Title: Thomas v. Metz

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Thomas v. Metz1986 WY 51714 P.2d 1205Case Number: 85-142Decided: 02/27/1986Supreme Court of Wyoming
PHYLLIS THOMAS, APPELLANT 
(PLAINTIFF), 

 
 
v. 

 
 
ALBERT V. METZ, JR., 
M.D., APPELLEE (DEFENDANT).

 
 
Appeal from the District 
Court, NatronaCounty, Harry E. Leimback, 
J.

 
 
 
 
Representing 
Appellant:

Steve D. Noecker and 
Rebecca H. Noecker of Johnson, MacPherson & Noecker, 
Rawlins.

 
 
Representing 
Appellee:

J.E. Vlastos and John 
Henley of Vlastos & Brooks, P.C., Casper.

 
 
Before THOMAS, C.J., and 
BROWN, URBIGKIT, MACY, JJ., and GUTHRIE, J., Retired.

 
 

BROWN, 
Justice.

 
 

[¶1.]     This is a medical 
malpractice action brought by appellant Phyllis Thomas against appellee Albert 
Metz, Jr., M.D. Appellant claimed she was damaged as a result of improper back 
surgery performed by appellee. Trial to a jury resulted in a verdict for 
appellee. Appellant presents the following issues:

 
 
"It was reversible error 
for the trial court to admit expert opinions of defendant's witnesses which were 
based upon defendant doctor's deposition and the opinions of other experts when 
this type of facts or data is not of the type reasonably relied upon by experts 
in the field.

 
 
"It was reversible error 
for the trial court to refuse to require disclosure of the underlying facts or 
data upon which the opinions of the defendant's experts were based prior to the 
giving of the opinions, or once having allowed the opinions, refusing to strike 
the opinions when it was disclosed that the facts or data was not of that type 
reasonably relied upon by experts in the field."

 
 

[¶2.]     We will 
affirm.

 
 

[¶3.]     The facts show that on 
April 17, 1982, appellant rolled over in bed and experienced pain in her back 
between her shoulder blades. She was admitted to the hospital that same day, 
complaining of pain between her shoulder blades, pain in her left arm, and 
numbness in the left thumb, index finger and middle finger. After consultation 
and testing by Dr. James Maddy and Dr. Malvin Cole, it was concluded that 
appellant was suffering a disc herniation at the Cervical 6/Cervical 7 (C-6/C-7) 
level, primarily on the left side. Neurosurgical consultation was then sought 
from appellee, who, after evaluation, confirmed the findings of Drs. Maddy and 
Cole, and recommended that surgery be performed to remove disc fragments that 
were pressing on the spinal cord and the left C-7 nerve 
root.

 
 

[¶4.]     After obtaining 
appellant's consent, appellee performed surgery to remove the disc fragments. A 
bone plug was then removed from appellant's hip and placed in the spine to fuse 
the two vertebral bodies. After surgery, appellant experienced pain on her right 
side, similar to that previously experienced on the left side. Further testing 
revealed the bone plug was encroaching upon the C-7 nerve root on the right 
side. Additional surgery was performed to alleviate the condition on April 27, 
1982.

 
 

[¶5.]     When appellant 
continued to experience pain, she consulted several physicians in Denver during the months 
of May and June, 1982. In June of 1982, appellant underwent further surgery in 
Denver. This 
surgery was performed by another physician, and consisted of removal of the 
first right thoracic rib.

 
 

[¶6.]     The pain persisted. An 
expert witness for appellant, Dr. John Williams, testified appellant now suffers 
from a condition known as "hysterical conversion" - where pain is a stress 
reaction and has no medical, anatomical or physiological basis. Dr. Robert 
Kelso, a clinical psychologist, examined and evaluated appellant and concluded 
that he believed "this disorder should show significant improvement within a 
12-month period."

 
 

[¶7.]     Appellant filed the 
present action on January 25, 1983. As noted above, trial to the jury resulted 
in a verdict for appellee.

 
 

[¶8.]     We will consider both 
of appellant's issues together. Basically, appellant claims the trial court 
erred by admitting the testimony of appellee's expert witnesses, alleging such 
witnesses improperly based their testimony upon appellee's apparent discovery 
deposition and previous opinions given by other 
physicians.

 
 

[¶9.]     We have heretofore 
recognized the need for expert testimony in medical malpractice actions. Vassos v. Roussalis, Wyo., 625 P.2d 768 (1981); and Govin v. Hunter, 
Wyo., 374 P.2d 421 (1962). See also, Annotation: Necessity of expert evidence to support an 
action for malpractice against a physician or surgeon, 81 A.L.R.2d 597 (1962). 
In Harris v. Grizzle, Wyo, 625 P.2d 747, 752 
(1981), we said:

 
 
"It is well settled that 
in all but the extraordinary medical malpractice case, the plaintiff has the 
burden of producing expert testimony to support a prima facie case of 
negligence. If the origin of the injury is obscure and not readily apparent to a 
layman, or if there are several equally probable causes of the condition, 
testimony of a qualified physician is essential to establish a reasonable 
probability that the physician's negligence caused the injury. This is such a 
case."

 
 

[¶10.]  The two expert witnesses who testified on 
behalf of appellee were Drs. Federico Mora and Philip Gordy. Dr. Mora is a 
graduate of Harvard Medical school and is a neurosurgeon practicing in 
New Mexico. He 
testified he knew appellee and had performed surgery with him on occasion. Dr. 
Mora further testified he thought the operation performed by appellee was 
appropriate, followed the proper procedure, and that the bone plug inserted was 
not too long. To demonstrate, he measured the bone plug in the presence of the 
jury using a caliper and the CAT scan film of the bone plug. Dr. Mora also 
explained the complicated nature of the surgery and the various causes of a bone 
plug protrusion other than the plug being too long.

 
 

[¶11.]  Dr. Philip Gordy also testified as an 
expert witness for appellee. Dr. Gordy is a graduate of the University of 
Michigan Medical School and is presently a consultant in neurosurgery and 
neurology. He testified he has performed this surgical procedure approximately 
1,000 times, and that in his opinion, the bone plug placed by appellee was 
neither too long nor too far to the right. Dr. Gordy further testified as to the 
possible cause of a bone plug protrusion other than the same being too long. 

 
 

[¶12.]  Appellant's counsel did not conduct a 
voir dire examination with respect to the medical qualifications of the 
witnesses. Appellant's main objection to the testimony of both expert witnesses 
is that such testimony was improperly based on material not reasonably relied 
upon by experts. Specifically, appellant claims it was improper for Dr. Mora to 
rely upon appellee's discovery deposition in giving his opinion at trial. 
Appellant further claims it was also error for Dr. Gordy to base his opinion 
upon appellee's discovery deposition, as well as Dr. Mora's 
deposition.

 
 

[¶13.]  Rules 702 and 703, Wyoming Rules of 
Evidence, are pertinent to this case and provide as 
follows:

 
 
"Rule 702. Testimony by 
Experts

 
 
"If scientific, 
technical, or other specialized knowledge will assist the trier of fact to 
understand the evidence or to determine a fact in issue, a witness qualified as 
an expert by knowledge, skill, experience, training, or education, may testify 
thereto in the form of an opinion or otherwise.

 
 
"Rule 703. Basis of 
Opinion Testimony by Experts

 
 
"The facts or data in the 
particular case upon which an expert bases an opinion or inference may be those 
perceived by or made known to him at or before the hearing. If of a type 
reasonably relied upon by experts in the particular field in forming opinions or 
inferences upon the subject, the facts or data need not be admissible in 
evidence."

 
 

[¶14.]  It is significant to note that appellee's 
deposition was only one of several sources of information Dr. Mora relied upon 
to base his opinion. When asked what materials he had reviewed to form his 
opinion, Dr. Mora testifed:

 
 
"Basically what I 
examined is I looked over the hospital records of Ms. Thomas here when she was 
treated in Casper. I have also looked at hospital records 
and personal notes of physicians who treated her when she went to Denver later on. 
Furthermore, I have read the depositions that were given by Dr. Metz, by Ms. 
Thomas, and by Dr. Williams, two that come to mind."

 
 
And when asked if he felt 
the surgery performed by appellee was appropriate, Dr. Mora 
answered:

 
 
"Well, basing myself on 
the hospital record and the review of the X rays, the operation was 
appropriate."

 
 

[¶15.]  Dr. Gordy based his opinion upon a review 
of hospital records, as well as appellee's deposition and depositions from the 
other physicians. He was then asked:

 
 
"Q. Doctor, based upon 
the information you have reviewed, have you an opinion as to whether or not the 
surgery performed on April 23, 1982, upon Plaintiff here by Dr. Metz was 
necessary? Answer yes or no.

 
 
"A. Yes, I have an 
opinion.

 
 
"Q. And what is that 
opinion?

 
 
"A. It was absolutely 
necessary."

 
 

[¶16.]  Trial counsel for appellant made an 
objection to the basis for Dr. Mora's expert testimony. After a conference at 
bench, the trial court ruled that counsel's objection was in the nature of 
impeachment and counsel would be allowed to thoroughly cross-examine the 
witness. Nevertheless, appellant's counsel was allowed to voir dire the witness 
regarding the basis of his opinion immediately after the bench conference. Voir 
dire was in fact conducted until such time as it appeared to the trial court 
that the questioning had exceeded the scope of voir dire, and had in fact, 
entered into the area of cross-examination.

 
 

[¶17.]  Ordinarily, it is within the sound 
discretion of the trial court whether voir dire of a witness will be allowed, or 
whether counsel must wait until cross-examination to attack the credibility of 
an expert witness. Such rulings will not be overturned on appeal absent a 
showing of prejudicial error. In Reed v. 
Hunter, Wyo., 663 P.2d 513, 517-518 (1983), this court 
stated:

 
 
 
 
"* * * [T]he purpose of 
the identical counterparts in the Federal Rules of Evidence was not to provide 
for blanket admissibility of expert opinion testimony. The trial court remains 
vested with discretion in deciding whether to exclude such testimony because it 
is deemed unnecessary or not helpful to the trier of the factual issues in 
reaching an independent conclusion as to the facts. The adequacy of any 
foundation for such opinion testimony is subject to scrutiny through 
cross-examination. [Citation.] * * *"

 
 
It should also be noted 
that if the credibility of an expert witness is still in question after 
cross-examination, counsel may then move to strike the testimony from the 
record.

 
 

[¶18.]  Likewise, it is a recognized rule in this 
state that rulings as to whether a witness is qualified to testify as an expert 
are discretionary with the trial court and will not be disturbed unless clearly 
and prejudically erroneous, and then only in extreme cases. Reed v. Hunter, supra; Coronado Oil Company v. Grieves, 
Wyo., 642 P.2d 423 (1982); Ferris v. Myers, Wyo., 
625 P.2d 199 (1981).

 
 

[¶19.]  Appellant's trial counsel was allowed to 
thoroughly cross-examine both expert witnesses, and attack the bases of their 
opinions for impeachment purposes. Rule 705, W.R.E. 
provides:

 
 
"Rule 705. Disclosure of 
facts or data underlying expert opinion.

 
 
"The expert may testify 
in terms of opinion or inference and give his reasons therefor without prior 
disclosure of the underlying facts or data, unless the court requires otherwise. 
The expert may in any event be required to disclose the underlying facts or data 
on cross-examination."1

 
 

[¶20.]  Appellant contends the court erred in 
refusing to require disclosure of facts upon which the experts based their 
opinions. But as we have already pointed out, the experts did state what records 
they had reviewed in making their conclusions. Therefore, the experts did 
disclose the basis of their opinions. In Ferris v. Myers, Wyo., 
625 P.2d 199, 204 (1981), we stated:

 
 
"While Rule 702, W.R.E. 
permits use of experts, this does not mean that the trial judge is required to 
let into evidence just any opinion under the cloak of it coming from a person 
learned in his field. Before an expert voices his opinion, it is good practice 
to voir dire as was done here to avoid a premature expression which might 
influence the jury, particularly in light of a suspected absence of adequate 
basis. This procedure is under the supervision of the trial court in his 
authority to exercise reasonable control over the mode and order of 
interrogating witnesses and presenting evidence so as to make the interrogation 
effective for the ascertainment of the truth. Rule 611(a), W.R.E. Whether the 
qualification of a witness with respect to his knowledge or special experience 
is sufficiently established is a matter resting largely in the discretion of the 
trial judge and his determination is usually final and will not be disturbed 
except in extreme cases. [Citations]"

 
 

[¶21.]  It is then within the province of the 
trier of fact to give whatever credence they may to the expert testimony as well 
as all the evidence in reaching a verdict.

 
 
"* * * The trier of fact 
must decide what weight is to be given to expert testimony, and it still remains 
the duty of the trier of the factual issues, whether jury or judge, to determine 
the credibility of all witnesses, including expert witnesses, and to evaluate 
the testimony of each in reaching its verdict. [Citations.]" Reed v. Hunter, supra, at 
518.

 
 

[¶22.]  We are not able to find prejudicial error 
inasmuch as appellee's two expert witnesses based their opinions in part upon 
the deposition of appellee. Appellant has failed to show how such prejudiced her 
or how such affected the jury's verdict. Both of the witnesses were qualified as 
experts and possessed a great deal of expertise in the area of 
neurosurgery.

 
 
"It is common practice 
for a prospective witness, in preparing himself to express an expert opinion, to 
pursue pretrial studies and investigations of one kind or another. Frequently, 
the information so gained is hearsay or double hearsay, insofar as the trier of 
the facts is concerned. This, however, does not necessarily stand in the way of 
receiving such expert opinion in evidence. It is for the trial court to 
determine, in the exercise of its discretion, whether the expert's sources of 
information are sufficiently reliable to warrant reception of the opinion. If 
the court so finds, the opinion may be expressed. If the opinion is received, 
the court may, in its discretion, allow the expert to reveal to the jury the 
information gained during such investigations and studies. Wide latitude in 
cross-examination should be allowed." Standard Oil Co. of California v. Moore, 251 F.2d 188, 222 (9th Cir. 1957), 
cert denied 356 U.S. 975, 78 S. Ct. 1139, 2 L. Ed. 2d 1148 
(1958).

 
 

[¶23.]  See also, 3 Louisell & Mueller, 
Federal Evidence, § 389, p. 655 (1979); and Comment, Wyoming Rules of Evidence 
701-706: Opinions and Expert Testimony, 13 Land & Water Law Review 975 
(1978).

 
 

[¶24.]  We have carefully reviewed the issues 
raised by appellant and are unable to find the trial court committed reversible 
error in allowing the testimony of appellee's expert 
witnesses.

 
 

[¶25.]  Affirmed.

1 Appellant does not claim 
disclosure of the bases of the experts' testimony was sought before 
trial.