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DOROTHY WEAVER, COADMINISTRATOR (ESTATE

OF DEMARIUS DOUGLAS WEAVER), ET AL.

v. CRAIG MCKNIGHT ET AL.

(SC 18974)

Rogers, C. J., and Palmer, Zarella, Eveleigh, McDonald, Espinosa and

Vertefeuille, Js.

Argued January 16—officially released September 2, 2014

D. Lincoln Woodard, for the appellants (plaintiffs).

Laura Pascale Zaino, with whom, on the brief, was

Thomas W. Boyce, Jr., for the appellees (defendant

Henry Amdur et al.).
Opinion

ROGERS, C. J. This appeal arises from the stillbirth

of Demarius Douglas Weaver (decedent). The plaintiffs,

Dorothy Weaver and Fred Weaver, as coadministrators

of the estate of the decedent, and Dorothy Weaver

(Weaver), individually, brought an action against the

defendants Henry Amdur and Thames Gynecological

Group, P.C.,1 claiming, among other things, that Amdur’s negligent failure to diagnose and treat Weaver’s

gestational diabetes caused the decedent’s stillbirth, a

claim the defendants dispute.

The dispositive issue in this appeal is whetherthe trial

court properly precluded two of the plaintiffs’ expert

witnesses, physicians board certified in obstetrics and

gynecology, from testifying to their opinion that Weaver’s untreated gestational diabetes caused the decedent’s stillbirth. The trial court precluded the experts’

respective opinions on the grounds that neither witness

had any training or experience in determining cause of

death and were not board certified in pathology. The

preclusion of these causation opinions led to a directed

verdict and judgment in favor of the defendants. The

plaintiffs appealed from the trial court’s judgment to

the Appellate Court, which affirmed the judgment.

Weaver v. McKnight, 134 Conn. App. 652, 658, 40 A.3d

786 (2012). We granted the plaintiffs’ petition for certification, limited to the following question: ‘‘Did the Appellate Court properly conclude that the trial court did

not abuse its discretion in precluding testimony by the

plaintiffs’ two experts, both of whom are board certified

in obstetrics and gynecology?’’ Weaver v. McKnight,

305 Conn. 907, 44 A.3d 183 (2012).

We conclude that the trial court’s decision to preclude

the expert testimony contradicted the facts in the

record and applicable law, thus amounting to an abuse

of discretion. Accordingly, we reverse the Appellate

Court’s judgment with direction to reverse the trial

court’s judgment and to remand the case for a new trial.

Furthermore, we also review certain evidentiary rulings of the trial court that are likely to arise again on

remand; see Practice Book § 84-11; namely, whether

the trial court properly: (1) precluded a treating physician from testifying about his opinion that Weaver had

developed gestational diabetes in the later stages of her

pregnancy; (2) precluded a treating nurse from testifying to her suspicion that Weaver had gestational diabetes and her concerns about the treatment given by

Amdur; and (3) permitted the defendants to cross-examine one of the plaintiffs’ expert witnesses about a censure issued to him by a voluntary membership

professional organization. We conclude that the trial

court abused its discretion in precluding the opinion

from the treating physician and in allowing the crossexamination about the censure, but we sustain the trial
court’s ruling precluding certain testimony of the treating nurse.

I

We begin with the relevant facts in the record.

Weaver, the decedent’s mother, received prenatal treatment from the defendants at Lawrence and Memorial

Hospital (hospital). Five days before the stillbirth of

the decedent, Weaver went in for a weekly visit and was

seen by Nancy Hess, an advanced practice registered

nurse. Hess detected a fetal heart rate and fetal movement. Weaver also underwent an ultrasound examination to take measurements of the fetus’ size and weight.

The next day, four days before the stillbirth, Hess

reviewed the ultrasound results. The ultrasound

showed a large fetus weighing more than eleven

pounds. Because of the size of the fetus, and Hess’

knowledge of test results showing that Weaver had

elevated blood sugar levels, Hess was concerned that

Weaver might have uncontrolled high blood sugarlevels

as a result of gestational diabetes. Hess contacted the

treating physician, Amdur, that same day and told him

of the fetus’ weight, which was larger than expected for

his gestational age of approximately thirty-eight weeks.

Hess also told Amdur certain facts about Weaver,

namely that she was thirty-five years old, she previously

had given birth to another child weighing about nine

pounds, and she had tested positive for the presence

of sugar in her urine during the last three checkups.

Amdur determined that the fetus was ‘‘macrosomic,’’ a

medical term for a large baby; see Stedman’s Medical

Dictionary (28th Ed. 2006) p. 1142 (defining ‘‘macrosomia’’ as ‘‘[a]bnormally large size of the body’’); and

told Hess that Weaver should be offered a scheduled

cesarean section to deliverthe fetus the following week.

Amdur did not order any further tests.

Weaver went in for a scheduled cesarean section four

days later, on Tuesday, May 16, 2006. The admitting

nurse and an attending physician, Craig McKnight, however, were unable to detect a fetal heart rate during a

preoperative ultrasound. McKnight confirmed the result

with a radiologist and then informed Weaver of the loss

of the baby. McKnight also ordered several tests to help

determine the cause of the stillbirth, including tests to

analyze Weaver’s blood sugar levels. McKnight delivered the decedent by cesarean section. Within one day

after the delivery, and after reviewing test results,

McKnight formed an opinion that Weaver had gestational diabetes and told Weaver that it appeared that

she had developed poor blood sugar control in the later

stages of her pregnancy.

A pathologist later performed an autopsy of the decedent and the placenta. The pathologist ruled out several

possible causes of the stillbirth, including birth defects

and infection, but was unable to determine an anatomic

cause of death based on her pathological examination.
The pathologist later testified during a deposition that

she had no opinion about whether gestational diabetes

played a role in the stillbirth. She also testified, however, that she would not have been able to see evidence

of poor blood sugar control in an autopsy, and she did

not know the mother’s or the decedent’s blood sugar

levels. According to the pathologist, determining

whether a mother suffered from poor sugar control is

more of ‘‘a clinical assessment rather than a pathological assessment.’’

The plaintiffs later filed this action against the defendants for the loss of the decedent and harm to Weaver.

According to the plaintiffs, Amdur should have known

from Weaver’s test results and the abnormally large size

of the fetus that Weaver suffered from uncontrolled

gestational diabetes, which created an increased risk

of stillbirth. The plaintiffs principally claimed in their

amended complaint that Amdur’s failure to diagnose

and treat Weaver’s gestational diabetes caused the decedent’s stillbirth. The defendants disputed the plaintiffs’

claims that Weaver had gestational diabetes or that

Amdur’s actions contributed to the stillbirth.

At trial, the plaintiffs offered the testimony of Russell

Jelsema, a physician and board certified obstetrician

and gynecologist, to establish the cause of the stillbirth.

Jelsema testified that he specializes in maternal-fetal

medicine, which focuses on the care of the mother and

fetus in the womb, and has been a practicing physician

since 1990. He completed a four year residency in

obstetrics and gynecology and a two year fellowship

specializing in the treatment of women with complicated pregnancies. According to his curriculum vitae,

Jelsema has authored more than two dozen publications, including peer reviewed articles, abstracts, and

book chapters, principally related to obstetrics and

gynecology. He currently maintains his own practice

with several hospitals, sees patients on consultation

from other physicians, and also teaches medical students and residents. Jelsema testified that approximately 25 percent of his patients have pregnancies

complicated by diabetes. Jelsema further testified that

he has been involved with the delivery of hundreds of

stillborn infants. As part of his practice, he routinely

reviews information, including autopsy, laboratory, and

clinical reports, to try to determine the cause of the

stillbirths and then explains his opinion about the cause

to the parents of the stillborn infant.

At trial, the plaintiffs offered Jelsema to opine that

Weaver had untreated gestational diabetes and that

Amdur’s failure to diagnose and treat this condition

caused the decedent’s stillbirth. Jelsema testified that,

in his opinion, Weaver had uncontrolled gestational diabetes, a condition that created an increased risk of a

stillbirth. According to Jelsema, when a mother has

untreated diabetes, the mother’s insufficient insulin lev-
els prevent her body from transferring blood sugar to

her cells, leaving an abnormally high level of sugar

remaining in the mother’s blood. This excess sugar is

then transferred to the fetus’ blood through the placenta. The fetus, which has normal insulin function,

then absorbs an abnormally high amount of blood sugar,

causing the fetus to grow unusually large. According

to Jelsema, the current understanding in the medical

field is that the increased level of blood sugar causes

acid to build up in the fetus’ veins, which can eventually

lead to its death. Jelsema testified that, even in the

absence of a pathologist’s determination of an anatomical cause of death, he can determine cause of death

from gestational diabetes by reviewing the autopsy

reports along with information not reviewed by the

pathologist, including the mother’s clinical and blood

sugar reports, and by excluding other possible causes

of death. The plaintiffs asked Jelsema at trial whether,

based on his review of the evidence, he had an opinion

about whether Weaver’s untreated gestational diabetes

caused or substantially contributed to the decedent’s

stillbirth.

The defendants, who previously had filed a motion

in limine to preclude this causation testimony, objected

to the plaintiffs’ offer for two reasons. First, the defendants argued that Jelsema lacked the requisite training

and experience to testify about cause of death. The

defendants observed that Jelsema was not a pathologist

and that the pathologist that examined the decedent

could not determine an anatomical cause of death. The

defendants further noted that during his deposition,

Jelsema was unable to testify knowledgeably about certain fetal conditions that the defendants contended may

have caused the decedent’s stillbirth. Second, the defendants asserted that the plaintiffs did not offer enough

evidence to provide a factual foundation for Jelsema’s

opinion that the gestational diabetes actually caused

the decedent’s stillbirth in this case.

After hearing argument by counsel, the trial court

precluded Jelsema’s causation opinion testimony. The

record reveals two grounds forthe trial court’s decision.

First, the trial court determined that Jelsema lacked

experience in determining cause of death: ‘‘Here the

matter specifically in issue for this question is the cause

of death. And the witness has testified that he’s written

a lot about diabetes. He’s studied a lot about diabetes.

He teaches about different things, but he’s never—he

hasn’t testified that he has any experience at all in

determining the cause of death.’’ Second, the trial

court—relying on our decision in Sullivan v. MetroNorth Commuter Railroad Co., 292 Conn. 150, 159, 971

A.2d 676 (2009), in which we noted that an ‘‘ ‘expert’s

knowledge or experience must be directly applicable

to the matter specifically in issue’ ’’—apparently determined that only a pathologist could testify about cause

of death. During argument on the defendants’ objection,
the trial court, citing Sullivan, asked the plaintiffs’

counsel if he could cite to ‘‘any cases suggesting that

a [physician] other than a pathologist can render an

opinion on the cause of death’’ and gave counsel the

lunch recess to find such a case. After the recess, the

plaintiffs’ counsel cited Marshall v. Hartford Hospital,

65 Conn. App. 738, 758, 783 A.2d 1085 (2001), in which

the Appellate Court concluded that a medical practitioner’s relevant experience and training, not the ‘‘artificial classification’’ of the witness’ medical specialty,

should govern the qualification inquiry. Nevertheless,

the trial court precluded Jelsema’s opinion testimony.

The plaintiffs then offered the testimony of another

proposed expert witness, Frank Bottiglieri, also a physician board certified in the practice of obstetrics and

gynecology, on the issue of causation. Bottiglieri has

practiced medicine for more than twenty years, and his

practice includes treatment of patients with high risk

pregnancies, including those impacted by gestational

diabetes. Bottiglieri testified that part of his practice

includes managing patients who have stillbirths, including those involving gestational diabetes, and that, in the

course of this practice, he reviews autopsy reports and

other clinical information to determine the cause of

the stillbirth. Bottiglieri also explained that untreated

gestational diabetes can cause a stillbirth. The plaintiffs

offered Bottiglieri’s opinion that Weaver’s untreated

gestational diabetes was a substantial factorin the decedent’s stillbirth.

The defendants objected to the offer of Bottiglieri’s

opinions for the same reasons supporting their objection to the offer of Jelsema’s opinion.

The trial court precluded Bottiglieri’s testimony, citing again to the requirement that an ‘‘ ‘expert’s knowledge or experience must be directly applicable to the

matter specifically in issue’ ’’ set forth in Sullivan v.

Metro-North Commuter Railroad Co., supra, 292 Conn.

159. The trial court explained: ‘‘I’m going to grant the

motion to preclude based on my determination that,

while the witness is very qualified to offer evidence

with regard to the standard of care, the qualifications

indicated by the examination do not rise to the level of

meeting the hurdle as placed by the directly applicable

language [in Sullivan] as it relates to time and cause

of death.’’

Because the trial court precluded the plaintiffs’

experts from testifying about causation, and the plaintiffs had no other causation evidence sufficient to establish their claims, the trial court granted a motion by

the defendants for a directed verdict at the close of

the plaintiffs’ evidence. The trial court then rendered

judgment for the defendants.

The plaintiffs’ appealed from that judgment to the

Appellate Court, which affirmed the trial court’s judg-
ment. The Appellate Court upheld the trial court’s decision to preclude the plaintiffs’ causation experts for

two reasons. Weaver v. McKnight, supra, 134 Conn.

App. 665–68. First, the Appellate Court agreed that there

was no evidence that Jelsema and Bottiglieri were qualified based on their training or experience to render an

opinion on cause of death. Id. Second, the Appellate

Court analyzed the ‘‘scientific validity’’ of their respective opinions, relying on a case employing the analysis

set forth in State v. Porter, 241 Conn. 57, 698 A.2d 739

(1997), cert. denied, 523 U.S. 1058, 118 S. Ct. 1384,

140 L. Ed. 2d 645 (1998), for assessing the validity of

scientific methods used to support an expert’s opinion.

Weaver v. McKnight, supra, 665–68. The Appellate

Court determined that ‘‘[a]lthough [Jelsema and Bottiglieri each] indicated that [they] could determine cause

of death even though a pathologist could not, the plaintiffs failed to produce any evidence indicating the validity of that medical opinion.’’ Id., 668. This certified

appeal followed.

II

The plaintiffs principally claim on appeal that the trial

court improperly precluded Jelsema’s and Bottiglieri’s

causation testimony. The plaintiffs assert that the

record shows that each of the witnesses has substantial

experience with the topic at issue, the cause of stillbirth,

and had ample factual support for their opinions that

Weaver’s gestational diabetes caused the decedent’s

stillbirth. The plaintiffs further argue that the trial

court’s decision to preclude the challenged testimony

rested on an untenable reading of the record that

ignored the witnesses’ testimony about their relevant

experience and, furthermore, that the trial court incorrectly determined that the witnesses could not testify

about the cause of stillbirth because they were not

pathologists. The defendants respond by conceding that

whether the witnesses were pathologists is not dispositive of the qualification inquiry. Rather, the defendants

argue that the trial court properly precluded the witnesses’ causation opinions because the witnesses were

not sufficiently familiar with certain concepts relating

to stillbirth and pathology. The defendants also contend

that the plaintiffs did not provide any independent facts

to support the witnesses’ opinions, and, therefore, their

opinions did not amount to anything more than speculation or conjecture. We agree with the plaintiffs.

We begin with our standard of review. We review a

trial court’s decision to preclude expert testimony for

an abuse of discretion. See, e.g., Sullivan v. Metro-North

Commuter Railroad Co., supra, 292 Conn. 157–58. We

afford our trial courts wide discretion in determining

whether to admit expert testimony and, unless the trial

court’s decision is unreasonable, made on ‘‘untenable

grounds’’; Hammond v. Bridgeport, 139 Conn. App. 687,

701, 58 A.3d 259 (2012); or involves ‘‘a clear misconcep-
tion of the law,’’ we will not disturb its decision. (Internal quotation marks omitted.) Sullivan v. Metro-North

Commuter RailroadCo., supra, 157. Although we afford

trial courts significant discretion, ‘‘[w]here it clearly

appears that an expert witness is qualified to give an

opinion, the exclusion of his testimony may be found to

be [an abuse of discretion].’’ See, e.g., Wray v. Fairfield

Amusement Co., 126 Conn. 221, 224, 10 A.2d 600 (1940);

see also Sullivan v. Metro-North Commuter Railroad

Co., supra, 157–58. To the extent the trial court makes

factual findings to support its decision, we will accept

those findings unless they are clearly improper. Fisher

v. Big Y Foods, Inc., 298 Conn. 414, 423, 3 A.3d 919

(2010). If we determine that a court acted improperly

with respect to the admissibility of expert testimony,

we will reverse the trial court’s judgment and grant a

new trial only if the impropriety was harmful to the

appealing party. Sullivan v. Metro-North Commuter

Railroad Co., supra, 158.

We also note our standards for admitting expert testimony. ‘‘Expert testimony should be admitted when: (1)

the witness has a special skill or knowledge directly

applicable to a matter in issue, (2) that skill or knowledge is not common to the average person, and (3)

the testimony would be helpful to the court or jury in

considering the issues. . . . [T]o render an expert opinion the witness must be qualified to do so and there must

be a factual basis for the opinion.’’ (Citations omitted;

footnote omitted; internal quotation marks omitted.) Id.

The Appellate Court affirmed the trial court’s preclusion of Jelsema’s and Bottiglieri’s causation testimony

on two separate grounds: (1) the witnesses lacked specialized knowledge or experience on the issue of cause

of death that would be helpful to a fact finder; and (2)

the plaintiffs did not present any evidence to support

the scientific validity of the witnesses’ methods for

determining cause of death when a pathologist was

unable to determine a cause. Weaver v. McKnight,

supra, 134 Conn. App. 665–68. We disagree with both

conclusions.

A

The Appellate Court concluded that the trial court

properly found that neither Jelsema nor Bottiglieri had

any relevant experience in determining the cause of

the stillbirth and therefore were not qualified to testify

about that topic. Id. The evidence in the record, however, refutes this conclusion and, instead, shows that

the plaintiffs established each of the requirements necessary for admitting their experts’ respective opinions

on the cause of the stillbirth in this case. We address

each requirement in turn.

1

As for the first requirement, the trial court’s finding

that Jelsema and Bottiglieri lacked any experience in
determining the cause of the stillbirth was clearly

improper. Both experts, through their experience as

obstetricians and gynecologists, had substantial knowledge and experience directly relevant to determining

the cause of stillbirth. Jelsema testified that he was a

board certified obstetrician and gynecologist, with a

specialty in maternal-fetal medicine, and had experience in treating pregnancies complicated by diabetes.

He further testified that, as part of his practice, he had

been involved in ‘‘hundreds’’ of deliveries of stillborn

infants. When treating a patient who gives birth to a

deceased infant, part of his routine care includes

determining the cause of the stillbirth. According to

Jelsema’s testimony, in such instances, he regularly

reviews autopsy reports, laboratory results, and clinical

information to identify a cause. Bottiglieri testified to

having similar experience in his practice. Bottliglieri

also delivers stillborn infants and routinely reviews

autopsy reports and other clinical and laboratory

reports to determine the cause. These stillbirths have

included infants stillborn to diabetic mothers. The witnesses’respective experiences in determining the cause

of a stillbirth are ‘‘ ‘directly applicable’ ’’; Sullivan v.

Metro-North Commuter Railroad Co., supra, 292 Conn.

159; to a matter at issue in the case, namely, whether

the defendants’ failure to diagnose and treat Weaver’s

gestational diabetes caused the decedent’s stillbirth.

The trial court’s finding to the contrary, that neither

Jelsema nor Bottiglieri had any experience determining

the cause of stillbirth, flatly contradicts the record and,

thus, is clearly incorrect. The Appellate Court therefore

improperly relied on this finding to reach its decision.2

The defendant argues, however, that ‘‘critical limitations’’ in Jelsema’s and Bottiglieri’s level of expertise

rendered them unqualified to testify. The defendants

assert that Jelsema and Bottiglieri cannot testify about

the cause of stillbirth because they both deferred to

pathologists on certain questions posed to them during

their depositions. For instance, the defendants claim

that Jelsema admitted during his deposition that

‘‘pathologists are ‘more expert’ when it comes to information related to the cause of fetal death’’ and that

both Jelsema and Bottiglieri were unable to fully testify

to the defendants’ satisfaction about the nature of a

rare fetal disorder called Beckwith-Wiedeman Syndrome. Even if we were to assume that these criticisms

are true, we disagree that they render the testimony

inadmissible.

The defendants’ criticisms go to the weight of the

witnesses’ testimony, not to its admissibility. ‘‘[I]f any

reasonable qualifications can be established, the objection goes to the weight rather than to the admissibility

of the evidence.’’ (Internal quotation marks omitted.)

State v. Palmer, 196 Conn. 157, 167, 491 A.2d 1075

(1985); Campbell v. Pommier, 5 Conn. App. 29, 37–38,

496 A.2d 975 (1985). An expert need not know every-
thing about a topic to be an expert in that field. See,

e.g., Mannino v. International Mfg. Co., 650 F.2d 846,

850 (6th Cir. 1981) (‘‘[T]he expert need not have complete knowledge about the field in question, and need

not be certain. He need only be able to aid the jury in

resolving a relevant issue.’’); State v. Davis, 116 Ohio

St. 3d 404, 426, 880 N.E.2d 31 (2008) (same); Novitski

v. Rusak, 941 A.2d 43, 49 (Pa. Super. 2008) (same); see

also Campbell v. Pommier, supra, 37–38 (trial court

improperly precluded expert with sufficient but

‘‘skimpy’’ credentials because witness’ depth of knowledge goes to weight of testimony). In addition, an expert

need not be the best or most qualified witness for his

testimony to be admissible. See, e.g., Davis v. Margolis,

215 Conn. 408, 413–17, 576 A.2d 489 (1990) (whether

another expert is more qualified does not affect admissibility inquiry); see also Pineda v. Ford Motor Co., 520

F.3d 237, 244 (3d Cir. 2008) (‘‘[i]t is an abuse of discretion to exclude testimony simply because the trial court

does not deem the proposed expert to be the best qualified or because the proposed expert does not have the

specialization that the court considers most appropriate’’ [internal quotation marks omitted]). Here, the

plaintiffs established Jelsema’s and Bottiglieri’s ‘‘ ‘reasonable qualifications’ ’’ based on their practical experience. See State v. Palmer, supra, 167. In light of the

witnesses’ qualifications, the defendants’ concerns are a

proper subject for cross-examination, but do not render

their testimony inadmissible. Milliun v. New Milford

Hospital, 310 Conn. 711, 733, 80 A.3d 887 (2013)

(‘‘[a]lthough there may be other possible causes that

the physicians did not consider, such matters go to

weight, not admissibility’’ of their opinions).

2

Turning to the second requirement for admitting

expert testimony, Jelsema’s and Bottiglieri’s respective

knowledge and experience about the causes of stillbirth

are not common to a layperson. The parties do not

dispute that the cause of stillbirth is not a matter of

common knowledge or experience, and thus requires

expert testimony. See Collette v. Collette, 177 Conn. 465,

471, 418 A.2d 891 (1979) (expert testimony required to

establish cause of miscarriage); see also Aspiazu v.

Orgera, 205 Conn. 623, 631, 535 A.2d 338 (1987) (‘‘[t]he

medical effect upon the human system of the infliction

of injuries, is generally not within the sphere of the

common knowledge of a lay witness’’ [internal quotation marks omitted]).

3

As for the third requirement, Jelsema’s and Bottiglieri’s causation opinion testimony would help the jury

in resolving the causation issues in the case. To be

helpful, an expert’s opinion testimony must aid the fact

finder in resolving an issue in the case and have some

basis in fact. See Sullivan v. Metro-North Commuter
Railroad Co., supra, 292 Conn. 158. An expert’s opinion

may not be based on surmise or conjecture. State v.

Nunes, 260 Conn. 649, 672–74, 800 A.2d 1160 (2002);

see also Gordon v. Glass, 66 Conn. App. 852, 856, 785

A.2d 1220 (2001) (‘‘[t]he expert opinion cannot rest on

surmise or conjecture because the trier of fact must

determine probable cause, not possible cause’’ [internal

quotation marks omitted]), cert. denied, 252 Conn. 909,

789 A.2d 994 (2002). Although ‘‘[s]ome facts must be

shown as the foundation for an expert’s opinion . . .

there is no rule of law declaring the precise facts which

must be proved before such an opinion may be received

in evidence. . . . Where the factual basis of an expert

opinion is challenged, therefore, the question before

the court is whether the uncertainties in the essential

facts on which the opinion is predicated are such as to

make an opinion based on them without substantial

value.’’ (Citation omitted; internal quotation marks

omitted.) State v. John, 210 Conn. 652, 677, 557 A.2d

93, cert. denied, 493 U.S. 824, 110 S. Ct. 84, 107 L. Ed.

2d 50 (1989).

In this case, the parties do not dispute that Jelsema’s

and Bottiglieri’s opinion testimony related directly to

causation, that is, whether Weaver’s gestational diabetes, and Amdur’s failure to diagnose and treat this condition, caused the decedent’s stillbirth, a necessary part of

the plaintiffs’ medical malpractice claim. See Aspiazu

v. Orgera, supra, 205 Conn. 630 (plaintiff in medical

malpractice case must prove that defendant’s negligence caused plaintiff’s harm).

The defendants claim, however, that the plaintiffs

failed to provide a factual basis forthe witnesses’ causation opinions, rendering them nothing more than surmise or conjecture. We disagree. The plaintiffs’

evidence presented at trial, if credited by a fact finder,

established the following: Weaver’s blood sugar levels

and the size of the decedent at the time of delivery

demonstrate that she suffered from undiagnosed late

term gestational diabetes that was poorly controlled;

mothers with gestational diabetes are at greater risk

for stillbirth; the risk of stillbirth increases when the

mother’s gestational diabetes is undetected or poorly

controlled; the decedent’s uncommonly large size at the

time of birth—more than eleven pounds—indicated that

the decedent was exposed to high levels of blood sugar;

and the current medical understanding is that high

blood sugar results in increased acid levels in the fetus’

bloodstream, which can become progressive and cause

death. The plaintiffs’ evidence, if credited, also supported the elimination of other possible causes of the

stillbirth besides gestational diabetes, including genetic

defects, physical abnormalities, and infection.

Taken together, these facts provided an ample factual

basis for the witnesses’ respective causation opinions.

See George v. Ericson, 250 Conn. 312, 321–24, 736 A.2d
889 (1999) (nontreating physician may base opinion on

medical records, test results, laboratory reports, and

party’s statements); Aspiazu v. Orgera, supra, 205

Conn. 631 (causal relation between injury and its later

physical effects may be established ‘‘by the direct opinion of a physician, by his deduction by the process of

eliminating causes other than the traumatic agency’’

[internal quotation marks omitted]). The defendants

contest the validity of these facts and the witnesses’

conclusions drawn from them, but those concerns are

properly tested on cross-examination and through the

defendants’ presentation of evidence. They do not render the challenged testimony inadmissible. See State v.

John, supra, 210 Conn. 677 (conflicting evidence goes

to weight of opinion).

On the basis of these factors, Jelsema and Bottiglieri

were clearly qualified to render an opinion on the cause

of the decedent’s stillbirth. Although we give our trial

courts wide discretion in ruling on the admissibility of

expert testimony, we willreverse a trial court’s decision

when it is based on untenable grounds or when the

expert’s qualifications are clear. See, e.g., Sullivan v.

Metro-North Commuter Railroad Co., supra, 292 Conn.

157–58, 160–61. Here, the trial court’s decision rested on

a clearly incorrect reading of the record, which amply

established the witnesses’ qualifications. Consequently,

we conclude that the Appellate Court’s decision to

affirm the trial court’s exercise of its discretion in denying the testimony of Jelsema and Bottiglieri was

improper.

B

We next turn to the Appellate Court’s decision to

uphold the trial court’s ruling on the alternative basis

that the plaintiffs did not establish the scientific validity

of the methods used by the witnesses to reach their

opinions. In reaching its decision on this basis, the

Appellate Court conflated the test to determine whether

a witness is qualified to give an opinion; see part II A

of this opinion; with a Porter analysis, which assesses

the validity of the methods that an expert used to reach

his conclusions. Weaver v. McKnight, supra, 134 Conn.

App. 665–68. Although the defendants challenged the

witnesses’ training and experience on the topic of the

cause of stillbirth, the defendants did not challenge the

validity of the scientific method that the witnesses used

to reach their causation opinions. Accordingly, we conclude that the Appellate Court’s decision based on a

Porter claim, which was not raised in the trial court,

was improper.

The Appellate Court relied on our decision in Klein

v. Norwalk Hospital, 299 Conn. 241, 9 A.3d 364 (2010),

a case applying a Porter analysis. The Appellate Court

was concerned with the scientific validity of Jelsema’s

and Bottiglieri’s testimony that they could determine

that gestational diabetes was a substantial factor in
causing the decedent’s stillbirth even when a pathologist could not. According to the Appellate Court, ‘‘with

respect to the . . . cases where Jelsema indicated that

he had determined the cause of death when a pathologist could not, there was no evidence regarding the

scientific validity of that opinion.’’ Weaver v. McKnight,

supra, 134 Conn. App. 666. The Appellate Court reached

the same conclusion for Bottiglieri’s testimony,

explaining that ‘‘[a]lthough [Bottiglieri] indicated that

he could determine a cause of death even though a

pathologist could not, the plaintiffs failed to produce

any evidence indicating the validity ofthat medical opinion.’’ Id., 668. According to the Appellate Court, nothing

supported these opinions exceptthe unsupported assertions of the witnesses, which the court found insufficient to establish the validity of their claims that they

could determine cause of death despite an inconclusive

determination by a pathologist. Id., citing Klein v. Norwalk Hospital, supra, 263.

In Porter, we followed the United States Supreme

Court’s decision in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786, 125 L. Ed. 2d

469 (1993), and held that testimony based on scientific

evidence should be subjected to a flexible test to determine the reliability of methods used to reach a particular conclusion. State v. Porter, supra, 241 Conn. 61–66.

A Porter analysis involves a two part inquiry that

assesses the reliability and relevance of the witness’

methods. Id., 63–64. First, the party offering the expert

testimony must show that the expert’s methods for

reaching his conclusion are reliable. A nonexhaustive

list of factors for the court to consider include: ‘‘general

acceptance in the relevant scientific community;

whether the methodology underlying the scientific evidence has been tested and subjected to peer review;

the known or potential rate of error; the prestige and

background of the expert witness supporting the evidence; the extent to which the technique at issue relies

[on] subjective judgments made by the expert rather

than on objectively verifiable criteria; whether the

expert can present and explain the data and methodology underlying the testimony in a manner that assists

the jury in drawing conclusions therefrom; and whether

the technique or methodology was developed solely

for purposes of litigation.’’ (Internal quotation marks

omitted.) State v. Guilbert, 306 Conn. 218, 231–32, 49

A.3d 705 (2012). Second, ‘‘the proposed scientific testimony must be demonstrably relevant to the facts of the

particular case in which it is offered, and not simply

be valid in the abstract. . . . Put another way, the proponent of scientific evidence must establish that the

specific scientific testimony at issue is, in fact, derived

from and based [on] . . . [scientifically reliable] methodology.’’ (Internal quotation marks omitted.) Id., 232.

We take this opportunity to stress that a Porter analysis is separate from our test used to determine whether
a witness is qualified to give expert testimony. As discussed in part II A of this opinion, all expert witnesses

must be qualified to present expert testimony on a particular subject. To establish qualifications, the party

presenting an expert witness must show that the witness has special knowledge or skills, not common to

the average person, that would be helpful to the fact

finder in resolving an issue in the case. See, e.g., State

v. Kemp, 199 Conn. 473, 476, 507 A.2d 1387 (1986),

overruled in part on other grounds by State v. Guilbert,

supra, 306 Conn. 226. A Porter analysis, however, is a

‘‘further hurdle,’’ beyond the general qualification

requirements, for admitting expert testimony based on

‘‘scientific’’ evidence and methods. See State v. Guilbert, supra, 230–31. Rather than assessing a witness’

qualifications (i.e., his knowledge and experience), a

Porter analysis assesses the witness’ methods (i.e., his

reasoning and procedures) used to reach his conclusions. An expert might be qualified to discuss a particular topic, but nevertheless have his opinion excluded

because the methods he used to reach that opinion were

unreliable. For example, in Klein v. Norwalk Hospital,

supra, 299 Conn. 262–63, we concluded that the trial

court improperly admitted certain scientific evidence

because it did not meet the requirements of Porter. In

Klein, the defendant offered the opinion of an expert

witness that the plaintiff’s decedent suffered from Parsonage Turner Syndrome, a rare condition. Id., 260. The

witness, who had treated patients with the syndrome,

diagnosed the decedent solely based on a review of the

decedent’s medical records. Id. Although the witness

clearly was qualified to testify about the nature of Parsonage Turner Syndrome based on his experience, the

defendant did not present any evidence to support the

reliability of the witness’ method for diagnosing the

condition. Id., 262–64. With no evidence to show that

this rare condition could be reliably diagnosed simply

through a review of medical records, we concluded that

the witness’ own experience with treating it was not

enough to prove the validity of his method for diagnosis. Id.

The Appellate Court’s reliance on a Porter analysis in

the present case was, however, not appropriate because

the defendants did not raise a Porter claim in the trial

court. To raise a Porter claim, the party opposing the

admission of the scientific evidence must first object

to the validity of the expert’s methods. State v. Porter,

supra, 241 Conn. 87. Once the opponent objects, the

proponent of the scientific evidence must demonstrate

that the methods underlying the evidence are reliable

and, therefore, valid. Id., 84–87. The failure to raise a

Porter claim in the trial court results in waiver of that

claim and it will not be considered for the first time on

appeal. United Technologies Corp. v. East Windsor, 262

Conn. 11, 30, 807 A.2d 955 (2002). The defendants in

this case did not raise a Porter claim in the trial court
because the defendants objected to the admission of

the witnesses’ causation opinions only on the ground

thatthe witnesses were not qualified by their knowledge

or experience to render an opinion on the topic of the

cause of stillbirth. The trial court therefore did not hold

a hearing, receive testimony, or render a decision on

the validity of the witnesses’ methods for determining

the cause of stillbirth. By assessing the witnesses’ methods for the first time on appeal, the Appellate Court

essentially deprived the plaintiffs of the opportunity to

present evidence supporting their methods for

determining the cause of stillbirth and improperly held

this lack of evidence against the plaintiffs.3

C

In light of our conclusions in parts II A and B of this

opinion, we consider whether the trial court’s improper

exclusion of the plaintiffs’ expert testimony requires

reversal of the judgment and a remand for a new trial.

When a court commits an evidentiary impropriety, we

will reverse the trial court’s judgment only if we conclude that the trial court’s improper ruling harmed the

plaintiffs. Sullivan v. Metro-North Commuter Railroad

Co., supra, 292 Conn. 158. In a civil case, a party proves

harm by showing that the improper evidentiary ruling

likely affected the outcome of the proceeding. Poulos

v. Pfizer, Inc., 244 Conn. 598, 614, 711 A.2d 688 (1998).

We conclude that the trial court’s decision harmed the

plaintiffs in this case. The preclusion of the plaintiffs’

causation evidence formed the basis for the trial court’s

decision to grant the defendants’ motion for a directed

verdict and to render judgment in the defendants’ favor.

With that causation evidence, the plaintiffs likely would

have sustained their burden of proof, resulting in the

denial of the defendants’ motion for a directed verdict

and allowing them to submit their case to the jury. The

plaintiffs are therefore entitled to a new trial.

III

In addition to their dispositive claim on appeal, the

plaintiffs also have raised three additional evidentiary

claims on issues previously addressed by the trial court

and that are likely to arise again on remand. Specifically,

the plaintiffs claim that the trial court improperly: (1)

precluded a treating physician from testifying about his

opinion that Weaver developed gestational diabetes in

the later stages of her pregnancy; (2) precluded a treating nurse from testifying about her ‘‘suspicion’’ that

Weaver had gestational diabetes and her concerns

about the treatment given by Amdur; and (3) allowed

the defendants to question Jelsema about a censure he

received from the American College of Obstetricians

and Gynecologists (College), a voluntary membership

professional organization. The Appellate Court did not

address these issues because it affirmed the trial court’s

judgment rendered in favor of the defendants. In light
of our decision to remand the case for a new trial, and

because these issues are likely to arise again on remand,

we address them here, in turn.

A

In addition to expert testimony from Jelsema and

Bottiglieri, the plaintiffs offered McKnight, the physician who delivered the decedent, to testify that Weaver

suffered from late term gestational diabetes, an opinion

McKnight expressed to Weaver while she was still in

the hospital after her cesarean section. After discovering that the decedent had died in utero, McKnight

ordered certain tests to look for a cause. Results from

these tests showed that Weaver had elevated blood

sugar levels when she came in for delivery, suggesting

poor blood sugar control. Within one day of the delivery,

while Weaver was still in the hospital, McKnight spoke

with Weaver and told her that ‘‘it looks like she had

developed poor [blood] sugar control at the end of her

pregnancy . . . .’’ McKnight testified at his deposition

that, at the time he spoke with Weaver, he had formed

the opinion that she had developed gestational diabetes

in the later stages of her pregnancy.

The defendants moved to preclude the plaintiffs from

offering McKnight’s opinions into evidence. The defendants argued that McKnight’s opinion that Weaver had

gestational diabetes related to the standard of care and

could not be admitted because: (1) the plaintiffs did

not disclose McKnight as a standard of care expert; and

(2) his opinions were based on information not available

to Amdur. The defendants feared that the plaintiffs

would use McKnight’s opinion about Weaver’s condition as improper standard of care evidence by presenting ‘‘McKnight as a treating physician who reached

a conclusion that the [plaintiffs claim Amdur] negligently failed to reach.’’ The plaintiffs responded that

McKnight’s opinion about Weaver’s condition was not

a standard of care opinion. The plaintiffs offered it

instead to resolve a key factual dispute in the case,

namely, whether Weaver in fact had gestational diabetes, a fact the defendants contested, which related to

the issue of causation.4

The trial court granted the defendants’ motion, apparently concluding that McKnight’s opinion related to the

standard of care issue and was impermissible. The trial

court explained its decision as follows: ‘‘I’m going to

grant the motion in limine to preclude the [plaintiffs]

from asking [McKnight] questions as to the standard of

care or that relate to the standard of care in this case.

That includes opinions which he may have arrived at.

It does not preclude, however, [McKnight] from being

a witness in this case as to the facts that he was aware

of or his conduct or tests that he may or may not have

ordered but he may not be asked his opinion as to

those facts as it relates to whether or not [Weaver] had

gestational diabetes.’’ The trial court also precluded the
plaintiffs from asking McKnight why he ordered any

tests, including those to determine Weaver’s blood

sugar levels, or whether the test results were elevated

or significant to him.

We agree with the plaintiffs that the precluded opinion testimony was not a standard of care opinion and

that the trial court abused its discretion in concluding

otherwise. Standard of care opinions establish two critical elements of a medical malpractice claim: (1) what

the standard of care required the defendant to do in

the particular circumstances of the case; and (2)

whether the defendant deviated from that standard. See

Dimmock v. Lawrence & Memorial Hospital, Inc., 286

Conn. 789, 813, 945 A.2d 955 (2008) (to succeed in

malpractice claim, plaintiff must prove: ‘‘[1] the requisite standard of care for treatment, [2] a deviation from

that standard of care, and [3] a causal connection

between the deviation and the claimed injury’’ [internal

quotation marks omitted]). The plaintiffs did not offer

any opinion from McKnight on any of those issues.

Indeed, the plaintiffs expressly represented that they

would not offer any opinion from McKnight on any of

the elements of a malpractice action, namely: (1) what

the standard of care required of Amdur in the circumstances; (2) whether Amdur’s conduct deviated from

that standard; and (3) whether that deviation caused

the decedent’s stillbirth. The plaintiffs, instead, offered

McKnight’s opinion, formed at the time he treated

Weaver, that she had gestational diabetes. Our courts

previously have allowed treating physicians to testify

to opinions formed during treatment when those opinions do not constitute standard of care opinions. See,

e.g., Wyszomierski v. Siracusa, 290 Conn. 225, 233–36,

963 A.2d 943 (2009) (upholding trial court’s decision to

allow treating physician to testify about opinions

formed during treatment, but not about standard of

care); cf. Milliun v. New Milford Hospital, supra, 310

Conn. 741 and n.20 (noting, without reviewing, Appellate Court’s conclusion that treating physicians can testify to opinions formed during treatment); see also Lane

v. Stewart, 46 Conn. App. 172, 176, 698 A.2d 929 (1997)

(‘‘[t]here is no justification for a rule that would wholly

exempt experts from placing before a tribunal factual

knowledge relating to the case in hand [or] opinions

already formulated’’ [internal quotation marks omitted]), cert. denied, 243 Conn. 940, 702 A.2d 645 (1997).

To be sure, McKnight’s opinion would have helped

establish that gestational diabetes caused the decedent’s stillbirth, a fact relevant to the plaintiffs’ causation theory. Nevertheless, its relevance to the plaintiffs’

causation theory does not turn McKnight’s opinion into

one on the standard of care. To the extent that there

was any danger that the jury might misuse McKnight’s

opinion on Weaver’s condition to determine how Amdur

should have acted in this case, that danger could have

been addressed with a limiting instruction rather than
precluding the testimony altogether. Accordingly, we

conclude that the trial court abused its discretion by

precluding it on the basis that McKnight’s opinion was

an improper standard of care opinion.

The defendants alternatively claim that we should

uphold the trial court’s decision to preclude McKnight’s

opinion about Weaver’s condition because it was not a

proper expert opinion, stated to a degree of probability.5

The defendants, citing to portions of McKnight’s deposition transcript, posit that McKnight opined only that

test results were ‘‘simply ‘suggestive’ ’’ of gestational

diabetes, but did not state an opinion, based on a reasonable degree of medical probability, that Weaver, in fact,

had gestational diabetes. We disagree.

McKnight clearly expressed an opinion during his

deposition that Weaver developed gestational diabetes

in the late stages of her pregnancy. ‘‘Expert opinions

must be based upon reasonable probabilities rather

than mere speculation or conjecture if they are to be

admissible in establishing causation. . . . To be reasonably probable, a conclusion must be more likely

than not. . . . Whether an expert’s testimony is

expressed in terms of a reasonable probability . . .

does not depend upon the semantics of the expert or

his use of any particular term or phrase, but rather, is

determined by looking at the entire substance of the

expert’s testimony.’’ (Emphasis omitted; footnote omitted; internal quotation marks omitted.) Milliun v. New

Milford Hospital, supra, 310 Conn. 730. At his deposition, McKnight testified that he told Weaver while she

was in the hospital that ‘‘it looks like she had developed

poor [blood] sugar control at the end of her pregnancy

. . . .’’ The plaintiffs’ counsel then asked McKnight: ‘‘So

as of that point in time [when] you had the conversation

with [Weaver], was it your opinion that she did develop

gestational diabetes in the later stages of her pregnancy?’’ McKnight answered: ‘‘Yes.’’ McKnight further

testified that he based his opinion on the test results

showing that Weaver had above normal blood sugar

levels and the unusually large size of the decedent when

delivered. Notably, McKnight was confident enough in

his opinion that he relayed it to Weaver and told her

that ‘‘if she were to have another pregnancy we would

want to watch [her blood sugar control].’’ This testimony, taken together, sufficiently establishes that

McKnight held his opinion to a reasonable degree of

probability. See Milliun v. New Milford Hospital, supra,

729–33 (medical reports stating physician’s ‘‘opinion’’

about patient’s condition and basis for that opinion

sufficient to satisfy probability requirement). We therefore disagree that the trial court could have precluded

the opinion on this basis.

B

In addition to McKnight, the plaintiffs also offered the

testimony of Hess, the nurse who attended to Weaver on
her regular prenatal visit the week before her cesarean

section. Around the time of that visit, Hess noticed that

Weaver had tested positive for high levels of sugar in

her urine and that an ultrasound showed that the fetus

was unusually large for its gestational age. During her

deposition, Hess testified that, after reviewing the test

results, she had a ‘‘suspicion that [Weaver] could potentially’’ have uncontrolled gestational diabetes and called

Amdurto notify him of the results. Hess furthertestified

that she was surprised when Amdur did not order any

further tests to assess the fetus’ health, but, instead,

instructed Hess to schedule Weaver for a cesarean section the following week.

The defendants moved to preclude Hess’ opinions

about her ‘‘suspicion’’ and ‘‘surprise’’ on the same

grounds that they moved to exclude McKnight’s opinion

testimony. The trial court granted the motion,

explaining that Hess could testify about ‘‘whatever acts

she did or didn’t do in connection with her interaction

with [Amdur]’’ but could not testify to her ‘‘expectations, impressions, concerns, [or] suspicions’’ because

they related to standard of care and could not properly

be offered on that basis.

The trial court properly exercised its discretion in

precluding these opinions. Unlike McKnight’s opinion,

the plaintiffs offered Hess’ testimony about her suspicion and her surprise to criticize Amdur’s actions under

the circumstances. Specifically, unlike the plaintiffs’

offer of McKnight’s testimony to resolve the factual

issue of whether Weaver actually had gestational diabetes, the plaintiffs told the trial court that they were

offering Hess’ ‘‘suspicion’’ that Weaver had gestational

diabetes to prove that Amdur also should have suspected this condition at the time he told Hess to schedule a cesarean section for the following week.6

In

addition, Hess’ ‘‘surprise’’ that Amdur did not order

further testing at that time to assess the fetus’ health

states Hess’ opinion about what Amdur should have

done under the circumstances. This testimony bears on

the level of care that Hess believed Amdur should have

exercised (i.e., whether Amdur should also have suspected that Weaver had gestational diabetes) and

whether he deviated from that standard by failing to

detect Weaver’s condition and by not taking further

steps to assess the fetus’ health. The plaintiffs did not,

however, disclose or qualify Hess as a standard of care

expert, rendering this testimony inadmissible. See, e.g.,

Friedman v. Meriden Orthopaedic Group, P.C., 272

Conn. 57, 69, 861 A.2d 500 (2004); Wright v. Hutt, 50

Conn. App. 439, 450–51, 718 A.2d 969, cert. denied, 247

939, 723 A.2d 320 (1998). The trial court thus acted

within its discretion by precluding this testimony

from Hess.

C

The plaintiffs also claim that the trial court improp-
erly allowed the defendants to question Jelsema about a

censure he received from the College. Jelsema testified

that he is affiliated with several professional organizations, including the College, which is a private organization whose members are obstetricians and

gynecologists. It is not a professional licensing board,

and membership in the College is entirely voluntary.

Jelsema has been a member of the College for more

than twenty years. Currently, he serves as an editor

for one of the organization’s publications. The College

censured him in 2009 for violating a section of its Code

of Professional Ethics that prohibited any member who

serves as an expert witness from testifying falsely and

about matters outside the member’s area of expertise.

During questioning at trial, outside the presence of the

jury, Jelsema testified that he had been censured, but

he denied that he had ever testified falsely or about

matters beyond his area of expertise. He also testified

that, notwithstanding the censure, no court had ever

cited him for perjury and, in the case at issue in the

censure, the court admitted Jelsema’s opinions into evidence. There is no evidence in the record that the censure has affected Jelsema’s membership status in the

College. His membership was not suspended or terminated, and he remains a full member. The trial court,

over the plaintiffs’ objection, nevertheless allowed the

defendants to question Jelsema about the censure after

concluding that ‘‘it’s clearly relevant to the veracity of

the witness . . . .’’7

The plaintiffs argue that the admission of this testimony was improper because the censure is improper

extrinsic evidence of alleged prior misconduct. The

plaintiffs acknowledge that under ourrules of evidence,

a party may ask a witness about prior misconduct if

that misconduct bears on the witness’ credibility. The

plaintiffs assert, however, that a party may not use

extrinsic evidence to prove the misconduct and that

allowing the defendants to question Jelsema about the

censure is tantamount to admitting extrinsic evidence

to prove he testified falsely and beyond his expertise

in the prior case. We agree with the plaintiffs.

We first set forth our standard of review. ‘‘To the

extent [that] a trial court’s admission of evidence is

based on an interpretation of [our law of evidence], our

standard of review is plenary. For example, whether

a challenged statement properly may be classified as

hearsay and whether a hearsay exception properly is

identified are legal questions demanding plenary

review. . . . We review the trial court’s decision to

admit [or exclude] evidence, if premised on a correct

view of the law, however, for an abuse of discretion.

. . . The trial court has wide discretion to determine

the relevancy of evidence and the scope of cross-examination. . . . Thus, [w]e will make every reasonable

presumption in favor of upholding the trial court’s ruling[s] [on these bases] . . . . In determining whether
there has been an abuse of discretion, the ultimate

issue is whether the court . . . reasonably [could have]

conclude[d] as it did.’’ (Citations omitted; internal quotation marks omitted.) State v. Davis, 298 Conn. 1, 10–

11, 1 A.3d 76 (2010).

Our evidentiary rules generally prohibit the use of

character evidence to prove that a person has acted

in conformity with a character trait on a particular

occasion, subject to limited exceptions. See Conn. Code

Evid. § 4-4 (a). One exception allows the admission of

evidence of a witness’ character for ‘‘truthfulness or

untruthfulness to impeach or support the credibility of

the witness.’’Conn. CodeEvid. § 4-4 (a)(3). One method

for impeaching a witness’ credibility allows a party to

cross-examine a witness about the witness’ prior misconduct (other than a felony conviction, which is governed by other rules), subject to certain limitations:

‘‘First, cross-examination may only extend to specific

acts of misconduct other than a felony conviction if

those acts bear a special significance upon the issue

of veracity . . . . Second, [w]hether to permit crossexamination as to particular acts of misconduct . . .

lies largely within the discretion of the trial court. . . .

Third, extrinsic evidence of such acts is inadmissible.’’

(Internal quotation marks omitted.) State v. Chance,

236 Conn. 31, 60, 671 A.2d 323 (1996); see also Conn.

Code Evid. § 6-6 (b) (2). Under these limitations, the

only way to prove misconduct of a witness for impeachment purposes is through examination of the witness.

See, e.g., Martyn v. Donlin, 151 Conn. 402, 408, 198

A.2d 700 (1964). The party examining the witness must

accept the witness’ answers about a particular act of

misconduct and may not use extrinsic evidence to contradict the witness’ answers. State v. Chance, supra, 60.

Turning to the present case, the first two requirements for prior misconduct impeachment were met.

First, the censure from the College is relevant to

Jelsema’s credibility. A panel of the College’s members

concluded that Jelsema violated the organization’s rules

of conduct by, among other things, testifying falsely as

an expert witness in a previous case. A claim that the

witness gave false testimony in a prior case is directly

relevant to a witness’ credibility. See, e.g., State v. Bova,

240 Conn. 210, 223, 690 A.2d 1370 (1997). Second, the

trial court exercised its discretion to allow the defendants to cross-examine Jelsema about his allegedly false

testimony in the prior case.

The third requirement presents a more difficult question because it is not clear under our law whether

allowing the defendants to question Jelsema about his

censure is equivalent to admitting extrinsic evidence

of the prior misconduct. Our case law clearly allows a

party to ask a witness whether the witness previously

engaged in the alleged bad act. State v. Chance, supra,

236 Conn. 60–61. It also clearly prohibits a party from
introducing exhibits or calling another witness to prove

that the witness committed the prior bad act. Id. The

issue in the present case, however, lies somewhere

between these two extremes: whether the prohibition

on extrinsic evidence precludes cross-examination of

the witness about another’s determination that the witness acted untruthfully. We have not been pointed to,

and are not aware of, any cases from this state directly

addressing this question. Several of our trial courts,

with the exception of the trial court in this case, have,

however, refused to allow a party to cross-examine a

witness about a censure issued to the witness by a

voluntary membership organization, finding any testimony about the censure to be irrelevant and based on

unduly prejudicial hearsay. See, e.g., D’Attilo v. Viscarello, Superior Court, judicial district of Waterbury,

Docket No. UWY-CV-05-4010135S (April 8, 2009); Sherwood v. Ogiela, Superior Court, judicial district of

Waterbury, Docket No. X02-CV98-0163648S (March 9,

2007); Hall v. Mansfield OB/GYN Associates, P.C.,

Superior Court, judicial district of Tolland, Docket No.

X07-CV02-78138 (May 2, 2005).

Commentators and courts in other jurisdictions have

addressed this question and generally have concluded

that ‘‘counsel should not be permitted to circumvent

the no-extrinsic-evidence provision by tucking a third

person’s opinion about prior acts into a question asked

of the witness who has denied the act.’’ S. Saltzburg,

‘‘Trial Tactics: Impeaching the Witness: Prior ‘Bad Acts’

and Extrinsic Evidence,’’ 7 Crim. Just. 28, 31 (Winter

1993). The commentary to the federal Rules of Evidence, citing the Saltzburg article, expressly prohibits

a party from questioning a witness about any consequences arising from the alleged misconduct. Fed. R.

Evid. 608, commentary to 2003 amendment (‘‘[T]he

extrinsic evidence prohibition of [r]ule 608 [b] bars any

reference to the consequences that a witness might

have suffered as a result of an alleged bad act. For

example, [r]ule 608 [b] prohibits counsel from mentioning that a witness was suspended or disciplined for

the conduct that is the subject of the impeachment,

when that conduct is offered only to prove the character

of the witness.’’). According to Professor Charles T.

McCormick, ‘‘[i]t is improper to inquire whether the

witness was ‘fired,’ ‘disciplined,’ or ‘demoted’ for the

alleged act—those terms smuggle into the record

implied hearsay statements by third parties who may

lack personal knowledge.’’ 1 C. McCormick, Evidence

(6th Ed. 2006) § 41, p. 183. The Third Circuit Court of

Appeals squarely addressed this issue in United States

v. Davis, 183 F.3d 231, 257 n.12 (as amended by slip

opinion, 197 F.3d 662, 663 n.1) (3d Cir. 1999), and concluded that, during cross-examination of a police officer, ‘‘the government cannot make reference to [the

witness’] forty-four day suspension or that Internal

Affairs found that he lied about the [prior] incident.
The government needs to limit its cross examination

to the facts underlying those events. . . . If he denies

that such events took place, however, the government

cannot put before the jury evidence that he was suspended or deemed a liar by Internal Affairs.’’ (Emphasis

in original.) See also United States v. Holt, 486 F.3d

997, 1001–1002 (7th Cir. 2007) (trial court properly precluded party from examining witness about suspension

for prior misconduct).8

Professor Colin C. Tait and Judge Eliot D. Prescott,

in their treatise about Connecticut evidence law, also

agree that a witness cannot be asked about the opinions

of others regarding the alleged misconduct. C. Tait &

E. Prescott, Connecticut Evidence (4th Ed. 2008)

§ 6.32.5, p. 362. They refer to this court’s decision in

State v. Bova, supra, 240 Conn. 210, as an example. In

Bova, the court upheld a trial court’s decision to preclude a party from asking a police officer about another

case in which a judge commented that another witness

was more credible than the police officer. Id., 222–24.

This court concluded that the judge’s comment in the

other case did not meet the first requirement for admitting misconduct testimony because the judge made no

express finding that the officer lied, and therefore the

comment did not sufficiently relate to the officer’s credibility. Id. Professor Tait and Judge Prescott go further

in their treatise, explaining that counsel could not have

asked the officer about the judge’s comment ‘‘[e]ven if

the judge had found that the officer lied as a witness

[because] that finding is not a conviction of perjury.

Such conduct, not being a conviction, can be proved

only by questions addressed to the witness, i.e., ‘Did you

lie in case X?’ If the witness denies such misconduct, the

questioner must ‘take’ the witness’s answer and cannot

introduce extrinsic evidence.’’ C. Tait & E. Prescott,

supra, p. 362; but see footnote 7 of this opinion.

The reasons for prohibiting such questions are the

same reasons for precluding extrinsic evidence in the

first place. Prohibiting a party from introducing extrinsic evidence of misconduct, either through the witness,

exhibits, or other witnesses, prevents a trial within a

trial on the collateral question of whether the witness

did, in fact, commit the alleged misconduct. See, e.g.,

1 C. McCormick, supra, pp. 182–84; 81 Am. Jur. 2d

767, Witnesses § 867 (2004). Such a minitrial about a

collateral issue distracts from the main issues at trial,

wastes the court’s and the jury’s time, and is frequently

based on hearsay evidence of questionable value. 1 C.

McCormick, supra, p. 183 (allowing parties to crossexamine witness about extrinsic proof of misconduct

will ‘‘smuggle into the record implied hearsay statements by third parties who may lack personal knowledge’’); 81 Am. Jur. 2d, supra, § 867, p. 767 (‘‘[s]uch

evidence is rejected because of the confusion of issues

and the waste of time that would be involved’’). The

Third Circuit described the risk as follows: ‘‘Allowing
such a line of questioning not only puts hearsay statements before the jury, it injects the views of a third

person into the case to contradict the witness. This

injection of extrinsic evidence not only runs afoul of

[r]ule 608 (b), but also sets the stage for a mini-trial

regarding a tangential issue of dubious probative value

that is laden with potential undue prejudice.’’ United

States v. Davis, supra, 183 F.3d 257 n.12, as amended

by 197 F.3d 663 n.1; see also United States v. Holt, supra,

486 F.3d 1001–1002 (‘‘asking [the witness] whether the

police department had punished him would introduce

the opinion of members of the police department’’ and

‘‘interject hearsay into the proceedings’’).

The facts of the present case provide a fitting example. Allowing the defendants to go beyond asking

Jelsema whether he lied in the underlying case by asking

him also about the College censure will turn his testimony into a minitrial on the significance and reliability

of the censure. Furthermore, the minitrial would consist

almost entirely of Jelsema’s testimony about the hearsay opinions of certain members of the College who

lacked personal knowledge about Jelsema’s underlying

conduct in the prior case. The plaintiffs contend that

the censure is unreliable because it is the product of

a biased organization and a proceeding that provided

Jelsema with no meaningful due process. According to

the plaintiffs, the College spends significant resources

lobbying for tougher medical malpractice liability caps

to protect obstetricians and gynecologists from liability.

The plaintiffs also argue that the College’s censure proceedings are intended to deter its members from testifying on behalf of plaintiffs in malpractice cases, citing

evidence that the organization has censured only members that testified for plaintiffs. Furthermore, Jelsema

testified that he was not provided a meaningful opportunity to defend himself: he could not speak for more

than thirty minutes before the disciplinary panel, could

not call expert witnesses in his favor, and could not

cross-examine witnesses against him. Jelsema also

denies that he testified falsely in the prior case. The

defendants disputed these claims and cross-examined

Jelsema, using the College’s procedures and publications, to challenge his characterization of the censure

proceedings. This is exactly the type of time wasting

dispute over a collateral issue that the bar on extrinsic

evidence is intended to prevent.

On the basis of these considerations, we conclude

that the prohibition on introducing extrinsic evidence

to contradict a witness who has denied the alleged prior

misconduct extends to cross-examining that witness

about the opinions of third parties regarding that misconduct and whether the witness suffered any consequences as a result.9 We previously have held that a

party can ask questions of a witness about the underlying misconduct, but may not introduce evidence to contradict the witness’ answers. State v. Chance, supra,
236 Conn. 60; Demers v. State, 209 Conn. 143, 157,

547 A.2d 28 (1988) (‘‘if on cross-examination a witness

denies having engaged in . . . prior acts of misconduct, the examiner must accept the answer and is prohibited from offering extrinsic evidence to prove such

acts’’). Our conclusion is consistent with that principle.

Turning back to the present case, we conclude that

the testimony concerning the censure by the College

is extrinsic evidence of an alleged prior misconduct

and, thus, inadmissible. The alleged misconduct at issue

here was Jelsema’s testimony in the prior case, not the

censure itself. When asked at trial, Jelsema denied that

he testified falsely or beyond his expertise in the prior

trial. Nevertheless, the trial court allowed the defendants to question Jelsema about the censure, using the

fact of the censure to contradict Jelsema’s denial and

prove that he had testified falsely and beyond his expertise in a prior case. Jelsema’s censure is extrinsic evidence of the alleged bad act because it reflects the

opinion of certain of the College’s members that

Jelsema did, in fact, commit the alleged bad acts. The

defendants could not have called the members of the

College grievance committee to testify about the censure, nor could they have introduced documents

reflecting the censure into evidence. State v. Chance,

supra, 236 Conn. 60–61. We see no principled reason

for allowing the defendants to circumventthese prohibitions by presenting that same evidence through

Jelsema. The collateral nature of the censure, and the

risk that its admission will lead to a minitrial about its

reliability are the same regardless of how the censure

is admitted into evidence. Accordingly, we conclude

that the trial court improperly permitted the defendants

to question Jelsema about the censure.

The defendants argue, in the alternative, that the censure was also relevant to Jelsema’s qualifications. We

disagree. The censure did not affect Jelsema’s right to

practice medicine because the College is not a professional licensing organization; membership is strictly

voluntary. Nor has the censure affected Jelsema’s membership in that organization. He remains a member and

serves as an editorial consultant for one of its publications. The plaintiffs represented to the trial court that

they would not use Jelsema’s membership in theCollege

to help establish his qualifications as an expert in the

field of obstetrics and gynecology if such testimony

would ‘‘[open] the door’’ to allowing testimony about

the censure. Most importantly, the censure itself does

not bear on the scope of Jelsema’s knowledge or experience with the issues in this case. To be sure, part of

the basis for the censure was a finding by the College

that Jelsema testified beyond his expertise in a different

case. But we have no evidence in the record to determine whether the issues in that other case are at all

similar or related to those in the present case. Notably,

the court in the prior case admitted Jelsema’s expert
testimony, contradicting the finding underlying the censure. The censure itself therefore does not inform us

about whether Jelsema is qualified on the subjects at

issue in this case. We thus disagree that the censure

was admissible on this alternative basis.

The judgment of the Appellate Court is reversed and

the case is remanded to that that court with direction

to reverse the trial court’s judgment and to remand the

case to that court for a new trial.

In this opinion the other justices concurred.

1 The plaintiffs also filed their action against the named defendant, Craig

McKnight, and Lawrence and Memorial Hospital but later withdrew all claims

against those parties. They are no longer defendants in this action and are

not parties to this appeal.

2 The trial court also implicitly concluded that Jelsema and Bottiglieri

were not qualified to testify about the cause of stillbirth because neither of

them is a board certified pathologist. The Appellate Court properly rejected

this argument. See Weaver v. McKnight, supra, 134 Conn. App. 665. Specialized certifications or degrees are not prerequisites to qualification for medical causation opinions. Fitzmaurice v. Flynn, 167 Conn. 609, 618, 356 A.2d

887 (1975)(‘‘[i]t is the scope of the [witness’] knowledge and not the artificial

classification by title that should govern the threshhold question of admissibility’’); but see General Statutes § 52-184c (specializations relevant to admission of standard of care opinion).

3 The Appellate Court likely turned to a Porter analysis because the defendants challenged the factual basis for the witnesses’ opinions. But rather

than reviewing whether the experts’ opinions had a basis in relevant facts,

the Appellate Court analyzed the validity of the witnesses’ methods used to

reach their opinions based on those facts. The ‘‘factual basis’’ inquiry is,

however, not a ‘‘backdoor’’ for introducing a Porter claim into the case

when that issue has not previously been raised. As described in part II A 3

of this opinion, the factual basis inquiry is part of determining an expert’s

qualification to render an opinion. One of the requirements for qualifying

an expert is that his expertise and opinions must be helpful to the fact

finder. To be helpful, an expert opinion must have some basis in relevant

facts—whetherthose facts are in the record or presented through a hypothetical question—to ensure that the opinion is not entirely speculative or irrelevant to the issues in the case. See, e.g., State v. Asherman, 193 Conn. 695,

716–17, 478 A.2d 227 (1984); see also Milliun v. New Milford Hospital,

supra, 310 Conn. 730 n.13 (expert opinion must be based on relevant facts

supported by evidence). For example, in Glaser v. Pullman & Comley, LLC,

88 Conn. App. 615, 629, 871 A.2d 392 (2005), a legal malpractice case, the

Appellate Court upheld a trial court’s preclusion of an expert opinion about

Connecticut law when the witness testified that he did not base his opinion

on Connecticut law, but instead used ‘‘national standards.’’ (Internal quotation marks omitted.) Because the issue in the malpractice case involved

Connecticut law, the expert’s opinion lacked a valid basis in relevant facts

and therefore would have been unhelpful to the jury. Id.

4 The defendants contend that the plaintiffs did not argue in the trial court

that McKnight’s opinion related to causation and, therefore, are precluded

from making this argument on appeal. We disagree. The plaintiffs repeatedly

made this assertion before the trial court during the argument on the defendants’ objection to the admission of McKnight’s opinion testimony.

5 The trial court did not base its decision on this argument and the defendants did not raise it as an alternative ground for affirming the trial court’s

decision. Nevertheless, because the parties have briefed this alternative

ground and the plaintiffs have not objected to our review of it, we address

it here. See, e.g., Milliun v. New Milford Hospital, 129 Conn. App. 81, 99

n.13, 20 A.3d 36 (2011).

6 The trial court also could have properly precluded this testimony because

Hess’ suspicion did rise to the level of an opinion held to a reasonable

degree of medical probability. Hess repeatedly testified during her deposition

that she had a ‘‘suspicion’’ about the ‘‘possibility’’ that Weaver developed

gestational diabetes, but did not testify that she came to the conclusion that

Weaver actually had that condition. The plaintiffs’ counsel acknowledged

this during argument on the defendants’ objection to the admission of her

testimony, telling the trial court that, ‘‘we are not saying [Hess] developed
the opinion within a reasonable degree of medical probability that [Weaver]

had late onset gestational diabetes, [Hess] did not get involved in subsequent

care, she didn’t reach that point.’’

7 The defendants claim that the record is inadequate for review on this

issue because the trial court did not articulate its basis for allowing the

censure into evidence. We disagree. The trial court expressly stated that it

admitted the censure because it was relevant to the credibility of the witness,

which directly implicates our rules of impeachment for credibility using

prior acts of misconduct. See Conn. Code Evid. §§ 4-4 and 6-6. We therefore

conclude that the record sufficiently reveals the basis for the trial court’s

decision and is adequate for our review.

8 Some courts, however, have held that a party may cross-examine a

witness about consequences of misconduct when the witness has been

found to have testified falsely by a court or a state administrative agency,

but was not convicted of perjury. See, e.g., United States v. Cedeno, 644

F.3d 79, 82–83 (2d Cir. 2011); United States v. Dawson, 434 F.3d 956, 958–59

(7th Cir. 2006); United States v. Whitehead, 618 F.2d 523, 529–30 (4th Cir.

1980). Because there is no such finding in this case, we do not address

these exceptions.

9 We do not decide whether a witness may be asked about a determination

by a judicial, state administrative agency, or licensing board, not resulting

in a perjury conviction, that the witness testified untruthfully in a prior

proceeding. See footnote 7 of this opinion.