Opinion ID: 1955029
Heading Depth: 1
Heading Rank: 2

Heading: Admissibility of the Medical Malpractice Panel's Opinion

Text: Whether the Panel's written opinion was admissible as evidence at trial, even though it contained hearsay, is a question of first impression arising under the Health Care Malpractice Insurance and Litigation Act (the Act), 18 Del.C. ch. 68. The General Assembly adopted the Act in 1976, in response to what was perceived to be a crisis in the continued availability of medical care, as a result of medical malpractice litigation. In passing the Act, the General Assembly specifically decided to make make modifications to the Delaware legal system, as it relates to health care malpractice claims. The preamble to the legislation stated, in part: WHEREAS, the General Assembly determines it is necessary to make certain major modifications to its current legal system as it relates to health care malpractice claims if the citizens of Delaware are to continue to receive a high quality of health care while still assuring that any person who has sustained bodily injury or death as a result of a tort or breach of contract on the part of a health care provider resulting from professional services rendered, or which should have been rendered, can obtain a prompt determination of adjudication of that claim and receive fair and reasonable compensation from financially responsible health care providers who are able to insure their liability, under a strictly construed fault principal as now, at a cost which is not prohibitive and does not lead to the problems and practices described above, while still maintaining Delaware's overall legal system as to health care malpractice claims except as modified by this legislation. 60 Del.Laws ch. 373 (1976) (Preamble) (emphasis added); See also Lacy v. Green, Del.Super., 428 A.2d 1171, 1174 (1981). The Act itself provides: This chapter applies to actions, cases and proceedings brought after April 26, 1976, and also applies to any further conduct of actions, cases and proceedings then pending, except to the extent that application of this chapter would not be feasible, or would work injustice, in which event former procedures apply. 18 Del.C. § 6857. One of the major modifications to the Delaware legal system was the provision establishing medical malpractice review panels to the extent necessary to carry out the Act. 18 Del.C. § 6803. The statutorily prescribed function of a malpractice review panel is to render to the [Superior] Court a written opinion, including any minority opinion or opinions,  expressing findings respecting (i) the defendant's conformity with the applicable standard of care, (ii) whether there exists a material issue of fact that does not require expert testimony, and (iii) causation and the extent and duration of the plaintiff's injury or impairment. 18 Del.C. § 6811(b) (emphasis added). The statute explicitly requires that [a]ny opinion rendered by a malpractice review panel shall state the grounds upon which it is based and ... identify the persons, texts or other authorities which were consulted by the panel in reaching its conclusion. 18 Del.C. § 6811(c). This subsection also provides that the panel's opinion shall be admissible as prima facie evidence in any proceeding before the Superior Court. Id. (emphasis added). The Act provides two opportunities for challenging an opinion which is rendered by a medical malpractice review panel. The first is before a panel opinion is admitted as evidence at trial. 18 Del.C. § 6811. After a medical malpractice opinion is issued, any party aggrieved by an opinion of a panel has a right to file a pretrial application for review by the Superior Court. 18 Del.C. § 6811(d). Following its review, the Superior Court is authorized to strike any portion of the panel's opinion which the Court finds to be based on error of law or not supported by substantial evidence. 18 Del.C. § 6811(e). [12] To the extent that the [Superior] Court strikes any portion of the opinion, the Panel's conclusions are denied the prima facie admissibility in any subsequent trial provided by 18 Del.C. § 6812. Robinson v. Mroz, Del.Super., 433 A.2d 1051, 1053 (1981). A failure to assert these statutory pre-trial bases for challenging a panel's opinion, within the thirty-day requirement of 18 Del.C. § 6811(d), constitutes a waiver. Everett v. Nejad, Del. Supr., 493 A.2d 969, 971 (1985) overruled on other grounds Brooks v. Johnson, Del. Supr., 560 A.2d 1001, 1004 (1989). The second opportunity for challenge arises during the trial. 18 Del.C. § 6812. Section 6812 of the Act reiterates the provision in Section 6811 that a written opinion of a malpractice review panel shall be admissible as prima facie evidence in the pending Superior Court action brought by the claimant. (emphasis added). Thus, a panel's opinion, unless modified by the Superior Court, pursuant to the procedure set forth in 18 Del.C. § 6811, is admissible in the Superior Court trial. 18 Del.C. § 6812. Nevertheless, an opportunity to challenge a panel's opinion at trial is set forth in the Act, which provides that any party shall have the right to call, at said party's cost, any witness who appeared before or submitted reports to the malpractice review panel as a witness. 18 Del.C. § 6812. If called, the witness shall be required to appear and testify. Id. The Act expressly contemplates that the opinion of a medical malpractice review panel will contain hearsay. The Act mandates that a panel's opinion identify the persons, texts or other authorities [relied upon] by the panel members in reaching its conclusion. 18 Del.C. § 6811(c). [13] Therefore, by its very nature, every opinion of a medical malpractice review panel is an amalgamation of hearsay. If the admissibility of a panel's opinion at trial was subject to the ordinary hearsay rules, it would never be received as evidence. The statutory framework of the Act, which establishes medical malpractice review panels and the procedures for challenging panel opinions, is unique in its design and gives the opinion of a medical malpractice review panel independent evidentiary significance. The Act has withstood constitutional challenges based upon due process, equal protection and the right to trial by jury. DiFilippo v. Beck, 520 F.Supp. 1009 (D.Del.1981); Brooks v. Johnson, 560 A.2d at 1002 (the statute meets constitutional standards); Lacy v. Green, Del.Super., 428 A.2d 1171 (1981). We now hold that the methods which the Act provides for challenging the conclusions set forth in a panel opinion, before and during trial, are legally adequate, even though the Act precludes hearsay objections to the admissibility of a panel opinion at trial. See DiFilippo v. Beck, 520 F.Supp. at 1018; Brooks v. Johnson, 560 A.2d at 1003. To the extent that the Act has modified the procedures and rules of evidence which govern other legal proceedings in Delaware, it is controlling. 18 Del.C. § 6857. Section 6812, unlike Section 6811 of the Act provides no statutory basis for any judicially imposed limitation upon the admissibility of a malpractice review panel's written opinion, at trial, including any minority opinion or opinions. In sustaining Dr. Kanaga's hearsay objection, the Superior Court disregarded the change in the Delaware legal system created by the Act, which gave independent evidentiary significance to an opinion by a medical malpractice review panel. The decision of the Superior Court, not to admit the Panel opinion in this case, was contrary to the directives of the Act and, therefore, erroneous as a matter of law. Consequently, we must examine the effect of the Superior Court's decision denying the Russells' motion to admit the Panel opinion as evidence at trial. Section 6853 of the Act relieves the plaintiff of the obligation of presenting expert medical testimony, if a malpractice review panel has found negligence to have occurred and to have caused the alleged personal injury or death and the opinion of such panel is admitted into evidence. 18 Del.C. § 6853. In the Russells' case, a majority of the Panel found that Dr. Kanaga was not negligent. The admission of the Panel's entire opinion into evidence would have placed the minority view, in favor of the Russells' position, before the jury. However, the Act does not afford the minority view the status of prima facie evidence. Therefore, the Russells would still have been required to present expert testimony, or to establish the applicability of another exception to that requirement, in accordance with 18 Del.C. § 6853. If the Russells had succeeded in having the Panel opinion admitted into evidence at trial, it would have been a Pyrrhic victory. As evidence, the Panel opinion would have constituted prima facie evidence that Dr. Kanaga was not negligent. 18 Del.C. § 6812. In this case, the Superior Court's decision not to admit the Panel opinion, at the Russells request, was not reversible error.