Opinion ID: 1280959
Heading Depth: 1
Heading Rank: 9

Heading: Evidence Sufficient for Presentation of the Case to a Jury was Established

Text: The evidence in the case at bar establishes that Dr. Tune possessed the requisite knowledge of the applicable local standard of care in 1983-84. The real problem with the district court's termination of the case, however, is by what right did the court deprive the jury of its function of deciding whether the plaintiffs had satisfactorily established that Dr. Tune, plaintiffs' expert witness, was acquainted with the local standard of medical care? That is a primary issue. Likewise, a major issue is the court's directing a verdict for the defendants. In a case recently before the Court, Clements Farms, Inc. v. Ben Fish & Son, 120 Idaho 185, 814 P.2d 917 (1991), the main issue involved a disclaimer and the requirement that to be effective a disclaimer must be conspicuous. The Uniform Commercial Code provides that the single issue, i.e., whether a term or clause is `conspicuous' or not is for decision by the court.  U.C.C. 28-1-201(10) (emphasis added). There is no such provision, or anything bearing a resemblance to the statute involved, in this case. Idaho Code § 6-1012 states: In any case, claim or action for damages due to injury to or death of any person, brought against any physician and surgeon or other provider of health care, ... such claimant or plaintiff must, as an essential part of his or her case in chief, affirmatively prove by direct expert testimony and by preponderance of all competent evidence, that such defendant then and there failed to meet the applicable standard of health care practice of the community in which care allegedly was or should have been provided ... Idaho Code § 6-1013 adds to I.C. § 6-1012 that the applicable standard of practice must be established by the plaintiff in the form of one or more knowledgeable, competent expert witnesses, and lays down, as one of the various prerequisites to the admission (foundation) that, as pertinent to this discussion, that such expert witness possesses professional knowledge and expertise coupled with actual knowledge of the applicable standard to which his or her expert testimony is addressed.... The foregoing should make it abundantly clear, in comparing the U.C.C. statutory provision in the Clements case with the instant Gubler case, that the statute in no way makes a district court the ultimate decision maker as to whether the plaintiff prevails or fails. If the plaintiff makes a prima facie case that the plaintiff's expert has become knowledgeable as to the local applicable standard of care the plaintiff is entitled to have the case laid before the jury which has been assembled, selected, and sworn to perform its function of decision making. At stake in the Gubler case is the constitutional right of jury trial. That right of plaintiffs was confiscated and the jury function usurped when the court ruled on his own thought that, on a foundational matter, its somewhat like a court trial ... Tr. Vol. II, p. 209, L1. 24-25. Those remarks were made immediately after hearing Mr. Powers, of counsel for the defense, relative to plaintiffs having Dr. Tune on the stand and under discussion were Dr. Tune's qualifications as an expert witness about to testify as an expert in plaintiffs' behalf as to the alleged negligence of Dr. Boe in regard to treating Jake Gubler. As is readily apparent to the reader, the defense was challenging Dr. Tune's qualifications for presenting such testimony. On reflection, it is better to set out the entire paragraph in which those remarks were made, so as to obtain the full flavor of the court's stance: THE COURT: Thank you. Gentlemen, at the risk of somewhat prolonging this, it appeared to me from closing argument that I need to ask the witness about three questions just to clarify what I think has already been testified to. I would never do this, of course, in the presence of the jury, but I think on a foundational matter it's somewhat like a court trial and I am going to exercise my prerogative and discretion to do so. R. 209-10 (emphasis added). At this juncture, so as to better understand how this flew out of hand, it is imperative to keep in mind that Mr. Hall had just prior thereto concluded his cross examination of Dr. Tune and had not asked any question of Dr. Tune which was relative to the time element of I.C. § 6-1012 and I.C. § 6-1013. Moreover, Mr. Hall's co-counsel had not presented any argument to the court which suggested or even intimated that a flaw, if not a fatality in plaintiffs' ability to go forward was found in the fact that Dr. Groberg's enlightenment of Dr. Tune as to the applicable standard of medical practice did not specifically include a span of time three or four years earlier than the date of their conversation. It is to be kept in mind that the jury would decide two issues: (1) were the defendants' actions or inactions negligent, resulting in injury to Jake Gubler, and (2) was that conduct below the applicable standard of care of which they found sufficient proof from the testimony, meaning any testimony from any of the parties involved or from the witnesses of any such parties. Had the case gone to the jury, in that manner the jury would have resolved the ultimate issue. However, suddenly that opportunity became precluded when the court intervened to ask a question which was not within its prerogative to ask, especially when counsel had not seen fit to do so: EXAMINATION BY THE COURT: Q. Doctor, would you describe for me precisely what you learned from Dr. Groberg about the deviation from the standard of care in Pocatello, Idaho, and the national standard of care applicable to board certified pediatricians in the recognition, diagnosis, and treatment of urinary tract infections or obstructions? A. I spoke to Dr. Groberg about the standard of pediatric care in Idaho regarding the diagnosis and management and further possible work-up of children with urinary tract infections and/or obstruction of the urinary tract, specifically whether a different standard might be applied in Idaho compared to elsewhere in the country. Q. And what was his response? A. Absolutely not, that he had practiced medicine in four states, and the standard was the same throughout. Q. Was specific reference made to Pocatello, Idaho? A. Not to the city. Q. Did he indicate that there was no deviation anywhere in Idaho as compared to the national standard? A. He indicated no deviation anywhere in Idaho. I said in Idaho, and he said absolutely not. Q. Was reference made to a time from such as 1983 or 1984 as to whether the standard deviated during that time frame? A. I do not recall a discussion of time. Q. When did this conversation take place? A. I'll have to look at my notes. July 20, 1988. R. 210-11. An inference is readily drawn that all counsel involved, there being more than one at the defendants' table and at the plaintiffs' table, had been of the same view as the doctors, i.e., that four or five years had no visible effect upon the local applicable standard of care, which is not difficult to expect. The district judge, however, without testifying to his own medical background and expertise, unfortunately and improperly, entered into the trial arena. There may be some Idaho case law precedent for such a judicial intervention, but I am unaware of it. In the cases of Frank v. East Shoshone Hosp., 114 Idaho 480, 757 P.2d 1199 (1988), and Dekker v. Magic Valley Reg. Med. Ctr., 115 Idaho 332, 766 P.2d 1213 (1988), this Court held that the expert affidavits in question did not satisfy the foundational requirements of I.C. § 6-1012 and § 6-1013. However, those two cases can be distinguished in that the affidavits in question made absolutely no reference to any knowledge of the applicable standard of care. The expert doctors had not made any attempt to inquire as to the applicable standard. In Frank this Court stated: Idaho Code § 6-1013(c) states that in any medical malpractice case, plaintiff must establish that such expert witness possesses professional knowledge and expertise coupled with actual knowledge of the applicable said community standard to which his or her expert testimony is addressed. The deposition testimony of plaintiffs' expert, Dr. Blaisdell, however, fails to establish that Dr. Blaisdell was familiar with the local standard of care at the East Shoshone Hospital. The record in Frank bears out that statement: Q. [By defendant's counsel] You haven't discussed the standard of care in particular with any doctors that practice in the area? A. [By Dr. Blaisdell] No sir. Q. Okay. You're not familiar with the emergency room procedures at the East Shoshone Hospital that were in effect in February of 1982 are you? A. Not in any detail, no sir. Deposition of Dr. Blaisdell, at 61. Consequently, [the Court] agree[d] with the trial court that as a matter of law plaintiffs' expert was not familiar with the applicable standard of care. Frank, 114 Idaho at 481, 757 P.2d at 1200. Likewise, in Dekker this Court stated: The affiants practice in Salt Lake City, and there is no indication in the record that they possess any knowledge of the standard of care in the area served by the Magic Valley Regional Medical Center. It is sufficient to say that the affidavits of the plaintiffs' experts in no way demonstrate any such familiarity. Dekker, 115 Idaho at 334, 766 P.2d at 1215. In Pearson v. Parsons, 114 Idaho 334, 337, 757 P.2d 197, 200 (Idaho 1988), this Court held that defendant's two expert affidavits in support of defendant's motion for summary judgment were both devoid of statements indicating actual knowledge of the standard of practice in the Blackfoot community. Defendants then argued that plaintiff's expert, Dr. Weeks', affidavit also failed to satisfy the actual knowledge test of I.C. § 6-1013. However, with respect to plaintiff's expert affidavit this Court stated: He possessed professional knowledge and expertise coupled with actual knowledge of the applicable ... community standard to which his ... expert opinion testimony is addressed. I.C. § 6-1013(c). I am also familiar with the standards of the community regarding the diagnosis and treatment of suspected and actual appendicitis. Thus, this Court, in some of the above cited cases, has rejected expert affidavits when there has been no attempt to inquire of the applicable standard. However, in Pearson this Court stated that plaintiff's expert affidavit satisfied the requirements of I.C. § 6-1013 even though the expert only stated that he was familiar with the applicable community standard. The case of Strode v. Lenzi, 116 Idaho 214, 775 P.2d 106 (1989), a more recently decided case, can also be distinguished for the same reasons. In Strode this Court held that plaintiff's expert affidavit failed to show that the expert was familiar with the applicable standard. The expert made no attempt to inquire of a local doctor as to the standard of care. The expert affidavit stated: The standard of care for a board certified orthopedic surgeon in Boise is that set by the American Academy of Orthopedic Surgeons and is the same standard under which I practice in Chicago, Illinois. I am, therefore, familiar with what is expected of a board certified orthopedic surgeon in Boise. Strode, 116 Idaho at 215, 775 P.2d at 107. This Court upheld the Buck rule, stating the following: If he is board certified in the same specialty, he must, at a minimum, inquire of a local specialist to determine whether the local community standard varies from the national standard for that board certified specialty... . Dr. Hall's affidavit shows no effort to obtain information regarding the local standard of care and, as the trial court noted, are conclusory statements which are incapable of objective evaluation by anyone... . Consequently, there was no showing of a genuine issue of fact which must be tried. Buck v. St. Clair, 108 Idaho 743, 702 P.2d 781 (1985). Strode, 116 Idaho at 216, 775 P.2d at 108. In the case at bar Dr. Tune made the inquiry and received the reply that the standard throughout Idaho was the same as the national standard. Dr. Tune testified that the standard hadn't changed since before 1983, and that it was classic text book, medical school learning. Dr. Boe testified that he learned of this standard during residency. Dr. Boe also testified as to what the standard was, showing that the standard in Pocatello in 1983-84 was the same as the national standard for diagnosing urinary tract infection or obstruction. Dr. Groberg and Dr. Davis stated they were aware of the applicable standard in 1983 in their affidavits. Therefore, Dr. Tune should not have been disqualified. If anything, his testimony is subject to cross examination and the credibility of his knowledge of the applicable standard in this case can be weighed by the jury. See Brown v. Colm, 11 Cal.3d 639, 114 Cal. Rptr. 128, 522 P.2d 688 (1974).