Opinion ID: 1168687
Heading Depth: 1
Heading Rank: 4

Heading: admissibility of testimony of orthopedic surgeons

Text: The defendant repeatedly objected to the testimony of orthopedic surgeons from San Francisco and Eugene on the ground that it had not been established that they were familiar with the standard of practice of podiatrists in the Eugene area or a similar community. The defendant further asserts that if practitioners of other schools are otherwise allowed to testify as to proper common procedures, they must first, as a foundation, testify that they are familiar with the applicable standard of practice in the community or a similar community. There is support for these propositions. For example, the writer of an annotation entitled Expert Witness in Malpractice Case, 8 A.L.R.2d 772, 774, cites numerous cases standing for this proposition: It is uniformly held that, to render competent in a malpractice case the expert testimony of a physician or surgeon from one community as to the standard of medical treatment required of the defendant practicing in another community, the witness must have knowledge of and familiarity with the practice and standard of the locality in question, or of similar or like communities, or of similar localities in the same general neighborhood. [7] The rule of law is that practitioners must exercise that degree of care and skill which an ordinary practitioner, in the same discipline in that community or a similar community, would exercise. As stated above, this is not a rule of evidence, but a rule of law. The evidence question is one of foundation or competency: Can an out-of-town expert testify as to the propriety of a local practitioner's treatment absent some knowledge of the standard of medical treatment in the community? The answer to the question has to be in the negative, but that does not end the inquiry, or even further the inquiry very much. The cases discussed in part II above make it clear that medical experts from one discipline are permitted to express expert opinions as to the appropriateness of the other practitioner's treatment not because they have been asked whether they are familiar with the skill and care customarily exercised by practitioners of the other discipline, but because they are familiar with the methods, practices, and procedures utilized by such practitioners. This rule applies as well to practitioners within the same discipline. The reason why one Eugene orthopedic surgeon is qualified to testify against another Eugene orthopedic surgeon is not because the witness is aware of the standard of skill and care normally exercised by orthopedic surgeons in Eugene, but because the witness is familiar with the method of treatment customarily used by members of the profession practicing in that locality. The inquiry, when considering whether the testimony of an expert with appropriate education and training can be received, is whether the expert has knowledge of the method of treatment customarily used by reasonably careful practitioners in the community or a similar community. Asking a witness if he or she is familiar with the applicable standard of practice in the community may be intended to evoke the response that the witness is familiar with the method of treatment, but the question is ambiguous in the sense that it suggests that the reference is to the legal standard of care, rather than the medical standard of proper medical practice. The reason the witness is permitted to express an opinion at all is not because of the witness's familiarity with the legal standard  for the witness may not know (and need not know) what is the legal standard  but because of the witness's knowledge of what constitutes proper medical treatment. We hold that if a witness's qualifications (by virtue of education or training) are otherwise established, the area of inquiry should be directed to his or her knowledge of the methods of customary and proper medical treatment in that or a similar community, not his or her knowledge of the standard of care or the standard of skill. [8] The competency of the expert to express an opinion is not established by knowledge of the legal standard of care but by knowledge of what is proper conduct by practitioners in the community or a similar community under circumstances similar to those which confronted the defendant. In the case at bar, there is evidence that podiatrists and orthopedic surgeons both treat bunions and hallux valgus; that the methods of treatment are similar; that the methods followed in San Francisco do not differ from those followed in the Eugene area; that both disciplines rely upon and follow some of the same texts; that both prescribe and read x-rays of the foot; that podiatrists and orthopedic surgeons attended the same medical conferences, at which the Austin surgical procedure was discussed; and that the McBride bunionectomy is commonly used by orthopedic surgeons and podiatrists. Such a foundation is sufficient to allow the testimony of both orthopedic surgeons. Similar admissibility questions will arise in other cases in the future. The party offering such evidence must show (1) that the witness possesses the necessary skill and knowledge to arrive at an intelligent conclusion touching the subject matter of the dispute, Malila v. Meacham, 187 Or. 330, 336, 211 P.2d 747 (1949), and (2) that the two disciplines, in their treatment of patients under circumstances similar to those which confronted the defendant, apply methods or practices which are identical or generally similar to those followed by persons practicing the defendant's discipline in that or a similar community. Such a showing can be made in numerous ways.