Case Name: Beth LINN and Anthony Linn, Appellants, v. Basil D. FOSSUM, M.D. and Dennis M. Lewis, M.D., Appellees
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 2004-10-18
Citations: 894 So. 2d 974
Docket Number: No. 1D03-4152
Parties: Beth LINN and Anthony Linn, Appellants, v. Basil D. FOSSUM, M.D. and Dennis M. Lewis, M.D., Appellees.
Judges: DAVIS, J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 894
Pages: 974–984

Head Matter:
Beth LINN and Anthony Linn, Appellants, v. Basil D. FOSSUM, M.D. and Dennis M. Lewis, M.D., Appellees.
No. 1D03-4152.
District Court of Appeal of Florida, First District.
Oct. 18, 2004.
Rehearing Denied Dec. 20, 2004.
Major B. Harding, Martin B. Sipple and Jennifer M. Heckman of Ausley & McMul-len, Tallahassee, for Appellants.
S. William Fuller, Jr., and William D. Horgan of Fuller, Johnson & Farrell, P.A., Tallahassee, for Appellee Basil D. Fossum, M.D.
No appearance for Appellee Dennis M. Lewis, M.D.

Opinion:
PADOVANO, J.
The plaintiffs, Beth and Anthony Linn, appeal from a final judgment entered for the defendant, Dr. Basil Fossum, in a medical malpractice case. They contend that testimony given by the defendant's medical expert should not have been admitted in evidence, because it was based entirely on the hearsay statements of other doctors. We conclude that the opinion testimony at issue was based in part on the expert's own assessment of the medical condition in question and that it was properly admitted. Therefore, we affirm.
The claim against Dr. Fossum was that he failed to diagnose an injury caused by Dr. Dennis Lewis, a general surgeon. Dr. Lewis had performed a diagnostic laparos-copy on Beth Linn to determine the cause of her abdominal pain. In the course of this procedure, Dr. Lewis accidentally cut Mrs. Linn's ureter, causing urine to leak into her abdomen. Mrs. Linn was subsequently treated by Dr. Fossum, who failed to diagnose the leak. Eventually, the leak caused a painful infection.
Before trial, the plaintiffs took the deposition of Dr. Dana Weaver-Osterholtz, the expert witness for the defense. Dr. Weaver-Osterholtz stated that in her opinion Dr. Fossum had complied with the applicable standard of care in attempting to identify the cause of Mrs. Linn's injury. She explained that Dr. Fossum had "performed all the tests that are normally performed by a urologist under the circumstances." She added however, that she would apply a more rigorous standard to herself, because she works in a tertiary care unit and is often required to treat injuries to the ureter. She said that if she had been treating Mrs. Linn, she would have stented the leak and drained her urinary system.
Dr. Weaver-Osterholtz stated that her opinion was based on her review of Mrs. Linn's medical records, the depositions of various other witnesses, her own experience and medical training, and a brief conference she had with several other urologists. These urologists were not witnesses in the trial, nor did they testify. Dr. Weaver-Osterholtz said that she had presented Mrs. Linn's case to her fellow physicians in a hypothetical "curb-side consult," and they all agreed that Dr. Fossum had met the standard of care.
After the deposition, the plaintiffs filed a motion to exclude the testimony Dr. Weaver-Osterholtz was prepared to give regarding the standard of care. They argued that her proposed testimony was a conduit for the inadmissible hearsay opinions of the other doctors and, as a part of this argument, they emphasized that her personal standard of care differed from that she intended to apply to Dr. Fossum at trial. The trial court denied the motion.
The plaintiff's expert, Dr. Carlos Santa Cruz, testified at trial that Dr. Fossum had breached the applicable standard of care. Dr. Weaver-Osterholtz was called as a defense witness to counter this opinion. On direct examination she was asked how she had determined the appropriate standard of care applicable to Dr. Fossum in Mrs. Linn's case. At that point, the plaintiffs renewed their objection. Defense counsel said that he would not ask Dr. Weaver-Osterholtz to relay the substance of the conversations with the other doctors, and the trial court overruled the objection. Dr. Weaver-Osterholtz then testified that she had presented the case to various urologists, but she did not testify on direct examination to what they said, the substance of their opinions, or whether their opinions supported Dr. Fossum's course of action.
On cross-examination, the plaintiffs questioned Dr. Weaver-Osterholtz about her conversations with these other doctors. In an attempt to impeach Dr. Weaver-Osterholtz with her deposition testimony, they asked whether her conferences with the other urologists were the basis for her opinion that Dr. Fossum's watch-and-wait approach was within the applicable standard of care. She replied that it was one of the bases for her opinion and that the other bases included a review of Mrs. Linn's medical records, witness depositions, and pertinent literature, as well as her own education, training and experience.
The jury returned a verdict for Dr. Fos-sum and, following the denial of post-trial motions addressed to the admissibility of the disputed expert testimony, the trial court entered a judgment in his favor. The plaintiffs filed this appeal to seek review of the judgment.
We begin with the proposition that an expert witness may render an opinion that is based in part on inadmissible evidence. See Houghton v. Bond, 680 So.2d 514, 522 (Fla. 1st DCA 1996); Sikes v. Seaboard Coast Line R.R. Co., 429 So.2d 1216, 1222 (Fla. 1st DCA 1983). This general principle is incorporated into the Florida Evidence Code in the following language: ¡
The facts or data upon which an expert bases an opinion or inference may be those perceived by, or made known to, the expert at or before the trial. If the facts or data are of a type reasonably relied upon by experts in the subject to support the opinion expressed, the facts or data need not.be admissible in evidence.
§ 90.704, Fla. Stat. (2003). The purpose of this section is to enable experts to reach their opinions and explain them in the manner in which they would in their own offices and laboratories. See Charles W. Ehrhardt, Florida Evidence § 704.1 (2004).
Section 90.704 enables a party to present an expert opinion that is based in part on a hearsay statement, even if the statement would not be admissible in evidence in its own right. If experts in a particular discipline customarily rely on hearsay to some extent in formulating a professional opinion, then it would be proper to allow an expert witness in that discipline to render an opinion that is based in part on hearsay. See Carratelli v. State, 832 So.2d 850, 861-862 (Fla. 4th DCA 2003). As the court explained in Bender v. State, 472 So.2d 1370, 1372 (Fla. 3d DCA 1985), the rule allowing an expert witness to consider hearsay statements in rendering an opinion came about because "the traditional constraints of the hearsay rule do not, in many instances, comport with the reality that expert opinions are based on other than first-hand observation."
The testimony at issue in this case is an opinion regarding the proper standard of medical care. According to section 766.102(1), Florida Statutes, the prevailing standard of care for a health care provider is "that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers." This subject, by its nature,, requires an understanding of what other experts in the field consider appropriate. A doctor would have to communicate in some way with other health care professionals to know what they regarded as "acceptable and appropriate."
The fact that Dr. Weaver-Oster-holtz spoke with other urologists in a setting she described as "curbside consult" does not lead us to conclude that her opinion was inadmissible. It is proper for an expert witness to consult with other experts in the same field in formulating an opinion. See, e.g., Bender; Capehart v. State, 583 So.2d 1009 (Fla.1991); see also Lewis v. Rego Co., 757 F.2d 66 (3d Cir. 1985); United States v. Brown, 299 F.3d 1252, 1257 (11th Cir.2002) (interpreting the federal rules). And this is particularly true .in the health care field, given the statutory definition of the standard of care. We would expect a doctor to speak with other doctors in .the same field, either in connection with a particular case or in a more general setting. Otherwise, it would be difficult to know the proper standard of medical care as defined by law.
The plaintiffs acknowledge these general principles of law, but they contend that the opinion in this case should have been excluded from evidence, because it was based exclusively on the • hearsay statements of the other urologists. They contend that Dr. Weaver-Osterholtz was merely a conduit for the hearsay statements made by the other doctors and that they were deprived of an opportunity to cross-examine any of these doctors.
It is true that section 90.704 does not authorize the admission of an opinion that is based exclusively on inadmissible evidence. See Maklakiewicz v. Berton, 652 So.2d 1208, 1209 (Fla. 3d DCA 1995). However, there is no impediment to the admission of an opinion that was based partly on inadmissible facts or data and partly on other information that is admissible. When that is the case, the expert opinion is properly buttressed by the admissible information. See, e.g., Riggins v. Mariner Boat Works, Inc., 545 So.2d 430, 432 (Fla, 2d DCA 1989) (observing that, "[w]hen a doctor renders an opinion based upon an inadmissible laboratory report, that opinion is usually buttressed by additional facts which are in evidence or by an examination of a patient whom the jury has also observed."); Capehart v. State, 583 So.2d 1009, 1012-1013 (Fla.1991); Carratelli, 832 So.2d at 861-862.
The question, then, is whether the opinion given by Dr. Weaver-Osterholtz at trial was based entirely on the hearsay statements of the other urologists. Our review of the record convinces us that it was not. As she stated in her testimony, Dr. Weaver-Osterholtz reviewed Mrs. Linn's medical records for approximately ten hours, as well as the deposition testimony of other witnesses in the case. In addition, she relied on her own medical education, training and experience in forming her opinion. The consultation with her colleagues was only a part of the basis for her opinion that Dr. Fossum complied with the standard of care.
The plaintiffs rely heavily on Dr. Weaver-Osterholtz's statement that she herself had a different standard of care and would have stented the leak rather than adopting a watch-and-wait approach. They argue that this testimony shows that Dr. Weaver-Osterholtz relied exclusively on the opinions of the other doctors in forming her opinion that Dr. Fossum met the applicable standard of care in treating Mrs. Linn. This argument is also unsupported by the record. Dr. Weaver-Osterholtz testified that the other doctors' opinions were only one factor she considered in formulating her opinion about the standard of care.
For example, on direct examination, Dr. Weaver-Osterholtz explained that one of the other factors on which she based her opinion that Dr. Fossum had met the standard of care was the fact that the type of ureteral leak Mrs. Linn had was "notoriously hard to diagnose." She pointed out that the symptoms are "vague," "very subtle and sometimes very hard to pick up." She further explained that "the tests [used to diagnose such leaks] are inaccurate" with only about a 33% accuracy rate, delaying the diagnosis of ureteral leaks most of the time. She also noted that the difficulty in diagnosing Mrs. Linn's leak was compounded by her long history of preexisting abdominal pain. As Dr. Weaver-Osterholtz explained, Mrs. Linn had long been debilitated by her chronic abdominal pain, so much so that she had previously had a hysterectomy to try to alleviate it and a laparoscopy to determine the cause of the pain.
Moreover, the personal standard that Dr. Weaver-Osterholtz would apply to herself is not the standard to be applied in determining medical negligence. As we have explained, the standard of care is the level of care that is recognized as acceptable and appropriate by reasonably prudent health care professionals. See § 766.102(1), Fla. Stat. (2003). Dr. Weaver-Osterholtz held herself to a higher standard than she would apply to urologists working in less specialized environments, but that is not a matter of any significance here. The question is not whether Dr. Fossum met the high standard Dr. Weaver-Osterholtz set for herself, but whether he met the standard for reasonably prudent doctors working in the same field. Dr. Weaver-Osterholtz thought that he did and we have no reason to question her opinion on this point.
In his dissent, Judge Kahn argues that our decision conflicts with the decision of the Fourth District Court of Appeal in Schwarz v. State, 695 So.2d 452 (Fla. 4th DCA 1997). There, a medical examiner testified on direct examination that he had consulted with another doctor who agreed with him about the substance of his opinion. He explained that the issue was unusual and he wanted to see what someone else thought about it. The argument in Schwarz was not that the medical examiner based his opinion on hearsay, but rather that he was allowed to bolster his opinion by implying that others experts agreed with him. The court reasoned that, if it is improper to allow an expert to refer to a treatise on direct examination, it must also be improper to allow the expert to refer to conversations with other experts about the issue at hand. Ultimately, the court affirmed the conviction on the ground that the error was harmless.
There are two critical differences between this case and Schwarz. First, the plaintiffs in this case are not arguing that Dr. Weaver-Osterholtz improperly bolstered her testimony. This point was not made in the trial court, nor was it made in this court. The appellants mentioned the alleged improper bolstering in passing in their initial brief, but it was clearly not the thrust of their argument. Nor could it have been. The argument was that Dr. Weaver-Osterholtz's opinion was based entirely on hearsay. It would be difficult to argue that Dr. Weaver-Osterholtz tried to bolster her opinion with the opinions of experts when she said from the beginning that she applied a different standard of care for herself and that she did not personally share the views of the doctors she consulted.
The second major difference' is that Dr. Weaver-Osterholtz did not testify on direct examination that other experts agreed with the opinion she was about to give. She said that she had consulted with other doctors, but this was in response to a question about what she had done to determine the standard of care. Presumably, a doctor would have to know a great deal more about the facts to know whether the standard was" met in a given case. The opinions of the other doctors were eventually revealed during the plaintiffs' cross-examination and attempted impeachment of Dr. Weaver-Osterholtz, but we hardly think this makes the case comparable to Schwarz.
We think that our opinion is consistent with the analysis in Schwarz, but we would have no basis to certify conflict in' any event. Article, V, section 3(b)(4) of the Florida Constitution provides that the supreme court may review a decision of á district court of appeal that "is certified by it to be in direct conflict with a decision of another district court of appeal." (Emphasis added). Here, the decisions are not even arguably in conflict. Both were affir-mances. At most, according to the dissent in the present case, the reasoning is different. We do not share that' view, but even if we did, it would not be a basis to certify conflict.
For these reasons, we conclude that the trial court did not err in admitting the opinion testimony of Dr. Weaver-Oster-holtz. Her opinion was not merely the conduit for the hearsay statements of other doctors, as the plaintiffs contend.
Affirmed.
DAVIS, J., concurs.
KAHN, J., dissents with opinion.