Section 28-01-46 was specifically designed to dispose of frivolous or nuisance medical malpractice actions at an early stage of the proceedings. Larson v. Hetland, 1999 ND 98, ¶ 12, 593 N.W.2d 785; Ellefson v. Earnshaw, 499 N.W.2d 112, 114 (N.D. 1993); Larsen v. Zarrett, 498 N.W.2d 191, 192 (N.D. 1993); Fortier v. Traynor, 330 N.W.2d 513, 516 (N.D. 1983). The statute provides for preliminary screening of totally unsupported claims, and seeks to prevent protracted litigation when a medical malpractice plaintiff cannot substantiate a basis for the claim.

Because we conclude below the requirements of the statute were not met, it is not necessary to decide the appropriate standard of review under N.D.C.C. § 28–01–46. See Greene v. Matthys , 2017 ND 107, ¶ 8, 893 N.W.2d 179 ; Haugenoe v. Bambrick , 2003 ND 92, ¶ 9, 663 N.W.2d 175 ; Larson v. Hetland , 1999 ND 98, ¶ 13 n. 2, 593 N.W.2d 785 ; Larsen v. Zarrett , 498 N.W.2d 191, 195 n. 2 (N.D. 1993).IV

We do not need to address which standard of review is appropriate because Greene has not met the requirements of N.D.C.C. § 28–01–46 as a matter of law. See Haugenoe v. Bambrick , 2003 ND 92, ¶ 9, 663 N.W.2d 175 ; Larson v. Hetland , 1999 ND 98, ¶ 13 n. 2, 593 N.W.2d 785 ; Larsen v. Zarrett , 498 N.W.2d 191, 195 n. 2 (N.D. 1993).IV

The word "obvious" means "easily understood; requiring no thought or consideration to understand or analyze; so simple and clear as to be unmistakable." Larsen v. Zarrett , 498 N.W.2d 191, 194 (N.D. 1993) (citations omitted). Related to N.D.C.C. § 28–01–46, this Court has stated:

The Supreme Court of North Dakota has not definitively decided what standard of review applies to a trial court's decision applying the statute involved in this case. See Larsen v. Zarrett, 498 N.W.2d 191, 195 n. 2 (N.D. 1993). It has, however, applied the "abuse of discretion" standard in an unpublished opinion. See Johnson v. Kennedy, No. 89-0341, 1990 WL 36947, at *1 (N.D. Mar.1, 1990).

The last possible exception to the three-month expert disclosure requirement under Section 28-01-46 is the "obvious occurrence" exception. Larsen v. Zarrett, 498 N.W.2d 191, 194-95 (N.D. 1993). The statute provides specific examples of when an expert opinion is unnecessary including incidents involving "lack of informed consent, unintentional failure to remove a foreign substance from within the body of a patient, or performance of a medical procedure upon the wrong patient, organ, limb, or other part of the patients's body, or other obvious occurrence. "N.D. Cent. Code § 28-01-46 (emphasis added).

Id. at 359 (citing Winkjer v. Herr, 277 N.W.2d 579, 583 (N.D. 1979)). See Larsen v. Zarrett, 498 N.W.2d 191, 192 (N.D. 1993). As in cases featuring physicians and surgeons, these elements must be established by expert testimony.

The expert affidavit must support a prima facie case for professional negligence, which we have defined as: "expert evidence establishing the applicable standard of care, violation of that standard, and a causal relationship between the violation and the harm complained of." Van Klootwyk, 2003 ND 112, ¶ 20, 665 N.W.2d 679 (citing Larsen v. Zarrett, 498 N.W.2d 191, 192 (N.D. 1993)). [¶ 19] Section 28-01-46, N.D.C.C., creates an affirmative defense.

[¶ 17] The Baptist Home argues our caselaw supports its construction of the statute because this Court has dismissed in their entirety under N.D.C.C. § 28-01-46 lawsuits in which clinics, which are not specifically named in the statute, have been sued along with physicians. See Larson v. Hetland, 1999 ND 98, 593 N.W.2d 785; Larsen v. Zarrett, 498 N.W.2d 191 (N.D. 1993). However, the Baptist Home's reliance on Hetland and Zarrett is misplaced because the issue was neither raised by the parties nor addressed by this Court.

However, expert testimony is not required "to establish a duty, the breach of which is a blunder so egregious that a layman is capable of comprehending its enormity." Larsen v. Zarrett, 498 N.W.2d 191, 192 (N.D. 1993) (quoting Arneson v. Olson, 270 N.W.2d 125, 132 (N.D. 1978)). The statute, therefore, does not apply to claims involving "unintentional failure to remove a foreign substance from within the body of a patient, or performance of a medical procedure upon the wrong patient, organ, limb, or other part of the patient's body, or other obvious occurrence."