Opinion ID: 2495708
Heading Depth: 1
Heading Rank: 3

Heading: The Medical Review Panel

Text: In response to a perceived crisis in this state caused by prohibitive costs in connection with medical malpractice insurance, our Legislature enacted the MMA in 1975, with the intended purposes of reducing or stabilizing medical malpractice insurance rates and ensuring the availability of affordable medical services to the general public. Spradlin v. Acadia-St. Landry Medical Foundation, 98-1977, p. 6 (La.2/29/00), 758 So.2d 116, 120; Hutchinson v. Patel, 93-2156 (La.5/23/94), 637 So.2d 415, 422. In order to achieve these ends, the MMA provided qualified health care providers with a number of advantages in derogation of the general rights of tort victims. Galloway v. Baton Rouge General Hosp., 602 So.2d 1003, 1005-06 (La.1992); Everett v. Goldman, 359 So.2d 1256, 1262-63 (La.1978). One of the principal advantages provided to qualified health care providers was that no action for malpractice against them or their insurers could be commenced in any court prior to submission of the complaint to a medical review panel, composed of three health care providers and one attorney, and the panel's issuance of its expert opinion. La.Rev.Stat. § 40:1299.47(B)(1)(a)(i); Galloway, 602 So.2d at 1006; Everett, 359 So.2d at 1263; see also La.Rev.Stat. § 40:1299.47(C) (The medical review panel shall consist of three health care providers who hold unlimited licenses to practice their profession in Louisiana and one attorney.). Although this requirement could be waived by the agreement of the parties, it was assumed that most malpractice cases against qualified health care providers will be filtered through such a panel. Everett, 359 So.2d at 1263; see also La.Rev.Stat. § 40:1299.47(B)(1)(c). Moreover, we further explained: Pretrial screening through a medical review panel is designed to weed out frivolous claims without the delay or expense of a court trial. It is thought that the use of such panels will encourage settlement because both parties will be given a preliminary view of the merits of the case. If a claim is found by the panel to be without merit it is thought that the claimant will be likely to abandon his claim or agree to a nominal settlement. Moreover, a plaintiff who gains a favorable opinion from the panel may be able to negotiate a favorable settlement with his defendants, a procedure which also avoids much of the time and expense of a trial. Thus, to the extent that the use of medical review panels encourages settlement of suits before trial, litigation costs will probably be reduced. Because out of court settlements usually do not garner the publicity of jury verdicts it is also hoped by proponents of the legislation that publicity concerning the award figure will be minimal and that this fact will gradually reduce awards granted by juries. Additionally since jury awards are believed generally to be larger than settlements, the increase in prevalence of the latter should serve to reduce the overall payment of claims. Thus, litigation costs and actual awards are expected to be lessened by virtue of the employment of pre-suit medical review panels. Everett, 359 So.2d at 1264 (citations omitted). Under this scheme, the sole duty of the panel is to express its expert opinion as to whether or not the evidence supports the conclusion that the defendant or defendants acted or failed to act within the appropriate standards of care. After reviewing all evidence and after any examination of the panel by counsel representing either party, the panel shall, within thirty days, render one or more of the following expert opinions, which shall be in writing and signed by the panelists, together with written reasons for their conclusions: (1) The evidence supports the conclusion that the defendant or defendants failed to comply with the appropriate standard of care as charged in the complaint. (2) The evidence does not support the conclusion that the defendant or defendants failed to meet the applicable standard of care as charged in the complaint. (3) That there is a material issue of fact, not requiring expert opinion, bearing on liability for consideration by the court. (4) When Paragraph (1) of this Subsection is answered in the affirmative, that the conduct complained of was or was not a factor of the resultant damages. If such conduct was a factor, whether the plaintiff suffered: (a) any disability and the extent and duration of the disability, and (b) any permanent impairment and the percentage of the impairment. La.Rev.Stat. § 40:1299.47(G). Any report of the medical review panel's expert opinion shall be admissible as evidence in any action subsequently brought by the claimant in a court of law. La.Rev.Stat. § 40:1299.47(H). Such expert opinion, however, shall not be conclusive and either party shall have the right to call, at his cost, any member of the medical review panel as a witness. Id. Thus, the opinion of the medical review panel is admissible, expert medical evidence that may be used to support or oppose any subsequent medical malpractice suit. Samaha v. Rau, 07-1726, p. 15 (La.2/26/08), 977 So.2d 880, 890; Galloway, 602 So.2d at 1007. Nevertheless, as with any expert testimony or evidence, the medical review panel opinion is subject to review and contestation by an opposing viewpoint. Samaha, 07-1726 at p. 15, 977 So.2d at 890. The opinion, therefore, can be used by either the patient or the qualified health care provider, and the jury, as trier of fact, is free to accept or reject any portion or all of the opinion. Everett, 359 So.2d at 1269. In the present matter both parties sought an all or nothing ruling on the admissibility of the panel opinion. On one hand, plaintiffs sought to exclude the opinion in its entirety because of the panel's credibility determinations upon which its ultimate opinion was based. In support of their position, plaintiffs cited the statutory duty of the panel and Third Circuit jurisprudence, arguing the panel, by exceeding its duty and invading the province of the factfinder, rendered its opinion legally invalid and inadmissible. See Whittington v. Savoy, 05-1169, p. 3 (La.App. 3 Cir. 5/31/06), 931 So.2d 1198, 1201 (holding the mandatory language of La.Rev.Stat. § 40:1299.47(H) presupposes the validity of the opinion itself). The defense, on the other hand, argued the mandatory language of the statutory provision requires the admission of the opinion in its entirety, regardless of its content. In support thereof, the defense cited this Court's holding in Galloway that the panel's opinion and findings are admissible by virtue of the statutory provision, La. R.S. 40:1299.47(H), and the statutory scheme put in place by the [MMA], 602 So.2d at 1007, as well as the Second and Fourth Circuit cases rendered in reliance therewith. See Hunter v. Bossier Medical Center, 31,026, p. 13 (La.App. 2 Cir. 9/25/98), 718 So.2d 636, 644 (the clear language of that statute makes the report of the MRP admissible at trial, even where `technical' defects exist); Beaucoudray v. Walsh, 07-0818, p. 21 (La.App. 4 Cir. 3/12/09), 9 So.3d 916, 927 (holding a simple reading of La. R.S. 40:1299.47(H) mandates the admissibility of the MRP opinion), writ denied, 09-0832 (La.5/29/09), 9 So.3d 168. [3] However, any reliance on our holding in Galloway in the present matter is misplaced because that decision did not involve a substantively defective panel opinion; rather, it involved a situation in which all three panel members, years after properly rendering their unanimous expert opinion, simply changed their minds. Moreover, because the circuits are clearly split on the admissibility of panel opinions rendered based on the panel's credibility determinations, it falls to this Court to resolve the issue by first interpreting the relevant statutory provisions and then applying them to the facts herein. Under well-established law, because all of the limiting provisions applicable to qualified health care providers are `special legislation in derogation of the rights of tort victims,' these provisions are all strictly construed. Spradlin, 98-1977 at p. 6, 758 So.2d at 120 (quoting Sewell v. Doctors Hosp., 600 So.2d 577, 578 (La. 1992)). Moreover, in accord with the general rules of statutory interpretation, the interpretation of any statutory provision begins with the language of the statute itself. In re Succession of Faget, 10-0188, p. 8 (La.11/30/10), 53 So.3d 414, 420. When the provision is clear and unambiguous and its application does not lead to absurd consequences, its language must be given effect, and its provisions must be construed so as to give effect to the purpose indicated by a fair interpretation of the language used. La. Civ.Code art. 9; La.Rev.Stat. § 1:4; In re Clegg, 10-0323, p. 20 (La.7/6/10), 41 So.3d 1141, 1154. Unequivocal provisions are not subject to judicial construction and should be applied by giving words their generally understood meaning. La. Civ.Code art. 11; La.Rev. Stat. § 1:3; see also Snowton v. Sewerage and Water Bd., 08-0399 at pp. 5-6 (La.3/17/09), 6 So.3d 164, 168. Words and phrases must be read with their context and construed according to the common and approved usage of the language. La.Rev.Stat. § 1:3. The word `shall' is mandatory and the word `may' is permissive. Id. Further, every word, sentence, or provision in a law is presumed to be intended to serve some useful purpose, that some effect is given to each such provision, and that no unnecessary words or provisions were employed. Colvin v. Louisiana Patient's Compensation Fund Oversight Bd., 06-1104, p. 6 (La.1/17/07), 947 So.2d 15, 19; Moss v. State, 05-1963, p. 15 (La.4/4/06), 925 So.2d 1185, 1196. Consequently, courts are bound, if possible, to give effect to all parts of a statute and to construe no sentence, clause, or word as meaningless and surplusage if a construction giving force to and preserving all words can legitimately be found. Colvin, 06-1104 at p. 6, 947 So.2d at 19-20; Moss, 05-1963 at p. 15, 925 So.2d at 1196. Where two statutes deal with the same subject matter, they should be harmonized if possible, as it is the duty of the courts, in the construction of statutes, to harmonize and reconcile laws. LeBreton v. Rabito, 97-2221, p. 7 (La.7/8/98), 714 So.2d 1226, 1229; Chappuis v. Reggie, 222 La. 35, 44, 62 So.2d 92, 95 (1952); La. Civ.Code art. 13. However, if there is a conflict, the statute specifically directed to the matter at issue must prevail as an exception to the statute more general in character. LeBreton, 97-2221 at p. 7, 714 So.2d at 1229; Kennedy v. Kennedy, 96-0732, p. 2 (La.9/9/97), 699 So.2d 351, 358 (on rehearing). Accordingly, we are bound to a strict interpretation of the plain language of the statutory provisions to which we now turn. La.Rev.Stat. § 40:1299.47(H) specifically provides: Any report of the expert opinion reached by the medical review panel shall be admissible as evidence in any action brought by the claimant. Accordingly, under the plain language of this provision, a panel's expert opinion is and shall be admissible. What constitutes an expert opinion, however, is clearly and succinctly defined in the preceding statutory provision, La.Rev.Stat. § 40:1299.47(G), which states the panel ... shall render one or more of the following expert opinions : (1) The evidence supports the conclusion... defendant ... failed to comply with the appropriate standard of care.... (2) The evidence does not support the conclusion ... defendant ... failed to meet the applicable standard of care.... (3) That there is a material issue of fact, not requiring expert opinion, bearing on liability for consideration by the court. (4) When Paragraph (1) of this Subsection is answered in the affirmative, that the conduct complained of was or was not a factor of the resultant damages. If such conduct was a factor, whether the plaintiff suffered: (a) any disability and the extent and duration of the disability, and (b) any permanent impairment and the percentage of the impairment. Given the plain language of this provision, an expert opinion is one rendered on the issues of whether or not the evidence supports a finding of substandard medical care and whether and to what degree that substandard care contributed to the resultant damages. However, when there exists a material issue of fact, not requiring an expert opinion, bearing on liability for consideration by the court, the statutory provision requires the opinion of the panel simply acknowledge the material issue and defer to the factfinder's consideration. In this way, the Legislature successfully retains the benefit of the panel members' education and training in the resolution of potentially complex medical issues, while preserving to the court and the jury their factfinding function. [4] Correspondingly, the panel's sole duty under our medical malpractice scheme is to express its expert opinion as to whether or not the evidence supports the conclusion the defendant or defendants acted or failed to act within the appropriate standard of care. La.Rev.Stat. § 40:1299.47(G); see also Samaha, 07-1726 at p. 14, 977 So.2d at 889. In performing this duty, the panel is not permitted to render an opinion on any disputed issue of material fact that does not require their medical expertise. With the standard of care not in dispute, the primary issue of whether the alleged acts of negligence even occurred in this case was one of material fact, the resolution of which did not require an expert medical opinion nor would have benefited from the panel's medical expertise. Therefore, by answering this material question of fact, the panel superseded its statutory authority. More significantly, by discrediting plaintiffs' evidence and relying strictly upon the medical records, the panel impermissibly rendered an opinion based on its resolution of an issue La.Rev. Stat. § 40:1299.47(G)(3) clearly and explicitly reserved to the jury. Simply stated, although a panel may render more than one opinion, the panel in this circumstance was not permitted to render one on whether the hospital's actions complied with the applicable standard of care as provided for in La.Rev.Stat. § 40:1299.47(G)(1) or (G)(2) because there existed a material issue of fact bearing on that very issue of liability, which did not required their medical expertise. Thus, while seemingly complying with the statutory mandate of La.Rev. Stat. § 40:1299.47(G)(2) by finding the evidence does not support the conclusion that the defendant ... failed to comply with the appropriate standard of care, the opinion rendered in this matter nevertheless does not conform to any of the statutory definitions because it is not based on the applicable medical standard or the panel's medical expertise, but rather, on its impermissible credibility determinations. It logically follows, therefore, the opinion rendered in this matter does not constitute an expert opinion as contemplated in the statutory scheme and, consequently, is neither subject nor entitled to the mandatory admission requirement for expert opinions set forth in La.Rev.Stat. § 40:1299.47(H). Moreover, to the extent the panel's opinion exceeded its statutory authority and sought to resolve a material issue of fact explicitly reserved to the jury, we find the opinion is inadmissible. However, any error on the District Court's part in admitting the opinion was rendered harmless by its redaction of the offending credibility language. As the record clearly demonstrates, the edited opinion summarized the position of the parties and the evidence already presented to the jury without any indication of the panel's credibility determinations. Therefore, this evidence was merely corroborative and cumulative of other properly introduced evidence. See State v. Taylor, 01-1638, p. 22 (La.1/14/03), 838 So.2d 729, 748 (admitting improper evidence which is merely corroborative and cumulative of other properly introduced evidence is harmless [error]). Because this error did not rise to a level which precluded the jurors from reaching a verdict based on the law and facts, we find the appellate court erred in determining de novo review of the record was necessary in this regard. Wooley v. Lucksinger, 09-0571, p. 68 (La.4/1/11), 61 So.3d 507. Moreover, regarding the District Court's alleged error in admitting Dr. Leonard's expert testimony, well-settled law gives the trial court much discretion in determining whether to allow a witness to testify as an expert under La.Code Evid. art. 702, and its judgment will remain undisturbed unless that discretion was abused. Cheairs v. State ex rel. Dep't of Transp. & Dev., 03-680 (La.12/2/03), 861 So.2d 536. As the record clearly shows, Dr. Leonard testified regarding his opinions on causation and breach of the standard of care; he did not testify to the panel's impermissible and inadmissible conclusions on these issues. [5] Accordingly, we find no abuse of the District Court's discretion in admitting his expert testimony concerning his expert opinion alone and further find the appellate court further erred in determining de novo review was necessary. Given the harmlessness of the District Court's error and the absence of an abuse of its discretion, we hold the jury's verdict must be reviewed for manifest error. Moreover, because the evidence concerning the issue before us was fully developed at trial and considering the passage of time, we now exercise our appellate jurisdiction of both law and fact in civil matters in the interests of judicial economy and efficiency and review the jury's verdict for manifest error. Wooley, 09-0571 at p. 68, 61 So.3d 507; see also Campo v. Correa, 01-2707, p. 11 (La.6/21/02), 828 So.2d 502, 510; see also, La. Const. Art. V, § 5(C).