Opinion ID: 2583948
Heading Depth: 1
Heading Rank: 9

Heading: Did the district court err in precluding the appellants' retained expert from offering opinions as to the standard of care for an infectious disease consultant?

Text: [¶ 36] Dr. Tredal, the appellants' emergency medicine expert, testified that the standard of care required Dr. Hrabal to consult with an infectious disease specialist: Q. Do you consult with infectious disease consultants in the emergency room? A. Yes. Q. Often? A. Reasonably  relatively frequently, yes. Q. On cases like this? A. Sure. Q. And in this presentation would that have been reasonable and appropriate? A. Yes, particularly if you weren't sure, if you hadn't been able to reasonably evaluate the patient yourself, sure. In later following up on this line of inquiry with Dr. Green, the appellants' counsel attempted to establish what the infectious disease consultant would do when brought into the case: Q. Now, if you had been called to the emergency room that day for a consultation, would a reasonable and prudent infectious disease consultant have been required to rule out a differential diagnosis of primary or secondary bacterial infection? A. Yes. An infectious disease specialist would have done that. But I think it is also important to know that any medical physician  MR. RUTLEDGE: Excuse me, Your Honor. I'm going to object to the last part of the answer as being nonresponsive. THE WITNESS: I'm sorry, Your Honor. THE COURT: Restate your question. Let's hear the answer one more time. Q. (BY MR. PICKERING): Well, would an infectious disease consultant having been called to the emergency department be required to rule out in the differential diagnosis in Mr. Armstrong? THE COURT: That calls for a yes or no. THE WITNESS: Yes. Q. (BY MR. PICKERING): And that would have been on February 28, '99? A. That's correct. Q. And what would a reasonable infectious disease consultant, reasonable and prudent infectious disease consultant would have had to do to rule it out? I mean what  tell me what they should have done? MR. RUTLEDGE: I don't know what the relevance is of what an infectious disease specialist would have done, Your Honor. MR. PICKERING: It is relevant, Your Honor, because  THE COURT: Just a minute. Sustained. MR. PICKERING: May I make an argument, please? THE COURT: Just a minute. Don't make arguments before the jury. (Whereupon the following proceedings were had at the bench.) THE COURT: Okay. Lower your voice. MR. PICKERING: Dr. Tredal testified that consultation would have been appropriate with an infectious disease consultant and required by the standard of care. If that had happened and one had been called, then I think he's entitled to testify what would have occurred. THE COURT: Kent? MR. RUTLEDGE: I don't think it makes any difference. In this case they did call an infectious disease specialist later on in the course of the case. And we know what did occur. THE COURT: I'm going to sustain the objection. [¶ 37] During the pretrial hearing upon the appellants' motion in limine directed at Dr. Stevens' standard of care testimony, the appellees argued that the question of causation and the question of standard of care were inextricably interwoven. That same concept leads to the conclusion that the district court erred in sustaining the appellees' objection to Dr. Green's testimony as to what an infectious disease consultant would do if called into the emergency room. Dr. Tredal testified that the standard of care required Dr. Hrabal to consult with an infectious disease specialist. It would be impossible for the jury to decide whether or not Dr. Hrabal's failure to seek such consultation played any part in causing the appellants' damages without knowing what the infectious disease specialist would do. If, for instance, the infectious disease experts agreed that a reasonable and prudent specialist in their field would do nothing more than what Dr. Hrabal had already done, then the failure to seek a consultation would have no causative effect. [¶ 38] The appellants did not make an offer of proof when the appellees' objection to Dr. Green's testimony was sustained. In this Court, they contend that Dr. Green would have testified as follows in accordance with his disclosure: [T]hat a reasonable and prudent infectious disease specialist should have, at a minimum, ordered the tests identified above, including blood cultures with gram stains, if not already obtained. It is likely that culture results would have been returned within 12 hours, if not earlier, and would have been positive. Gram stains could have provided earlier important information. Mr. Armstrong should have then been immediately treated with IV antibiotics appropriate to the results of the gram stain and appropriate to a patient with his allergies. [¶ 39] Despite the district court's abuse of discretion in sustaining the appellees' motion, we will affirm the decision of the district court because there was no resultant prejudice to the appellants. Dr. Green's testimony takes up 227 pages of trial transcript. During the course of his testimony, he answered numerous questions about the matters quoted above from his disclosure, and his testimony contained detailed information about what tests should have been performed when Armstrong entered the emergency room, what antibiotics he should have been given, and the likelihood that those antibiotics would have prevented the endocarditis. The clear impact of Dr. Green's testimony was a statement of what an infectious disease specialist would have done had he or she been called in for a consultation.