Opinion ID: 1615292
Heading Depth: 1
Heading Rank: 6

Heading: proof of medical malpractice

Text: Now we return to the core issue: Was a jury issue made on medical malpractice? Intertwined with this question are the other two assignments of error, namely, that the circuit judge erred in excluding the testimony by Dr. Dugger as to the standard of care required in New York, and the minimum training required to make a diagnosis of spinal meningitis. The plaintiffs argue that sufficient evidence was presented  despite the circuit judge's ruling  to survive a motion for a directed verdict. We do not agree. On the other hand, if the trial court erred in excluding admissible evidence and that evidence added to the evidence presented to the jury would have survived a motion for directed verdict, then we must reverse. Since this case was tried, this Court in Hall v. Hilbun, 466 So.2d 856 (Miss. 1985), effectively abolished the locality rule insofar as determining whether a medical expert opinion should be admitted. The circuit court did not have the benefit of this decision. We must, therefore, hold that he erred when he used the locality rule to determine the admissibility of medical expert opinion. Under Hall v. Hilbun Dr. Dugger was qualified to testify as an expert on whether the St. Albans medical personnel committed medical malpractice in treating Debbie. The exclusion of that portion of his testimony on this basis of the locality rule was error. For this reason we must reverse. Undoubtedly, had the circuit judge admitted this testimony, he would not have entered a directed verdict for the defendants. Serious questions remain, however, as to the competency of Dr. Dugger's opinion. This either was not brought out in the trial or was not addressed by the circuit judge. The admission of expert testimony is ordinarily addressed to the sound discretion of the trial judge. Alman Bros. Farms & Feed Mill, Inc. v. Diamond Laboratories, Inc., 437 F.2d 1295 (5th Cir.1971); Dickerson v. Shepard Warner Elevator Co., 287 F.2d 255 (6th Cir.1961); Lehigh Portland Cement Co. v. Dobbins, 282 Ala. 513, 213 So.2d 246 (1968); Sovereign Camp W.O.W. v. Davis, 5 So.2d 480, 242 Ala. 235 (1941); Texas Emp. Ins. Ass'n v. Steadman, 415 S.W.2d 211 (Tex.Civ.App. 1967); 51 C.J.S. Evidence, § 551(2)(a) (1964). Because from this record we are unable to determine whether or not the trial court in the exercise of sound discretion would, or should have permitted Dr. Dugger's testimony in full, we review these problems now, and give guidelines for retrial. The basic question, aside from Dr. Dugger's professional qualifications, is whether a proper or sufficient predicate was laid for him to express an expert opinion. In the first place, the circuit judge was manifestly correct in excluding the portions of the St. Albans medical record, and indeed the plaintiffs do not argue the court erred in doing so. The trial record shows that upon the defendants' motion the circuit judge entered an order on January 14, 1984, excluding from evidence all the St. Albans records because they had not been certified as required by Miss. Code Ann. § 41-9-101-119, and excluded any statements made by Henry and Claudine to hospital personnel or statements made by the St. Albans physicians to the Hickoxes. Also, as above noted, at the trial of the cause, plaintiffs sought to introduce the handwritten notes of December 2 and 6, and the narrative summaries of Debbie's hospitalization through the testimony of Capt. McCullough, the medical custodian at Keesler Air Force Base, and the court sustained the objection to their introduction. The circuit judge was correct because of the plaintiffs' failure to comply with Miss. Code Ann. § 41-9-109. As we have noted, attached as part of the exhibit to the federal government's motion to dismiss the Hickoxes' Federal Tort Claim is what purports to be a narrative summary from the clinical record of the December 15, 1972, hospitalization, the first paragraph of which recites: HISTORY OF PRESENT ILLNESS: This was the first St. Albans Naval Hospital admission for this 8 month old white female, who had had a history of vomiting and diarrhea with intermittent fever for 13 days prior to admission. On admission the child was felt to have gastorenteritis with dehydration, but after several hours of hydration it became apparent that nuchal rigidity was present with a bulging anterior fontanelle. A lumbar puncture was performed and proved positive for bacterial meningitis. This summary gives the discharge diagnosis of: 1. Haemophilis influenza meningitis. 2. Oral and cutaneous candidiasis. This photostatic copy, however, fails to show Debbie's name and was made an exhibit to the government's motion to dismiss, solely for the purpose of showing all the documents which had been filed with the government by plaintiffs' attorneys pursuing their Federal Tort Claims Act claim. There is nothing to show that this is in truth and in fact part of Debbie's hospital record at St. Albans. Without proper foundation, none of the purported medical records pertaining to Debbie's medical treatment in St. Albans is competent evidence and should be excluded. [8] Dr. Dugger as a treating physician at Keesler Air Force Base on doubt became quite familiar with the St. Albans records on medical file at Keesler. It is not clear whether his medical opinions totally excluded information contained in those records, or indeed if it was possible for him to do so. No opinion based in whole or in part on information contained in the St. Albans medical records should be admitted. Clark v. State, 409 So.2d 1325, 1328 (Miss. 1982); Entex, Inc. v. Rasberry, 355 So.2d 1102 (Miss. 1978); Spears v. State, 241 So.2d 148 (Miss. 1970); City of Laurel v. Upton, 253 Miss. 380, 175 So.2d 621 (1965); Wild v. Bass, 252 Miss. 615, 173 So.2d 647 (1965). Furthermore, there is a serious question whether the hypothetical question contained sufficient factual information upon which Dr. Dugger could express an expert opinion. This was never addressed by the circuit court. The hypothetical question omits any medical diagnosis, omits tests leading to any diagnosis, and fails to indicate when, how, or if such tests were made. The hypothetical question in this case encompassed only the testimony of the parents, lay witnesses  a skimpy predicate at most to express an opinion on proper medical treatment. Clearly, no expert should be permitted to express an expert opinion on a hypothetical question which omits necessary facts, or fails to give a sufficient factual basis for the expert witness to express a valid opinion. See: Bennett v. Punton Sanitarium Ass'n., 213 Mo. App. 363, 249 S.W. 666, 672 (1923) (hypothetical must contain all pertinent history). Kale v. Douthitt, 274 F.2d 476, 482 (4th Cir.1960): The facts upon which the expert bases his opinion or conclusion must permit reasonably accurate conclusions as distinguished from mere guess or conjecture. Kruszewski v. Holz, 265 Md. 434, 290 A.2d 534, 540 (1972): Of course, any assumption made must be grounded on a fair summation of the material facts in evidence and those material facts must be sufficient in scope, for the witness to formulate a rational opinion. Also in McCraney v. Kuechenberg, 144 Ind. App. 629, 248 N.E.2d 171, 174 (1969), the Indiana Court noted: Whether a witness' sources of information are sufficiently reliable to warrant reception of an opinion is for the trial court in the exercise of its discretion to determine and we hold that the admissibility of such opinion is necessarily dependent upon the laying of a proper factual predicate. And, in Dean v. Carolina Coach Company, Inc., 287 N.C. 515, 215 S.E.2d 89, 91 (1975), the North Carolina Supreme Court stated: As a general rule, a hypothetical question which omits any reference to a fact which goes to the essence of the case and therefore presents a state of facts so incomplete that an opinion based on it would be obviously unreliable is improper and the expert witness's answer will be excluded. See also, Peppercorn v. Murphy, 114 Cal. App. 101, 299 P. 762 (1931); Jenson v. Findley, 17 Cal. App.2d 536, 62 P.2d 430, 435 (1972); In re Grahlman's Will, 248 Iowa 535, 81 N.W.2d 673, 681 (1957); Starr v. Oriole Cafeterias, 182 Md. 214, 34 A.2d 335, 336 (1943). It therefore follows that any expert opinions by Dr. Dugger as to whether there was proper medical treatment of Debbie by St. Albans personnel, must be based on sufficient competent evidence in the record before the jury to enable him to express an opinion. This can only be resolved by the trial judge on remand under the guidelines herein enunciated. Although not assigned as error, we also note the trial court erred in sustaining defense objections to Dr. Dugger's opinions as to when a physician should expect a virus infection or something else in diagnosing a patient. He was competent to express such medical opinions. We make this observation to prevent this error recurring on retrial. We observe further, for purposes of the trial on remand, that the hypothetical question is by no means the only vehicle providing a legally sufficient foundation for an expert's opinion. See Rule 703, Mississippi Rules of Evidence, and comment thereto. Where feasible other means, such as having the expert witness sit in the courtroom and hear the testimony of foundation witnesses, are often superior to the hypothetical question. REVERSED AND REMANDED. ROY NOBLE LEE, P.J., DAN M. LEE, PRATHER, ROBERTSON and ANDERSON, JJ., concur. WALKER, C.J., and SULLIVAN and GRIFFIN, JJ., not participating.