Title: Sammons v. Doctors for Emergency Services

State: delaware

Issuer: Delaware Supreme Court

Document:

IN THE SUPREME COURT OF THE STATE OF DELAWARE 
ELIZABETH SAMMONS, individually 
) 
and as ADMINISTRATRIX of the ESTATE)  No. 40, 2006 
of GAIL E. SAMMONS, Deceased,  
) 
 
 
 
 
 
 
 
)  Court Below:  Superior Court 
 
 
 
Plaintiffs Below,  
)  of the State of Delaware in 
 
 
 
Appellants,  
 
)  and for New Castle County 
 
 
 
 
 
 
 
) 
v. 
 
 
 
 
 
 
)  C.A. No. 03C-12-267 
 
 
 
 
 
 
 
) 
DOCTORS FOR EMERGENCY 
 
) 
SERVICES, P.A., EDWARD R. SOBEL,  ) 
M.D., and FAMILY PRACTICE  
 
) 
ASSOCIATES, 
 
 
 
 
) 
 
 
 
 
 
 
 
) 
 
 
 
Defendants Below, 
 
) 
 
 
 
Appellees.  
 
) 
 
Submitted:  September 13, 2006 
Decided:  December 4, 2006 
Corrected:  December 6, 2006 
 
Before STEELE, Chief Justice, BERGER and RIDGELY, Justices. 
 
 
Upon appeal from the Superior Court.  AFFIRMED in part, VACATED in 
part, and REMANDED in part. 
 
 
John C. Phillips, Jr., Joseph J. Farnan, III, Brian E. Farnan (argued), Phillips, 
Goldman & Spence, P.A., Wilmington, Delaware for appellants. 
 
 
Mason E. Turner, Jr. (argued), Prickett, Jones & Elliott, P.A., Wilmington, 
Delaware; Colleen D. Shields (argued), Elzufon, Austin, Reardon, Tarlov & 
Mondell, P.A., Wilmington, Delaware; for appellees. 
 
 
 
 
 
STEELE, Chief Justice: 
 
2
 
This is a medical malpractice action arising from Gail Sammons’s death in 
which plaintiff-appellant, Elizabeth Sammons,1 appeals a jury verdict for the 
defendants-appellees, Doctors for Emergency Services, P.A., Edward R. Sobel, 
M.D., and Family Practice Associates.2  DFES, Dr. Sobel, and Family Practice 
Associates treated Gail from January 2, 2002, until her death on January 5, 2002.  
Sammons’s trial strategy focused on the defendants’ alleged failure to diagnose 
sepsis which allegedly caused Gail’s death.  A Superior Court jury rejected 
Sammons’s theory and found for the defendants. 
 
Sammons argues in this appeal that the trial judges’ abuse of their respective 
discretion on several evidentiary issues caused the adverse result.3 
                                                 
1  
The plaintiff-appellant is the mother of the deceased, Gail E. Sammons.  When we use 
the name “Sammons,” we refer to the plaintiff appellant.  When we use “Gail,” we refer to the 
deceased. 
 
2  
The original defendants were Christiana Care Health Services, Inc. (a/k/a Christiana 
Healthcare Systems, Inc. a/k/a Wilmington Hospital and Medical Center of Delaware), St. 
Francis Hospital, Inc., Doctors for Emergency Services, P.A., Jamie E. Roques, M.D., Edward R. 
Sobel, D.O., Michael Baram, M.D., Ori Shokek, M.D., Amy Robinson, M.D., and Robert 
Rosenbaum, M.D.  On March 12, 2004, Sammons filed a motion to amend her complaint to add 
Family Practice Associates, P.A. as a defendant, and the trial judge granted the motion.  
Sammons later settled with Christiana Care and St. Francis and dismissed her claims against Drs. 
Baram, Robinson, Roques, and Shokek.  The remaining defendants are Doctors for Emergency 
Services, P.A., Edward R. Sobel, and Family Practice Associates.   
 
3  
Because the original assigned trial judge who handled pretrial issues became involved in 
a lengthy bench trial, a different judge presided for trial.  The previous judge ruled on the motion 
regarding the affidavit of merit and motions in limine but did not preside over the jury trial.  We 
use “his” to identify the initially assigned judge and “her” to identify the judge who presided 
over the trial.    
 
 
3
 
First, Sammons argues that the trial judge abused his discretion by 
precluding Sammons’s expert, Dr. Bridges, from offering an expert opinion on 
causation and failure to diagnose sepsis.  Sammons identified Dr. Bridges as her 
expert in pretrial discovery but did not disclose that Dr. Bridges would be offered 
to opine on causation and failure to diagnose sepsis.  Later, Dr. Bridges offered his 
heretofore undisclosed opinion on causation and sepsis during a pretrial deposition.  
DFES counsel did not attend that deposition but asserts that he would have done so 
had he been put on notice that Dr. Bridges would opine on cause of death and 
failure to diagnose sepsis.  Because Sammons did not put opposing counsel on 
notice that Dr. Bridges would so opine at his deposition, the trial judge did not 
abuse his discretion when he precluded Dr. Bridges from testifying regarding 
causation and failure to diagnose sepsis at trial. 
 
Second, Sammons contends that the trial judge abused his discretion by 
permitting DFES to adopt Dr. Roques’s designated expert, Dr. Zenilman, as their 
own, after Sammons dismissed Dr. Roques.  Sammons complains that allowing Dr. 
Zenilman’s opinion testimony at trial unfairly prejudiced her.  Dr. Roques had 
disclosed Dr. Zenilman’s opinion on July 15, 2005, well before the December 15, 
2005 trial began.  DFES timely notified Sammons that they would be using Dr. 
Zenilman as an expert after Dr. Roques was no longer a party to the case.  
Therefore, Sammons had ample notice of the nature and substance of Dr. 
 
4
Zenilman’s opinions, and adequate notice that DFES would be calling him as their 
expert.  Sammons has identified no unfair prejudice resulting from admitting Dr. 
Zenilman’s testimony and, therefore, the trial judge did not abuse his discretion 
when he allowed DFES to present Dr. Zenilman’s expert medical testimony.      
 
Third, Sammons contends that the trial judge abused her discretion by 
permitting DFES’s counsel to discuss Sammons’s settlement with Christiana Care 
for the purpose of shifting liability to the settling defendant during his opening and 
closing statements.  We hold that the trial judge did not abuse her discretion 
because DFES’s counsel did not directly discuss any settlement amount, or the 
reason for settlement, but merely mentioned settlement to help the jury understand 
the alignment of the parties and to determine pro rata fault, if necessary.   
 
Fourth, Sammons argues that the trial judge abused her discretion when she 
refused to admit Gail’s photograph.  We hold that the trial judge acted within her 
discretion because the photograph was neither necessary to identify Gail nor was it 
relevant to any disputed issue in the case.   
 
Fifth, Sammons argues that the trial judge abused her discretion by 
precluding Sammons from impeaching a DFES expert by crossexamining him on 
DFES’s 2004 sepsis policy.  Sammons did not establish at trial that this policy 
reflected the applicable standard of care at the time that defendants cared for Gail 
in 2002.  Therefore, the trial judge properly concluded that a failure to follow the 
 
5
policy would not be relevant to contradict the expert witness’s opinion on the 
standard of care applicable in 2002. 
 
Sixth, Sammons argues that the trial judge abused her discretion by 
precluding Sammons’s expert, Dr. Haines, from explaining his unavailability at 
trial during his videotaped testimony.  We hold that the trial judge was within her 
discretion to give the jury a general instruction on witness unavailability rather 
than tell the jury the specific reason why the witness was unavailable.   
 
Seventh, Sammons contends that the trial judge erred by permitting the 
father of an attorney associated with the law firm representing Dr. Roques to sit as 
a juror in the case.  Dr. Roques was not a party at the time of jury selection, and 
there was no evidence that the juror had any knowledge about the case or his son’s 
firm’s former involvement.  Therefore, the trial judge properly acted within her 
discretion when she permitted the attorney’s father to sit as a juror.   
 
Eighth, Sammons contends that the trial judge abused her discretion by 
giving the jury a curative instruction regarding Sammons’s counsel’s statements 
during closing rebuttal argument.  After consideration of the record, we hold that 
the trial judge did not abuse her discretion because the trial judge’s statements did 
not unfairly deny her a fair trial.  
Ninth, Sammons contends that the trial judge abused her discretion by 
refusing to give her proffered instruction on cross claims and by improperly 
 
6
addressing the jury’s questions.  We hold that the trial judge adequately instructed 
the jury regarding the cross claims without providing them with confusing and 
unnecessary information that would have made it more difficult for them to make a 
reasoned and informed decision in the case.  The trial judge’s responses to the 
jury’s questions fell within her properly exercised discretion because they were 
consistent with Sammons’s theory of the case and reiterated the pattern jury 
instructions.   
We also review the trial judge’s decision to dismiss the case sua sponte 
under Superior Court Civil Rule 60(b) after the jury verdict and the entry of 
judgment.  We hold that the trial judge abused her discretion when she dismissed 
the case sua sponte in the absence of a showing of fraud in the judicial process.  
Therefore, we vacate the trial judge’s order dismissing the case and remand the 
case to the trial judge to reinstate the judgment entered after the jury verdict.  
 
Accordingly, we AFFIRM in part, VACATE in part, and REMAND in part. 
 
FACTS AND PROCEDURAL HISTORY 
Gail Sammons, 41, suffered from sickle cell disease.  On January 3, 2002, at 
approximately 3:15 p.m., Gail arrived at St. Francis emergency room complaining 
of pain similar to sickle cell crisis.  On January 4, 2002, the staff treated Gail with 
pain medication and IV fluids, released her at approximately 2:10 a.m. and advised 
 
7
her to follow up with her doctor as soon as possible.  Later that day, at 
approximately 12:55 p.m., an ambulance took Gail to Wilmington Hospital where 
Dr. Rosenbaum examined Gail at approximately 1:55 p.m. and diagnosed Gail as 
suffering from a sickle cell crisis.  Dr. Perri, a resident, called Family Practice, 
Gail’s primary care physicians, to admit Gail to the hospital.  Family Practice 
residents, Dr. Robinson and Dr. Shokek, examined Gail.  Dr. Robinson then called 
a Family Practice physician to discuss Gail’s condition and develop a treatment 
plan.  There is some dispute regarding the phone call and to whom Dr. Robinson 
spoke.  Nevertheless, during that phone call, a Family Practice physician approved 
Gail’s admittance to Wilmington Hospital.  Dr. Shokek signed Gail’s admitting 
order at approximately 6:30 p.m.  The Family Practice residents’ admitting 
diagnosis was:  painful sickle cell crisis.  The hospital staff took Gail to a hospital 
floor at approximately 10:45 p.m. where her condition deteriorated.  On January 5, 
2002, at approximately 12:00 a.m., Gail was unresponsive.  The staff called a code 
blue, and pronounced her dead at 1:25 a.m.  
Elizabeth Sammons, individually as the mother of Gail Sammons and as 
Administratrix of Gail Sammons’s estate, filed this action in Superior Court 
against the physicians who treated Gail and their employers, alleging that their 
medical negligence caused Gail’s death.   
 
8
Shortly after Sammons filed her complaint in Superior Court, counsel for 
Christiana Health Services, Inc. and various employee doctors filed a motion 
seeking a ruling on whether Sammons’s affidavit of merit and curriculum vitae, 
filed under seal with the complaint, complied with 18 Del. C. § 6853.  A Superior 
Court judge ruled that “the Court believes that the affidavits are in order and 
comply with the statutory language as to each named defendant.”  As a result, the 
case proceeded, and the Superior Court judge kept the affidavit of merit 
confidential as required by statute.   
Before the trial began, the parties filed motions in limine.  On September 12, 
2005, Family Practice and Dr. Sobel moved to preclude Sammons’s expert 
witness, Dr. Bridges, from opining at trial regarding causation and failure to 
diagnose sepsis. Although Dr. Bridges offered this opinion in his August 25, 2005 
deposition, Sammons had not disclosed this particular opinion regarding sepsis and 
causation in any of Sammons’s pretrial discovery responses.  Sammons’s actual 
response to discovery directed to expert testimony identified him solely as an 
expert on sickle cell life expectancy.   
 
9
On November 9, 2005, Sammons moved to preclude Dr. Zenilman4 from 
testifying on behalf of DFES, Family Practice, or Dr. Sobel contending that none 
of these defendants had identified Dr. Zenilman as an expert.   
On November 18, 2005, the trial judge entered an Order precluding Dr. 
Bridges from opining at trial on causation and failure to diagnose sepsis.  The trial 
judge denied Sammons’s motion in limine and permitted DFES to call Dr. 
Zenilman as its medical expert to offer his expert medical opinion disclosed in Dr. 
Roques’s discovery response.     
The Superior Court held a jury trial from December 12, 20055 to December 
21, 2005.  On December 21, 2005, the jury returned a verdict in favor of the 
remaining defendants, DFES, Family Practice and Dr. Sobel.  After the entry of 
judgment, DFES moved to have the trial judge review Sammons’s affidavit of 
merit regarding Sammons’s expert that the initially assigned judge had approved in 
2004.6  On January 18, 2006, the judge who ultimately presided over the jury trial 
wrote a letter to Sammons’s counsel stating that the affidavit of merit was deficient 
                                                 
4  
Dr. Roques, while a party, retained Dr. Zenilman as his expert, but Sammons dismissed 
her claim against Dr. Roques before trial. 
 
5  
Because the assigned trial judge was involved in a lengthy Bench trial, the case was 
assigned to a different judge for trial.  The previous judge ruled on the motion regarding the 
affidavit of merit and motions in limine but did not preside at trial.   
 
6  
The trial judge re-reviewing the affidavit of merit was a different judge than the one who 
originally approved the affidavit of merit in 2004.   
 
 
10
with respect to DFES, and, therefore, Sammons should not have been allowed to 
proceed against DFES.  The trial judge also stated that she planned to hold a 
hearing with counsel and Sammons’s expert, Dr. Munoz, to determine Sammons’s 
counsel’s efforts to comply with 18 Del. C. § 6853.7  The trial judge noted that she 
needed to determine an appropriate remedy8 but did not identify a remedy at that 
time.9    
Sammons filed a motion for reargument of the post trial letter opinion and 
appealed.  Specifically, the appeal sought our review of (1) the trial judge’s 
decision on the two motions in limine regarding Dr. Bridges and Dr. Zenilman, (2) 
various trial rulings, and (3) the trial judge’s January 18, 2006 letter opinion.  
DFES filed a motion to stay the appeal pending resolution of the issues relating to 
the trial judge’s January 18, 2006 letter opinion.  On February 21, 2006, this Court 
granted the stay and remanded the case to Superior Court for the proceedings 
outlined in the trial judge’s January 18, 2006 letter and for consideration of 
                                                 
7  
Sammons v. Doctors for Emergency Services, P.A., 2006 WL 1522479 (Del. Super. Ct.)  
 
8  
The trial judge suggested that an appropriate remedy might be “that the case should be 
dismissed against DFES under Rule 60(b), nunc pro tunc.”  Id.  
 
9  
Although the letter opinion did not dismiss the case against DFES, the trial judge, in her 
March 31, 2006 Opinion and Order, indicated that her letter opinion of January 18, 2006 and 
dismissed the case.  Sammons v. St. Francis Hosp., Inc., 2006 WL 1134890, at *8 (Del. Super. 
Ct.) (“For all of the foregoing reasons, the Motion for Reargument of this Court’s January 18, 
2006 decisions dismissing this case for failure to comply with 18 Del. C. § 6853 is hereby 
denied.” (emphasis added).   
 
 
11
Sammons’s motion for reargument.  We retained jurisdiction under Supreme Court 
Rule 19(c).   
 
On March 31, 2006, the trial judge issued an Opinion and Order denying 
Sammons’s motion for reargument of the Superior Court’s January 18, 2006 
decision that the Affidavit of Merit failed to comply with the statutory standard in 
18 Del. C. § 6853 with respect to DFES.  The trial judge also entered an order 
dismissing Sammons’s claim against DFES10 but did not vacate the jury verdict 
before entering the order.11   
DFES filed a motion to tax its attorneys’ fees and costs against Sammons on 
April 6, 2006.  On April 26, 2006, the trial judge issued a letter to counsel neither 
granting nor denying DFES’s request for attorney fees.  In that letter the trial judge 
did state that Sammons’s counsel would be responsible for payment of any fees 
awarded.  The trial judge also stated that she intended to issue a Rule to Show 
                                                 
10  
The trial judge stated: 
 
I am once again constrained to conclude that Plaintiff should never have been 
permitted to proceed against DFES in the first instance.  In short, the Affidavit of 
Dr. Eric Munoz to support Plaintiff’s claim of medical negligence against DFES 
did not then, and does not now, in light of the evidence produced at trial, pass 
statutory muster.  Therefore, in accordance with the applicable statute, 
Plaintiff’s claims against DFES are hereby dismissed.  The Court will, upon 
application of DFES, consider whether additional remedies are appropriate, but 
will not offer such remedies sua sponte.  Sammons, 2006 WL 1134890, at *2 
(emphasis added). 
 
11  
The trial judge did not state under which rule she dismissed the case.  Therefore, we 
assume that the trial judge followed through on her suggestion in the January 18, 2006 letter 
opinion and dismissed the case against DFES under Super. Ct. Civ. R. 60(b), nunc pro tunc.   
 
 
 
12
Cause directing Sammons’s counsel to show why he had not violated Superior 
Court Civil Rule 11.  The trial judge stated that she would schedule the Rule to 
Show Cause hearing after this appeal has been decided and she requested guidance 
from this Court regarding the appropriateness of the sanction to better assess the 
full extent of the expenses that DFES had incurred at the trial level and in 
defending the appeal.  The trial judge returned the case to this Court on April 26, 
2006. 
 
On April 28, 2006, Sammons filed her Amended Notice of Appeal also 
seeking this Court’s review of the trial judge’s March 31, 2006 Opinion and Order 
and her rulings in her April 26, 2006 letter to counsel.   
 
DISCUSSION 
1. 
The trial judge did not abuse his discretion by limiting the scope of Dr. 
 
Bridges’s trial testimony and by permitting Dr. Zenilman to offer 
 
testimony as DFES’s medical expert.   
 
 
Sammons has two arguments relating to experts involved in the trial.  
 
First, Sammons argues that the trial judge abused his discretion by granting 
Dr. Sobel and Family Practice’s motion in limine to limit Dr. Bridges’s 
testimony.12  Sammons contends that the trial judge improperly precluded her 
                                                 
12  
The trial judge granted the motion in part and denied it in part.  The part he denied is not 
an issue on appeal.   
 
 
13
expert, Dr. Bridges, from opining at trial that Gail suffered from sepsis during her 
visit to the emergency room and that the defendants’ failure to diagnose sepsis 
caused Gail’s death.  Sammons argues that because she disclosed Dr. Bridges’s 
opinion regarding sepsis and causation in his August 25, 2005 deposition before 
the discovery deadline,13 and because that opinion critically affected her 
presentation of her theory of liability, granting the motion to exclude this testimony 
at trial unfairly prejudiced her.   
 
Second, Sammons argues that the trial judge abused his discretion by 
permitting DFES to use Dr. Zenilman as their expert because DFES never 
identified him as their expert in discovery before the deadline for doing so.  
Sammons also argues that she was unfairly prejudiced because DFES expanded the 
scope of Dr. Zenilman’s opinion beyond that proffered when Dr. Roques’s 
identified him as his expert witness.  Sammons further contends that she did not 
have sufficient notice that Dr. Zenilman’s testimony would include an opinion on 
cause of death because cause of death was not relevant to Dr. Roques’s alleged 
liability or that of his employer, St. Francis.  Sammons submits that the trial judge 
made inconsistent rulings on the admissibility of the parties’ respective experts 
which resulted in unfair prejudice to her. 
                                                 
13  
Sammons notes the discovery deadline as August 31, 2005.  The parties stipulated to 
extending the discovery deadline to October 31, 2005, but the trial judge never entered an order 
formally acknowledging the parties’ agreement to extend the discovery deadline.   
  
 
14
 
We review the Superior Court’s evidentiary rulings restricting or allowing 
expert testimony under an abuse of discretion standard.14  “When an act of judicial 
discretion is under review the reviewing court may not substitute its own notions of 
what is right for those of the trial judge, if his judgment was based upon 
conscience and reason, as opposed to capriciousness or arbitrariness.”15  
 
“[T]he trial court has discretion to resolve scheduling issues and to control 
its own docket.”16  Under Superior Court Civil Rule 16, the trial judge enters a trial 
scheduling order which governs pretrial conferences, scheduling, and trial 
management.17  Superior Court Civil Rule 16 mandates that parties follow the trial 
                                                 
14  
Bush v. HMO of Del., 702 A.2d 921, 923 (Del. 1996) (citing Pinkett v. Brittingham, 567 
A.2d 858, 860 (Del. 1989). 
 
15  
Coleman v. PricewaterhouseCoopers, LLC, 902 A.2d 1102, 1106 (Del. 2006) (citing 
Chavin v. Cope, 243 A.2d 694, 695 (Del. 1968)). 
 
16  
Coleman, 902 A.2d at 1107 (citing Valentine v. Mark, 873 A.2d 1099 (Del. 2005)).  
 
17  
Super. Ct. Civ. R. 16(b) provides, in pertinent part: 
 
Scheduling and planning.   
Except in categories of actions exempted by the Court as inappropriate, the judge 
shall, after consulting with the attorneys for the parties and any unrepresented 
parties, by a scheduling conference, telephone, mail, or other suitable means, 
enter a scheduling order that limits the time: 
(1) To join other parties and amend the pleadings; 
(2) To file and hear motions; and   
(3) To complete discovery. 
The scheduling order may also include: 
(4) The date, or dates for conferences before trial, a final pretrial conference, and 
trial; and  
(5) Any other matters appropriate in the circumstances of the case.   
The order shall issue as soon as practicable but in no event more than 120 days 
after filing of the complaint.  A schedule shall not be modified except by leave of 
the Court upon a showing of good cause. 
 
15
judge’s scheduling order, and these rules assure that the parties conduct discovery 
in an orderly fashion.  “Parties must be mindful that scheduling orders are not 
merely guidelines but have full force and effect as any other order of the [Superior] 
Court.”18   
 
Parties must comply with the discovery rules by identifying expert witnesses 
and disclosing the substance of their expected opinions as a precondition to the 
admissibility of expert testimony at trial.19  The Superior Court, in Duncan v. 
                                                                                                                                                             
 
18  
Fletcher v. Doe, 2005 WL 1370188 (Del. Super. Ct. 2005) (Order) (The Superior Court 
judge allowed the plaintiff’s expert to testify even though he did not disclose his expert until one 
day after the date mandated by the scheduling order because the defendant could not have been 
unfairly prejudiced as a result of the delay.  This case illustrates why parties must comply with 
court mandated scheduling orders; however, upon application in order to avoid manifest 
injustice, a judge may relieve the parties of dates mandated by the scheduling order.). 
 
19  
Bush, 702 A.2d at 923 (citing Stafford v. Sears, Roebuck & Co., 413 A.2d 1238 
(Del. 1980)).  See Superior Court Civil Rule 26(b)(4), which mandates the rules regarding 
experts, provided in pertinent part:  
 
(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 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 the expert 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.  
 
See also Superior Court Civil Rule 26(e)(1)(B) which sets forth the requirements for 
supplementation regarding expert witnesses: 
(1) A party is under a duty seasonably to supplement the response with respect to 
any question directly addressed to…B) the identity of each person expected to be 
called as an expert witness at trial, the subject matter on which the person is 
expected to testify, and the substance of the person’s testimony.  Super. Ct. Civ. 
R. 26 (e)(1)(B)  
 
16
Newton & Sons Co., recently discussed that Court’s standard practice regarding 
scheduling orders and expert witness disclosure.20  In Duncan, the plaintiff argued 
that she did not need to do anything more than to identify her expert witnesses and 
then defendants could take depositions to learn what those opinions might be.  The 
trial judge disagreed:  
This is contrary to the scheduling order and this Court’s practice.  
Plaintiff was to identify her experts and provide their reports as to 
their expert opinions.  Then, Defendants would be on notice of the 
bases for the expert opinions, and, pursuant to the scheduling order, 
respond in kind as to their experts and supply the bases for their 
opinions by way of a report.  It is not reasonable to require 
Defendants’ counsel to go on a wild goose chase with Plaintiff’s 
experts or to depose Plaintiff’s experts without the benefit of having 
the opinions and the medical or scientific reasoning for those 
opinions.21 
 
 
A. 
Dr. Bridges’s expert medical testimony. 
It is with the above described Superior Court practice in mind that we address 
the ruling limiting Dr. Bridges’s expert testimony.  Here, the trial judge’s Superior 
Court Civil Rule 16(b) pretrial scheduling order required Sammons to identify 
expert witnesses on or before April 15, 2005.22  On April 15, 2005, Sammons 
                                                                                                                                                             
 
20  
Duncan v. Newton & Sons Co., 2006 WL 2329378 (Del. Super. Ct. 2006). 
 
21  
Id. at *6. 
 
22  
The original plaintiff expert disclosure deadline was February 15, 2005.  The trial judge 
extended the plaintiff expert disclosure deadline first to March 15, 2005, and then later to April 
15, 2005.   
 
 
17
disclosed Dr. Bridges as an expert witness who would offer an opinion regarding 
sickle cell patients’ life expectancies.  Sammons’s expert witness discovery 
response did not disclose that Dr. Bridges would be offered for an opinion on 
causation or a failure to diagnose sepsis.23  At Dr. Bridges’s discovery deposition 
on August 25, 2005, Sammons’s counsel asked him questions relating to causation 
and failure to diagnose sepsis over objections from counsel for Dr. Sobel and 
Family Practice.  DFES counsel, however, did not attend the deposition.  DFES’s 
counsel contends that he saw no reason to attend when Sammons’s discovery 
response purported to offer Dr. Bridges’s expert testimony solely to establish 
Gail’s sickle cell life expectancy.    
 
Although Sammons argues that the trial judge should have permitted her to 
supplement expert disclosures under Superior Court Civil Rule 26(e) and that she 
                                                 
23  
Sammons’s expert discovery response, in pertinent part, as it related to Dr. Bridges 
provided:  
 
Kenneth Bridges, M.D. will offer at trial an expert opinion as to Gail Sammons’ 
life expectancy.  Dr. Bridges has reviewed Gail Sammons’ medical records as 
well as the postmortem report.  After reviewing the information, it is Dr. Bridges’ 
opinion, to a reasonable degree of medical certainty that, that Gail Sammons’ life 
expectancy would have been 65 to 70 years of age.  This opinion is based on Gail 
Sammons’ infrequent Acute Pain Crisis (the records indicate previous ER 
treatments in 1999, 1996, and 1992) and the relative good condition of her organs.  
It is also based on the fact that Gail Sammons had a relative benign course of 
Sickle Cell disease during childhood, which is when most organ damage occurs.  
This is verified by the fact that Gail Sammons only decided to get tested for the 
genetic traits of a Sickle Cell patient after her brother died from complications of 
sickle cell disease.  Dr. Bridges is available for deposition at the convenience of 
the parties. 
 
 
18
reserved the right to supplement, amend, or modify her expert disclosures in her 
expert identification discovery response,24 Sammons, in fact, did not supplement 
her expert disclosure or submit Dr. Bridges’s proffered expanded opinion to the 
court or to opposing counsel before participating in Dr. Bridges’s pretrial 
deposition.  During oral argument, we specifically asked Sammons’s counsel 
whether he had made any effort to supplement the expert discovery response and 
counsel stated that he had not. 
 
The trial judge granted Family Practice and Dr. Sobel’s motion to restrict the 
scope of Dr. Bridges’s testimony reasoning that it would disrupt the orderly 
process of the court to allow parties to disclose expert opinions for the first time 
during trial depositions.25  The trial judge stated: 
With respect to causation, I will prohibit Dr. Bridges from testifying 
about causation because no opinion about causation was disclosed at 
all by Dr. Bridges by the time of plaintiff’s expert disclosures, which I 
believe the deadline was April 15, 2005.  And it’s just not sufficient 
that Dr. Bridges did testify about causation at his deposition on 
August 25 and it is also to me not significant that perhaps defendant’s 
counsel explored some causation issues at deposition testimony.  
There was a trial scheduling order and it is just contrary to the trial 
scheduling order in this case as well as the practice in this Court to 
allow an opinion to be disclosed for the first time at a deposition that 
occurs after the deadline has passed for disclosure of expert 
opinions…In this case it would just wreak havoc on the orderly 
                                                 
24  
Sammons’s expert disclosure, in pertinent part:  “Plaintiffs reserve the right to 
supplement, amend, and/or modify these disclosures based on the discovery of any additional 
facts and/or the development of any additional opinions.”   
 
25  
The trial judge granted the motion in part and denied it in part.  The part of the motion 
that was denied is not at issue in the present appeal.   
 
19
development of expert’s opinions if an opinion didn’t have to be 
disclosed by the deadline and could be broached for the first time at a 
discovery deposition following that because, among other things, the 
parties challenging the expert need to know before they attend the 
deposition what the opinions are going to be.  So for all of those 
reasons, the Court will bar Dr. Bridges from testifying regarding 
causation.   
 
 
The purpose of the Rule 16 scheduling order and discovery deadlines are to 
improve the efficiency of trials.  The expert identification deadline assists the 
parties in conducting useful discovery of expert’s opinions.  Pursuant to Rule 26, 
the expert disclosure statements should identify the expert’s opinions and the basis 
for those opinions so that the opposing party can properly prepare for depositions 
and trial.  Here, Sammons did not properly and timely disclose Dr. Bridges’s 
opinion regarding causation and failure to diagnose sepsis before the expert 
disclosure date mandated by the trial judge’s scheduling order.  Contrary to 
Sammons’s assertion, she did not cure the discovery deficiency simply by 
disclosing Dr. Bridges’s opinion regarding a failure to diagnose sepsis and 
causation during a deposition scheduled by another party for discovery purposes.  
Further, Sammons’s counsel neither moved to amend the Rule 16 scheduling order 
upon a “showing of good cause,” supplemented their original expert disclosure to 
expand Dr. Bridges’s opinion nor contacted DFES counsel to notify him of Dr. 
Bridges’s expanded opinion before the scheduled deposition.  Without notice of 
the proposed expanded expert opinion to be proffered, DFES was entitled to rely 
 
20
on Sammons’s disclosure.  DFES could fairly assume it to be an accurate statement 
of the expert’s anticipated opinion at his deposition as well as later at trial.  DFES 
relied on Sammons’s expert disclosure statement, and did not attend the deposition.  
Therefore, the trial judge did not abuse his discretion when he granted Family 
Practice and Dr. Sobel’s motion to restrict Dr. Bridges’s trial testimony.   
 
B. 
Dr. Zenilman’s expert medical testimony. 
We now turn to Dr. Zenilman’s expert medical testimony.  Dr. Roques 
identified Dr. Zenilman as his expert medical witness on July 15, 2005.26  Dr. 
Roques disclosed that Dr. Zenilman had standard of care opinions related to Dr. 
Roques’s involvement and causation opinions related to Sammons’s theory that 
Gail died from sepsis.27  On October 27, 2005, Sammons agreed to dismiss Dr. 
                                                 
26  
According to the trial scheduling order, Defendant expert disclosures were due on July 
15, 2005. 
 
27  
Dr. Roques expert disclosure, in pertinent part, as it relates to Dr. Zenilman, provides:  
 
Dr. Zenilman is being offered as an expert in the field of infectious diseases with 
opinions on the standard of care for Dr. Roques, causation, and 
damages…Zenilman [has] reviewed the Complaint, medical records, Plaintiff’s 
expert reports and deposition transcripts taken to date…Zenilman will opine that 
Dr. Roques met the standard of care in his treatment of [sic] Sammons.  Dr. 
Zenilman will opinion that [sic] Sammons did not die from septic 
shock…Zenilman will opine that all the treatment that was received by Ms. 
Sammons by Dr. Roques was within the standard of care.  The standard of care 
for this patient did not require admission to the hospital when she was seen at St. 
Francis and it was within the standard of care to discharge her that day.  In 
addition, Dr. Zenilman will opine that Ms. Sammons did not die from septic 
shock and that the most likely cause of death was her aspirating on her own 
vomit…All of…Zenilman’s opinions are based on reasonable medical 
probability. 
 
 
21
Roques from the case.  On October 28, 2005, DFES’s counsel informed 
Sammons’s counsel that he planned to call Dr. Zenilman at trial.  Sammons 
cancelled Dr. Zenilman’s deposition that was scheduled for November 2, 2005.  
DFES’s counsel called Sammons’s counsel to verify that Sammons’s counsel did, 
indeed, wish to cancel the deposition.  On November 3, 2005, DFES’s counsel sent 
Sammons’s counsel a letter informing him that Dr. Zenilman would testify on 
December 14, 2005, and further explained Dr. Zenilman’s opinion.28  DFES 
contends that they elaborated upon Dr. Zenilman’s opinion in their letter because 
Sammons cancelled Dr. Zenilman’s deposition and DFES wanted to avoid an 
argument that Sammons did not have the benefit of understanding the specifics of 
Dr. Zenilman’s causation opinion, which Sammons might have gained had she 
chosen to go forward with the deposition.  Sammons contends, however, that 
                                                 
28  
The letter states, in pertinent part:   
 
As previously indicated, it is Dr. Zenilman’s opinion, within terms of reasonable 
medical probability, based on his review of these records and his training and 
experience in his subspecialty of infectious disease medicine, that Ms. Sammons 
did not die of septic shock.  The most probable cause of death is aspiration of 
vomit and that her death was an acute event, not the result of gradual deterioration 
in her condition.  No source of infection was identified on autopsy, including the 
microscopic evaluation.  Furthermore, had the patient been in septic shock, as 
contended by plaintiff, there would have been evidence of inflammation, 
particularly in the end organs that serve as filters (kidney, liver, lung), which was 
absent.  The blood work was not diagnostic of sepsis in a sickle cell patient such 
as Ms. Sammons.  Leukocytosis in these patients is often due to the physiological 
stress of a sickle crisis.  Nevertheless, the possibility of occult infection was 
properly considered at Wilmington Hospital and she was covered with broad-
spectrum antibiotics.  Likewise, the blood pressure was not diagnostic of sepsis, 
as the primary care notes clearly indicate that her normal blood pressure was 90-
100/60-70. 
 
22
DFES’s letter contained “new” opinions and those opinions went beyond the scope 
of the initial opinions Dr. Roques had disclosed in his expert witness discovery 
response.  On November 9, 2005, Sammons moved to preclude Dr. Zenilman from 
testifying on behalf of DFES, Family Practice, or Dr. Sobel contending that none 
of these defendants had identified Dr. Zenilman as an expert and that he, therefore, 
should not be permitted to testify on their behalf at trial.  The trial judge denied the 
motion stating: 
 
The bottom line position that I have is that I believe the 
defendants should be allowed to call Dr. Zenilman for these reasons:  
One, the practice in New Castle County Superior Court, as I 
understand it, is that it is not uncommon for defendants to potentially 
rely on other experts.  And I think plaintiffs were sufficiently on 
notice of that.  I’ve heard their arguments to the contrary.  Secondly, 
the opportunity for the deposition was right then and there available 
and Dr. Zenilman, as chief of infectious diseases at Johns Hopkins, 
obviously has an extremely busy schedule and it will be hard to 
schedule if the deposition was canceled.  I think that although there is 
a claim that Saint Francis—there was never a claim by plaintiffs 
against St. Francis that St. Francis caused the death.  That’s not 
sufficient for me to bar the testimony of Mr. Zenilman.  I do think that 
the letter that [DFES’s counsel] sent summarizing the further opinions 
of Dr. Zenilman are not beyond the scope of what Dr. Zenilman’s 
conclusion or opinion was with respect to the causation of death, that 
she died of aspiration of her own vomit rather than sepsis.   
 
The trial judge distinguished this case from Russell v. K-Mart29 noting that the 
pretrial expert disclosure noted in K-Mart stated that the expert would “testify for 
                                                 
29  
Russell v. K-Mart Corp., 761 A.2d 1, 3 (Del. 2000) (holding that the trial judge did not 
abuse his discretion by limiting an expert’s testimony to information disclosed in his reports and 
letters). 
 
23
Plaintiffs in this case.  His CV is attached.  The subject matter on which he will 
testify are [sic] contained in the records that have already been supplied to 
[defense] counsel.”  The trial judge denied Sammons’s motion to preclude Dr. 
Zenilman’s testimony because DFES’s expert disclosure regarding Dr. Zenilman 
was much more specific than the expert disclosure in K-Mart.  
We agree that Sammons had fair and sufficient notice that Dr. Roques was 
going to use Dr. Zenilman as an expert and for what purposes because Dr. Roques 
filed his expert disclosure on July 15, 2005, and was a party to the case up until 
October 27, 2005.  DFES notified Sammons that they would be using Dr. 
Zenilman as an expert on October 28, 2005.  Dr. Roques, Dr. Sobel, and Family 
Practice all reserved the right to use the other’s experts.  DFES asserted the right to 
call any witness “properly identified by any other party.”30  We can infer from the 
record, as could Sammons’s counsel, that DFES did not disclose Dr. Zenilman as 
their expert at the outset of the trial because Dr. Roques planned to call him.  Then, 
when Dr. Roques was no longer a party to the case, DFES’s counsel timely 
informed Sammons of his intention to use Dr. Zenilman as an expert before the 
date Sammons had scheduled Dr. Zenilman’s deposition. 
Further, the information in DFES’s November 3, 2005 letter did not 
improperly expand the scope of Dr. Zenilman’s opinion.  Rather, DFES’s counsel 
                                                                                                                                                             
 
30  
DFES reserved this right in the pretrial stipulation.   
 
24
provided Sammons with an expanded explanation of the scope of Dr. Zenilman’s 
opinion in light of the fact that Sammons had chosen not to depose him.  Although 
Sammons asserts that cause of death was not an issue with regard to St. Francis 
and Dr. Roques, Dr. Roques’s expert discovery response did state that Dr. 
Zenilman would offer an opinion relating to cause of death, which was a 
significant issue in the case.31  Therefore, Sammons had sufficient notice that Dr. 
Zenilman would, if asked, offer an expert opinion on causation.  We hold that the 
trial judge properly exercised his discretion when he denied Sammons’s motion. 
 
2. 
The trial judge did not abuse her discretion by permitting DFES’s 
counsel to refer to Sammons’s settlement with Christiana Care during 
his opening statement and closing argument. 
 
 
Sammons argues that the trial judge abused her discretion when she allowed 
DFES’s counsel to refer to Sammons’s settlement with Christiana Care during 
opening statement and closing argument.  Sammons argues that DFES’s statements 
were improper and prejudicial because they were made to persuade the jury that all 
liability lay with the settling defendants.  
In her words, Sammons alleges that the comments were an attempt to “shift 
blame and infer that Christiana Care, not DFES, Dr. Sobel, or Family Practice, was 
liable.”  Sammons argues that counsel’s interjection of comments on her settlement 
                                                 
31  
Sammons alleged in her pleading that as a result of St. Francis’s negligence, the risk of 
harm to Gail increased, which resulted in her death. 
 
25
with Christiana Care denied her right to a fair trial under D.R.E. 408 and violated 
the standard set forth in Alexander v. Cahill,32 thereby entitling her to a new trial. 
Evidentiary rulings are reviewed for abuse of discretion.33  D.R.E. 408 
provides: 
Evidence of (1) furnishing or offering or promising to furnish, or (2) 
accepting or offering or promising to accept, a valuable consideration 
in compromising or attempting to compromise a claim which was 
disputed as to either validity or amount is not admissible to prove 
liability for or invalidity of the claim or its amount.34 
 
 
The two principles underlying Rule 408 are: “1) the evidence of compromise 
is irrelevant since the offer may be motivated by a desire to terminate the litigation 
rather than from any concession of weakness of position; and 2) public policy 
favors compromise in settlement of disputes.”35 When evidence is offered for 
another purpose, however, Rule 408 “does not require exclusion of settlement 
related evidence.”36  In Brown, we found the trial judge’s instruction to the jury 
about why a settling defendant was no longer part of the case was not improper; in 
                                                 
32  
Alexander v. Cahill, 829 A.2d 117 (Del. 2003). 
 
33  
Whittaker v. Houston, 888 A.2d 219, 222 (Del. 2005); Wilmington Country Club v. 
Cowee, 747 A.2d 1087, 1092 (Del. 2000).   
 
34  
D.R.E. 408. 
 
35  
Capital Mgmt. Co. v. Brown, 813 A.2d 1094, 1100 (Del. 2002).  
 
36  
Id. at 1100-01. 
 
 
26
fact, the purpose of the instruction was to avoid jury confusion and speculation 
about the alignment of the parties.37 
In Alexander, we discussed the need for the trial judge or the parties 
themselves to disclose to the jury the fact that a third party defendant had settled to 
avoid confusion.38  When considering whether to discuss settlements in the 
presence of the jury, the trial judge should “carefully exercise his discretion and 
balance the probative value of the evidence for a permissible purpose against the 
prejudicial effect and risk the evidence will be used for an improper purpose.”39  
The trial judge, however, must be “more skeptical of the party’s purpose” when a 
party seeks to admit evidence disclosing the facts of a settlement.40 
 
In Alexander, the plaintiff, a passenger in a school bus, was injured in a 
multicar accident.41  The trial judge allowed defendant’s counsel to ask plaintiff on 
crossexamination whether she and her husband had reached a settlement against 
certain third-party defendants.42  We found that D.R.E. 408 barred this testimony 
because “counsel asked the question for the purpose of persuading the jury that the 
                                                 
37  
Id. at 1101. 
 
38  
Alexander, 829 A.2d at 125.   
 
39  
Id. (quoting Schlossman & Gunkelman, Inc. v. Tallman, 593 N.W.2d 374 (N.D. 1999)). 
 
40  
Id. 
 
41  
Id. at 119. 
 
42  
Id. at 127. 
 
 
27
persons to blame for the accident had already admitted liability, raising the 
question that the plaintiff’s claim against [the remaining defendant] might be 
invalid . . . by suggesting that the [plaintiff] had already been guaranteed some 
payment toward damages,” rather than asking the question to clarify the alignment 
of the parties.43  
In the present case, the trial judge properly allowed DFES’s counsel to make 
remarks explaining that Christiana Care had settled during his opening statement 
and closing argument.  In fact, statements regarding settlement were specifically 
discussed in a pre-trial conference.  As the trial judge noted: 
[T]hey are allowed to do that under Alexander versus Cahill.  What they are 
not allowed to do is ask the terms of the settlement or were you paid or 
anything like that . . . It would be just inconceivable that a jury couldn’t be 
informed of [settling defendants] that, otherwise they are not going to have 
any understanding as to why they are not here. 
 
DFES’s counsel, unlike defendant’s counsel in Alexander, made statements 
conforming to the parties’ pre-trial understanding.  Sammons refers to the 
following during DFES’s opening statement: 
You’re going to hear in this case about the different 
responsibilities of different people within the Christiana Care system, 
who has the responsibility to do what.  And basically when the orders 
are written, they are taken off by the nursing staff and the nursing staff 
has the responsibility to carry them out unless they have some 
problem, in which case they go back to the doctor.  Well, in this case 
for the most part that simply didn’t get done.  But the failure of the 
                                                 
43  
Id. 
 
28
nursing staff is subsumed within the claim that the plaintiff brought 
against Christiana Care, which has been settled. 
 
Sammons also refers to the following from DFES’s closing argument: 
And there is a third possible mistake and we can’t tell from the 
records, but it doesn’t seem like anybody was attending for Ms. 
Sammons at the time she became sick and threw up.  And if you 
believe that the mechanical asphyxia thing, as ugly as that is to think 
about, is what happened, maybe something could have been done had 
they been attending to her.  But Christiana Care has settled.  They’re 
not here.  That’s their responsibility. 
  
In Alexander, the defendant’s statements during cross examination were 
improperly admitted and were contrary to the parties’ pre-trial agreement that the 
third party settlement would only be mentioned during opening statements and in 
the judge’s final instructions.44  DFES’s counsel did not reveal any amount of 
settlement and counsel used the statements to help the jury understand the 
alignment of the parties and to determine pro rata fault, if applicable.  DFES’s 
statements did not suggest that Sammons’s claim against DFES may be invalid or 
that the jury should disregard DFES’s wrongdoing simply because Sammons’s 
might, inferentially have received some damages from a settlement with Christiana 
Care. 
As in Brown, any prejudicial effect the statements may have had was 
outweighed by the ample testimony presented to the jury during trial and the jury 
                                                 
44  
Alexander, 829 A.2d at 127. 
 
 
29
instructions given by the trial judge.  The trial judge instructed the jury that 
Christiana Care had settled but specifically charged the jury to find whether DFES 
was “medically negligent;” “whether either or any of the defendants remaining in 
the case were negligent;” and, whether their negligence caused Gail’s death.  
Although Christiana Care had settled, the trial judge instructed the jury that they 
“must determine whether Doctors for Emergency Services, Edward Sobel D.O., 
Family Practice Associates, P.A., as well as, Christiana Care Health Services and 
St. Francis Hospital or all of them were negligent and whether that negligence was 
the proximate cause” of Gail’s death.  The trial judge acted within her discretion 
when she permitted DFES’s counsel to refer to the settlement as he did in his 
opening statement and closing argument.  Accordingly, we affirm. 
 
3. 
The trial judge did not abuse her discretion by precluding Sammons 
from displaying Gail’s photograph to the jury.   
 
 
Sammons argues that the trial judge abused her discretion when she refused 
to admit Gail’s photograph because it was “relevant and probative of identity.” At 
trial, Sammons’s counsel argued for admission of the photograph to show the jury 
that “Gail” “was a person and that she existed.”  The trial judge refused to admit 
the photograph because it was not relevant, reasoning that the jury would not need 
to see a picture of Gail to understand that she was a person “who existed.”   
 
30
 
The standard of review for evidentiary issues on appeal is abuse of 
discretion.45  In the present case, there was no dispute at trial that Gail was a 
deceased person who was once alive.  The photograph was not unique and did not 
shed any light on any material issue in the case.  Therefore, the photograph had no 
independent relevance.  Accordingly, we conclude that the trial judge properly 
exercised her discretion by refusing to admit the photograph into evidence, and 
accordingly we affirm that ruling.   
 
4. 
The trial judge did not abuse her discretion by precluding Sammons 
from impeaching a DFES expert by using DFES’s 2004 sepsis policy.  
 
 
Sammons argues that the trial judge abused her discretion by not permitting 
Sammons to impeach DFES’s expert and fact witnesses with DFES’s 2004 sepsis 
policy.  Sammons contends that she should have been permitted to impeach 
DFES’s witness, Dr. Rosenblaum,46 with the 2004 DFES policy because his 
testimony that Gail was not suffering from sepsis on January 4, 2002, contradicted 
the 2004 policy containing a protocol for diagnosing sepsis in emergency room 
patients.  Initially, the trial judge refused to allow Sammons to impeach Dr. 
                                                 
45  
See Green v. St. Francis Hosp., Inc., 791 A.2d 731, 737 (Del. 2002) (where we found that 
the trial judge did not abuse his discretion by permitting a photograph and videotape to be 
introduced into evidence because the arrangement of the room was an integral part of each 
party’s case at trial). 
 
46  
Dr. Rosenblaum is a DFES employee.   
 
 
31
Rosenblaum with the 2004 policy because Sammons had not disclosed that policy 
in the pretrial stipulation.  Later, the trial judge clarified her ruling by stating that it 
was not a proper basis for impeachment because “impeachment is used to 
demonstrate dishonesty.”  Sammons contends that the trial judge abused her 
discretion and misapplied the law regarding impeachment.  
 
The standard of review for evidentiary issues on appeal is abuse of 
discretion.47  The trial judge has discretion to determine which modes of 
impeachment may be used.48  In general, impeachment can be conducted by 
“showing the existence of bias, a prior inconsistent statement, untruthful or 
dishonest character, or defective ability to observe, remember, or recount the 
matter about which the witness testifies.”49  “A witness may be impeached on 
cross-examination or by other evidence contradicting the witness as to a material 
matter or establishing some other ground for impeachment.”50  “When 
impeachment evidence is offered to show bias, competency, or contradiction, the 
admissibility of that evidence is controlled by DRE 402 and 403.”51  Under D.R.E. 
                                                 
47  
Davis v. Maute, 770 A.2d 36, 41 (Del. 2001).  
 
48  
81 Am. Jur. 2d Witnesses § 830 (2006). 
 
49  
Id. (footnotes omitted). 
 
50  
Id. (footnotes omitted). 
 
51  
Baumann v. State, 891 A.2d 146, 148 (Del. 2005).  See also United States v. 
Winchenbach, 197 F.3d 548 (1st Cir. 1999) (impeachment with proof of prior inconsistent 
statement is governed by Rule 403 not 608 (b)); United States v. Tarantino, 846 F.2d 1384, 1409 
 
32
402 “[a]ll relevant evidence is admissible, except as otherwise provided by statute 
or by these rules or by other rules applicable in the courts of this State.”52  D.R.E. 
403 permits the exclusion of relevant evidence, “if its probative value is 
substantially outweighed by the danger of unfair prejudice, confusion of the issues 
or misleading the jury, or by considerations of undue delay, waste of time or 
needless presentation of cumulative evidence.”53 
 
The record reflects that DFES’s sepsis policy did not exist until two years 
after Gail’s death.  Therefore, it could not be used to impeach or contradict Dr. 
Rosenblaum’s testimony because the 2004 protocol neither formalized nor 
purported to formalize the standard of care at the time that Dr. Rosenblaum 
examined Gail in 2002.  If Sammons had provided a witness that established that 
the 2004 sepsis policy was consistent with the applicable standard of care for 
diagnosing sepsis when Dr. Rosenblaum examined Gail in 2002, then it may have 
qualified as “a material matter” with which Sammons might have contradicted his 
testimony.  But because science and medicine evolve over time and the record 
discloses no information in that regard, the protocol for diagnosis of sepsis may 
                                                                                                                                                             
(D.C. Cir. 1988) (Admissibility of extrinsic evidence offered to contradict witness is governed by 
Rules 402 and 403, not 608 (b)); United States v. Lopez, 979 F.2d 1024 (5th Cir. 1992) (Rule 403 
controls the admission of contradiction evidence). 
 
52  
D.R.E. 402. 
 
53  
D.R.E. 403.  
 
 
 
33
have been different in 2002 than in 2004.  Therefore, the trial judge did not abuse 
her discretion by refusing to permit Sammons to impeach Dr. Rosenblaum with the 
2004 sepsis policy.  Accordingly, we affirm that ruling. 
 
5. 
The trial judge did not abuse her discretion by precluding Sammons’s 
expert, Dr. Haines, from explaining his unavailability at trial during his 
videotaped trial testimony.   
 
 
Sammons argues that the trial judge abused her discretion by excluding Dr. 
Haines’s testimony explaining why he was not available for trial.  We review for 
abuse of discretion.54   
 
It is customary practice for the trial judge to tell the jury that a witness is 
unavailable for trial and that the reason for the witness’s unavailability is not 
relevant.  Sammons offered Haines’s testimony by videotape at trial because he 
unexpectedly was called to active military duty two months before trial.  The trial 
judge would not permit Sammons to explain that military duty caused Haines’s 
absence.  Instead, the trial judge gave a general explanation regarding witness 
unavailability.  In weighing the relevance of the reason he could not appear against 
the possible sympathy that reason might draw to Sammons, the trial judge opted 
for a general explanation.  After considering the record, we conclude that the trial 
judge properly exercised her discretion.  Sammons suffered no unfair prejudice 
                                                 
54  
Davis, 770 A.2d at 41. 
 
 
34
from being denied the opportunity to tell the jury that military duty prevented Dr. 
Haines’s from appearing at trial.  Accordingly, we affirm.    
6. 
The trial judge properly exercised her discretion when she permitted 
the father of an attorney associated with the firm representing Dr. 
Roques’s to remain on the jury.   
 
 
Sammons contends that the trial judge erred by failing (1) to dismiss or 
question a juror after learning that a juror was the father of an associate in the law 
firm representing Dr. Roques; and, (2) to give Sammons’s proposed voir dire.   
 
“A decision not to discharge a juror following voir dire into an incident will 
not be overturned without a showing of prejudicial abuse of discretion by the [trial 
judge].”55   
 
The standard preliminary questions for the jury venire for Superior Court 
civil trials include the following questions: 
Do you know anything about this case through personal 
knowledge, discussion with anyone, the news media, or any other 
source?. . .The plaintiff is represented by ____, of the law firm ____.  
The defendant is represented by ____, of the law firm ____. . . Do you 
know the attorneys in this case or any other attorney or employee in 
their firms? . . .Do you have any bias or prejudice either for or against 
the plaintiff or the defendant?56 
 
 
Under 10 Del. C. § 4511(c), “[a] person who is not disqualified may be 
excluded from jury service by the Court only upon a finding that such person 
                                                 
55  
Skinner v. State, 575 A.2d 1108, 1121 (Del. 1990) (citing Williams v. State, 494 A.2d 
1237, 1243 (Del. 1985); see also Styler v. State, 417 A.2d 948, 953 (Del. 1980).    
 
56  
Del. P.J.I. Civ. § 1.1 (2000). 
 
 
35
would be unable to render impartial jury service or would be likely to disrupt or 
otherwise adversely affect the proceedings.”57   
 
Sammons dismissed Dr. Roques from the case on October 27, 2005.  
Therefore, his attorneys were not involved at the time of jury selection.  An 
attorney who worked for the law firm who had represented Dr. Roques58 wrote a 
letter to the trial judge two days into the trial advising her that he believed that his 
father was a member of the jury.59  The attorney informed the trial judge that he 
and his father had never discussed the case, that his father did not know anything 
about the case, and that his father did not know about either his or his firm’s 
involvement in the case.  On December 14, 2005, the trial judge met with the 
parties to discuss the issue, and Sammons requested that the trial judge remove the 
attorney’s father from the jury.  The trial judge decided to keep the father on the 
jury because there was no evidence that he knew anything about the case or about 
his son’s involvement in the case.  The trial judge had asked the jury the standard 
voir dire questions, as well as specialized questions that counsel proposed at jury 
selection.  At the time of jury selection, Dr. Roques was not a defendant in the 
case, and therefore neither he, the attorneys, nor the firm representing him were 
                                                 
57  
10 Del. C. § 4511(c). 
 
58  
The attorney had been involved in the case by attending several depositions. 
 
59  
The attorney informed the judge that he had spoken with his mother who told him that his 
father was sitting on an eight-day trial.  The attorney was not certain that his father was sitting on 
this particular case.   
 
36
mentioned in the preliminary questions to the jury venire.  The attorney’s father 
gave no positive response to any of the questions asked of the venire.  The trial 
judge noted that the name of the firm had not been mentioned at all during jury 
selection, and she stated that she would instruct the parties to avoid mentioning the 
firm during trial.  We hold that the trial judge’s finding that the juror’s ability to 
render an impartial verdict had not been compromised does not amount to an abuse 
of discretion.  The trial judge was within her discretion to permit the juror to stay 
on the jury because there was no evidence of partiality or bias toward any party.  
Accordingly, we affirm.  
 
7. 
The trial judge did not abuse her discretion by giving the jury a 
curative instruction concerning statements made by Sammons’s counsel 
during closing rebuttal argument. 
 
 
Sammons argues that the trial judge abused her discretion by giving the jury 
a curative instruction concerning statements made by Sammons’s counsel during 
rebuttal closing. Sammons contends that the trial judge’s curative instruction was 
improper because Sammons’s rebuttal closing statements were fully supported by 
the record.  Therefore, Sammons argues that she is entitled to a new trial.   
 
37
The standard of review on appeal of a trial judge’s decision to give a 
curative instruction is abuse of discretion.60  “To establish abuse of discretion ‘the 
appellants must show that the improper comment was ‘significantly prejudicial so 
as to deny them a fair trial.’”61  In civil trials, “[a]ny effort [by counsel] to mislead 
the jury or appeal to its bias or prejudice is inappropriate and, where objection is 
made, the trial court is obliged to act firmly with curative instructions even where 
no objection is forthcoming until after summations.”62   The timing and nature of 
curative instructions to the jury is a matter for the trial judge, who, after having 
presided over the entire trial, is in a better position to determine whether a curative 
instruction should be given.63   
Here, the alleged improper statement by Sammons’s counsel during closing 
rebuttal closing was as follows: 
You know what else you didn’t hear Doctors for Emergency Services 
talk about?  Did you hear them once talk about the board.  Once?  Did 
they mention the board, the board that has the patients’ name on it and 
shows her taken to the floor.  If it’s not their patient, why would [sic] 
                                                 
60  
Davis, 770 A.2d at 41 (Del. 2001) (finding that the trial court’s decision not to provide a 
cautionary instruction after defense counsel referred to the accident in a personal injury action as 
a “fender-bender” constituted an abuse of discretion). 
 
61  
DeAngelis v. Harrison, 628 A.2d 77, 80 (Del. 1993) (quoting Shively v. Klein, 551 A.2d 
41, 44 (Del. 1988)).  
 
62  
Id.  
 
63  
See Jardel Co. v. Hughes, 523 A.2d 518, 533 (Del. 1987) (finding no abuse of discretion 
when the trial judge gave a curative instruction during general jury instruction rather than an 
immediate cautionary instruction). 
 
 
38
it come off as soon as family practice residents came?  Because it is 
their patient.  The patient is still in the emergency room and they’re 
supposed to care for the patient. 
 
After an objection by DFES’s counsel, the trial judge instructed the jury to 
disregard Sammons’s counsel’s argument on this issue by stating: 
Ladies and Gentleman of the Jury during [Sammons’s counsel’s] 
rebuttal closing argument he made reference to the fact that the name 
on the board in the emergency department - - as long as her name, the 
patient’s name remained there that the care remained the 
responsibility of the emergency physicians, and there was no evidence 
to suggest that that’s how the transfer occurs or that the board itself in 
any way suggests or in any way is instrumental in making the change 
from the emergency room doctor’s care to the primary care doctors, so 
[sic] you should disregard that comment. 
 
After reviewing the record, we see no testimony or evidence either 
consistent with counsel’s statement or the inference he wished the jury to draw 
from his statement.  The trial judge’s curative instruction, based on her recollection 
of the evidence, was intended to prevent the jury from drawing an inference 
inconsistent with the record.  We are satisfied with the trial judge’s curative 
instruction to the jury. Sammons has not convinced us, through her briefs or 
otherwise, that the trial judge’s curative instruction to the jury so inaccurately 
represented the record that it unfairly prejudiced her and constituted an abuse of 
discretion.  Accordingly, we affirm. 
 
 
39
8. 
The trial judge did not err by refusing Sammons’s request for jury 
instructions on cross claims and did not abuse her discretion when she 
responded to juror questions.   
 
 
Sammons argues that the trial judge erred when she denied Sammons’s 
request for instructions regarding DFES, Dr. Sobel, and Family Practice’s cross 
claims.  Sammons also argues that the trial judge provided incorrect responses to 
two questions posed by the jury during its deliberations.     
 
“The standard of review for a denial of a requested jury instruction is de 
novo.”64  “While some inaccuracies and inaptness in statements are to be expected 
in any [jury] charge, this court will reverse if the alleged deficiency in the jury 
instructions undermined the jury’s ability to intelligently perform its duty in 
returning a verdict.”65  “A trial court’s charge to the jury will not serve as grounds 
for reversible error if it is ‘reasonably informative and not misleading, judged by 
common practices and standards of verbal communication.’”66  We will examine 
the jury instructions as a whole to make this evaluation.67  “On request of the jury 
after submission of the cause, a trial court has power in open court to give 
                                                 
64  
Manlove v. State, 867 A.2d 902 (Table) (Del. 2005) (citing Ayers v. State, 844 A.2d 304, 
309 (Del. 2004)). 
 
65  
Riggins v. Mauriello, 603 A.2d 827, 830 (Del. 1992) (citing Probst v. State, 547 A.2d 
114, 199 (Del. 1988)).  
  
66  
Probst v. State, 547 A.2d 114, 119 (Del. 1988) (quoting Flamer v. State, 490 A.2d 104, 
128 (Del. 1983)). 
 
67  
See Flamer v. State, 490 A.2d 104, 128 (Del. 1983). 
 
 
40
additional instructions.”68 “A trial court acts in its discretion when deciding to give 
the jury a supplemental instruction.”69   
 
We first will determine whether the trial judge erred by denying Sammons’ 
request for jury instructions.  Sammons requested that the trial judge instruct the 
jury about the bases for the cross claims.  The trial judge denied her request and  
reasoned that it would unnecessarily confuse the jury because the jury did not need 
to know the specific details about the cross claims.  The trial judge was satisfied 
that when the jury completed a verdict sheet allowing for apportionment of 
negligence they would understand the cross claims in issue.70  The trial judge’s 
                                                 
68  
Zimmerman v. State, 565 A.2d 887, 890-91 (Del. 1989) (citing 76 Am. Jur. 2d Trial § 
1046 (1975) (holding that giving a supplemental jury instruction on the theory of accomplice 
liability in response to jury questions was not reversible error)).   
 
69  
Id. at 891 (citing Sheeran v. State, 526 A.2d 886, 893 (Del. 1987)).   
 
 
70  
Trial judge:  
 
I don’t think it matters that they understand what these cross claims are.  You 
[counsel] have to understand that they [jury] don’t understand…most jurors have 
not taken courses in civil procedure and don’t understand this terminology.  As it 
is I think the instructions are difficult enough for them [jury].  If you start using 
those terms freely you are going to lose them [jury].  If you look at the verdict 
sheet and the way we describe the responsibility of the jury to apportion 
negligence I don’t think they [jury] needs to know that that’s because of cross 
claims.   
 
The cross claim is the way it gets legally into Court but it’s not the way 
the jury’s frame of reference is.  The jury’s frame of reference is they have six 
different people they have to consider here, entities, and which ones of them, if 
any, have X percentage of negligence.  And if you start saying cross claims and 
all of this other stuff I think it’s highly confusing to them [jury] and…it’s not 
necessary based on the way the settling co-defendants instruction was given…it’s 
not normally used.  It’s subsumed in the way we do our verdict sheet. 
 
 
 
41
final instructions explained that Christiana Care and St. Francis had settled with 
Sammons before the trial.  The trial judge stated, “the parties who remain in this 
case, that is, Doctors for Emergency Services, Dr. Sobel, and Family Practice 
Associates, have asserted a cross claim against the settling defendants asserting 
that their negligence was the proximate cause of Gail Sammons’ [sic] death.”  
Then the trial judge further instructed the jury regarding apportionment of damages 
and the verdict form.   
After consideration of the trial judge’s ruling and the jury instructions as a 
whole, we find that the trial judge’s refusal to instruct the jury about the bases of 
the cross claims did not constitute reversible error.  The trial judge adequately 
instructed the jury regarding the cross claims so that they could make a reasoned 
and informed decision in the case without confusing the jury by overburdening 
them with unnecessary information.   
 
We now determine whether the trial judge abused her discretion by 
responding to the jury’s questions as she did.  During deliberation, the jury sent out 
a note with questions.  One of the questions was:  “are we to determine if sepsis 
caused Gail’s death or if medical negligence caused her death?”  The trial judge 
met with the parties to discuss counsels’ proposed responses to the question and 
then gave the jury the following answer:  “the Plaintiff’s theory against these 
defendants is that the death was caused by sepsis that these defendants failed to 
 
42
diagnose.  If you decide that the patient did not die of sepsis, then you must find 
these defendants not negligent.”  Sammons contends that the jury could decide 
whether the defendants’ medical negligence on any theory caused Gail’s death and 
that it would have been consistent with Sammons’s theory of the case for the jury 
to find the defendants liable for any negligence proximately causing her death and 
that they were not limited to the theory that failure to diagnose sepsis proximately 
caused Gail’s death.   
 
The jury’s question indicated that they may have been confused about 
whether they were limited to a theory that sepsis caused Gail’s death or if they 
could find for the plaintiff if they found any other medical negligence by the 
remaining defendants caused her death.  Put another way, could DFES, Family 
Practice, and Dr. Sobel be found liable even if the jury did not find that Gail died 
as a result of the defendants’ failure to diagnose sepsis?  The trial judge gave an 
adequate answer to the jury’s question based on Sammons’s theory of the case 
from the beginning.  Sammons had to allege and prove a theory establishing a 
standard of care and a deviation from that standard of care that caused Gail’s 
death.71  Sammons’s theory of the case throughout the entire trial was that DFES, 
Family Practice, and Dr. Sobel were liable because they failed to diagnose sepsis 
                                                 
71  
See 18 Del. C. § 6853(e):  “No liability shall be based upon asserted negligence unless 
expert medical testimony is presented as to the alleged deviation from the applicable standard of 
care in the specific circumstances of the case and as to the causation of the alleged personal 
injury or death…” 
 
 
43
and that the defendants’ failure to diagnose that condition resulted in Gail’s death.  
Therefore, DFES, Family Practice, and Dr. Sobel could only be liable if the jury 
found that Gail died because of their failure to diagnose sepsis.  The trial judge’s 
instruction was consistent with Sammons’s theory throughout the entire case and 
consistent with the mandate of 18 Del. C. § 6853(e).72  Sammons cannot utilize a 
catchall category of medical malpractice; Sammons put the defendants on notice of 
her theory of the case.  She offered expert medical testimony to support that 
theory.  It was on that theory alone that the jury could find negligence and 
                                                 
72. 
Sammons’s counsel made several statements during his opening statement that indicated 
that their theory of the case was that the defendants failed to diagnose Gail with sepsis and she 
died from sepsis, for example: 
 
This is a case about doctors who failed to diagnose a condition that caused the 
death of Gail Sammons, Elizabeth Sammons’s daughter. . .There are two medical 
conditions that Gail was suffering from on January 4, 2002.  The first is sickle cell 
anemia.  The second was sepsis. . .Sepsis is what cause her death on that day the 
evidence will show. . .The evidence will show that Gail did not get that needed 
medical attention on January 4, 2002 and ultimately died because of the doctors’ 
failure to diagnose her sepsis. . .You will hear from the experts that these results 
from these labs, the CBC and urinanalysis, were alarming  and along with her 
vital signs were shouting that Gail had sepsis to anyone who would listen. . .They 
failed to recognize, however, that Gail was also suffering from sepsis despite the 
overwhelming evidence of it. . .The evidence will show that some time between 
6:30 and 8:40 p.m. Gail’s untreated sepsis went into what is known as septic 
shock…Her undetected sepsis was about to cause her death. . .On behalf of Mrs. 
Sammons we submit that the evidence in this case will…show…that the 
defendants simply failed to recognize the critical nature of Gail’s condition and 
her sepsis on January 4th, 2002; thus causing her untimely death. 
 
Sammons’s counsel reiterated his theory of the case in his closing argument: 
 
 . . . And what is bad about this case is that doctors failed to diagnose Gail with 
sepsis even though she had all the factors.  And what is bad about this case is that 
because no doctor diagnosed Gail with sepsis her sepsis went untreated and 
caused her death. 
 
 
44
causation sufficient to establish liability.  The trial judge properly exercised her 
discretion by focusing the jury on Sammons’s theory of the case, and she gave an 
adequate response to the jury’s question.   
 
The jury also asked a question regarding whether DFES was responsible for 
a patient during the patient’s entire stay in the emergency room.  After hearing 
arguments from counsel, the trial judge decided to instruct the jury to rely on its 
own recollection of the evidence.  She also reminded the jury that arguments of 
counsel are not evidence in this case.  The trial judge did not abuse her discretion 
because her response was intuitively accurate and complied with the pattern jury 
instructions.73  Accordingly, we affirm.  
                                                 
73  
Del. P.J.I. Civ. § 3.3 (2000).   
 
 
45
 
9. 
The trial judge abused her discretion by entering an order of dismissal 
under Superior Court Civil Rule 60(b) sua sponte.   
 
 
We review the trial judge’s order dismissing the case under Superior Court 
Civil Rule 60(b) sua sponte for abuse of discretion.74   
Rule 60(b) contemplates relief only upon a party’s motion by permitting a 
party to seek relief “from a final judgment, order, or proceeding.”75  Rule 60(b), 
however, “does not limit the power of a Court . . . to set aside a judgment for fraud 
upon the Court.”76  Thus, although Rule 60(b) contemplates relief only upon a 
party’s motion, a trial judge may provide relief under Rule 60(b) sua sponte when 
there is “fraud upon the court.”77  For a trial judge to provide relief from a final 
judgment on the ground that a party committed fraud upon the court, a “heavy 
                                                 
74  
See Wife B. v. Husband B., 395 A.2d 358, 359 (Del. 1978); Battaglia v. Wilmington Sav. 
Fund Soc’y, 379 A.2d 1132, 1135 (Del. 1977). 
 
75  
Super. Ct. Civ. R. 60(b); see 11 Charles Alan Wright & Arthur R. Miller, Federal 
Practice and Procedure § 2865. 
 
76  
Super. Ct. Civ. R. 60(b); see Wright & Miller, § 2870. 
 
77  
Super. Ct. Civ. R. 60(b); see Epstein v. Matsushita Elec. Indus. Co. (In re MCA, Inc. 
S’holder Litig.), 785 A.2d 625, 634 (Del. 2001) (“[A] trial court [under Court of Chancery Rule 
60(b)] has the power ‘to set aside a judgment for fraud upon the Court.’  A court does not have to 
wait for a party to make a motion for relief under this section; rather a court may take 
independent action to relieve a party from a judgment pursuant to this rule.”) (quoting Del. Ch. 
Ct. R. 60(b)); see also Wright & Miller, §§ 2865, 2870. 
 
 
46
burden” must be met.78  Ultimately, there must be “a showing of ‘the most 
egregious conduct involving a corruption of the judicial process itself.’”79 
In the present case, the trial judge dismissed the case against DFES under 
Rule 60(b) sua sponte.  Therefore, the trial judge’s order of dismissal was 
permissible only if there was fraud upon the court.  Although the trial judge found 
that Sammons’s affidavit of merit did not comply with 18 Del. C. § 6853, the trial 
judge made no factual findings that Sammons committed fraud upon the court by 
presenting the affidavit of merit.  The trial judge, in her January 18, 2006 letter 
opinion, indicated that she wanted to schedule a hearing to hear evidence on 
Sammons’s counsel’s efforts to comply with § 6853, and to determine to what 
extent Dr. Munoz, if any, was responsible for misleading Sammons’s counsel or 
the court.  The trial judge, however, did not conduct that hearing.  Furthermore, the 
original trial judge had previously reviewed Sammons’s affidavit of merit and 
concluded that the affidavit complied with § 6853.   
Under these circumstances, Sammons’s presentation of her affidavit of merit 
cannot be said to be egregious conduct “involving a corruption of the judicial 
process itself” at this stage of the proceedings.  Therefore, we conclude that the 
trial judge abused her discretion when she dismissed the case under Rule 60(b) sua 
                                                 
78  
Epstein, 785 A.2d at 639. 
 
79  
Id. (quoting Wright & Miller, § 2870). 
 
47
sponte; at the time she dismissed the case, she had no record evidence of fraud on 
the court that would permit DFES to seek relief following the jury’s final judgment 
without a motion, a hearing, and the admission of evidence that established fraud.  
Accordingly, we vacate the trial judge’s order dismissing the case and remand with 
instructions to reinstate the judgment.   
For the foregoing reasons, the judgment of the Superior Court is 
AFFIRMED in part, VACATED in part, and REMANDED in part.