Case Name: CARBONELL v. BLUHM
Court: Michigan Court of Appeals
Jurisdiction: Michigan
Decision Date: 1982-03-17
Citations: 114 Mich. App. 216
Docket Number: Docket No. 52494
Parties: CARBONELL v BLUHM
Judges: Before: D. C. Riley, P.J., and R. M. Maher and Cynar, JJ.
Reporter: Michigan appeals reports; cases decided in the Michigan Court of Appeals.
Volume: 114
Pages: 216–232

Head Matter:
CARBONELL v BLUHM
Docket No. 52494.
Submitted December 7, 1981, at Detroit.
Decided March 17, 1982.
Leave to appeal applied for.
Thomas Carbonell, a physician specializing in obstetrics and gynecology, subsequent to having heart surgery and suffering a stroke lost consciousness at his home. He was taken to Henry Ford Hospital where he had previously been a patient. Complaining of pain in his left shoulder, Dr. Carbonell was examined by R. Garcia, M.D., a physician who had previously treated Dr. Carbonell. After X-rays were taken of Dr. Carbonell’s shoulder, Dr. Garcia’s diagnosis was that Dr. Carbonell probably had bruised or sprained his shoulder. Subsequently, Dr. Garcia referred Dr. Carbonell to G. Bluhm, M.D., a specialist in rheumatology. Dr. Carbonell discontinued his work as a surgical assistant. Subsequently, Dr. Carbonell was again admitted to Henry Ford Hospital. Further X-rays were taken. Dr. Bluhm eventually diagnosed Dr. Carbonell’s condition as a hidden posterior dislocation of the shoulder. Thereafter, a closed reduction procedure was conducted. Dr. Carbonell alleged that he has experienced permanent pain and restriction of movement in the shoulder. Dr. Carbonell filed suit against Dr. Bluhm, Dr. Garcia, and Henry Ford Hospital for negligence in Wayne Circuit Court. The court, Harry J. Dingeman, Jr., J., entered judgment for the defendants on a jury verdict of no cause of action for the defendants. The plaintiff appealed, alleging that: (1) the court erred in failing to grant a mistrial on the basis of alleged improper statements in defense counsel’s closing argument; (2) the court erred when it struck portions of his expert’s testimony when the expert used the personal pronoun "I” in describing the appropriate standard of care; (3) the court erred in failing to give the requested standard jury instruction on the statutory mortality table; and (4) the court erred in excluding as hearsay the clinical impressions of an emergency room physician who worked at the hospital and treated the plaintiff when he was admitted. Held:
References for Points in Headnotes
75 Am Jur 2d, Trial § 233.
5 Am Jur 2d, Appeal and Error § 773.
61 Am Jur 2d, Physicians and Surgeons § 205 et seq.
22 Am Jur 2d, Death § 269.
29 Am Jur 2d, Evidence §§ 496, 497.
75 Am Jur 2d, Trial § 193.
1. The court did not abuse its discretion in failing to grant a mistrial. Allowance of statements made by counsel in closing argument is not error requiring reversal if the statements are in response to arguments made by opposing counsel. Here, the comments of defense counsel referred to one of plaintiffs expert witnesses who was unable to come to Michigan for trial and had to be deposed in Massachusetts. Since, initially, counsel for plaintiff in his closing argument made allegations regarding the defendants’ part in nonproduction of certain X-rays for the expert witness to view, the door was opened for defense counsel to comment on the subject. Further, the trial court did not abuse its discretion in denying the plaintiffs motion for a mistrial based on defense counsel’s describing during closing argument his attempts at gaining access to the plaintiffs income tax return.
2. The expert’s use of the pronoun "I” was improper. Because the stricken responses involved the expert’s own personal practices, the trial court did not err in striking those responses before the video-taped deposition was played to the jury.
3. The court’s determination that the requested standard jury instruction should not be given does not constitute error requiring reversal. The instruction is not applicable for a person not in an average, normal, healthy condition. Here, there was ample evidence to support the position that the plaintiff was not a normal, healthy, 50-year-old male at the time of trial. He underwent heart surgery and had suffered a stroke.
4. The trial court did not err in excluding from evidence the clinical impressions of the emergency room physician. The statement at issue is a diagnosis and not a mere statement of physical condition. Since the impression is contained in a writing, although it may be an admission, and thus not hearsay at all, it must qualify on its own for admission into evidence. The hearsay exception in the rules of evidence for statements made for purposes of medical treatment or medical diagnosis in connection with treatment is not applicable because it does not apply to statements made by a doctor regarding a patient’s physical condition but only to statements made by a patient of his physical condition, symptoms or medical history. The exception for business records does not apply either, since medical diagnosis is excluded under the hearsay exception for business records in the Michigan Rules of Evidence.
Affirmed.
R. M. Maher, J., dissented. He would reverse and remand for a new trial. He believes that the comments made by the defense counsel were not made in response to plaintiff’s counsel’s closing argument. Further, he believes that the potential impact on the jury of defense counsel’s attack on the integrity of the plaintiff’s counsel should constitute error requiring reversal. Here, the improper remarks of defense counsel were not preceded by similar improper remarks by plaintiffs counsel.
Opinion of the Court
1. Trial — Argument of Counsel — Appeal.
Allowance of statements made by counsel in his closing argument is not error if the statements are made in response to arguments made by opposing counsel.
2. Appeal — Motions — Mistrial.
, Denial of a motion for a mistrial will not be reversed on appeal unless it is demonstrated that such a denial constituted an abuse of the trial court’s discretion.
3. Physicians and Surgeons — Medical Malpractice.
A treating physician is liable for damages when it is shown that he departed from the standard of care which is known as customary medical practice; the measuring standard of care is founded upon how other doctors in that field of medicine would act and not how any particular doctor would act.
4. Jury — Jury Instructions — Mortality Tables.
A standard jury instruction should be used whenever it is applicable, accurate and requested by a party; the standard jury instruction regarding the statutory mortality table is not applicable for a person not in an average normal, healthy condition (GCR 1963, 516.6[2]; SJI 34.01).
5. Evidence — Hearsay — Medical Treatment — Rules of Evidence.
The rule of evidence regarding an exception to the hearsay rule for statements made for purposes of medical treatment or medical diagnosis in connection with treatment refers to statements by the patient; the rule does not apply to statements by the doctor regarding the patient’s physical condition (MRE 803[4]).
Dissent by R. M. Maher, J.
6. Trial — Argument op Counsel.
It cannot be demonstrated what effect any particular statement of counsel has on a jury; no litigant should be expected to demonstrate affirmatively a prejudicial effect on the jury resulting from improper remarks of the opposing counsel.
7. Trial — Argument of Counsel.
Improper remarks by a plaintiff’s counsel do not necessarily result in a reversible error where they are in direct response to improper statements of defense counsel.
Lopatin, Miller, Freedman, Bluestone, Erlich & Rosen, for plaintiff.
Kitch, Suhrheinrich, Smith, Saurbier & Drutchas, P.C., for defendants.
Before: D. C. Riley, P.J., and R. M. Maher and Cynar, JJ.

Opinion:
D. C. Riley, P.J.
Plaintiff appeals from a judgment of no cause of action entered against him in circuit court. The claim brought by plaintiff alleges professional negligence against the individual defendants for their failure to diagnose plaintiffs dislocated shoulder when he sought treatment at defendant hospital's emergency room.
In 1972, plaintiff, a physician specializing in obstetrics and gynecology, experienced physical difficulties and discovered the existence of cardiac problems. Surgery to replace a heart valve was successfully conducted in early 1973, after which plaintiff resumed his practice. In July of 1973, plaintiff suffered a stroke but after treatment regained muscle usage and nearly complete sensation in his left arm. After the stroke, plaintiff no longer practiced medicine but acted as a surgical assistant to fellow doctors.
On February 2, 1974, plaintiff lost consciousness while at home and fell to the floor. He was taken to defendant hospital's emergency room and then transferred to the cardiology floor. Plaintiff complained of pain in his left shoulder and X-rays were taken which showed no positive injury. Therefore, defendant Garcia's tentative diagnosis was that plaintiff had probably bruised or sprained his shoulder. The shoulder pain continued after plaintiff's discharge from the hospital and he was unable to achieve a full range of movement of the left arm. The pain and problems persisted, thus, plaintiff pursued further medical treatment from defendant Garcia who referred plaintiff to defendant Bluhm, a specialist in rheumatology. Plaintiff was forced to discontinue his work as a surgical assistant.
On April 27, 1974, plaintiff was admitted to defendant hospital for further treatment. Dr. Bluhm changed the anti-inflammatory medication and ordered X-rays. The new medication had reduced the swelling in the shoulder and, on the basis of the X-rays, Dr. Bluhm suspected a hidden posterior dislocation of the shoulder. This diagnosis was confirmed and a closed reduction procedure was conducted. The plaintiff was discharged the following day. He testified that he experienced permanent pain and restriction of movement in the shoulder.
I
Plaintiff contends that the court committed error in failing to grant him a mistrial on the basis of defense counsel's closing argument. The comments objected to were that allegedly plaintiff's counsel had withheld evidence from his expert and that "obviously something is going on" between plaintiff's counsel's firm and plaintiff's expert. -
One of plaintiffs experts was unable to come to Michigan for the trial and, therefore, had to be deposed in Massachusetts. Defendant objected to the deposition and filed an application for emergency leave to appeal. This Court reached its decision against defendant late Friday, December 14, 1979. The plaintiff then sought a trial court order allowing the X-rays on exhibit to be taken to Massachusetts for the deposition. However, because of the lateness of the hour, no circuit judge was available to sign the order and defendants' counsel refused to stipulate to taking the X-rays to the deposition. Plaintiff thus argues that, because defense counsel would not stipulate to the taking of the X-rays already introduced into evidence to Massachusetts to allow the expert to review them, defense counsel's argument that plaintiff was withholding evidence from his own expert was incorrect and prejudicial.
This argument is difficult only in its facts and not the law. The appellate briefs must be compared with the more than 300-page trial transcript to resolve the confusion. Defense counsel's closing argument that plaintiff did not provide the X-rays to his expert refers not only to the deposition of December 15, 1979, but to plaintiffs failure to provide the X-rays to his expert during the entire course of the expert's preparation for the case. Furthermore, the record shows that, in his initial closing argument, plaintiffs counsel made allegations as to defendants' part in the nonproduction of the X-rays. These allegations against defendants introduced the subject of nonproduction of the X-rays and "opened the door" to comment on the subject by defense counsel in his closing argument. Allowance of statements made by counsel in closing argument will not be an error if the state- merits are made in response to arguments made by opposing counsel. Haynes v Monroe Plumbing & Heating Co, 48 Mich App 707, 721; 211 NW2d 88 (1973).
The plaintiff also objects to defense counsel's comments concerning plaintiffs experts and his counsel's firm. The trial court denied plaintiffs motion for a mistrial based on these alleged errors. The denial of a motion for a mistrial will not be reversed unless it is shown that the denial constituted an abuse of discretion. Flinn v Sun Oil Co, 96 Mich App 59, 62; 292 NW2d 484 (1980), People v Coffman, 45 Mich App 480, 487; 206 NW2d 795 (1973).
The Supreme Court defined "abuse of discretion" in Spalding v Spalding, 355 Mich 382, 384-385; 94 NW2d 810 (1959), in the following manner:
"[A]n abuse of discretion involves far more than a difference in judicial opinion between the trial and appellate courts. The term discretion itself involves the idea of choice, of an exercise of the will, of a determination made between competing considerations. In order to have an 'abuse' in reaching such determination, the result must be so palpably and grossly violative of fact and logic that it evidences not the exercise of will but perversity of will, not the exercise of judgment but defiance thereof, not the exercise of reason but rather of passion or bias."
Having reviewed the record, we conclude that the trial court did not abuse its discretion.
II
The plaintiff alleges that the trial court commit ted reversible error in denying his motion for a mistrial in response to defense counsel's reference to plaintiffs income tax returns during closing arguments.
Defense counsel had repeatedly tried to have plaintiff produce his income tax returns before trial, which plaintiff failed to do. At trial, the court denied defense counsel's request for an instruction concerning the tax forms. Defendants were informed by the trial court that the failure to produce the tax records could be used when plaintiff made a claim of lost wages. The judge said: "You may argue to the jury the lack of proofs, as you see it, of earning capacity, but the request to instruct is refused."
During closing argument, defense counsel began describing his attempts at obtaining plaintiffs income tax returns. This was immediately objected to on the ground that this was not in evidence. Defense counsel continued mentioning his motion to produce the records to which plaintiffs counsel also objected. Both objections were sustained. Defense counsel then stated that he had tried to get the records and that plaintiffs counsel had not shown the income tax records to the jury. Again, plaintiffs counsel objected. At this point, the trial judge excused the jury and explained that defense counsel could properly comment on the lack of plaintiffs proof with respect to income. loss but that he could not go through the details of the pretrial procedures undertaken to have the records produced. Defense counsel then stated that he would limit himself to comment consistent with the instruction. Plaintiffs counsel moved for a mistrial because he thought the remarks already made were "very prejudicial".
The standard of review applied to a trial court's denial of a motion for a mistrial has been discussed earlier in this opinion. We must determine whether the court abused its discretion. It was not the fact that defense counsel raised the subject of tax returns, which had been held proper by the court, but the manner in which he introduced the subject that is objected to. The references to which plaintiff objects all occurred during the same short span of closing arguments. We conclude that the trial court did not abuse its discretion in denying plaintiffs motion.
Ill
The plaintiff further contends that the court erred when it struck portions of his expert's testimony when the expert used the personal pronoun "I" in describing the applicable standard of care. The plaintiffs Massachusetts expert, during his video-taped deposition, answered questions by responding with what he would have done rather than with what the standard of practice was.
A treating physician is liable for damages when it is shown that he departed from the standard of care which is known as customary medical practice. Wood v Posthuma, 108 Mich App 226, 230; 310 NW2d 341 (1981). The measuring standard of care is founded upon how other doctors in that field of medicine would act and not how any particular doctor would act. Rytkonen v Lojacono, 269 Mich 270; 257 NW 703 (1934). The expert's use of the pronoun "I" was improper. Id. Because the stricken responses involved the expert's own personal practices, the trial court did not err in striking those responses before the video-taped deposition was played to the jury.
IV
Plaintiff argues that the court erred in failing to give Standard Jury Instruction (SJI) 34.01 as requested. That instruction involves the statutory mortality table and the court initially agreed to give the instruction. After closing argument, the court refused to give the instruction because the table is for ordinarily healthy persons which the court believed was inappropriate as to the plaintiff.
The Court in Javis v Ypsilanti Board of Education, 393 Mich 689, 697; 227 NW2d 543 (1975), held that GCR 1963, 516.6(2) requires that the standard jury instructions be used whenever they are applicable, accurate and requested by a party. Standard Jury Instruction 34.01 is not applicable for a person not in an average, normal, healthy condition. Fortner v Koch, 272 Mich 273, 279; 261 NW 762 (1935).
In this case, there was ample evidence to support the position that plaintiff was not a normal, healthy, 50-year-old male at the time of trial. He underwent heart surgery in 1973, and suffered a stroke later that year and suffered from seizures and recurring cardiac problems. He stated that he did not expect to live much longer than ten years. Plaintiff's counsel repeated this expectation in closing argument and noted that plaintiff might live longer because "he is a man that does not quit". The court's determination that the instruction should not be given is not reversible error.
V
Plaintiffs final allegation is that the court erred in excluding as hearsay the clinical impressions of an emergency room physician who worked at the defendant hospital and treated plaintiff when he was admitted. The statement at issue appeared under a box on the medical chart labeled "Clinical Impressions". The emergency doctor wrote "Impression: Frozen shoulder, secondary to old trauma".
Both parties agree that the statement is actually an admission by an agent of defendant hospital. Therefore, the admission is not hearsay at all according to MRE 801(d)(2)(D). Plaintiff contends that because the statement is an admission, the impression should have been admitted. However, the impression is contained in a writing which must qualify on its own for admission. The Court stated in Lovend v Beaumont Hospital, 78 Mich App 686, 688; 261 NW2d 37 (1977): "Unquestionably, the admissibility of party admissions is well-established. However, the party admission was contained in a business record and, therefore, involves a second level of hearsay that must also come within the business records exception to be admissible."
The plaintiff argues in the alternative to the business record exception that the statement was "made for purposes of medical treatment or medical diagnosis in connection with treatment" and, thus, it qualifies as a hearsay exception under MRE 803(4).
This exception is not applicable here as it permits statements by the patient of his physical condition, symptoms, or medical history. The rule in MRE 803(4) does not apply to statements by the doctor regarding the patient's physical condition. Gallaway v Chrysler Corp, 105 Mich App 1, 9; 306 NW2d 368 (1981).
The admission contained in the report can only then be admitted if MRE 803(6) is applicable. That rule provides that the records of a regularly conducted activity are an exception to the hearsay rule. This rule is commonly known as the business records exception. The rule states:
"(6) Records of regularly conducted activity. A memorandum, report, record, or data compilation, in any form, of acts, transactions, occurrences, or events, made at or near the time by, or from information transmitted by, a person with knowledge, if kept in the course of a regularly conducted business activity, and if it was the regular practice of that business activity to make the memorandum, report, record, or data compilation, all as shown by the testimony of the custodian or other qualified witness, unless the source of information or the method or circumstances of preparation indicate lack of trustworthiness. The term 'business' as used in this paragraph includes business, institution, association, profession, occupation, and calling of every kind, whether or not conducted for profit." (Emphasis added.)
The rule in MRE 803(6) has béen subject to minimal appellate review since 1978, when the Michigan evidence rules were adopted. The precursor to the present rule was MCL 600.2146 (Stat Ann 1962 Rev §27A.2146): "Under this statute it has been held that hospital records are admissible as business entries to the extent they record events and acts, such as admissions, discharges, and ministrations in the hospital, although they are not ordinarily admissible as a means of introducing medical history or diagnosis." Bond v Greenwood, 34 Mich App 41, 43; 190 NW2d 731 (1971). The Court went on to say that a general description of a physicál condition, as distinguished from a diagnosis, was admissible under the business records statute. Id. Plaintiff makes an attempt to classify the clinical impression in this case as a mere statement of a physical condition, rather than a diagnosis and, thus, bring this case under the holding in Bond. We have determined, as did the trial court, that the statement at issue is a diagnosis and not a mere statement of physical condition.
The language of MRE 803(6) varies from that of the Federal Rule 803(6) in a way that is determinative to this case. The Michigan rule applies to "acts, transactions, occurrences, or events"; the federal rule applies to "acts, events, conditions, opinions, or diagnoses". (Emphasis added.) The Michigan rule is narrower in scope than its federal counterpart. Michigan apparently has chosen to exclude medical diagnosis from the business record exception, MRE 803(6). Therefore, the trial court did not err in excluding the clinical impression offered by plaintiff.
Affirmed. Costs to appellees.
Cynar, J., concurred.
Unfortunately, certain language in Echols v Rule, 105 Mich App 405, 411; 306 NW2d 530 (1981), regarding MRE 803(4), which was approved by the writer, would suggest otherwise; to the extent that it does, I now disavow the same.