Opinion ID: 2633506
Heading Depth: 3
Heading Rank: 2

Heading: The MCCP Proceedings in the Instant Case

Text: On August 7, 2000, the plaintiffs filed a medical tort claim before the MCCP, pursuant to HRS § 671-12, against twelve respondents as indicated in the table below: ----------------------------------------------------------------------------------------------- Respondent Description ----------------------------------------------------------------------------------------------- Dr. Pohlson the physician who performed the surgical biopsy ----------------------------------------------------------------------------------------------- Carlos E. Moreno-Cabral, M.D. cardiothoracic surgeon consulted during the biopsy ----------------------------------------------------------------------------------------------- Dr. Hattori the anesthesiologist who assisted in John's care during the surgical biopsy ----------------------------------------------------------------------------------------------- Mitsuo Hattori, M.D., Inc. Dr. Hattori's medical practice ----------------------------------------------------------------------------------------------- Dr. Vanderford a KMS-employed pediatric intensivist involved in the post-biopsy care and treatment of John ----------------------------------------------------------------------------------------------- Todd T. Kuwaye, M.D. a pediatric resident ----------------------------------------------------------------------------------------------- Dr. Moseley a surgical resident who assisted Dr. Pohlson in the surgical biopsy ----------------------------------------------------------------------------------------------- the Medical Center the hospital where John was admitted for evaluation and treatment ----------------------------------------------------------------------------------------------- KMS the physicians group which employed Dr. Vanderford ----------------------------------------------------------------------------------------------- The State of Hawai`i dba University the institution which conducts the residency training of Hawai`i John A. Burns School of program Medicine ----------------------------------------------------------------------------------------------- Hawai`i Residency Programs, Inc. a not for profit corporation which coordinated the residency training of Drs. Kuwaye and Moseley. ----------------------------------------------------------------------------------------------- John Does 1-10; Jane Does 1-10; unidentified defendants ----------------------------------------------------------------------------------------------- The plaintiffs alleged that the above respondents were negligent in their treatment and care of John and that Dr. Pohlson and Dr. Hattori failed to obtain informed consent from the plaintiffs regarding the course of treatment. Specifically, the plaintiffs alleged that KMS, under the doctrine of respondeat superior, [7] was vicariously liable for the negligent acts and omissions of its employee-physicians who treated John. On September 12, 2000, KMS filed a request for a more definite statement pursuant to HRS § 671-12(c) (1993), [8] seeking an order from the Department of Commerce and Consumer Affairs (DCCA) requiring the plaintiffs to name the specific employees of KMS whose care allegedly imposed vicarious liability, as well as the treatment by each such employee who was alleged to have breached the standard of care. Although no order was issued by the DCCA director with respect to KMS's request, the record reflects that the DCCA director, on September 21, 2000, entered an order granting the Medical Center's request (which it had apparently filed) for a more definite statement setting forth all of the facts upon which [the plaintiffs] base[d their] claim against [the Medical Center]. On September 29, 2000, the plaintiffs complied with the DCCA's order and submitted a second claim letter with additional factual information as to both the Medical Center and KMS, noting that, in addition to Dr. Vanderford, who is an employee of KMS and was named an individual respondent for her alleged negligence in John's post-operative care, the plaintiffs also alleged vicarious liability for the negligent acts of any and all other KMS employees connected with John's care treatment. In their second claim letter, the plaintiffs also included the following caveat: Please be informed that these further clarifications shall not be construed to limit [the plaintiffs'] theories of liability; and are subject to further modification based upon additional information as it becomes available. Thereafter, on October 3, 2000, the Medical Center filed its second request for a more definite statement, which was summarily denied. On October 20, 2002, KMS's counsel sent a letter to the plaintiffs' counsel, indicating that, because [the plaintiffs] have not voiced criticisms of any other [KMS]-employed physicians ..., we assume that the claim against [KMS] is based upon the alleged negligence of only Dr. Vanderford. Based on these assumptions, we have not re-filed a Request for More Definite Statement, but have prepared and submitted our Response to Claim. In response, the plaintiffs' counsel, in a letter dated November 3, 2000, stated: As you know, the MCCP process is jurisdictional, and many of the facts are not clear yet because no depositions have been taken. Accordingly, you should not assume that the claims against KMS are based upon the negligence of only Dr. Vanderford, as you suggest[ed] in your letter. It is possible that any of the other respondents may allege that another (currently unidentified) respondent did something below the standard of care, or my own expert might so opine. Realistically, absent further developments or information, I think KMS and any other employees, agents, apparent agents, ostensible agents, and/or agents by estoppel of KMS or any other respondents connected with John Duong's care and treatment will be deemed to be vicariously liable for their negligent acts and omissions. On October 22, 2000, the plaintiffs filed their MCCP pre-hearing statement, reiterating their position that, [d]espite knowledge that John had an extremely large mediastinal mass with significant narrowing of the trachea, one or more of John's health care providers failed to take necessary precautions against the risk of total airway obstruction. The pre-hearing statement included, inter alia, facts relating to Dr. Woodruff's examination of John, her discussion with John's parents, and her performance of a bone marrow aspiration to determine whether the tumor was cancerous. In response, KMS stated in its responsive pre-hearing statement that: The only claim of independent negligence asserted as to KMS related to care rendered by Dr. Vanderford who is alleged to have negligently monitored and treated [John's] condition, and conducted the intubation attempts, resuscitation efforts and the code blue. At the time of the hearing, it will be Dr. Vanderford's position that she was not consulted, and had no legal responsibility, with respect to the advisability of preoperative or intraoperative airway management. After the biopsy, when John was returned to the PICU, he was in respiratory distress, Dr. Vanderford attempted multiple interventions to remedy the situation. The fact that her resuscitation efforts were unsuccessful is no reflection of the quality of care rendered by Dr. Vanderford. The Medical Center also filed its pre-hearing statement, wherein it maintained that: In [the plaintiffs'] discussion of the facts regarding the allegedly deficient medical care provided to John [], [the plaintiffs] have not identified or named any specific person as being an allegedly negligent employee, servant, or agent of [the Medical Center]. [The plaintiffs] have not offered any specific criticisms of the nursing or support staff at [the Medical Center]. On January 24, 2001, the MCCP held a hearing on the plaintiffs' claims. At the hearing, Dr. Pohlson testified, asserting that she rejected the various treatments ( i.e., radiation therapy and/or administration of corticosteroid therapy) that could have shrunk the tumor on the basis of warnings and recommendations she received from Dr. Woodruff, who insisted she go ahead with the surgical biopsy without first shrinking the tumor. The plaintiffs claimed that this was the first time they were aware of Dr. Woodruff's substantial involvement in John's treatment. [9] The next day, the plaintiffs' counsel informed KMS, via a letter dated January 25, 2001, that: We have no earlier notice of Dr. Woodruff's alleged active role in the decision not to administer corticosteroid and/or irradiation therapy to John Duong; and, of course, discovery has not been available because it is not permitted in MCCP proceedings. Therefore, Dr. Woodruff was not named individually as a [r]espondent in the MCCP claim. However, based on the assumed accuracy of Dr. Pohlson's MCCP testimony regarding the extent of Dr. Woodruff's active involvement in the decision not to attempt to shrink the mediastinal mass pre-operatively, and by virtue of Dr. Woodruff's status as an employee and/or agent (ostensible, apparent or otherwise) of KMS ..., it is our position that KMS ... [is] vicariously liable for Dr. Woodruff's tortious acts and/or omissions in this matter. We will be proceeding on that basis, in part, in the First Circuit Court action which will be filed shortly after receipt of the MCCP's decision. On the same day, the MCCP issued its advisory opinion, finding no actionable negligence. On March 8, 2001, the plaintiffs filed their rejection of the MCCP's advisory opinion pursuant to HRS § 671-16.