Opinion ID: 1489278
Heading Depth: 1
Heading Rank: 4

Heading: Obstructing or Precluding the Testimony of Various Witnesses

Text: Coulter argues that the trial court abused its discretion in block[ing] Coulter's efforts to obtain expert testimony from various witnesses that Coulter questioned or wished to call. We preface our analysis with a discussion of the expert testimony that is relevant and required in a medical malpractice action in this jurisdiction. The plaintiff in a medical malpractice case bears the burden of proof on three issues: the applicable standard of care, a deviation from that standard by the defendant, and a causal relationship between that deviation and the plaintiff's injury. Woldeamanuel v. Georgetown Univ. Hosp., 703 A.2d 1243, 1244 (D.C. 1997) (citation and internal quotation marks omitted). Each of these elements must usually be proved by expert testimony. Id., citing Cleary v. Group Health Ass'n, 691 A.2d 148, 153 (D.C.1997) (Generally, in a medical malpractice negligence action, the plaintiff must present medical expert testimony to establish the standard of care, expert testimony that the defendant's conduct deviated from that standard of care, and expert testimony establishing that the alleged deviation proximately caused the plaintiff's injuries) (citations omitted). The personal opinion of [a] testifying expert as to what he or she would do in a particular case ... is insufficient to prove the applicable standard of care. Strickland v. Pinder, 899 A.2d 770, 773 (D.C.2006) (quoting Travers v. District of Columbia, 672 A.2d 566, 568 (D.C. 1996)). Rather, the testifying expert must establish that the relevant standard of care is followed nationally, either through reference to a published standard, discussion of the described course of treatment with practitioners outside the District at seminars or conventions, or through presentation of relevant data. Strickland, supra, 899 A.2d at 773-74 (internal punctuation and citations omitted); Snyder v. George Washington Univ., 890 A.2d 237, 241 n. 3 (D.C.2006) (standard-of-care testimony must reflect some evidence of a national standard, such as attendance at national seminars or meetings or conventions, or reference to published materials, when evaluating a medical course of action or treatment). Further, an expert's educational and professional background is not sufficient to demonstrate that he is familiar with the national standard of care. Strickland, supra, 899 A.2d at 774; Nwaneri v. Sandidge, 931 A.2d 466, 467 (D.C.2007) (Dr. Woratyla's expertise in the field of vascular surgery, standing alone, without specific testimony or evidence in the record establishing the basis for his knowledge of the national standard of care ... was insufficient to lay the proper evidentiary foundation to allow Dr. Woratyla to give expert opinion testimony that appellant deviated from the standard of care). Where the expert makes no attempt to link his testimony to any certification process, current literature, conference or discussion with other knowledgeable professionals, there is no basis for his discussion of the national standard of care. Strickland, supra, 899 A.2d at 774. `[I]t is insufficient for an expert's standard of care testimony to merely recite the words `national standard of care.' Strickland, supra, 899 A.2d at 773 (quoting Hawes v. Chua, 769 A.2d 797, 806 (D.C.2001)). On the other hand, the fact that an expert did not expressly use the words `national standard' when stating his expert opinion does not, in itself, render his opinion inadmissible; rather, [o]ur primary concern is whether it is reasonable to infer from [the] testimony that such a standard is nationally recognized. Snyder, supra, 890 A.2d at 245 (citations and internal quotation marks omitted). Once an expert explicitly indicate[s] the basis for his or her knowledge of the national standard of care, he may state what the national standard of care is. Hill, supra, 933 A.2d at 328 (emphasis omitted). It is counsel's duty to lay the necessary foundation to establish that an expert is competent to testify about the national standard of care. Id. The trial judge has wide latitude in the admission or exclusion of expert testimony, and his or her decision with respect thereto should be sustained unless it is manifestly erroneous. Hawes, supra, 769 A.2d at 801 (internal punctuation and citation omitted). [A] trial judge is not obliged to qualify a proffered expert when there are articulable reasons to doubt his competency. Glorious Food v. Georgetown Prospect Place Assocs., 648 A.2d 946, 948 (D.C.1994).

Coulter first sought to present standard-of-care testimony by Dr. Woodyear, whom Coulter offered as an expert with respect to, inter alia, the handling of breast cancer complaints by primary care physicians and the scheduling of diagnostic procedures. After Coulter's counsel had questioned Dr. Woodyear at length during voir dire, the court ruled that he would not be permitted to testify. Coulter now complains that the trial court obstructed her effort to establish Dr. Woodyear's qualifications by disallowing questions and answers pertinent to his qualifications and by harassment. We reject that claim as well as Coulter's claim that the trial court improperly precluded Dr. Woodyear from giving standard-of-care testimony. It is true that the trial court sustained many of the steady barrage of objections that defendants' lawyers raised to questions that Coulter's counsel posed to Dr. Woodyear. But, the transcript shows, those rulings were occasioned by questions that persistently were vague or ambiguous, or that lacked foundation, called for speculation, had already been asked and answered, or sought answers about legal concepts, [21] or that attempted to lead the witness toward the definition [of standard of care] that he couldn't give in his deposition. [22] The court also struck a number of Dr. Woodyear's answers because they were non-responsive or because, in his answers, Dr. Woodyear gave expert opinions before he had been accepted to testify as an expert. But the court also overruled a number of defense counsel's objections (stating, e.g., that Coulter's counsel has to start somewhere) [23] and several times the court attempted to assist Coulter's counsel, instructing him to fix [his] question or to make it more specific or to take another stab. On this record, we cannot agree that the court improperly obstructed Coulter's presentation of evidence. Judge Combs Greene provided a detailed explanation of her ruling that Coulter had failed to establish a foundation for Dr. Woodyear to give standard-of-care testimony. [24] We need not discuss all aspects of her ruling. It suffices to note that, although Dr. Woodyear described his extensive experience in performing breast examinations and referring patients with breast cancer complaints, nothing in his testimony established that he attended national conferences, or kept current with pertinent medical literature, from which he would be familiar with the national standard of care. [25] Cf. Nwaneri, supra, 931 A.2d at 471 (referring to attendance at national meetings and keeping current with the state of the medical art as a minimally sufficient foundation for giving standard-of-care testimony) (quoting Hawes, supra, 769 A.2d at 808). Accordingly, the trial judge did not err in ruling that he would not be permitted to offer standard-of-care testimony. Nor  in light of the trial court's wide latitude in the admission or exclusion of expert testimony, Hawes, supra, 769 A.2d at 801  can we say that the trial judge abused her discretion in ruling that although Dr. Woodyear could perhaps qualify as an expert in family care medicine, his inability to give standard of care testimony would confuse the jury and call for the jury to speculate since what would happen is he would be called upon to opine about Dr. Taylor's actions or inactions or his care... but he wouldn't be able to talk about whether that fell below the standard required.
Coulter offered Dr. Abel, a physician who is Board-certified in internal medicine and oncology, as an expert in the medical evaluation and care of breast abnormalities. Coulter's counsel proffered that Dr. Abel would testify that had proper measures been pursued when Coulter was seen by Dr. Taylor at Gerald Family Care, Coulter's breast cancer would have been identified. Defense counsel objected to Dr. Abel's qualification to offer standard-of-care testimony on the grounds, inter alia, that his practice does not entail evaluating patients who present for the first time with breast complaints. The trial court ruled that Dr. Abel could present expert testimony about oncology generally, but deferred ruling on whether he could address standard-of-care issues. Whether Dr. Abel was qualified to testify on standard-of-care issues presents a somewhat closer question than did the same issue with respect to Dr. Woodyear. As our case law establishes, Dr. Abel was not incompetent to testify as an expert on standard-of-care issues affecting defendants merely because he is not a specialist in the particular field of which he speaks. Haidak v. Corso, 841 A.2d 316, 323 (D.C.2004) (quotation marks and citations omitted). And, Dr. Abel did testify that he attends interdisciplinary breast conferences where practitioners in various medical specialities present all of the new or current cases of breast cancer and the cases are discussed among the different specialities to promote effective management and discuss the techniques and technologies used in the evaluation of breast abnormalities. At least arguably, this testimony provided a minimally sufficient foundation for him to give standard-of-care testimony. Cf. Nwaneri, supra, 931 A.2d at 473 (listing discussion with other knowledgeable professionals in a list of credentials  any of which would have been legally sufficient to establish a basis for [expert's] discussion of the national standard of care) (emphasis added). However, we need not pause over whether it was error to preclude Dr. Abel from presenting standard-of-care testimony as to Dr. Taylor and Gerald Family Care, because it appears from the record that neither Dr. Abel nor any of Coulter's other witnesses would present causation testimony as to these defendants (or as to Dr. Asomani). Defense counsel advised the court  in stark contrast to the proffer that Coulter's counsel made as to the doctor's expected opinion testimony at trial  that in his deposition Dr. Abel testified that he would not opine as to whether Coulter had a palpable lump at the time she saw Dr. Taylor in 2001, or whether a lump would have been detected by mammogram at that time, or whether Coulter had a breast tumor at that time. [26] Even if we assume that the trial court erred in precluding testimony by Dr. Abel that Dr. Taylor and Gerald Family Care breached the standard of care, the portions of the record available to us suggest that the error was harmless with respect to Coulter's ability to prove the elements of her case against these defendants and afford us no basis for disturbing the court's ruling.
Explaining to the court that Dr. Joe D. Haines, a family care practitioner, was out of the country and not available to testify at trial, Coulter's counsel asked the court to permit him to read into the record pertinent portions of Dr. Haines's deposition testimony. Dr. Haines had testified during his deposition that all of the defendants violated the standard of care by not ordering, or by their delay in ordering, a mammogram. Having read the portions of Dr. Haines's deposition transcript that defendants offered, the court denied Coulter's request. The court observed that Dr. Haines had offered only personal opinion, acknowledged explicitly that he was not able to testify to standard of care, and, when asked about pertinent literature on mammograms, was unable to cite any. [27] Coulter now argues that other wrongfully excluded evidence or the testimony of defendants' experts may have shown that Dr. Haines' opinion was nationally recognized. However, it was Coulter's counsel's duty to lay the necessary foundation for Dr. Haines's testimony to be admitted as standard-of-care testimony. [28] Hill, supra, 933 A.2d at 328. Coulter's counsel failed to lay that foundation, and so the trial court did not err in excluding his testimony. [29]