Opinion ID: 2357967
Heading Depth: 1
Heading Rank: 1

Heading: improper admission of testimony.

Text: The first contention which we address involves the trial court's allowance of testimony by appellee's medical expert. Specifically, appellee's medical expert testified, over objection, that a handwritten result on a laboratory slip was 460 units. Appellant further complains that this error was exacerbated rather than cured by the ensuing judicial comments. Careful review of the record compels us to agree. An examination of the parties' respective theories of the case reveals that the jury's resolution of whether the disputed result was 460 or 160 was a pivotal issue, and that admission of the challenged testimony was gravely prejudicial. Scrutiny of the context of the testimony and the subsequent judicial comments demonstrates that the prejudicial error was far from cured. Appellee's theory of the case was presented through one expert witness, Dr. Robert P. Bass, Jr. [1] Dr. Bass is an osteopathic, Board Certified family practitioner who had practiced for twenty-five years at the time of trial. [2] Dr. Bass testified that appellee entered the hospital suffering from acute pancreatitis, an inflammation of the pancreas. Dr. Bass based his diagnosis of pancreatitis on the results obtained from a laboratory test for serum amylase. He opined that an elevated amylase result was the hallmark of pancreatitis. Furthermore, he declared that the laboratory slip indicated that appellee's amylase was 460 units, which represented an elevation from a normal range of 60 to 200 units. Given this cardinal sign of pancreatitis, Dr. Bass stated that the recognized treatment for appellee's condition was nonsurgical. He testified that in ninety-five percent of all pancreatitis cases, the symptoms resolved almost spontaneously within forty-eight to seventy-two hours, with only close observation and supportive treatment including hydration, intravenous fluids, and possible antibiotics to prevent infection. [3] In response to inquiries regarding appellee's documented bacterial infection, Dr. Bass testified that the bacterial infection could not have been significant because appellee did not have an accompanying fever. Laboratory results from a blood sample taken before the operation showed the presence of Escherichia coli (E. Coli) bacteria. Dr. Bass admitted that the existence of E. Coli in the body outside of the digestive system signified an infection in the body, and if the infection reached the blood stream it could possibly become a life-threatening situation. Dr. Bass testified, however, that even in instances of overwhelming infection, treatment should be restricted to antibiotic therapy. It was Dr. Bass' ultimate opinion, therefore, that appellee had pancreatitis and a mild bacterial infection, neither of which required surgical intervention. This being so, appellant did not, according to Dr. Bass, conform to reasonable standards of the medical profession in that he exposed appellee to the unnecessary risk of surgery and the complications which followed thereafter. The defense presented three expert witnesses, including the defendant/appellant, to substantiate their position that surgery was not only a proper course of treatment, but an essential one. The defense experts were Dr. Charles C. Wolferth, a Board Certified general surgeon who has practiced since 1954; Dr. George P. Rosemond, a Board Certified general and thoracic surgeon who was retired at the time of trial, having practiced from 1934; and the appellant, a Board Certified general, colon and rectal surgeon who has practiced since 1951. [4] The testimony of these three medical experts was that at the time appellee was admitted to the hospital, he was in a state of shock from an overwhelming and life-threatening bacterial infection. Because of this infection and irrespective of its source, the defense experts testified that emergency surgery was required. While the cause of the infection was not located during the exploratory surgery, the defense experts were adamant that there were no indications of pancreatitis. The appellant, Dr. Marks, suspected that the infection was caused by a perforated diverticulitis, [5] and Dr. Wolferth suggested that the infection originated from inflammation and leakage of the sigmoid colon. Both of these diagnoses accounted for the appearance of E. Coli bacteria in the abdominal cavity. A lavage of the abdominal cavity was performed to cleanse out the abnormal, infectious fluid, and then drains were inserted and the incision packed closed. The defense countered Dr. Bass' diagnosis of pancreatitis by attacking the serum amylase result which Dr. Bass claimed to be 460. Dr. Bass had professed no knowledge of the clinical procedures for serum amylase testing at Thomas Jefferson University Hospital in 1970. The defense presented Dr. Schwartz, Director of the Clinical Laboratory of Thomas Jefferson University Hospital. Dr. Schwartz testified that he was familiar with that hospital's laboratory procedures in 1970 and at present, and that because of the way the test was performed, it was impossible for a value of 460 to be obtained, while it was common to reach a result of  It can hardly be argued that Dr. Bass' interpretation of the serum amylase result was anything but inadmissible testimony. Appellee, in fact, completely avoids discussion in his brief on the propriety of this testimony. The scope of expert testimony is limited: Expert testimony is permitted only as an aid to the jury when the subject matter is distinctly related to a science, skill, or occupation beyond the knowledge or experience of the average layman. McCormick, Handbook on the Law of Evidence, § 13, (2nd ed. 1972); Commonwealth v. Newsome, [462] Pa. [106], 337 A.2d 904 (Filed 1975); Commonwealth v. Hoss, 445 Pa. 98, 283 A.2d 58 (1971). Where the issue involves a matter of common knowledge, expert testimony is inadmissible. Collins v. Zediker, 421 Pa. 52, 218 A.2d 776 (1966). Commonwealth v. O'Searo, 466 Pa. 224, 229, 352 A.2d 30, 32 (1976). Here, Dr. Bass lacked any special expertise which would qualify him to decipher the numerical notations on the laboratory slip  he was neither a handwriting expert, nor was he the preparer of the document. The source of Dr. Bass' interpretation was common knowledge, for which expert testimony is impermissible. His testimony on this subject was a usurpation of the jury's traditional function and manifestly erroneous. To justify a reversal because of a ruling on evidence, the ruling must not only be technically erroneous, but it must also be harmful to the appellant. Anderson v. Hughes, 417 Pa. 87, 208 A.2d 789 (1965). We do not hesitate to find prejudice here. The ultimate issue before the jury was whether surgery had been necessary; i.e., whether they believed Dr. Bass' version or whether they believed the defense version. The jury obviously decided the issue in favor of Dr. Bass' version. Since the crux of Dr. Bass' testimony was that appellee had pancreatitis, and that diagnosis hinged on his interpretation of the serum amylase result as 460, the improper admission of Dr. Bass' repeated and steadfast translation of that result was 460 was fatal to appellant's case. Where erroneously admitted evidence goes to the heart of the issue, this court must reverse and remand for a new trial. Commonwealth ex rel. Buchakjian v. Buchakjian, 301 Pa.Super. 213, 447 A.2d 617 (1982). The trial court, however, refused to find error in its admission of this testimony. In its opinion denying the post-trial motions, that court held that the immediate instructions to the jury cured any potential for error. The injurious line of questioning began when Dr. Bass was allowed to testify, over objection by counsel for appellant, that the hospital records included a laboratory report which recorded appellee's serum amylase as 460 units. Appellee's counsel had Dr. Bass reiterate this numerical value several times, over objection. The trial judge, apparently perplexed as to the reason for the persistent and strident objections, [6] ventured to look at the laboratory slip himself. After observing the slip and within hearing of the jury, he proclaimed, It's a test with a number on it, 460. (Supplemental Record at p. 43). Appellant's counsel respectfully protested, whereupon the trial judge gave the following instruction to the jury and then endeavored to clarify the problem himself by questioning Dr. Bass: THE COURT: The jury will have to decide whether that is 460. Again, ladies and gentlemen, it is not my opinion that matters. Maybe I am confused at this point, but it ultimately will be for you to decide, and we will wait to hear what cross-examination might clarify this. I don't prepare the basis. I am in the dark the same as you, and if I call it 460 and for some reason it is not, then, that is for you to decide. THE COURT (Contd.) I will give this back to the doctor and you can pass that around to the jury at this point. It may assist them in understanding the testimony. Before you do that, again with the same caveat from me, ladies and gentlemen of the jury, I was about to ask a question. I think that I should ask it. Doctor, it has `normal value' on this sheet. There is a whole column, this is a printed form, and it has a 60-200 units. THE WITNESS: That's correct. THE COURT: As I understand it, you are saying this particular hospital's formal ( sic ) value scope was within from 60 to 200 and that was on their printed form? THE WITNESS: That's correct. THE COURT: Then, immediately beside that in the column `result' it has the number 460, subject to this being cleared up in your case by cross-examination, is that what you meant when you referred to the numbers, Doctor? THE WITNESS: Yes. THE COURT: And that 460, in your interpretation of this report it is that a test was done and the result was 460? THE WITNESS: That's exactly right. Mr. STARR: Your Honor, may I be heard? THE COURT: I will pass this to the jury. You can cross-examine him about it. I don't want to go into it any further. (Supplemental Record at pp. 43-44). At this point, the laboratory slip was marked as an exhibit and examined by the jury. Appellee's counsel then proceeded to stress that the amylase result was crucial to the plaintiff's case (Supplemental Record at p. 45), and had Dr. Bass state several more times that the result was 460. Thereafter, through his lengthy direct examination, Dr. Bass referred to the elevated amylase reading not as an assumption of fact or even his interpretation, but as a fact itself. It was not until midway through Dr. Bass' cross-examination that the jury was advised of the controversy over the amylase result. The defense introduced into evidence the surgical resident's report which noted the serum amylase result after it had been called up from the laboratory. This exhibit was examined by the jurors, and counsel directed their attention to a comparison with other numerals on the report to determine whether the amylase was 160 or 460. [7] Counsel for appellant also posed several questions in which he asked Dr. Bass to assume that the amylase result was actually 160 instead of 460. Dr. Bass exhibited considerable difficulty in making such an assumption: Q: . . . You have agreed with me if it's less than 160 it's no hallmark? A: It's stated in two places in the record that it's 460. (Reproduced Record at p. 235a). We are mindful that the admission of improper evidence can be cured by appropriate instruction from the court: [T]he mere admission of improper evidence is not always ground for a new trial. Such an error may be cured and rendered harmless by striking out the evidence and eliminating it from the jury's consideration. Lilly v. Metropolitan Life Insurance Co., 318 Pa. 248, 177 A. 778; Mitchell v. Edeburn, 37 Pa.Super. 223. However, if the evidence is of a sort that tends to prejudice the minds of the jurors, the error is not cured by instructions to disregard it. Hamory v. Pennsylvania M. & S.R. Co., 222 Pa. 631, 72 A. 227. Whether or not the error is corrected, therefore, involves a consideration of the circumstances under which the irrelevant evidence was given and its probable effect on the jury. Saunders, et al. v. Commonwealth, 345 Pa. 423, 29 A.2d 62. McJunkin v. Kiner, 157 Pa.Super. 578, 581, 43 A.2d 608, 609 (1945). Consideration of the circumstances here, however, forces us to conclude that the trial court's instruction failed to have any curative effect. First of all, the trial judge's instructions were a response to the judicial comment only. He informed the jurors that his opinion did not matter, and never advised them that Dr. Bass' opinion did not matter either. To the contrary, he questioned Dr. Bass further to make sure that Dr. Bass' interpretation was that the result was 460. Thus, the supposed curative instruction served to highlight Dr. Bass' interpretation rather than to strike it from the jury's consideration. Furthermore, any possibility that the instruction actually neutralized the effect of Dr. Bass' improper testimony was dashed by Dr. Bass' continued characterization of that result as 460 throughout his lengthy examination. While the trial judge had stated that this confusion might be cleared up on cross-examination, during the whole course of direct examination the jury had no inkling as to why 460 could be anything other than 460. To make matters worse, the laboratory slip was passed to the jurors immediately after both Dr. Bass and the trial judge had identified it as 460, and before they were aware of appellant's alternate interpretation. Of course, that laboratory result does resemble 460 in the absence of notice that it might be 224 referred to the elevated amylase level as a given. Unfortunately, the trial judge, in his charge to the jury failed to elucidate that the 460,  Thus, we find that Dr. Bass' improper testimony constituted prejudicial error which was not cured by the instruction of the trial court.