Title: National Bank of Commerce v. Quirk

State: arkansas

Issuer: Arkansas Supreme Court

Document:

NATIONAL BANK of COMMERCE, William E. Golden,
  M.D., and Kimberly A. Golden, M.D., Co-
Guardians of the Estate of Emily Jane Golden,
Arkansas Department of Human Services v. J.
Gerald QUIRK, M.D., Gaylon L. Brunson, M.D.,
 Vikki A. Stefans, M.D., Bernadette Lange,
  M.D., Richard E. Leitheiser, Jr., M.D.,
William M. Chadduck, M.D., Diane R. Edwards,
M.D., Karen Everett, M.D., Janice W. Allison,
 M.D., W. Mark, Molpus, M.D., and American
       Physician's Insurance Exchange

94-575                                             ___ S.W.2d ___

                    Supreme Court of Arkansas
                 Opinion delivered March 18, 1996


     1.   Civil procedure -- admission of depositions provided for under
     rules -- both witnesses were out of state at time of trial. --
     Where there was no dispute that both doctors were out of state
     at the time of trial and there was no allegation that the
     absence of either expert was procured by the appellants, Ark.
     R. Civ. P. 32 clearly provided for the admission of both
     depositions.

     2.   Civil procedure -- depositions -- rules do not distinguish
     between discovery and evidentiary depositions. -- Arkansas
     Rule of Civil Procedure 32 does not distinguish between
     discovery and evidentiary depositions; any party, not only the
     party who took the deposition, may use the deposition of a
     witness, whether or not a party, for any purpose at the trial
     or hearing, if the party demonstrates to the court the
     existence of one of the conditions specified in Rule 32(a)(3). 
     3.   Civil procedure -- plaintiff's burden of proof in medical
     malpractice cases requires expert testimony when asserted
     negligence is not matter of common knowledge. -- The Medical
     Malpractice Act provides that in any action for medical injury
     the plaintiff must prove the applicable standard of care, that
     the medical provider failed to act in accordance with that
     standard, and that such failure was a proximate cause of the
     plaintiff's injuries; the plaintiff's burden of proving the
     applicable standard of care and the defendant's failure to
     comply with that standard requires expert testimony when the
     asserted negligence does not lie within the jury's
     comprehension as a matter of common knowledge.

     4.   Civil procedure -- medical malpractice -- exclusion of
     critical expert testimony constituted prejudicial error. --  
     Where one of the proffered depositions provided opinions
     regarding the applicable standard of care, the alleged
     negligence of appellees Quirk and Brunson, and proximate
     causation and the other physician's deposition provided that
     he examined the appellant mother in the delivery room, he
     conducted a cervical exam, discussed the "appropriate"
     treatment which he prescribed for her uterine contractions,
     and discussed the procedures he followed during her subsequent
     pregnancies, the exclusion of their depositions deprived the
     guardians of expert testimony in a situation in which such
     testimony was required; the exclusion of critical expert
     testimony in a medical malpractice case with multiple experts
     on each side constituted prejudicial error.

     5.   Constitutional law -- issue not properly briefed and argued at
     trial -- argument procedurally barred. -- Where the
     constitutional issue was not properly briefed and argued to
     the trial court, the argument was procedurally barred; the
     supreme court will not strike down a legislative act on
     constitutional grounds without first having the benefit of a
     fully developed adversary case; moreover, the guardians did
     not raise the specific constitutional arguments they sought to
     advance on appeal; at trial, they merely made conclusory
     statements that the statute was unconstitutional. 

     6.   Evidence -- ruling on relevancy -- factors on review -- no
     abuse of discretion shown. -- A trial court's ruling on the
     relevancy of evidence will not be reversed absent an abuse of
     discretion; further, a trial court's weighing of probative
     value against unfair prejudice under Ark. R. Evid. 403 will
     not be reversed unless there has been a manifest abuse of
     discretion; here the appellants failed to demonstrate an abuse
     of discretion regarding either determination.

     7.   Evidence -- trial court has discretion to exclude otherwise
     admissible testimony -- no abuse of discretion found. --  
     The guardians' argument that the trial court improperly 
          excluded evidence of the doctor's "charting practices" was
     without merit where the guardians did not assert that the
     trial court abused its discretion regarding the prejudicial
     effect of the testimony, they simply asserted that the
     testimony was admissible under Ark. R. Evid. 404 and 608 which
     address character evidence; however, it is within the trial
     court's discretion to exclude otherwise admissible testimony
     under Ark. R. Civ. P. 403, and the appellate court could not
     say that the trial court abused its discretion in excluding
     the testimony.

     8.   Evidence -- exclusion of evidence of past employment as
     medical expert not error -- no abuse of discretion found. -- 
     The guardians' contention that the trial court erred in 
          excluding evidence of the doctor's past employment as a
     medical expert was without merit; the guardians failed to
     demonstrate that the trial court abused its discretion in
     concluding the testimony was not relevant; the doctor's past
     experience as a medical expert for a plaintiff's attorney,
     though it may have been extensive, was not relevant.

     9.   Negligence -- doctrine of res ipsa loquitur -- when doctrine
     may be invoked. -- The doctrine of res ipsa loquitur may apply
     in cases of medical malpractice on the part of any and all
     medical care providers as defined by the Medical Malpractice
     Act if the essential elements for application of the doctrine
     exist; the theory of res ipsa loquitur may be invoked when: 
     (1) the defendant owes a duty to the plaintiff to use due
     care, (2) the accident is caused by the thing or
     instrumentality under the control of the defendant, (3) the
     accident which caused the injury is one that, in the ordinary
     course of things would not occur if those having control and
     management of the instrumentality used proper care, and (4)
     there is an absence of evidence to the contrary. 

     10.  Jury -- res ipsa loquitur instruction properly refused --
     substantial evidence to contrary that accident had not even
     occurred. -- The guardians' proposed jury instruction, which
     related to the question of whether the doctor was negligent in
     the use of forceps, was properly refused where there was
     substantial "evidence to the contrary" that an accident was
     caused by the thing or instrumentality under the control of
     the defendant or that an accident even occurred during the
     delivery. 

     11.  Appeal & error -- no objection made at trial to limitation on
     closing argument -- issue not preserved for appeal. -- On
     appeal the guardians asserted that the trial court erred in
     limiting argument time because it was clear that the
     circumstances of this case necessitated a longer closing
     argument; however, the guardians did not object to the trial
     court's limitation upon closing argument, thus, the issue was
     not preserved for appeal. 

     12.  Trial -- trial court has wide discretion to control counsel's
     arguments -- no prejudice shown in trial court's refusal to
     allow damage argument. -- A trial court has wide discretion in
     controlling, supervising, and determining the propriety of
     counsels' arguments, and an appellate court will not reverse
     absent a showing of manifest abuse; the guardians' assertion
     that the trial court erred in prohibiting them from arguing
     damages in the rebuttal portion of their argument was without
     merit where they could not show they were prejudiced by the
     ruling; the jury returned a verdict in favor of the defendants
     on the issue of liability; therefore, the jury was never
     required to consider the issue of damages; the appellate court
     will not reverse in the absence of a showing of prejudice.  

     13.  Parties -- direct-action statute limited to insurance carriers
     of cooperative non-profit organizations -- individuals are not
     mentioned. -- The Arkansas direct-action statute is limited to
     the insurance carriers of cooperative non-profit
     organizations, municipalities, agencies, or subdivisions of
     municipalities or of the state, improvement districts, school
     districts, or other organizations of any kind or character not
     subject to suit in tort; the statute makes no mention of
     individuals. 

     14.  Appeal & error -- no authority or convincing argument made --
     decision of trial court will be affirmed. -- Where an
     appellant cites no authority, nor makes a convincing argument,
     and where it is not apparent without further research that the
     point is well taken, the decision of the trial court will be
     affirmed.

     15.  Parties -- suits allowed under direct-action statute --
     statute not applied retroactively. -- The direct-action
     statute only allows suits against insurers for the negligence
     of their insureds when the insured is a charitable
     organization or governmental entity; the amendment to Act 292
     simply added the clause "except to the extent that they be
     covered by liability insurance" as qualifying an employee's
     immunity; consequently, there was no retroactive application
     as was argued by the guardians because the court had
     previously recognized that employees have only a qualified
     immunity and that actions can be maintained against them to
     the extent they are protected by insurance.

     16.  Judgment -- standard of review for summary judgment -- factors
     on review. -- The standard for review of a summary judgment is
     whether the evidentiary items presented by the moving party in
     support of the motion left a question of material fact
     unanswered and, if not, whether the moving party is entitled
     to judgment as a matter of law; the court views all proof in
     the light most favorable to the party opposing the motion,
     resolving all doubts and inferences against the moving party; 
     however, when the movant makes a prima facie showing of
     entitlement to summary judgment, the respondent must meet that
     proof with proof showing a genuine issue as to a material
     fact. 

     17.  Physicians & surgeons -- proof required in an action for
     medical injury -- burden of proof. -- Arkansas Code Annotated
      16-114-206 (1987) provides that in any action for medical
     injury the plaintiff must prove the applicable standard of
     care, that the medical provider failed to act in accordance
     with that standard, and that such failure was a proximate
     cause of the plaintiff's injuries; the plaintiff's burden of
     proving the applicable standard of care and the defendant's
     failure to comply with that standard requires expert testimony
     when the asserted negligence does not lie within the jury's
     comprehension as a matter of common knowledge.

     18.  Physicians & surgeons -- residents entitled to summary
     judgment as a matter of law -- no argument offered that either
     resident deviated below the required standard. -- Where, on
     appeal, the guardians offer no argument that either resident
     deviated below the required standard of care for a resident,
     the guardians failed to establish on appeal that they
     presented any evidence of the standard of care required, and
     did not cite any evidence in the record to support the theory
     that residents should be held to the same standard as other
     licensed doctors, the residents were entitled to judgment as
     a matter of law; the trial court did not err in granting the
     summary judgments.

     19.  Motions -- motion for directed verdict -- factors on review.
     -- In determining whether a directed verdict should have been
     granted, the evidence is reviewed in the light most favorable
     to the party against whom the verdict is sought and given its
     highest probative value, taking into account all reasonable
     inferences deducible from it; a motion for directed verdict
     should be granted only if there is no substantial evidence to
     support a jury verdict; where the evidence is such that
     fair-minded persons might reach different conclusions, then a
     jury question is presented, and the directed verdict should be
     reversed. 

     20.  Motions -- directed verdict properly granted -- no proof
     presented as to applicable standard of care. -- Where, in
     granting the directed verdict, the trial court had concluded
     that the witness was not familiar with the standard of care at
     the University of Arkansas Medical School as to the duties of
     a resident in that particular situation, the appellate court
     found that the guardians failed to present proof of the
     applicable standard of care and of the defendant's failure to
     comply with that standard. 

     21.  Damages -- child had no independent right to recover medical
     expenses -- trial court's ruling proper. -- A child is not
     given an independent right to recover the cost of the medical
     treatment; in case of injury to a minor child, there are two
     separate and distinct causes of action:  one in favor of the
     infant for his injuries and one in favor of the parent for
     losses suffered by the parent; no award for damages may be
     made in an action brought on behalf of the child where the
     child is unemancipated and not responsible for his own debts
     and has not paid the bill for such expenses; the trial court
     correctly concluded that the child did not have an independent
     right to recover medical expenses.

     22.  Limitation of actions -- trial court found right of parents to
     recover expenses incurred on behalf of their daughter barred
     by statute of limitations -- trial court not in error. --
     Where the guardians conceded that the last wrongful act
     complained of occurred in January 1991, and the child's
     parents did not even become parties to the action, and then
     only as guardians, until February 18, 1993, the right of the
     parents to recover expenses incurred on account of the injury
     to their child was, as the trial court concluded, barred by
     the statute of limitations. 

     23.  Parties -- motion for intervention improperly denied --
     intervenor had an independent cause of action. -- The trial
     court's denial of the motion for intervention on the basis
     that ADHS's claims were derivative of the parents' claims for
     recovery of medical expenses incurred during the minority of
     the child was in error where ADHS's claims were clearly not
     derivative of the claims of the parents; ADHS had an
     independent right to recover the cost of benefits provided
     from persons who are liable for injury to a medicaid recipient
     pursuant to Ark. Code Ann.  20-77-301 (Repl. 1991),  20-77-
     304 (Repl. 1991), and Ark. Code Ann.  20-77-307 (Supp. 1995);
     the trial court erred in denying the intervention; the
     appellate court reversed.

     24.  Appeal & error -- appellees not unreasonable in their belief
     that additional portions of the record were needed for proper 
     consideration of the issues -- motion to retax costs denied.
     -- Where the court could not say that the appellees were
     unreasonable in their belief that additional portions of the
     record were needed for consideration of the issues initially
     raised by the guardians, the guardians' motion to retax costs
     was denied.
     

     Appeal from Pulaski Circuit Court; Chris Piazza, Judge;
affirmed in part, reversed and remanded in part.
     David Hodges; Bernard Whetstone; and Bob Davidson, for
appellants.
     Richard B. Dahlgren, for appellant ADHS.
     Anderson & Kilpatrick, by:  Overton S. Anderson and Mariam T.
Hopkins, for appellees William M. Chadduck, M.D., and American
Physicians Insurance Exchange.
     Shaw, Ledbetter, Hornberger, Cogbill & Arnold, by:  Charles R.
Ledbetter, for appellee Diane R. Edwards, M.D.
     Mitchell, Williams, Selig, Gates & Woodyard, by:  R.T. Beard,
III, for appellee Gaylon L. Brunson, M.D.

     Andree Layton Roaf, Justice.MARCH 18, 1996.   *ADVREP9*






NATIONAL BANK OF COMMERCE,
WILLIAM E. GOLDEN, M.D., AND
KIMBERLY A. GOLDEN, M.D., CO-
GUARDIANS OF THE ESTATE OF
EMILY JANE GOLDEN, ARKANSAS
DEPARTMENT OF HUMAN SERVICES,
                    APPELLANTS,

V.

J. GERALD QUIRK, M.D., GAYLON
L. BRUNSON, M.D., VIKKI A.
STEFANS, M.D., BERNADETTE
LANGE, M.D., RICHARD E.
LEITHEISER, JR., M.D., WILLIAM
M. CHADDUCK, M.D., DIANE R.
EDWARDS, M.D., KAREN EVERETT,
M.D., JANICE W. ALLISON, M.D.,
W. MARK MOLPUS, M.D. AND
AMERICAN PHYSICIAN'S INSURANCE
EXCHANGE,
                    APPELLEES,




94-575




APPEAL FROM THE PULASKI COUNTY
CIRCUIT COURT,
NO. 92-5822,
HON. CHRIS PIAZZA, JUDGE,
















AFFIRMED IN PART, REVERSED AND
REMANDED IN PART.                    JUSTICE ANDREE LAYTON ROAF




     This is a medical malpractice case.  The appellants are the
co-guardians of Emily Jane Golden ("guardians") and the Arkansas
Department of Human Services ("ADHS"), which provided medical
benefits to her.  The appellees are ten physicians employed by the
University of Arkansas for Medical Sciences ("UAMS"), including two
who treated Emily Golden's mother, Kim Golden, during her pregnancy
and delivery, Drs. J. Gerald Quirk and Gaylon L. Brunson, and eight
others who provided medical treatment to Emily after her birth. 
Appellee American Physicians Insurance Exchange, ("APIE") is the
malpractice carrier for the physicians.  The guardians filed suit
against the physicians, alleging that Emily Golden suffered
injuries as a result of negligence during her delivery and in the
failure to subsequently diagnose her birth injuries.  The trial
court granted summary judgment to two of the physicians and
dismissed the complaint as to one physician during the trial; a
jury returned a verdict in favor of the remaining physicians.  The
guardians appeal the denial of their motion for new trial and the
orders granting the summary judgments and dismissal.  ADHS appeals
the denial of its motion to intervene.  We agree that the trial
court erred in excluding the depositions of two of the guardians'
obstetrical experts and in denying ADHS's motion to intervene.  We
affirm in part and reverse and remand for new trial as to Drs.
Quirk and Brunson, and to allow the intervention of ADHS.
     Emily Jane Golden was born at the UAMS hospital on October 3,
1985.  This action was commenced on October 26, 1992, after Emily's
parents obtained a diagnosis that she suffered a spinal cord injury
at birth.   Dr. Kim Golden, Emily's mother, had asked Dr. J. Gerald
Quirk, an obstetrician on the UAMS medical school faculty, to
handle her pregnancy and delivery.  Emily was delivered
approximately seven and a half months into the pregnancy.  Dr.
Quirk elected to perform a vaginal delivery rather than a cesarian
section, and he used forceps during the delivery.  Another
obstetrician, Dr. Gaylon L. Brunson, had examined Kim Golden during
her premature labor while Dr. Quirk was out of town.  The Goldens
contend that Emily's spinal cord was stretched at birth, and that
her vertebra may have been fractured.  They further contend that
the remaining physicians named in the lawsuit, also UAMS employees 
or residents at the time, were negligent in failing to discover the
extent of Emily's injuries.  The child was ultimately diagnosed as
having a spinal cord injury, as opposed to cerebral palsy, when she
was 7 years of age.  The Goldens also sued APIE pursuant to the
Arkansas Direct Action statute, as insurer of the state employee
physicians.  The trial court granted APIE's motion to dismiss prior
to trial, granted summary judgment to two of the physicians who
examined Emily after her birth, Drs. Allison and Molpus, and
dismissed the complaint during the trial as to Dr. Everett, another
physician who examined Emily.  The appellant ADHS moved to
intervene pursuant to Ark. Code Ann.  20-77-304 (Repl. 1991) in
order to recover medicaid benefits paid on behalf of Emily after
her medical insurance had been exhausted.  The trial court denied
the motion on the basis that ADHS's claims were derivative of
Emily's parents' claims for recovery of her medical expenses, and
those claims were time barred.
               1. Exclusion of deposition testimony
     The guardians first contend that the trial court improperly
excluded depositions of two of their experts contrary to the rules
of civil procedure.  This issue bears only on the case against Drs.
Quirk and Brunson because the excluded expert testimony concerned
only the issue of their negligence in treating Kim Golden during
her labor and delivery.  After the original complaint was filed,
APIE filed a motion for a pretrial scheduling order requesting that
it be allowed to take the discovery depositions of the guardians'
expert witnesses prior to and in a separate proceeding from any
evidentiary depositions.   The guardians' counsel objected that the
rules of civil procedure did not distinguish between discovery and
evidentiary depositions and asserted they would not waive the
wording of Ark. R. Civ. P. 32.
     At a hearing on the motion, the guardians again argued the
rules of civil procedure did not distinguish between discovery and
evidentiary depositions.  The trial court entered a scheduling
order which provided that the defendants were entitled to take
"discovery" depositions of all the plaintiffs' expert witnesses and
that the depositions "shall not be used as direct testimony at
trial unless the witness is deceased."  The order further provided
that, if it was determined that a witness would be otherwise
unavailable to attend trial, "plaintiff shall notify all defense
counsel so that an evidentiary deposition can be scheduled
subsequent to and in a separate proceeding from the discovery
deposition."
     Prior to the start of the trial, the guardians filed motions
seeking permission to read at trial the depositions of Dr. Frank
Miller, who had been present during Kim Golden's labor, and Dr.
Melvyn J. Ravitz, both experts for the case against Drs. Quirk and
Brunson.  The motions asserted that Dr. Miller's deposition was
taken at his office in Lexington, Kentucky, and that Dr. Ravitz was
an obstetrician in Manasquan, New Jersey.  The motion further
stated Dr. Ravitz was suffering from a medical problem and was
unable to attend the trial.  The trial court denied the guardians'
motion to introduce the depositions of Dr. Ravitz and Dr. Miller
based on the pretrial order. The trial court found that exceptional
circumstances did not exist in the case of Dr. Ravitz and appellees
were not given notice pursuant to the pretrial order that Dr.
Miller's deposition was to be an evidentiary deposition.  We agree
that the trial court erred in excluding the depositions.
     Rule of Civil Procedure 32 provides in part:
          (a) Use of Depositions. At the trial or upon the hearing
     of a motion or an interlocutory proceeding, any part or
     all of a deposition, so far as admissible under the rules
     of evidence applied as though the witness were then
     present and testifying, may be used against any party who
     was present or represented at the taking of the
     deposition or who had reasonable notice thereof, in
     accordance with any of the following provisions: . . .

               (3) The deposition of a witness, whether or not a
     party, may be used by any party for any purpose if the
     court finds: . . .

               (B) that the witness is at a greater distance than
     100 miles from the place of trial or hearing, or is out
     of this state, unless it appears that the absence of a
     witness was procured by the party offering the
     deposition; . . . . 
There is no dispute that both Dr. Miller and Dr. Ravitz were out of
state at the time of trial.  There is no allegation that the
absence of either expert was procured by the appellants.  Rule 32
clearly provides for the admission of both depositions.
     Drs. Quirk and Brunson assert that the trial court properly
denied admission of the depositions for failure to comply with the
pretrial order.  They rely upon Ark. R. Civ. P. 26, General
Provisions Governing Discovery, which provides in part:
          (b) Scope of Discovery. Unless otherwise limited by order
     of the court in accordance with these rules, the scope of
     discovery is as follows:

               (4) Trial Preparation: Experts. Discovery of facts
     known and opinions held by experts, otherwise
     discoverable under the provisions of subdivision (b)(1)
     of this rule and acquired or developed in anticipation of
     litigation or for trial, may be obtained only as follows:

               (A)(i) A party may through interrogatories require
     any other party to identify each person whom the other
     party expects to call as an expert witness at trial, to
     state the subject matter on which he is expected to
     testify, and to state the substance of the facts and
     opinions to which the expert is expected to testify and
     a summary of the grounds for each opinion. 

               (ii) Upon motion, the court may order further
     discovery by other means, subject to such restrictions as
     to scope and such provisions, pursuant to subdivision
     (b)(4)(C) of this rule, concerning fees and expenses as
     the court may deem appropriate.  (Emphasis added.)
Drs. Quirk and Brunson assert that Rule 26(b)(4)(A)(ii) allows the
trial court discretion to distinguish between discovery and
evidentiary depositions.  
     However, this Court has clearly stated that Rule 32 does not
distinguish between discovery and evidentiary depositions.  Whitney
v. Holland Retirement Center, 323 Ark. 16, 912 S.W.2d 427 (1996). 
We stated that the rule has been construed to provide that any
party, not only the party who took the deposition, may use the
deposition of a witness, whether or not a party, for any purpose at
the trial or hearing, if the party demonstrates to the court the
existence of one of the conditions specified in Rule 32(a)(3).  Id.
     In Goodwin v. Harrison, 300 Ark. 474,