Opinion ID: 1983480
Heading Depth: 1
Heading Rank: 1

Heading: The exclusion of Dr. Friedman's testimony on standard of care.

Text: Carol Taylor offered Dr. Emmanuel Friedman as an expert medical witness to testify about the standard of care applicable to Dr. Hill in this case and his breach of that standard. The following testimony had been received prior to Dr. Friedman's taking the witness stand: Dr. Hill had testified that his specialty was general surgery, that he was a fellow of the American College of Surgeons (ACS), and that to belong to that national organization, a surgeon must have a basic number of years of training and submit reports on fifty major surgical cases. Dr. Parker Harris, a board-certified specialist in obstetrics and gynecology, had testified that a general surgeon would be held to the same standard of care as a gynecologist when performing gynecological surgery at Eastern Maine Medical Center. An extensive voir dire of Dr. Friedman revealed the following facts concerning his qualifications to testify about the standard of care applicable to Dr. Hill. Dr. Friedman was a general surgeon and a board-certified obstetrician-gynecologist. At the time of trial, he was a professor of obstetrics and gynecology at the Harvard Medical School and chief of obstetrics at the Beth Israel Hospital in Boston, Massachusetts. During the course of his thirty-year career, he has performed at least twenty operations a year involving general surgical procedures. He testified in the voir dire that general surgery is a specialty and that a general surgeon is held to the same standard as a gynecologist when performing gynecological surgery. He made clear that he would be testifying to the standards of care applicable to a general surgeon and that he applied that standard of care when he reviewed the actions of Dr. Hill. Dr. Friedman was also a fellow of the American College of Surgeons, and he testified that he would be applying standards promulgated by the ACS to Dr. Hill in this case. He described the ACS as a national organization that sets standards to which its member surgeons are held and has as objectives the maintenance of those standards and the continuing education of its members. The standards are promulgated by publications, journals and teaching conventions. All fellows of the ACS receive basic information about standards of care. Furthermore, the ACS is affiliated with a joint commission on accreditation of hospitals which insures that the promulgated standards are carried out by the hospitals throughout the nation that are accredited by that joint commission. Finally, Dr. Friedman testified that a fellow of the ACS practicing surgery in Bangor, Maine, is held to the same standard of care as one practicing in Boston, Massachusetts. After completion of the voir dire, the trial justice refused to admit testimony of Dr. Friedman about the standard of care applicable to Dr. Hill. A review of the record reveals three possible reasons the trial justice may have had for that ruling. Each will be set forth and discussed below. None of the grounds is tenable, and we must conclude that the trial justice erroneously excluded that testimony. The presiding justice based his ruling, at least in part, on a finding that Dr. Friedman neither was a general surgeon nor had practiced general surgery. Those findings are clearly erroneous. Dr. Friedman testified that he is both an obstetrician-gynecologist and a general surgeon and that he had performed at least twenty surgical operations a year involving general surgery during the course of his thirty-year career. In the face of that uncontroverted testimony, the trial justice's ruling cannot be upheld on that ground. As a second ground, the trial justice apparently ruled that Dr. Friedman could not testify because he was not convinced that Dr. Friedman, being an obstetrician-gynecologist, could testify to the standard of care applicable to a general surgeon. The trial justice seemed concerned that Dr. Friedman would apply gynecological standards. That concern was unwarranted for two reasons. First, Dr. Friedman testified that he would be describing the standards of care applicable to a general surgeon. Second, a member of one specialty may testify to the standard of care applicable to another specialty as long as the witness is familiar with the standard of care and qualified to testify about it. Fitzmaurice v. Flynn, 167 Conn. 609, 618-19, 356 A.2d 887, 892 (1975); Radman v. Harold, 279 Md. 167, 171-72, 367 A.2d 472, 477 (1977); Siirila v. Barrios, 398 Mich. 576, 248 N.W.2d 171 (1976). Dr. Friedman testified that he knew the standard of care applicable to a general surgeon, and the record establishes that he was qualified to testify about that standard. Moreover, the diagnosis and treatment of some medical problems may be of concern to doctors of different specialties, and in an area of concurrent expertise, a common standard of care may be shared. Baoust v. Kraut, 377 A.2d 4, 7 (Del.1973). That is the situation presented by this record. Not only did Dr. Friedman testify generally that a general surgeon is held to the same standard of care as a gynecologist when performing a gynecological surgery, but Dr. Harris testified that that was so at Eastern Maine Medical Center under the standards of the Center. Since the record established that gynecologists and general surgeons share a common standard of care with respect to the surgical procedure involved here, the trial justice erred by not allowing Dr. Friedman to testify on the ground that he was in a different branch of medicine than Dr. Hill. See Baoust, 377 A.2d at 7; Katsetos v. Nolan, 170 Conn. 637, 646-47, 368 A.2d 172, 178 (1976); Chenoweth v. Kemp, 396 So.2d 1122, 1125 (Fla. 1981); Creasey v. Hogan, 292 Or. 154, 164-67, 637 P.2d 114, 121-22 (1981); cf. Fridena v. Evans, 127 Ariz. 516, 520, 622 P.2d 463, 467 (1981) (orthopedic surgeon properly permitted to testify about standard of care applicable to a doctor of osteopathy). Finally, the trial justice seemingly ruled that national standards would not apply to Dr. Hill because he was not a specialist and therefore Dr. Friedman could not testify because he was unfamiliar with the standard of care applicable to a Bangor general surgeon. [1] Defendant strenuously argues that the trial justice's ruling can be upheld on this ground. He bases his argument on the premise that a general surgeon is equivalent to a general practitioner and, for that reason, he would not have us apply the rule enunciated in Roberts v. Tardiff, 417 A.2d 444, 452 (Me.1980), that [a] medical specialist should be held to national standards of care and treatment appropriate to the specialty. We are not persuaded by defendant's argument. The instant record establishes that Dr. Hill should be held to a national standard of care as a specialist. Dr. Hill testified that he specialized in general surgery. Dr. Friedman testified on voir dire that a general surgeon, as distinguished from a general practitioner, is a specialist, adding, He is a specialist in the area of surgery as opposed to a physician who practices general diagnostic general practice type activity. Furthermore, Dr. Hill is a fellow of the American College of Surgeons, a national organization which sets standards of care for its member surgeons. It is clear from this record that the ACS plays an important role in setting and maintaining national standards of care for surgical specialists. A fraternity of highly-specialized and sophisticated surgeons with national organizations committed to the dissemination of the most current medical knowledge and standards in the field should clearly be held to one common standard. Jenkins v. Parrish, 627 P.2d 533, 537 (Utah 1981). Where, as in this case, a doctor holds himself out as a specialist, he will be held to the same standard of care of all physicians in that specialty. Kronke v. Danielson, 108 Ariz. 400, 403, 499 P.2d 156, 159 (1972); Roberts, 417 A.2d at 452; Brune v. Belinkoff, 354 Mass. 102, 109, 235 N.E.2d 793, 798 (1968); Naccarato v. Grob, 384 Mich. 248, 253-54, 180 N.W.2d 788, 791 (1970). Because Dr. Friedman knew the standard of care applicable to a general surgeon in the circumstances of this case and because he was qualified to testify to that standard, the trial justice erred in excluding his testimony on any ground that national standards were not applicable to Dr. Hill. Defendant argues in the alternative that, because the jury found Dr. Hill to be negligent, it was harmless error to exclude Dr. Friedman's testimony about the standard of care applicable to Dr. Hill and his breach of that standard. He contends that Dr. Friedman's excluded testimony would have no effect on the jury's finding that Dr. Hill's negligence did not proximately cause any injury to Carol Taylor. Prejudicial injury occurs only if the evidence excluded was relevant and material to a crucial issue and if it can with reason be said that such evidence, if admitted, would probably have affected the result or had a controlling influence on a material aspect of the case. Minott v. F. W. Cunningham & Sons, 413 A.2d 1325, 1329 (Me.1980) ( quoting Towle v. Aube, 310 A.2d 259, 264 (Me.1973)). We cannot reasonably say that Carol Taylor's case was not prejudiced by the exclusion of her only medical expert who would testify that Dr. Hill was negligent in removing her right ovary. It is true that the jury could have found that the removal of the right ovary did not in fact cause Carol Taylor's alleged injuries. If the jury had so found, Dr. Friedman's excluded testimony, as set forth in the offer of proof, would not have changed the result. However, because the jury was not specifically asked whether Carol Taylor suffered an injury, that is not the only possible explanation for the jury's differing answers to the interrogatories. In answering the second special interrogatory in the negative, the jury could have found either that Carol Taylor did not suffer the alleged injuries or that Dr. Hill's negligence was not the legal cause of the injuries she suffered. [2] Either finding would have been quite possible on this record. The jury could have disbelieved Carol Taylor's testimony about her injuries, for it had been considerably impeached on cross-examination. Or the jury could have decided that she had suffered injuries but that they were not caused by negligent removal of the right ovary. The jury finding of negligence did not necessarily require a finding that Dr. Hill was negligent in removing the entire right ovary. The jury would have been warranted in finding Dr. Hill negligent for failing to read the prior surgical report concerning the VHSO performed in July of 1977 but not negligent in removing the entire right ovary in the circumstances. On that finding, even though the jury believed Mrs. Taylor's account of her symptoms, it could have rationally decided that negligent failure to read the 1977 report did not proximately cause her any injury. Lacking Dr. Friedman's testimony that Dr. Hill should have called in a specialist to do the biopsy on the growth if he felt he was not capable of doing so himself and that Dr. Hill was negligent in removing the entire right ovary, the jury may have been unable to find a type of negligence proximately causing Carol Taylor's alleged injury. We cannot say that the excluded evidence would not have had a controlling influence on a material aspect of the case. Towle, 310 A.2d at 264.