Opinion ID: 2607402
Heading Depth: 1
Heading Rank: 3

Heading: limitation of plaintiff's cross-examination of defendant and defendant's expert witnesses.

Text: Plaintiff next contends her cross-examination of the defendant and defendant's witnesses on factors and elements underlying their opinions as to other possible causes of Bobby's injuries was erroneously restricted by the trial court. In medical malpractice actions, strong reliance has to be placed on expert rather than lay testimony. Goheen v. Graber, 181 Kan. 107, 115, 309 P.2d 636 (1957) (Robb, J., dissenting). The admission of expert testimony is based on necessity arising out of the particular facts of each case. Expert testimony is necessary where normal experience and qualifications of lay persons serving as jurors does not permit them to draw proper conclusions from the facts and circumstances of the case. State v. Hodges, 239 Kan. 63, 67, 716 P.2d 563 (1986). The following questions were asked on cross-examination of Dr. Buehler, a pediatrician/geneticist, who testified that Sandra's alleged drug use caused Bobby's injuries: Q. [by MR. SCHROER] What I'm trying to get at, is it possible that there can be just a few cells killed because the lack of oxygen again wasn't for very long or wasn't much a lack just a little bit. And then can there be some damage that  at all levels in between clear to death? MR. HECK: Objection to possibilities, Your Honor. .... MR. SCHROER: I think I should be allowed this line of questioning. THE COURT: Well, I think if you are asking about possibilities I think that's objectionable, I would sustain the question as you put it to the witness. You can inquire about that subject but not about possibilities. MR. SCHROER: I thought I should be permitted to do that on cross, Your Honor, not because of the same requirement on direct but I'll abide by your Honor's ruling. .... Q. [by MR. SCHROER] Let me ask you to assume as I've already showed you, the neurologist opinions of Dr. Mills, that there was hypoxic encephalopathy. Is it possible you could have both a teratogenic cause and also have a cause from the OB process or delivery that could result in hypoxic encephalopathy also? MR. HECK: Objection form, possibility Your Honor. THE COURT: Sustained. Similarly, the following questions were asked on cross-examination of Dr. Ransdell: Q. [by MR. SCHROER] Isn't it true a child can suffer some damage if the heart rate is below 100 for a prolonged period of time? MR. HECK: Objection to the form of the question. That has to be based on reasonable medical probability Your Honor. Also, not enough facts in the hypothetical which the witness can give an answer. MR. SCHROER: I would suggest it is cross-examination, Your Honor. MR. HECK: The standard [is] still the same if the Court please. THE COURT: Sorry? MR. HECK: The standard is still the same as it's related to the opinion unless we are dealing with guessing, speculation, and if we are, I think it has to be stated. .... Q. [by MR. SCHROER] Would you agree that a baby could suffer some damage, but it might be less, if it wasn't very long? MR. HECK: Objection, Your Honor, same objection, on foundation. He said he doesn't know. Also not based on reasonable medical probability. THE COURT: Yes, sustained. .... Q. [by MR. SCHROER] You can have brain damage without having hypoxia, can't you? MR. HECK: I am going to object again. Your Honor. Should be phrased as to reasonable degree of medical probability. And also foundation as relates to this witness. There is no pediatric neurologist. THE COURT: Well, sustained as to the standard only. .... Q. [by MR. SCHROER] Did I ask you if there was a possibility that there was stress on the baby? MR. HECK: Objection, form, possibility. THE COURT: Yes, sustained. .... Q. [by MR. SCHROER] Now, do you have  is it true that the more prolonged the heart depression is, the more serious is the damage from that depression? MR. HECK: Objection, calls for speculation unless we talk about probability, Your Honor. The same foundation objection, reasonable medical probability. THE COURT: I agree. The following question was asked on cross-examination of Dr. Buck, an OB/GYN, who testified that Bobby did not suffer hypoxic encephalopathy as a result of defendant's negligence. Q. [by MR. SCHROER] Okay. Let me ask you, then, is it possible that this Apgar is lower because of depression of the fetal heart tones between 11:59 and 12:58? MR. HECK: Objection, form as to possibility. THE COURT: Yes, sustained. During direct examination expert witnesses must confine their opinions to relevant matters which are certain or probable, not those which are merely possible. Nunez v. Wilson, 211 Kan. 443, Syl. ¶ 1, 507 P.2d 329 (1973) (emphasis added). When medical experts are giving opinion testimony, the expert must give such opinions within a reasonable medical probability. The expressions `probably,' `more likely than not,' and others of similar import are proper qualifications for a medical expert's opinion testimony if, taken as a whole, the testimony reflects an honest expression of professional opinion as to reasonable medical probabilities. 211 Kan. 443, Syl. ¶ 2. Plaintiff asserts that the reasonable medical probability standard does not apply to cross-examination because on cross-examination the expert witness is not testifying as to his or her opinion. She argues that on cross-examination, the attorney is attempting to discern the factors, elements, and mental processes considered by such expert in arriving at his opinion and that this is the only manner in which the credibility of the expert's opinion can be challenged. Once the trial court has determined that a witness is qualified to testify as an expert witness, the court cannot regulate the factors or mental processes used by the expert in reaching his opinion or conclusion on the case. The factors and mental processes used by the expert can only be challenged by cross-examination testing the witness' credibility. City of Bonner Springs v. Coleman, 206 Kan. 689, 695, 481 P.2d 950 (1971). Thus, to properly challenge the opinions and conclusions of an expert witness the examining party must be able to fully and effectively cross-examine the expert witness. The importance of cross-examination of an expert witness has been recognized in numerous decisions. In Timsah v. General Motors Corp., 225 Kan. 305, 317, 591 P.2d 154 (1979), we concluded that `[t]he latitude permitted in the cross-examination of an expert witness is even wider than in the case of an ordinary opinion witness.' (Quoting Bott v. Wendler, 203 Kan. 212, 228, 453 P.2d 100 [1969].) Great latitude is necessarily indulged in the cross-examination of an expert witness in order that the intelligence and powers of discernment of the witness, as well as capacity to form a correct judgment, may be submitted to the jury so it may have an opportunity for determining the value of his or her testimony. 225 Kan. at 317 (citing Bourgeois v. State Highway Commission, 179 Kan. 30, 34, 292 P.2d 683 [1956]). On at least two occasions we have recognized that a party may cross-examine physicians and expert witnesses regarding possible causes of an injury. In Gant v. Gas Service Co., 156 Kan. 685, 687, 135 P.2d 533 (1943), the court held that the district court did not err in allowing cross-examination of a physician regarding whether it would be possible for a person to have sustained a permanent injury from the kind of a fall described by plaintiff. (Emphasis added.) Similarly, in Timsah the court concluded it was appropriate to question these experts on other possible causes of the apparent defects. 225 Kan. at 317. (Emphasis added.) Cross-examination of expert witnesses on possible causes of an injury is appropriate. The trial judge improperly limited plaintiff's cross-examination of defendant's expert witnesses. If trial court error does not prejudice the substantial rights of a party, it affords no basis for a reversal of a judgment and must be disregarded. Hagedorn v. Stormont-Vail Regional Med. Center, 238 Kan. at 701. Our review of the record leads us to conclude that in this case the improper limitation of plaintiff's cross-examination of the experts was harmless error.