Opinion ID: 2332096
Heading Depth: 1
Heading Rank: 1

Heading: Future Surgery

Text: The record shows that the plaintiff has been experiencing pain in his neck and lower back with consequential partial disablement ever since the accident and that, notwithstanding a course of conservative treatment for some four years, the wearing of a cervical collar for about six months, the use of a traction gear prescribed by one of the doctors, his submission to heat therapy, his faithful compliance with all medical advice, his unceasing search for relief and rehabilitation from a variety of medical practitioners in the general practice of medicine, including highly skilled doctors in the field of neurology and orthopedic surgery, Michaud, so he testified, still suffers with little improvement from the constant pain in his neck and lower back brought on by the accident. Chiropractic and psychiatric treatment also proved fruitless. Dr. Victor Parisien, the plaintiff's expert witness whose qualifications as an orthopedic surgeon were admitted, diagnosed the plaintiff's ailment as a herniation, a ruptured disc or discs in the neck and in the lumbar area. Hard to say how many, but at least one in each level. The doctor further testified that, after four years, Michaud had reached perhaps not a plateau, but, I don't think that he's going to improve any, and, yes, I think he's reached almost an end point. I think that the only thing that can happen now is, it can get worse. He specifically found as established from the plaintiff's limitation of movement and the x-rays a permanent impairment at twenty percent of the body of the neck so far as his neck injury was concerned, and twenty percent of the body in regard to his back injury, or a total permanent physical impairment of forty percent. Dr. Thomas F. Shields, another orthopedic surgeon and witness for the plaintiff, also testified to the permanent character of Michaud's physical condition: Pain is something I can't see or feel for the patient, but, from examination and everything, it's lasted so long, I think it's probably permanent in his situation. Dr. John P. Greene, an orthopedic surgeon and witness presented by the defense, confirmed the plaintiff's chronic cervical strain which in the doctor's opinion had reached an end result. But there was medical evidence in disagreement respecting the permanent character of the plaintiff's condition. In other words, it was an issue in the case, whether Michaud's pain problem as he described it in his testimony, as well as his physical impairment resulting from the accident, was a permanent condition. It is in connection with the question of the permanency of the plaintiff's pain involvement that the issue of future surgery to relieve the pain arose. In estimating the results of a fusion operation, which involves an excision of the ruptured disc, possibly with a fusion of the spine, both in the neck and in the lumbar area in this case, Dr. Parisien testified that the results for pain relief are not one hundred percent, but may reach only fifty to seventy percent and, in some cases, people are made worse by this type of surgery. Indeed, Dr. Parisien was asked on direct examination: Q. At the time of your examination, did you make a determination as to whether or not there would be a surgical procedure which would be available on election by Mr. Michaud, which might correct this situation? A. Well, there is a possibility that surgery may be necessary. I haven't actually proposed it to him, so far, because the results - - - [Defendant's counsel]: Your Honor, unless it's a probability, then, I object. I believe that the reason for the requisite certainty has not been established for such procedure, and I would object to any testimony as being speculative. [Plaintiff's counsel]: It's preliminary question, your Honor. I'm going to get into that. The Court: I'll permit the answer. You may answer. A. I would - - - I haven't really proposed. I have proposed some forms of treatment to Mr. Michaud in an attempt to relieve him of some of his pain, and I think primarily, he should have further conservative non-operative treatment, and, if that fails, then, a consideration could be given to operation. Following the doctor's answer that he was not proposing any surgical intervention at that time, a specific and limited answer which the Court below had permitted, counsel for the plaintiff asked Dr. Parisien what sort of operation he was talking about. Without objection and without any request for a limiting instruction from the Court, the doctor was allowed to give a brief description of the mechanics of a fusion operation. Through cross-examination, counsel for the defendant sought to have the doctor concede that surgery would be advisable only if there were evidence of progressive neurological deficit, a contention with which the doctor disagreed, although admitting that some doctors do subscribe to the same. At any rate, no motion to strike the doctor's testimony was made at the close of his court appearance. Similarly, Dr. Shields was permitted to give a more elaborate description of a fusion operation without objection or reservation and without any request to limit the purpose of such evidentiary details of an operation which was not being recommended at the time and which was elective on the part of the plaintiff at any rate. Furthermore, the doctor was allowed to state the length of hospital confinement in such operations. As with Dr. Parisien, the defendant's counsel on cross-examination of Dr. Shields had the doctor concede that only in some cases would surgery be advisable in the absence of progressive neurological deficit. Again, no motion to strike the doctor's testimony relating to surgery was made at the termination of his court appearance. It is only at the close of all the evidence that counsel for the defendant moved to strike so much of Dr. Parisien's and Dr. Shields' testimony as dealt with the disc surgery. Defendant's counsel, in support of his motion, stated to the Justice below that he had objected initially and believed there was a continuing objection to such testimony. Plaintiff's counsel advised the Court that it was agreed he [defendant's counsel] had a continuing objection; nevertheless, he argued that the plaintiff's position was that the possibility of the disc operation is part of the overall medical picture of what Michaud faces for the future and that, since no evidence of the costs of the operation or hospital confinement had been introduced, no prejudice had resulted to the defendant. The Court denied the motion, ruling that [t]here's sufficient evidence for the jury to consider these matters. We agree with the defendant's contention it is well settled law that damages are not recoverable when uncertain, contingent, or speculative. Damages must be grounded on established positive facts or on evidence from which their existence and amount may be determined to a probability. They must not rest wholly on surmise and conjecture. Gottesman & Co. v. Portland Terminal Co., 139 Me. 90, 27 A.2d 394 (1942); Lawson v. McLeod, 152 Me. 67, 123 A.2d 199 (1956); Ginn v. Penobscot Company, Me., 334 A.2d 874, 887 (1975). See also State v. Mitchell, Me., 390 A.2d 495 (1978). A mere possibility that future pain or suffering might be caused by an injury, or that some disability might result later therefrom is not as such sufficient to warrant an assessment of damages therefor. Mere surmise or conjecture as the term possibility usually connotes cannot be regarded as legal proof of an existing fact or of a future condition that will result. Expert witnesses can give their opinion respecting future consequences that are shown to be probable, from which it may be inferred that they are reasonably certain to follow. [2] See Stevens v. Illinois Cent. R. Co., 306 Ill. 370, 137 N.E. 859 (1922); Michalski v. Wagner, 9 Wis.2d 22, 100 N.W.2d 354 (1960); Hahn v. McDowell, 349 S.W.2d 479, 482 (Mo.App., 1961); Healy v. White, 173 Conn. 438, 378 A.2d 540 (1977); Evans v. Liquori, 374 A.2d 774 (R.I., 1977). There must be evidence of the probability of surgery recommendation before the medical expert may testify about a possible need of a future operation. See Ernshaw v. Roberge, 86 N.H. 451, 170 A. 7 (1934). In the instant case, notwithstanding the plaintiff's testimony that Dr. Shields had suggested an operation, both Dr. Parisien and Dr. Shields himself expressly stated they had not as yet recommended surgery. However that may be, the offending evidence was not wholly irrelevant. The plaintiff was seeking damages for an injury which he claimed to be permanent. The permanency of his injury was in dispute. The plaintiff's injury could not be considered a permanent injury if the permanency of the injury could have been avoided by submitting to treatment by a physician, including surgery, when a reasonable person would do so under the same circumstances. There is a positive duty upon a person injured through the negligence of another to minimize his damages and to use reasonable diligence in securing medical or surgical aid. Wells v. Gould and Howard, 131 Me. 192, 160 A. 30 (1932); see also Potts v. Guthrie, 282 Pa. 200, 127 A. 605 (1925); Cero v. Oynesando, 48 R.I. 316, 138 A. 45 (1927); Ouillette v. Sheerin, 297 Mass. 536, 543, 9 N.E.2d 713, 717 (1937); Budden v. Goldstein, 43 N.J.Super. 340, 128 A.2d 730 (1957). Thus, the plaintiff had the burden of proof that his injury is a permanent condition, i. e. a condition which he could not avoid wholly or partially by submitting to reasonable surgical treatment. Even though the defendant has the burden of proving that the plaintiff unreasonably failed to mitigate his damages by submission to surgery, evidence having a tendency to show that the surgical operation to effect a cure or lessen the pain in an effort to minimize damages would involve substantial hazards with doubtful results is relevant in support of the permanency of the injury. Where the evidence in the instant case was that the plaintiff's injury would otherwise be permanent, it was proper to have the jury consider the nature of the surgical treatment available, its chance of success, the accompanying pain and suffering involved, to determine if under the circumstances a reasonable person might well decline to undergo the surgical intervention, even if recommended, a refusal to submit to the same under such circumstances imposing no restriction against recovering full damages for the injury as a permanent one. Zimmerman v. Ausland, 266 Or. 427, 513 P.2d 1167, 62 A.L.R.3d 1 (1973); see also Casimere v. Herman, 28 Wis.2d 437, 137 N.W.2d 73 (1965); Couture v. Novotny, 297 Minn. 305, 211 N.W.2d 172 (1973); Hildyard v. Western Fasteners, Inc., 33 Colo.App. 396, 522 P.2d 596 (1974). [3] If the defendant was of the opinion that the evidence of the details of the possible operations might be too prejudicial, in that its probative value under the circumstances might be substantially outweighed by the danger that such evidence might submerge the issues in a sea of unfairness or mislead the jury respecting the particular purpose for which it might be considered, he should have sought its exclusion on that ground (M.R.Evid. 403), or should have requested a limiting instruction (M.R. Evid. 105). Absent such specific articulation or such request to limit the scope of such evidence, we must assume that the defendant was not insisting on his original objection. See State v. Rogers, Me., 389 A.2d 36 (Opinion August 2, 1978). Furthermore, the tendered concession, made by counsel for the plaintiff at the time of the defendant's motion to strike the evidence of Dr. Parisien and Dr. Shields at the close of all the evidence, to the effect that counsel for the parties had agreed that the defendant's original objection would be considered as a continuing objection, was not compelling upon the Justice below. He did not agree to treat it so, and under the circumstances of this case we cannot say that there was an abuse of discretion on the part of the trial Court. From this record, there is nothing to indicate that the presiding Justice was, or should have been, aware at the time the evidence was introduced that the defendant was maintaining his objection thereto. The rule is well established that objections to evidence should be stated at the time it is offered, and with sufficient definiteness to apprise the court and the opposite party of the precise grounds of the objection; and all objections not thus specifically stated, should be held to be waived. (Emphasis provided). State v. Savage, 69 Me. 112, 114 (1879). To the same effect, see Monroe Loan Society v. Owen, 142 Me. 69, 46 A.2d 410 (1946). The requirement of contemporaneous objection to evidence which a party believes to be inadmissible is a salutary one. Its chief purpose is to afford the trial court an opportunity to rule on the evidence before it is heard by the jury. To await the close of the evidence and seek for the first time to rule out evidence by motion to strike, if such procedure were allowed as an ordinary trial practice, would frustrate the beneficial objectives of the simultaneous objection rule, so-called, would lead to abuse and subject the parties to unnecessary costly retrials. Additionally, a review of the evidence convinces us that the admission of the doctors' description of the possible disc operations which they had not as yet recommended, even if the defendant's objections had been timely taken, did not in this case prejudice the defendant in connection with the amount of the damages the jury awarded the plaintiff. It was stipulated that the plaintiff had a life expectancy of twenty-one years and a work time potential of thirteen years. The jury could find from the evidence that the plaintiff was permanently disabled to the extent of forty percent of his body, that he would be unable personally to participate in his tree removal and paving business during the thirteen years of his work expectancy and that for the rest of his life he would be tormented by the pain and suffering which has been his lot since the accident. We cannot say that it would have been unreasonable for the jury to render the award which they did, even if the evidence of the possible disc operations had been kept out of the case. [4]