Opinion ID: 2535932
Heading Depth: 1
Heading Rank: 4

Heading: Dr. Mansel's expert opinion and whether it placed blame/fault on BMH-NM

Text: ¶ 29. Dr. Mansel, a pulmonary and critical-care physician, testified at trial concerning the cause of Alex's death, relying on Alex's medical records. In his testimony Dr. Mansel stated that Alex was dehydrated when he came to the hospital. Alex coughed and dislodged a scab, causing him to bleed. The clot was removed, and the hospital personnel began to give Alex oxygen. Dr. Mansel stated that Alex had a pulse, however, it was lost, and hospital personnel began cardiopulmonary resuscitation (CPR), or chest compressions. An employee attempted to place an intravenous line in Alex's subclavian vein, located under the collar bone. After several attempts, an IV was placed in Alex, however, his neck began to swell. Another IV was placed near his groin. Dr. Mansel opined that the guide wire for the IV, not uncommonly, was not placed in the correct location. Dr. Mansel stated: [I]n two to five percent of people you will get what is called a pneumothorax so that you pierce part of the lung and if you do enough of these as I have it's just going to happen. That is despite your best attempt. We just know that it's going to happen because peoples [sic] anatomy are different. But when that happens and that it's like a balloon having a little leak, that air is going to leak out of the lungs. He stated that both of Alex's lungs collapsed. Dr. Mansel stated that Alex had bilateral pneumothoraces, as evidenced by an x-ray report. He also stated that Alex had experienced a tension pneumothorax on his left side. Ultimately, Dr. Mansel stated that Alex did not die from exsanguination. He stated that This was a blood clot that got dislodged that got in [Alex's] airway and blood oxygen got low, series of things happened. These lungs collapsed and he died but not from an artery being severed or some below the standard of care or exsanguination. ¶ 30. In contrast, Dr. Burton, expert witness for the Burnwatts, testified that Dr. Laurenzo had deviated from the standard of care. She stated that, during the tonsillectomy, the surgical plane went too deeply into Alex's muscle in the right tonsil. In Dr. Burton's opinion, this dissection injured deeper blood vessels than normal. ¶ 31. We find that the trial court did not err by denying the Burnwatts' renewed motion to exclude expert witness testimony from Dr. Mansel. The trial court carefully monitored the proposed and actual testimony and opinions rendered by Dr. Mansel at all stages of the litigation. Dr. Mansel's testimony was within the limitations set by the trial court in its rulings and passed muster pursuant to Rules 401 and 403. ¶ 32. While the trial court granted summary judgment and dismissal to BMH-NM, it considered that neither party had an expert who would provide testimony critical of the care of BMH-NM or its staff. In addition, the trial court considered Dr. Laurenzo's deposition testimony in which Dr. Laurenzo stated that he had no criticism of the resuscitation efforts by BMH-NM, and that BMH-NM staff had done everything possible to save Alex. The trial court also considered the Burnwatts' acknowledgment that BMH-NM had not committed any negligent act or omission. The order specified that the Burnwatts premised their confession of the motion for summary judgment on Dr. Laurenzo's representation to the court that he would not point the finger at BMH-NM. ¶ 33. However, in the later order granting partial summary judgment to the Burnwatts on the issue of apportionment of fault, the trial court expressly stated that the grant of partial summary judgment should not be interpreted to mean that Dr. Laurenzo and ENT Consultants were prohibited from presenting their theory of the case. Indeed, the trial court reviewed the deposition testimony from all the expert witnesses, including Dr. Mansel. With regard to Dr. Mansel's deposition testimony, the trial court determined that his testimony opine[d] that William [Alex] Burnwatt in all probability died from a bilateral pneumothorax and an [occluded] airway and not from bleeding. In addition, the trial court determined that Dr. Mansel had no criticism of any employee of BMH-NM. Dr. Mansel agrees that everything was done correctly by the hospital staff. While the trial court's main focus was the issue of apportionment of fault, the order nevertheless demonstrated that the trial court reviewed Dr. Mansel's testimony, and, that the testimony placed no blame on BMH-NM. ¶ 34. Similar to the deposition testimony, Dr. Mansel's trial testimony placed no blame on BMH-NM. As previously quoted, Dr. Mansel stated that, due to varying human anatomy in a certain percentage of patients, the placement of the guide wire for the IV may fail in some patients. ¶ 35. In its August 29, 2008, order denying the Burnwatts' renewed motion to exclude the testimony of Dr. Mansel, the trial court reviewed the expert witnesses' testimony provided at trial. Based on that testimony, the trial court determined, pursuant to Mississippi Rules of Evidence 401, that Dr. Mansel's testimony was relevant. [3] The testimony also met the balancing test of Rule 403, which states: Although, relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. In its analysis, the trial court thoroughly considered the testimony presented at trial and whether it met the balancing test of Rules 401 and 403. The trial court stated: Plaintiff's expert, Dr. Deborah Burton, opines that Dr. Laurenzo breached the standard of care when he performed a tonsillectomy on Alex Burnwatt by operating below the normal surgical plane and injuring the deeper blood vessels that are not typically injured during surgery. She further testified that the autopsy report indicates that there was a tear or laceration in the main jugular vein which would normally be encountered during the tonsillectomy. Dr. Burton also indicated that the injury to the jugular vein is an indication that Dr. Laurenzo operated below the normal plane. It is Dr. Burton's opinion that Alex Burnwatt died from a severe loss of blood. The autopsy report of Dr. Steven Hayne, an expert Pathologist, indicated that the right jugular vein had a laceration which was caused by the IV guide wire, pressure from IV fluids, or a surgical tool (tonsillectomy). Dr. Hayne's autopsy report states that Alex Burnwatt's organs were pale which indicates a significant loss of blood. According to Dr. Hayne, the loss of blood (exsanguination) was a contributing cause of Alex Burnwatt's death. Defendant's expert, Dr. Keith Mansel, was allowed to testify at trial. It was Dr. Mansel's opinion that Alex Burnwatt did not suffer from a severe loss of blood; the IV guide wire inserted during the code caused the tear in the internal jugular vein; and that Alex Burnwatt died not from loss of blood (exsanguination), but from a blood clot which dislodged and blocked his airway resulting in collapsed lungs. The loss of blood suffered by Alex Burnwatt is a relevant factor in this matter. A jury could infer that if Alex Burnwatt bled to death, Dr. Laurenzo operated below the plane injuring major blood vessels. Dr. Mansel's testimony as to the amount of blood lost, the cause of the injury to the jugular vein, and the cause of death of Alex Burnwatt is relevant as to whether or not Dr. Laurenzo operated below the surgical plane. It is the opinion of the Court that Dr. Mansel's testimony is relevant and reliable and would assist the trier of fact. The jury was instructed at the June 2007 trial that no actions of omissions or commission by any employee of BMH-NM during or after the code caused or contributed in any way to the death of Alex Burnwatt or the Plaintiffs' damages. The probative value of Dr. Mansel's testimony substantially outweighs the danger of confusion of the issues or misleading the jury. The Plaintiffs' renewed motion to exclude the testimony of Dr. Mansel is not well taken and should be denied. ¶ 36. This Court has held that parties have a right to their theory of the case. Eckman, 876 So.2d at 979. [4] This case concerns whether Dr. Laurenzo's actions or omissions fell below the standard of care. As such, Dr. Laurenzo and ENT Consultants have the right to present their theory of the events that led to Alex's death by way of expert testimony. The trial court monitored Dr. Mansel's expert-witness testimony. See Cato, 15 So.3d at 423 (a trial court may limit expert testimony that is admitted into evidence). Dr. Mansel's testimony did not place blame on BMH-NM, rather it explained that a certain percentage of IV guide wires may be located improperly. Due to a number of events, it was Dr. Mansel's opinion that Alex died from a pneumothorax and not exsanguination. In addition, the trial court gave limiting instructions on BMH-NM's lack of liability. See Cato, 15 So.3d at 423 (a trial court may limit expert testimony and give limiting jury instructions). ¶ 37. Further, the trial court properly considered whether Dr. Mansel's testimony met the requirements of Rules 401 and 403. The trial court correctly found that Dr. Mansel's testimony was relevant to the issue of the cause of Alex's death and that it was reliable. In addition, the trial court recognized that the testimony should have been included because its probative value was not substantially outweighed by the danger of confusion of the issues or misleading the jury. To be clear, this opinion should not be construed to make any determination on the weight or credibility of the experts' testimony in this case, for that is an issue that is yet to be determined and is within the province of the jury, not this Court. Once a witness is qualified as an expert to render expert testimony, then it is within the province of the trier of fact to give weight and credibility to the testimony. Palmer v. Anderson Infirmary Benevolent Ass'n, 656 So.2d 790, 796 (Miss.1995). We find that the trial court did not err in denying the Burnwatts' renewed motion for exclusion of Dr. Mansel's expert testimony.