Opinion ID: 1058370
Heading Depth: 1
Heading Rank: 9

Heading: Cross-Examination: Learned Treatise

Text: We next address whether the Court of Appeals correctly held that the trial court erred in allowing the plaintiff to cross-examine Dr. Eichorn with a learned treatise without first identifying the treatise and establishing the treatise to be reliable. See Tenn. R. Evid. 618. The plaintiff argues that the Court of Appeals erred in holding that the cross-examination was improper because there was no showing that a learned treatise was being used in challenging Dr. Eichorn's testimony and opinions as to the cause of the decedent's death. The defendants argue that the Court of Appeals properly concluded that the cross-examination relied upon a learned treatise that was not identified and established to be reliable as required by Rule 618. The record reveals that the following exchanges occurred during the plaintiff's cross-examination of Dr. Eichorn: Q. Let me see if you agree with this concept: Hypotension from any cause may produce cerebral or spinal cord inschemia. Hypotension may be associated with positioning and is usually caused by venous pooling; that is, the sitting position, or decreased venous return, as in a prone position with increased intra-abdominal pressure. And that second part we did not have in that case, did we? A. Correct. .... Q. Hypotension may be associated with positioning and is usually caused by venous pooling, e.g., the sitting position. When the head and spinal cord are elevated above the level of the heart, blood pressure should be referenced to head level to ensure that monitored pressure reflects perfusion pressure. Do you agree or disagree with that? .... Q. Are you familiar with the Manual of Complications in Anesthesia? A. There are two or three of them, which one? Q. How about Michael Mahla? A. Say that again. Q. Mahla. M-A-H-L-A? A. I don't believe I have that book. Q. You've got those in your library, don't you? A. It's possible. I don't know. Q. Do you consider those to be reliable texts, Complications in Anesthesia? A. I understand the nature of your question. I don't choose to characterize any textbook or publication as authoritative or reliable, because, frankly, they're just words. Defense counsel objected on the ground that the text was not shown to be reliable, but the trial court allowed the cross-examination to continue. Although the Mahla text is not again mentioned, the transcript shows the following: Q. Let me see if you agree with this. For patients in a head elevated position, the appropriate zero reference for blood pressure is the brain at the external meatus, not the heart. Failure to use the brain as the zero reference, after sitting a patient up, will lead to an overestimation of cerebral perfusion pressure. Do you agree or disagree with that? A. In very specific selected circumstances, I would agree with that. A sitting posterior fossa craniotomy would fall under that rubric. This type of procedure that we're talking about today would not. .... Q. Accidental hypotension is quite probably the most frequent complication of the sitting position. It's presence requires rapid detection and prompt treatment if significant cerebral hypoxia is to be avoided. Agree or disagree? A. Again, same answer. In selected circumstances, because if you used the exact words  and that passage used the words `sitting position,' you must understand  and the jury needs to understand  that that concept was generated in the anesthesiology teaching and literature having to do with patients sitting bolt upright.... In that kind of sitting position, yes that's a valid statement. Applied to the type of surgery that this patient had that we're talking about today, no, it doesn't apply. Rule 618 of the Tennessee Rules of Evidence contains the requirements for impeaching an expert witness with a learned treatise: 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, by other expert testimony, or by judicial notice, may be used to impeach the expert witness's credibility but may not be received as substantive evidence. Rule 618 allows a party to impeach an expert witness by testing the expert's knowledge and understanding of a topic at issue. Cohen et al., § 6.18[2]. When the requirements of Rule 618 are satisfied, the most common approach for using this impeachment technique is for counsel to read a portion of a treatise, ask the expert witness whether he or she agrees with the treatise, and compare the treatise with the expert's response. Id. at § 6.18[2][b]. In considering these principles, we first emphasize that the record is not entirely clear on this issue. As noted, the defendants initially objected on the basis that the Mahla treatise was not shown to be reliable or authoritative. When Dr. Eichorn declined to identify this treatise (or indeed, any textbook) as authoritative, no questions were asked based on the Mahla treatise, nor was the treatise shown to be physically present or used in any way. When the trial court overruled the defendants' objection by allowing the cross-examination to continue, the plaintiff asked Dr. Eichorn to agree or disagree with several principles without mentioning the Mahla treatise or any other learned treatise, just as the plaintiff had done before the Mahla treatise was mentioned. The plaintiff asserted at trial and maintains on appeal that these questions were not read from a specific learned treatise, but rather, were based on the testimony and evidence already presented at trial. Indeed, the plaintiff notes that Dr. Eichorn was not asked to compare his testimony to another source and was not asked to explain why his testimony differed from another specific source. We cannot presume that there was reversible error based on the record before us. After the defendants objected to the mention of the Mahla treatise, that treatise was never again mentioned. Moreover, the defendants did not make any further specific objections to the questioning, did not make an offer of proof, and did not ask the trial court to make factual findings as to whether a learned treatise was being used during the subsequent cross-examination. In short, we cannot presume that a learned treatise was being used in violation of Rule 618 based solely on how the questions were phrased. Accordingly, the Court of Appeals erred in concluding that the trial court committed reversible error in allowing the cross-examination of Dr. Eichorn.