Case Name: Dennis CATRON, Appellant, v. ROGER BOHN, D.C., P.A., and Bohn Chiropractic Clinic, Appellees
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1991-05-15
Citations: 580 So. 2d 814
Docket Number: No. 90-00902
Parties: Dennis CATRON, Appellant, v. ROGER BOHN, D.C., P.A., and Bohn Chiropractic Clinic, Appellees.
Judges: DANAHY, A.C.J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 580
Pages: 814–822

Head Matter:
Dennis CATRON, Appellant, v. ROGER BOHN, D.C., P.A., and Bohn Chiropractic Clinic, Appellees.
No. 90-00902.
District Court of Appeal of Florida, Second District.
May 15, 1991.
Rehearing Denied June 18, 1991.
Cary Alan Cliff of Faerber & Miller, Naples, for appellant.
Gerald W. Pierce of Henderson, Franklin, Starnes & Holt, P.A., Fort Myers, for appellees.

Opinion:
CAMPBELL, Judge.
Appellant, Dennis Catron, seeks reversal of the final summary judgment entered against him in his action for medical negligence against appellees, Dr. Roger Bohn, a chiropractic physician, and Bohn Chiropractic Clinic. The trial judge found "that the record disclosed no competent, substantial evidence that Dr. Roger Bohn committed or omitted some act which violated the standard of care of reasonable chiropractic health care providers_" We reverse.
In opposition to appellees' motion for summary judgment, appellant had submitted the affidavit of Dr. Michael D. Lusk, a board certified neurosurgeon, who examined and performed surgery upon appellant for the removal of spinal disc fragments subsequent to appellant's examination and treatment by appellee, Dr. Bohn. Appel-lees had submitted in support of their motion the affidavit of Dr. William R. Boritz, a doctor of chiropractic medicine. Dr. Bor-itz opined that "the care and examination afforded Dennis Catron by Roger Bohn, D.C., met and exceeded the standard of care for chiropractic within the Naples and similar communities in the State of Florida." Dr. Lusk, on the other hand, opined in substantial part as follows:
9. According to the medical records of Dr. Bohn, Dennis Catron presented to Dr. Bohn on July 14, 1987, with an oral history clearly indicative of cervical compression. The records of Dr. Bohn indicate that he took two (2) x-rays of Dennis Catron at that time.
10. The medical records of Dr. Bohn indicate that Dennis Catron presented himself to Dr. Bohn the following day, July 15, 1987, his condition now "advanced" and "worse symptomatically."
11. The medical records of Dr. Bohn for July 15, 1987, indicate on their face that Dr. Bohn performed treatment (the use of the word "treatment" appearing on the notes themselves as well as in response to Dennis Catron Interrogatory 6C of Dr. Bohn).
12. That the medical records of Dr. Bohn indicate that the patient was positive for LHermitte's Sign on July 15, 1987, which indicates spinal cord injury (spinal cord compression) in Dennis Ca-tron.
13. That Dr. Bohn's medical records indicate that he also performed traction and distraction procedures on Dennis Ca-tron during the same July 15, 1987, office visitation.
14. That, although I am familiar with Dr. Bohn's records of July 15, 1987, wherein he wrote of the possibility of referral for neurologic evaluation, his notes for the same day state "[patient] told to go home and stay still, no softball, scheduled appointment for Friday can't get in Thursday." This is indicative to me of a failure to immediately refer for neurological or neurosurgical examination and further indicative of an intent to continue chiropractic treatment.
15. That it is my considered medical opinion, within a reasonable degree of medical probability, that Dr. Roger Bohn, D.C. had sufficient medical history on July 14, 1987, which history was only further enhanced and "worse symptomatically" the following day, to clearly indicate the existence of serious cervical compression in Dennis Catron. That, with the indications so presented, Dr. Bohn should have discontinued further treatment or examination and immediately referred the patient for neurological or neurosurgical examination and treatment. Dr. Bohn's failure to cease examination and treatment in favor of immediate referral was a departure from the standard of care for physicians, including chiropractitioners, in Naples and similar communities in the State of Florida.
In order to have granted the summary judgment for appellees on the basis of a lack of competent substantial evidence in the record to support the allegation that Dr. Bohn violated the reasonable standard of care of chiropractic health care providers, the trial judge necessarily had to reject the affidavit of Dr. Lusk. The trial judge in the summary judgment does not specify the basis for his reasoning and neither do we have a transcript of the summary judgment hearing to illuminate his reasoning. We must conclude, however, from the arguments presented to us here that Dr. Lusk's affidavit was rejected because the trial judge concluded that under the terms of section 766.102(2)(a), (b), and (c), Florida Statutes (Supp.1988), Dr. Lusk was not qualified as an expert permitted to testify in a medical negligence action as a "similar health care provider" similar to Dr. Bohn's chiropractic specialty, nor did Dr. Lusk qualify as an expert that was "not a similar health provider" but permitted to testify because of the exception provided in section 766.102(2)(c)2.
We conclude under the facts of this case that Dr. Lusk's affidavit should have been considered and summary judgment for ap-pellees thereby denied.
The facts, as we must accept them for the purpose of our review of the summary judgment for appellees, establish that on approximately July 14, 1987, appellant, Mr. Catron, consulted Dr. Bohn with complaints of pain and stiffness in his back, shoulders and neck. He was examined and treated by Dr. Bohn and scheduled for another appointment for July 15, 1987, when he was again examined and treated by Dr. Bohn. Dr. Bohn filed answers to interrogatories served on him by appellant that state as follows: (1) As to the nature of his examinations of Mr. Catron: "X-ray, orthopedic and neurological examinations."
(2) As to his description of his examination and treatment of Mr. Catron:
Description of examination is contained in office notes. Treatment consisted of trigger point therapy to the upper trapez-ius muscles for pain relief of muscle spasms. Energy point stimulation with a mild negative charge to same area. Blocked pelvis category III for pelvic stabilization. Approximately 4-6 oz. of sustained pressure posterior to anterior on C2 and 5. Additional orthopedic tests were performed at that time on the cervical spine to test for disc involvement and cord pressure. This procedure consisted of supine cervical distraction and compaction using light pressure with slight rotation.
(3) As to the conclusions he drew as a result of his evaluation and examination of Mr. Catron: "Following the first day's evaluation, a herniated disc was indicated in the cervical spine with associated radicu-litis and myofascitis. Upon an extended examination on July 15, 1987 a possible ruptured disc with cord pressure was suspected, however, appeared inconsistent with case history as reported by the patient."
(4) As to the findings he made from each x-ray: "Widening of the intervertebral disc space, indicating disc protrusion at the posterior aspect of C4-5-6 on the lateral film."
(5) As to his prognosis and diagnosis of Mr. Catron: "Following the initial examination: Cervical disc syndrome, Cervical bra-chial symdrome [sic]. Upon additional evaluation on July 15, 1987: Possible disc rupture with associated cord pressure. Refer out for additional neurological evaluation."
(6) As to his advice to Mr. Catron: "Mr. Catron was informed of my findings following his first visit. However, I was unable to contact the patient following his second visit to be referred out for additional neurological testing by Dr. Bercaw because the patient did not have a phone at the time."
After Mr. Catron's second appointment with Dr. Bohn, Mr. Catron consulted another chiropractor who referred him to the emergency room at the hospital where he was admitted and subsequently operated on by Dr. Lusk. It is important to our resolution of this appeal to focus on the circumstances surrounding the alleged failure of Dr. Bohn to comply with the reasonable standard of care for chiropractors of the community. Dr. Bohn's own expert, Dr. Boritz, in his affidavit, bases his opinion that Dr. Bohn complied with the appropriate standard of care on the following statement: "Based upon a review of his records and the answers to interrogatories, it appears that Dr. Bohn correctly diagnosed a disc problem at C5/C6 and attempted to contact Mr. Catron by telephone in order to refer him to a neurologist for further work up." Dr. Lusk, on the other hand, in his opposing affidavit, bases his opinion of Dr. Bohn's failure to meet the appropriate standard of care on Dr. Bohn's failure to immediately refer Mr. Catron to a neurologist and for Dr. Bohn to immediately cease treatment.
It appears to us that both Dr. Boritz and Dr. Lusk agree that the appropriate standard of care for a chiropractor in his treatment of Mr. Catron was not to subject Mr. Catron to any chiropractic manipulation or treatment but refer him immediately to a neurologist. Dr. Boritz in his affidavit does not refer to "treatment" by Dr. Bohn but only to "examination." However, even Dr. Bohn seems to admit that he did not ever actually refer Mr. Catron to a neurologist but only sought to contact him for the purposes of referral after examination and treatment. Even viewed in the light most favorable to Dr. Bohn, it is a disputed question of fact as to when and what treatment he gave to Mr. Catron and whether he timely or ever actually referred Mr. Catron to a neurologist.
Under those circumstances, it appears conclusively that Dr. Lusk's affidavit should have been considered pursuant to the provisions of section 766.102.
Two provisions of section 766.102 appear to mandate the consideration of Dr. Lusk's affidavit in this case. Subsection 766.-102(1) requires that a person seeking damages based on death or personal injury resulting from the negligence of a health care provider must establish that health care provider's negligence based upon proof that the health care provider breached the prevailing standard of care that is recognized by reasonably prudent "similar health care providers" as acceptable and appropriate. Under section 766.102(2)(c)l, a "similar health care provider" may testify as an expert in such an action. The phrase "similar health care provider" is defined in subsection 766.102(2), which is comprised of paragraphs (a) and (b), and a concluding qualifying sentence. Paragraph (a) defines "similar health care provider" for those cases in which the allegedly negligent health care provider is not or does not hold himself out as a medical specialist (a "generalist"). Paragraph (b) applies to those cases in which the allegedly negligent health care provider is or does hold himself out to be a medical specialist (a "specialist"). Thus, the definition of medical specialist or specialty would appear critical.
At this point, it is appropriate for us to note that section 766.102 and many other sections of chapter 766 are appalling in their lack of definition of critical terms and in their total lack of consistency in the manner of use and apparent meaning of those numerous critical and undefined terms. For instance, "medical specialty" is nowhere defined in any applicable statutes. It is quite obvious that that term is used to apply to specialists in the whole spectrum of health care providers. Therefore, the use of the term "medical" without definition is inappropriate as many health care providers do not fall under any usual classification of "medical" health care providers. For instance, the term "health care providers" as defined in subsection 766.101(l)(b) includes many practitioners and groups who do not fit under a "medical" classification. Neither is "specialty," "specialist" or "discipline or school of practice" anywhere defined. In resort to a dictionary to find a definition of common usage, we find that The American Heritage Dictionary of the English Language 1240 (New College Edition 1979), defines "specialty" as: "1. A special pursuit, occupation, service, product, or the like. 2. An aspect of medicine to which physicians confine their practice after certification of special knowledge by examination_" That dictionary also defines "specialize" as: "1. To train or employ oneself in a special study or activi-ty_" "Specialist" is defined as "1. a. One who has devoted himself to a particular branch of study or research, b. A physician certified to limit his practice to a specified field...." The argument could thus be made that chapter 460, Florida Statutes (1987), which defines and regulates the practice of chiropractic, places a chiropractic physician in the category of a specialist as is contemplated by section 766.102(2)(b) when that section discusses those who practice in a "medical specialty." That would certainly appear to be a proper classification when a chiropractor is compared to a medical doctor limited to a general practice (commonly described in the medical profession as a "G.P.") and normally only considered to be a "generalist" as defined under 766.102(2)(a).
Since we find, however, that the admission of Dr. Lusk's affidavit does not depend on whether Dr. Bohn may be considered a medical specialist, it is not necessary for us to determine that the legislature intended by its enactment of section 766.102(2)(b) to characterize the practice of chiropractic as a "medical specialty" as that term is used in subsection 766.-102(2)(b). We conclude nevertheless that Dr. Lusk was a "similar health care provider" as contemplated by subsection 766.-102(2). Subsection 766.102(2) concludes its provisions with this qualifying statement: "However, if any health care provider described in this paragraph is providing treatment or diagnosis for a condition which is not within his specialty, a specialist trained in the treatment or diagnosis for that condition shall be considered a 'similar health care provider.' " Under normal methods of statutory construction, we should conclude that that statement was meant to apply only to subsection 766.102(2)(b). The statement refers to "any health care provider described in this paragraph_" (Emphasis supplied.) It also speaks to the health care provider treating or diagnosing "for a condition not within his special-ty_" (Emphasis supplied.) However, limiting that qualifying statement to subsection 766.102(2)(b) and not applying it also to subsection 766.102(2)(a), in our opinion, defies logic and leads to an unreasonable result. Under that interpretation, a specialist could only testify as an expert in eases against other specialists, either his specialty or others, and he could not testify regarding the prevailing professional standard of care for a general practitioner who is diagnosing or treating a condition that is within that specialist's specialty. We, therefore, interpret that statement to apply to all of subsection 766.102(2). Logic and reason mandates that when any health care provider is treating or diagnosing a patient for a condition, and the prevailing professional standard of care for that treating or diagnosing health care provider requires that he refer the patient for treatment or diagnosis to a specialist, then such a specialist should be considered in every such case a "similar health care provider" for the purpose of testifying as an expert.
It is our primary duty to give effect to legislative intent and, if a literal interpretation of a statute leads to unreasonable results, then we should exercise our power to interpret the statute in such a way as to impart reason and logic to it. Radio Tel. Communications, Inc. v. Southeastern Tel. Co., 170 So.2d 577, 580 (Fla.1964). We believe our interpretation of this statute conforms to our duty. When legislative language is susceptible of more than one interpretation, we are required to adopt the interpretation that will avoid an unreasonable result. Foley v. State, 50 So.2d 179 (Fla.1951); Grade v. Deming, 213 So.2d 294 (Fla. 2d DCA 1968); Agrico Chem. Co. v. State Dep't of Envtl. Reg., 365 So.2d 759 (Fla. 1st DCA 1978), cert. denied, 376 So.2d 74 (Fla.1979).
Unfortunately, it is apparent that in enacting this legislation, the legislature has, without redefining the terms for the purposes of this legislation, often used terms with commonly accepted meanings for purposes at great variance from those commonly accepted meanings. By doing so, the legislative intent in this legislation is often difficult to determine from the literal wording of the statute. In that context, it appears that the legislature has often made certain literal statements it did not mean using the commonly accepted meaning of the literal terms used and, to the contrary, has also often intended things it has not clearly said.
Following our interpretation then, if the appropriate standard of care for a chiropractor such as Dr. Bohn in his examination and treatment of Mr. Catron was that Mr. Catron should have been referred to a neurologist for further examination and treatment, then Dr. Lusk, as a neurologist, was, pursuant to that last quoted statement of section 766.102(2), a "similar health care provider." He was, therefore, qualified by section 766.102(2)(c)l to testify as an expert in this case.
Even if our conclusions based upon statutory interpretations so far are incorrect and Dr. Lusk is not a "similar health care provider" authorized by section 766.-102(2)(c)l to testify as an expert in an action against a chiropractor, he would certainly have been qualified to testify by section 766.102(2)(c)2. The pertinent sections of section 766.102(2)(c) provide:
(c) The purpose of this subsection is to establish a relative standard of care for various categories and classifications of health care providers. Any health care provider may testify as an expert in any action if he:
1. Is a similar health care provider pursuant to paragraph (a) or paragraph (b); or
2. Is not a similar health care provider pursuant to paragraph (a) or paragraph (b) but, to the satisfaction of the court, possesses sufficient training, experience, and knowledge as a result of practice or teaching in the specialty of the defendant or practice or teaching in a related field of medicine, so as to be able to provide such expert testimony as to the prevailing professional standard of care in a given field of medicine. Such training, experience, or knowledge must be as a result of the active involvement in the practice or teaching of medicine within the 5-year period before the incident giving rise to the claim. (Emphasis supplied.)
Both Dr. Boritz's affidavit and chapter 460 define the practice of chiropractic so as to clearly place it as a "related field of medicine" to neurology thereby qualifying Dr. Lusk to testify. Dr. Lusk, the treating neurologist to whom Mr. Catron was referred by another chiropractor, clearly met the other requirements of section 766.-102(2)(c)2.
The summary judgment is reversed and this cause remanded for further proceedings consistent with this opinion.
DANAHY, A.C.J., concurs.
ALTENBERND, J., concurs specially.