Opinion ID: 2370675
Heading Depth: 1
Heading Rank: 1

Heading: Testimony of Dr. Golding

Text: Dr. Kleeman first argues that the trial court erred by allowing Dr. Golding to offer expert testimony. He argues that Dr. Golding was not qualified because he had not operated since 1986 and had relinquished all surgical privileges by 1988. Additionally, Dr. Kleeman points out that Dr. Golding was never trained in and had never performed any lapar[a]scopic surgery, observed an ALIF, or cared for a post-operative ALIF patient. Goudreault counters that, although Dr. Golding retired from surgery for health reasons, he remained active in medicine. Goudreault points out that his was not strictly a lapar[a]scopic procedure because the complications required conversion to an open approach, which was within Dr. Golding's experience. Goudreault asserts that Dr. Golding was very familiar with the ... lumbar anatomy and while [he] had never performed a lapar[a]scopic spinal surgery, he was well familiar with the techniques and [related] equipment. Goudreault maintains that vascular injuries are not unique to the ALIF procedure and that compartment syndrome can arise from various types of surgery. Expert witness testimony is required to establish a prima facie medical negligence case. See RSA 507-E:2, I (1997). A witness is qualified as an expert by knowledge, skill, experience, training, or education. N.H. R. Ev. 702. In deciding whether to qualify a witness as an expert, the trial judge must conduct an adequate investigation of the expert's qualifications. Milliken v. Dartmouth-Hitchcock Clinic, 154 N.H. 662, 667, 914 A.2d 1226 (2006) (quotation omitted); cf. RSA 516:29-a, I (2007). Because the trial judge has the opportunity to hear and observe the witness, the decision whether a witness qualifies as an expert is within the trial judge's discretion. Milliken, 154 N.H. at 667, 914 A.2d 1226 (quotation omitted). We will not reverse that decision absent a clearly unsustainable exercise of discretion. Hodgdon v. Frisbie Mem. Hosp., 147 N.H. 286, 289, 786 A.2d 859 (2001); State v. Lambert, 147 N.H. 295, 296, 787 A.2d 175 (2001). Our inquiry is whether the record establishes an objective basis sufficient to sustain the discretionary judgment made. Lambert, 147 N.H. at 296, 787 A.2d 175. To prevail on appeal, the defendant must demonstrate that the court's ruling was clearly untenable or unreasonable to the prejudice of his case. Id. (quotation omitted). After a hearing, the trial court ruled that [b]ased on his training and experience,... Dr. Golding is qualified to render his opinions about the surgery performed on the plaintiff and his follow-up care together with opinions about the role and responsibility of Dr. Kleeman as the lead surgeon ... on plaintiff's procedure. We cannot say that the trial court's ruling was an unsustainable exercise of discretion. Dr. Golding had training in vascular surgery and was board-certified in thoracic, cardiovascular and general surgery. Although he no longer operates, he has been licensed to practice medicine since 1959 and is currently licensed to practice in three states. During his career, he taught medicine, performed research and practiced as a cardiac surgeon. He is an attending surgeon and consultant at three different hospitals. In addition to teaching surgeons about compartment syndrome, Dr. Golding authored a chapter about vascular trauma in a medical textbook including a discussion of compartment syndrome. Dr. Golding's lack of laparascopic ALIF experience and training does not negate his ability to advance the jury's understanding and determination of facts at issue. Although a medical degree does not automatically qualify a witness to give an opinion on every conceivable medical question, Mankoski v. Briley, 137 N.H. 308, 313, 627 A.2d 578 (1993) (quotation omitted), we have held that [t]he lack of specialization in a particular medical field does not automatically disqualify a doctor from testifying as an expert in that field. Milliken, 154 N.H. at 667, 914 A.2d 1226 (quotation omitted); see also Mankoski, 137 N.H. at 312, 627 A.2d 578 (An orthopedic surgeon is not per se unqualified to render expert testimony on the psychological health of a patient.). Although Dr. Golding had not operated on patients since 1986 and had never personally performed an ALIF, he had performed surgery in the posterior lumbar area hundreds of times and had assisted to resolve major vascular problems that occurred during spinal fusions. Thus, we find no error in the trial court's ruling qualifying Dr. Golding as an expert. See N.H. R. Ev. 702.
Dr. Kleeman next argues that the trial court erred by allowing Dr. Golding to opine that Dr. Kleeman more likely than not caused at least one of Goudreault's vascular injuries. Dr. Kleeman points out that Dr. Golding also testified that either Dr. Nepomnayshy or Dr. Kleeman could have caused Goudreault's vascular injuries. He contends that Dr. Golding's opinion on causation had no foundation under RSA 516:29-a, I, because of insufficient facts or data and a lack of reliable principles reliably applied to the facts of th[is] case. Goudreault argues that Dr. Golding's opinion was admissible because he based it upon the records, depositions and testimony coupled with his experience as a surgeon. Goudreault maintains that any inconsistent testimony given by Dr. Golding should go the weight of his opinion, not its admissibility. To make out a prima facie case of medical negligence, a plaintiff must introduce, by expert testimony, evidence sufficient to warrant a reasonable juror's conclusion that the causal link between the negligence and the injury probably existed. Bronson v. The Hitchcock Clinic, 140 N.H. 798, 801, 677 A.2d 665 (1996); see RSA 507-E:2, I(c). The plaintiff need only show with reasonable probability, not mathematical certainty, that but for the defendant's negligence, the harm would not have occurred. Bronson, 140 N.H. at 802-03, 677 A.2d 665. A medical expert's competent opinion that the defendant's negligence probably caused the harm establishes the quantum of expert testimony necessary. See id. at 802, 677 A.2d 665; see also N.H. R. Ev. 704; Emerson v. Bentwood, 146 N.H. 251, 256, 769 A.2d 403 (2001). However, such an opinion is admissible only after it has been shown to the satisfaction of the court that the testimony is based upon sufficient facts or data; ... is the product of reliable principles and methods; and ... [that t]he witness has applied the principles and methods reliably to the facts of the case. RSA 516:29-a, I; see also N.H. R. Ev. 702. Thus, an expert's testimony must rise to a threshold level of reliability to be admissible under New Hampshire Rule of Evidence 702. Emerson, 146 N.H. at 254, 769 A.2d 403 (quotation omitted). The proper focus for the trial court is the reliability of the expert's methodology or technique. The trial court functions only as a gatekeeper, ensuring a methodology's reliability before permitting the fact-finder to determine the weight and credibility to be afforded an expert's testimony. Baker Valley Lumber v. Ingersoll-Rand, 148 N.H. 609, 616, 813 A.2d 409 (2002). The facts or data in the particular case upon which an expert bases an opinion or inference may be those perceived by or made known to the expert at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence. N.H. R. Ev. 703. The trial court permitted Dr. Kleeman to explore the basis for Dr. Golding's opinion in the jury's presence before allowing him to render an opinion on causation. Dr. Golding testified that [t]he basis is when I reviewed the records and some depositions and testimony that I heard here yesterday and forty years of experience in surgery. Dr. Golding conceded that the records he reviewed did not expressly identify which doctor caused the vascular injuries, but he elaborated that [i]n reviewing the operative records, there was a progression of major bleeding episodes coupled with his sense of how dissection in the retro-peroneal space is done, and how vessels get injured in the retro-peroneal space. He added that the use of blunt and sharp dissection ... requires traction and counter-traction performed by two sets of hands, which occurred here in an area of blood vessels that can easily be damaged by either traction or counter-traction. Dr. Golding testified that two vascular injuries were [c]ertainly caused by traction and a third could be from the traction. The trial court recessed to examine the record outside of the jury's presence in response to Dr. Kleeman's objection. Dr. Golding was then allowed to give his opinion that more likely than not that Doctor Kleeman caused at least one of these vascular injuries. The trial court did not expressly rule as to the reliability of Dr. Golding's methodology. He appears to have relied upon something akin to differential etiology, Baker Valley Lumber, 148 N.H. at 616, 813 A.2d 409, a standard scientific technique of identifying the cause of a medical problem by eliminating the likely causes until the most probable one is isolated. Westberry v. Gislaved Gummi AB, 178 F.3d 257, 262 (4th Cir.1999). We find no error in admitting this testimony because admissibility of expert opinions turns upon the reliability of the expert's methodology or technique, Baker Valley Lumber, 148 N.H. at 616, 813 A.2d 409, and not upon the expert's conclusion, see id. at 615, 813 A.2d 409; see also Baxter v. Temple, 157 N.H. 280, 285, 949 A.2d 167 (2008). To the extent there were gaps in Dr. Golding's explanations, these omissions concern the relative weight and credibility of competing expert testimony rather than the basic reliability of such testimony, and are the province of the fact-finder, not the trial court. Baker Valley Lumber, 148 N.H. at 615, 813 A.2d 409. [O]bjections to the basis of an expert's opinion go to the weight to be accorded the opinion evidence, and not to its admissibility. Id. (quotation omitted). The appropriate method of testing the basis of an expert's opinion is by cross-examination of the expert. Id. at 615-16, 813 A.2d 409 (quotation omitted).
Prior to trial, Goudreault sought to exclude any evidence suggesting that, by testifying, Dr. Golding was failing to abide by the ACS policy statement on expert testimony because he lacked sufficient experience to offer opinion testimony on matters related to the ALIF procedure. The Trial Court ( McGuire, J.) denied Goudreault's motion in limine, ruling that the standard is relevant to the competency and credibility of Dr. Golding, particularly where he is a Fellow of the [ACS], and is not unfairly prejudicial. Goudreault moved for reconsideration clarifying that he objected only to identification of the ACS as the source of statements and not their contents. The Trial Court ( Murphy, J.) reconsidered the earlier decision and granted Goudreault's motion in limine, ruling it is appropriate to prevent injustice. Dr. Kleeman argues that the trial court erred by granting plaintiff's untimely motion to reconsider. He urges that the policy statement exposed a legitimate basis for rejecting Dr. Golding's testimony because it would have demonstrated [that] the professional organization Dr. Golding relies upon to burnish his reputation had promulgated recommendations that, if ... followed, would have precluded him from testifying due to a lack of experience and demonstrated competence in ALIF surgery and post-operative care. Dr. Kleeman cites case law attaching weight to similar policies promulgated by the American Association of Neurosurgeons. See Austin v. American Ass'n of Neurological Surgeons, 253 F.3d 967 (7th Cir.2001), cert. denied, 534 U.S. 1078, 122 S.Ct. 807, 151 L.Ed.2d 693 (2002). Goudreault argues that medical specialty societies, such as ACS, ... should not have any role in determining the qualifications of any expert witness in a judicial proceeding. Rather, he maintains that the trial court made the determination that Dr. Golding was qualified as an expert guided by judicial standards and not those of a private organization. We review a trial court's decisions on the admissibility of evidence under an unsustainable exercise of discretion standard. Boynton v. Figueroa, 154 N.H. 592, 599-600, 913 A.2d 697 (2006). We will not disturb the trial court's decision absent an unsustainable exercise of discretion. Id. at 600, 913 A.2d 697. To meet this standard, [Dr. Kleeman] must demonstrate that the trial court's rulings were clearly untenable or unreasonable to the prejudice of h[is] case. Desclos v. S.N.H. Med. Ctr., 153 N.H. 607, 610, 903 A.2d 952 (2006). We cannot say that the trial court's ruling was unreasonable or untenable. [T]he power to [reconsider an issue once decided] remains in the court until final judgment or decree. Redlon Co. v. Corporation, 91 N.H. 502, 506, 23 A.2d 370 (1941) (quotation omitted). It is immaterial that different judges act. Id. Upon clarification of Goudreault's motion in limine, Judge Murphy concluded that reconsideration of Judge McGuire's prior ruling was necessary to prevent injustice. The trial court could have reasoned that its ruling was necessary to avoid juror confusion regarding the threshold determination of expert witness competency. Emery v. Company, 89 N.H. 165, 169, 195 A. 409 (1937) (The question whether one possesses the requisite qualifications to testify as an expert is one of fact for the trial court....). Thus, we cannot say the trial court's ruling exceeded its broad discretion to fix the limits of cross-examination. State v. Miller, 155 N.H. 246, 253, 921 A.2d 942 (2007).