Title: ANKENY v GRUNSTEAD
Citation: N/A
Docket Number: 13173
State: Montana
Issuer: Montana Supreme Court
Date: June 24, 1976

No, 13173 I N THE SUPREME COIJRT O F THE STATE O F M O N T A N A 1976 G E R A L D E . ANKENY , JR. , P l a i n t i f f and Respondent, LAURIE GRUNSTEAD, R O L A N D M . GRUNSTEAD and MILLIE GRUNSTFAD, Defendants and Appellants. Appeal from: D i s t r i c t Court of t h e Thirteenth J u d i c i a l D i s t r i c t , Honorable C. B. Sande, Judge presiding. Counsel of Record: For Appellants : Garlington, Lohn and Robinson, Missoula, Montana Sherman V. Lohn argued, and Gary L, Graham argued, Missoula , Montana For Respondent: Reno and Dolve, B i l l i n g s , Montana James A. Reno argued, B i l l i n g s , Montana Roger A. Kander, Long Beach, California Submitted: March 8, 1976 Decided : JUR 2 4 1976 Filed: rjUM 2 4 19-0 Hon. A.B. Martin, D i s t r i c t Judge, s i ~ t i n g for Chief J u s t i c e James T. Harrison, delivered the Opinion of the Court: In t h i s action the d i s t r i c t court, Yellowstone County, s i t t i n g without a jury, awarded Gerald E. Ankeny, Jr. $83,302 as damages for i n j u r i e s claimed t o have been sustained on June 15, 1970, a s a r e s u l t of an intersection c o l l i s i o n between a motor bike operated by Ankeny and a car owned by Roland M. Grunstead and Millie Grunstead and driven by t h e i r daughter Laurie Grunstead. Of the t o t a l damages the court awarded $409 for emergency hospital expenses, $5,248 f o r medical care provided by the Veterans Administration, and the balance of $77,645 f o r general damages. Grunsteads do n o t , on t h i s appeal, deny responsibility f o r the c o l l i s i o n , but claim as a defense t h a t the vehicular c o l l i s i o n was not the cause of the low back i n j u r i e s f o r which the court i n large part awarded damages. Ankeny began experiencing low back trouble while i n the military service i n 1965. From that time he was plagued with low back pain f o r which he repeatedly sought medical r e l i e f . H i s trouble was f i n a l l y diagnosed as spondylolisthesis, a congential low back defect. A s a l a s t r e s o r t he underwent surgery f o r a spinal fusion, which was performed February 16, 1969. Following a postoperative period of about one year, Ankeny was directed t o Doctor Pearlman, a radiologist with the Denver Veterans Hospital. According t o Ankeny, Doctor Pearlman examined him, told him t o discontinue the use of t h e back brace and re- Leased him without prescribing further medication o r treatment. Ankeny t e s t i f i e d t h a t from March 1970 t o June 15, 1970, a period o i about three and one half months, he was f r e e of low back pain. The inference which Ankeny would have drawn from the foregoing circumstances is t h a t a s o l i d fusion had been achieved but t h a t i t was displaced by the force of the intersection c o l l i s i o n . To f o r t i f y t h i s inference, Ankeny called Doctor Hertwig as a witness. Doctor Hertwig t e s t i f i e d t h a t as Ankeny's ward physician he had examined X-ray reports prepared by Doctors Pearlman, Edwards and McCowen. In response t o a request f o r ad- mission by Grunsteads, Ankeny admitted these reports were genuine. Pertinent portions of Doctor pearlman's report were put i n evi- dence by t h i s testimony: "Q. Well do you have a copy of Doctor Pearlman's l e t t e r there? A. Yes, the X-rays were taken i n February of 1970 a t the Denver VA Hospital and I w i l l read the reports as * * * A s seen by Doctor Pearlman, ' M r . Gerald Ankeny had a back fusion * * * i n February, 1969. X-rays of h i s back i n February of 1970 t o t h i s hospital, show a s o l i d fusion and s t a b l e back.' And then he goes on t o s t a t e * * * 'There i s no d i s a b i l i t y i n , and he i s able t o work, performing any a c t i v i t i e s t h a t he wishes. ' , and it i s signed by N. Pearlman, M.D." D r . Hertwig a l s o t e s t i f i e d from a hospital discharge summary dictated by a D r . Edwards f o r a hospitalization period running from August 13 through September 21, 1969. D r . Hertwig summarized t h i s report: "A. * * * the report a t t h a t time was t h a t M r . Ankeny complained of no radiation of pain down e i t h e r leg, and s t r a i g h t leg raising and neurologic examinations were e s s e n t i a l l y negative. His fusion was s t a t e d t o be moderately s t a b l e , and found t h i s patient t o be remark- ably normal physically. X-ray of the lumbar area was e s s e n t i a l l y normal and showed .thearea of previous fusion." D r . Hertwig a f t e r being shown an X-ray taken August 18, 1969, was asked: "Q. N o w with reference t o t h a t negative, is there anything there t h a t indicates any findings t h a t would indicate t o you t h a t there i s not a s o l i d fusion? A. No, there is not * * *.I' D r . Hertwig next made a comparison of two X-rays, one taken i n August 1969, before the accident, and one taken i n August 1970, about two months a f t e r the accident. The doctor's comparison e l i c i t e d the testimony t h a t the 1970 X-ray showed "some increased subluxation, slipping forward of t h i s vertebra, and I think you can see t h a t distance there, a distance of about one centimeter ." Preliminary t o posing a hypothetical question counsel s t a t e d , "Now from the f a c t s t h a t you have r e c i t e d so f a r , it would appear there was a fusion and t h a t following the fusion something happened which caused t h e X-rays taken i n 1970 t o show subluxation * * *.I! Because the "facts recited" had reference t o the reports read by D r . Hertwig, Grunsteads objected t h a t the f a c t s r e l i e d on i n the hypothetical question should not be given probative weight. While counsel did not a t t h i s time c l e a r l y s t a t e t h a t he was objecting on the ground of hearsay, subsequent objections t o the use of the reports leave no doubt t h a t hearsay was the basis of the objection. D r . Hertwig responded t o the hypothetical question by con- cluding t h a t there was "considerable possibility" t h a t the body blow received i n the accident would have a "likely * * * effect" on Ankeny ' s fusion. A t conclusion of D r . Hertwig's testimony on d i r e c t examina- t i o n , counsel f o r defendants moved: "MR. JONES: Prior t o cross examination of the doctor, counsel for the defendants moves t o s t r i k e any testimony and any opinions rendered by t h i s witness which a r e pre- dicated upon alleged factual reports by t h i r d p a r t i e s , not present i n the courtroom and not subject t o cross examina- t i o n , and moves * *-* t o s t r i k e any testimony based upon h i s own knowledge, based upon h i s own expertise. 11 In contradistinction t o Ankeny's medical evidence, Grun- steads called two expert witnesses, D r . McDonald and D r . Drouillard, s p e c i a l i s t s respectively i n orthopedic surgery and radiology. Both examined X-rays taken before and a f t e r the accident and each t e s t i - fied t h a t e s s e n t i a l l y the same degree of fusion f a i l u r e existed before the accident, as a f t e r the accident. It was D r . McDonald's conclusion t h a t the accident did not cause the fusion break down, and t h a t while it "may have aggravated the s i t u a t i o n * * * the aggra- vation was minimal compared t o the existing problem." The crux of Grunsteads' appeal i s t h a t unless the X-ray re- ports of D r . Pearlman and Edwards a r e given probative weight there is no substantial evidence t o support the conclusion the c o l l i s i o n was the cause of the fusion f a i l u r e , p a r t i c u l a r l y so i n t h e l i g h t of the contrary testimony by Grunsteads' medical experts. We, therefore, turn t o the question of what weight and consideration, i f any, should be given t o the medical reports objected t o by Grunsteads. W e find no d i f f i c u l t y i n holding the reports a r e per s e hearsay. Ankeny likewise does not question t h i s facet of defendants' objection t o the reports. Instead, Ankeny a s s e r t s there a r e other grounds justifying the reception and consideration of the reports by the t r i a l court, notwithstanding t h e i r hearsay nature. One of these grounds i s predicated on Grunsteads' request f o r an admission by Ankeny t h a t the reports i n question were genuine. Ankeny i n substance claims the request f o r admission of genuineness is tantamount t o Grunsteads introducing the contents of the report i n t o evidence, and having done so, they waive any objection t o Ankeny's use of the reports. This claim i s hardly worthy of note. Grunsteads repeatedly pointed out t h a t by asking for an admission of genuineness of the reports they were not conceding t h a t the information contained therein was true. Ankeny next suggests t h a t D r . Hertwig's reliance on the reports gave the reports probative value f o r t h e purpose of deter- mining t h e cause of t h e fusion break. W e disagree and hold the probative value of the reports is limited t o the use t h a t D r . Hertwig made of them. In making prognosis o r recommending treatment, doctors frequently r e l y upon medical diagnosis made by others who a r e experts i n a given specialty. Klaus v. Hillberry, 157 Mont. 277, 485 P.2d 54. D r . Hertwig's testimony c l e a r l y shows t h a t h i s use of the reports was limited t o advising Ankeny a s t o h i s condi- tion and future care. For t h i s limited purpose the reports were not objectionable on the ground of hearsay. Wallace v. Wallace, 85 Mont. 492, 279 P. 374. During the course of t r i a l , Ankeny sought t o have D r . Hertwig express opinions r e l a t i v e t o the fusion break. The record i s barren of any expert opinion by D r . Hertwig on the c r i t i c a l issue of whether the fusion was s o l i d o r broken p r i o r t o the accident. The absence of such an opinion is understandable. A t one point D r . k.twig frankly admitted t h a t he was not qualified t o i n t e r p r e t X-rays. When questioned on cross examination r e l a t i v e t o the c r i t i c a l issue, he s t a t e d he would have t o defer t o the opinion of a s p e c i a l i s t i n radiology and orthopedic surgery. In summary, the limiting circumstances of D r . Hertwig's use of the reports denied Grun- steads any opportunity t o t e s t the t r u t h of the reports by cross examination. The reports a r e therefore c l e a r l y hearsay and inadmis- s i b l e f o r the purpose of showing t h a t the accident was the cause of the fusion break. Shillingstad v. Nelson, 141 Mont. 412, 378 P.2d 393; Pickett v. Kyger, 151 Mont. 87, 439 P.2d 57. - 6 - With the X-ray reports removed from consideration, the next issue raised i s whether there i s s u f f i c i e n t evidence t o support the t r i a l court's judgment a s t o t h e cause of the back defect. W e keep i n mind the r u l e t h a t a t r i a l court's findings w i l l not be disturbed on appeal where there is substantial evidence t o support them. Olsen v. Sundling, 128 Mont. 596, 281 P.2d 499. In Sands v. Superior Bldg. Co., 136 Mont. 531, 349 P.2d 314, the Court explains substantial evidence: "Substantial evidence has been defined by t h i s court a s such evidence ' a s w i l l convince reason- able men and on which such men may not reasonably d i f f e r a s t o whether it establishes t h e p l a i n t i f f s 1 case, and, i f a l l reasonable men must conclude t h a t the evidence does not e s t a b l i s h such case, then it i s not substantial evidence. I " I n t h i s case, the determination of whether the fusion was s o l i d p r i o r t o the accident must necessarily be made by medical s p e c i a l i s t s s u f f i c i e n t l y competent t o assess the injury. It cannot be l e f t t o speculation, conjecture, inference o r guess. Graham v. Rolandson, 150 Mont. 270, 435 P.2d 263. A s said i n Bearman v. Prudential Ins. Co. of America, 186 F.2d 662, 665, (10th Cir.1951), "only a medical expert with training, s k i l l , and experience could form a considered judgment and express an i n t e l l i g e n t opinion." With respect t o causation the general r u l e as t o proof re- quired was s e t f o r t h by Judge Jameson i n Wilson v. Northland Grey- hound Lines, 166 F.Supp. 667, 675 (D.Mont. 1958): " ' P l a i n t i f f must prove by legally s u f f i c i e n t evidence t h a t a l l the i n j u r i e s f o r which he claims damages a r e properly a t t r i b u t a b l e , i n a medical sense, t o the acci- dent. While p l a i n t i f f need not e s t a b l i s h such causal connection with c e r t a i n t y , he must do so with reasonable c e r t a i n t y o r by a preponderance of t h e evidence. * * * There can be no recovery f o r an injury o r condition which t h e evidence shows might have resulted from two o r more causes, f o r only one of which defendant i s responsible. So, too, it is not s u f f i c i e n t f o r one seeking damages f o r a condition claimed t o have resulted from an acci- dent or injury t o show that such accident or injury might or could have caused the condition; other causes should be excluded. "I With the hearsay reports of Doctors Pearlman and Edwards excluded, and with D r . Hertwig eliminated as an expert, the only legally sufficient testimony relative t o the condition of the fusion before and a f t e r the accident i s that of D r . McDonald and D r . Drouillard which clearly refutes the contention the accident caused the fusion t o f a i l . W e therefore hold there i s no substan- t i a l credible evidence for the t r i a l court's conclusion the accident was the cause of the fusion failure. Ankeny next proposes that i f the evidence i s not sufficient to show the fusion failure was caused by the accident, then the evidence i s sufficient for the purpose of proving aggravation of the preexisting condition of h i s back. The case was not presented to the d i s t r i c t court on t h i s theory, but there is evidence t o sup- port some degree of aggravation. A s we understand Ankeny's reasoning, the general damages awarded by the court was primarily for the pain and anticipated continuing discomfort of the low back injury. H e argues it is unimportant whether the pain i s from the break of the fusion i n the accident, or from the aggravation of a preexisting fusion failure, because i n either instance the pain and discomfort w i l l be the same. From t h i s he deduces the damages should be the same. However clever t h i s argument may be, it does not take into account the f u l l scope of D r . McDonald's uncontradicted testimony. While the doctor's testimony gives medical support t o Ankeny's theory of aggravation, the doctor minimizes the aggravation by comparing it with the condition of Ankeny's back prior t o the accident. The flaw in Ankeny's contention is ,pointed out by the doctor. The pre- existing condition of the back was much more serious injurywise than the aggravation of that condition. We therefore cannot accept Ankeny's proposition the damages would be the same under either theory. We recognize Ankeny is entitled to some special and general damages, but a proper assessment of these damages would require a new trial. If Ankeny can prove no more than minimal aggravation, any recovery on a new trial might not justify the delay and expense involved. As a means of providing Ankeny an alternative to a new trial, the district court's judgment is modified to award damages in the total amount of $15,000. In fixing damages in this amount, the $409 for special damages allowed by the district court is not included for the reason there is no legally sufficient evidence of such damage. We also exclude all but $500 of the medical bill sub- mitted by the Veterans Administration for the reason that the medical treatment furnished by the Veterans Administration was primarily for physical and mental conditions not shown to be caused by the accident. If Ankeny should elect not to accept the judgment as modified, the judgment of the district court is reversed and the cause is remanded for a new trial on the issue of damages for aggravation of the injury. Judge, sitting for Chief Justice James T. Harrison. W e Concur: M r . J u s t i c e Frank I. Haswell, concurring i n p a r t and dissenting i n part: I concur i n the majority holding t h a t there is no sub- s t a n t i a l credible evidence t h a t the accident caused p l a i n t i f f ' s fusion f a i l u r e . I a l s o concur with the majority i n finding evi- dence t o support some degree of aggravation of a preexisting back injury. I cannot agree t h a t we, a s an appellate court, can separate and determine t h e amount of damages a t t r i b u t a b l e t o aggravation of the preexisting back injury from those a t t r i b u t a b l e t o t h e fusion f a i l u r e , reduce the judgment accordingly, and give the p l a i n t i f f the option of accepting the reduced award o r securing a new t r i a l . The t r i a l judge must make t h i s f a c t u a l determination and f i x the damages accordingly. I would award a new t r i a l on the amount of such damages. Justice. '-.