Case Title: Special v. W. Boca Med. Ctr.

Citation: 

Docket Number: SC11-2511

State: florida

Court: Florida Supreme Court

Date: 2014-11-13T00:00:00Z

Document:
Supreme Court of Florida 
 
 
____________ 
 
No. SC11-2511 
____________ 
 
FRANK SPECIAL, et al.,  
Petitioners, 
 
vs. 
 
WEST BOCA MEDICAL CENTER, et al.,  
Respondents. 
 
[November 13, 2014] 
 
LABARGA, C.J. 
 
This case is before the Court for review of the decision of the Fourth District 
Court of Appeal in Special v. Baux, M.D., et al., 79 So. 3d 755 (Fla. 4th DCA 
2011).  In its decision, the district court ruled upon the following question, which 
the court certified to be of great public importance: 
IN A CIVIL APPEAL, SHALL ERROR BE HELD HARMLESS 
WHERE IT IS MORE LIKELY THAN NOT THAT THE ERROR 
DID NOT CONTRIBUTE TO THE JUDGMENT? 
 
Id. at 771-72.  We have jurisdiction.  See art. V, § 3(b)(4), Fla. Const.  As we 
explain below, we answer the certified question in the negative.  We hold that the 
test for harmless error requires the beneficiary of the error to prove that the error 
 
 
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complained of did not contribute to the verdict.  Alternatively stated, the 
beneficiary of the error must prove that there is no reasonable possibility that the 
error complained of contributed to the verdict.  We begin by setting forth the facts 
and the procedural history of this case, and we then turn to our discussion of the 
proper harmless error test in civil appeals.  We conclude with our discussion of the 
harmless error test as applied to the facts of this case.  Because there is a 
reasonable possibility that certain errors by the trial court contributed to the 
verdict, we reverse the judgment of the district court and remand for a new trial. 
 
In order to avoid any possible confusion stemming from our multiple 
opinions, we further explain that a majority of this Court (Chief Justice Labarga 
and Justices Lewis, Quince, and Perry) concur as to the harmless error standard 
that we announce today.  Moreover, a majority of this Court (Chief Justice Labarga 
and Justices Pariente, Lewis, Quince, and Perry) concur that Petitioner, Frank 
Special, is entitled to a new trial.  While the separate opinions reach different 
conclusions about the three instances of harmless error argued as grounds for a 
new trial, as explained more fully below, the plurality opinion grants a new trial 
based on two harmful errors (the exclusion of testimony relating to the over-
diagnosis of amniotic fluid embolus (AFE) and the exclusion of testimony 
regarding statements made to the medical examiner through her attorney). 
 
 
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FACTS AND PROCEDURAL HISTORY 
 
In 2003, Susan Special (Susan) died following the delivery of her son.  
Frank Special (Special), as the personal representative of his wife Susan’s estate, 
sued Dr. Ivo Baux and his related corporations (Baux), and West Boca Medical 
Center, Inc. (West Boca), for negligence.  The Fourth District detailed the 
following events concerning the birth: 
Susan Special became pregnant at age 38.  Five weeks before 
her due date, [Susan] underwent a cesarean delivery.  She was 
wheeled into the operating room at the Center’s labor and delivery 
suite.  Dr. Baux, the anesthesiologist, administered spinal anesthesia.  
A moment after the placenta was removed, Susan became 
unresponsive, her blood pressure fell precipitately, and she went into 
cardiopulmonary arrest.  Dr. Baux and hospital staff attempted to 
revive her.  She was temporarily resuscitated and transferred to the 
Intensive Care Unit, where another cardiopulmonary arrest occurred.  
Susan died five hours after the delivery. 
 
Id. at 757. 
 
Following Susan’s death, Special filed a lawsuit against defendants Baux 
and West Boca, which alleged that the defendants’ negligence caused Susan’s 
death.  The lawsuit proceeded to trial, at which the cause of Susan’s death was the 
central issue.  Special alleged that Baux and West Boca “were negligent in 
administering anesthesia, in monitoring [Susan’s] system and controlling her fluids 
during surgery, and in responding to her cardiopulmonary arrests.”  Id.  Baux and 
West Boca defended against these claims and asserted that Susan’s death was 
 
 
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caused by an amniotic fluid embolus (AFE), which is an allergic reaction that 
develops when a mother’s blood mixes with amniotic fluid.   
 
The parties offered conflicting expert testimony concerning the cause of 
Susan’s death.  Ultimately, the jury found that Baux and West Boca were not liable 
for Susan’s death, and the trial court entered judgment in favor of the defendants.  
Special appealed to the Fourth District Court of Appeal, which ultimately 
considered this case en banc in order “to reconsider other decisions of this court 
describing the harmless error test in civil cases.”  Id. at 757.  The district court held 
that “[t]o avoid a new trial, the beneficiary of the error in the trial court must show 
on appeal that it is more likely than not that the error did not influence the trier of 
fact and thereby contribute to the verdict.”  Id. at 771.  The district court then 
applied the “more likely than not” harmless error test to the facts of Special and 
concluded that it was more likely than not that the alleged errors did not contribute 
to the verdict.  Id. at 772.  Having concluded harmless error, the district court 
affirmed the trial court’s judgment in favor of Baux and West Boca. 
 
However, the district court certified to this Court a question of great public 
importance for the purpose of determining the proper test for harmless error in civil 
appeals.  This Court accepted jurisdiction in order to consider the certified 
question.  In addition to the question certified by the district court, before this 
Court, Special argues specific instances of harmful error: (1) the exclusion of the 
 
 
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proffered testimony of Dr. Gary Dildy, the defense AFE expert; and (2) the 
exclusion of evidence related to the alleged witness tampering of Dr. Barbara 
Wolf, the chief deputy medical examiner.  We begin with our discussion of 
harmless error and the appropriate test for harmless error in civil appeals.  We then 
evaluate the assertions of error in this case in light of the test that we announce 
today.  
ANALYSIS 
The Test for Harmless Error 
 
The purpose of the harmless error analysis is to “conserve judicial labor by 
holding harmless those errors which, in the context of [a] case, do not vitiate the 
right to a fair trial and, thus, do not require a new trial.”  State v. DiGuilio, 491 So. 
2d 1129, 1135 (Fla. 1986).  Although the harmless error analysis serves a clear 
purpose, over time, the test for determining whether error is indeed harmless has 
been fluid.  As we discuss below, this Court has previously set forth the test for 
harmless error in criminal appeals; however, the question certified by the district 
court calls upon this Court to announce the correct test for harmless error in civil 
appeals.  Because the certified question presents a pure question of law, our 
standard of review is de novo.  See Jackson-Shaw Co. v. Jacksonville Aviation 
Auth., 8 So. 3d 1076, 1085 (Fla. 2008) (citing Macola v. Gov’t Emp. Ins. Co., 953 
So. 2d 451, 454 (Fla. 2006)).  
 
 
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As we consider the proper test for determining harmless error in civil 
appeals, we are mindful of the harmless error rule contained in section 59.041, 
Florida Statutes (2003), which provides as follows: 
Harmless error; effect.—No judgment shall be set aside or 
reversed, or new trial granted by any court of the state in any cause, 
civil or criminal, on the ground of misdirection of the jury or the 
improper admission or rejection of evidence or for error as to any 
matter of pleading or procedure, unless in the opinion of the court to 
which application is made, after an examination of the entire case it 
shall appear that the error complained of has resulted in a miscarriage 
of justice.  This section shall be liberally construed. 
§ 59.041, Fla. Stat. (2003).1  Under this rule, appellate courts must evaluate 
harmless error on a case-by-case basis.  Moreover, within the context of each case, 
in order to determine whether “the error complained of has resulted in a 
miscarriage of justice,” the court’s analysis must include an examination of the 
entire record.  What remains, however, with respect to civil appeals, is an 
interpretation of the language “resulted in a miscarriage of justice”—i.e., the 
determination of a test for harmless error.  Over time, a number of approaches to 
harmless error have evolved.  This evolution has resulted in the application of a 
variety of tests to determine harmless error.       
However, it is appropriate to begin our analysis of the proper test for 
harmless error in civil appeals with this Court’s decision in DiGuilio—a seminal 
                                          
 
 
1.  The harmless error rule contained in section 59.041 was codified in 1911 
and has not substantively changed since that time. 
 
 
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decision in the line of cases interpreting harmless error in Florida, wherein this 
Court set forth the test for harmless error in criminal cases.  In DiGuilio, the 
defendant was convicted of conspiracy to traffic in cocaine.  491 So. 2d at 1130.  
On appeal, his conviction was reversed by the district court because the prosecutor 
improperly “elicited testimony from a witness which could be interpreted by the 
jury as a comment on [the defendant’s] right to remain silent.”  Id.  The district 
court certified a question of great public importance to this Court, asking this Court 
to determine whether comments on a defendant’s right to remain silent are subject 
to harmless error analysis, as opposed to a rule of per se reversal.  Id.  This Court 
answered the certified question in the affirmative and held that while comments on 
a defendant’s right to remain silent amount to constitutional error, such comments 
“are subject to harmless error analysis. . . .”  Id. at 1137.   
Having held that the harmless error test applied to DiGuilio’s claim of error, 
this Court explained that in order to demonstrate harmless error, “the beneficiary of 
the error [has the burden] to prove beyond a reasonable doubt that the error 
complained of did not contribute to the verdict or, alternatively stated, that there is 
no reasonable possibility that the error contributed to the conviction.”  Id. at 1135, 
1139 (citing Chapman v. California, 386 U.S. 18, 24 (1967)).  Thus, as opposed to 
a result-oriented test that is strictly focused on the accuracy of the result or the 
weight of the evidence, the DiGuilio harmless error test focuses on the effect of the 
 
 
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error on both the trier-of-fact and the result.  See Johnson v. State, 53 So. 3d 1003, 
1007 (Fla. 2010) (emphasis added) (“The test for harmless error focuses on the 
effect of the error on the trier of fact.”); Burns v. State, 699 So. 2d 646, 652 (Fla. 
1997) (noting that reversal is required if the error contributed to the jury’s 
recommendation or the error contributed to the outcome).  To emphasize the 
appellate court’s duty to focus on the effect of the error on the trier-of-fact, we 
explained that the harmless error test is not: 
a sufficiency-of-the-evidence, a correct result, a not clearly wrong, a 
substantial evidence, a more probable than not, a clear and 
convincing, or even an overwhelming evidence test.  Harmless error is 
not a device for the appellate court to substitute itself for the trier-of-
fact by simply weighing the evidence. 
 
DiGuilio, 491 So. 2d at 1139.  Moreover, a determination of whether an error is 
harmless should not be made in a vacuum.  Rather, the 
[a]pplication of [this] test requires an examination of the entire record 
by the appellate court including a close examination of the permissible 
evidence on which the jury could have legitimately relied, and in 
addition an even closer examination of the impermissible evidence 
which might have possibly influenced the jury verdict. 
 
Id. at 1135.  Thus, the appellate court must remain focused on the error itself in 
order to evaluate whether the beneficiary of the error has proven that there is no 
reasonable possibility that the error contributed to the verdict.   
 
 
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The Test for Harmless Error in Civil Appeals 
Although the test for harmless error as stated in DiGuilio applies to criminal 
appeals, we conclude that this test, with slight modification to accommodate the 
civil context, is also the appropriate test for harmless error in civil appeals.  Thus, 
today, we announce the following test for determining harmless error in civil 
appeals:  
To test for harmless error, the beneficiary of the error has the burden 
to prove that the error complained of did not contribute to the verdict.  
Alternatively stated, the beneficiary of the error must prove that there 
is no reasonable possibility that the error contributed to the verdict.  
  
Thus, as in DiGuilio, the responsibility for proving harmless error remains 
with the beneficiary of the error, who must demonstrate that there is no reasonable 
possibility that the error contributed to the verdict.  As the appellate court evaluates 
whether the beneficiary of the error has satisfied its burden, the court’s obligation 
is to focus on the effect of the error on the trier-of-fact and avoid engaging in an 
analysis that looks only to the result in order to determine harmless error.  Could 
the admission of evidence that should have been excluded have contributed to the 
verdict?  Could the exclusion of evidence that should have been admitted have 
contributed to the verdict?  Unless the beneficiary of the error proves that there is 
no reasonable possibility that the error contributed to the verdict, the error is 
harmful.     
 
 
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We observe that this test is consistent with the harmless error rule codified in 
section 59.041, and the Legislature’s intent that relief be granted only in the event 
of “a miscarriage of justice.”  An appellate court’s harmless error analysis is not 
limited to the result in a given case, but it necessarily concerns the process of 
arriving at that result.  “A large word like justice, incorporated into a rule 
governing harmless error, compels an appellate court to concern itself not alone 
with a particular result but also with the very integrity of the judicial process.”  
Roger J. Traynor, The Riddle of Harmless Error 17 (1970).  By focusing on the 
effect of the error on the trier-of-fact, the appellate court will evaluate harmless 
error in a manner that is consistent with section 59.041.   
Moreover, the application of the no reasonable possibility test for harmless 
error in civil appeals will serve multiple purposes.  The test acts in a manner so as 
to conserve judicial resources while protecting the integrity of the process.  
Additionally, the test strikes the proper balance between the parties.  While the 
party that seeks relief must still identify the error and raise the issue before the 
appellate court, this test properly places the burden of proving harmless error on 
the beneficiary of the error.  Requiring the beneficiary of the error to demonstrate 
that there is no reasonable possibility that the error contributed to the verdict 
discourages efforts to introduce error into the proceedings.  “Equity and logic 
demand that the burden of proving such an error harmless must be placed on the 
 
 
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party who improperly introduced the evidence.  [Placing] the burden of proof on 
the party against whom the evidence is used . . . would simply encourage the 
introduction of improper evidence.”  Gormley v. GTE Prod. Corp., 587 So. 2d 455, 
459 (Fla. 1991).   
The no reasonable possibility test also strikes the appropriate balance 
between the need for finality and the integrity of the judicial process.  The test 
recognizes that not all errors have a reasonable possibility of contributing to the 
verdict, but the test affords relief on account of errors that do.  Further, the 
application of the no reasonable possibility test for harmless error will foster 
consistency in appellate courts’ analyses of harmless error.  Having articulated the 
proper test for harmless error in civil appeals, we now apply the test to the facts of 
the present case.   
Evaluation of Harmless Error in this Case 
Special argues that the trial court committed harmful error when it excluded 
the proffered cross-examination of the defense AFE expert and when it excluded 
evidence related to two circumstances of alleged witness tampering.  We discuss 
each of these arguments in turn.  Consistent with the discussion that follows, we 
conclude that the exclusion of the cross-examination testimony and the exclusion 
of certain evidence of witness tampering were indeed harmful.  
 
 
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The Cross-Examination of Dr. Dildy 
 
The cause of Susan’s death was the key issue at trial.  Baux and West Boca 
defended themselves against Special’s allegations of negligence on the grounds 
that Susan died as the result of AFE.  Special contested the AFE diagnosis and 
attempted to demonstrate that West Boca had a practice of over-diagnosing AFE.  
To that end, Special argues that the trial court erred when it precluded counsel 
from cross-examining Dr. Gary Dildy, the defense AFE expert, concerning 
whether West Boca was over-diagnosing AFE.   
 
At trial, Dr. Dildy opined that Susan died of AFE.  Dr. Dildy’s diagnosis 
was a diagnosis of exclusion, at which he arrived after ruling out other possible 
causes of death.  On cross-examination, Dr. Dildy testified that approximately one 
in 20,000 births results in AFE, but the occurrence of AFE can range from one in 
8,000 to one in 80,000 births.  Special sought to further cross-examine Dr. Dildy 
with a line of questioning that was intended to undermine the credibility of the 
testimony of those who diagnosed Susan as having died from AFE—including the 
testimony of Dr. Mark Adelman, the West Boca pulmonologist who diagnosed 
Susan with AFE after the emergency began.  Dr. Adelman testified that the 
national average for AFE diagnoses can range from approximately one in 30,000 
births to one in 80,000 births, but he estimated that during the then-eighteen-year 
existence of the obstetrics department at West Boca, there were 20,000 births and 
 
 
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one to two AFE diagnoses per year.  Special introduced an interrogatory response 
from West Boca that showed that contrary to Dr. Adelman’s estimate of 20,000 
births per year, the average number of births per year at West Boca was about 
2,200 births.  Based on the national averages of AFE as testified to by 
Dr. Adelman and Dr. Dildy, Special sought to elicit an opinion from Dr. Dildy on 
whether AFE was being overdiagnosed at West Boca.   
The defense objected to this line of questioning.  After receiving argument 
from the parties, the trial court sustained the defense objection.  However, the trial 
court allowed Special to proffer the cross-examination of Dr. Dildy.  In relevant 
part, Special proffered the following:  
SPECIAL: Dr. Dildy, if, in fact, there are one to two amniotic 
fluid emboluses diagnosed . . . at West Boca Medical Center every 
year, and there are, in fact, 2,200 births per year . . . what does that tell 
you about West Boca Medical Center?  
 
DILDY: Well, under those assumptions, there’s about one per 
thousand, that would be higher than the generally quoted rates in the 
literature.  On the one hand, over a short period of time, it’s certainly 
possible that things can occur in clusters.  Over the long term, if there 
were strong data to suggest that amniotic fluid embolism were 
occurring at that rate over a period—over many years, then I would 
probably have to say that it’s being overdiagnosed. 
 
SPECIAL: And, if, in fact, there’s evidence that over a 17- to 
18-year period, it’s consistently one to two amniotic fluid emboluses 
per year, diagnosed by the critical care doctor, Dr. Adelman, and there 
are 2,200 births approximately per year, over that same period of time, 
do you believe the term “amniotic fluid embolism,” at West Boca 
Medical Center, is being overused? 
 
 
 
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DILDY: If they were at that rate over a long period of time, I 
suspect there’s many cases where you have presumed amniotic fluid 
embolism, but the pattern may not be—in fact, even in our study we 
had a number of presumed cases we excluded. . . .  But, I would say 
certainly there’s no question, there are cases of abnormal outcomes 
and disease states that are labeled as amniotic fluid embolism, where 
other people would argue it’s not.   
 
SPECIAL: If there is 1 in 2,000 births a year, that’s 
approximately ten times what you told us is a fair national average, 
correct?  
 
DILDY: Either ten times or five times, depending upon how 
you do the math, right?  
 
SPECIAL: The math that you gave us was, that you believe is a 
reasonable number, that 1 in 20,000 patients have AFE, correct? 
 
DILDY: That’s one number I offered. It could be 1 in 8,000. 
 
SPECIAL: It could be 1 in 80,000? 
 
DILDY: It could be 1 in 80,000. 
 
SPECIAL: So if there is one a year in West Boca Medical 
Center, that would be 1 in 2,000 as opposed to 1 in 20,000, that’s ten 
times the national average.  
 
DILDY: That would be a higher rate, correct. 
 
SPECIAL: If it’s 1 in 80,000, it would be 40 times the national 
average, right?  
 
DILDY: Correct. 
 
* * * 
 
SPECIAL: . . . If there are two AFEs a year at West Boca 
Medical Center, and the national average is 1 in 80,000 say, okay, and 
 
 
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there’s 2 per 2,000 at West Boca Medical Center, just doing the math, 
that would be 80 times the national average? 
 
DILDY: Under those assumptions, right. 
 
SPECIAL: Under those assumptions, what would that tell you 
about AFE and West Boca Medical Center? 
 
DILDY: I would be very concerned that if this is actually a 
recorded incidence, as opposed to somebody’s recollection.  Because 
if you ask me, what’s the incidence of this or that, I could give you a 
number which is going to be a pretty ballpark number.  If that’s a 
documented incidence, I would be concerned that the rate is probably 
inflated. 
 
SPECIAL: And although you might be off here or there, you 
wouldn’t be off by 40, 80 times the national average, would you, at 
your hospital? 
 
DILDY: It just depends on how the question is asked. . . . 
 
SPECIAL: If you’re asked how many you diagnose a year and 
you say one to two, it shouldn’t be off by 30, 40 times, should it? 
 
DILDY: No, I would say in a place that does a little over 2,000 
deliveries a year, you could easily have one or two a year per couple 
of years or here or there, but you wouldn’t expect to have one or two 
per year long term, no.  But this case here, we’re talking about, it 
doesn’t matter what all these other cases are, this case is this case, and 
this case is an amniotic fluid embolism.   
   
Following the proffer, the trial court restated its ruling that Special would not be 
allowed to cross-examine Dr. Dildy on the issue of over-diagnosis.  On appeal, 
although the district court concluded that the trial court should have allowed the 
excluded testimony, the court also determined that the exclusion of Dr. Dildy’s 
testimony was harmless error under the “more likely than not” standard.   
 
 
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We agree with the district court that the trial court erred in excluding the 
testimony.  The rules of evidence provided the trial court with no discretion to 
exclude the contested cross-examination.  Section 90.403 of the Florida Statutes 
permits trial courts to exclude only evidence in which the “probative value is 
substantially outweighed by the danger of unfair prejudice, confusion of issues, 
misleading the jury, or needless presentation of cumulative evidence.”  § 90.403, 
Fla. Stat. (2007).  Florida courts do not have the authority to bar or limit adverse or 
relevant evidence such as Special attempted to present here.  Because the trial 
court erred when it excluded Dr. Dildy’s testimony, we proceed to evaluate the 
error in light of the harmless error test we announce today.  In doing so, we 
conclude that Baux and West Boca, as the beneficiaries of the error, have not 
demonstrated that there is no reasonable possibility that the exclusion of 
Dr. Dildy’s testimony contributed to the verdict. 
Was the Exclusion of Dr. Dildy’s Testimony Harmless Error? 
The essence of Special’s argument on this issue is as follows: the jury should 
have been allowed to hear Dr. Dildy’s opinion that if one to two out of 2,200 births 
each year at West Boca resulted in a diagnosis of AFE, West Boca was 
overdiagnosing AFE—thus drawing into question the credibility of the diagnosis 
of Susan.  Special contends that the exclusion of this testimony was harmful error.  
We agree.   
 
 
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During the trial, Dr. Dildy reiterated his opinion that Susan died from AFE.  
Dr. Dildy also agreed that AFE was a diagnosis of exclusion, in other words, it is 
diagnosed only after other explanations are ruled out.  As noted by the district 
court in this case, “[w]here the diagnosis is one of exclusion, the frequency with 
which one comes to that conclusion is a ‘material fact’ bearing upon the credibility 
of the diagnosis.”  Special, 79 So. 3d at 759 (footnote omitted).  By precluding the 
jury from considering Dr. Dildy’s testimony with regard to the over-diagnosis of 
AFE, Special was prevented from presenting evidence to demonstrate and further 
support the argument that physicians at West Boca were over-diagnosing AFE.  
The inability to address this issue through Dr. Dildy during cross-examination 
hindered Special’s efforts to undermine the credibility and weight of Baux and 
West Boca’s defense with regard to the cause of Susan’s death as well as the 
credibility of Dr. Dildy, who held steadfast to the AFE diagnosis.  See id. at 759-60 
(“The cross-examination was also relevant to Dr. Dildy’s direct examination where 
he testified to the incidence of AFE in births and its rarity.” (emphasis supplied)).   
We reject the Fourth District’s conclusion that the error was harmless 
because the excluded testimony was cumulative.  The Fourth District stated:  
This issue was presented to the jury through the testimony of Dr. 
Adelman and in part from Dr. Dildy.  This evidence allowed the 
plaintiff’s attorney in closing argument to hammer on the significance 
of the statistical abnormality. 
 
 
 
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Id. at 772.  Because the battle of experts has become as much a part of a trial as the 
conflict that the litigation addresses, see Marsh v. Valyou, 977 So. 2d 543, 548 
(Fla. 2007) (quoting Berry v. CSX Transp., Inc., 709 So. 2d 552, 571 (Fla. 1st 
DCA 1998)); Emory v. Fla. Freedom Newspapers, 687 So. 2d 846, 847 (Fla. 4th 
DCA 1997); Secada v. Weinstein, 563 So. 2d 172, 172 (Fla. 3d DCA 1990); 
Langston v. King, 410 So. 2d 179, 180 (Fla. 4th DCA 1982), Special’s inability to 
critically address the issue of over-diagnosis with Dr. Dildy significantly 
handicapped his case.  Also without merit is Baux and West Boca’s allegation that 
if the trial court erred in excluding this testimony, the error was harmless because 
Special was able to discuss this issue during closing argument.  The commentary 
of counsel in closing is not evidence, nor may the jury consider the mere argument 
as evidence when it deliberates and renders a verdict.  See Braddy v. State, 111 So. 
3d 810, 843 (Fla. 2012) (“The trial court properly instructed the jury that 
statements [offered] during closing argument did not constitute evidence to be 
considered in determining [the defendant’s] guilt.”), cert. denied, 134 S. Ct. 275 
(2013).  Barring an entire line of cross-examination of an expert witness 
concerning critical facts and opinions directly related to the core issue of a case 
necessitates recognition that the responses of the expert witness here would have 
yielded powerful impeachment evidence.  Dr. Dildy’s concession as to the 
inaccuracies and anomalies of Dr. Adelman’s AFE diagnoses would have 
 
 
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reasonably had a significant effect on the jury’s deliberations and decisions, 
particularly with regard to the cause of Susan’s death.   
Given the relevance and probative force of Dr. Dildy’s testimony, the 
exclusion of this cross-examination was in fact harmful.  The jury should have 
been permitted to hear testimony on this factual issue and to weigh it against the 
statements and credibility of the testifying experts.  To the extent that Baux and 
West Boca allege that Dr. Adelman’s numbers concerning the rate of AFE at the 
hospital were “grossly overestimated,” and thus should not serve as a basis for 
Special’s allegation of over-diagnosis, this was an issue for the jury to determine.  
There is more than a “reasonable possibility” that the trial court’s erroneous 
evidentiary ruling contributed to the verdict, and accordingly, a new trial is 
required.  See DiGuilio, 491 So. 2d at 1135.  Having concluded that the exclusion 
of Dr. Dildy’s testimony was harmful error, we now turn to the exclusion of 
evidence of alleged witness tampering.  
Witness Tampering 
Special also argues that the trial court erred when it excluded evidence 
relating to the defense’s alleged witness tampering of Dr. Barbara Wolf, the deputy 
chief medical examiner who performed the autopsy on Susan.  Dr. Wolf concluded 
that the autopsy revealed no evidence of AFE and opined to a reasonable degree of 
medical certainty that Susan did not die of AFE.  A part of the autopsy included 
 
 
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obtaining specimens that were used to create slides for microscopic examination in 
order to determine the presence of AFE.   
According to Special, the defense attempted to intimidate Dr. Wolf because 
she did not agree that AFE was the cause of Susan’s death.  At trial, Dr. Wolf 
testified that while the majority of AFE-related deaths yield evidence of AFE in the 
autopsy, the autopsy of Susan revealed no evidence of AFE.  Although the district 
court did not address this issue in its opinion, “. . . once this Court has jurisdiction 
of a cause, it has jurisdiction to consider all issues appropriately raised in the 
appellate process, as though the case had originally come to this Court on appeal.”  
Savoie v. State, 422 So. 2d 308, 312 (Fla. 1982).  Although “[t]his authority to 
consider issues other than those upon which jurisdiction is based is discretionary 
with this Court and should be exercised only when these other issues have been 
properly briefed and argued and are dispositive of the case,” we do so here because 
of the serious nature of witness tampering allegations.  Id.   
Florida courts permit evidence of threats or witness intimidation if the 
threats are attributable to the opposing party.  See Koon v. State, 513 So. 2d 1253, 
1256 (Fla. 1987) (“It has been held that evidence of threats made against witnesses 
is inadmissible to prove guilt unless the threats are shown to be attributable to the 
defendant.”) (citing Duke v. State, 142 So. 886 (Fla. 1932); Jones v. State, 385 So. 
2d 1042 (Fla. 1st DCA 1980); Coleman v. State, 335 So. 2d 364 (Fla. 4th DCA 
 
 
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1976)); see also State v. Price, 491 So. 2d 536, 536-37 (Fla. 1986) (“A third 
person’s attempt to influence a witness is inadmissible on the issue of the 
defendant’s guilt unless the defendant has authorized the third party’s action.”); 
Manuel v. State, 524 So. 2d 734, 735 (Fla. 1st DCA 1988) (noting that testimony 
concerning witness intimidation is admissible “provided the attempt was with the 
authority, consent, or knowledge of the defendant”).2  It is admissible because it is 
“evidence of a consciousness of guilt,” and there is nothing more sacred than 
judicial proceedings that are free from attempts to tamper with or intimidate 
witnesses.  See Coronado v. State, 654 So. 2d 1267 (Fla. 2d DCA 1995).  Indeed, 
without a judicial proceeding free of intimidation and threats, there is no reason for 
the fact-finding process.  The decision to permit evidence of unscrupulous conduct, 
however, is tempered by those “circumstances where testimony concerning third-
party threats may . . . be deemed so prejudicial as to require its exclusion” despite 
                                          
 
 
2.  In Lynch v. McGovern, 270 So. 2d 770, 772 (Fla. 4th DCA 1972) 
(quoting Wigmore on Evidence, Vol. 2 (3d ed.), section 278, at 120), the Fourth 
District stated: 
* * * it has always been understood—the inference, indeed, is 
one of the simplest in human experience—that a party’s falsehood or 
other fraud in the preparation and presentation of his cause, his 
fabrication or suppression of evidence by bribery or spoliation, and all 
similar conduct, is receivable against him as an indication of his 
consciousness that his case is a weak or unfounded one; and from that 
consciousness may be inferred the fact itself of the cause’s lack of 
truth and merit (emphasis added). 
 
 
- 22 - 
otherwise being admissible according to the evidentiary rules.  See Koon, 513 So. 
2d at 1256 (citing State v. Price, 491 So. 2d 536 (Fla. 1986)). 
The trial court addressed the alleged intimidation as two separate issues:    
(1) whether sufficient evidence was presented to introduce into evidence the fact 
that a disciplinary proceeding had been filed against Dr. Wolf by the Florida 
Department of Health (DOH); and (2) whether the defense attempted to intimidate 
Dr. Wolf prior to her deposition.  The trial court allowed Special to only proffer 
Dr. Wolf’s testimony on these issues.  We evaluate each allegation in turn.   
Department of Health Complaint 
 
After the initiation of the lawsuit against Dr. Baux, a DOH complaint was 
initiated against him.  To assist in the defense of Dr. Baux, his attorney, Eugene 
Ciotoli, hired Dr. Stephen Factor as an expert.  Dr. Factor reviewed the slides from 
the autopsy, and contrary to Dr. Wolf’s conclusion, determined that the slides 
showed widespread proof of AFE. 
The record reveals that subsequently, a Dr. Katims, at DOH, recommended 
in a memorandum that  
we open a file on Barbara Wolf, M.D., the medical examiner who did 
the initial autopsy and specifically indicated that she found no 
evidence of amniotic fluid embolus.  At the request of a defense 
attorney, another pathologist reviewed the tissue and apparently cut 
new sections and found evidence of widespread embolism from 
amniotic fluid.  This is a serious error and we should open the file so 
that we may deal with it appropriately.   
 
 
 
- 23 - 
When DOH issued a formal complaint against Dr. Wolf, she hired counsel, 
William Pincus, to defend her.   
Special sought to introduce evidence of the DOH complaint against 
Dr. Wolf as evidence of witness tampering.  However, the trial court concluded 
that there was an insufficient link between the defense and the filing of the 
complaint.  The trial court precluded testimony “with respect to the [DOH] 
investigation . . . [because] I don’t believe there’s a sufficient evidentiary nexus to 
allow us to go there [and address witness intimidation] at this point.  [Dr. Wolf] 
doesn’t know who filed [the complaint that led to the disciplinary proceeding], and 
we can surmise who may or may not have, but I don’t think we have enough to go 
there.”  We agree.  
Dr. Factor’s observations were made during the course of his role in 
defending Dr. Baux’s DOH matter, and it appears that the defense attorney request 
referenced in the memorandum from Dr. Katims was a request that Dr. Factor 
review the slides in order to assist in defending Dr. Baux—not a request that DOH 
issue a complaint against Dr. Wolf.  The evidence in the record demonstrates that 
DOH initiated its investigation of Dr. Wolf in light of Dr. Factor’s conclusions, not 
because of a specific request by the defense.  Thus, we agree with the trial court’s 
conclusion that there was an insufficient factual basis to attribute the DOH 
 
 
- 24 - 
complaint against Dr. Wolf to Baux or West Boca.  Thus, this evidence was 
properly excluded.    
Statements to Dr. Wolf 
Although we agree with the trial court’s exclusion of evidence relating to the 
DOH complaint, we conclude that the trial court erred when it excluded evidence 
of witness tampering in the form of statements made to Dr. Wolf through her 
attorney.  Special was precluded from introducing Dr. Wolf’s testimony about the 
statements because the trial court concluded that while relevant, the evidence 
constituted double hearsay.  As we explain, the jury was entitled to hear this 
evidence.    
About three months after the filing of the DOH complaint against Dr. Wolf, 
Dr. Wolf was deposed by the defense.  According to Dr. Wolf, just before the 
deposition, her lawyer (William Pincus) told her of statements from Dr. Baux’s 
defense counsel (Eugene Ciotoli). Allegedly, Mr. Ciotoli suggested to Mr. Pincus 
that Dr. Wolf might not want to embarrass herself by maintaining that the autopsy 
showed no evidence of AFE and that a world-renowned AFE expert was going to 
contradict her opinion and testify that the slides on which she saw no evidence of 
AFE were actually replete with evidence of AFE.  Dr. Wolf was handed 
photographs of the slides just before the deposition, which she reviewed, and 
ultimately determined that her opinion was the same, that there was no evidence of 
 
 
- 25 - 
AFE on the slides.  At trial, Special proffered the following testimony from 
Dr. Wolf: 
SPECIAL: Please tell us what you were told and by who? 
 
DR. WOLF: I was informed by Mr. Pinkus [sic] that, as he phrased it, 
I would not want to embarrass myself according to the defense 
attorney, by disagreeing with Dr. Factor, who was identified to me as 
the defense expert involved in the Board of Medicine complaint.  
 
SPECIAL: And— 
 
DR. WOLF: I’m sorry. 
 
SPECIAL: Go ahead. 
 
DR. WOLF: I was also given a note.  Mr. Ciotoli gave my lawyer, 
who was also present, who then gave to me a notebook containing a 
number of photographs that were identified as being photographs 
taken by Dr. Factor of the slides in this case that allegedly 
demonstrated the presence of amniotic fluid. 
 
SPECIAL: All right.  How, did you—the information that you got 
regarding not wanting to go up against Dr. Factor, was that 
information provided to you by your lawyer that he got from the 
defense lawyer, is that how you understood it? 
 
DR. WOLF: Yes, it was.   
 
Dr. Wolf did not change her opinion that the autopsy did not reveal evidence of 
AFE, nor her conclusion that Susan did not die of AFE.  But, she stated during her 
proffered testimony that she believed that the statements and related conduct were 
an attempt to get her to change her testimony: 
SPECIAL: Okay.  What did you think after you looked at the pictures, 
after you heard what you had been told first, that it was supposedly on 
 
 
- 26 - 
these slides, and then you looked at these pictures and it wasn’t there.  
What did you think somebody was attempting to do to your 
testimony? 
 
DR. WOLF: By being offered that, being shown these photographs 
immediately before my deposition, I assumed that an attempt was 
being made to change my mind. 
 
SPECIAL: And you were not intimidated in that regard, were you? 
 
DR. WOLF: Certainly not. 
 
This relevant evidence was admissible.  In Jost v. Ahmad, the Second 
District Court of Appeal addressed an allegation of witness tampering in a medical 
malpractice case.  Jost, 730 So. 2d 708, 710 (Fla. 2d DCA 1998).  The plaintiff’s 
treating physician testified that the hospital’s insurance carrier contacted the 
physician’s risk management officer, and the carrier attempted to pass along 
information to the physician suggesting that he should remember that his 
“testimony was to limit collateral damage.”  Id. at 709-10.  The trial court denied 
the plaintiff’s request to question the physician about the communication before 
the jury.  Id. at 710.  The Second District held that the trial court reversibly erred 
by excluding the communication because attempts at witness intimidation are        
“ ‘fundamentally unfair and pervert the truth-seeking function.’ ”  Id. at 711 
(quoting McCool v. Gehret, 657 A.2d 269 (Del. 1995)).  The district court 
explained that to determine whether the communication should be admitted, the 
“threshold question [wa]s whether the matter is relevant,” which “turns on the 
 
 
- 27 - 
meaning of the communication as it could be reasonably understood by [the 
targeted witness].”  Id. at 710.  With this question in mind, the Second District 
concluded that the excluded testimony should have been admitted as both 
impeachment and substantive evidence.  See id. at 711. 
Evidence of this nature “need not lead inescapably towards a single 
conclusion to be relevant, it need only make certain facts more probable than not.”  
McQueeney v. Wilmington Trust Co., 779 F.2d 916, 921 (3d Cir. 1985).  In this 
case, it is more probable than not that a third party with the “authority, consent, or 
knowledge” of Baux, if not West Boca as well, attempted to influence Dr. Wolf 
and alter her testimony.  See Manuel, 524 So. 2d at 735 (citing Price, 491 So. 2d 
536).  Neither Baux nor West Boca has provided this Court with a reason to 
conclude that some other person or party would have had a motive to harass       
Dr. Wolf as occurred here, and it is unlikely that some other person or party would 
have been privy to and interested in Dr. Wolf’s conclusions regarding the cause of 
Susan’s death.  The circumstances strongly suggest that the defense or someone 
working on behalf of the defense was responsible for the events that occurred prior 
to Dr. Wolf’s deposition, and that party intended to and did exert pressure on 
Dr. Wolf in an effort to change her opinion.      
Special satisfied the requirements in Jost that the challenged testimony must 
be relevant and the communication reasonably understood by the targeted witness 
 
 
- 28 - 
as an attempt to intimidate.  First, in its order, the trial court properly found         
Dr. Wolf’s testimony to be relevant.  This testimony concerned the key issue in 
this case—the cause of Susan’s death.  Second, although Dr. Wolf may not have 
changed her testimony nor been intimidated, she understood the intent of the 
events preceding her deposition to be an effort to alter her conclusion.   
Moreover, because the intimidating parties were acting as agents of Baux, 
the trial court’s hearsay concerns are eliminated.  Compare Jost, 730 So. 2d at 710 
(permitting admission of communications to the targeted doctor from the 
defendant’s insurance carrier, which is “akin to a communication from [the 
defendant] . . . [and not akin to] a communications from a third party with no direct 
interest in the outcome of the case.”), with Nagel v. State, 774 So. 2d 835, 838 
(Fla. 4th DCA 2000) (ruling that a police officer’s testimony was inadmissible 
because the state did not present evidence that the contested telephone call “was 
made with appellant’s authority, consent, or knowledge”).  The trial court’s failure 
to admit testimony on this issue amounted to an abuse of discretion, and in light of 
the harmful error caused by the exclusion of this evidence, a new trial is required.  
CONCLUSION 
 
For the foregoing reasons, in a civil appeal, the test for harmless error 
requires the beneficiary of the error to prove that the error complained of did not 
contribute to the verdict.  Alternatively stated, the beneficiary of the error must 
 
 
- 29 - 
prove that there is no reasonable possibility that the error complained of 
contributed to the verdict.  We reverse the district court’s decision and remand for 
proceedings consistent with this opinion.   
 
It is so ordered.  
QUINCE and PERRY, JJ., concur. 
PARIENTE, J., concurs in part and dissents in part with an opinion. 
LEWIS, J., specially concurs in part and dissents in part with an opinion. 
POLSTON, J., dissents with an opinion in which CANADY, J., concurs. 
 
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND 
IF FILED, DETERMINED.   
 
PARIENTE, J., concurring in part and dissenting in part. 
I join the majority in concluding that a new trial is warranted based on the 
erroneous and harmful exclusion of testimony regarding the overdiagnosis of 
amniotic fluid embolus (AFE) that the plaintiff sought to elicit during the cross-
examination of the defense’s expert witness.  I dissent, however, from the 
majority’s decision to adopt the same harmless error standard for civil cases as is 
used in criminal cases, despite the different burdens of proof and constitutional 
interests that are implicated in the civil and criminal contexts.  I also disagree with 
the majority’s conclusion that the trial court erred in excluding evidence related to 
the alleged witness tampering of the deputy medical examiner.   
My primary disagreement is with the majority’s decision to adopt the 
criminal “no reasonable possibility” test for harmless error, which is grounded in 
 
 
- 30 - 
the “beyond a reasonable doubt” standard of proof that applies in criminal trials.  
Because a different standard applies in civil cases, and because the attributes of the 
two types of cases are very different, I would adopt the “more likely than not” 
standard set forth by the Fourth District Court of Appeal and require the 
beneficiary of the error in a civil case to show that it is more likely than not that the 
error did not influence the trier of fact and thereby contribute to the verdict.   
I begin by discussing my view concerning the appropriate standard for 
harmless error in civil cases and then proceed to address each of the specific 
instances of alleged error in turn. 
I.  Harmless Error Standard in Civil Cases 
 
While I disagree with the ultimate standard adopted by the majority, I do 
agree with both the majority and the Fourth District in rejecting the outcome-
determinative “but for” test for determining harmless error in civil cases in favor of 
an “effect on the trier-of-fact” approach, as embodied in the harmless error 
approach this Court adopted in State v. DiGuilio, 491 So. 2d 1129, 1135 (Fla. 
1986).  See majority op. at 8-9; Special v. Baux, 79 So. 3d 755, 770-71 (Fla. 4th 
DCA 2011).  As this Court explained in DiGuilio, “harmless error analysis must 
not become a device whereby the appellate court substitutes itself for the jury.”  
DiGuilio, 491 So. 2d at 1136.  Further, placing the burden of proof on the 
 
 
- 31 - 
beneficiary of the error, as the majority properly does, is consistent with our own 
precedent in civil cases: 
Equity and logic demand that the burden of proving such an error 
harmless must be placed on the party who improperly introduced the 
evidence.  Putting the burden of proof on the party against whom the 
evidence is used, as the district court did, would simply encourage the 
introduction of improper evidence.  The record in this case shows that 
the issue of liability was close.  We cannot say that the jury’s verdict 
on liability was not improperly influenced by the evidence of the 
Gormleys’ insurance claim.  The likelihood of improper influence on 
the liability issue was not rebutted by the one who introduced the 
evidence. 
Gormley v. GTE Prods. Corp., 587 So. 2d 455, 459 (Fla. 1991); see also Sheffield 
v. Superior Ins. Co., 800 So. 2d 197, 203 (Fla. 2001) (“The burden of proving that 
the admission of the collateral source evidence was harmless rests on [the 
beneficiary of the collateral source evidence].”).    
However, because of the differing burdens of proof and constitutional rights 
at stake, I disagree with the majority’s adoption of the identical standard for 
harmless error in civil cases as applies in criminal cases.  By adopting the test for 
harmless error that applies to criminal cases without even referencing the different 
burdens and interests that apply in the civil context, the majority favors form over 
substance and offers no compelling explanation as to why the “no reasonable 
possibility” language from DiGuilio, which is rooted in the “beyond a reasonable 
doubt” burden of proof, should be used in civil cases.  As stated by the Fourth 
 
 
- 32 - 
District, the harmless error test for civil cases “should acknowledge the particular 
attributes of those cases.”  Special, 79 So. 3d at 770.       
Indeed, the most obvious attribute of civil cases that distinguishes them from 
their criminal counterparts is the “preponderance of the evidence” burden of proof 
that applies instead of the “beyond a reasonable doubt” standard that is the 
hallmark of criminal prosecutions.  Although the harmless error test articulated by 
this Court in DiGuilio is based on the “beyond a reasonable doubt” standard that 
applies in the criminal context, DiGuilio, 491 So. 2d at 1138, the majority omits 
any discussion of the completely different “preponderance of the evidence” 
standard that applies in the civil context—despite adopting the identical harmless 
error test. 
Specifically, instead of acknowledging this important difference, the 
majority simply transplants the “no reasonable possibility” language from the 
criminal harmless error test into the civil test it adopts, while eliminating the 
“beyond a reasonable doubt” portion of the test articulated in DiGuilio.  Although 
unstated, the majority would presumably substitute the phrase “more likely than 
not” in place of “beyond a reasonable doubt,” and thus the test would require the 
beneficiary of the error to prove “more likely than not” that the error did not 
contribute to the verdict, or alternatively stated, that there is “no reasonable 
 
 
- 33 - 
possibility” that the error contributed to the verdict.  Because this test does not 
account for the different burdens of proof, it simply makes no sense. 
While it is of course true that trial level burdens of proof and appellate 
standards of legal error are different concepts, I respectfully disagree with Justice 
Lewis’s assertion in his separate opinion that “[t]he level of a factual burden of 
proof at trial has nothing to do with the standards for appellate legal error.”  
Specially concurring in part & dissenting in part op. at 48 (Lewis, J.).  As the 
majority itself makes clear, the harmless error test seeks to determine the effect a 
particular error had on the trier of fact and is not a device for an appellate court to 
improperly substitute its judgment for that of the jury.  See majority op. at 8 
(“Harmless error is not a device for the appellate court to substitute itself for the 
trier-of-fact by simply weighing the evidence.” (quoting DiGuilio, 491 So. 2d at 
1139)).  In other words, the harmless error test asks the appellate court to put itself 
in the shoes of the jury and analyze how the error affected the jury, taking into 
consideration the permissible evidence upon which the jury could have 
legitimately relied and the impermissible evidence that may have influenced the 
jury’s verdict.   
In my view, the only way to properly assess how an error would have 
affected the jury is to apply an appellate standard that accounts for the burden of 
proof the jury was required to apply at trial.  Such an approach does not 
 
 
- 34 - 
“commingle[] and confuse[]” trial level burdens with appellate standards.  
Specially concurring in part & dissenting in part op. at 48 (Lewis, J.).  Instead, it 
appropriately acknowledges the proper role of an appellate court performing a 
harmless error test and recognizes that assessing the impact of an error on the 
jury—as the majority itself concludes to be the correct approach—requires the test 
applied by the appellate court to account for the burden applied by the jury. 
Section 59.041, Florida Statutes (2003), provides that a court may not set 
aside a judgment or grant a new trial in any case, whether civil or criminal, unless 
“the error complained of has resulted in a miscarriage of justice.”  As the majority 
appropriately recognizes, “[u]nder this rule, appellate courts must evaluate 
harmless error on a case-by-case basis” and determine what constitutes a 
“miscarriage of justice” based on the record and factors present in each particular 
case.  Majority op. at 6.   
In his separate opinion, Justice Lewis suggests that the Legislature’s use of 
the same “miscarriage of justice” language for both criminal and civil cases 
“specifically and unambiguously” indicates that the Legislature intended the same 
harmless error test to apply in both contexts.  Specially concurring in part & 
dissenting in part op. at 48 (Lewis, J.).  However, it is the test this Court adopted in 
DiGuilio that gives meaning to the phrase “miscarriage of justice” in criminal 
cases—while respecting the Legislature’s authority to enact harmless error 
 
 
- 35 - 
statutes—and that sets forth a framework for applying the standard on a case-by-
case basis.  In fact, this point was recognized by the Fourth District, which 
explained that “the trigger for reversible error is the occurrence of a ‘miscarriage of 
justice’; how the courts have defined this term has determined the scope of the 
statute’s application.”  Special, 79 So. 3d at 761.     
Any analysis that is specific to each case must account for the particular 
attributes and distinctive features of that case.  In other words, while “miscarriage 
of justice” is the standard that the Legislature has chosen to apply to all cases, what 
constitutes a “miscarriage of justice” in one case is not the same as what 
constitutes a “miscarriage of justice” in another.  It is up to the judiciary to develop 
a framework for assessing and analyzing this determination in individual cases.  If 
the statute clearly and unambiguously set forth the specific test for courts to apply 
to determine whether an error is harmless in an individual case, courts would not 
have struggled for more than a century to interpret the statute, and this Court would 
not now be called upon to provide a framework for analyzing what constitutes a 
“miscarriage of justice” in civil cases.             
Instead of adopting the identical test for the sake of consistency between 
cases that arise in contexts that are completely different, I would adopt the well-
reasoned opinion of the Fourth District as to the appropriate standard for harmless 
error in civil cases.  Sitting en banc, the Fourth District cogently articulated why 
 
 
- 36 - 
the proper test should require the beneficiary of the error to prove “more likely 
than not that the error did not influence the trier of fact and thereby contribute to 
the verdict.”  Special, 79 So. 3d at 771.  
In my view, the Fourth District persuasively explained why a different 
standard for reversal is well-suited to civil cases: 
In formulating a harmless error test in civil cases, it is important 
to recognize that DiGuilio derived its formulation from the elevated 
burden of proof in criminal cases: 
The harmless error test . . . places the burden on the state, 
as the beneficiary of the error, to prove beyond a 
reasonable doubt that the error complained of did not 
contribute to the verdict or, alternatively stated, that there 
is no reasonable possibility that the error contributed to 
the conviction. 
DiGuilio, 491 So. 2d at 1135 (emphasis added) (citation omitted).  
This elevated test acknowledges (1) the higher burden of proof in 
criminal cases, which amplifies the potential effect of an evidentiary 
error on the trier of fact, and (2) the special concern for the legitimacy 
of criminal convictions expressed in the constitutional and statutory 
protections accorded to criminal defendants.  A harmless error test for 
civil cases should acknowledge the particular attributes of those cases. 
Id. at 770.  In other words, as DiGuilio makes clear, the “no reasonable possibility” 
language in the criminal harmless error test cannot be divorced from the “beyond a 
reasonable doubt” language, since the two phrases are simply alternative 
formulations of the same test, which is rooted in the “particular attributes” of 
criminal prosecutions.  See Chapman v. California, 386 U.S. 18, 24 (1967) (“There 
is little, if any, difference between our statement in [a prior case] about ‘whether 
 
 
- 37 - 
there is a reasonable possibility that the evidence complained of might have 
contributed to the conviction’ and requiring the beneficiary of a constitutional error 
to prove beyond a reasonable doubt that the error complained of did not contribute 
to the verdict obtained.”); see also Black’s Law Dictionary 1457 (10th ed. 2009) 
(defining “reasonable doubt” as “the belief that there is a real possibility that a 
defendant is not guilty”).   
 
When the Court is required to address harmless error in criminal cases, it is 
always the State that has obtained a conviction against a defendant based in some 
measure on an erroneous legal ruling at trial.  Therefore, the strictest formulation 
of the harmless error test, as set forth in DiGuilio, is consistent with the State’s 
responsibility to ensure that convictions are secured without the assistance of 
harmful errors, which is an important public policy concern.  See DiGuilio, 491 So. 
2d at 1138-39.    
By contrast, an error in a civil case could result in potential harm to either a 
plaintiff or a defendant.  Thus, the use of the same standard for harmless error as 
applies to the burden of proof in civil cases—that a particular occurrence was 
“more likely than not”—vindicates the concerns that the majority refers to as 
“conserv[ing] judicial resources while protecting the integrity of the process.”  
Majority op. at 10.  It also “strikes the proper balance between the parties.”  Id.  In 
fact, a harmless error test based on the “preponderance of the evidence” standard 
 
 
- 38 - 
actually strikes a better and more appropriate balance because it takes into account 
how each of the parties in a civil case may be affected by an erroneous legal ruling.   
As stated by the Ninth Circuit Court of Appeals regarding why that circuit 
applies a different harmless error standard for civil and criminal cases: 
The purpose of a harmless error standard is to enable an 
appellate court to gauge the probability that the trier of fact was 
affected by the error.  Perhaps the most important factor to consider in 
fashioning such a standard is the nature of the particular fact-finding 
process to which the standard is to be applied.  Accordingly, a crucial 
first step in determining how we should gauge the probability that an 
error was harmless is recognizing the distinction between civil and 
criminal trials.  This distinction has two facets, each of which reflects 
the differing burdens of proof in civil and criminal cases.  First, the 
lower burden of proof in civil cases implies a larger margin of error.  
The danger of the harmless error doctrine is that an appellate court 
may usurp the jury’s function, by merely deleting improper evidence 
from the record and assessing the sufficiency of the evidence to 
support the verdict below.  This danger has less practical importance 
where, as in most civil cases, the jury verdict merely rests on a more 
probable than not standard of proof. 
The second facet of the distinction between errors in civil and 
criminal trials involves the differing degrees of certainty owed to civil 
and criminal litigants.  Whereas a criminal defendant must be found 
guilty beyond a reasonable doubt, a civil litigant merely has a right to 
a jury verdict that more probably than not corresponds to the truth. 
The civil litigant’s lessened entitlement to veracity continues 
when the litigant becomes an appellant.  We conclude that a proper 
harmless error standard for civil cases should reflect the burden of 
proof.  Just as the verdict in a civil case need only be more probably 
than not true, so an error in a civil trial need only be more probably 
than not harmless.  In other words, when an appellate court ponders 
the probable effect of an error on a civil trial, it need only find that the 
jury’s verdict is more probably than not untainted by the error. 
 
 
 
- 39 - 
Haddad v. Lockheed Cal. Corp., 720 F.2d 1454, 1458-59 (9th Cir. 1983) (emphasis 
added) (citations omitted).  The Tenth Circuit Court of Appeals has also aptly 
explained why “absent some countervailing policy . . . the harmless error standard 
should mirror the standard applied at trial,” since logic requires the stringency of 
the test for judging error on appeal to be the same as the stringency of the standard 
applied at trial.  U.S. Indus., Inc. v. Touche Ross & Co., 854 F.2d 1223, 1252 n.39 
(10th Cir. 1988).   
Although Justice Lewis in his separate opinion relies on McQueeney v. 
Wilmington Trust Co., 779 F.2d 916 (3d Cir. 1985), for the proposition that the 
same standard should apply in both contexts, the Third Circuit Court of Appeals 
has adopted “a moderately stringent, though not unreasonably high, standard in 
civil as well as criminal cases”—unlike the most stringent test for harmless error 
that this Court adopted in DiGuilio for criminal cases.  Id. at 927; see also Gov’t of 
Virgin Islands v. Toto, 529 F.2d 278, 284 (3d Cir. 1976) (explaining that the Third 
Circuit follows the “middle ground” or “highly probable” test for harmless error).  
The harmless error test adopted by the Third Circuit is simply not the standard in 
Florida, and the considerations identified by the Third Circuit as a basis for 
applying the same test are therefore less persuasive.  See Roger J. Traynor, The 
Riddle of Harmless Error 35 (1970) (explaining that an appellate court has three 
options in choosing a harmless error standard: (1) more probable than not; (2) 
 
 
- 40 - 
highly probable; or (3) almost certain); McQueeney, 779 F.2d at 924 (stating that 
“beyond a reasonable doubt” is “a more stringent standard than ‘high 
probability,’ ” as followed in the Third Circuit).   
The Third Circuit has stated, as a basis for adopting the same test for 
harmless error in civil and criminal cases, that “broad institutional concerns 
militate against increasing the number of errors deemed harmless.”  McQueeney, 
779 F.2d at 927.  This Court, however, already follows that policy in applying the 
most stringent of possible harmless error standards for criminal cases, where the 
defendant’s constitutional liberty interest is always at stake.  Unlike in Florida, the 
Third Circuit’s test for harmless error in the criminal context is not based on the 
“beyond a reasonable doubt” standard.  To apply a lower standard for civil cases 
than an already less stringent standard that applies to criminal cases would lead to 
the kind of potential for an increased number of errors that is simply not an issue in 
Florida. 
For all these reasons, I would adopt the Fourth District’s cogent articulation 
of the proper test for harmless error in civil cases.  Under this approach,  
harmless error occurs in a civil case when it is more likely than not 
that the error did not contribute to the judgment.  To avoid a new trial, 
the beneficiary of the error in the trial court must show on appeal that 
it is more likely than not that the error did not influence the trier of 
fact and thereby contribute to the verdict. 
Special, 79 So. 3d at 771.     
 
 
- 41 - 
II.  The Alleged Errors 
 
Having set forth what I believe to be the appropriate test for harmless error 
in civil cases, I now address the two specific instances of alleged error in this case.  
In short, I agree with the majority’s conclusion as to the first, but disagree as to the 
second.   
A.  Exclusion of Cross-Examination Concerning AFE 
Although I disagree with this Court’s adoption of the same test for harmless 
error in civil cases as the Court applies in criminal cases, I agree with the majority 
that the error in restricting the cross-examination of the defense expert regarding 
the overdiagnosis of AFE was not harmless error, regardless of which standard is 
applied.  Because the focus of the entire case revolved around whether Susan 
Special’s death was caused by medical malpractice or AFE, the limitation on the 
cross-examination and the acknowledgment by the defense’s own expert 
concerning the possibility of overdiagnosis of AFE cannot be said to amount to 
harmless error.  That is, Baux and West Boca have not demonstrated that it is more 
likely than not that the exclusion of this testimony did not contribute to the jury’s 
verdict finding the defendants not liable.  This testimony directly called into 
question the credibility of the AFE diagnosis in this case, particularly because AFE 
is a diagnosis of exclusion, and unduly restricted Special’s ability to undermine the 
defense expert’s testimony in the minds of the jurors.   
 
 
- 42 - 
Further, I agree that the ability of trial counsel to argue about overdiagnosis 
in closing is not a substitute for having the defense’s own expert acknowledge the 
overdiagnosis of AFE, where the competing expert opinions were the focal point of 
this medical malpractice case.  See Linn v. Fossum, 946 So. 2d 1032, 1041 (Fla. 
2006) (“We conclude that the trial court erred in allowing Dr. Weaver-Osterholtz 
to testify that she consulted with colleagues and that this error was not harmless 
because the competing expert opinions on the proper standard of care were the 
focal point of this medical malpractice trial.”); see also Donshik v. Sherman, 861 
So. 2d 53, 56 (Fla. 3d DCA 2003) (“Where, as here, the competing expert 
opinions, on both sides, were the focal point of the trial, we cannot deem the error 
in the introduction of the ACAS report to be harmless.”). 
Accordingly, because the trial court’s error in restricting the cross-
examination of the defense expert was not harmless, a new trial is warranted. 
B.  Exclusion of Testimony Concerning Alleged Witness Tampering 
Lastly, based on the record before the trial court, I disagree with the majority 
that there was any error in disallowing testimony of the deputy medical examiner, 
Dr. Barbara Wolf, on what the plaintiff alleged to be “witness tampering.”  I 
deplore, as does this Court, any threats or attempts at intimidation attributable to 
the adverse party.  The key, however, is that the proper predicate must be laid to 
show that it was the adverse party or its agent that made the threats or attempted to 
 
 
- 43 - 
intimidate a witness.  To allow a party to argue witness intimidation where there is 
insufficient evidence demonstrating that this is what occurred is incredibly 
prejudicial to the party being accused of the improper conduct.  See Penalver v. 
State, 926 So. 2d 1118, 1129-30 (Fla. 2006).  The majority, in fact, recognizes this 
critical point in correctly concluding that there was an insufficient factual basis to 
attribute the Department of Health complaint against Dr. Wolf to the defendants 
and that this evidence was therefore properly excluded.  
However, as to the pre-deposition comments allegedly made to Dr. Wolf by 
her attorney, neither Dr. Wolf’s attorney nor Baux’s defense attorney, the original 
declarant, testified as to what was said.  Therefore, as the trial court properly 
recognized, the double hearsay issue with these alleged statements presents a 
threshold problem for their admission.  
Moreover, simply being provided with photographs of slides taken by 
another expert, Dr. Factor, does not, in itself, amount to witness intimidation.  
There would have been nothing wrong with the plaintiff asking Dr. Wolf at trial if 
her attorney showed her photographs of slides taken by Dr. Factor before her 
deposition and whether that changed her opinion regarding her conclusion about 
the cause of death.  That is a far cry, though, from allowing the plaintiff to argue to 
the jury that agents of the defense attempted to intimidate the witness and that 
those actions are evidence of their culpability.  
 
 
- 44 - 
It may be that in a new trial, a more specific nexus can be established with 
the defendants’ alleged actions to pressure Dr. Wolf to change her testimony, 
including testimony from either of the two attorneys who engaged in the alleged 
conversation.  The current record, however, is devoid of anything but hearsay and 
attenuated connections, with speculation having to fill the missing pieces.  While I 
do not object to the further development of facts on this issue on remand, I would 
affirm the trial court’s decision to exclude the evidence based on the facts as 
presented.   
III.  Conclusion 
 
In sum, I concur in the majority’s conclusion that a new trial is warranted 
based on the trial court’s error, which was not harmless, in excluding cross-
examination testimony from the defense expert concerning the overdiagnosis of 
AFE.  I dissent, however, from the majority’s adoption of the identical standard for 
harmless error in civil cases as applies in the criminal context.  This decision, in 
my view, fails to account for the important differences that exist between civil and 
criminal trials.   
 
LEWIS, J., specially concurring in part and dissenting in part. 
 
I concur with the well-reasoned and intellectually direct majority opinion as 
it accepts and adopts the standard for review that the beneficiary of the error must 
establish that there is no reasonable possibility that the error contributed to the 
 
 
- 45 - 
verdict to uphold application of harmless error.  I also concur with the common 
sense and logical majority opinion and conclude that the failure of the trial court to 
permit the jury to hear testimony from Dr. Dildy concerning the extremely high 
rate of amniotic fluid embolus (AFE) diagnoses at West Boca constitutes harmful 
error that merits a new trial.  I write separately only because I believe that 
additional justifications not mentioned by the majority explain why the harmless 
error test adopted today is appropriate in all civil appeals.  Further, contrary to the 
majority in one limited area, I would permit the full exploration and further 
development of both allegations of witness intimidation in connection with the new 
trial proceedings.  
The Harmless Error Standard 
I agree with the majority’s conclusion that the “no reasonable possibility” 
harmless error standard preserves judicial resources, protects the integrity of the 
judicial process, and strikes the appropriate balance between parties.  Equity and 
logic demand that the burden of proving an error to be harmless must be placed on 
the party who improperly introduced the evidence.  Placing the burden on the party 
that introduced the error serves not only to penalize the offending party, but also 
discourages future efforts to introduce error into proceedings.  If we were to place 
the burden of proof on the party against whom the evidence is used, we would 
simply encourage the introduction of improper evidence.  Gormley v. GTE Prod. 
 
 
- 46 - 
Corp., 587 So. 2d 455, 459 (Fla. 1991); see also Sheffield v. Superior Ins. Co., 800 
So. 2d 197, 203 (Fla. 2001) (“[W]hen a trial lawyer leads a judge into an obvious 
error . . . cries of harmless error on appeal are likely to fall on deaf ears.”) (quoting 
Mattek v. White, 695 So. 2d 942, 944 (Fla. 4th DCA 1997)). 
However, I also believe that DiGuilio’s pervasiveness in harmless error 
assessments underscores why this Court should not depart from it by adopting a 
different standard for civil proceedings.  See State v. DiGuilio, 491 So. 2d 1129, 
1135 (Fla. 1986).  Developing a different standard would only foster inconsistency 
and confusion in Florida law.  See McQueeney v. Wilmington Trust Co., 779 F.2d 
916, 927 (3d Cir. 1985) (discussing the varying standards of review in civil cases, 
and why creating a different test for harmless error in the civil versus criminal 
context would only add unnecessary confusion and complication for the courts).  
Furthermore, by applying the DiGuilio test in the civil context, we signal to 
litigating parties that our courts will not review allegations of error lightly, nor 
perpetuate such errors by affording them less scrutiny than the “reasonable 
possibility of affecting the verdict” standard provides.  Further, by applying the 
DiGuilio test, we endorse a public policy that discourages any increase in the 
number of errors that our courts deems harmless.  See McQueeney, 779 F.2d at 
927 (“[B]road institutional concerns militate against increasing the number of 
errors deemed harmless.”).   
 
 
- 47 - 
In DiGuilio, we addressed the relevant statutory authority, and explained 
why section 924.33, Florida Statutes (1981), applied as opposed to section 59.041.  
See 491 So. 2d at 1133-34.  Section 924.33 provides: 
No judgment shall be reversed unless the appellate court is of the 
opinion, after an examination of all the appeal papers, that error was 
committed that injuriously affected the substantial rights of the 
appellant.  It shall not be presumed that error injuriously affected the 
substantial rights of the appellant. 
This section is part of chapter 924, which is titled “Criminal Appeals and 
Collateral Review.”  § 924.33, Fla. Stat. (2003).  The DiGuilio Court stated that 
section 924.33 applied because that statute: (1) applies to all judgments regardless 
of the type of error involved; and (2) explicitly provides that there shall be no 
presumption that errors are reversible unless it can be shown that they are harmful.  
See 491 So. 2d at 1133-34.  Although section 59.041 did not apply in DiGuilio, the 
differences between this section and section 924.33 are not such as to render 
DiGuilio’s analysis inapposite.  Section 59.041 provides: 
No judgment shall be set aside or reversed, or new trial granted by any 
court of the state in any cause, civil or criminal, on the ground of 
misdirection of the jury or the improper admission or rejection of 
evidence or for error as to any matter of pleading or procedure, unless 
in the opinion of the court to which application is made, after an 
examination of the entire case it shall appear that the error complained 
of has resulted in a miscarriage of justice.  This section shall be 
liberally construed. 
 
 
 
- 48 - 
§ 59.041, Fla. Stat. (2003) (emphasis supplied).  The plain language of this section 
demonstrates that the Legislature has specifically and unambiguously elected not 
to apply a different harmless error standard in criminal and civil cases.3   
Justice Pariente, in her concurring in part and dissenting in part opinion, 
criticizes the majority for “favoring form over substance” and adopting a harmless 
error standard in civil cases that is inconsistent with the clear legislative directive 
articulated in section 59.041.  She claims that the majority has ignored critical 
factors, such as the differing burdens of proof and other “particular attributes” that 
distinguish civil from criminal cases, and contends that the DiGuilio standard is 
inapplicable in civil cases.  Justice Pariente simply comingles and confuses trial 
level burdens of proof and trial level “particular attributes” with appellate 
standards of legal error.  The level of a factual burden of proof during trial has 
nothing to do with the standards for appellate legal error.  In criticizing the 
majority’s analysis, Justice Pariente has also neglected to consider the deference 
this Court has traditionally afforded the Legislature for policy decisions that have 
been made regarding the harmless error standard.  In fact, we specifically 
                                          
 
 
3.  Section 90.104, Florida Statutes (2009), is also applicable to the instant 
case.  It addresses rulings on evidence and provides that  
 
(1) A court may predicate error, set aside or reverse a judgment, 
or grant a new trial on the basis of admitted or excluded evidence 
when a substantial right of the party is adversely affected . . . [and the 
issue is preserved]. 
 
 
- 49 - 
recognized in DiGuilio that the “authority of the legislature to enact harmless error 
statutes is unquestioned.”  491 So. 2d at 1134.   
Here, the Legislature has established through section 59.041 the public 
policy that appellate courts shall not reverse trial court judgments “in any cause, 
civil or criminal,” unless the error complained of has resulted in a miscarriage of 
justice.  It certainly cannot be disputed that the Legislature was unaware when it 
made this policy decision that the trial level burden of proof differs in civil and 
criminal cases, or that other “particular attributes” differentiate the two types of 
cases.  However, because Justice Pariente considers the Legislature’s policy 
determinations to be inconsistent with her view, she basically ignores them 
altogether.  Justice Pariente relies upon the “particular attributes” approach to 
conclude that the “more likely than not” standard developed by the Fourth District 
is appropriate in all civil cases.  This approach, however, not only disregards our 
holding in DiGuilio that recognized the Legislature retains broad authority to 
regulate the application of harmless error statutes, but also completely ignores the 
plain language of section 59.041.  In so doing, Justice Pariente has essentially 
concluded that section 59.041 is irrelevant and should not impact the determination 
of the appellate standard for legal error that should apply in civil cases.  While 
Justice Pariente and other lower court judges may not agree with the statutes, it is 
inappropriate for them to suggest that their personal views of the applicable 
 
 
- 50 - 
harmless error standard should trump the standard contained in the statutory 
structure.  Justice Pariente advances a dual standard for civil and criminal cases 
contrary to the single standard established in the Florida Statutes. 
Additional Harmful Error 
I disagree only with the majority’s determination that the trial court did not 
err when it precluded Special from further exploring and presenting evidence that 
strongly suggested that Baux and West Boca attempted to intimidate the key fact 
witness, medical examiner Dr. Wolf, regarding the Department of Health (DOH) 
complaint.  The decision to preclude Dr. Wolf’s testimony on this important 
subject amounted to an abuse of discretion and was not harmless error.  With a 
remand for a new trial, I would permit further exploration and development of 
material facts on this issue.    
Standard of Review 
 
A trial court’s decision to admit evidence is reviewed under the abuse of 
discretion standard.  See Braddy v. State, 111 So. 3d 810, 858 (Fla. 2012), cert. 
denied, 134 S. Ct. 275 (2013); Simmons v. State, 934 So. 2d 1100, 1116 (Fla. 
2006) (“A trial court has wide discretion concerning the admissibility of evidence 
and the range of subjects about which an expert can testify.”).  A court’s discretion, 
however, is circumscribed by the rules of evidence, see Johnston v. State, 863 So. 
2d 271, 278 (Fla. 2003), and a ruling on the admissibility of evidence will 
 
 
- 51 - 
constitute an abuse of discretion if it is based “on an erroneous view of the law or 
on a clearly erroneous assessment of the evidence.”  Cooter & Gell v. Hartmarx 
Corp., 496 U.S. 384, 405 (1990); Johnson v. State, 969 So. 2d 938, 949 (Fla. 
2007).  
Here, the precluded testimony concerned whether there had been an extra-
judicial attempt to intimidate and discredit Dr. Wolf, the medical examiner, 
because she disagreed as to the cause of Susan’s death—the dispositive issue in 
this case.  Dr. Wolf, as the governmental expert charged with investigating deaths, 
expressed the opinion that Susan did not die from AFE.  Because there is a very 
real and reasonable view that the failure to admit testimony on this issue also 
contributed to the verdict, I disagree with the majority’s conclusion that the 
decision to preclude evidence on this testimony was harmless and not an abuse of 
discretion.   
Analysis 
 
Florida courts permit evidence of threats or witness intimidation if the 
threats are attributable to the opposing party.  See Koon v. State, 513 So. 2d 1253, 
1256 (Fla. 1987) (“It has been held that evidence of threats made against witnesses 
is inadmissible to prove guilt unless the threats are shown to be attributable to the 
defendant.” (citing Duke v. State, 142 So. 886 (Fla. 1932); Jones v. State, 385 So. 
2d 1042 (Fla. 1st DCA 1980); Coleman v. State, 335 So. 2d 364 (Fla. 4th DCA 
 
 
- 52 - 
1976))); see also State v. Price, 491 So. 2d 536, 536-37 (Fla. 1986) (“A third 
person’s attempt to influence a witness is inadmissible on the issue of the 
defendant’s guilt unless the defendant has authorized the third party’s action.”); 
Manuel v. State, 524 So. 2d 734, 735 (Fla. 1st DCA 1988) (noting that testimony 
concerning witness intimidation is admissible, “provided the attempt was with the 
authority, consent, or knowledge of the defendant”).4  It is admissible because it is 
“evidence of a consciousness of guilt,” see Coronado v. State, 654 So. 2d 1267, 
1269 (Fla. 2d DCA 1995),5 and there is nothing more sacred than judicial 
                                          
 
 
4.  In Lynch v. McGovern, 270 So. 2d 770, 772 (Fla. 4th DCA 1972) 
(quoting Wigmore on Evidence, Vol. 2 (3d ed.), section 278, at 120), the Fourth 
District stated: 
* * * it has always been understood—the inference, indeed, is one of 
the simplest in human experience—that a party’s falsehood or other 
fraud in the preparation and presentation of his cause, his fabrication 
or suppression of evidence by bribery or spoliation, and all similar 
conduct, is receivable against him as an indication of his 
consciousness that his case is a weak or unfounded one; and from that 
consciousness may be inferred the fact itself of the cause’s lack of 
truth and merit (emphasis added). 
 
5.  See also Edward W. Cleary, McCormick on Evidence, § 273, at 660 (2d 
ed. 1972) (footnotes omitted):  
[W]rongdoing by the party in connection with his case, amounting to 
an obstruction of justice[,] is also commonly regarded as an admission 
by conduct.  By resorting to wrongful devices he is said to give 
ground for believing that he thinks his case is weak and not to be won 
by fair means.  Accordingly, a party’s false statement about the matter 
in litigation, whether before suit or on the stand, his fabrication of 
false documents, his undue pressure, by bribery or intimidation or 
 
 
- 53 - 
proceedings that are free from attempts to tamper with or intimidate witnesses.  
Indeed, without a judicial proceeding free of intimidation and threats, there is no 
reason for the fact-finding process.  The decision to permit evidence of 
unscrupulous conduct, however, is tempered by those “circumstances where 
testimony concerning third-party threats may . . . be deemed so prejudicial as to 
require its exclusion” despite otherwise being admissible according to the 
evidentiary rules.  See Koon, 513 So. 2d at 1256 (citing Price, 491 So. 2d at 536).   
In Jost v. Ahmad, the Second District Court of Appeal addressed an 
allegation of witness tampering in a medical malpractice case.  730 So. 2d 708, 710 
(Fla. 2d DCA 1999).  The plaintiff’s treating physician testified that the hospital’s 
insurance carrier contacted the physician’s risk management officer, and the carrier 
attempted to pass along information to the physician suggesting that he should 
remember that his “testimony was to limit collateral damage.”  Id. at 709-10.  The 
trial court denied the plaintiff’s request to question the physician about the 
communication before the jury.  Id. at 710.  The Second District held that the trial 
court reversibly erred by excluding the communication because attempts at witness 
intimidation are “fundamentally unfair and pervert the truth-seeking function.”  Id. 
at 711 (quoting McCool v. Gehret, 657 A.2d 269, 276 (Del. 1995)).  The same rule 
                                                                                                                                        
other means, to influence a witness to testify for him . . . all these are 
instances of this type of admission by conduct. 
 
 
- 54 - 
applies here.  The district court explained that to determine whether the 
communication should be admitted, the “threshold question [wa]s whether the 
matter is relevant,” which “turns on the meaning of the communication as it could 
be reasonably understood by [the targeted witness].”  Id. at 710.  With this question 
in mind, the Second District concluded that the excluded testimony should have 
been admitted as both impeachment and substantive evidence.  See id. at 711. 
Here, during trial, Special asserted that he should be permitted to present 
evidence that individuals, on behalf of Baux and West Boca, attempted to 
intimidate Dr. Wolf into changing her expert opinion that AFE was not the cause 
of Susan’s death.  According to Dr. Wolf’s attorney Bill Pincus, Baux’s attorney 
had told him that “the Defendants had hired a ‘nationally-renowned’ expert in the 
field of amniotic fluid embolism (‘AFE’) who had found ‘pervasive evidence’ of 
AFE in the tissue samples taken from the Decedent” and “suggested that Dr. Wolf 
may not want to ‘embarrass herself’ by seeking to defend her earlier conclusions 
(of no evidence of AFE) . . . .”  Prior to this conversation, and it is arguable 
although not fully developed “at the request of a defense attorney,” a complaint 
had even been filed with DOH against Dr. Wolf, which jeopardized her medical 
license.  Dr. Wolf learned of this complaint immediately prior to her deposition 
with defense counsel, during which she had to discuss and defend her conclusion 
 
 
- 55 - 
that AFE was not the cause of Susan’s death.  Full evidence concerning this 
attempted intimidation should be disclosed and explored. 
The trial court addressed the alleged intimidation as two separate issues: (1) 
whether sufficient evidence was presented to introduce into evidence the fact that a 
disciplinary proceeding had been filed against Dr. Wolf by DOH; and (2) whether 
individuals had attempted to intimidate Dr. Wolf prior to her deposition.  The trial 
court only allowed Special to proffer Dr. Wolf’s testimony on these issues.  
Although the trial court found the testimony addressing witness tampering with 
regard to activities occurring prior to Dr. Wolf’s deposition to be relevant, it ruled 
that testimony on this issue was inadmissible because it constituted double hearsay.  
The trial court also precluded testimony “with respect to the [DOH] investigation . 
. .  [because] I don’t believe there’s a sufficient evidentiary nexus to allow us to go 
there [and address witness intimidation] at this point.  [Dr. Wolf] doesn’t know 
who filed [the complaint that led to the disciplinary proceeding], and we can 
surmise who may or may not have, but I don’t think we have enough to go there.” 
The trial court’s concern regarding the evidentiary nexus between Dr. 
Wolf’s testimony and the apparent witness intimidation is misplaced.  It is clear 
that a third party with the “authority, consent, or knowledge” of Baux, if not West 
Boca as well, attempted to influence Dr. Wolf and alter her testimony.  See 
Manuel, 524 So. 2d at 735.  No other persons or party would have been privy to, 
 
 
- 56 - 
and interested in, Dr. Wolf’s conclusions regarding the cause of Susan’s death.  
Who else would have asked Dr. Wolf to reconsider her earlier conclusions?  Who 
else would have initiated a complaint with DOH against Dr. Wolf?  Who else 
would have had a personal interest in her testimony?  The answers to these 
questions indicate that the defense or someone working on behalf of the defense 
was responsible for the events that occurred prior to Dr. Wolf’s deposition, and 
that party intended to, and did, exert pressure on Dr. Wolf in an effort to change 
her opinion.  In any event, the evidence should be explored and the truth exposed.       
With regard to the dictates of Jost—that the challenged testimony must be 
relevant and the communication reasonably understood by the targeted witness as 
an attempt to intimidate—Special appears to have satisfied this standard.  First, in 
its order, the trial court found this testimony to be relevant.  Additionally, this 
testimony concerned the key issue in this case—the cause of Susan’s death.  
Second, although Dr. Wolf may have neither changed her testimony nor been 
intimidated, she understood the intent of the events preceding her deposition to be 
an effort to alter her conclusion.  Accordingly, the trial court should have stayed 
the proceedings and addressed the problem and allegations of intimidation at the 
time they were brought to the court’s attention.  Judicial proceedings must be free 
from improper efforts to intimidate witnesses and, when that issue arises, courts 
must be prepared to respond and react lest we allow justice to be undermined.  The 
 
 
- 57 - 
trial court’s failure to do so, and thereby ensure that the trial was not tainted by 
extraneous influences, was not a harmless error.  The trial court’s failure to admit 
testimony on this issue amounted to an abuse of discretion.   
To the extent that Baux and West Boca allege that this evidence of 
intimidation is too attenuated to be admitted, I note that evidence of this nature 
“need not lead inescapably towards a single conclusion to be relevant, it need only 
make certain facts more probable than not.”  See McQueeney, 779 F.2d at 921.  
Here, Special provided sufficient support for the trial court to rule the testimony 
admissible and deserving of the jury’s consideration.  Consequently, this testimony 
should have been admitted as substantive evidence of Baux and West Boca’s lack 
of faith in their defense that AFE caused Susan’s death.  Most certainly, if further 
evidence is available, it must be considered in connection with a new trial. 
Moreover, if in fact these activities were concerted efforts to intimidate Dr. 
Wolf, it is appropriate to conclude that they derived from parties who acted with 
the “authority, consent, or knowledge” of Baux, if not West Boca as well.  See 
Manuel, 524 So. 2d at 735.  Neither Baux nor West Boca has provided this Court 
with a reason to conclude that some other person or party would have had a motive 
to harass Dr. Wolf as occurred here.  Additionally, because the intimidating parties 
were acting as agents of Baux, the trial court’s hearsay concerns are eliminated.  
Compare Jost, 730 So. 2d at 710 (permitting admission of communications to the 
 
 
- 58 - 
targeted doctor from the defendant’s insurance carrier, which is “akin to a 
communication from [the defendant] . . . [and not akin to] a communications from 
a third party with no direct interest in the outcome of the case”), with Nagel v. 
State, 774 So. 2d 835, 838 (Fla. 4th DCA 2000) (ruling that a police officer’s 
testimony was inadmissible because the state did not present evidence that the 
contested telephone call “was made with appellant’s authority, consent, or 
knowledge”). 
Based on the relevance of the testimony to both the very core issue of the 
litigation (the AFE diagnosis), and demonstrated efforts to change or silence 
contradictory evidence concerning the cause of Susan’s death, I would conclude 
that the erroneous rulings by the trial court amounted to harmful error.  The 
evidence of witness tampering was relevant to the theory of causation espoused 
and should have been admitted as substantive evidence to discredit those involved 
in the efforts.  The failure of the trial court to admit this testimony constituted an 
abuse of discretion and this Court should not conclude that there is no reasonable 
possibility that these errors did not affect the deliberations of the jury and its 
determination that Baux and West Boca were not responsible for Susan’s death.  
See DiGuilio, 491 So. 2d at 1135. 
 
 
- 59 - 
In conclusion, I would remand this case for a new trial because without the 
evidence excluded here, the fairness and integrity of this litigation has been 
compromised.  
POLSTON, J., dissenting. 
 
I agree with Justice Pariente’s dissent from the majority’s decision to adopt 
the same harmless error standard for both the criminal and civil contexts even 
though criminal and civil cases are subject to different burdens of proof.  The 
Fourth District Court of Appeal properly held that “harmless error occurs in a civil 
case when it is more likely than not that the error did not contribute to the 
judgment.”  Special v. Baux, M.D., et al., 79 So. 3d 755, 771 (Fla. 4th DCA 2011).  
I also agree with Justice Pariente’s conclusion that the trial court did not err in 
excluding the pre-deposition comments allegedly made to Dr. Wolf as inadmissible 
hearsay.  However, unlike Justice Pariente and the majority, I do not believe that a 
new trial is warranted in this case because the improper restriction of Dr. Dildy’s 
cross-examination testimony was harmless. 
 
Reviewing the entire record, it is more likely than not that the trial court’s 
restriction of Dr. Dildy’s cross-examination did not contribute to the judgment.  
The proffered cross-examination is cumulative of other evidence actually presented 
to the jury regarding the possibility of overdiagnosis of AFE at West Boca 
because, during Dr. Adelman’s testimony, “Special was able to elicit national 
 
 
- 60 - 
statistics showing incidence of AFE diagnosis at West Boca was about 15 times the 
rate elsewhere.”  Id. at 757.  Moreover and importantly, the proffered cross-
examination would have added very little (if any) support to Special’s position, 
especially considering that Dr. Dildy’s proffered testimony strongly emphasized 
that a possible statistical anomaly in all AFE cases at West Boca would not matter 
here because this case in particular was a case of AFE.  As the Fourth District 
explained, 
[t]he ultimate purpose of the proposed cross-examination was to call 
into question the hospital’s AFE diagnosis by suggesting that the 
hospital diagnosed that condition about 15 times more than the rate 
elsewhere.  This issue was presented to the jury through the testimony 
of Dr. Adelman and in part from Dr. Dildy.  This evidence allowed 
the plaintiff’s attorney in closing argument to hammer on the 
significance of the statistical abnormality.  During the proffer of Dr. 
Dildy, he said that if the incidence of AFE at the hospital were 
accurate, he would be concerned that AFE was being over-diagnosed.  
Yet, even when confronted with the statistics documenting this 
possibility, he persisted in his opinion that Susan presented a special 
case of AFE.  He testified, “But this case here, we’re talking about, it 
doesn’t matter what all these other cases are, this is this case, and this 
case is an amniotic fluid embolism.” 
Id. at 772 (emphasis added). 
 
Accordingly, because I disagree with the majority’s adoption and application 
of the criminal harmless error standard in this civil case, I respectfully dissent. 
CANADY, J., concurs. 
Application for Review of the Decision of the District Court of Appeal - Certified 
Great Public Importance  
 
 
 
- 61 - 
 
Fourth District - Case No. 4D08-2511 
 
 
(Palm Beach County) 
 
Gary Mitchell Cohen and Andrew Bryan Yaffa of Grossman Roth, P.A., Boca 
Raton, Florida, and Philip Mead Burlington and Andrew A. Harris of Burlington & 
Rockenbach, P.A., West Palm Beach, Florida, 
 
 
for Petitioners 
 
Michael Keith Mittelmark, Megan Kathleen Zavoina and Kabir Asrani of 
Michaud, Mittelmark, Marowitz & Asrani, PLLC, Boca Raton, Florida, on behalf 
of West Boca Medical Center; Irene Marie Porter, Mark Hicks, and Shannon Kain 
of Hicks, Porter, Ebenfeld & Stein, P.A., Miami, Florida, and Eugene L. Ciotoli of 
Bobo Ciotoli Bocchino Newman Corsini White & Buigas, P.A., North Palm 
Beach, Florida, on behalf of Ivo Baux, M.D., PA., and Pinnacle Anesthesia, P.L., 
 
 
for Respondents