Case Name: Winston LARGIE and Luvon Largie, Appellants, v. Michael GREGORIAN, M.D., Michael Gregorian, M.D., P.A., Jessica Wang, A.R.N.P.C., Steven Meyerson, M.D., and Steven Meyerson, M.D., P.A., Appellees
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 2005-07-13
Citations: 913 So. 2d 635
Docket Number: No. 3D04-2701
Parties: Winston LARGIE and Luvon Largie, Appellants, v. Michael GREGORIAN, M.D., Michael Gregorian, M.D., P.A., Jessica Wang, A.R.N.P.C., Steven Meyerson, M.D., and Steven Meyerson, M.D., P.A., Appellees.
Judges: Before FLETCHER, WELLS, and CORTIÑAS, JJ.
Reporter: Southern Reporter, Second Series
Volume: 913
Pages: 635–645

Head Matter:
Winston LARGIE and Luvon Largie, Appellants, v. Michael GREGORIAN, M.D., Michael Gregorian, M.D., P.A., Jessica Wang, A.R.N.P.C., Steven Meyerson, M.D., and Steven Meyerson, M.D., P.A., Appellees.
No. 3D04-2701.
District Court of Appeal of Florida, Third District.
July 13, 2005.
Rehearing and Rehearing En Banc Denied Nov. 7, 2005.
Laurie Waldman Ross and Theresa Gir-ten; Barbara C. McCauley, Miami, for appellants.
Mintzer, Sarowitz, Zeris, Ledva & Meyers, Coral Gables, and Barbara S. Diamond, for appellee, Jessica Wang.
Before FLETCHER, WELLS, and CORTIÑAS, JJ.

Opinion:
WELLS, J.
Winston and Luvon Largie, plaintiffs below, appeal a summary judgment in their medical malpractice action in favor of defendant, registered nurse practitioner Jessica Wang. Because we agree that the Largies failed to comply with presuit investigation requirements delineated in Chapter 766 prior to running of the statute of limitations, we affirm.
In March and April 2000, Winston Lar-gie was seen by Jessica Wang, an advanced registered nurse practitioner, at the offices of Dr. Michael Gregorian. Nurse Wang's notes confirm that a blood test performed on Mr. Largie during this period showed an elevated prostate specific antigen (PSA) level and that a follow-up PSA test should be performed. Although Mr. Largie continued to be seen at Dr. Gregorian's offices until the following May, no follow up PSA tests were done.
In August 2001, Mr. Largie started-seeing Dr. Steven Meyerson. Dr. Meyerson also had a blood test performed on Mr. Largie, which,- like the test performed while he was a patient of Dr. Gregorian's office, showed that Mr. Largie had an elevated PSA level. Dr. Meyerson did not, however, immediately refer Mr. Largie to a urologist. In May 2002, Mr. Largie was diagnosed with prostate cancer.
In late 2002, the Largies served Dr. Gregorian with a notice of intent to initiate a medical malpractice action. That notice was accompanied by a corroborating affidavit stating:
AFFIDAVIT OF EXPERT OPINION
1.My name is Frank Waxman. I am a physician licensed to practice medicine in the State of Florida. I am a primary care physician.
2. I have review (sic) the medical records of Winston Largie including the office records of Dr. Michael Gregorian.
3. Mr. Largie had an elevated PSA in April 2000 which required further follow up. Dr. Gregorian as well as Dr. A. Scott Dansky failed to do a follow up to Mr. Largie's elevated PSA.
4. Failure to do a follow up to an elevated PSA is a deviation from the standard of care. In this case it is probable that such failure caused a delay in the. diagnosis of Mr. Largie's prostate cancer. Such delay probably caused the cancer to develop further causing a negative impact on the patient.
5. No opinion of mine has been disqualified in any court.
Under penalty of perjury, I declare that I have read the above affidavit and the facts stated in it are true.
(Emphasis added).
On January 10, 2003, the Largies filed suit against Dr. Gregorian for medical malpractice. Although they had served neither a notice of intent to initiate litigation nor a corroborating affidavit on Nurse Wang, they alleged a medical malpractice claim against her as well. It was not until seven months after the action was filed against Nurse Wang that she was served with a notice of intent and the same corroborating affidavit that had been served on Dr. Gregorian.
The action against Nurse Wang was dismissed and re-filed in November 2003. See § 766.106(3)(a), Fla. Stat. (2002)("[n]o suit may be filed for a period of 90 days after notice is mailed to any prospective defendant . [during which] the prospec tive defendant's insurer or self-insurer shall conduct a review to determine the liability of the defendant"). Nurse Wang then challenged the Largies' compliance with Chapter 766 presuit investigation requirements claiming that they had failed to provide corroboration of reasonable grounds to support a claim of medical malpractice. The trial court, following two hearings on the matter, agreed, stating that "each defendant has a right and you have an obligation as plaintiffs lawyer to do a separate investigation as to each one and you must provide a separate affidavit as to the negligence of everybody that you claim was negligent [and y]ou haven't done it here." The court below entered judgment in Nurse Wang's favor. For the following reasons, we affirm.
As the Florida Supreme Court has repeatedly stated, the presuit procedures delineated in Chapter 766 are "intended to address a legitimate legislative policy decision relating to medical malpractice and establish! ] a process intended to promote the settlement of meritorious claims at an early stage without the necessity of a full adversarial proceeding." Williams v. Campagnulo, 588 So.2d 982, 983 (Fla.1991); see also Patry v. Capps, 633 So.2d 9, 11-12 (Fla.1994)(stating the purpose of "the presuit notice and screening requirements set forth in the statute . are 'designed to facilitate the amicable resolution of medical malpractice claims' " and to "promote the settlement of meritorious claims early in the controversy in order to avoid full adversarial proceedings") (quoting Ingersoll v. Hoffman, 589 So.2d 223, 224 (Fla.1991)).
To accomplish this goal, Chapter 766 of the Florida Statutes sets out "a complex presúit investigation procedure that both the claimant and defendant must follow before a medical negligence claim may be brought in court." Kukral v. Mek-ras, 679 So.2d 278, 280 (Fla.1996). While the procedures set forth in Chapter 766 are not intended to deny access to the courts, they are "more than mere technicalities." Correa v. Robertson, 693 So.2d 619, 621 (Fla. 2d DCA 1997); see also Apostolico v. Orlando Reg'l Health Care Sys., Inc., 871 So.2d 283, 286 (Fla. 5th DCA 2004)("Florida courts are required to construe the Medical Malpractice Act 'so as not to unduly restrict a Florida citizen's constitutionally guaranteed access to the courts, while at the same time carrying out the legislative policy of screening out frivolous lawsuits and defenses' ")(quoting Kukral, 679 So.2d at 284); Melanson v. Agravat, 675 So.2d 1032, 1033-1034 (Fla. 1st DCA 1996) (confirming that although the presuit notice and screening statutes should be construed in favor of access to the courts, presuit notice and screening requirements are more than mere technicalities).
The first step in implementing this policy "requires a claimant to determine whether reasonable grounds exist to believe that someone acted negligently in the claimant's care or treatment and that this negligence caused the claimant's injury." Kukral, 679 So.2d at 280. This requires both investigation and corroboration of the results of the investigation by "a verified written medical expert opinion." § 766.203(2), Fla. Stat. (2002); see also § 766.104(1), Fla. Stat. (2002)(providing that no medical negligence action may be filed unless the attorney filing the action has made "a reasonable investigation . to determine that there are grounds for a good faith belief that there has been negligence").
By definition, an investigation consists of: (1) review of the case against each potential defendant; (2) consultation with a medical expert; and; (3) written corroboration of negligence by a medical expert:
"Investigation" means that an attorney has reviewed the case against each and every potential defendant and has consulted with a medical expert and has obtained a written opinion from said expert.
§ 766.202(4), Fla. Stat. (2002).
Requiring a written expert opinion as part of the presuit investigation assures the defendant that the claim was preceded by a reasonable investigation; "that there is justification for the Plaintiffs' claim, i.e., that it is not a frivolous medical malpractice claim . [; and] that the claim is legitimate." Kukral, 679 So.2d at 282; Wolfsen v. Applegate, 619 So.2d 1050, 1054-55 (Fla. 1st DCA 1993)(stating that the purpose of reviewing a corroborating affidavit is "to ensure that a claim or denial has been preceded by a 'reasonable investigation,' and that it 'rests on a reasonable basis'-i.e., 'to eliminate frivolous claims and defenses' ")(quoting § 766.201(2)(a)1, Fla. Stat. (1989)).
The expert opinion provided to Nurse Wang. completely fails to satisfy these purposes. It makes no mention of Nurse Wang whatsoever, either by name or job description; it makes no reference to the standard of care applicable to a certified registered nurse practitioner or to any deviation from that standard of care; and, it does not suggest, much less corroborate, that any investigation took place with regard to Nurse Wang or that any reasonable grounds exist to support the Largies' claim against her as expressly mandated by Chapter 766. In fact, and as the most recent amendments to Chapter 766 confirm, the expert opinion affidavit does not suggest that the expert rendering the opinion is qualified to opine as to a nurse practitioner. See § 766.102(6), Fla. Stat. (2004)(providing that as to a nurse practitioner an expert opinion must be rendered by a licensed physician who otherwise qualifies as an expert witness and who "by reason of active clinical practice or instruction of students, has knowledge of the applicable standard of care for . nurse practitioners"); see also § 766.203(2), Fla. Stat. (2004)(requiring a corroborating opinion from a medical expert as defined in section 766.202(6)); § 766.202(6), Fla. Stat. (2004)(defining a medical expert as one who meets the requirements of section 766.102). Thus, while the Largies' expert affidavit may be sufficient as to the physicians named in it, it fails to demonstrate any investigation as to Nurse Wang and is wholly insufficient.
Moreover, when pointedly asked to explain what had been done to investigate the Largies' claim against Nurse Wang, counsel did no more than point to the affidavit referencing only Drs. Gregorian and Dansky and their breach of the standard of care. This was inadequate. Because the record clearly shows that the Largies failed to conduct a reasonable investigation as to "each and every potential defendant," specifically, Nurse Wang, the legislative purpose of Chapter 766 was frustrated, mandating elimination of the claim against her from this suit. See § 766.206(2),. Fla. Stat. (2002)(authorizing dismissal of actions predicated on notices of intent not in compliance with the reasonable investigation requirements of sections 766.201 through 766.212); § 766.203(2), Fla. Stat. (2002)(stating that prior to issuing a notice of intent to sue, the claimant "shall conduct an investigation to ascertain that there are reasonable grounds" to initiate a medical negligence action and that corroboration of such "shall be provided by submission of a verified written medical expert opinion . at the time the notice of intent to initiate litigation is mailed").
' The Largies maintain that it is of no moment that Nurse Wang was not specifi cally named in the verified expert affidavit since the notice of intent advised her of the allegations against her. At oral argument, the Largies fastened onto Maldonado v. EMSA Ltd. P'ship, 645 So.2d 86, 89 (Fla. 3d DCA 1994), to support this proposition, a position adopted by the dissent. This argument misses the point, as Maldonado confirms.
Maldonado involved an action in which the two defendants named in a medical malpractice suit (a partnership that provided emergency physicians to a hospital and the hospital itself) were the same two potential defendants named in the corroborating affidavit. Two issues were raised on appeal: (1) the qualifications of the expert to render an opinion, and (2) whether the notice of intent and affidavit provided sufficient information of the plaintiffs claim to permit the response mandated by Chapter 766. No issue was raised as to whether the corroborating affidavit was sufficient to confirm that the statutorily mandated investigation had taken place as to one of the defendants named in the suit for the simple reason that both defendants named in the suit had also been named in the affidavit.
Regarding whether "the trial court erred in granting . [a] motion for summary judgment based on the . failure to set forth facts describing the alleged negligence in the affidavit or notice of intent," the Maldonado court correctly concluded that the corroborating affidavit need only "outline the factual basis for the opinion," and that "[t]aken together, 'the notice of intent to initiate and the corroborating medical expert opinion . must sufficiently indicate the manner in which the 'defendant doctor allegedly deviated from the standard of care, and must provide adequate information for the defendant ] to evaluate the merits of the claim.' " Id. at 89. Deciding whether. a defendant named in both the notice and the affidavit received sufficient information to respond is not the same as deciding whether a verified expert opinion, which makes no mention of a defendant named in a malpractice suit, the standard of care applicable to that defendant, or any breach of that standard of care, is sufficient to corroborate that an investigation has determined that the claim is legitimate as to that defendant. As the Florida Supreme Court has confirmed, a notice of intent and a corroborating affidavit serve distinct purposes. One advises of an event, the other corroborates legitimacy of a claim following investigation; the two do not supplement one another:
There are disparate purposes underlying the requirement of serving a notice of intent to sue and the requirement of providing a verified written medical expert opinion corroborating reasonable grounds to support a claim of medical negligence. The purpose of a notice of intent to sue is to give the defendant notice of the incident in order to allow investigation of the matter and promote presuit settlement of the claim. The expert corroborative opinion, on the other hand, is designed to prevent the filing of baseless litigation....
The expert opinion to be supplied is not one which delineates how the defendants were negligent.... Obviously, the corroborative medical opinion adds nothing to the Plaintiffs' notice of their claim. It merely assures the Defendants, and the court, that a medical expert has determined that there is justification for the Plaintiffs' claim, i.e., that it is not a frivolous medical malpractice claim. The purpose of the medical expert opinion is to corroborate that the claim is legitimate, not to give notice of it.
Kukral, 679 So.2d at 282 (quoting Stebilla v. Mussallem, 595 So.2d 136, 138 (Fla. 5th DCA 1992))(first emphasis added).
Where, as here, the verified affidavit does not confirm that, as to a defendant, an investigation has taken place, (that is, that the claim against that defendant is "legitimate"), this statutory requirement cannot be cured by unverified statements regarding that defendant detailed in the notice of intent. Because the issue in this case is whether the plaintiffs fulfilled their statutory presuit obligations and not whether the defendant had sufficient information to respond, Maldonado, 645 So.2d at 89, is in no way dispositive.
Of course, Nurse Wang's response to the Largies' notice and affidavit cannot be read as a waiver of the requirement of a corroborating medical opinion as the Largies suggest. As the court in Archer v. Maddux, 645 So.2d 544, 546-47 (Fla. 1st DCA 1994), stated when faced with a similar argument:
We do not believe the defendants' own investigation, presumably conducted in a good faith effort to comply with section 766.106(3), Florida Statutes (1993), can fairly be construed as a waiver of their right to a corroborating medical opinion. If Ms. Archer's timely-filed notice of intent to litigate fulfilled a purpose of the presuit requirements by giving Dr. Maddux sufficient notice to evaluate Archer's claim with an eye toward disposition out of court, so much the better.
But this does not excuse the lack of a verified written medical expert opinion. "There are disparate purposes underlying the requirement of serving a notice of intent to sue and the requirement of providing a verified written medical expert opinion corroborating reasonable grounds to support a claim of medical negligence." Stebilla, 595 So.2d at 139. One clear purpose of requiring corroboration is to spare all parties (not to mention the judiciary) the time and expense of litigating spurious claims. The expert opinion requirement is designed "to prevent the filing of baseless litigation . [and] to corroborate that the claim is legitimate." Stebilla, 595 So.2d at 139. No party should be called on to defend at trial against allegations no competent witness can be found to support.
(Emphasis added).
Any other result would run counter to the very intent of the presuit provisions, that is, to reduce the "high cost of medical malpractice claims in the state . by requiring early determination of the merit of claims . [by means of] reasonable investigation preceding] . malpractice claims." Musculoskeletal Inst. Chartered v. Parham, 745 So.2d 946, 949 (Fla.1999)(quoting § 766.201, Fla. Stat. (1989)).
In sum, the problem here is that the expert opinion does not suggest, much less demonstrate, that any expert concluded that there were reasonable grounds to believe that Nurse Wang was negligent in her care or treatment of the plaintiff. Thus, there was no confirmation that plaintiffs had conducted a reasonable investigation as to this defendant or that there existed "reasonable grounds to initiate medical negligence litigation" against this nurse. § 766.203(2), Fla. Stat. (2002). What makes this failure even more egregious is that Nurse Wang gave notice that the affidavit was insufficient more than six months before expiration of the statute of limitations, yet the Largies did nothing to rectify the defect.
In Correa, 693 So.2d at 621, the defendants maintained that the corroborating affidavit was insufficient because the affi-ant was not a medical expert. Although this "defect" was raised long before the statute of limitations ran, the claimant did nothing to address it. The Second District concluded the failure to comply with pre-suit notice requirements warranted dismissal observing "it was human failure, not the presuit requirements which barred [claimant] from entry to the courthouse". Correa, 693 So.2d at 621 (quoting Royle v. Florida Hospital-East Orlando, 679 So.2d 1209, 1212 (Fla. 5th DCA 1996)) (citations omitted); see Winson v. Norman, 658 So.2d 625, 626 (Fla. 3d DCA 1995)(affirm-ing an order striking an affidavit and dismissing an action after the limitations period had run, where the corroborating opinion was not from a qualified medical expert because "one of the primary thrusts of Florida's statutory medical malpractice scheme is to 'weed out' cases which are not, even prima facie, supported by some reliable independent indication of their merits"); see also McPherson v. Phillips, 877 So.2d 755, 760 (Fla. 4th DCA 2004)(noting that the statute of limitations "circumscribefs] the trial court's discretion in dealing with a [claim of] Chapter 766 noncompliance"); Tapia-Ruano v. Alvarez, 765 So.2d 942, 943-44 (Fla. 3d DCA 2000)(affirming dismissal where the statute of limitations had run and plaintiff provided no reason for failure to comply with the presuit requirements); Central Florida Reg'l Hosp. v. Hill, 721 So.2d 404, 406 (Fla. 5th DCA 1998)(finding that "[t]he failure to provide corroboration is fatal if the limitation period has run"). The same reasoning applies here.
Therefore, on the record before us, we cannot conclude that the court below erred in deciding that Nurse Wang was entitled to summary judgment based on the total failure of the Largies to demonstrate that, as to this defendant, the presuit investigation requirements of Chapter 766 had been satisfied. Accordingly, the order under review is affirmed.
FLETCHER and WELLS, JJ., concur.
. Dr. Dansky is a urologist to whom Mr. Largie was referred in April 2000 for treatment of a urinary tract infection. Dr. Dansky was neither advised of Mr. Largie's elevated 'PSA level nor did Dr. Dansky independently order a PSA test.