but instead became a
board-certified ophthalmologist. He served four years in the
United States Air Force as an ophthalmologist before entering
private practice as a general ophthalmologist. He had performed
various types of surgeries throughout his career, though he had
never repaired a detached retina. He had also performed laser
treatments for proliferative diabetic retinopathy. 3

¶14 Expert indicated that over his forty years of practice, he
had diagnosed many patients with retinal tears and detachments.
Typically, he explained, general ophthalmologists detect and
diagnose retinal tears and detachments and then refer the patients
with those conditions to retina specialists for surgery. After
surgery, he said, those patients are usually seen by retina
specialists for immediate follow up, and then they return to
general ophthalmologists for continued care.

¶15 Expert testified that he read medical literature related to
retinal detachments throughout his career and had continued to

3. “Proliferative retinopathy is the advanced stage [of diabetic
retinopathy,] where abnormal new blood vessels grow on the
surface of the retina. These vessels may break and bleed into the
vitreous, the clear watery gel that fills the eye, and cause severe
vision loss.” Mira Sachdeva, Diabetic Retinopathy, Johns Hopkins
Med., https://www.hopkinsmedicine.org/health/conditions-and-
diseases/diabetes/diabetic-retinopathy [https://perma.cc/6A7G-V
ZND].

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do so since retiring from providing clinical care. He discussed
three specific studies related to retinal detachments—one
recommending surgery within three days for some detachments,
one comparing outcomes of detachment repair surgeries
performed within twenty-four hours to those of surgeries
performed later, and one indicating that certain patients should
be carefully screened for missed retinal breaks.

¶16 After the examination of Expert, the court stated,

I find that . . . this is an extremely complicated field
that requires expert testimony. [Expert] is an over
40-year practicing ophthalmologist. He’s conducted
surgery. He’s reviewed the literature. It would
certainly be helpful to the jury to hear testimony and
his opinions in that regard, so I’m going to . . . allow
it.

The court then confirmed with Expert that he would opine
(1) “that failure to diagnose the retinal tear earlier was a breach of
the standard of care” and (2) “that, based on [Expert’s] experience
with patients who had . . . similar situation[s], and [Expert’s]
review of the literature, . . . those delays correspond to loss of
vision.”

The Trial

¶17 After the rule 702 hearing, the trial proceeded.
Montgomery called Gardiner as her first witness. He admitted
that the October 12 imaging showed a peripheral retinal
detachment. He explained that he did not identify the detachment
at the time the scan was taken because he was focused on the
central retina. He said he was “not disputing the fact that [he]
missed the retinal detachment.” And he stated that “the sooner [a
doctor] can refer a patient to a retina specialist, the better, because
a peripheral detachment can progress to a central detachment”
and “that’s the urgency for referral to a retina[] specialist.”

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Montgomery v. Gardiner

However, Gardiner indicated that Montgomery’s “peripheral
detachment did not progress to a central detachment” and “her
vision was still 20/30 when [Doctor] saw her two months later.”
Gardiner then opined that “whether or not she had the retinal
detachment repair . . . in October or in December, she most likely
would’ve suffered a similar outcome.” Nonetheless, he agreed
that “if the retinal detachment had been treated” in October, he
“would not [have] expect[ed] it to significantly affect her vision
going forward.”

¶18 Montgomery next called Expert to testify. He began by
explaining his background, education, and training, as recounted
above. Using a diagram, he then identified various parts of the
eye, including the retina. Expert was asked to explain the function
of the retina, which he did, saying, “The retina is the actual seeing
tissue of the eyes. So when light comes into the eye and hits the
retina, the retinal cells are stimulated and, in turn, messages are
sent to the brain through the optic nerve.” Expert identified “a
place within the retina” called the macula. The macula, he said, is
“the center of the retina,” and it provides “color vision and sharp
visual acuity.” Expert also explained that the area in the rear of
the eye—between the lens and the retina—is called the vitreous
space and that it is filled with vitreous fluid, “an inactive gel-like
substance that sort of [functions as] the internal skeleton of the
eye” and “drains toxins and other metabolic products from the
retina and other inner parts of the back of the eye.”

¶19 Expert testified that when there is “a break or a tear in the
retina,” “the tear allows fluid that’s in the vitreous to go through
the tear . . . into the subretinal space.” He said that this
“percolat[ing]” of fluid into the subretinal space “elevates the
retina.” As fluid continues to pass through the tear, Expert
explained, “it spreads underneath the retina, . . . and the more it
spreads, the more likelihood there is of it getting to the macular
tissue.” The risk “when the retina is [so] elevated,” Expert
declared, is that “it can lead to a full detachment [of the retina],
which can affect the macula.” Expert testified that when the

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macula becomes detached (a mac-off detachment), “the potential
for [restoring] good vision [through] surgical repair is much lower
than it [is] if the macula [is] still on” (a mac-on detachment).
Specifically, Expert stated that if the macula is detached, a patient
after surgery likely will not “be able to even see the big E on the
eye chart,” but if the macula is on, there is “an opportunity to still
get vision in the . . . 20/50 to 20/80 range.” For that reason, Expert
explained, when a retinal detachment is discovered, the standard
of care is to refer the patient to a retina specialist “within the first
day or so after the diagnosis.” Such a reference is usually made
“urgently,” especially if the macula is still attached “because that
would indicate there’s still a possibility of getting a good visual
result after the surgery.”

¶20 Expert was asked to review Montgomery’s imaging from
October 12. He pointed out markers that “[i]n most cases . . .
would indicate a retinal detachment.” He stated that the scan
showed “the retina ha[d] been elevated from its usual location,
probably by fluid” and that the source of the fluid was “most
probably . . . a break or a tear in the retina.” He reaffirmed that
“an urgent diagnosis and treatment referral is the standard of care
associated with the ophthalmological practice of diagnosing
retinal tears and treating them.” And he opined that Gardiner had
breached that standard of care.

¶21 Expert also reviewed Doctor’s report from examining
Montgomery on December 10, 2017. In that report, Doctor
indicated that Montgomery had “retinal detachment with
multiple breaks,” which Expert clarified meant “there were tears
in the retina in several different locations.” Expert explained that
only one tear was visible on the imaging done on October 12
because that image did not show the peripheral retina. Expert also
discussed Surgeon’s operative report. 4 In that report, Surgeon
noted that Montgomery had proliferative retinopathy but that she
had “undergone successful treatment of proliferative disease and

4. Surgeon passed away before the trial in this case.

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Montgomery v. Gardiner

relaxation of hemorrhage with clearance” and that she also had
undergone “a vitrectomy in the left eye a few years [previously].”5
Surgeon made the following statement regarding Montgomery’s
condition following her left-eye cataract surgery: “[E]ver since the
surgery, she complained of darkening of the peripheral vision,
which has become progressively worse until yesterday, when she
. . . presented a detachment of the entire retina, except for the
central macula, miraculously.” When asked if this was a “partial
detachment situation,” Expert responded, “Well, he’s describing
it as the fact that the macula’s attached, so it’s partial in the sense
that the periphery was detached, but not the center.” Expert stated
that peripheral detachment would cause darkening of the
peripheral vision.

¶22 In response to questioning by Montgomery’s attorney,
Expert then testified as follows:

Q. Have you ever encountered a patient in your
40-year history who had a late diagnosis of a
retinal tear that, following surgery, came
away with what we would call a vision
acuity above 20/50?

A. No.

Q. Conversely, have you ever had a
postoperative care patient who had a retinal
tear that was diagnosed and had surgery to
correct the tear within 10 days, that came out

5. “Vitrectomy is a surgical procedure undertaken by a specialist
where the vitreous humor gel that fills the eye cavity is removed
to provide better access to the retina.” Vitrectomy, The Found. of
the Am. Society of Retina Specialists, https://www.asrs.org/
patients/retinal-diseases/25/vitrectomy [https://perma.cc/T67W-
EBPW].

20230415-CA 10 2025 UT App 146
Montgomery v. Gardiner

of that surgery with ocular vision at worse
than 20/50?

A. Generally not.

Q. Can you say with . . . a reasonable degree of
certainty, in your professional medical
opinion, that the delay in [Montgomery’s]
surgery is what resulted in the injury that
[Montgomery] suffered?

A. I would.

Thereafter, Expert opined again that “Gardiner’s failure to
diagnose and ultimately refer [Montgomery] for treatment
result[ed] in the injury [Montgomery] suffered.”

¶23 On cross-examination, Expert first acknowledged that
Montgomery “lost her central vision” and that “the macula is
responsible for the central vision.” He also acknowledged that
when Montgomery’s retinal detachment was finally diagnosed on
December 10, 2017, her macula was still attached, “her visual
acuity . . . was 20/30-plus,” and her interocular pressure was
“normal.” Expert agreed that “one of the . . . primary factors of
[Montgomery’s] vision loss [was] hypotony”—which he later
described as when “the pressure in the eye, the intraocular
pressure, is low”—and he acknowledged that “the hypotony
occurred subsequent to the surgical repair of the detached retina.”
He also stated that Montgomery’s “history of proliferative
diabetic retinopathy” was “one of many” causes of her vision loss
and that the “weakness in [her] retina” from the “many breaks . . .
that had to be treated” was another cause.

¶24 Ultimately, Expert agreed with UVEC’s counsel’s
characterization of his opinion as being “that the failure to
diagnose and refer the patient after the detached retina occurred
was the cause of [Montgomery’s] vision loss.” Expert then said he

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Montgomery v. Gardiner

had been “very surprised” to learn that Montgomery’s recorded
vision was 20/30 at her December 10 exam, and he stated that he
thought that measurement of her visual acuity and the
measurement of her interocular pressure that day may have been
incorrect. But he said that even if those measurements were
accurate, his causation opinion would not change.

¶25 On redirect, Expert clarified that although he had been
asked on cross-examination “a whole bunch of questions about
the central macula,” “it wasn’t just [Montgomery’s] central
macula that was affected”—“[i]n fact, it was the peripheral
macula.” He explained that when “the retina gets detached and
deprived of its circulation, the worse the peripheral vision”
becomes and, therefore, that “if you have a patient who’s
experiencing darkening of their peripheral area,” “the main
culprit[] would be retinal detachment.” Thus, Expert declared, the
darkening of Montgomery’s peripheral vision was a result “of a
retinal detachment.” “[I]n fact,” Expert noted, “[Surgeon said]
that it was a miracle that the central vision was still attached.”

¶26 Expert was also asked about low pressure in the eye. He
explained that when the pressure is low, that “means that the fluid
production is abnormally low” and something in the ciliary body,
which makes aqueous humor, “is not working well.” 6 Expert and
Montgomery’s counsel then engaged in the following exchange:

6. At the front of the eye, there is “an anterior chamber, which is
the area between [the] lens and cornea,” and “a posterior
chamber, which is the area between [the] lens and iris.”
Aqueous Humor & Vitreous Humor, Cleveland Clinic,
https://my.clevelandclinic.org/health/body/24611-aqueous-humo
r-vitreous-humor [https://perma.cc/PF45-XGY6]. “In the posterior
chamber, the ciliary body makes aqueous humor.” Id. “The
aqueous humor keeps [the] eye inflated and provides
nourishment.” Id. The vitreous humor, on the other hand, “makes
(continued…)

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Montgomery v. Gardiner

Q. Okay. But if there’s low pressure and there’s
low vitreous fluid, what happens to the eye?

A. The eye will deflate like a beach ball.

Q. And if the eye deflates, then that allows what
to happen?

A. . . . [T]he retina is turned into a number of
folds, almost like an umbrella in its folded
state, and, of course, the eye can’t tolerate
that, and the vision that’s produced by that
retina is very poor.

Q. Vision would be occluded by the folds?

A. . . . [N]ot so much occluded by the folds, but
the retina being thrown into folds makes it
hard to get a single image.

Q. So if you have . . . a hole in your bucket and
the water’s coming out and you don’t have a
rigid, firm, plastic outside, which . . . an
eyeball doesn’t have, what happens?

A. Well, . . . the eyeball deflates. It can’t hold . . .
its normal functioning state. It has to be
perfectly spherical in order for the optics of
the eye to focus light on the retina.

Q. And that’s because, when light comes
through the pupil towards the [macula], . . .

up the vitreous body located in the vitreous cavity [at the back of
the eye,] between [the] lens and retina.” Id.

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Montgomery v. Gardiner

those light beams are directed at a straight
angle; is that correct?

A. Correct. That’s correct.

Q. Okay. And so if you have the eye with low
pressure, low vitreous fluid, it’s deflating,
then that light’s not going to come in straight.

A. Correct.

Q. That causes bad vision.

A. Correct.

Q. And, in fact, if you have this tear and the
fluid is coming into this vitreous area, is that
increasing the rapidity with which these
folds will form?

A. Eventually, yes.

Q. And does that have an impact on the
peripheral vision?

A. It does.

Q. . . . The question that I’m asking you is, did
the failure to find this tear and fix it urgently
result in the harm that my client suffered?

A. Yeah. I think that that question encompasses
it completely.

Q. And do you agree with Dr. Gardiner’s
testimony that, if this had been found
rapidly, the vision could’ve been absolutely
saved?

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A. I believe that it would’ve been much better,
yes.

¶27 On recross-examination, Expert and UVEC’s counsel then
had the following exchange:

Q. [You are not testifying] that . . . leaks behind
the retina and . . . the retinal detachment[]
[were the] cause of [Montgomery’s]
hypotony, are you?

A. No, . . . I’m really not saying that, because I
think that the failure of the ciliary body to
keep up its production is totally related,
because the ciliary body is part of the iris-
choroid-ciliary body continuum.[7]

Q. Okay.

A. So anything that will affect the far reaches of
the eye, such as subretinal fluid expansion, is
going to have an impact on the ciliary body’s
production . . . of aqueous [humor], leading
to hypotony.

Q. And that’s exactly what occurred here,
correct?

7. The iris, choroid, and ciliary body together make up the uvea,
“a three-part structure that surrounds most of [the] eye.” Uvea,
Cleveland Clinic, https://my.clevelandclinic.org/health/body/
uvea [https://perma.cc/43ED-6NNU]. The choroid in particular
“is a thin sheet of tissue packed with blood vessels” that “wrap[s]
around the central and rear-most sections of [the] eyeball” and
“supplies blood to various parts of [the] eye (especially [the]
retina[]).” Id.

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A. Yeah, . . . I’m saying that there was a
relationship, but that was not the primary
thing going on. . . . [N]othing is black and
white in ophthalmology. There can be
concurrent pathological processes that go on.

Motion for Judgment as a Matter of Law

¶28 At the close of Montgomery’s case-in-chief, UVEC moved
for judgment as a matter of law under rule 50 of the Utah Rules of
Civil Procedure, arguing “that a reasonable jury would not have
[a] legally sufficient evidentiary basis to find [for Montgomery]
on the element of causation.” After hearing oral arguments from
both sides, the court granted the motion, reasoning as follows:

I’ve taken some time to reconsider the
testimony in this case, and based on my review of
the testimony, I believe [Montgomery] has failed to
provide sufficient expert testimony to meet the
necessary standard here.

I assumed that [Montgomery] would call a
retina[] specialist to provide the type of testimony
we need here. . . .

[Expert’s] testimony . . . lacks specificity. He
didn’t give a specific explanation as to how or why
the delay caused the loss of vision here. That’s . . .
too slight. I erred on the side of allowing the jury to
hear that testimony, thinking that he would get
there. In the end, he simply didn’t.

And based on that, it gives me no pleasure to
. . . have to grant . . . the [r]ule 50 motion.

The court then entered judgment against Montgomery,
dismissing her claims with prejudice.

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The Appeal and Cross-appeal

¶29 Montgomery timely appealed the grant of UVEC’s motion
for judgment as a matter of law. And UVEC filed a cross-appeal,
arguing that the court improperly denied UVEC’s motion in
limine to exclude Expert’s causation testimony.

ISSUES AND STANDARDS OF REVIEW

¶30 Montgomery asserts in her appeal that the district court
erred in granting UVEC’s motion for a judgment as a matter of
law. “We review a [district] court’s grant of [judgment as a matter
of law] for correctness, and will sustain a [judgment as a matter of
law] if, after examining all evidence in a light most favorable to
the non-moving party, there is no competent evidence that would
support a verdict in the non-moving party’s favor.” Gilbert Dev.
Corp. v. Wardley Corp., 2010 UT App 361, ¶ 15, 246 P.3d 131
(cleaned up).

¶31 UVEC claims on cross-appeal that the district court abused
its discretion when it denied UVEC’s motion in limine to exclude
causation testimony from Expert because he was unqualified.
“We review a district court’s decision to admit or exclude expert
witness testimony for an abuse of discretion and will not reverse
that decision unless it exceeds the limits of reasonability.” Taylor
v. University of Utah, 2019 UT App 14, ¶ 10, 438 P.3d 975 (cleaned
up), aff’d, 2020 UT 21, 466 P.3d 124. “We also review decisions
relating to the qualifications of a witness as an expert or as a lay
witness for an abuse of discretion.” Hallett v. Tully, 2024 UT App
90, ¶ 14, 552 P.3d 779 (cleaned up).

ANALYSIS

¶32 To reach the issue raised by Montogomery’s appeal, we
must first determine whether Expert was qualified. We therefore

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first address UVEC’s cross-appeal and then turn to
Montogomery’s appeal.

I. UVEC’s Cross-appeal on Expert’s Qualifications

¶33 UVEC asserts that the district court erred by denying its
motion in limine to exclude causation testimony from Expert.
UVEC argues that “while [Expert] may have been qualified to
opine on the standard of care applicable to [Gardiner] during his
postoperative care of [Montgomery], he was not qualified to opine
on the harm, if any, caused by the delayed repair of
[Montgomery’s] detached retina.”

¶34 Under rule 702(a) of the Utah Rules of Evidence, “a witness
who is qualified as an expert by knowledge, skill, experience,
training, or education may testify in the form of an opinion or
otherwise if the expert’s scientific, technical, or other specialized
knowledge will help the trier of fact to understand the evidence
or to determine a fact in issue.”

¶35 “It is true that, ordinarily, a practitioner of one school of
medicine is not competent to testify as an expert in a malpractice
action against a practitioner of another school.” Burton v.
Youngblood, 711 P.2d 245, 248 (Utah 1985). And UVEC points us to
Kent v. Pioneer Valley Hosp., 930 P.2d 904 (Utah Ct. App. 1997), in
which we held that a nurse’s “affidavit [did] not provide the
requisite foundation to qualify her as an expert capable of
testifying as to the proximate cause of [the] plaintiff’s alleged
nerve damage.” Id. at 907. There, we reasoned that while “a nurse
may well be trained in the proper location to administer
injections, we [we]re not persuaded that a nurse is qualified to
opine as to nerve damage caused by an allegedly improper
injection.” Id. We determined that knowledge related to that issue
fell within the expertise of a neurologist. See id. UVEC now
contends that Kent demonstrates that Expert was not qualified to
testify on causation because retina specialists treat retinal
problems and Expert is not a retina specialist. We are not
persuaded.

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Montgomery v. Gardiner

¶36 This is not an instance where an expert medical witness
attempted to testify regarding matters of expertise associated with
a different school of medicine. Expert is an ophthalmologist.
Ophthalmology is “a branch of medical science dealing with the
structure, functions, and diseases of the eye.” Ophthalmology,
Merriam-Webster, https://www.merriam-webster.com/dictionar
y/ophthalmology [https://perma.cc/U8VZ-2ZN5]. Thus, Expert
was qualified to opine about “the structure, functions, and
diseases of the eye,” id., including causes of vision loss. Moreover,
“[a] retina specialist is an ophthalmologist who has undergone
additional training to become an expert in the diagnosis,
management and treatment of diseases and surgery of the
vitreous body of the eye . . . and the retina.” What is the Difference
Between an Ophthalmologist and a Retina Specialist?, Associated
Retina Consultants, https://associatedretinaconsultants.com/wha
t-is-the-difference-between-an-ophthalmologist-and-a-retina-spe
cialist/ [https://perma.cc/8LVH-CV6E]. In other words,
ophthalmology is a medical specialty, and a retina specialist
practices in a sub-specialty of ophthalmology, not a different
specialty altogether. See Kierstan Boyd, Ophthalmology
Subspecialists, Am. Academy of Ophthalmology (Feb. 24, 2023),
https://aao.org/eye-health/tips-prevention/ophthalmology-subsp
ecialists [https://perma.cc/D6S4-BC5W] (identifying a “retina
specialist” as a “subspecialist” in ophthalmology). Accordingly,
this case is unlike Kent. There, a registered nurse attempted
to provide causation testimony within the specialty of
neurology, but here, Expert opined as to causation within his own
specialty.

¶37 The facts of this case fall closer to those in Patey v. Lainhart,
1999 UT 31, 977 P.2d 1193, than to those in Kent. In Patey, a party
asserted that a particular expert could not “testify about
endodontic treatments because he [was] not an endodontist” but
instead “practice[d] general dentistry.” Id. ¶ 17. See generally
Endodontics, Merriam-Webster, https://www.merriam-webster.co
m/dictionary/endodontics [https://perma.cc/4PMN-AYNN]
(defining endodontics as “a branch of dentistry concerned with

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Montgomery v. Gardiner

diseases of the pulp”). The dentist “testified that one-fourth of his
dental education related to endodontics; that he was licensed by
the state to perform endodontic procedures; that he had
maintained an ongoing educational study of both general
dentistry and endodontics by taking post-graduate courses,
studying current professional publications, and attending 20 to 40
hours of professional seminars per year; and that endodontics
constituted a substantial portion of his 36-year practice.” Patey,
1999 UT 31, ¶ 18. Our supreme court determined that the dentist
“was highly qualified, from both formal training and actual
practice, to give expert opinions in general dentistry and
endodontics.” Id.

¶38 Similarly, Expert’s formal training and actual practice
qualified him to opine about causes of vision loss and
consequences of delayed detection of retinal tears and
detachments. Expert testified that he is a board-certified general
ophthalmologist with over 40 years of practice, that during his
practice he diagnosed many patients with retinal tears and
detachments, that he provided postoperative care for patients
with these conditions, that he performed various other types of
ocular surgeries, that he performed laser treatments for
proliferative diabetic retinopathy, and that he reviews and is up
to date on current medical literature about retinal tears and
detachments. Therefore, Expert was qualified.

¶39 UVEC further argues that Expert is unqualified because he
refers patients to retina specialists when they need surgical repair
or treatment for proliferative diabetic retinopathy and because he
stated he would defer to a retina specialist “as to the appropriate
surgical technique to repair a detached retina” and as to “the
impact of [proliferative diabetic retinopathy] on [Montgomery’s]
current visual acuity.” But our supreme court addressed a similar
argument in Patey and found it unpersuasive:

[The dentist’s] consultation of other experts in the
field of endodontics did not disqualify him from

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Montgomery v. Gardiner

testifying on the subject himself. Simply because an
expert, qualified under [r]ule 702, admits that he or
she consults other experts or admits that other
specialists may be more qualified in some areas does
not render that expert unqualified to testify in a
matter. The rules of evidence establish a minimum
baseline for expert qualifications. They do not
mandate that litigants call only the most highly
qualified experts to testify.

Id. ¶ 19 (cleaned up). Here, the fact that a retina specialist could
opine as to the cause of Montgomery’s vision loss—and may be
even more qualified than Expert to do so—does not render Expert
unqualified to opine on the subject. Expert satisfied the
“minimum baseline” required by rule 702, id., by demonstrating
through his education and experience that he was qualified to
opine on the subject at hand. And the fact that Expert did not
himself perform retinal surgeries does not mean that he was
unqualified to testify as to the consequences of delaying these
surgeries; his education and experience provided him with such
information. Therefore, the court did not abuse its discretion in
deeming him qualified to provide causation testimony in this
case.

II. Montgomery’s Direct Appeal

¶40 We next address Montgomery’s appeal. Montgomery
asserts that the district court erred when it granted
UVEC’s motion for judgment as a matter of law on the issue of
causation.

¶41 Under rule 50 of the Utah Rules of Civil Procedure,
judgment as a matter of law may be granted “[i]f a party has been
fully heard on an issue during a jury trial and the court finds that
a reasonable jury would not have a legally sufficient evidentiary
basis to find for the party on that issue.” Utah R. Civ. P. 50(a)(1).
“To establish medical malpractice, a plaintiff must prove,” among

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Montgomery v. Gardiner

other things, “injury proximately caused by the [health care
provider’s] breach” of the applicable standard of care. Morgan v.
Intermountain Health Care, Inc., 2011 UT App 253, ¶ 8, 263 P.3d 405.
“Proximate cause is generally determined by an examination of
the facts, and questions of fact are to be decided by the jury.”
Mahmood v. Ross, 1999 UT 104, ¶ 22, 990 P.2d 933. “Thus, courts
should refuse to grant a [judgment as a matter of law] on issues of
causation if there is any evidence which might lead a reasonable
jury to find a causal connection between a breach and a
subsequent injury.” Id. (emphasis added).

¶42 Here, Expert testified that Gardiner breached the
applicable standard of care by not identifying Montgomery’s
retinal detachment that was visible in the October 12 scan and by
failing to make an urgent referral to a retina specialist. He then
provided repeated testimony of a causal connection between that
breach and Montgomery’s loss of vision. On direct examination,
he testified as follows:

Q. Can you say . . . with a reasonable degree of
certainty, in your professional medical opinion, that
the delay in [Montgomery’s] surgery is what
resulted in the injury that [Montgomery] suffered?

A. I would.

He thereafter reaffirmed his opinion that “Gardiner’s failure to
diagnose and ultimately refer [Montgomery] for treatment
result[ed] in the injury [Montgomery] suffered.”

¶43 On cross-examination, Expert agreed with UVEC’s
counsel’s characterization of his opinion as being “that the failure
to diagnose and refer the patient after the detached retina
occurred was the cause of [Montgomery’s] vision loss.” Then on
redirect examination, while again under questioning by
Montgomery’s attorney, he testified as follows:

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Montgomery v. Gardiner

Q. The question that I’m asking you is, did the
failure to find this tear and fix it urgently
result in the harm that my client suffered?

A. Yeah. I think that that question encompasses
it completely.

Plainly, Expert provided repeated testimonial evidence—on
which a reasonable jury could rely—that Gardiner’s breach of the
applicable duty of care caused the injury to Montgomery.

¶44 UVEC acknowledges that Expert provided “conclusory
opinion[s] that the delay [in diagnosis] caused [Montgomery’s]
vision loss.” But it notes that a jury cannot be left to “speculate
and guess on too many elements in the chain of causation.” Jackson
v. Colston, 209 P.2d 566, 569 (Utah 1949). See generally Mahmood,
1999 UT 104, ¶ 22 (explaining that a jury is not “free to find a
causal connection between a breach and some subsequent injury
by relying on unsupported speculation”). And it argues that the
jury here needed to hear more from Expert than his conclusory
opinion to base a finding of causation on more than mere
speculation.

¶45 Specifically, UVEC asserts that “preventing a mac-on
detachment from progressing to a mac-off detachment was the
only specific reason [Expert] gave to explain why prompt referrals
for surgical repair result in better visual outcomes” and that “[i]t
was undisputed [that Montgomery’s] detached retina had not
progressed to a mac-off detachment before it was repaired.” “In
other words,” UVEC argues, “the mere passage of time between
detachment and repair does not establish a causal connection
between ‘delayed’ repair and loss of vision.”

¶46 Additionally, UVEC observes that Expert “agreed that
hypotony and [proliferative diabetic retinopathy] were causes of”
Montgomery’s vision loss. And it asserts that “there was no
testimony offered, expert or otherwise, to prove [Gardiner’s]

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Montgomery v. Gardiner

failure to diagnose the retinal detachment caused or contributed
to [the hypotony]” and that it “was also undisputed that
[Montgomery’s proliferative diabetic retinopathy] predated
[Gardiner’s] care.” UVEC then argues that, “[h]aving
acknowledged that [Montgomery’s] vision loss was caused by
hypotony that developed after the retinal repair and by her
preexisting [proliferative diabetic retinopathy], neither of which
were caused by [Gardiner], in order for the jury to find in favor of
[Montgomery] on causation[,] [it] would have had to have heard
more from [Expert] than his conclusory opinion that the delay
caused [Montgomery’s] vision loss.”

¶47 UVEC’s arguments suffer from two infirmities. First, when
a qualified expert provides an admissible yet conclusory
opinion on causation and a jury relies on that opinion to find
that the defendant’s breach caused the plaintiff’s injuries,
the jury’s finding is not the product of speculation. An
expert’s opinion is admitted only if it “will help the trier of fact
to understand the evidence or to determine a fact in issue.” Utah
R. Evid. 702(a) (emphasis added). Thus, if a causation opinion
is admitted into evidence, the jury is not speculating if it bases
its causation finding on that opinion. 8 Lack of a sufficient basis
for the expert’s opinion may make the opinion
inadmissible under rule 702(b), and a less-than-stellar articulation
of a proper basis for the opinion may be exposed through cross-
examination and closing argument. But again, the jury’s reliance
on a properly admitted expert opinion does not amount to
speculation.

¶48 Second, UVEC presents an incomplete picture of Expert’s
testimony. While Expert acknowledged that prompt diagnosis

8. We have concluded that the district court did not abuse its
discretion in determining that Expert was qualified under rule
702(a) to offer a causation opinion, and UVEC did not argue
below, and does not argue on appeal, that Expert’s causation
opinion was inadmissible under rule 702(b).

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Montgomery v. Gardiner

and referral to a retina specialist of retinal detachments was
important in preventing mac-on detachments from becoming
mac-off detachments and thereby achieving better outcomes, he
did not testify that this was the only reason this timing mattered
or the only reason a patient could suffer a worse visual outcome
after a delay. Instead, he opined that the “weakness in
[Montgomery’s] retina” from the “many breaks . . . that had to be
treated”—which weakness the jury might have inferred increased
because of the delayed diagnosis and referral—was one cause of
Montgomery’s ultimate loss of vision. Then on redirect
examination, Expert further clarified that although he had
testified fairly extensively about the dangers of mac-off retinal
detachment and that delayed treatment of peripheral detachment
increased the risk of mac-off retinal detachment, “it wasn’t just
[Montgomery’s] central macula that was affected”—“[i]n fact, it
was the peripheral macula.” He then explained that when “the
retina gets detached and deprived of its circulation, the worse the
peripheral vision” becomes and, therefore, that “if you have a
patient who’s experiencing darkening of their peripheral area,”
“the main culprit[] would be retinal detachment.”

¶49 Additionally, Expert testified about the process of fluid
leaking from a retinal tear in the lengthy exchange from his
redirect testimony included above. See supra ¶ 26. This testimony
established several important points, including that
Montgomery’s decrease in peripheral vision was caused by
vitreous material leaking into the subretinal space, that vision loss
associated with retinal detachment can progress “as more and
more of the photoreceptor layer and the retina gets detached and
deprived of its circulation,” and that the leaking of fluid
“[e]ventually” increases the rapidity with which the retina “is
turned into a number of folds.” In this context, Montgomery’s
counsel then asked, “[D]id the failure to find this tear and fix it
urgently result in the harm that my client suffered?” Expert relied,
“Yeah. I think that that question encompasses it completely.”
Finally, counsel asked whether Expert agreed “that, if this had
been found rapidly, the vision could’ve been absolutely saved,”

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Montgomery v. Gardiner

and Expert said, “I believe that it would’ve been much better,
yes.”

¶50 Moreover, not only did Expert identify the “weakness in
[Montgomery’s] retina” from the “many breaks . . . that had to be
treated” as a cause of her vision loss—in addition to hypotony and
proliferative diabetic retinopathy—he also tied the late diagnosis
of Montgomery’s retinal detachment to the hypotony that
developed after the corrective surgery. Specifically, he said that
the retinal detachment could have been related to “the failure of
the ciliary body to keep up its production” of aqueous humor and
that the lack of adequate aqueous humor led to hypotony. He
explained that the retinal detachment could have affected the
ciliary body’s production of aqueous fluid “because the ciliary
body is part of the iris-choroid-ciliary body continuum” and
“anything that . . . affect[s] the far reaches of the eye, such as
subretinal fluid expansion, is going to have an impact on the
ciliary body’s production . . . of aqueous [humor].”

¶51 From the portions of Expert’s testimony identified above,
a reasonable jury could have found a causal connection between
Gardiner’s delay in diagnosing Montgomery’s retinal detachment
and Montgomery’s subsequent vision loss. 9 The jury could have

9. UVEC contends that Ruiz v. Killebrew, 2020 UT 6, 459 P.3d 1005,
applies here and requires a different result. In Killebrew, a baby
suffered a hypoxic brain injury during delivery. See id. ¶ 4. The
plaintiffs’ experts testified that the medical team that assisted with
the delivery breached the applicable standard of care and that the
injury occurred “because [the baby] was not delivered until after
10:30 p.m.” Id. ¶¶ 3‒4, 13. But the experts “did not testify that if
the defendants had not breached the standard of care, [the baby]
would likely have been born by 10:30 p.m.” Id. ¶ 28. In other
words, the Killebrew plaintiffs needed to show both (1) that the
delay of the delivery until after 10:30 p.m. caused the injury and
(2) that the defendants’ breach of duty caused a delay until 10:30
(continued…)

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Montgomery v. Gardiner

accepted Expert’s explanation and found that the delay in
diagnosing Montgomery’s detachment led to leaking of excess
vitreous fluid and that this contributed to Montgomery’s vision
loss—either of its own accord or by impacting the ciliary body’s
production of aqueous humor or both. The jury could also have
believed that prolonged lack of retinal circulation impacted
Montgomery’s later vision. Ultimately, the jury could have been
persuaded that the weakened state of the retina from having
multiple tears was at least a partial cause of Montgomery’s vision
loss and that the retina would not have been as weak as it was if
Montgomery had received surgery months earlier.

¶52 While UVEC argues that Montgomery’s measurements for
intraocular pressure and visual acuity prior to Surgeon
reattaching the retina undermine Expert’s explanation, it is up to
the jury to determine whether the delay caused all, some, or none
of Montgomery’s vision loss. Expert—an ophthalmologist with 40
years of clinical experience—maintained his causation opinion
even after learning about Montgomery’s pre-surgical
measurements. A jury could have been persuaded from this and
Expert’s explanations of progressive damage that Montgomery’s
measurements were not dispositive in ruling out delay as at least
a partial cause of her vision loss. Thus, rather than granting
judgment as a matter of law, the district court should have
permitted UVEC to present its case—complete with competing
expert opinions—and allowed the jury to perform its fact-finding
role. See Management Comm. of Graystone Pines Homeowners Ass’n
v. Graystone Pines, Inc., 652 P.2d 896, 897–98 (Utah 1982) (“In
[granting judgment as a matter of law], the court is not free to

p.m., and they failed on the second point. Here, however, neither
side disputes that there is a link between Gardiner’s failure to
timely diagnose Montgomery’s detached retina and her delay in
receiving surgery to reattach the retina. And, as we have
discussed, Expert’s opinion provided evidence that the delay was
at least a cause of Montgomery’s injury. Therefore, Killebrew is
distinguishable and does not apply.

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Montgomery v. Gardiner

weigh the evidence and thus invade the province of the jury,
whose prerogative it is to judge the facts. [Judgment as a matter
of law] is only appropriate when the court is able to conclude, as
a matter of law, that reasonable minds would not differ on the
facts to be determined from the evidence presented.” (cleaned
up)). In sum, granting UVEC’s motion for judgment as a matter of
law constituted error.

CONCLUSION

¶53 Expert was qualified to opine on causation, so UVEC’s
cross-appeal fails. And Montgomery’s appeal is well taken—the
district court erred in granting judgment as a matter of law for
UVEC because Expert’s testimony provided evidence that could
support a finding that Gardiner’s breach of duty caused injury to
Montgomery. We therefore reverse the court’s order granting
UVEC’s rule 50 motion and its subsequent judgment dismissing
Montgomery’s claims. We remand this case for a new trial or
other appropriate proceedings consistent with this opinion.

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