Opinion ID: 1960120
Heading Depth: 1
Heading Rank: 1

Heading: Cross-Examination of Defendant's Witnesses on the Basis of Learned Treatises

Text: During the course of the trial, counsel for plaintiffs used articles contained in various medical publications to cross-examine both Dr. Wesselhoeft and his expert witness, Dr. Peter Altman (Dr. Altman). Two medical treatises, one entitled Complications of Pediatric Surgery, and another entitled Complications in Surgery and Trauma, were authenticated by plaintiffs' expert, Dr. Brand during the course of his videotaped deposition. This use was proper pursuant to Rule 803(18) of the Rhode Island Rules of Evidence, which reads as follows:  Learned Treatises. To the extent called to the attention of an expert witness upon cross-examination or relied upon by the witness in direct examination, statements contained in published treatises, periodicals, or pamphlets on a subject of history, medicine, or other science or art, established as a reliable authority by the testimony or admission of the witness or by other expert testimony or by judicialnotice. If admitted, the statements may be read into evidence but may not be received as exhibits. In addition, counsel for plaintiffs used in cross-examination an excerpt from the Australian NZ Journal of Surgery. Doctor Altman testified that he was not familiar with this journal, which contained a suggestion that a needle biopsy was a viable alternative to the surgery performed by Dr. Wesselhoeft. Counsel for plaintiffs also used an article from a publication entitled Archives of Surgery. Doctor Wesselhoeft acknowledged that he was familiar with this publication and that he had read portions of it on occasion. This article suggested that the use of a nerve stimulator would be helpful in locating and avoiding the spinal accessory nerve. The article suggested that it would be advisable to use such a stimulator in this type of operation. Further, articles were used in cross-examination from The Annals of the Royal College of Surgeons of England and another publication entitled Surgery, Gynecology and Obstetrics. These articles contained suggestions that the spinal accessory nerve should be identified and avoided during surgery. While Dr. Wesselhoeft testified that he did not read the former publication, he did admit that he was familiar with both publications. Doctor Altman testified that he was not familiar with The Annals of the Royal College of Surgeons of England. He was familiar with the latter publication but not with the articles in question. We are of the opinion that, under Rule 803(18), articles, with which a witness is familiar and which have been admitted to be authoritative, properly may be the subject of cross-examination. Indeed, if an expert witness authenticates such an article, it may be read into evidence as part of the case-in-chief of the proponent and certainly may be utilized in the cross-examination of an adverse witness. However, a learned treatise or an article that is part of a medical journal, but which is notauthenticated, should not be used for purposes of cross-examination or for purposes of proof of an issue that is material to the outcome of a case. The reporter's notes on this subject indicate that, while such distinguished writers as Professors McCormick, Morgan, and Wigmore generally have favored the admissibility of learned treatises, the great weight of authority has indicated that a treatise or article must be authenticated as authoritative either by the witness under examination or by another witness who may be the proponent's own expert before it is used on cross-examination. See Carroll v. Morgan, 17 F.3d 787, 790 (5th Cir.1994) (quoting Fed. R. Evid. 803(18), wherein the court held that [c]ross-examination of expert witnesses with published articles is permitted if the publication is `established as a reliable authority by the testimony or admission of the witness or by other expert testimony '). In Carroll, although the witness under cross-examination refused to recognize the materials as authoritative, another medical expert had testified that the authorities utilized were reliable; nevertheless, the court held that an error excluding such material would not automatically warrant reversal. See Carroll, 17 F.3d at 790; see also Dawsey v. Olin Corp., 782 F.2d 1254 (5th Cir.1986) (holding that plaintiffs were not entitled to use statements contained in a manual issued by the former Department of Health, Education, and Welfare to cross-examine an expert witness because no witness had testified that the manual was a reliable authority). Consequently, we are of the opinion that the trial justice erred in permitting the use of certain portions of the Australian NZ Journal of Surgery and The Annals of the Royal College of Surgeons of England, when no expert witness had authenticated these materials as reliable. We must note, however, that both Dr. Wesselhoeft and Dr. Altman strained all credulity when they refused to recognize as authoritative articles in journals with which they were familiar. Their patternof rejecting all such articles out of hand undoubtedly did not enhance their credibility with the trial justice. Nevertheless, we are inclined to apply the rule as set forth in the advisory committee's note to Rule 803(18) and require that learned treatises utilized for purposes of cross-examination should be authenticated as reliable by an expert witness. We also recognize that even though a medical journal may have wide recognition, a particular article contained therein may not necessarily be authoritative. The defendant argues that there was no evidence in this case to support the jury's verdict on the negligence count save that suggested by excerpts from treatises used in cross-examination. He argues that Dr. Brand did not in his deposition testimony state that Dr. Wesselhoeft deviated from the standard of practice because the nerve was injured during the course of the procedure. Our reading of Dr. Brand's deposition did include the following excerpt, which managed to elude the persistent objections of counsel for defendant. BY MR. ROBINSON:    Q. Assuming, if you will, that Dr. Wesselheoft [ sic ] made no special attempt to identify the spinal accessory nerve when he performed the cervical node excision, that failure to do so, in your opinion, is that a deviation from the standard of practice when performing a cervical node excision of the posterior cervical triangle?    THE DEPONENT: Well, the answer to that question's yes. BY MR. ROBINSON: Q. And what is that opinion?    THE DEPONENT: Well, given the question as asked, if a surgeon, any surgeon were to perform a cervical lymph node biopsy without paying attention to the presence of the nerve and thus injured it, if one was  if a surgeon was not paying attention to the presence of the nerve and thus injured it, whether by lack of knowledge of its presence or inattention to the safe conduct of the procedure, that would be a deviation from standard of care. This testimony by Dr. Brand, together with other evidence relating to the speed with which the operation was performed (approximately six minutes) and the testimony by Dr. Wesselhoeft himself that he did not in the course of the operation see the accessory nerve and that he did not specifically look for it would certainly have supported a jury determination of negligence. Counsel for plaintiffs, in cross-examining Dr. Wesselhoeft from the previous trial transcript, elicited admissions from him that in performing the surgery on Ashley he did not see the spinal accessory nerve, that he did not isolate it, and that he did not look for it. Thus, we are of the opinion that the use of unauthenticated excerpts from medical treatises and/or articles did not constitute prejudicial error in light of the totality of the evidence presented.