Source: http://masscases.com/cases/sjc/377/377mass514.html
Timestamp: 2019-04-22 13:57:11+00:00

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CIVIL ACTION commenced in the First District Court of Essex on May 14, 1977.
After removal to the Superior Court, the case was reported to the Appeals Court by Banks, J., a District Court judge sitting under statutory authority. The Supreme Judicial Court granted a request for direct review.
Stephen A. Moore (Jean F. Farrington with him) for the plaintiff.
William F. Quinn, Jr., for the defendants.
a professional employee of Salem Orthopedic, to Quinn's daughter Patricia. Quinn defended and filed a counterclaim on the basis of the alleged breach by Dr. Conway of a promise to produce a specific medical result. Salem Orthopedic moved for an order referring the case to a malpractice screening tribunal pursuant to G. L. c. 231, Section 60B. The judge denied this motion and reported the question of law whether this statute applied to Quinn's counterclaim. See Mass. R. Civ. P. 64, 365 Mass. 831 (1974). We granted Salem Orthopedic's petition for direct appellate review. See Mass. R.A.P. 11(a), 365 Mass. 854 (1974). It is our opinion that Quinn's contractual counterclaim is subject to the statute and that it should initially be screened by a malpractice tribunal. We therefore answer the reported question in the affirmative.
We summarize the facts stated in the pleadings and in the answers of the parties to interrogatories, treating uncontradicted statements as true and resolving conflicts in favor of Quinn. In an automobile accident on October 4, 1974, Patricia suffered severe injuries including various lacerations, a cerebral concussion, a ruptured spleen, and a compound fracture of the femur. She was cared for at the North Shore Children's Hospital in Salem by Dr. Conway between that day and December 21, 1974. Dr. Conway operated on Patricia's left thigh and knee on October 21, 1974, in order to repair the fracture of the femur. Owing to extensive comminution of the fracture and ensuing difficulty in seating a metal plate securely, this operation left Patricia's leg noticeably crooked and shorter than her other leg.
On May 14, 1975, Dr. Conway performed a second operation (1975 operation) on Patricia's leg for the purpose of straightening and lengthening it. He originally intended to straighten the bone and fix it with a blade plate. During the course of the operation, however, he determined the bone tissue to be too soft to anchor such a plate. He therefore used a number of pins in conjunction with a bone graft, achieving some, but not complete, improvement in the condition of Patricia's leg.
Surgeons other than Dr. Conway performed two other operations on Patricia during 1976 and 1977 aimed at further improving her leg. Neither was completely successful. At the time this action was brought in June of 1977, some deformity and lateral instability of the knee persisted.
Quinn alleged that he had a conversation with Dr. Conway sometime in December of 1974, the import of which was that Dr. Conway agreed to perform the 1975 operation and stated that it would straighten and lengthen Patricia's leg. Quinn predicates his counterclaim on this statement, which he characterizes as an express promise by Dr. Conway to achieve a particular result. Although Dr. Conway describes his statements as being greatly more equivocal with regard to the likely result of the surgery, we need not resolve this factual dispute to decide the reported question of law. We will, therefore, treat Quinn's characterization as accurate.
The foundation for Quinn's contractual counterclaim was probably laid by our decision in Sullivan v. O'Connor, 363 Mass. 579 (1973). Prior Massachusetts law had recognized a right of action "in tort" to recover for malpractice or "in contract" to recover for breach of a physician's implied promise not to commit malpractice. See, e.g., Riggs v. Christie, 342 Mass. 402, 405-406 (1961); Capucci v. Barone, 266 Mass. 578, 581 (1929); Small v. Howard, 128 Mass. 131, 135 (1880), overruled on other grounds by Brune v. Belinkoff, 354 Mass. 102, 108 (1968). See also Miller, The Contractual Liability of Physicians and Surgeons, 1953 Wash. U.L.Q. 413, 413-416 (tracing development of tort concept of malpractice from implied contractual obligations); Restatement (Second) of Torts Section 299A, Comment c (1965) (equating tort duty of physician to implied understanding). Legislative enactments juxtaposing the phrase "tort or contract" with the phrase "malpractice, error or mistake" recognized the similarity of these two theories of recovery. See G. L. c. 231, Section 59C, as amended through St. 1960, c. 69; G. L. c. 233, Section 79C; G. L.
c. 260, Section 4. In Sullivan, however, we followed the lead of those other States which allowed recovery against a physician who expressly agrees to produce a certain medical result and then, without fault, fails to do so. 363 Mass. at 581-583. See generally, Annot., 43 A.L.R.3d 1221 (1972) (collecting cases). The remedy authorized by Sullivan may include compensation for the detriment, including pain and suffering, needlessly incurred in reliance on the physician's promise and for any worsening of condition resuting from the abortive treatment. 363 Mass. at 586-588.
Section 60B. We reserved decision of this question in Austin v. Boston Univ. Hosp., 372 Mass. 654, 655 n.4 (1977). For reasons we shall explain, we now conclude that the answer is "yes."
The legislative history of Section 60B offers essentially no guidance, suggesting that the Legislature acting in 1975 did not specifically consider the impact of Sullivan on its scheme for controlling malpractice insurance costs. The bill originally filed and the redrafted bill reported out of committee both required screening of "[e]very action of tort or breach of contract for malpractice, error or mistake ...." 1975 House Doc. No. 5978, Section 6, Section 60B. 1975 House Doc. No. 6196, Section 6, Section 60B. On the suggestion of the House Committee on Bills in the Third Reading, the Legislature later substituted a bill lacking the words "of tort or breach of contract." See 1975 House Doc. No. 6315, Section 5, Section 60B; 1975 House Journal 2144 (June 10, 1975). This altered language was ultimately enacted. See St. 1975, c. 362, Section 5, Section 60B.
Previous decisions by this court also furnish no guidance. We recently considered the question whether a patient's action under G. L. c. 93A, Section 9, alleging that a nursing home committed an unfair or deceptive trade practice by rendering negligent care, was appropriate for tribunal screening. See Little v. Rosenthal, 376 Mass. 573 (1978). In that case, we voiced our belief that "all treatment-related claims were meant to be referred to a malpractice tribunal." Id. at 576. Reasoning that the plaintiff in Little relied on the same factual allegations to support her claim under c. 93A and her claim of malpractice, we concluded that both claims were "treatment related" and properly considered by a Section 60B tribunal. Id. at 577.
Little is helpful but not decisive in our disposition of the present case. In theory, an action under Sullivan embraces only the issues (1) whether the physician made an absolute promise, (2) whether he failed to perform the obligation thus assumed, and (3) what damages are traceable to such breach of his contract. Also in theory, it would be irrelevant whether the physician conformed to the appropriate standard of medical care, for his liability on such an action may exist independently of fault. The action is not, therefore, "treatment related" in the sense of Little because it raises factual issues different from those involved in the usual malpractice action based on negligence. Cf. Scandura v. Trombly Motor Coach Serv., Inc., 370 Mass. 612, 618 (1976) (liability under implied contract to use due care no broader than tort liability); Forman v. Wolfson, 327 Mass. 341, 343 (1951) (action on implied promise to use due care barred by judgment in earlier tort malpractice action).
and absolute undertaking will usually be a question of fact, it may be impossible for a trial judge to separate true Sullivan-type claims from claims involving at most breach of the tort-based duty of care before the case is on trial. [Note 4] Thus, a frivolous action alleging breach of contract may have considerable nuisance value, and the bringing of such an action may well induce settlement or defense costs all out of proportion to its merits.
and thereby induce voluntary discontinuance of meritless actions.
One additional problem requires attention. The parties have apparently assumed that, if Quinn's claim were referred to a tribunal, the tribunal would consider the evidence bearing on whether Dr. Conway made an express contract. The statutory function of the tribunal is, however, to separate malpractice claims into two classes: those appropriate for judicial evaluation and those involving merely an unfortunate medical result. G. L. c. 231, Section 60B, first par. In performing this function, the tribunal may examine predominately medical evidence. Id. fifth par. The medical focus of a Section 60B tribunal is further emphasized by the requirement that one member be a physician or, when the defendant is not himself a physician, a representative of the defendant's field of health care providers. Id. third par. All of these factors are strongly indicative of a legislative intention that a tribunal should evaluate only the medical aspects of a malpractice claim for the purpose of distinguishing between cases of tortious malpractice and those involving "merely an unfortunate medical result."
Thus, the question whether the parties made the agreement as alleged in the counterclaim is beyond the competence of a screening tribunal. However, because the Quinns' claim is based exclusively on an express contract, the question for decision by the tribunal is whether the evidence presented in the offer of proof "is sufficient to raise a legitimate question ... appropriate for judicial inquiry" (id. first par.) on the issue whether the medical result obtained is consistent with the medical result allegedly promised by the health care provider. Such screening is also necessary as a matter of administrative convenience to deal with those cases that superficially seem to involve, but may not in fact involve, express promises.
breach by a physician or other health care provider of an express promise to produce a specific medical result is subject to the screening provisions of G. L. c. 231, Section 60B. The case is remanded to the Superior Court for further proceedings consistent with our answer to the question reported. If the tribunal concludes that the medical result achieved by Dr. Conway is consistent with the promise which he allegedly made, the Quinns may thereafter pursue their counterclaim through the usual judicial process only on filing a bond in the form and amount prescribed by the statute.
[Note 1] Patricia A. Quinn, daughter of William F. Quinn, was added as a plaintiff in counterclaim following the commencement of this action. See Mass. R. Civ. P. 13(h), 365 Mass. 758 (1974); id. 20(a), 365 Mass. 766 (1974). Because the legal questions raised by Patricia's counterclaim are, despite differences in the damages requested, identical to those raised by Quinn's, we make no further mention of it in this opinion.
[Note 2] We upheld the screening and bonding requirements against a variety of constitutional attacks in Paro v. Longwood Hosp., 373 Mass. 645 (1977), and no constitutional question is presently before us.
[Note 3] Other inconclusive indications of legislative intent include the following. The act adding Section 60B also created a joint underwriting association (JUA) to provide malpractice coverage during the crisis period. St. 1975, c. 362, Section 6. The JUA provisions envisioned insurance against claims arising from "negligence or malpractice." Id. In addition, the act empowered a special commission to study the problem of malpractice insurance within the Commonwealth and to make recommendations about solutions thereto. Id. Section 12. See also St. 1977, c. 474 (extending life of commission to December 31, 1979). The commission evidently conceived its role as limited to investigating negligent malpractice. See Interim Report, 1976 House Doc. No. 4380, at 4 (defining malpractice as "improper treatment or culpable neglect").

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