J.People v. Sutter Health CA1/2

Filed 11/4/26 J.P. v. Sutter Health CA1/2 NOT TO BE PUBLISHED IN OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115. IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA FIRST APPELLATE DISTRICT DIVISION TWO J.P., a Minor, etc., et al., Plaintiffs and Appellants, A173629 v. SUTTER HEALTH et al., (Alameda County Super. Ct. No. RG19046060) Defendants and Respondents. Laura Holloway, a 37-year-old mother of two, died at Alta Bates Summit Medical Center in 2018. (J.P. v. Sutter Bay Hospitals (Jan. 9, 2026, A171454) [nonpub. opn.] (J.P. I).)1 Medical records indicate that Holloway was found seizing on the floor of her hospital room on September 6; she did not regain consciousness and was pronounced dead on September 8. Holloway’s minor children (plaintiffs) sued 20 defendants, claiming defendants “negligently overdosed [Holloway] with Dilaudid,” “a powerful 1 On our own motion, we take judicial notice of the unpublished opinion and briefs in J.P. I. (See Rel v. Pacific Bell Mobile Services (2019) 33 Cal.App.5th 882, 886 [“On our own motion, we take judicial notice of [two prior opinions] as well as the underlying appellate records”]; Evid. Code, § 452, subd. (d).) Additionally, pursuant to California Rules of Court, appellants incorporate by reference the entire record in J.P. I. (Cal. Rules of Court, rule 8.124(b)(2) [“An appendix may incorporate by reference all or part of the record . . . in a prior appeal in the same case”].) 1 synthetic opiate medication administered by injection and which is, milligram for milligram, between 5 to 10 times more potent than morphine,” leading to Holloway’s death. As proof of their theory, plaintiffs point to several “anomalies” in Holloway’s medical records, which they claim support the “reasonable inference” of a coordinated attempt to hide the alleged overdose. In J.P. I, we affirmed summary judgment in favor of Alta Bates, concluding that plaintiffs failed to raise a triable issue of material fact as to causation; that is, plaintiffs offered no admissible evidence that the alleged overdose of Dilaudid, even if true, caused Holloway’s death. In this appeal, plaintiffs challenge the trial court’s entry of summary judgment in favor of Jenna Dean, M.D., a doctor who treated Holloway twice at Alta Bates. We adopt the same reason explained in J.P. I—a lack of admissible evidence of causation—for rejecting plaintiffs’ instant appellate arguments, and we identify an additional reason: Plaintiffs’ opening brief fails to adequately present their arguments for appellate review, thereby forfeiting all claims of error. Accordingly, the order granting summary judgment is affirmed. BACKGROUND I. Factual Background2 On August 30, 2018, Laura Holloway was admitted to Sutter Solano Medical Center with complaints of “fever and generalized body aches” stemming from “sepsis . . . due to [a] dental abscess.” On September 2, Holloway was transferred to Alta Bates for evaluation and treatment by a dentist, Daniel Nam, D.D.S. 2 Because we detailed Holloway’s medical treatment in J.P. I, here, we provide only a brief timeline of the treatment relevant to this appeal. 2  On September 3, Dean visited Holloway for the first time at 7:50 a.m. Holloway complained of severe facial pain, for which she had been receiving Dilaudid (hydromorphone),3 so Dean added another medication, Norco (hydrocodone/acetaminophen),4 as needed for pain and to transition Holloway off Dilaudid. Dean performed a physical examination, recorded Holloway’s vital signs, reviewed Holloway’s laboratory, radiology, and echocardiogram results, and discussed the care plan with Holloway. Later on September 3, Nam met with Holloway, who noted swelling around Holloway’s upper right premolar and molar and scheduled a dental extraction at his office the following day. Disputed medical administration records indicate that at 1:00 a.m. on September 4, Eileen Zheng, a registered nurse, administered a one milligram injection of Dilaudid.5 The records further reflect that at 1:11 a.m., Eric Koch, a registered nurse, administered a one milligram injection of Dilaudid. 3 Medical records indicate that a different Alta Bates doctor, Judith Stanton, M.D., who saw Holloway on September 2, had initially prescribed Dilaudid. Holloway continued to receive Dilaudid injections while under Dean’s care. 4 As alleged by plaintiffs, Norco is an opiate pain medication that Holloway had been prescribed “[f]or years” “for the pain caused by [her] lupus,” a diagnosis which predated her 2018 hospitalization by “several years.” Plaintiffs further allege that because of Holloway’s “frequent and long term use” of Norco, she had become “addicted to opiate pain medication.” Thus, plaintiffs claim that Dean negligently maintained the Dilaudid prescription “when because of [Holloway’s] Opiate Addiction, the standard of care required [Dean] to prescribe non-opiate pain medication.” 5 The medical records also show that the 1:00 a.m. time entry on September 4 was created at 5:13 p.m. the following evening. Zheng would later testify at deposition that the 1:00 a.m. time entry was a charting error because she had not been working at the hospital then. According to Zheng, she administered the Dilaudid during her shift at 5:13 p.m., when the record note was created. 3  Around 8:15 a.m., still on September 4, Jlyshae Burns, a registered nurse, noted that Holloway was “awake and alert” and continued to report pain. Shortly thereafter, Mariaelena Puente, a registered nurse, scheduled a “gurney van” to transport Holloway to Nam’s office in Oakland, where Amy Blake, D.D.S. extracted three teeth. Holloway returned to Alta Bates that afternoon, and upon returning, Holloway requested pain medication; Dean was notified. Dean visited Holloway for a second and last time around 1:15 p.m. on September 4. According to Dean’s note in Holloway’s medical records, Holloway continued to experience severe facial pain and felt that her lupus was flaring. Dean recorded Holloway’s recent lab results and vital signs, both of which were taken earlier that morning. Dean’s note also indicated that Holloway stated she needed help finding an outpatient rheumatologist for her lupus, but except for an on-going low-grade fever, Dean did not document any abnormalities. Shortly before 2:30 p.m. on September 4, Holloway met with the hospital pastor, who reported that Holloway was “quite receptive” to the visit. The pastor offered Holloway “words of encouragement” and planned to visit her again the following day. Later that night, Holloway reported that the pain in her right jaw was “10/10,” and a nurse provided pain medication to Holloway “with good effect.” A 10:51 p.m. entry in Holloway’s medical records by Delane Waters, a registered nurse, noted that Holloway “tolerated mouth rinse with moderate amount of blood on gauze.” At 7:00 a.m. the next day, September 5, 2018, Holloway was reported to be alert and oriented as to person, place, time, and situation. Holloway was still reporting pain but refused Norco, instead requesting Dilaudid. The attending nurse “explain[ed]” to Holloway that she should attempt the oral 4 medication first before intravenous medication and reported that Holloway was “reluctant but took the [Norco].” Because Holloway reportedly “feels very weak,” the nurse also “[a]ssisted [Holloway] to the bathroom.” At 11:52 a.m. on September 5, Holloway was seen by Michael Huynh, M.D.6 Huynh noted that Holloway was “conversing well, denied any chest pain but did have pain in the mouth where recent extraction took place.” Holloway was otherwise awake, alert, and oriented as to person, place, and time, “hemodynamically stable and was planned to discharge back to [Sutter] Solano for continued care.” Shortly after midnight on September 6, Holloway was found on the floor of her room by Josephine Lu, a registered nurse. “While trying to reposition” Holloway, she “start[ed] to have a seizure for 3 minutes.” Lu called the rapid response team and notified the on-call doctor Tamika Bailey, M.D., who visited Holloway “in person” and noted: “At the time of my exam [Holloway] is having possible partial seizures, as she has intermittent jerking of her arms and legs. Her eyes are open but she is nonverbal.” Holloway was given Ativan to break the seizure; Holloway’s family was notified and consented to a CT scan of Holloway’s head. Holloway’s CT scan and physical exam were “all consistent with brain death,” and, on September 8, 2018, Holloway was declared deceased. II. Procedural History In December 2019, plaintiffs, by and through their guardian ad litem, filed a civil suit against Dean and several other doctors and entities. The complaint was amended multiple times, resulting in a seventh amended 6 Huynh entered the record of his visit with Holloway on October 11, 2018, because “the note intended for 9/5/18 was not completed due to unknown reason[s].” 5 complaint filed in October 2024 that asserted a single cause of action for wrongful death due to medical malpractice against Dean, Sutter East Bay Medical Group, Inc., and Sutter Bay Medical Foundation. With respect to Dean, plaintiffs alleged inter alia that she negligently prescribed Dilaudid instead of a “non-opiate pain medication” and “failed to order an arterial blood gas test” for Holloway. Dean and Sutter East Bay Medical Group (defendants) moved for summary judgment, asserting “there are no triable issues of material fact on the issue of breach of the standard of care or causation.” In support of the motion, defendants offered declarations of two physicians: Cyntha Fenton, M.D. and Neal Benowitz, M.D. Fenton declared that Dean’s treatment of Holloway was “entirely appropriate and [was] in keeping with the standard of care.” Specifically, Fenton opined that Dean “correctly continued [Holloway’s] pain management by Dilaudid and appropriately ordered oral Norco to transition [Holloway] from IV to oral medication,” and “that there was no cause for an order for arterial blood gases . . . because there was no indication . . . that [Holloway] had respiratory or metabolic acidosis.” Similarly, Benowitz declared that a one milligram dose of Dilaudid, like the doses Holloway received, “[was] not extraordinarily high” and “there is no evidence to support the idea of a lethal overdose of opiates.” Benowitz further opined that Holloway “did not suffer an overdose of hydromorphone,” “that hydromorphone did not cause [Holloway] to experience a seizure or otherwise decompensate during the early morning hours on 9/6/2018,” and “to a reasonable degree of medical probability that medication did not cause or contribute to [Holloway’s] death.” Plaintiffs opposed the motion for summary judgment, arguing that Dean failed to learn that Holloway “was a narcotic addict,” failed to inspect 6 Holloway’s belongings “to ensure that she had not brought any of her outpatient prescribed narcotic pain medication into the hospital,” failed to take into account Holloway’s “liver dysfunction,” negligently prescribed Norco “while continuing to prescribe Dilaudid,” negligently failed to switch Holloway’s pain medication “to a non-narcotic pain reliver,” and by “allowing Dr. Nam to schedule [Holloway] for dental treatment on 9/4/18 when such dental treatment should have been performed on 9/3/18 at Alta Bates Hospital.” In support of their opposition, plaintiffs offered declarations by Bryan Young, M.D. and Louis Caplan, M.D.; however, neither declaration contained the proper attestation.7 Young noted “a charted overdose of Dilaudid in Ms. Holloway’s Medication Administration Record (the MAR) for the time of 1:11 AM on 9/4/18,” as well as Zheng’s testimony that there “was an error in the charting and that no such administration actually occurred.” However, Young opined, “Because there is no correction of the charted drug administration by RN Zheng at 1:00AM, [Young had] no alternative but to accept the charted administration as reflecting that she provided the medication as charted.” Therefore, Young concluded “Holloway suffered a hypoxic brain injury from narcotic overdose.” Young also identified several “anomalies” in Holloway’s medical records as “evidence that . . . Holloway was brain-injured in the early morning hours of 9/4/18 and her condition was inaccurately reported in her medical records after that time” and further believed “there is no credible evidence that she 7 Both Young and Caplan signed their declarations outside of California and therefore were required to certify or declare the accuracy of their declarations “ ‘under penalty of perjury under the laws of the State of California.” (Code Civ. Proc., § 2015.5.) Further undesignated statutory references are to the Code of Civil Procedure. 7 suffered a fatal anoxic seizure that caused her brain injury,” leaving “only [one] other reasonable alternative to explain how she became brain injured”: “the overdose on 9/4/18.” Moreover, Young reviewed Holloway’s cell phone call records and noted that after 12:51 p.m. on September 4, there were “no calls made or received by Ms. Holloway’s [sic] on her cell phone,” which Young found “very unusual” because “[n]ormally” patients would contact family or friends “and inform them that the treatment was successful.” Thus, Young concluded the seizure and medical records were “contrived” to coverup the accidental overdose. Like Young, Caplan “found that Ms. Holloway’s [medical] records after the charted overdose raised substantial questions about her course after that event.” Thus, Caplan declared: “If I had to choose between seizure and narcotic overdose as a cause for [Holloway’s] brain injury, I would have to choose narcotic overdose because seizure leading to fatal anoxic brain injury given Ms. Holloway’s medical history is very improbable, less than 20 percent, while narcotic overdose is well over 50%.” Plaintiffs also submitted the declarations of John Pappas, M.D., D.D.S., an oral surgeon who opined about Holloway’s dental care, and Jason Somerby, a registered nurse at Kaiser Permanente who opined about Holloway’s nursing care. Somerby further opined that Zheng’s explanation for the erroneous 1:11 a.m. time entry was “patently false” because he “use[d] an almost identical” system at Kaiser and believed Zheng would have needed to “affirmatively override” a system warning due to the earlier 1:00 a.m. dose of Dilaudid by Koch. Additionally, plaintiffs submitted the declarations of Clara Holloway, Holloway’s stepmother, and Victoria Rodgers, Holloway’s “close friend”; both 8 generally declared that Holloway did not make or answer any telephone calls after September 3, 2018. On reply, defendants argued that plaintiffs “provided no admissible” evidence to raise a triable issue of fact and objected to Young and Caplan’s declarations as inadmissible hearsay because they did not contain the proper attestation.8 Prior to the hearing on defendant’s motion, the court issued a tentative ruling, indicating that it was inclined to grant the summary judgment motion because plaintiffs “relied on the Young declaration, which was inadmissible due to the defective attestation.” Plaintiffs contested the tentative ruling and requested leave to file an amended declaration with proper attestation. The court granted leave and “made clear that Young’s amended declaration could not change any of the text in the declaration. The only change the court permitted plaintiffs to make was to the attestation.” The court admonished plaintiffs’ counsel “to file the same declaration that Young had already signed, but this time attesting that he was signing the declaration under penalty of perjury of the laws of the State of California.” On April 1, 2025, two days before the continued hearing, plaintiffs filed an amended declaration containing the proper attestation. The next day, defendants filed objections identifying 30 “additional citations” and “impermissible modifications” to the substance of Young’s declaration and asserting prejudice because they had “no opportunity to address these new 8 Defendants also objected to the declarations of Pappas, Somerby, and Rodgers, upon which the court did not rule. (§ 437c, subd. (q) [“In granting or denying a motion for summary judgment . . . , the court need rule only on those objections to evidence that it deems material to its disposition of the motion. Objections to evidence that are not ruled on . . . shall be preserved for appellate review”].) 9 assertions and the ‘citations’ allegedly supporting the same.” Defendants attached to their objections a copy of Young’s amended declaration with the changes highlighted. Plaintiffs’ counsel filed a declaration in reply, claiming that except for changing one “minor sentence,” all the changes were “to fix typographical errors.” The declaration included four pages of “Comment/Explanation” for the changes, which acknowledged additional “Medical Record Bates number[s],” “addition[s] to the content of the declaration,” and “clarifications” but asserted the “differences” were “no[t] substantive change[s] in meaning.” On April 4, 2025, the day after the continued hearing on defendants’ summary judgment motion, the court issued an order granting the motion for summary judgment and sustaining defendants’ objection to the entirety of Young’s declaration. The court found that defendants’ evidence established that Dean’s treatment complied with the applicable standard of care and did not cause or contribute to Holloway’s death. The court explained that plaintiffs failed to raise a triable issue of fact because the original Young and Caplan declarations did not contain the proper attestation and were therefore “inadmissible in [their] entirety.” Moreover, the Pappas declaration did not contain any reference to Dean, and the Somerby declaration contained only one reference to Dean but did not state that Dean breached the standard of care or otherwise caused Holloway’s death. As for Young’s amended declaration, the court disregarded it in its entirety because plaintiffs “failed to comply with the court’s express conditions for filing an amended declaration . . . and because it would be unfair to consider the late-filed declaration.” “Even if,” the court continued, it were to consider Young’s original declaration, the declaration would not raise 10 a triable issue of fact. The court explained that Young’s opinion that Holloway’s medical records were “forged (as opposed to, e.g., inaccurate) is beyond his expertise” and was “based on conjecture, speculation, lack[ed] foundation, and lack[ed] a reasonable basis.” Similarly, Young’s opinion that Holloway brought opioids from home was “based on conjecture and speculation.” The court therefore sustained defendants’ objection to the Young declaration, granted the summary judgment motion, and entered judgment accordingly. Plaintiffs filed a timely notice of appeal from “the grant of summary judgment to defendant Jenna Dean, M.D.”9 DISCUSSION In this appeal, like in J.P. I, plaintiffs argue they “submitted sufficient evidence to create a triable issue of fact about the circumstances of [Holloway’s] brain injury.” Plaintiffs point us to eight “significant and material anomalies” in Holloway’s dental and medical records, which, according to plaintiffs, when “combined” rise to “a reasonable inference . . . that [Holloway] was brain injured by narcotic overdose precipitated by the 1:11AM Overdose.” 10 9 The opening line of plaintiffs’ opposition to defendants’ summary judgment motion reads: “[Sutter East Bay Medical Group’s] liability is based only on Dr. Dean’s liability. If Dr. Dean is not liable for plaintiffs’ harm then neither is [Sutter East Bay Medical Group].” Consistent with their position in the trial court, plaintiffs’ notice of appeal and opening brief mention only Dean. Thus, as defendants argue in their brief, plaintiffs have abandoned any claim that Sutter East Bay Medical Group is independently liable and, as such, we will limit our discussion to plaintiffs’ claim of liability with respect to Dean. (Herzberg v. County of Plumas (2005) 133 Cal.App.4th 1, 20 [“deem[ing] plaintiffs to have abandoned the issue” because they “have submitted no argument on the issue in their briefs on appeal”].) 10 In summary, plaintiffs’ eight anomalies are: (1) the erroneous charting of the alleged overdose of Dilaudid; (2) vital sign data omitted from 11  We do not need to individually address each so-called anomaly because, even assuming plaintiffs correctly identify inconsistencies in Holloway’s records, there is no admissible evidence that Holloway was accidentally given an overdose of Dilaudid, nor do the inconsistencies give rise to a reasonable inference that the records were falsified as opposed to a demonstration of unintentional mistakes. In the absence of any alleged overdose, plaintiffs concede that their claim fails.11 Therefore, the trial court properly granted defendants’ motion for summary judgment. The purpose of summary judgment is to allow courts to “cut through the parties’ pleadings in order to determine whether, despite their allegations, trial is in fact necessary to resolve their dispute.” (Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, 843.) To prevail on a summary judgment motion, the defendant must show that one or more of the elements of each cause of action cannot be established or that there is a complete defense to the claims. (§ 437c, subd. (p)(2).) If the defendant makes such a September 4 medical record entry; (3) inconsistencies in dental records from Nam’s office, e.g., Nam did not bill for Holloway’s treatment despite Holloway being privately insured; (4) record entries that suggest Holloway was still at Alta Bates when she was purportedly at Nam’s office; (5) record entries from Alta Bates that did not accurately reflect Holloway’s dental procedure, e.g., some doctors noted Holloway had one or two teeth removed instead of three; (6) the failure to promptly provide Holloway’s stepmother with information about her dental procedure; (7) the absence of cell phone calls after the alleged overdose; and (8) a “strikingly deficient” entry by Dean, and Huynh’s record entry created after Holloway’s death. 11 As stated in their opening brief: “Plaintiffs concede that if [Holloway’s] initial brain injury was caused by a seizure around midnight on 9/6/2018 that event is too remote from the time when Dr. Dean last cared for [Holloway] to be related to Dr. Dean’s care.” “But,” plaintiffs continue, “if narcotic overdose was the cause, then the evidence submitted by plaintiffs establishes that there is a triable issue of fact as to whether Dr. Dean’s care was negligent and was a substantial factor in causing the narcotic overdose.” 12 showing, then the burden shifts to the plaintiff to raise a triable issue of material fact. (Ibid.) We review orders granting summary judgment de novo. (Applegate v. Carrington Foreclosure Services, LLC (2025) 112 Cal.App.5th 356, 364.) We consider both parties’ evidence, except that to which an objection has been sustained, viewing it “in the light most favorable to plaintiffs as the losing parties, liberally construing their evidentiary submission while strictly scrutinizing [the defendant’s] showing.” (McCurry v. Singh (2024) 104 Cal.App.5th 1170, 1175.) On appeal, we “ ‘apply the same three-step analysis as the trial court.’ ” (Zaragoza v. Adam (2025) 109 Cal.App.5th 113, 118 (Zaragoza).) “ ‘ “First, we identify the issues framed by the pleadings. Next, we determine whether the moving party has established facts justifying judgment in its favor. Finally, if the moving party has carried its initial burden, we decide whether the opposing party has demonstrated the existence of a triable, material fact issue.” ’ ” (Id. at p. 118.) Because the operative seventh amended complaint asserts a single cause of action for wrongful death due to medical malpractice,12 we begin with the second step of assessing whether Dean satisfied the moving burden. I. Moving Burden Under the second step, we consider whether Dean met her moving burden of showing “ ‘that one or more elements of the cause of action . . . cannot be established.’ ” (Zaragoza, supra, 109 Cal.App.5th at p. 118; § 437c, 12 Whether framed as a claim for wrongful death or medical negligence, both causes of action require breach of a duty of care and a causal connection between the breach and the harm. (Borrayo v. Avery (2016) 2 Cal.App.5th 304, 310 [elements of medical malpractice claim]; Musgrove v. Silver (2022) 82 Cal.App.5th 694, 705 [elements of wrongful death claim].) 13 subd. (p)(2).) For claims of medical negligence, “expert testimony is required to establish . . . [citation] . . . whether the defendant’s conduct proximately caused the plaintiff’s injuries within a reasonable medical probability.” (Zaragoza, pp. 118–119.) Based on our independent review of the admitted evidence, we conclude Dean’s expert declarations satisfied the moving burden of showing that she did not cause Holloway’s injuries. As discussed above, defendants’ expert Fenton opined that Dean did not breach the standard of care, and Benowitz opined that Dean did not cause Holloway’s death. Specifically addressing plaintiffs’ alleged theories of negligence, Fenton opined that Dean “correctly continued” Holloway’s pain management with Dilaudid and that there was no need to test for arterial blood gases. Benowitz also opined that Holloway “did not suffer an overdose of hydromorphone” and “that medication did not cause or contribute to [Holloway’s] death.” Moreover, plaintiffs did not object to either declaration; thus, the court properly considered them. (§ 437c, subd. (b)(5) [“Evidentiary objections not made . . . shall be deemed waived”].) Plaintiffs now claim Dean’s experts relied on “disputed” medical records, citing the alleged “anomalies” in Holloway’s medical and dental records. But assuming arguendo that plaintiffs correctly identify anomalies in Holloway’s records, none of the anomalies pertain to the care rendered by Dean. For example, plaintiffs focus heavily on their claim that Holloway’s dental records were “fabricated” but even assuming fabrication, the dental records do not concern Dean’s care and thus do not undermine Dean’s experts’ opinions. Plaintiffs only anomaly targeting Dean is that her entry on September 4, 2018, was “strikingly deficient” because it did “not mention anything at all about [Holloway’s] dental treatment.” However, the challenged entry 14 occurred after plaintiffs allege that Holloway was given the second dose of Dilaudid; thus, even assuming this allegation is true, it does not undermine Fenton’s or Benowitz’s opinions regarding the standard of care or causation. (See Morales-Simental v. Genentech, Inc. (2017) 16 Cal.App.5th 445, 460–461 [rejecting plaintiffs’ argument “that contradictions in the declarations and deposition testimony . . . raise credibility questions for the jury”].) Because the trial court correctly concluded Dean satisfied her moving burden, we consider whether plaintiffs’ evidence raised a triable issue of material fact. II. Triable Issue of Material Fact Under the third and final step of our summary judgment analysis, we consider whether plaintiffs raised a triable issue of material fact. (Zaragoza, supra, 109 Cal.App.5th at p. 118.) Even liberally construing their evidence, as we must, plaintiffs fail to raise the necessary triable issue of material fact as to causation. (Ibid.) “Regarding causation, ‘the plaintiff must offer an expert opinion that contains a reasoned explanation illuminating why the facts have convinced the expert, and therefore should convince the jury, that it is more probable than not the negligent act was a cause-in-fact of the plaintiff’s injury.’ ” (Sanchez v. Kern Emergency Medical Transportation Corp. (2017) 8 Cal.App.5th 146, 155.) While a plaintiff opposing summary judgment is entitled to reasonable inferences in their favor (Zaragoza, supra, 109 Cal.App.5th at p. 118), plaintiffs’ experts must still offer a “reasoned explanation connecting the factual predicates to the ultimate conclusion” (Sanchez, at p. 156). As our Supreme Court has explained, “ ‘An expert opinion has no value if its basis is unsound,” which means the expert “ ‘must provide a reasonable 15 basis for the particular opinion offered, and that an expert opinion based on speculation or conjecture is inadmissible.’ ” (Sargon Enterprises, Inc. v. University of Southern California (2012) 55 Cal.4th 747, 770; see also Osaze v. Aparicio-Gee (2026) 123 Cal.App.5th 795, 811–812.) Thus, “the trial court acts as a gatekeeper to exclude expert opinion testimony that is (1) based on matter of a type on which an expert may not reasonably rely, (2) based on reasons unsupported by the material on which the expert relies, or (3) speculative.” (Sargon Enterprises, Inc., at pp. 771–772.) That said, the gatekeeping function does not allow a court to “weigh an opinion’s probative value or substitute its own opinion for the expert’s opinion. Rather, the court must simply determine whether the matter relied on can provide a reasonable basis for the opinion or whether that opinion is based on a leap of logic or conjecture.” (Id. at p. 772.) Further, in opposing a summary judgment motion, “The opposing party may rely upon inferences, but ‘those inferences must be reasonably deducible from the evidence, and not such as are derived from speculation, conjecture, imagination, or guesswork.’ ” (Santa Clara Valley Water Dist. v. Century Indemnity Co. (2023) 89 Cal.App.5th 1016, 1035.) We must use common sense in drawing inferences. (Booth v. Santa Barbara Biplane Tours, LLC (2008) 158 Cal.App.4th 1173, 1177.) As the trial court correctly noted, neither the Pappas declaration nor the Somerby declaration raises a triable issue of fact as to Dean. Pappas does not discuss Dean’s care at all, and Somerby’s only reference to Dean does not express an opinion that Dean breached the applicable standard of care or otherwise caused or contributed to Holloway’s death. 13 13 Somerby noted that around 5:00 p.m. on September 4, “Dean ordered Ms. Holloway’s cardiac monitoring to be discontinued” and “transferred” 16  Caplan’s declaration did not include a proper attestation, and plaintiffs never attempted to correct it; thus, as defendants’ asserted in their objections, Caplan’s declaration is inadmissible. (Kulshrestha v. First Union Commercial Corp. (2004) 33 Cal.4th 601, 618 [“an out-of-state declaration which materially deviates from section 2015.5 . . . cannot be used as evidence”].) And the declarations submitted by Holloway’s stepmother and friend do not create a triable issue of fact because neither is an expert qualified to opine on the appropriate standard of care or medical causation. (San Antonio Regional Hospital v. Superior Court (2024) 102 Cal.App.5th 346, 350 [standard of care and causation require “ ‘ “competent expert testimony” ’ ”].) Thus, the only declaration potentially remaining for our consideration is Young’s. Consistent with the “ ‘weight of authority,’ ” the parties ask us to review the trial court’s exclusion of Young’s declaration for abuse of discretion. (Duarte v. Pacific Specialty Ins. Co. (2017) 13 Cal.App.5th 45, 52; see also San Francisco Print Media Co. v. The Hearst Corp. (2020) 44 Cal.App.5th 952, 962 [“We review a ruling excluding expert testimony for abuse of discretion”].) Although our Supreme Court has declined to decide “whether a trial court’s rulings on evidentiary objections based on papers alone in summary judgment proceedings are reviewed for abuse of discretion or reviewed de novo,” it is a question we need not decide in this appeal. (Reid v. Google, Inc. (2010) 50 Cal.4th 512, 535.) Again, because Young’s declaration was excluded because it did not contain a proper attestation, we Holloway “to a lower-level nursing care unit” “without making any chart note explaining why she made those orders.” “The failure of any explanation,” Somerby opined, “lends support to my suspicion that some important change in Ms. Holloway’s condition had taken place.” 17 need not consider it,14 but, even if properly attested to and admitted, the declaration would not raise a triable issue of fact. The backbone of plaintiffs’ theory is that Holloway was overdosed in the early morning hours of September 4, after purportedly receiving injections of Dilaudid at 1:00 a.m. and 1:11 a.m., and that all subsequent medical and dental records were “a pretext” to coverup this accidental overdose. As plaintiffs concede, if the alleged overdose did not occur, then there is no basis for liability against Dean. In this regard, Young’s opinion is based on a single medical record entry that is inconsistent with the entirety of Holloway’s records, which reflects that Holloway was awake, alert, and interacting with numerous medical professionals and hospital staff throughout her hospitalization until her recorded seizure on September 6. As such, Young’s opinion is unfounded and fails to raise a triable issue of fact regarding the alleged overdose or causation, nor does it give rise to a reasonable inference of an overdose or causation. In support of plaintiffs’ theory, they offer Young’s conclusion that an overdose occurred because Zheng did not correct the 1:00 a.m. time entry in the medical records to reflect the time she actually administered the Dilaudid. “Because there is no correction of the charted drug administration by RN Zheng at 1:00 AM,” Young declared, “I have no alternative but to accept that charted administration as reflecting that she provided the medication as charted.” But this assumption as to the chart’s accuracy is both speculative and inconsistent with the state of the record. The medical 14 It is settled that we review the trial court’s exclusion of untimely evidence for abuse of discretion, and under that standard, we see no abuse of discretion in the trial court’s exclusion of Young’s amended declaration, which did not comply with the court’s express limitations on its grant of leave to amend. (Bozzi v. Nordstrom, Inc. (2010) 186 Cal.App.4th 755, 765.) 18 record entry reflecting a 1:00 a.m. dose of Dilaudid was in fact created at 5:13 p.m. the following afternoon, which is when Zheng testified at deposition that Holloway was “awake and alert” but at a self-described pain level of “ten”; thus, Zheng administered the Dilaudid and created the medical record entry with the erroneous 1:00 a.m. timestamp. In fact, as Zheng further testified, she was not present at the hospital at 1:00 a.m. and therefore could not have given Holloway an injection of Dilaudid at that time. Zheng’s explanation is also consistent with Alta Bates’s medicine inventory records that reflect Zheng retrieved a single vial of Dilaudid for Holloway at 5:09 p.m. on September 4, which is consistent with a 5:13 p.m. administration. Much like hospital inventory records also reflect that Koch retrieved a single vial of Dilaudid for Holloway on September 4 at 1:08 a.m., which is consistent with the recorded 1:11 a.m. administration. Notably, there is no record that any Dilaudid was taken for Holloway from the Alta Bates’s inventory on September 4 before Koch, and the next record that Dilaudid was taken from Atla Bates’s inventory for Holloway was again by Koch shortly before 5:00 a.m. that same day, which is consistent with the medical administration records reflecting Koch gave Holloway a one milligram dose of Dilaudid at 5:05 a.m. on September 4. Thus, contrary to Young’s opinion, the medical records affirmatively demonstrate that Holloway could not have received a 1:00 a.m. injection of Dilaudid. Young opines that “[a]ll opiate medications . . . must absolutely be accounted for in writing” but does not address Alta Bates’s inventory records showing when the Dilaudid administered to Holloway was retrieved, which match the medical administration records demonstrating 1:11 a.m. and 5:05 a.m. doses of Dilaudid and Zheng’s erroneous 5:13 p.m. entry. Thus, to form his opinion that he has “no alternative but to accept” that Holloway was 19 overdosed on Dilaudid, Young must have ignored, without any explanation, the undisputed inventory records evidencing the time of the retrieval of Dilaudid for Holloway, which themselves are entirely consistent with the medical administration records, leaving Young’s opinion without any evidentiary support. Absent any factual or medical basis for Young’s opinion that Holloway was overdosed with Dilaudid, it must be excluded as based on speculation. And, as plaintiffs’ counsel stated at the hearing on defendants’ summary judgment motion: “Well, if [the court] can’t consider [Young’s declaration], then there’s no point in being here today, is there? [Young’s declaration is] the only evidence I really have.” Moreover, plaintiffs’ suggestion that it is reasonable to infer causation based upon the purported anomalies is inconsistent with the evidence they presented. For instance, plaintiffs cite Somerby’s declaration to argue that Zheng’s “false statements” about “accidentally” entering 1:00 a.m. time give rise to the “reasonable inference” that she was “covering up” Holloway’s overdose of Dilaudid. However, Somerby’s conclusion is based on the representation that in 2021, he used an “almost identical” record system when working at a Sutter hospital “for about six months.” There is no evidence that the 2018 system used by Zheng at Alta Bates was similar to the 2021 system Somerby used for six months at a different hospital, nor was there any showing that Somerby is qualified to opine as to the technical differences between the medical record systems. Thus, Somerby’s opinion as to the record system in use here that resulted in his conclusion that Zheng was not credible is speculative at best and certainly