COLLINS, Judge.
Plaintiff Donna Preston, decedent William M. Prestons widow and estate representative, appeals an order dismissing her wrongful death action alleging medical malpractice against Defendant Assadollah Movahed, M.D. After a compliance hearing, the trial court concluded the facially valid Rule 9(j) pre-lawsuit medical expert review certification in Plaintiffs medical malpractice complaint was factually unsupported when it was filed, which was two days before the expiration of the applicable statute of limitations period. Therefore, the trial court granted Defendants motion to dismiss the complaint for substantive Rule 9(j) noncompliance.
On appeal, Plaintiff contends the trial court erred by dismissing her complaint because the certificate substantively complied with Rule 9(j). We disagree. Because competent evidence supported the trial courts factual findings, which in turn supported its legal conclusions and ultimate decision that the Rule 9(j) certificate was factually unsupported at the time Plaintiff had filed her complaint and before the statute of limitations period had expired, we affirm the trial courts order dismissing her complaint for substantive Rule 9(j) noncompliance.
I. Procedural History and Factual Background
Plaintiffs complaint and later medical expert deposition testimony reveals the following facts: Around 8:30 a.m. on 3 February 2014, William M. Preston (Preston) presented to Vidant Medical Centers emergency department complaining of chest pain and shortness of breath. Prestons emergency room electrocardiogram (EKG) test revealed abnormalities consistent with myocardial ischemia, a condition where not enough blood reaches the heart. That evening, Preston was admitted to the hospitals observation unit under the care of attending physician Pranitha Prodduturvar, M.D. After Dr. Prodduturvar examined Preston, she ordered a cardiac workup including, inter alia , a nuclear stress test (NST).
Around noon the next day, hospital providers administered Prestons NST. An NST involves injecting a patient with radioactive material and subjecting him to cardiovascular exercise in order to obtain nuclear images of the heart revealing blood flow while under stress and at rest. Dr. Movahed, the hospitals attending nuclear cardiologist, who was neither acting as a formal cardiology consult nor had personally examined Preston, was assigned to interpret Prestons NST results. Interpreting the results of an NST involves assessing the treadmill stress test and EKG tracings taken of the heart, in conjunction with analyzing the nuclear cardiology images.
Following the test, Dr. Movahed orally reported his interpretation of Prestons NST to cardiology fellow Deepak Joshi, M.D., with instructions for Dr. Joshi to communicate his findings to Prestons then-attending physician, Neha Doctor, M.D. In Dr. Movaheds later-dictated report, he noted a perfusion defect in [Prestons] heart ... might be due to significant gas in the stomach, but ... he could not rule out ischemia as a possible cause of the abnormality. Dr. Movahed also suggested, based upon Prestons abnormal NST, [o]ne may consider a [coronary computed tomography angiogram, also known as a] CTA, which is an additional cardiac test to evaluate suspected coronary artery disease.
Subsequently, on 4 February 2014, attending physician Dr. Doctor personally examined Preston and ordered his discharge from the hospital. Preston was instructed to follow up with his primary care physician about ordering an MRI to assess potential neurological causes for his symptoms and was scheduled for an outpatient cardiology follow-up on 20 February 2014.
On 6 February 2014, Preston was examined by his primary care physician, who ordered the MRI. On 10 February 2014, Preston returned to his primary care physician to discuss the MRI results, which revealed no neurological explanation for Prestons symptoms. On 13 February 2014, six days before his scheduled outpatient cardiology follow-up, Preston suffered a fatal heart attack in his home.
On 25 November 2015, Plaintiff filed a wrongful death medical malpractice complaint against Dr. Prodduturvar and Dr. Doctor, and four medical entities associated with Vidant Medical Center (first complaint). Plaintiff alleged the physicians were medically negligent in their care of Preston during his admission to the hospital and their failure to order further immediate testing and medical treatment before he was discharged from the hospital. Neither Dr. Movahed nor Dr. Joshi were named in the first complaint.
On 12 February 2016, two days before the applicable statute of limitations period expired, Plaintiff filed a second wrongful death medical malpractice complaint, this time naming Dr. Movahed and Dr. Joshi, and their employer, Pitt County Memorial Hospital, Incorporated, d/b/a Vidant Medical Center (second complaint). The second complaint asserted Dr. Movahed was negligent in that he
a. Failed to accurately interpret and communicate the findings and significance of diagnostic tests performed on Mr. Preston;
b. [F]ailed to adequately, appropriately and timely suggest and perform a full assessment and work-up to rule out life-threatening acute coronary artery disease for a patient at high risk for the disease, including, but not limited to, cardiac catheterization ;
c. [F]ailed to recommend a cardiology consult for Mr. Preston prior to his discharge from Vidant Medical Center with acute chest pain;
d. [F]ailed to conduct an adequate assessment of Mr. Prestons risk factors for coronary artery syndrome;
e. [F]ailed to prescribe any treatment to Mr. Preston for possibility of acute coronary artery disease before discharging him from the hospital; [and]
f. [F]ailed to comply with standards of practice among physicians and cardiolovascular [sic] disease specialists with the same or similar training and experience in Pitt County, North Carolina, or similar communities in 2014[.]
The complaint also included the following Rule 9(j) certificate:
the medical care of the defendant and all medical records pertaining to the alleged negligence of this defendant that are available to the plaintiff after reasonable inquiry have been reviewed before the filing of this complaint by a person who is reasonably expected to qualify as an expert witness under Rule 702 of the North Carolina Rules of Evidence and who is willing to testify that the medical care did not comply with the applicable standard of care.
On 25 April 2016, Defendant filed his answer to the second complaint, denying all allegations of negligence and breach of the standard of care, and moving to dismiss Plaintiffs action, inter alia , [i]f discovery indicates that Plaintiff did not comply with the requirements of Rule 9(j)[.]
On 9 August 2016, in response to Defendants Rule 9(j) interrogatories, Plaintiff identified Stuart Toporoff, M.D., a physician specializing in the area of cardiology, and Andy S. Pierce, M.D., a physician specializing in the area of internal medicine and hospitalist care, as her Rule 9(j) pre-review medical experts. Attached to her response, Plaintiff included, inter alia , Dr. Toporoffs curriculum vitae and a Rule 9(j) pre-review medical expert affidavit signed by Dr. Toporoff. In his affidavit, Dr. Toporoff stated he had reviewed the medical records related to medical care provided to William Preston during his presentation with chest pain to Vidant Medical Center on February 3-4, 2014 and had been provided a packet of information ... about the training and experience of ... [Dr.] Movahed and the Answer of Defendant Neha Doctor, MD to the first complaint. Based upon his review of these materials, Dr. Toporoff opined that the medical care provided to William Preston during his admission to Vidant Medical Center ... for chest pain, failed to comply with the applicable standard of care for the evaluation of a patient with chest and arm pain who presented with Mr. Prestons signs, symptoms and medical history and expressed [his] willingness to testify to the above if called upon to do so.
On 15 December 2016, Plaintiff submitted an expert witness designation, identifying her Rule 9(j) experts Dr. Toporoff and Dr. Pierce, as well as nuclear cardiologists Mark I. Travin, M.D., and Salvador Borges-Neto, M.D.
On 23 March 2017, Defendant deposed Dr. Toporoff. During his deposition, Dr. Toporoff confirmed that Dr. Movaheds involvement in Prestons care was limited to interpreting his NST results. Dr. Toporoff also admitted that, as a non-nuclear cardiologist who never interpreted the results of an NST, he was incompetent to qualify as a nuclear cardiologist against Dr. Movahed or criticize his interpretation of the nuclear imaging component of Prestons NST. But, Dr. Toporoff testified that he felt qualified as a clinical cardiologist who interpreted EKG tracings when administering treadmill stress tests to patients and thus comfortable stating Dr. Movaheds interpretation of the EKG component of Prestons NST fell below the applicable standard of care. However, Dr. Toporoff further testified that, when initially consulted to review the case before Plaintiff filed her first lawsuit against the physicians, he told Plaintiff not to name Dr. Movahed because Dr. Toporoff refused to testify against him unless Plaintiff retained a nuclear cardiologist competent and willing to testify that Dr. Movaheds interpretation of the nuclear imaging component of Prestons NST fell below the applicable standard of care. As to what new information Dr. Toporoff reviewed in between the filings of the first and second lawsuit, he admitted that the only additional medical record was the nuclear images from Prestons NST, which he confirmed he was incompetent to interpret, and Dr. Doctors pleading in response to the first lawsuit.
On 16 June 2017, Defendant filed a second motion to dismiss Plaintiffs second complaint under North Carolina Civil Procedure Rules 12(b)(6), 9(j), and 41. In response, Plaintiff submitted a third affidavit from Dr. Toporoff signed 15 September 2017. In his third affidavit, Dr. Toporoff explained in greater detail the significance of Dr. Doctors pleading in response to the first complaint, which Dr. Toporoff had reviewed prior to signing his second Rule 9(j) affidavit naming Dr. Movahed before Plaintiff filed the second complaint. Dr. Toporoff stated as follows:
7) Based on the representation by Dr. Doctor in those documents of the following information: that Dr. Movaheds report was NOT available to her prior to Mr. Prestons discharge; that Dr. Movahed had specifically made recommendations to the hospitalist; and that Dr. Joshi communicated the results of the nuclear stress test with cardiologys recommendation for an outpatient CT angiogram, I informed [Plaintiff] I was willing to testify that Dr. Movahed and Dr. Joshi violated standards of care in their collaboration and treatment of Mr. Preston.
8) My criticisms of Drs. Movahed and Joshi include: failures to interpret, diagnose, document and communicate to the ordering physician the presence of chest pain and ST wave depression changes during Mr. Prestons nuclear treadmill stress test that were consistent with ischemia; and failure to recommend an immediate cardiology consult for Mr. Preston prior to his discharge.
On 18 September 2017, the trial court held a Rule 9(j) compliance hearing on Defendants motion to dismiss Plaintiffs complaint. On 25 October 2017, the trial court entered an order, concluding in relevant part that Dr. Movaheds deposition testimony established the facially valid Rule 9(j) certificate in Plaintiffs second complaint was factually unsupported when filed, and that Plaintiff had failed to comply with Rule 9(j)s substantive requirements before the applicable statute of limitations period had expired. Accordingly, the trial court granted Defendants motion to dismiss Plaintiffs complaint for substantive Rule 9(j) noncompliance. Plaintiff appeals.
II. Discussion
On appeal, Plaintiff contends the trial court erred by granting Defendants motion to dismiss her action for noncompliance with Rule 9(j) because (1) her complaint satisfied the purpose and substantive requirements underlying Rule 9(j) ; (2) the trial court erred by determining it was unreasonable for Plaintiff to expect Dr. Toporoff to qualify as an expert witness against Dr. Movahed; and (3) three of the trial courts twenty-seven factual findings supporting its ultimate ruling were not supported by competent evidence. Because Plaintiffs challenges to the trial courts factual findings inform our analysis as to whether her first two issues presented have merit, we first address Plaintiffs challenges to the evidentiary sufficiency of the trial courts factual findings.
A. North Carolina Civil Procedure Rule 9(j)
Rule 9(j) serves as a gatekeeper, enacted by the legislature, to prevent frivolous malpractice claims by requiring expert review before filing of the action. Vaughan v. Mashburn , --- N.C. ----, ----, 817 S.E.2d 370, 375 (2018) (quoting Moore v. Proper , 366 N.C. 25, 31, 726 S.E.2d 812, 817 (2012) ). The Rule mandates that a medical malpractice complaint shall be dismissed unless
[t]he pleading specifically asserts that the medical care and all medical records pertaining to the alleged negligence ... have been reviewed by a person [ (1) ] who is reasonably expected to qualify as an expert witness under Rule 702 of the Rules of Evidence and [ (2) ] who is willing to testify that the medical care did not comply with the applicable standard of care[.]
N.C. Gen. Stat. § 1A-1, Rule 9(j)(1) (2017) (emphases added). However, a complaint facially valid under Rule 9(j) may be dismissed if subsequent discovery establishes that the certification is not supported by the facts, at least to the extent that the exercise of reasonable diligence would have led the party to the understanding that its expectation was unreasonable. Moore , 366 N.C. at 31-32, 726 S.E.2d at 817 (internal citations omitted).
Because Rule 9(j) requires certification at the time of filing that the necessary expert review has occurred, compliance or noncompliance with the Rule is determined at the time of filing[,] id. at 31, 726 S.E.2d at 817, 366 N.C. 25 (citations omitted), and when conducting this analysis, a court should look at the facts and circumstances known or those which should have been known to the pleader at the time of filing[,] id. (quoting Trapp v. Maccioli , 129 N.C. App. 237, 241, 497 S.E.2d 708, 711 (1998) ).
B. Standard of Review
We review de novo a trial courts dismissal of a medical malpractice complaint for substantive Rule 9(j) noncompliance.
Estate of Wooden ex rel. Jones v. Hillcrest Convalescent Ctr., Inc. , 222 N.C. App. 396, 403, 731 S.E.2d 500, 506 (2012) (citations omitted). Where, as here, a trial court determines a Rule 9(j) certification is not supported by the facts, the court must make written findings of fact to allow a reviewing appellate court to determine whether those findings are supported by competent evidence, whether the conclusions of law are supported by those findings, and, in turn, whether those conclusions support the trial courts ultimate determination. Id. (quoting Moore , 366 N.C. at 32, 726 S.E.2d at 818 ).
Additionally, because Rule 9(j) imposes multiple threshold pleading requirements that must be satisfied to survive dismissal, each one must be factually supported in order to be substantively compliant with Rule 9(j). Thus, if subsequent discovery establishes a facially valid certificate has no factual support for one of Rule 9(j)s strict pleading requirements, a medical malpractice complaint is properly dismissed for substantive Rule 9(j) noncompliance. See , e.g. , McGuire v. Riedle , 190 N.C. App. 785, 788, 661 S.E.2d 754, 758 (2008) (affirming dismissal for substantive Rule 9(j) noncompliance solely on the ground that the [p]laintiff did not present the trial court with an expert who was willing to testify that the medical care did not comply with the applicable standard of care. (quoting N.C. Gen. Stat. § 1A-1, Rule 9(j)(1) )).
C. Sufficiency of Factual Findings
The trial court here entered twenty-seven findings supporting its ultimate decision to dismiss Plaintiffs complaint for substantive Rule 9(j) noncompliance. In her brief, Plaintiff challenges only the evidentiary sufficiency of factual findings 22, 24, and 27, rendering the remaining twenty-four findings binding on appeal. Ingram v. Henderson Cty. Hosp. Corp., Inc. , --- N.C. App. ----, ----, 815 S.E.2d 719, 733 (2018) (citation omitted). We thus first address the evidentiary sufficiency of each challenged finding, and then assess whether the trial courts findings supported its conclusions and ultimate decision.
1. Factual Finding 22
Plaintiff first challenges factual finding 22, which reads: Dr. Toporoff ... admitted that Dr. Movaheds involvement was limited to the interpretation of the nuclear stress test that was performed on Mr. Preston. During his deposition, Dr. Toporoff specifically confirmed that Dr. Movaheds involvement in this case is the interpretation of the nuclear stress test that was performed on Mr. Preston[.] This exchange supplied competent evidence to support the finding.
Plaintiff argues the finding was erroneous because the nuclear stress test involves two parts: the exercise treadmill stress test and the nuclear heart images and Dr. Toporoff was critical of Dr. Movaheds interpretation of the ... exercise treadmill portion, which revealed issues with Mr. Prestons heart requiring immediate further testing. Plaintiffs explanation of the NST does not make the challenged finding erroneous, nor does it contradict or undermine the competent evidence supporting the finding. Moreover, [t]he well-established rule is that findings of fact by the trial court supported by competent evidence are binding on the appellate courts even if the evidence would support a contrary finding. Scott v. Scott , 336 N.C. 284, 291, 442 S.E.2d 493, 497 (1994) (citation omitted).
2. Factual Finding 24
Plaintiff next challenges factual finding 24, which reads: Dr. Toporoff only agreed to testify in the Second Lawsuit if Plaintiffs counsel retained a nuclear cardiologist. She argues this finding was erroneous because Dr. Toporoff (1) opined in his Rule 9(j) affidavits that Prestons medical care failed to comply with the standard of care and expressed [his] willingness to testify to the above if called upon to do so; and (2) testified when deposed that, at the time he signed his second Rule 9(j) affidavit prior to the filing of the second lawsuit, he felt comfortable saying that Dr. Movahed failed to meet the standard of care as to the interpretation of the exercise treadmill test.
When deposed, Dr. Toporoff testified that during his initial pre-lawsuit review before Plaintiff filed her first complaint against the hospitalists, he said to Plaintiff that he would not add Dr. Movahed to the lawsuit unless she got another nuclear cardiologist to interpret the images because Dr. Toporoff did not want to get into an across-the-table where [Dr. Movahed was] highly competent in that field on paper and [he] ha[d] no business criticizing his summaries. After Dr. Toporoff acknowledged he was unqualified to testify against Dr. Movahed as a nuclear cardiologist, he explained: [T]hats how [Dr. Movaheds] name got added later [to the second lawsuit]. I refused to be a nuclear cardiologist against [Dr. Movahed]. Later, when asked whether he wanted to change any answers to his prior testimony, Dr. Toporoff stated:
At the beginning, I just wanted to make it clear, because I remember a conversation I had with [Plaintiffs attorney], that I would not testify against Dr. Movahed unless she came up with a nuclear cardiologist because I did not want to be across from him where hes talking about nuclear images and I have to say, I know nothing. And once we agreed that she would get somebody else, then I felt I could handle myself clinically.
The above testimony, including Dr. Toporoffs testimony that he would not testify against Dr. Movahed unless [Plaintiff] came up with a nuclear cardiologist provides competent evidence directly supporting the trial courts challenged finding number 24 that Dr. Toporoff only agreed to testify in the Second Lawsuit if Plaintiffs counsel retained a nuclear cardiologist. To the extent Plaintiff argues that Dr. Toporoffs Rule 9(j) affidavits or other deposition testimony may have supported a different finding, findings of fact by the trial court supported by competent evidence are binding on the appellate courts even if the evidence would support a contrary finding. Id. (citation omitted). We overrule this argument.
Although unnecessary to our resolution of this issue, we nonetheless address Plaintiffs argument that Dr. Toporoff consistently and sufficiently indicated his ability to render opinions regarding the treadmill stress test and the communication failure of those results. To support this argument, Plaintiff emphasizes Dr. Toporoffs later deposition testimony in which he confirmed he had opinions separate and apart from the NST images and was comfortable ... when [he] did the 9(j) affidavit[ ] ... saying that Dr. Movahed failed to meet the standard of care as it applies to a cardiologist interpreting a treadmill stress test [.]
Dr. Toporoffs statement that he had opinions separate and apart from the NST images was immediately followed by his confirmation that he didnt feel as confident expressing those [opinions] until [he] had some kind ... of support for the NST images as well. Moreover, merely having an opinion does not indicate ones willingness to testify as to that opinion. Additionally, Dr. Toporoffs confirmation that he was comfortable ... when [he] did the 9(j) affidavit ... saying that Dr. Movahed failed to meet the standard of care as it applies to a cardiologist interpreting a treadmill stress test was not an unequivocal assertion that he was willing to testify against Dr. Movahed. Regardless of whether Dr. Toporoff had opinions or was comfortable saying something about Dr. Movahed regarding the treadmill-stress-test component of interpreting the NST, Dr. Toporoffs testimony considered contextually establishes that his willingness to testify against Dr. Movahed in any capacity was conditioned upon having the support of a nuclear cardiologist who was competent and willing to testify against Dr. Movahed as to the nuclear-imaging component.
3. Factual Finding 27
Plaintiff next challenges factual finding 27, which reads: [A]s of the date the Second Lawsuit was filed, Plaintiff had no cardiologist competent or willing to testify against ... Dr. Movahed .... Plaintiff argues this finding was unsupported because [t]he record makes clear that Dr. Toporoff was able and willing to testify against Dr. Movahed, and ... was qualified to do so.
The unchallenged findings establish that Dr. Toporoff was Plaintiffs only Rule 9(j) pre-lawsuit review cardiologist, and the two nuclear cardiologists were consulted months after the second lawsuit was filed and after the statute of limitations had expired. Having concluded above that Dr. Toporoffs testimony supported challenged factual finding 24-Dr. Toporoff only agreed to testify in the Second Lawsuit if Plaintiffs counsel retained a nuclear cardiologist-that finding, along with unchallenged factual finding 8 establishing that Plaintiff failed to retain a nuclear cardiologist until months after she filed the second lawsuit, support the part of challenged finding 27 that as of the date the Second Lawsuit was filed, Plaintiff had no cardiologist ... willing to testify against ... Dr. Movahed ....
In light of our conclusion that competent evidence supported that part of the finding that no cardiologist was willing to testify against Dr. Movahed at the time Plaintiff filed her second lawsuit, we need not address the sufficiency of evidence supporting that part of the finding as to whether Dr. Toporoff was competent to testify in any capacity against Dr. Movahed. See Vaughan , --- N.C. at ----, 817 S.E.2d at 375 ([R]ule [9(j) ] averts frivolous actions by precluding any filing in the first place by a plaintiff who is unable to procure an expert who both meets the appropriate qualifications and, after reviewing the medical care and available records, is willing to testify that the medical care at issue fell below the standard of care. (emphasis added)).
D. Sufficiency of Legal Conclusions
Having concluded challenged factual findings 22, 24, and the no cardiologist willing to testify portion of finding 27 were supported by competent evidence, our review is whether those findings and the trial courts remaining unchallenged findings supported its conclusions and ultimate decision to dismiss Plaintiffs complaint for substantive Rule 9(j) noncompliance.
The trial court made the following relevant factual findings:
2. ... Mr. Preston ... had a nuclear stress test (NST) conducted.
3. The NST was interpreted by an attending nuclear cardiologist ..., Dr. Movahed.
8. On February 12, 2016, [Plaintiff] filed a second malpractice lawsuit ....
10. This Second Lawsuit alleges that Dr. Movahed ... w[as] negligent in [his] care and treatment of Mr. Preston prior to his discharge from VMC.
12. The Second Lawsuit ... contained a certification paragraph that was facially compliant with Rule 9(j)....
13. ... Plaintiff identified two 9(j) expert witnesses: Dr. Stuart Toporoff, a non-nuclear cardiologist ..., and Dr. Andy Pierce, a hospitalist ....
14. On December 15, 2016, Plaintiff formally designated her expert witnesses, which, in addition to Drs. Toporoff and Pierce, included two nuclear cardiologists, Dr. Mark Travin ... and Dr. Salvadore Borges-Neto ....
15. Plaintiff does not contend, nor would the record support, that these two nuclear cardiologists were consulted with, or agreed to provide testimony, prior to the Plaintiff filing either of the two lawsuits.
16. On March 31, 2017, Defendants deposed Dr. Pierce, who admitted that he is not a cardiologist and, therefore, is not really the person to critique Movahed.
19. On March 23, 2017, Defendants [deposed] Dr. Toporoff, a clinical cardiologist. Dr. Toporoff admitted that he is not a nuclear cardiologist, and has never interpreted nuclear stress tests.
22. Dr. Toporoff ... admitted that Dr. Movaheds involvement was limited to the interpretation of the nuclear stress test that was performed on Mr. Preston.
23. Dr. Toporoff ... testified that he had no business criticizing and did not feel competent criticizing Dr. Movaheds interpretation of the NST, and that he would look like a fool trying to interpret the [NST] images. Dr. Toporoff further testified that he would not testify against Dr. Movahed unless [Plaintiffs attorney] came up with a nuclear cardiologist [expert]. 24. Accordingly, Dr. Toporoff only agreed to testify in the Second Lawsuit if Plaintiffs counsel retained a nuclear cardiologist.
25. Plaintiff did not consult with [nuclear cardiologist] Dr. Travin until March 30, 2016.
26. Plaintiff did not consult with [nuclear cardiologist] Dr. Borges-Neto until mid-November, 2016.
27. Accordingly, as of the date the Second Lawsuit was filed, Plaintiff had no cardiologist ... willing to testify against ... Dr. Movahed ....
Upon the findings, the trial court made the following relevant legal conclusions:
31. Dr. Toporoffs deposition testimony demonstrated that, at the time the Second Lawsuit was filed, he was not willing to testify that the medical care at issue failed to comply with the applicable standard of care.
34. Dr. Pierce testified that he had no opinions that were critical of the medical care provided by Dr. Movahed ....
35. As Mr. Preston died February 13, 2014, Plaintiff had two years to file a medical malpractice action. ...
36. As of the date that the statute of limitations expired for the Second Lawsuit, February 13, 2016, Plaintiff had not complied with Rule 9(j).
37. Despite the fact that Plaintiff subsequently obtained a nuclear cardiologist willing to testify regarding Dr. Movahed, it was only after the Second Lawsuit had been filed and after the statute of limitations had expired. ...
We hold these findings support the conclusions, and the conclusions support the trial courts ultimate determination that Plaintiff has failed to comply with the requirements of Rule 9(j) in regard to her Complaint in the Second Lawsuit, and that therefore, [her complaint] should be dismissed in its entirety, with prejudice. Specifically, finding 13 establishes that Dr. Toporoff was Plaintiffs only Rule 9(j) cardiologist who had reviewed Prestons care before the second lawsuit was filed. Finding 24 establishes that Dr. Toporoff only agreed to testify against Dr. Movahed if Plaintiff hired a nuclear cardiologist. And findings 14, 15, 25, and 26 establish that Plaintiff failed to consult with the nuclear cardiologists she retained until months after she filed the second lawsuit. Those findings support the part of finding 27 that, as of the date the Second Lawsuit was filed, Plaintiff had no cardiologist ... willing to testify against ... Dr. Movahed .... These findings support the trial courts dispositive conclusion that Plaintiff has failed to comply with the requirements of Rule 9(j) in regard to her Complaint in the Second Lawsuit and its ultimate decision to dismiss her complaint for substantive Rule 9(j) noncompliance. Cf. Thigpen v. Ngo , 355 N.C. 198, 204, 558 S.E.2d 162, 166-67 (2002) (Allowing a plaintiff to file a medical malpractice complaint and to then wait until after the filing to have the allegations reviewed by an expert would pervert the purpose of Rule 9(j).). Accordingly, we affirm the trial courts order.
In light of our holding that the trial courts findings and conclusions supported its determination that Plaintiff failed to substantively comply with Rule 9(j)s requirement of securing a pre-lawsuit review medical expert willing to testify against Dr. Movahed, we need not address Plaintiffs remaining challenges to the sufficiency of the findings or conclusions supporting the trial courts additional determination that Plaintiff failed to substantively comply with Rule 9(j)s requirement that it was reasonable for Plaintiff to expect Dr. Toporoff to qualify as an expert witness against Dr. Movahed. Cf. McGuire , 190 N.C. App. at 788, 661 S.E.2d at 758 (affirming dismissal of a medical malpractice complaint for substantive Rule 9(j) noncompliance solely on the ground that the [p]laintiff did not present the trial court with an expert who was willing to testify .... (citation omitted)); id. at 788 n.1, 661 S.E.2d at 758 n.1 (We decline to address the parties arguments regarding Dr. Majors review of the care given. In order to satisfy the Rule 9(j)(1) requirements, plaintiffs expert must have been willing to testify. Because he was not so willing, it is irrelevant whether he in fact reviewed the care that plaintiff received.).
III. Conclusion
Because the trial courts findings supported by Dr. Toporoffs deposition testimony established that his willingness to testify against Dr. Movahed was conditioned upon Plaintiff securing a nuclear cardiologist, both of whom were consulted and retained months after she filed her second complaint and the applicable statute of limitations period had expired, no factual support existed for that part of Plaintiffs Rule 9(j) certification that her second complaint had been reviewed by a person ... willing to testify that the medical care did not comply with the applicable standard of care. Accordingly, we affirm the trial courts order granting Defendants motion to dismiss Plaintiffs complaint for substantive Rule 9(j) noncompliance.
AFFIRMED.
Judges TYSON and ZACHARY concur.
The remaining Defendants have settled the claims against them and Plaintiff has voluntarily dismissed them from this appeal pursuant to N.C. R. App. P. 37(e)(2) (2018).
Plaintiff attached Dr. Toporoffs 10 November 2015 affidavit, which was relevant to her first lawsuit against the hospitalists. She later supplied Defendant with Dr. Toporoffs 12 February 2016 affidavit, which was relevant to her second lawsuit and intended to be attached to her response. We discuss only Dr. Toporoffs second affidavit.