Title: Smith v. Central Vermont Hospital, Inc.

State: vermont

Issuer: Vermont Supreme Court

Document:

Smith v. Central Vermont Hospital, Inc. (2003-378); 177 Vt. 540;
861 A.2d 1089

2004 VT  113

[Filed 09-Nov-2004]

                                 ENTRY ORDER

                                2004 VT  113

                      SUPREME COURT DOCKET NO. 2003-378

                               JUNE TERM, 2004

  Susan C. Smith, Administratrix of    }	APPEALED FROM:
  The Estate of Shaun M. Smith 	       }
                                       }
       v.	                       }	Washington Superior Court
                                       }	
  Central Vermont Hospital, Inc.,      }
  Central Vermont Medical              }	DOCKET NO. 306-6-01 Wncv
  Center, Inc., and 	               }	
  Gary H. Goldberg, M.D.               }
                                                Trial Judge: Mary Miles Teachout

             In the above-entitled cause, the Clerk will enter:

       ¶  1.  Plaintiff in this medical malpractice action appeals from a
  summary judgment of the Washington Superior Court in favor of defendants
  Dr. Gary H. Goldberg and Central Vermont Hospital.  Plaintiff contends the
  court erred in striking an expert's affidavit and consequently finding a
  failure of proof on the element of causation.  We agree, and therefore
  reverse and remand.  

       ¶  2.  As found by the trial court, the facts may be briefly
  summarized.  Plaintiff is the administratrix of the estate of her son,
  Shaun Smith, who died at the age of eighteen while being treated at
  defendant Central Vermont Hospital.  Shaun was injured in a bicycle
  accident on July 1, 1999.  Emergency medical personnel found him sitting on
  the side of the road, complaining of back and mouth pain. The EMS squad
  transported him to CVH, where he presented with facial trauma and appeared
  to be extremely combative.  Dr. Goldberg, a specialist in emergency
  medicine, consulted with the emergency personnel and examined Shaun, but
  did not immediately call for the assistance of a surgeon or
  anesthesiologist.  Shaun was placed in restraints and given anti-anxiety
  medication.  One and a half hours later, he was sent to x-ray.  Upon
  returning from x-ray, he appeared to have difficulty breathing.  After
  several attempts, he was successfully intubated (a tube was inserted to
  help with his breathing).  By then, however, he had aspirated enough blood
  into his lungs that he was unable to breathe despite the intubation.  He
  died shortly thereafter.     
   
       ¶  3.  Plaintiff filed a medical malpractice action against Dr.
  Goldberg and CVH.  In February 2002, defendants moved for summary judgment,
  noting that plaintiff had failed to provide a timely disclosure of the
  expert opinions on which she planned to rely and therefore could not
  establish the elements of her claim.  The court denied the motion, but
  established a new discovery schedule, requiring disclosure of all experts
  by June 6, 2002, after which plaintiff would be precluded from disclosing
  any experts.  Plaintiff disclosed as her expert Dr. Andrew Sumner, a
  specialist like Dr. Goldberg in emergency medicine.  Dr. Sumner was deposed
  in September.  In his deposition testimony, Dr. Sumner opined that-in view
  of Shaun's symptoms and medical history -Dr. Goldberg had been negligent in
  failing to call immediately for the assistance of a surgeon and
  anesthesiologist to consult on the need to intubate, but also indicated
  that the failure to intubate right away was negligent and a proximate cause
  of Shaun's death.  At one point, Dr. Sumner acknowledged that if a surgeon
  and anesthesiologist had counseled against immediate intubation, "then I
  wouldn't be critical of [Dr. Goldberg]."  

       ¶  4.  In December 2002, defendants filed a second motion for
  summary judgment.  In support of the motion, they filed the affidavits of
  the two surgeons and the anesthesiologist who had actually been called to
  intubate Shaun after several hours at the hospital.  All three physicians
  stated that-if they had been called earlier-they would not have recommended
  intubation.  In her opposition to the motion, plaintiff adduced no
  affidavits or other expert testimony to directly refute the opinion of the
  three specialists, but did note that Dr. Mason (the surgeon) had
  acknowledged in his deposition that he was not an expert in intubation, and
  that Dr. Sharp (the anesthesiologist) had admitted that it was difficult to
  assess what was required in the emergency room without having been there. 
  Plaintiff also attached an affidavit from Dr. Sumner in which he stated
  that, in light of Shaun's agitation, medical history, and facial injuries,
  a reasonable standard of medical care required a rapid sequence intubation
  (RSI) when Shaun arrived at the hospital, and that Dr. Goldberg's failure
  to administer one was negligent and a proximate cause of Shaun's death.     
       
       ¶  5.  Defendants moved to strike Dr. Sumner's affidavit as a "sham"
  under V.R.C.P. 12(f), arguing that it set forth an "additional" theory of
  liability that had been "conjured to create a fictitious basis of
  liability" and that had not been disclosed in Dr. Sumner's deposition. 
  Following a hearing, the court found that the affidavit set forth a "new"
  opinion that had not been timely disclosed, in violation of V.R.C.P. 26(e),
  which requires a party to supplement responses to discovery, and that the
  proper sanction was exclusion of the affidavit under V.R.C.P. 37(c)(1). 
  Rule 37 provides, in pertinent part, that a party who fails without
  substantial justification to supplement responses as required by Rule 26(e)
  is not, unless such failure is harmless, permitted to use such evidence at
  trial or in a motion.  The court found that the omission was not harmless
  in light of the additional time and expense required to re-depose Dr.
  Sumner and the resulting "erosion" of confidence in the efficiency of the
  judicial system.  Without the affidavit, the court concluded that plaintiff
  had no proof that the failure to immediately intubate was a proximate cause
  of Shaun's death.  The court further noted that plaintiff had adduced no
  expert evidence directly refuting the opinions of the three specialists
  that they would not have recommended intubation if consulted earlier. 
  Accordingly, the court concluded that plaintiff had failed to make a
  showing sufficient to support a claim of liability, and entered judgment in
  favor of defendants.  This appeal followed.      

       ¶  6.  We note initially that plaintiff's pro se brief does not
  expressly challenge the trial court's  decision to exclude Dr. Sumner's
  affidavit.  Plaintiff does, however, claim that Dr. Sumner's deposition
  testimony-fairly read-raised the same argument in abbreviated form that was
  contained in the affidavit.  Accordingly, if plaintiff is correct, the
  trial court's rationale for exclusion-that the affidavit raised a new,
  untimely theory of liability-would be untenable.  

       ¶  7.  Upon careful review of the record evidence, we conclude that
  plaintiff is correct.  Plaintiff's expert-witness disclosure statement,
  submitted on June 6, 2002, indicated that Dr. Sumner was of the opinion
  that defendants had been negligent in failing to arrange for an 

    immediate consultation with a general surgeon to assist in the
    initial assessment and stabilization; consultation with an
    anesthesiologist to endotracheally intubate such patient and
    paralyze him to facilitate rapid completion of the head CT and
    other radiographic studies; and consultation with a neurosurgeon
    if there was one on the medical staff.   

      Had this been done in an expeditious manner, Shaun Smith would
    have received early airway management and been diagnosed with a
    severe head injury.

  (Emphasis added.)  

       ¶  8.  Consistent with the expert disclosure, Dr. Sumner testified
  at his deposition that Dr. Goldberg should have called for the assistance
  of a surgeon and anesthesiologist, and also stated that a special
  intubation procedure, known as a rapid sequence intubation or RSI, was  an
  immediate necessity.  Dr. Sumner testified to this effect twice.  His
  initial statement was as follows: "So what I'm saying the standard is, is
  you-here's this kid, he hits a door, he's wild, he's agitated, he's got a
  head injury, you call anesthesia in, surgery, you intubate this kid then
  and there." (Emphasis added.)  A subsequent statement was to the same
  effect: "Well, that's the gross idea where I'm going, is what I say the
  standard is. He's got a moderate head injury, he should have had rapid
  sequence intubation."  (Emphasis added.)  

       ¶  9.  As the trial court correctly noted, Dr. Sumner subsequently
  stated in the deposition that Dr. Goldberg would not have been negligent if
  a surgeon and anesthesiologist had been consulted at the outset and had
  advised against immediate intubation.  As the trial court also correctly
  observed, this subsequent statement appears to contradict Dr. Sumner's
  earlier expressed opinion that the circumstances called for an immediate
  intubation procedure, as well as his subsequent affidavit reaffirming this
  opinion.  However, the trial court's conclusion that Dr. Sumner had
  actually "abandoned" the initial theory of liability-premised on the need
  for an immediate intubation-is not at all clear from the record.   Indeed,
  in light of Dr. Sumner's subsequent affidavit, it appears to be more likely
  that he abandoned the theory of liability premised on the failure to
  consult with other specialists.   

       ¶  10.  Whether the two theories of liability are inconsistent is a
  different question, however, from whether Dr. Sumner's affidavit sets forth
  a virtually new theory of liability.  In this regard, the record evidence
  does not, in our view, support the trial court's conclusion that Dr.
  Sumner's affidavit stated a new and untimely theory of liability that had
  not been stated at the deposition or disclosed in a timely supplemental
  response under V.R.C.P. 26(e).   Rule 26(e) imposes a continuing duty upon
  a party "to supplement or correct" previously disclosed discovery responses
  "to include information thereafter acquired . . .  if the party learns that
  the [earlier] response is in some material respect incomplete or incorrect
  and if the additional or corrective information has not otherwise been made
  known to the other parties during the discovery process or in writing." 
  Although Dr. Sumner's affidavit may have emphasized one previously stated
  theory of liability over another, it did not contain newly acquired
  information or state a new theory that had not previously been disclosed at
  the deposition.  Accordingly, we are persuaded that the affidavit contained
  no genuinely new material within the meaning of Rule 26(e).
     
       ¶  11.  Even if the affidavit's emphasis on one theory over another
  could be construed as falling within the scope of the rule, however, we
  would have difficulty upholding the court's sanction as reasonably
  commensurate with the purported violation and within the court's otherwise
  broad discretion.  See David v. Caterpillar, Inc., 324 F.3d 851, 857 (7th
  Cir. 2003) (court's ruling on  Rule 26 violation is entrusted to broad
  discretion of trial court); Bigelow v. Bigelow, 171 Vt. 100, 106,