Opinion ID: 2194743
Heading Depth: 1
Heading Rank: 4

Heading: Dr. Townsend's Motion for a Judgment as a Matter of Law

Text: Dr. Townsend's next argument is that the court erred in not granting his Super. Ct. Civ. R. 50 motion for judgment as a matter of law at the close of Ms. Donaldson's case-in-chief, and that as a result, Ms. Donaldson was not entitled to use any of the testimony that came in through either Dr. Townsend or the Hospital to make her prima facie case. This argument is based on a misreading of Rule 50. That rule reads, in pertinent part: If during a trial by jury a party has been fully heard on an issue and there is no legally sufficient evidentiary basis for a reasonable jury to find for that party on that issue, the Court may determine the issue against that party and may grant a motion for judgment as a matter of law against that party with respect to a claim or defense that cannot under the controlling law be maintained or defeated without a favorable finding on that issue. Super. Ct. Civ. R. 50 (emphasis added). The plain language of the rule demonstrates that the trial court was not obligated to rule at the close of the plaintiff's case. The rule is similar to Super. Ct. Crim. R. 29(b), which provides that the trial court may reserve decision on a motion for judgment of acquittal, proceed with the trial (where the motion is made before the close of all the evidence), submit the case to the jury and decide the motion either before the jury returns a verdict or after it returns a verdict of guilty. Unlike Super. Ct. Civ. R. 50, Super. Ct.Crim. R. 29(b) requires a judge who has reserved ruling until the close of all of the evidence to judge the motion for judgment of acquittal solely on the basis of the evidence at the time the ruling was reserved. [21] Thus, whether or not Ms. Donaldson had made out a prima facie case by the time that she rested, the trial court was not required to grant the motion. [22]
Because the trial court acted within its discretion in denying Dr. Townsend's Rule 50 motion, we must next address his contention that Ms. Donaldson was not entitled to the testimony of the Hospital's expert to establish her prima facie case. We disagree. As Wigmore has stated, [T]he sufficiency of evidence which will defeat [a motion for judgment as a matter of law] may be found in the opponent's own evidence. . . . 9 WIGMORE ON EVIDENCE § 2495 (1981) (emphasis in original). Indeed, we have previously held that an opponent's experts can be used to defeat summary judgment. In Abbey v. Jackson, 483 A.2d 330, 331 (D.C.1984), a medical malpractice action, the trial court had granted summary judgment for the defendant on the grounds that the plaintiff had named no experts of her own, but had merely cross-designated the defendant's experts. We reversed the grant of summary judgment, holding that this cross-designation was sufficient to send the matter to trial. It would be unreasonable to permit a plaintiff to rely on an opposing party's expert witnesses to defeat summary judgement and then prohibit the plaintiff from using those experts at trial. We have, on other occasions, affirmed a grant of summary judgment where a plaintiff failed to designate its own expert, but those cases involved fact patterns that led the trial court to conclude that there was no basis to believe that the defendant's experts would in fact be helpful to the plaintiff at trial. In Berkow v. Lucy Webb Hayes Nat. Training School for Deaconesses, 841 A.2d 776, 780 (D.C.2004), for example, we upheld a grant of summary judgment despite the appellant's claim that he could have provided adequate standard of care testimony through the defendants' experts. We found this argument unpersuasive because he had never notified the defendants that he intended to do so . . . and, in any event, there is no record basis . . . for believing that [he] could have used defense witnesses to establish the standard of care and defendants' departure from it. Id. Similarly, in Eibl v. Kogan, 494 A.2d 640 (D.C.1985) (per curiam), we upheld a grant of summary judgment, concluding that this is not a case in which a plaintiff might reasonably be expected to elicit, on cross-examination, testimony from which a jury might glean support for his contention. Id. at 643 n. 2. The situation here is distinguishable from those in Berkow and Eibl. There is no question that Ms. Donaldson can elicit helpful expert testimony from Dr. Bechamp. She has already done so. Thus, the fact that the testimony came in through an expert for the Hospital is not a bar to its use by Ms. Donaldson. Moreover, as we noted above, Dr. Townsend recognized before trial that he and the Hospital had conflicting theories of the case. This, coupled with Ms. Donaldson's cross-designation of Dr. Bechamp and her attempt to subpoena him during her case in chief should have put him on notice that such testimony could be forthcoming. Thus, we hold that the testimony of Dr. Bechamp could be utilized by Ms. Donaldson in establishing her prima facie case. [23]
In his final argument concerning his motion for judgment as a matter of law, Dr. Townsend maintains that, even with Dr. Bechamp's testimony, the evidence presented at trial was insufficient to demonstrate causation. On a motion for judgment as a matter of law, the record must be viewed in the light most favorable to the non-moving party, and that party [here Ms. Donaldson] is entitled to the benefit of every reasonable inference from the evidence. Washington Metro. Area Transit Auth. v. Jeanty, 718 A.2d 172, 174 (D.C.1998) (citing Shewmaker v. Capital Transit Co., 79 U.S.App.D.C. 102, 103, 143 F.2d 142, 143 (1944)). As long as there is some evidence from which jurors could find the necessary elements, a trial judge must not grant a directed verdict. Marshall v. District of Columbia, 391 A.2d 1374, 1379 (D.C.1978). Whether the evidence was sufficient to go to the jury is a question of law, which we consider de novo. Jeanty, supra, 718 A.2d at 174. With respect to medical malpractice claims, `[m]edical testimony as to the mere possibility of a causal relation . . . is not sufficient standing alone to establish such relation,' particularly where the causation element is unclear. Talley v. Varma, 689 A.2d 547, 553 (D.C.1997) (quoting Sponaugle v. Pre-Term Inc., 411 A.2d 366, 368 (D.C.1980)). Thus, Ms. Donaldson needed to show to a reasonable degree of medical probability or certainty that subsequent events leading to her injuries would have occurred differently had Dr. Townsend not violated the standard of care. See Kling, supra, 564 A.2d at 717; Talley, supra, 689 A.2d at 553. As we discussed above, because the jury verdict form was insufficient, [24] the record must reflect adequate causation evidence for each of the four breaches of the standard of care found by the jury.
During direct examination by the Hospital at the de bene esse deposition, counsel told Dr. Bechamp, Whenever I ask you a question about your opinion, you can assume I'm going to ask you an opinion to a reasonable degree of medical certainty or probability, so I don't have to keep repeating that. [25] Dr. Bechamp acknowledged that he understood. Immediately thereafter, counsel asked Dr. Bechamp: Do you have an opinion, sir, as to whether if the small bowel had been inspected in the way you believe it should have been performed, that Ms. Donaldson's course would have been different? Dr. Bechamp replied: I think if the perforation had been discovered . . . and that had occurred on that Saturday . . . they usually have a very benign or uneventful postoperative course. They may stay an extra day or two in the hospital, but basically the rest of the course is uneventful. And certainly, this lady's course was not that way. Counsel for the Hospital then went on to ask a series of questions about whether specific injuries suffered by Ms. Donaldson would have occurred if the bowel had been inspected properly. Dr. Bechamp answered that neither her respiratory problems, nor her ventilatory problems, nor the scarring to her fallopian tubes would have occurred. Dr. Townsend argues that Dr. Bechamp's answers in this series of questions were couched in qualifying terms and that the blanket statement at the beginning of the questioning regarding all answers being to a reasonable degree of medical certainty were insufficient to expertize the testimony. A close examination of Dr. Bechamp's testimony belies this assertion. Dr. Bechamp's statement, I think if the perforation had been discovered . . . they usually have a very benign or uneventful postoperative course, came immediately after counsel told him that his answers should be to a reasonable degree of medical certainty or probability. Assuming without deciding that counsel's blanket statement that all of Dr. Bechamp's answers should be to a reasonable degree of medical certainty or probability was insufficient to expertize all of Dr. Bechamp's answers thereafter, certainly Dr. Bechamp understood that medical certainty or probability was the standard he was being asked to apply in this question, which immediately followed counsel's instruction. This conclusion is supported by his subsequent testimony regarding specific maladies that Ms. Donaldson suffered. Dr. Bechamp testified that, had Ms. Donaldson been properly diagnosed, she would not have experienced . . . adult respiratory distress syndrome. He further stated, [I]t's a reasonable certainty that . . . [Ms. Donaldson's fallopian] scarring is related to the pelvic abscess she had. These statements are unqualified and confirm that Dr. Bechamp gave his causation testimony on these injuries to a reasonable degree of medical certainty or probability.
As with her claim of Dr. Townsend's failure to properly inspect the bowel, Ms. Donaldson relies on Dr. Bechamp's testimony to provide the causation evidence for her theories that Dr. Townsend's failure to recommend a CT scan or obtain a consultation proximately caused her injuries. Still assuming arguendo that counsel's blanket statement regarding medical certainty was insufficient to expertize all of Dr. Bechamp's testimony, his causation testimony on this point was sufficient to allow the issue to go to the jury. After establishing that Dr. Bechamp's opinion was that Dr. Townsend should have obtained a CT scan or consulted with another doctor on January 11th, counsel then asked Dr. Bechamp whether he had an opinion as to how that would have influenced Dr. Townsend's medical course. Dr. Bechamp answered that if they could have intervened sooner on this lady [they could have] perhaps diminished her postoperative course. At that point, the Hospital sought to clarify that Dr. Bechamp was giving a proper expert opinion. When you say could [have], counsel asked, are you saying that you're just guessing about that, or do you have an opinion. Dr. Bechamp interrupted the attorney and responded, My experience would be that you would certainly the patient would do better if you intervened earlier. That's what I'm saying. When you evaluate a patient with an acute distended abdomen, if you can make a diagnoses of an abscess, with CAT scan, ultra sound, whatever way you make it, you want to intervene as soon as possible. (Emphasis added). Dr. Bechamp's use of the term certainly makes clear that he understood the applicable standard and was utilizing it in his answers, as instructed, without regard to whether the question explicitly asked him whether the causal relationship was to a medical certainty or medical probability. Thus, there was sufficient evidence of causation to send the theories of failing to obtain a CT scan or to seek a consultation to a jury. [26]
Finally, we conclude that there is also sufficient testimony to support the theory that the failure to hospitalize Ms. Townsend before January 13th was a proximate cause of her injuries. As we discussed in note 12, supra, Dr. Townsend has conceded that Dr. Bechamp supplied standard of care testimony stating that Dr. Townsend should have hospitalized Ms. Donaldson on January 11th. While Dr. Bechamp is never actually asked whether the failure to hospitalize was a cause of her injuries, this logically follows from his conclusion that further tests or a consultation likely would have prevented her injuries. Furthermore, Ms. Donaldson's expert, Dr. London, testified that, even if a surgeon had waited two days to conduct surgery on Ms. Donaldson, her injuries would have been greatly reduced if Dr. Townsend had hospitalized her on January 11th rather than waiting until January 13th. The testimony of Drs. Bechamp and London, read together, provides the requisite evidence of causation on this issue. For the reasons stated herein, we hold that the trial court did not err in allowing the jury to determine liability based on the testimony presented. Because we find no error regarding the other issues before us, [27] the insufficient jury form did not undermine the verdict rendered at trial. For the foregoing reasons, the judgment of the trial court is Affirmed.