Introduction

In McMahon v. Sanford, 2025 ND 184 (N.D. Nov. 5, 2025), the North Dakota Supreme Court affirmed an amended judgment dismissing a self-represented patient’s claims, with the appeal focused on six counts of intentional infliction of emotional distress (IIED) arising from his treatment at Sanford medical facilities. The decision addresses four principal issues:

• whether the district court abused its discretion by denying an oral motion to continue a summary judgment hearing (¶¶ 5–7);
• whether the court erred by proceeding to summary judgment without allowing more discovery, where no Rule 56(f) request was made below (¶¶ 8–9);
• whether IIED claims tied to medical-discharge and pain-medication decisions require an expert affidavit under N.D.C.C. § 28-01-46, and whether the “obvious occurrence” exception applies (¶¶ 11–17); and
• whether the remaining non-medical IIED allegations met North Dakota’s “strenuously high” threshold for extreme and outrageous conduct (¶¶ 18–21).

The case reinforces several procedural guardrails (continuances, preservation, summary judgment standards) and, most significantly, clarifies the reach of N.D.C.C. § 28-01-46 to non-negligence tort labels when the gravamen is professional medical judgment. It also reiterates the narrow compass of the “obvious occurrence” exception and the stringent bar for IIED in North Dakota.

Summary of the Opinion

• Continuance: No abuse of discretion in denying the plaintiff’s oral request to continue the summary judgment hearing; he had ample notice, stipulated to the reply brief deadline, received the filed reply two days before argument, and conceded his misunderstanding (¶¶ 5–7).
• Discovery: The argument that more time for discovery was required was not preserved; the appellant did not seek a continuance under N.D.R.Civ.P. 56(f) or move to compel discovery in the district court (¶¶ 8–9).
• Expert Affidavit Requirement: Three IIED claims (forced discharge with IV/pain needs; refusal of pain meds in ER; delayed replacement of spilled scheduled pain meds) involved medical decision-making and therefore required an expert affidavit under § 28-01-46. The plaintiff’s attempt to reframe them as “administrative” did not avoid the statute (¶¶ 11–15).
• Obvious Occurrence Exception: Inapplicable; decisions on discharge and pain management are not within lay knowledge and require expert testimony on the standard of care (¶¶ 16–17).
• IIED Threshold: The remaining IIED claims (verbal abuse, ridicule, humiliation, failure to investigate, pattern of hostility) did not, singly or cumulatively, meet the “extreme and outrageous” standard as a matter of law (¶¶ 18–21).
• Disposition: Amended judgment affirmed (¶ 22).

Analysis

Precedents Cited and Their Role

• Jury v. Barnes County Municipal Airport Authority, 2016 ND 106, ¶ 14, 881 N.W.2d 10. The Court relied on Jury to reiterate that pro se litigants receive no special leniency as to procedural rules. This underpinned the denial of the continuance: a self-represented party is “equally bound by applicable rules” (¶ 6).
• Desert Partners IV, L.P. v. Benson, 2019 ND 19, ¶ 10, 921 N.W.2d 444. Provides the abuse-of-discretion standard for reviewing a continuance denial, guiding the Court’s conclusion that the district court acted within its discretion (¶ 6).
• Moe v. State, 2015 ND 93, ¶ 11, 862 N.W.2d 510. Establishes that issues not raised below will not be addressed on appeal, foreclosing the discovery-extension argument (¶ 8).
• Krebsbach v. Trinity Hosps., Inc., 2020 ND 24, 938 N.W.2d 133. Cited both for the summary judgment standard (¶ 10) and substantively to explain the line between ordinary negligence and malpractice: claims needing medical expertise fall within professional malpractice, regardless of labels (¶¶ 13–14).
• Ortega v. Sanford Bismarck, 2019 ND 133, ¶ 17, 927 N.W.2d 872. Defines the elements of medical negligence and the necessity of expert evidence to establish standard of care, breach, and causation, supporting the § 28-01-46 analysis (¶ 13).
• Sime v. Tvenge Associates Architects & Planners, P.C., 488 N.W.2d 606 (N.D. 1992). Emphasizes that the “actual nature of the action” controls; plaintiffs cannot escape malpractice confines through artful pleading, a principle the Court extends to IIED when the allegations center on medical judgment (¶ 14).
• Greene v. Matthys, 2017 ND 107, 893 N.W.2d 179. Explains the narrow “obvious occurrence” exception: it applies only where a layperson can assess negligence without expert aid and focuses on the occurrence itself, not the outcome (¶¶ 16–17).
• G.K.T. v. T.L.T., 2011 ND 115, 798 N.W.2d 872; Lucas v. Riverside Park Condos., 2009 ND 217, 776 N.W.2d 801. Establish and apply the “strenuously high” IIED threshold, excluding “mere insults, indignities, threats, annoyances, petty oppressions, or other trivialities” (¶¶ 19–20).
• Muchow v. Lindblad, 435 N.W.2d 918 (N.D. 1989); Neppel v. Development Homes, Inc., 2021 ND 5, 953 N.W.2d 642. Illustrate how severe facts still may not meet the “extreme and outrageous” bar; the Court analogizes McMahon’s allegations to these precedents to affirm dismissal (¶¶ 20–21).
• Out-of-state persuasive authorities: Votre v. County Obstetrics & Gynecology Group, P.C., 966 A.2d 813 (Conn. App. Ct. 2009) (IIED and other non-negligence claims can “sound in” malpractice where proof depends on medical standards) (¶ 14); Ferguson v. Kennestone Hospital, Inc., 899 S.E.2d 357 (Ga. Ct. App. 2024) (medication decisions are within professional assessment) and Szymborski v. Spring Mountain Treatment Center, 403 P.3d 1280 (Nev. 2017) (discharge planning requires expert testimony), both reinforcing that discharge and pain-medication decisions are medical judgments (¶ 15).

Legal Reasoning

1) Continuance Denial (N.D.R.Ct. 6.1(b))

The district court denied an oral continuance request made at the hearing. The Supreme Court affirmed, noting: McMahon received multiple notices with the correct hearing scope and date (¶ 7), stipulated to the reply-brief schedule, had two days to review a short, six-page reply filed on time (¶ 7), and admitted his misunderstanding was his “fault.” Applying the abuse-of-discretion framework from Desert Partners IV (¶ 6) and the pro se rule from Jury (¶ 6), the Court found no arbitrary or unreasonable action (¶ 7).

2) Discovery Complaints Not Preserved (N.D.R.Civ.P. 56(f))

McMahon argued the court should have allowed more time for discovery before entering summary judgment. But he neither filed a Rule 56(f) declaration nor moved to continue on discovery grounds. The record shows he acknowledged no motion to compel and deferred a discovery meeting until after the hearing (¶ 9). Under Moe, unpreserved issues are not considered on appeal (¶ 8). The Court therefore declined to address the argument (¶ 9).

3) Expert Affidavit Requirement Applies to Medical-Judgment-Based IIED (N.D.C.C. § 28-01-46)

The statute mandates dismissal without prejudice unless, within three months of commencing suit, a plaintiff serves an affidavit with an admissible expert opinion supporting a prima facie case of professional negligence against physicians, nurses, or hospitals, subject to narrow exceptions (¶ 11). Although McMahon styled his claims as IIED, three were anchored in alleged wrongful discharge and pain-management decisions (Claims 1, 2, and 4) (¶ 12).

Drawing on Ortega and Krebsbach, the Court explained that “professional negligence” and “malpractice” are functionally synonymous and encompass failures to meet professional standards requiring specialized medical skill (¶¶ 13–14). The touchstone is whether the claim hinges on matters “requiring special skills not ordinarily possessed by lay persons” (Krebsbach, ¶ 12). Decisions about when to discharge a patient with an IV and ongoing pain needs, whether to administer pain medication in the ER, and how to manage a dose inadvertently spilled are medical judgments that demand expert context (¶ 15). Attempts to relabel those judgments as “administrative” do not change their medical character (¶¶ 14–15).

The Court cited persuasive authorities confirming that medication and discharge decisions belong squarely within professional medical assessment (¶ 15). Because McMahon undisputedly did not timely serve an expert affidavit (¶ 11), the district court properly dismissed those IIED claims.

4) “Obvious Occurrence” Exception Is Narrow and Inapplicable

The “obvious occurrence” exception in § 28-01-46 dispenses with an expert affidavit only where the occurrence is plainly within lay knowledge, and the “occurrence that led to the result, not the result itself,” is obvious (Greene, ¶ 14). The Court held that whether and when to discharge a patient or to provide pain medication are not obvious occurrences to non-experts and therefore require expert guidance on the standard of care (¶¶ 16–17).

5) IIED Threshold Not Met for Non-Medical Allegations

The remaining IIED claims alleged verbal abuse, ridicule, humiliation, failure to investigate, and a hostile pattern (¶ 18). Under G.K.T. and Lucas, IIED requires conduct “beyond all possible bounds of decency” and does not extend to insults, indignities, or annoyances (¶ 19). Muchow and Neppel illustrate that even distressing conduct by officials or caretakers often fails to meet the stringent standard (¶¶ 20–21).

Applying these precedents, the Court agreed with the district court that, even assuming the allegations true and viewed cumulatively, they did not satisfy the extreme-and-outrageous bar as a matter of law (¶ 21). Summary judgment was therefore appropriate.

Impact and Implications

• Claim Framing and § 28-01-46 Compliance: Plaintiffs cannot avoid the expert-affidavit gatekeeping function by relabeling medically grounded grievances as IIED (or other non-negligence torts). When the underlying facts are medical judgments (discharge planning, pain-medication decisions), § 28-01-46 applies.
• Narrow “Obvious Occurrence” Exception: The decision underscores the exception’s tight limits. Medical decisions about discharge and pain management are not “obvious” to lay jurors; expert articulation of standard-of-care is indispensable.
• IIED in Health-Care Settings: Allegations of rudeness, humiliation, or hostile bedside manner—without more—will rarely clear North Dakota’s elevated IIED threshold. Litigants should consider whether alternative causes of action exist and whether evidence can meet the “extreme and outrageous” standard.
• Procedural Discipline for Pro Se Litigants: The Court reiterates that pro se status does not excuse noncompliance with scheduling orders, motion practice, or preservation requirements. Oral requests for continuance made on the day of hearing face an uphill battle absent concrete prejudice and good cause.
• Summary Judgment Practice: Parties opposing summary judgment should: (a) timely seek Rule 56(f) relief with specific declarations if discovery is incomplete; (b) move to compel if discovery responses are deficient; and (c) avoid conflating hearing types—oral argument on legal issues does not demand additional evidentiary development.
• Hospitals and Providers: The ruling provides assurance that discharge and medication decisions will be treated as professional judgments requiring expert proof. It also encourages clear documentation of the clinical rationale that would anchor expert testimony if litigation ensues.

Complex Concepts Simplified

• Professional Negligence vs. Ordinary Negligence: If deciding whether conduct met a professional medical standard requires specialized knowledge, the claim sounds in professional negligence (malpractice), even if the complaint uses a different label like IIED.
• Expert Affidavit (N.D.C.C. § 28-01-46): In malpractice-type actions against physicians, nurses, or hospitals, a plaintiff must serve an expert’s affidavit within three months of filing, stating an admissible opinion that supports a prima facie case (standard of care, breach, and causation). Failure to do so generally mandates dismissal.
• “Obvious Occurrence” Exception: A narrow carve-out where laypeople can recognize negligence without expert help (e.g., wrong-limb surgery). It focuses on whether the occurrence (not merely a bad outcome) is obvious. Medical judgment calls about discharge/medication are not obvious.
• IIED Threshold: To win IIED, conduct must be “extreme and outrageous” — far beyond everyday rudeness or insensitivity. Courts act as gatekeepers to decide this threshold question before a jury considers the claim.
• Continuance Standards: Continuances must be promptly sought for good cause and supported by declarations or equivalent. Late, oral requests generally fail absent compelling justification.
• Issue Preservation and Rule 56(f): To claim more time for discovery before summary judgment, a party must explicitly request a continuance with specific reasons, typically through a Rule 56(f) declaration. Courts will not entertain such arguments for the first time on appeal.

Conclusion

McMahon v. Sanford clarifies and reinforces several important principles in North Dakota civil litigation and health-care tort law. First, it confirms that IIED claims rooted in medical decision-making—such as discharge and pain management—are subject to the expert-affidavit requirement of § 28-01-46, and that the “obvious occurrence” exception does not reach such inherently clinical judgments. Second, it reiterates that North Dakota’s IIED threshold is exceptionally high; allegations of insults or hostile behavior by medical staff, without more, do not suffice as a matter of law. Third, it underscores procedural rigor: pro se litigants must comply with the rules; continuances must be promptly and properly supported; and discovery-based objections must be preserved via Rule 56(f) or comparable motions.

Practically, the decision counsels plaintiffs to secure early expert support whenever their claims implicate professional medical standards, regardless of how the claims are styled. It also affirms courts’ gatekeeping role in filtering IIED allegations that, even if distressing, do not rise to “extreme and outrageous” conduct. In sum, McMahon strengthens the doctrinal boundary between professional malpractice and non-medical torts while sharpening the procedural expectations governing summary judgment practice in North Dakota.