Opinion ID: 533630
Heading Depth: 2
Heading Rank: 1

Heading: Well, lets take a look at the record.

Text: 34 The oropharynx was clear. The tympanic membranes were normal. The chest was clear. And there were no upper respiratory symptoms. Now those are supporting symptoms and findings of flu. The testimony continued: 35 Q. If it were represented to you that the presenting clinical signs [of H-1-N-1] were vomiting, fever, no upper respiratory infection symptoms appeared until resolution of the vomiting and the fever, would these--the information you have in here be consistent with that? 36 A. No, and I'll tell you why. If it were presented to me as you just said, if the presenting symptoms of flu are vomiting, fever and no respiratory symptoms, in this child, you still have to contend with the dizziness and the lethargy. 37 Dr. Mendelsohn's critical testimony occurred when the defense attempted to impeach him by asking him how he knew Dr. Kruse had not seen hundreds of cases presenting exactly the same symptoms as Daniel's. Dr. Mendelsohn responded: 38 I assume that Dr. Kruse had seen lots of patients.... 39 Now I would predict that if one went through all the cases, and I've had an opportunity to look at some of them, but if one went through all the cases, I would predict that you will not find this combination of vomiting, dizziness, lethargy and absence of a supportable diagnosis. 40 Dr. Mendelsohn then examined several case histories, some selected by defense counsel at the court's invitation, purportedly to show case histories identical to Daniel's. Dr. Mendelsohn succinctly distinguished the symptoms and diagnosis of each one from Daniel's case history. 6 At this point, the government was unable to present any other extrinsic evidence to contradict Dr. Mendelsohn's testimony. 41 When a witness like Dr. Mendelsohn has given coherent and facially plausible testimony that is not contradicted by extrinsic evidence, a finding based on that testimony can virtually never be clear error. Anderson v. City of Bessemer, 470 U.S. 564, 575, 105 S.Ct. 1504, 1512, 84 L.Ed.2d 518 (1985); Palila v. Hawaii Dep't of Land & Natural Resources, 852 F.2d 1106, 1110 (9th Cir.1988). The district court's conclusions that Daniel's symptoms were not consistent with the flu, that Dr. Kruse should have been suspicious of meningitis and performed a spinal tap, and that Daniel's injuries were aggravated by the delay in treatment, have support in the record. Consequently, the government's contention on appeal that Daniel's flu developed into a rapidly fulminating meningitis after Dr. Kruse's March 4, 1984 diagnosis is a red herring. 42 Further, the government's argument that no evidence could demonstrate that a delay in diagnosis and treatment would have increased Daniel's injuries, because by the time meningitis is diagnosed most of the damage has been done, is not supported by the record. Dr. Kruse himself admitted that early diagnosis of meningitis has a profound impact on the patient's prognosis. Dr. Mendelsohn agreed that early treatment is vital: the outcome in meningitis is measured in terms of hours of delay in treatment. 7 43 The government's attempts to impeach Mrs. Yako's testimony regarding her son's symptoms on March 4, 1984, with evidence that she incorrectly recalled the location and the length of the examination are diminished by a medical history taken from her the following day. Dr. Freudenthal, who examined Daniel on March 5, 1984, recorded Marie Yako's description of Daniel's symptoms from Saturday, March 3, 1984. His notes mirror what she testified she told Dr. Kruse on Sunday, March 4, 1984. Dr. Freudenthal's notes state that Daniel was normal on Friday and that on Saturday he just lay in bed and vomited 15 or 16 times, did not seem to respond to verbal stimuli, could not sit or stand without help, and had a temperature of 101 degrees. The notes reflect the vomiting began on Saturday. This is strong evidence either that Mrs. Yako told Dr. Kruse what she testified she told him, or that he failed to elicit from her the history of Daniel's case as she described it to Dr. Freudenthal. Dr. Kruse admitted it is a physician's responsibility to obtain a thorough and accurate history. 44 After examining the entire available record of this case on appeal, we are not left with the definite and firm conviction that a mistake has been committed. Accordingly, the trial court did not clearly err in finding malpractice. 45 Whether The District Court Erred in Determining The Amount of Damages