Title: Winterholler v. Zolessi

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Winterholler v. Zolessi1999 WY 142989 P.2d 621Case Number: 98-246, 98-274Decided: 11/04/1999Supreme Court of Wyoming
 
TONYA WINTERHOLLER, RONALD WINTERHOLLER, and JON 
WINTERHOLLER by Ronald Winterholler, His Father and Next Friend, Appellants 
(Plaintiffs),

v.

LEONEL ZOLESSI, M.D., 
Appellee (Defendant).

 

Appeal from the District 
Court of Campbell County, Honorable Dan R. Price, 
Judge.

Walter Urbigkit, 
Frontier Law Center, Cheyenne, Argument by Mr. Urbigkit, representing 
Appellants.

Jeffrey C. 
Brinkerhoff and Hampton K. O'Neill of Brown, Drew, Massey & Sullivan, 
Casper, Argument by Mr. Brinkerhoff, representing 
Appellee.

Before 
LEHMAN, C.J., and THOMAS, MACY, GOLDEN, and HILL, JJ.

HILL, 
Justice.

[¶1]      Following a 
jury's rejection of Appellant Tonya Winterholler's malpractice claim arising 
from Appellee Dr. Zolessi's performance of a laparoscopic hysterectomy, 
Appellant filed the two consolidated appeals.  In Case No. 98-246, Appellant claims 
that she was denied a fair trial when the district court limited her to one 
standard of care expert only days before trial and, at trial, refused to allow 
her treating physicians to express criticism of Dr. Zolessi's care. Appellant 
also argues that she was denied a fair trial when the district court refused to 
permit her substituted expert to testify regarding his opinion that Dr. 
Zolessi's placement of surgical hardware was below the standard of care. 
Finally, Appellant contends that the district court abused its discretion in 
allowing Dr. Zolessi to present evidence of Appellant's teenage 
abortion.

[¶2]      In Case No. 
98-274, Appellant claims that the district court erred in awarding costs to Dr. 
Zolessi without a hearing. Finding that the district court abused its discretion 
in excluding the late-discovered expert opinion, and that the order limiting 
Appellant to one standard of care expert is not based upon the facts of this 
case, we reverse in part and remand. Due to the resolution of Case No. 98-246, 
Case No. 98-274 regarding the award of costs is moot. 

ISSUES

[¶3]      In Case No. 
98-246, Appellant lists five lengthy issues for consideration. In a shortened 
version, they are as follows:

1. Whether the 
Court's decision that surprise to Defendant justified the exclusion of testimony 
by Plaintiffs'1 designated expert witness was an 
abuse of discretion?

2. Whether the 
Court's decision was legally unjustified, factually improper, and an abuse of 
discretion in restricting Plaintiffs to one expert witness for any standard of 
care testimony?

3. Whether the 
Court's decision was an abuse of discretion, in violation of litigants' 
guaranteed rights to a fair trial and factually erroneous in limiting 
Plaintiffs' treating physicians from providing testimony which was considered 
critical of the Defendant surgeon's [actions]?

4. Whether the 
Court's decision was an abuse of discretion when determining that defense 
counsel had an unqualified right to require [Appellant] to submit to examination 
by Defendant's designated expert witness?

5. Whether the 
Court's decision was an abuse of discretion in determining that a teenage 
abortion which had occurred thirteen years before the hysterectomy surgery could 
be introduced into evidence?

Appellee 
consolidates the issues as follows:

1. Whether it 
was a reasonable exercise of discretion for the trial court to strike Dr. 
Oliphant's new, previously undesignated, undisclosed, surprise, and 
contradictory opinion, first offered late on the eve of trial, concerning Dr. 
Zolessi's alleged "negligent" placement of the trocar?

2. Whether it 
was a reasonable exercise of discretion for the trial court to limit plaintiffs 
to one expert on the issue of standard of care to testify at trial to avoid 
unnecessary, cumulative, inconsistent and confusing testimony from plaintiffs' 
various experts?

3. Whether it 
was a reasonable exercise of discretion for the trial court to allow evidence of 
the plaintiff Tonya Winterholler's abortion as part of her pertinent medical 
history, when her previous medical history, including a complication following 
her abortion, was relevant to her claim that Dr. Zolessi misdiagnosed chronic 
pelvic inflammatory disease?

In Case No. 
98-274, we decline to repeat the parties' lengthy statement of issues and 
restate the issue as:

Whether the 
district court abused its discretion in awarding costs to Appellee without 
scheduling, sua sponte, a hearing on the matter?

FACTS

[¶4]      For approximately 
four years, Dr. Zolessi treated Appellant for tubal pregnancy problems and other 
obstetric and gynecological complaints. Treatment culminated in Dr. Zolessi's 
performance of Appellant's laparoscopic hysterectomy in late March of 1992. 
Laparoscopic surgery requires the surgeon to place a laparascope through the 
umbilicus and then, through small incisions at various locations in the abdomen, 
place two or three surgical instruments, known individually as a trocar, through 
which the surgical tools are manipulated.

[¶5]      The day following 
surgery, after recovery from the effects of the anesthesia, Appellant 
experienced severe back pain and discovered bruising into her flank, abdomen, 
and left labia. Problems persisted after her release and, on April 11, 1992, 
Appellant returned to the emergency room complaining of back pain. At her next 
scheduled appointment with Dr. Zolessi on the 13th of April, Appellant sought an 
explanation as to the bruising and why she was continuing to experience pain. 
Dr. Zolessi surmised that the anesthesia through an epidural procedure may have 
caused the post-surgery bleeding.

[¶6]      Appellant 
continued to experience pain and received no satisfactory answer, as to its 
cause, from a series of doctors. Appellant eventually consulted Dr. Steven 
Freedman, a California board certified obstetrician/gynecologist, in May, 1992. 
Dr. Freedman diagnosed her problem as stemming from the severing of an 
epigastric artery due to the placement of the trocar during the laparascopic 
procedure. Following this diagnosis, Appellant came under the care of Dr. 
Painter, who arranged an appointment with another specialist for possible 
treatment.

[¶7]      In March of 1994, 
Appellant and her family filed a complaint alleging medical negligence in Dr. 
Zolessi's pre-surgical, surgical, and post-surgical care. Essentially, Appellant 
claimed that she was not given sufficient information about the risks of the 
surgery, that Dr. Zolessi was negligent in performing the surgery and in failing 
to recognize that the epigastric artery was severed, and that he failed to 
provide reasonable post-surgical treatment. Appellant designated three expert 
witnesses in April of 1995 - her treating physicians, Dr. Freedman and Dr. 
Painter, and another obstetrician/gynecologist, Dr. Woodard. All were deposed by 
the defense during discovery. At one point during Dr. Painter's deposition, Dr. 
Zolessi's counsel advised Appellant's counsel that three standard of care 
experts was excessive.

[¶8]      In May of 1997, 
Appellant took the trial deposition of Dr. Freedman, as he could not attend the 
trial in person. On September 23, 1997, Ms. Winterholler filed a motion for a 
continuance of the trial date because of the health problems of her expert, Dr. 
Woodard. Dr. Zolessi objected, claiming that Dr. Woodard's testimony was not 
necessary since Dr. Freedman and Dr. Painter were also designated to give 
opinions on the standard of care. The district court continued the trial from 
October of 1997 to June of 1998.

[¶9]      In February, due 
to Dr. Woodard's failing health, Appellant filed a motion to substitute Dr. 
Oliphant, another obstetrician/gynecologist, to take Dr. Woodard's place at 
trial. The trial court granted the motion, and Dr. Oliphant's deposition was 
taken on April 20, 1998, approximately six weeks before the trial date. The 
morning of the deposition, Dr. Oliphant conducted a physical examination of 
Appellant. Based upon that examination, Dr. Oliphant offered his opinion at his 
deposition that the placement of the trocar fell below the applicable standard 
of care.

[¶10]   Shortly thereafter, Dr. Zolessi 
filed a motion to strike this opinion and a motion to limit Ms. Winterholler to 
one standard of care expert. A hearing on the pending motions was held on May 
20, 1998. On May 21, the trial court issued a decision letter granting the 
motion to strike the opinion of Dr. Oliphant relating to the placement of the 
trocar and ordering plaintiffs to choose one standard of care expert. Appellant 
chose Dr. Oliphant as her standard of care witness; however, he was not 
permitted to testify regarding the negligent placement of the trocar. At trial, 
the jury heard the testimony of Dr. Painter and portions of Dr. Freedman's 
deposition, but Appellant was not permitted to present testimony from these 
witnesses criticizing Dr. Zolessi's care. The jury found in favor of Dr. 
Zolessi, and judgment was entered on June 26, 1998. A timely appeal 
followed.

[¶11]   Pursuant to U.R.D.C. 501 and 
W.R.C.P. 54(d), Dr. Zolessi served his certificate of costs on July 20, 1998, in 
the amount of $10,028.84. Appellant filed a resistance to these costs, and Dr. 
Zolessi then filed a response. The trial court awarded a majority of the costs 
submitted by Dr. Zolessi, $8,474.30, without a hearing. Appellant appealed the 
district court's order, and the cases were consolidated by this 
Court.

STANDARD OF 
REVIEW

[¶12]   Each of the issues raised by 
Appellant are governed by an abuse of discretion standard of review. We have 
described this standard as follows:

The admission or 
exclusion of expert testimony is a decision within the sound discretion of the 
district court, and its decision will not be overturned absent a showing of 
clear and prejudicial abuse of discretion. Yung v. State, 906 P.2d 1028, 1037 
(Wyo. 1995).

"Judicial 
discretion is a composite of many things, among which are conclusions drawn from 
objective criteria; it means a sound judgment exercised with regard to what is 
right under the circumstances and without doing so arbitrarily or capriciously. 
Byerly v. Madsen, 41 Wn. App. 495, 704 P.2d 1236 (1985)." Vaughn v. State, 962 P.2d 149, 151 (Wyo. 1998) (quoting Martin v. State, 720 P.2d 894, 897 (Wyo. 
1986)).

Rogers v. State, 
971 P.2d 599, 601 (Wyo. 1999).

DISCUSSION

Case No. 
98-246

1. Preclusion of 
Expert Opinion Due to Unfair Surprise.

[¶13]   Appellant contends that the trial 
court abused its discretion in precluding Dr. Oliphant's opinion that Dr. 
Zolessi's placement of the trocar was below the standard of care. She maintains 
that the error lies in the trial court's determination that this opinion came as 
an unfair surprise to the defense which, therefore, did not have adequate time 
to respond to the issue prior to trial. In essence, Appellant claims that the 
district court erroneously restricted the development of her theory of the case. 
"This is a threshold concern because a litigant usually is entitled to a remand 
and a new trial if it was unfairly prejudiced in the presentation of its case." 
Stauffer Chemical Company v. Curry, 778 P.2d 1083, 1100 (Wyo. 1989). On appeal, 
the question is whether the trial court could reasonably find that the 
"avoidance of possible hardship to parties and the accomplishment of substantial 
justice to the merits of [the] claims" was best served by the exclusion of Dr. 
Oliphant's opinion that the placement of the trocar was negligent. Ford Motor 
Company v. Kuhbacher, 518 P.2d 1255, 1260 (Wyo. 1974).

[¶14]   Initially, we note that Dr. Zolessi 
does not refer us to a specific rule under which the district court excluded 
that portion of Dr. Oliphant's testimony. Rather, he argues that the trial 
court's decision is an appropriate exercise of the court's inherent power to 
limit and otherwise control the admissibility of proffered expert testimony. We 
have identified two sources for this authority in the past, W.R.C.P. 16,2 (Salveson v. Cubin, 791 P.2d 581, 
582, fn. 1 (Wyo. 1990); Oukrop v. Wasserburger, 755 P.2d 233, 237-38 (Wyo. 
1988)); and W.R.E. 401-403.3 Hall v. Hall, 708 P.2d 416, 421 
(Wyo. 1985); Kobos v. Everts, 768 P.2d 534, 545 (Wyo. 
1989).

[¶15]   Dr. Zolessi infers that the trial 
court's decision may be founded on W.R.C.P. 16 because Dr. Oliphant's opinion 
was given after the expert designations were filed and only shortly before 
trial. He maintains that the circumstances of this case are similar to those in 
Salveson, supra. There, in a medical malpractice case, plaintiffs sought to add 
a handwriting expert to testify concerning the physician's office notes after 
the expert designation deadline. The trial court prohibited the late listing, 
reasoning that it related to a peripheral issue which should have been disclosed 
in discovery. The trial court concluded that the request for a handwriting 
expert "is creating issues way beyond what was contemplated by the parties. . . 
. [This issue] seems to be developed as an afterthought and could have been 
contemplated and dealt with during the discovery period." Salveson, 791 P.2d  at 
583. On appeal, this Court held that no abuse of discretion occurred because 
there could have been a timely designation of the witness at the pretrial 
conference. We further found that the appellee would have been "ambushed" if the 
expert were permitted to testify on rebuttal. 

[¶16]   Dr. Zolessi argues that, here, 
Appellant had four years to designate expert testimony on the negligent 
placement of the trocar but did not do so until weeks before the trial. Thus, as 
in Salveson, the belated claim is an afterthought. Dr. Zolessi further contends 
that, if admitted, Dr. Oliphant's testimony on the trocar placement would have 
required Dr. Zolessi to retain a new expert to respond to the claim. We find the 
analogy to Salveson misplaced. Unlike the circumstances in Salveson, the opinion 
proffered by Dr. Oliphant was not a collateral issue. It was an opinion directly 
related to Appellant's claim that the surgery was below the standard of care. In 
addition, Dr. Oliphant was not retained as an expert in this case until Dr. 
Woodard could no longer participate. Therefore, Dr. Oliphant's opinion could not 
have been known at an earlier time. Finally, Dr. Zolessi's designated standard 
of care witness, Dr. Townsend, is a well-qualified board certified 
obstetrician/gynecologist. The designation stated that Dr. Townsend was prepared 
to testify that Dr. Zolessi "properly performed the surgery." Therefore, Dr. 
Zolessi's need to employ a new expert to respond to this issue is unsupported by 
the record.

[¶17]   On the other hand, Appellant likens 
the facts of this case to those found in Oukrop, supra. In that case, the trial 
court admitted the expert testimony of Dr. Collins as to the long-range effects 
of a drug over defendant's objection that the testimony exceeded the pretrial 
disclosure. While the disclosure of Dr. Collins' testimony and his report were 
limited to the immediate toxic effects of the drug, the Notice of Experts also 
stated that any of the listed witnesses may testify regarding the propensities 
of the drug, and that the damages suffered by the defendant were a direct result 
of the drug overdose prescribed by the defendant. 755 P.2d  at 237. Due to the 
submissions prior to trial, the trial court found no unfair surprise. We agreed, 
stating, "[i]n substance, the trial court ruled that [there was ample] notice of 
such potential testimony." Id. at 238. Appellant claims that, as in Oukrop, Dr. 
Zolessi had ample notice of Appellant's claim that the placement of the trocar 
was a substantial causative factor in the severance of her epigastric artery and 
subsequent pain.

[¶18]   Looking to the record, there is no 
doubt that Dr. Freedman and Dr. Woodard were questioned regarding trocar 
placement. It is also beyond question that neither of these experts specifically 
stated that the trocar placement was below the standard of care. In Dr. 
Freedman's discovery deposition in 1995, he testified that the placement of the 
trocar was not below the standard of care, but rather, it was "bad technique and 
poor judgment." Dr. Freedman's trial deposition in 1997, however, clarified this 
statement as follows:

Q. Now, with 
respect to the placement of the trocars, that's another example of how different 
surgeons can place those trocars differently, correct?

A. No, sir. As 
we learn our techniques, we learn various ways to stay out of trouble, and one 
of the ways of staying out of trouble is to not put the trocars where he put 
them, and, therefore, it is not beneath the standard of care as I testified 
today. It is poor judgment and bad technique.

Q. But the 
answer to my question, first of all, is that there are different techniques in 
placing the trocars, as well as different techniques of every aspect of the 
surgery?

A. Well, that 
would imply that under some circumstances this would be considered good 
technique, and the answer is no, it is never considered good technique. In other 
words, as a teacher of the technique, as I'm instructing my students, I would 
tell them there are different alternatives for the placement, but this would 
never be listed as one of the alternatives.

. . . 
.

Q. [In your 
previous deposition you answered] "There are different ways of doing every 
aspect of the procedure starting with even the trocar placement." That was your 
answer on that date; correct?"

A. But Jeff, you 
see, you're confusing the issue. The issue is you can safely place the trocar in 
many places.

Q. Thank 
you.

A. And that is 
my testimony. But his placement of the trocar would not be included in those 
alternative placements. 

Q. You placed 
the trocar differently than Dr. Zolessi did?

A. I'm saying 
that as you learn proper placement of the trocar, there are safe places to put 
it and unsafe places. Where he put it would be included in the list of unsafe 
places.

. . . 
.

Q. . . . Doctor, 
your testimony is that while you placed the trocars differently, the way he 
placed the trocars met the standard of care; isn't that 
true?

. . . 
.

A. If our 
interest is to allow the jury to understand the issue, as I've testified, the - 
there are a number of ways of placing trocars, and we are taught that there are 
areas to avoid while placing the trocars. Dr. Zolessi placed the trocars in an 
area that we are all trained to avoid. It is not beneath the standard of care. 
It is just bad technique.

Q. Doctor, the 
answer to my question is Dr. Zolessi's placement of the trocars met the standard 
of care, correct?

. . . 
.

A. There is a 
difference between falling beneath the standard of care or meeting the standard 
of care. I believe it did neither. Certainly if Dr. Zolessi was my student and 
he was placing his trocars in that way, I would strongly admonish him and tell 
him never to do it that way again.

(Emphasis 
added.)

[¶19]   Dr. Woodard's opinion letter 
generally stated "complications . . . due to . . . procedure suggest less than 
optimal technique and skill." In his deposition, however, he also took the 
opportunity to expand on this statement. First, he testified, "[t]he surgical 
procedure just didn't happen in a way that would seem to be standard. In other 
words, it seems like a substandard operation, and the end result sort of speaks 
for itself." Later in the deposition, he responded to defense counsel's 
questions as follows:

Q. In any event, 
I take it that it is your opinion that her chronic back pain resulted from the 
use of the aquapurator which dissected pelvic nerves?

A. Coupled with 
the injury to the epigastric artery.

Q. Right. And 
how in your opinion was the epigastric artery injured?

A. The 
laparoscopy involves several ports, small incisions, one in the naval, one 
immediately in the midline, the suprapubic area, and two ports laterally in the 
abdominal wall in the area of McBurney's point, which is where appendical 
incisions are frequently made, except this was on the left side not the right 
side. These incisions are usually 2 1/2 centimeters in length or less, sometimes 
more.

[¶20]   The incision that was placed by Dr. 
Zolessi was not in the position that was optimal. Optimal position means it's 
lateral to the rectus muscle, more near the anterior superior iliac spine, which 
is a bony landmark. . . .

. . . 
.

Q. I think 
you've told me that you believe that the pain was caused - first one element of 
that chronic back pain was the dissection of the pelvic nerves by the 
aquapurator; is that correct?

A. 
Yes.

Q. And another 
explanation for the pain was the puncture or dissection of the epigastric artery 
when he put one of the trocars in; is that correct?

A. That's 
correct. . . . So it's a combination, not a single item.

(Emphasis 
added.) In light of this testimony, it is clear that Appellant's experts were 
critical of the trocar placement but did not definitively state that it was 
below the standard of care. Thus, the alleged surprise in this case is that Dr. 
Oliphant took the next step and was the first expert to clearly state that the 
trocar placement was below the standard of care.

[¶21]   We are mindful that "where the 
authority to perform a proposed action rests within the discretion of the court 
we must allow considerable latitude in which he may exercise his discretion." 
Waldrop v. Weaver, 702 P.2d 1291, 1294 (Wyo. 1985) (quoting Carman v. Slavens, 
546 P.2d 601, 603 (Utah 1976)). However: 

[T]his does not 
mean that the court has unrestrained power to act in an arbitrary manner. 
Fundamental to the concept of the rule of law is the principle that reason and 
justice shall prevail over the arbitrary and uncontrolled will of any one 
person; and that this applies to all men in every status: to courts and judges, 
as well as to autocrats or bureaucrats. The meaning of the term `discretion' 
itself imports that the action should be taken within reason and good conscience 
in the interest of protecting the rights of both parties and serving the ends of 
justice. It has always been the policy of our law to resolve doubts in favor of 
permitting parties to have their day in court on the merits of a 
controversy.

Id. (emphasis 
added). We have recognized that "avoidance of possible hardship to parties and 
the accomplishment of substantial justice to the merits of claims should be 
among the factors which the trial court considers." Ford Motor Company, 518 P.2d  
at 1260 (Wyo. 1974).

[¶22]   In deciding whether a party's 
supplementation of its disclosures after the conclusion of expert discovery is 
fair under the circumstances, courts have considered the following 
factors:

(1) whether 
allowing the evidence would incurably surprise or prejudice the opposing 
party;

(2) whether 
excluding the evidence would incurably prejudice the party seeking to introduce 
it;

(3) whether the 
party seeking to introduce the testimony failed to comply with the evidentiary 
rules inadvertently or willfully;

(4) the impact 
of allowing the proposed testimony on the orderliness and efficiency of the 
trial; and

(5) the impact 
of excluding the proposed testimony on the completeness of the information 
before the court or jury.

Dada v. 
Children's National Medical Center, 715 A.2d 904, 909 (D.C. 1998) (quoting 
Weiner v. Kneller, 557 A.2d 1306, 1311-12 (D.C. 1985)). See also Gregory P. 
Joseph, American Law Institute, Emerging Expert Issues Under the 1993 Disclosure 
Amendments to the Federal Rules of Civil Procedure, 29 (1999), and cases cited 
therein. In those instances in which the trial court relies on W.R.E. 403, 
unfair surprise is relevant to the trial court's consideration of unfair 
prejudice to the opposing party. Thus, the factors mentioned above will be 
relevant to the trial court's determination under W.R.E. 403, as well. See 
Magyar v. Wisconsin Health Care Liability Insurance Plan, 564 N.W.2d 766, 769-70 
(Wis. 1997) (proper analysis is to weigh the probative value of the testimony 
against the danger of unfair surprise).

[¶23]   The record is silent as to how the 
trial court weighed the importance of Dr. Oliphant's testimony against Dr. 
Zolessi's claim of surprise. The trial court merely stated, "I feel the defense 
has not had and will not have sufficient time to respond to this new opinion." 
Applying the considerations enumerated earlier, we find no indication that 
Appellant willfully failed to comply with the evidentiary rules. Dr. Oliphant 
was designated as a witness only when Dr. Woodard could not continue in this 
capacity. Dr. Oliphant performed his examination and was available for 
deposition approximately one month after the trial court allowed his 
substitution and eight weeks before trial. Given the credentials and involvement 
in the case of Dr. Zolessi's expert, we find nothing which indicates that this 
time was insufficient to formulate a response. Finally, the absence of Dr. 
Oliphant's opinion clearly prevented the jury from hearing all the information 
regarding Appellant's claims.

[¶24]   Thus, we are unable to find support 
in the record for the conclusion that the admission of Dr. Oliphant's testimony 
would incurably surprise or prejudice the defense. It is not difficult, however, 
to see that the exclusion of the opinion stating there was a breach of the 
standard of care prejudiced Appellant's ability to present the merits of her 
malpractice claim. In light of the record before us, we must conclude that the 
district court abused its discretion in excluding Dr. Oliphant's opinion, and, 
therefore, reverse and remand.

2. Limitation to 
One Standard of Care Expert.

[¶25]   Appellant contends that the 
district court abused its discretion in limiting her to one standard of care 
expert even though Dr. Zolessi had made no objection to the three designated 
experts until four weeks before the trial. Appellant claims the court abused its 
discretion primarily because the decision inappropriately establishes a rule of 
law allowing but one standard of care expert per specialty in every case. Dr. 
Zolessi refutes this allegation, stating that he sought "only to establish that, 
under the unique facts and circumstances of this case, such a limitation was a 
reasonable exercise of the trial court's discretion." Since this issue is likely 
to arise on remand, we address it here.

[¶26]   There is no rule limiting the 
number of witnesses a party may call on a particular fact or issue. Mintun v. 
State, 966 P.2d 954, 959 (Wyo. 1998). W.R.E. 403 permits a trial court to 
exclude relevant evidence for "considerations of undue delay, waste of time, or 
needless presentation of cumulative evidence." Id. This rule is to be used 
sparingly because it excludes evidence which is concededly relevant and 
probative. Towner v. State, 685 P.2d 45, 49 (Wyo. 1984).

[¶27]   It is well-established that the 
determination under W.R.E. 403 is a matter within the discretion of the trial 
court. Kobos By and Through Kobos v. Everts, 768 P.2d 534, 546 (Wyo. 1989). In 
Kobos we stated:

Not all evidence 
which is entirely duplicative is therefore cumulative and excludable. Evidence 
may vary in degree of persuasiveness, and when an item of proof which is offered 
on a point is very different in character or persuasive impact from an item of 
proof previously received, the former cannot be considered merely "cumulative" 
of the latter. Moreover, at times it is entirely reasonable for a party to 
insist, "One witness is good, but two or three will make my case much stronger, 
even though all will testify in a similar vein." In short, the discretion of the 
trial judge to exclude cumulative evidence must be exercised in a discriminating 
fashion, and with wisdom, particularly where the evidence in question goes to 
issues of central importance in the case. (Quoting 2 D. Louisell and C. Mueller, 
Federal Evidence § 128 at 74-75 (footnote omitted) (citations 
omitted)).

[¶28]   The trial court retains 
considerable latitude even with admittedly relevant testimony in rejecting 
evidence which is cumulative or in requiring that evidence be brought to the 
jury's attention in a manner least likely to cause confusion. However, the 
litigant "is entitled to an opportunity to adduce relevant, competent evidence 
bearing on the issues to be tried." Hamling v. United States, 418 U.S. 87, 125, 
94 S. Ct. 2887, 2911-12, 41 L. Ed. 2d 590, reh'g denied 419 U.S. 885, 95 S. Ct. 157, 
42 L. Ed. 2d 129 (1974). Thus, evidence which in the context of the litigation is 
merely repetitious or time consuming may be excluded, but only if time 
consideration substantially outweighs the incremental probative value of the 
proffered evidence. M. Graham, Handbook of Federal Evidence § 403.1 at 179 (2d 
ed. 1986).

Id. at 
546.

[¶29]   As can be seen by the guidelines 
discussed above, each determination must be made on the facts of the case before 
the judge. Our review of the record leads us to conclude that the trial court's 
determination was not based upon the unique facts of the case, but rather, it 
laid down a general rule excluding more than one expert to testify on the 
standard of care.

[¶30]   The district court ruled that 
Appellant would have to choose one of these experts to testify regarding the 
standard of care. The basis of the trial court's decision was stated as 
follows:

My reasoning on 
the above limitation to one standard of care expert is that allowing more than 
one witness on such an issue would merely encourage each party to call more 
witnesses to support their position. Such encouragement would unduly lengthen 
the trial, waste time and be cumulative. To the extent the opinions are alleged 
to be inconsistent, the specter of confusion of the issues seems quite 
high.

(Emphasis 
added.) The concern that allowing more than one expert witness for Appellant 
would encourage Appellee to also designate several witnesses was not present in 
this case. Appellant's designation of three experts at the outset of trial, 
years before the trial court's decision, generated the designation of but one 
expert on the standard of care on behalf of Dr. Zolessi. At the motions hearing, 
counsel for Dr. Zolessi stated, "as far as standard of care, I'm willing to live 
or die with him. That's the way it is in every case." Thus, the record supports 
Appellant's contention that the trial court's decision was based on the 
application of a general rule rather than the facts of this 
case.

[¶31]   In addition, the trial court stated 
that "[t]o the extent the opinions are alleged to be inconsistent, the specter 
of confusion of the issues seems quite high." (Emphasis added.) Allegations of 
confusion are an insufficient foundation on which to exclude evidence. Moreover, 
our review of the record reveals that the allegations of inconsistency at the 
hearing may be generously characterized as overstated. Defense counsel alleged 
that "Dr. Freedman had no criticisms about the placement of the trocars." As 
discussed earlier in this opinion, Dr. Freedman seemed to have fairly 
substantial criticism of the trocar placement. Defense counsel also represented 
that "Dr. Freedman essentially had no informed consent criticisms," but that 
"Dr. Woodard, the original expert designated, did have." Any inconsistencies 
within Dr. Freedman's trial deposition and Dr. Woodard's opinion were 
irrelevant, given that Dr. Woodard was no longer a potential witness at the 
trial.4

[¶32]   Dr. Zolessi's final argument to the 
trial court discussed unfair prejudice. Counsel stated, "I think it would be 
unfair for the Plaintiff to have three witnesses all addressing the standard of 
care issue. The inference to the jury is that I could only find one person to 
support my case, and yet, he's got three to support his." While this may be 
true, Dr. Zolessi opted to designate one expert knowing Appellant designated 
three. In any event, the question is not numbers but the substance and need for 
the testimony offered and whether the inconsistencies in expert testimony are 
such that the jury could weigh the conflicting information for itself. On 
remand, we urge the trial court to address these issues should it determine that 
Appellant be limited to one standard of care expert under W.R.E. 
403.

3. Evidence of 
Teenage Abortion.

[¶33]   Appellant claims the district court 
abused its discretion in admitting evidence of her teenage abortion which had 
occurred 13 years before the hysterectomy surgery. Appellant claimed the 
incident had "no relevance to the issues presented by her present complaint of 
1992 medical malpractice," or if relevant, it "should be excluded because of the 
nature of the evidence in raising religious and adverse reactions which are 
unfairly prejudicial." We disagree.

[¶34]   Appellant alleged that Dr. Zolessi 
was negligent in his diagnosis of pelvic inflammatory disease as the basis for 
the hysterectomy. The trial court did not abuse its discretion in finding that 
to defend the claims of misdiagnosis and unnecessary surgery, Dr. Zolessi should 
be permitted to develop evidence explaining why he made his diagnosis. That 
evidence necessarily includes the patient's medical history pertinent to the 
diagnosis. The abortion was mentioned several times in her medical records, and 
expert testimony was presented which established that a prior abortion is a 
relevant fact to a diagnosis of pelvic inflammatory disease. As to the 
prejudicial nature of this evidence, the trial court correctly determined that 
this concern could be effectively addressed during voir 
dire.

Case No. 
98-274

[¶35]   The second appeal addresses the 
propriety of the district court's order allowing Dr. Zolessi approximately 
$8,474.00 in trial costs pursuant to U.R.D.C. 501 and W.R.C.P. 54(d). Both rules 
permit the trial court to award specific costs to the prevailing party. Because 
we are remanding this case to the district court, the issues in Case No. 98-274 
are moot. 

CONCLUSION

[¶36]   The district court abused its 
discretion when it determined that the avoidance of possible hardship to parties 
and the accomplishment of substantial justice to the merits of the claims was 
best served by the exclusion of Dr. Oliphant's opinion that the placement of the 
trocar was negligent. The court also failed to consider the facts of the case 
when ruling on Dr. Zolessi's motion to limit Appellant to one standard of care 
expert. On that basis, we reverse and remand this matter. We find no abuse of 
discretion, however, in the trial court's admission of evidence relating to 
Appellant's prior medical history.

[¶37]   Because Case No. 98-246 is reversed 
and remanded, we vacate the appeal in Case No. 98-274 challenging the award of 
costs.

Footnotes

1 The 
claimants below and on appeal include Ms. Winterholler and members of her 
family. For simplicity, we will refer to Ms. Winterholler as 
Appellant.

2 W.R.C.P. 
16(f) provides:

Sanctions - If a party or party's attorney fails to obey a scheduling or 
pretrial order, or if no appearance is made on behalf of a party at a scheduling 
or pretrial conference, or if a party or a party's attorney is substantially 
unprepared to participate in the conference, or if a party or party's attorney 
fails to participate in good faith, the judge, upon motion or the judge's own 
initiative, may make such orders with regard thereto as are just, and among 
others any of the orders provided in Rule 37(b)(2)(B),(C) and 
(D).

W.R.C.P. 37(b)(2)(B) permits an "order refusing to allow the disobedient 
party to support or oppose designated claims or defenses, or prohibiting the 
disobedient party from introducing designated matters into 
evidence."

3 W.R.E. 403 
provides:

Exclusion of relevant evidence on grounds of prejudice, confusion, or 
waste of time.

Although relevant, evidence may be excluded if its probative value is 
substantially outweighed by the danger of unfair prjudice, confusion of the 
issues, or misleading the jury, or by considerations of undue delay, waste of 
time, or needless presentation of cumulative 
evidence.

4 We note 
that at his trial deposition, Dr. Freedman testified "[t]he evidence provided by 
the patient implies that with regard to informed consent and the patient's 
awareness of her alternatives or options with regard to her gynecological 
problems was beneath the standard of care. With regard to informed consent 
documentation, I have not been able to find that documentation, and, therefore, 
must conclude it inadequate, in that it's not present in the records that I 
received."