Opinion ID: 2194743
Heading Depth: 1
Heading Rank: 3

Heading: Dr. Bechamp's Standard of Care Testimony

Text: The decision of whether to allow expert testimony is within the sound discretion of the trial court. District of Columbia v. Anderson, 597 A.2d 1295, 1299 (D.C.1991). In exercising this discretion, however, the court must act within the proper legal framework. See Gubbins v. Hurson, 885 A.2d 269, 278-79 (D.C.2005). Dr. Townsend makes two main arguments in support of his position that Dr. Bechamp's testimony from the de bene esse deposition testimony [11] should have been excluded: (1) it was outside the scope of the Hospital's Rule 26(b)(4) statement and (2) Dr. Bechamp changed without notice his testimony that Dr. Townsend violated the standard of care [12] by failing to hospitalize Ms. Donaldson on January 11th. The objections to Dr. Bechamp's standard of care testimony are based on claims of unfair surprise and undue prejudice. We address first the legal standard applicable to a claim of surprise and prejudice, and then the argument that the standard of care testimony should have been excluded because it was outside the Hospital's Rule 26(b)(4) statement. We conclude that Dr. Townsend suffered neither undue surprise nor undue prejudice from its admission. We then address separately his argument pertaining to Dr. Bechamp's testimony that Dr. Townsend breached the standard of care by not hospitalizing Ms. Donaldson on January 11th.
In Weiner v. Kneller, 557 A.2d 1306 (D.C.1989) we reversed the trial court for excluding testimony omitted from a Rule 26(b)(4) statement despite the fact that the appellant had notified the other side nine days before to anticipate this testimony. Weiner set out five factors for a trial court to consider when confronted with a claim of surprise and prejudice: (1) whether allowing the evidence would incurably surprise or prejudice the opposite party; (2) whether excluding the evidence would incurably prejudice the party seeking to introduce it (3) whether the party seeking to introduce the testimony failed to comply with the evidentiary rules inadvertently or willfully; (4) the impact of allowing the proposed testimony on the orderliness and efficiency of the trial; and (5) the impact of excluding the proposed testimony on the completeness of information before the court or jury. Id. at 1311-12. Application of those factors in this case leads us to conclude that the trial court did not err in admitting Dr. Bechamp's testimony. We begin with the question of surprise and prejudice.
At his de bene esse deposition, Dr. Bechamp gave opinions about the standards of care governing Dr. Townsend's performance of the bowel inspection and his failure to consult with another doctor in a timely fashion. Dr. Townsend's primary complaint is that the Hospital's Rule 26(b)(4) statement indicated that Dr. Bechamp would testify only as to the issues of causation and damages, and thus, he argues, the standard of care testimony was outside the scope indicated and therefore should have been excluded. This argument is unsupported by the record. The Hospital's Supplemental and Amended Rule 26(b)(4) statement set out the following anticipated testimony from Dr. Bechamp: He is further expected to testify that the small bowel cannot be visually inspected for damage in its entirety by means of a laparoscopy, and that the standard of care requires a laparotomy so that the bowels can be handled or visually inspected. He is further expected to testify that in connection with the plaintiff's readmission to Sibley Hospital, Dr. Townsend should have told Dr. DeRosa that he had removed some yellow tissue, believed to be fat, at the time the uterus was perforated, and he will comment on how this may have influenced the patient's management. Dr. Beauchamp [sic] will be asked to respond to and rebut at trial the specific opinions of the experts of other parties hereto. (Emphasis added). Thus, contrary to Dr. Townsend's claims, the Hospital's Rule 26(b)(4) statement did disclose that Dr. Bechamp was expected to testify on standard of care issues, [13] the plaintiff's readmission to the Hospital, and Dr. Townsend's consultation with Dr. DeRosa. While the Rule 26(b)(4) statement leaves room for testimony on these issues, even assuming that [the Hospital's] Rule 26(b)(4) statement was defective in this respect, we find no basis for reversal because the circumstances presented here satisfy the Weiner test. Kling v. Peters, 564 A.2d 708, 714 (D.C.1989) (affirming a trial court's decision to admit expert testimony on causation where the relevant Rule 26(b)(4) statement said only that he [would] focus upon the failure of the defendant . . . to render appropriate and adequate medical care and treatment). [14] Dr. Bechamp's testimony did not unduly surprise Dr. Townsend. The Hospital disclosed in the Joint Pretrial Statement that Dr. Bechamp is expected to render opinion testimony consistent with [the Hospital's] Rule 26(b)(4) Statement and his deposition. (Emphasis added). At his discovery deposition, Dr. Bechamp had testified repeatedly about standard of care issues. See id. at 714-15. Moreover, as Dr. Townsend concedes in his brief, the adversarial nature of the two defendants during trial alerted him that the Hospital might solicit expert testimony that he had violated the standard of care. In any event, a trial judge is not required to enforce the strict letter of a pretrial statement or 26(b)(4) statement as long as it determines that allowing expert testimony will not constitute unfair surprise at trial. See Bushong v. Park, 837 A.2d 49, 54 (D.C.2003) (Regardless of what the pretrial statement might or might not say about the expected testimony of an expert witness . . . the witness' testimony is properly admitted, notwithstanding any failure to mention certain words in the pretrial documents, if the actual testimony does not surprise the opposing party.). [15] Given Dr. Bechamp's prior statements addressing standard of care issues and the adversarial nature of the co-defendants at trial, we conclude that the admission of this testimony should not have unduly surprised Dr. Townsend. Furthermore, Dr. Townsend was not unduly prejudiced by Dr. Bechamp's testimony. Ms. Donaldson had cross-designated Dr. Bechamp as her expert and had listed him in the Joint Pretrial Statementa document signed by Dr. Townsend's counselas one of her witnesses. She described him as an expert witness for Defendant Sibley Memorial Hospital [who] may be called to testify on [the] breach of the standard of care as to both Defendants, as well as causation and damage issues. Thus, even if the trial court had not permitted the Hospital to ask Dr. Bechamp about the standard of care, Ms. Donaldson could have done so in accordance with her designation of him as a witness. Dr. Townsend argues specifically that the trial court's ruling prejudiced him because the court had previously precluded one of his experts, Dr. Fitzpatrick, from giving standard of care testimony regarding hospitalization. Even assuming this is true, Dr. Townsend has waived that argument because he failed to ask the trial judge for permission to recall Dr. Fitzpatrick in order to mitigate the harm. See 2101 Wisconsin Assocs. v. D.C. Dep't of Employment Servs., 586 A.2d 1221, 1225 (D.C.1991) (Petitioner never sought to recall claimant as a witness, and hence cannot claim prejudice from the examiner's restrictions.). See generally Williams v. Gerstenfeld, 514 A.2d 1172, 1177 (D.C. 1986) (As a general rule, matters not properly presented to a trial court will not be resolved on appeal.). Dr. Townsend asserts that recalling Dr. Fitzpatrick would have prejudiced him with the jury by extending the trial into the holidays, and cites the First Circuit case of Alberty-Vélez v. Corporación de Puerto Rico para la Difusión Pública, 242 F.3d 418, 426 (1st Cir.2001). [16] But at the time of the testimony at issue, Christmas was still over a week away and Dr. Fitzpatrick's office was nearby in Baltimore. Moreover, by not making the request, he foreclosed the possibility that the trial court could have fashioned an alternative solution. A party who fails to seek permission to recall a witness is on weak ground when he later asserts prejudice. Therefore, because we conclude that Dr. Bechamp's testimony did not incurably surprise Dr. Townsend, and that he did not preserve his claim of prejudice with respect to Dr. Fitzpatrick, [17] the first prong of the Weiner test is satisfied.
Regarding the second prong of the Weiner testwhether excluding the evidence would incurably prejudice the party seeking to introduce itwe conclude that the evidence was highly relevant to the Hospital's case and its efforts to show that Dr. Townsend's actions were the proximate cause of Ms. Donaldson's injuries. Dr. Townsend urges that the standard of care testimony was not relevant to the Hospital's defense because the Hospital did not need to establish that Dr. Townsend breached the standard of care to defeat Ms. Donaldson's claim. While it may not have been necessary for the Hospital to prove that Dr. Townsend violated the standard of care in order to show that it was not liable, such testimony was certainly relevant to its defense. See, e.g., Plough, Inc. v. Nat'l Acad. of Sciences, 530 A.2d 1152, 1158 (D.C.1987) (testimony is relevant when it has a `tendency to make the existence of [a] fact that is of consequence to the determination of the action . . . more probable . . . than it would be without the evidence.') (quoting FED. R.EVID. 401). A breach of the standard of care by Dr. Townsend could have led the jury to conclude that this breach was an intervening factor and that, therefore, any breach by the Hospital was not a proximate cause of Ms. Donaldson's injuries. See, e.g., District of Columbia v. Zukerberg, 880 A.2d 276, 281 (D.C.2005) (This court has defined proximate causation as that cause which, in natural and continual sequence, unbroken by any efficient intervening cause, produces the injury and without which the result would not have occurred.) (emphasis added) (citing St. Paul Fire & Marine Ins. Co. v. James G. Davis Constr. Corp., 350 A.2d 751, 752 (D.C.1976)).
The remaining prongs of Weiner require only brief analysis. As to the third prongwhether the party seeking to introduce the testimony failed to comply with the evidentiary rules inadvertently or willfullyDr. Townsend claims that the language of the Rule 26(b)(4) statement was a willful effort to deceive him. See Adkins v. Morton, 494 A.2d 652, 660 (D.C. 1985). The record does not support this conclusion. Rather than leave the term standard of care out of its statement entirely, the Hospital stated that Dr. Bechamp would provide such testimony and cross-referenced his pre-trial deposition, in which he discussed standard of care issues at length. Cf. Kling, supra, 564 A.2d at 714. With respect to the fourth prong whether there was an adverse effect on the orderliness or efficiency of the trialno such showing has been made. Finally, with respect to the fifth prongthe impact of excluding the testimony on the completeness of information before the jury this consideration strongly supports the trial court's decision to admit Dr. Bechamp's testimony.
Dr. Townsend also contends that Dr. Bechamp's testimonyelicited by Ms. Donaldson on cross-examination at Dr. Bechamp's de bene esse depositionthat the standard of care required Ms. Donaldson to be hospitalized by January 11th changed from his discovery deposition testimony taken approximately a year before, and that this change constitutes unfair surprise. This argument does not withstand scrutiny. At his discovery deposition Dr. Bechamp initially testified that, within a reasonable degree of medical certainty, Ms. Donaldson should have been hospitalized by January 11th. Under cross-examination, Dr. Bechamp stated that the standard of care did not require hospitalization, though it did require further evaluation on January 11th. In contrast, at his de bene esse deposition, Dr. Bechamp testified that the standard of care did require that Ms. Donaldson be hospitalized by January 11th. [18] When confronted with this apparent contradiction, Dr. Bechamp acknowledged, I would change that answer, based on the fact I did have an opportunity to review the x-rays. [At the time of my discovery deposition] [a]ll I had was a typewritten report. And when I looked at the x-rayswhen I saw the x-rays I would change my answer to that question. Dr. Bechamp also acknowledged that he had first seen the x-rays several weeks before the de bene esse deposition. Although Dr. Bechamp's testimony regarding the standard of care for hospitalizing Ms. Donaldson changed from his initial deposition, we conclude that the trial court did not abuse its discretion in admitting this testimony. While Dr. Bechamp did not testify during the discovery deposition that the standard of care required hospitalization on January 11th, he did testify, to a reasonable degree of medical certainty, that Dr. Townsend should have hospitalized her at that time. This changed testimony at the de bene esse hardly constitutes a startling reversal under the circumstances. Furthermore, Dr. Bechamp asserted in his discovery deposition that the standard of care required further follow-up testing on January 11th. Therefore, his overall position that Dr. Townsend had violated the standard of care was consistent because Dr. Townsend did not conduct such testing in a timely fashion. Read in its entirety, Dr. Bechamp's changed testimony was only marginally inconsistent with his original deposition. Finally, as the trial court noted, Dr. Townsend was able to use Dr. Bechamp's inconsistent testimony from his discovery deposition to impeach him at the de bene esse deposition, mitigating any prejudicial effect the change in testimony may have had. The trial court also instructed the jury about prior inconsistent statements as part of the jury instruction on impeachment. See Standardized Civil Jury Instructions for the District of Columbia No. 3.08 (2002 ed. rev.). In addition to his claim of surprise, Dr. Townsend urges that Dr. Bechamp's testimony was particularly prejudicial to him because it was the only evidence that he violated the standard of care by not hospitalizing Ms. Donaldson on January 11th. This is inaccurate. Ms. Donaldson's expert, Dr. London, testified that the standard of care required Dr. Townsend, as of January 11, 2000, to do [o]ne of two things. Hospitalize her for evaluation or observation . . . or diagnostic procedures [like a CT scan]. [19] Given the marginal nature of the inconsistency, the ability to impeach the testimony with the prior testimony, the trial court's instructions, and the lack of prejudice, we conclude that there was no error it its admission. [20]