Title: Freshwater v. Scheidt

State: ohio

Issuer: Ohio Supreme Court

Document:

[Cite as Freshwater v. Scheidt, 86 Ohio St.3d 260, 1999-Ohio-161.] 
 
 
 
 
 
FRESHWATER ET AL., APPELLANTS, v. SCHEIDT ET AL., APPELLEES. 
[Cite as Freshwater v. Scheidt (1999), 86 Ohio St.3d 260.] 
Evidence — Expert witness — Reliance on published medical literature in forming 
opinion — Statements contained in literature can be used for purposes of 
impeachment — Reliance on published medical literature can be established 
without an express acknowledgement by the testifying expert that he or she 
relied upon it. 
If an expert witness relies upon published medical literature in forming his or her 
opinion, or the expert provides testimony sufficient to establish that the 
literature is reliable authority, or the literature is part of the expert’s own 
publication, statements contained in the literature can be used for purposes 
of impeachment.  The requisite reliance upon published medical literature or 
its 
authoritative 
nature 
can 
be 
established 
without 
an 
express 
acknowledgement by the testifying expert that he or she had relied upon the 
literature or that it is authoritative.  (Stinson v. England [1994], 69 Ohio 
St.3d 451, 633 N.E.2d 532, construed and followed.) 
(No. 97-1502 — Submitted April 13, 1999 — Decided September 1, 1999.) 
APPEAL from the Court of Appeals for Paulding County, No. 11-96-10. 
 
In 1993, appellant Kathleen M. Freshwater was referred by her personal 
physician to appellee Dr. Robert B. Scheidt, a general surgeon, for chronic 
abdominal pain.  Scheidt examined Kathleen and concluded that she would benefit 
from having her gallbladder removed.  In a preoperative medical report, Scheidt 
noted that “[t]his 70 year old patient is having bouts of abdominal pain, increased 
gas and also nausea.  The patient has had a gallbladder ultrasound which is 
negative but a hepatobiliary scan shows an ejection fraction with CCK stimulation 
of only 9%, this being abnormal[.]  [W]e feel that the patient will benefit from a 
 
2 
laparoscopic cholecystectomy.  This has been thoroughly discussed with the 
patient and she is aware that there is a possibility this may not help and also that 
we may have to do additional conversion from laparoscopic technique to open 
technique for a successful surgery.”  In the report, Scheidt also set forth Kathleen’s 
present physical condition, medications that she was taking, and her medical 
history.  Kathleen had undergone numerous past surgeries.  Her surgeries listed in 
the report included “[h]erniorrhaphy, cyst removed from ovaries, appendectomy, T 
& A and surgery for a ‘twisted bowel,’ D & C.” 
 
On November 9, 1993, Kathleen underwent surgery at appellee Paulding 
County Hospital to remove her gallbladder.  The laparoscopic cholecystectomy 
performed on Kathleen was referred to as a “closed” or “blind” technique, which 
involved the initial insertion of a “Veress” needle.  In his postoperative report, 
Scheidt noted that the needle was inserted at the umbilicus, that it was followed by 
a trocar and camera, and that he was “lucky to get in avoiding bowel.”  Scheidt 
noted further that “[t]he bowel was adherent to the anterior parietal peritoneum 
along the scar line which was to the right of the umbilicus, but there was also some 
bowel surrounding the trochar and we could not visualize the gallbladder.  We 
therefore  * * * spent a considerable period of time taking down adhesions  * * *.  
We inspected the bowel as we progressed and there was no injury to bowel wall.  It 
was entirely intact when it was finally taken down.  * * * We were able to insert 
the light lens [and] camera through the umbilical port and get a proper view of the 
gallbladder.   * * * [T]he gallbladder was removed  * * * and retrieved through the 
umbilical port.” 
 
Shortly after surgery, Kathleen had noticeable swelling of her body and 
severe abdominal pain.  Kathleen was eventually transported by ambulance to 
another hospital, where she underwent further surgery to repair a perforation to her 
small bowel.  The perforation occurred as a result of the laparoscopic procedure 
 
3 
performed by Scheidt.  During this time, Kathleen became seriously ill and almost 
died.  She was hospitalized for seventy-seven days, the majority of which was 
spent in the intensive-care unit.  She also incurred extensive medical bills. 
 
On September 29, 1994, Kathleen and her husband, appellant Dewain 
Freshwater, filed a complaint against Scheidt, his incorporated medical practice, 
and Paulding County Hospital.  Appellants alleged, among other things, that 
Scheidt was negligent in failing to inform Kathleen of the risks associated with the 
surgery, and that Scheidt was negligent in the performance of the operation itself.  
Appellants’ claims against the hospital included claims predicated on the theory of 
agency by estoppel and the negligent credentialing of Scheidt.  Dewain also sought 
recovery against appellees for loss of consortium. 
 
Prior to trial, appellants dismissed their negligence claims against the 
hospital.  Additionally, the hospital entered an admission that Scheidt was an agent 
of the hospital by estoppel and that if Scheidt was found liable to appellants for 
malpractice, the hospital would be vicariously liable for his conduct. 
 
During the trial, testimony was presented that various surgical methods 
could be used in removing a patient’s gallbladder.  The methods utilized were 
classified generally as either open or closed procedures.  In 1993, the closed 
laparoscopic procedure performed on Kathleen was a relatively new technique.  
From 1990 through 1992, Scheidt attended medical training courses in which he 
learned how to perform the laparoscopic cholecystectomy.  He also learned when it 
was appropriate to use a laparoscopic procedure and contraindications that 
warranted the use of other surgical methods. 
 
At trial, appellants’ counsel attempted to have Scheidt acknowledge the 
authoritative nature of his medical training in which he learned how to perform 
laparoscopic cholecystectomies.  Counsel intended to demonstrate that Scheidt had 
been negligent in performing the laparoscopic cholecystectomy, that he had been 
 
4 
aware of the risks and dangers associated with the procedure, and that, given 
Kathleen’s prior surgeries and the increased risk of underlying adhesions from the 
surgeries, Scheidt should have resorted to an alternative safer method of removing 
the gallbladder.1  On cross-examination, Scheidt was questioned as follows: 
 
“Q.  And were the people who presented you with the training on 
laparoscopic surgery authorities in the field of laparoscopic surgery? 
 
“A.  Well, they were the teachers.  I hardly know how to define authority.  
Certainly what they had to say was helpful and useful. 
 
“Q.  And you looked to them for guidance? 
 
“A.  I looked to them for helpful suggestions.  I already knew how to do 
laparoscopic surgery.  I had done a lot of it before, but I was looking for any kind 
of clues or small ideas that could help me do good surgery from them. 
 
“Q.  Okay.  And were the courses that you took  * * * for laparoscopic 
surgery for cholecystectomies  * * * courses that you used to determine 
laparascopic surgery and how to perform it? 
 
“A.  They were certainly helpful to me. 
 
“Q.  Okay.  And would you agree that  * * * Dr. Kulkin is an authority on 
laparoscopic surgery on the closed technique? 
 
“A.  I don’t remember him by name.  I couldn’t answer that question. 
 
“Q.  Okay.  Do you, you don’t know that he’s an authority or not?  Do you 
remember the course work? 
 
“A.  I remember that I took the course.  I’m not sure I can specifically recall 
the course work, per se.  Many, many courses are combined in my mind. 
 
“Q.  Okay.  So this person may not be authoritative, you may not have 
gotten anything out of him? 
 
“A.  I couldn’t possibly say that. 
 
“Q.  Okay.  Well, I’d like to ask you some questions about this to see if you 
 
5 
agree with him or if you don’t agree with him. 
 
“A.  Fine. 
 
“MR. RIEMENSCHNEIDER [DEFENSE COUNSEL]:  Your honor, I’m just going 
to object, hearsay.” 
 
Subsequently, the following discussion took place between counsel for the 
litigants and the trial court: 
 
“THE COURT:  The record should reflect that counsel and the court and Dr. 
Scheidt are present in the courtroom out of the presence of the jury.  There were 
several evidentiary issues that needed to be addressed on the record here. 
 
“First, let’s start with the training manual issue.  Counsel wish to make any 
arguments on the record? 
 
“MR. O’NEIL [COUNSEL FOR PLAINTIFFS]: Yes, Your Honor.  * * * Your 
Honor, we had identified the training manual that was provided to us in discovery.  
In fact, there is a cover sheet on the training manual  * * *.  It says, ‘Enclosed are 
copies of the requested documentation provided by Dr. Scheidt in response to 
request for any course work and/or continuing education courses.  * * * ’ 
 
“And in there is a course work from an advanced laparoscopic surgery for 
general surgery and another course study.  * * * 
 
“Dr. Scheidt in his deposition indicated  * * * at, if I’ve got the right page, 
page 35, ‘The procedure you went through on November 9, ‘93, is that the same 
procedure that you had learned on in these hands-on courses?’  ‘Yes.’ 
 
“And then, ‘Had you made any alterations or changes in the manner of the 
procedure?’  He says, ‘Yes’; and then the next line he changes that, and says, 
‘What changes have you made from the time of your training and the time of the 
laparoscopy on Mrs. Freshwater?’ 
 
“ ‘I’m sorry, I didn’t understand your question.  No I’ve made, I have not 
made any changes from my training.’ 
 
6 
 
“Later on in the deposition, I asked him about authoritative sources on page 
50; and I asked a question, ‘The courses you took, whether it was hands-on or 
otherwise, is there anyone there who you considered an authority on laparoscopy 
that you can recall?’ 
 
“His answer was, ‘I thought my teachers were good, I can’t remember their 
names.’ 
 
“And so, Your Honor, I think that this is how he learned how to do what he 
does; and it should be able to [be] gone into by me for purposes of notice of how to 
do the procedures correctly, notice of potential harms, and if he did the procedure 
correctly. 
 
“ * * * 
 
“THE COURT:  Well, but you’re talking about procedures, Joe, as opposed to 
all of the content in that training manual.  It is going to be the ruling of the court 
that the training manual is not going to be admissible.  I feel, it is my position that, 
again, that hearsay, you’re wanting to admit it for the truth of the matter contained 
in that document and the correctness of that procedure; which, again, it may be 
correct, I don’t know; but I think you need a witness here who can be cross-
examined before you can get that evidence in.” 
 
Also at trial, Dr. Karl A. Zucker, an expert witness for appellees, testified 
that Scheidt did not deviate from accepted standards of medical care in removing 
Kathleen’s gallbladder.  Upon cross-examination of Zucker, counsel for appellants 
attempted to question Zucker about statements contained in a book entitled 
“Surgical Laparoscopy,” which had been edited and written in part by Zucker.  The 
statements were in a chapter entitled “Open Laparoscopy,” written in part by a 
colleague of Zucker’s, Dr. Fitzgibbons.  Additionally, appellants’ counsel also 
sought to cross-examine Zucker with respect to other medical literature authored 
by Fitzgibbons.  This additional literature had apparently been referred to by 
 
7 
Zucker in some of Zucker’s other publications.  When questioned about the 
writings that Fitzgibbons had authored, Zucker avoided answering whether 
Fitzgibbons was an “authority” in the field and he further refused to acknowledge 
whether the medical literature authored by Fitzgibbons was “authoritative” in 
nature: 
 
“Q.  When you have written articles on laparoscopic surgery, have you 
frequently cited Dr. Fitzgibbons as an authority on the open laparoscopic 
technique? 
 
“A.  I’m not sure the word ‘authority’ is one I’d use; but he’s a colleague, a 
personal friend, my kids play with his kids.  So he’s a respected colleague, and I 
often will quote him.  I think he’s very honorable and honest individual with very 
good experience. 
 
“Q.  And you value his opinion? 
 
“A.  Yes. 
 
“Q.  And when you put out your book, he’s the one who wrote the chapter 
with another doctor or two on open laparoscopic? 
 
“A.  Yes. 
 
“ * * * 
 
“Q.  * * * Doctor, I have — did you quote Dr. Fitzgibbons because you 
believed he was an authority in the area of open laparoscopic surgery? 
 
“A.  As I said, I’m not sure I used the word ‘authority.’ 
 
“Q.  Well, that’s my question, though.  It’s of some legal significance as to 
the questions I can ask you or cannot ask you, and I’d like to know if you consider 
him an authority in the area of open laparoscopic surgery. 
 
“  * * * 
 
“Q. * * * Have you relied upon Dr. Fitzgibbons at all in your profession of 
informing other doctors as to the open Hasson technique? 
 
8 
 
“A.  I’ve quoted Dr. Fitzgibbons; but I don’t always, you know, agree with 
his writing or what he advocates. 
 
“Q.  Did you rely upon, did you think he was authoritative enough to write a 
chapter in your book? 
 
“A.  Again, I’m not sure about the word ‘authoritative,’ but I value his 
opinion and his expertise.  I invited him to write a chapter in a textbook that I 
wrote on laparoscopic surgery. 
 
“Q.  Did you rely upon the materials presented in that chapter of your book 
for any part of your testimony today? 
 
“A.  I certainly, I used part of that in coming up to my opinions and every 
day practice as well as in this testimony. 
 
“Q.  Did you rely upon his part of the chapter that dealt with complications 
and risk factors of not using the open technique? 
 
“ * * * 
 
“Q.  Did you rely upon any studies or statistics that he had as to the open 
Hasson technique versus the closed technique in coming to your conclusions for 
trial today? 
 
“A.  Well, as I said, I agree with some of the things and I disagree with other 
parts of his writings * * *.” 
 
The trial court prevented counsel for appellants from cross-examining 
Zucker with respect to statements in Zucker’s book.  The trial court concluded that 
in accordance with Stinson v. England (1994), 69 Ohio St.3d 451, 633 N.E.2d 532, 
the medical literature could not be used to impeach the testimony of Zucker. 
 
On September 26, 1996, following trial, the jury returned a general verdict in 
favor of appellees.  In response to interrogatories, the jury concluded that Scheidt 
had not been negligent in his care and treatment of Kathleen and that Scheidt had 
properly informed Kathleen of the risks and dangers associated with the operation.  
 
9 
On September 30, 1996, the trial court entered judgment for appellees. 
 
Appellants appealed to the Third District Court of Appeals, claiming that the 
trial court erred in restricting their use of medical literature in the cross-
examination of Scheidt and Zucker.  Relying in part on Stinson, supra, the court of 
appeals overruled appellants’ assignments of error and affirmed the judgment of 
the trial court.  The court of appeals held that because Scheidt and Zucker did not 
explicitly concede the “authoritative” nature of the literature in question, the 
literature could not be used by appellants for purposes of impeachment. 
 
The cause is now before this court upon the allowance of a discretionary 
appeal. 
__________________ 
 
Arthur, O’Neil, Mertz & Bates Co., L.P.A., Rodney M. Arthur, Joseph W. 
O’Neil and Daniel R. Michel, for appellants. 
 
Eastman & Smith, Ltd., Rudolph A. Peckinpaugh, Jr., and John D. Wiley, 
Jr., for appellees Robert B. Scheidt, M.D., F.A.C.S., and Robert B. Scheidt, M.D., 
F.A.C.S., Inc. 
 
Robison, Curphey & O’Connell, E. Thomas Maguire and Timothy D. Krugh, 
for appellee Paulding County Hospital. 
 
Leeseberg, Maloon, Schulman & Valentine and Geoffrey M. Wardle, urging 
reversal for amicus curiae, Ohio Academy of Trial Lawyers. 
 
Buckingham, Doolittle & Burroughs, L.L.P., and Carol A. Costa, urging 
affirmance for amicus curiae, Ohio Association of Civil Trial Attorneys. 
__________________ 
 
DOUGLAS, J.  The central issue in this case concerns the extent to which 
statements from learned treatises and other publications may be used to impeach 
the testimony of expert witnesses.  Prior to the promulgation of Evid.R. 706,2 
effective July 1, 1998, rules governing the use of learned treatises evolved under 
 
10 
the common law.  In Hallworth v. Republic Steel Corp. (1950), 153 Ohio St. 349, 
41 O.O. 341, 91 N.E.2d 690, paragraph two of the syllabus, the court held that 
learned treatises, even though properly identified, authenticated, and recognized as 
standard authority, are not admissible in evidence to prove the truth of the matter 
asserted therein.  Rather, “learned treatises are considered hearsay, may not be 
used as substantive evidence, and are specifically limited to impeachment purposes 
only.”  Ramage v. Cent. Ohio Emergency Serv. Inc. (1992), 64 Ohio St.3d 97, 110, 
592 N.E.2d 828, 838, citing Giannelli, Ohio Evidence Manual (1989), Section 
702.06, Author’s Comment; Piotrowski v. Corey Hosp. (1961), 172 Ohio St. 61, 15 
O.O.2d 126, 173 N.E.2d 355; Lambert v. Dally (1972), 30 Ohio App.2d 36, 59 
O.O.2d 29, 281 N.E.2d 857; and Hallworth, supra. 
 
Later, in Stinson v. England (1994), 69 Ohio St.3d 451, 633 N.E.2d 532, this 
court set forth the conditions under which learned treatises can be used to impeach 
the credibility of expert witnesses.  Counsel may use a learned treatise to impeach 
a testifying expert by establishing that the expert is either unaware of the text or 
unfamiliar with its contents.  Id., paragraph two of the syllabus.  Additionally, the 
substance of a learned treatise can be used to impeach the credibility of an expert 
witness if the expert has relied upon the treatise in forming his or her opinion or 
the expert has acknowledged the authoritative nature of the treatise.  Id.3 
 
In Stinson, we determined that the trial court committed reversible error by 
permitting the cross-examination of an expert with the use of a medical treatise 
after the expert had stated categorically that he did not consider the text 
authoritative.  Thus, “instead of impeaching the credibility of Dr. Warner [the 
expert], appellee was permitted to contradict his testimony through the use of the 
contents of the text despite his earlier testimony that it was not authoritative.  This 
use constituted an impermissible presentation of hearsay evidence to the jury.”  Id., 
69 Ohio St.3d at 458, 633 N.E.2d at 539. 
 
11 
 
In the case at bar, both the trial court and court of appeals ruled that Stinson 
prevented appellants’ counsel from cross-examining Scheidt and Zucker about the 
medical literature in question.  On cross-examination, both Scheidt and Zucker 
would not explicitly concede the “authoritative” nature of the literature.  
Nevertheless, although Scheidt and Zucker refused to explicitly acknowledge the 
authoritative nature of the medical literature, they implicitly conceded as much.  
See Jacober v. St. Peter’s Med. Ctr. (1992), 128 N.J. 475, 487, 608 A.2d 304, 311.  
Scheidt testified that he “hardly [knew] how to define authority,” but that his 
teachers in the area of laparoscopic surgery were “helpful and useful,” and that he 
looked to his teachers for “helpful suggestions.”  He also stated that the courses 
pertaining to laparoscopic cholecystectomies “were certainly helpful to me.”  With 
respect to Zucker, he testified that Fitzgibbons was a “respected colleague,” “I 
often will quote him,” and that he was “a very honorable and honest individual 
with very good experience.”  Zucker further stated that he valued Fitzgibbons’s 
“opinions and his expertise,” and had “invited him to write a chapter in a textbook 
that I wrote on laparoscopic surgery.”  Zucker also testified that he had relied upon 
materials presented in the chapter in that he “used part of that [chapter] in coming 
up to my opinions in everyday practice as well as in this testimony.” 
 
In Stinson, we determined that it was error to allow the medical treatise to be 
used for impeachment purposes because a proper foundation had not been laid 
establishing the text as a reliable authority.  However, Stinson was not intended to 
allow testifying experts to adroitly evade cross-examination simply by avoiding 
such words as “rely” or “authority” or any forms of those words.  Indeed, if an 
expert witness relies upon published medical literature in forming his or her 
opinion, or the expert provides testimony sufficient to establish that the literature is 
reliable authority, or the literature is part of the expert’s own publication, 
statements contained in the literature can be used for purposes of impeachment.  
 
12 
The requisite reliance upon published medical literature or its authoritative nature 
can be established without an express acknowledgement by the testifying expert 
that he or she had relied upon the literature or that it is authoritative. 
 
The testimony of Scheidt and Zucker established that the medical literature 
at issue was reliable authority.  Moreover, testimony and other evidence in the 
record indicate that Scheidt and Zucker also relied upon the literature in forming 
their opinions.  The literature was not offered by appellants’ counsel as substantive 
evidence.  Instead, the literature was intended to call into question the weight to be 
attached by the fact finder to the testimony of Scheidt and Zucker.  In this regard, 
the restricted cross-examination of Scheidt and Zucker by the trial court harmed 
the fact-finding process and prevented the jury from adequately assessing the 
credibility of the witnesses. 
 
Accordingly, we believe that, in this case, the trial court’s decision to 
prohibit cross-examination with respect to the medical literature in question 
constituted prejudicial error.  See Civ.R. 61 and R.C. 2309.59.  Therefore, the 
judgment of the court of appeals is reversed, and the cause is remanded for a new 
trial. 
Judgment reversed 
and cause remanded. 
 
MOYER, C.J., RESNICK, F.E. SWEENEY, PFEIFER and LUNDBERG STRATTON, 
JJ., concur. 
 
COOK, J., dissents. 
FOOTNOTES: 
1. 
Expert testimony elicited at trial indicated that adhesions can develop as a 
result of prior surgeries.  Adhesions can cause organs to stick together or cause 
organs such as the small bowel to stick to the underside of the abdominal cavity.  
Counsel for appellants attempted to establish that Scheidt was aware that adhesions 
 
13 
would be present, that the perforation to Kathleen’s small bowel occurred during 
the blind insertion of the Veress needle or insertion of the trocar, and that Scheidt 
fell below the standard of acceptable medical care in performing the operation and 
by utilizing the closed procedure instead of an open technique in removing the 
gallbladder. 
2. 
Evid.R. 706, entitled “Learned treatises for impeachment,” provides: 
 
“Statements contained in published treatises, periodicals, or pamphlets on a 
subject of history, medicine, or other science or art are admissible for impeachment 
if the publication is either of the following: 
 
“(A) Relied upon by an expert witness in reaching an opinion; 
 
“(B) Established as reliable authority (1) by the testimony or admission of 
the witness, (2) by other expert testimony, or (3) by judicial notice. 
 
“If admitted for impeachment, the statements may be read into evidence but 
shall not be received as exhibits.” 
 
As indicated in the Staff Notes to Evid.R. 706, the rule “codifies the 
common law rule, making it more readily accessible for trial use.”  The Staff Notes 
further provide that “[a] possible expansion of the common law rule concerns the 
use of judicial notice to establish the treatise as a reliable authority.  A court taking 
judicial notice of Gray’s Anatomy illustrates this aspect of the rule. 
 
“The trial court decides under Evid.R. 104(A) if the treatise is a ‘reliable 
authority’ and Evid.R. 105 requires a limiting instruction upon request.  If an 
opposing expert witness refuses to recognize a treatise as reliable, the judge may 
permit the impeachment subject to counsel’s subsequent laying of the foundation 
through its own expert.  There is no need to inform the jury of the trial court’s 
determination.” 
3. 
In Stinson v. England (1994), 69 Ohio St.3d 451, 633 N.E.2d 532, paragraph 
two of the syllabus, we also held that “[t]he learned treatise exception to the 
 
14 
hearsay rule set forth in Fed.Evid.R. 803(18) has no counterpart in Ohio Evid.R. 
803.”  In Ohio, the use of learned treatises is limited to impeachment purposes 
only.  Ramage v. Cent. Ohio Emergency Serv., Inc. (1992), 64 Ohio St.3d 97, 110, 
592 N.E.2d 828, 838.  Conversely, Fed.Evid.R. 803(18) allows treatises to be used 
as substantive evidence as an exception to the hearsay rule.  See Weissenberger’s 
Ohio Evidence Treatise (1999) 343, Section 706.1.  Notably, a majority of the 
states have adopted Fed.Evid.R. 803(18) “in either words or substance.”  Walsh & 
Rose, Increasing the Useful Information Provided by Experts in the Courtroom:  A 
Comparison of Federal Rules of Evidence 703 and 803(18) with the Evidence 
Rules in Illinois, Ohio, and New York (1995), 26 Seton Hall L.Rev. 183, at 229.  
Moreover, it appears that the federal rule has “enjoyed genuine success in the 
courtroom.”  Id. at 252.  In this regard, we respectfully refer this matter to the Ohio 
Supreme Court Rules Advisory Committee to fully review Fed.Evid.R. 803(18) 
and, if appropriate, suggest a counterpart in Ohio Evid.R. 803, allowing treatises 
and other publications to be used as an exception to the hearsay rule. 
__________________ 
 
COOK, J., dissenting.  While I agree with the rule announced by the 
majority, I do not agree that the record in this case supports the application of the 
rule and therefore would affirm the judgment of the court of appeals that the 
exclusion of the evidence was not an abuse of discretion.