Court Opinion

ID: 9766728
Source: CourtListenerOpinion
Date Created: 2023-08-29 04:57:17.149754+00
Date Added: 2024-06-11T07:30:25.234048
License: Public Domain

Justice FLAHERTY,
dissenting in part while concurring in the judgment.
I agree with the majority that the jury instructions were not erroneous and that the trial justice did not commit reversible error when she redacted portions of Dr. Kim’s and Dr. Duffs videotaped depositions. However, I most respectfully disagree with the majority’s holding that the plaintiff waived his right to appeal certain evidentiary rulings because he failed to provide this Court with a portion of the record. Although it is the opinion of the majority that this failure precludes appellate review, in the trial transcripts that were provided to this Court, the trial justice stated and restated her rationale for each of the disputed evidentiary rulings. I therefore believe that the record that Riley provided is more than satisfactory to enable this Court to address the issues raised on appeal.
I
Waiver of Appellate Review
Article I, Rule 10(b)(1) of the Supreme Court Rules of Appellate Procedure says that it is incumbent on an appellant to provide this Court with “such parts of the proceedings not already on file as the appellant deems necessary for inclusion in the record.” Our rules of appellate waiver serve an important function — the integrity of the appellate process would be undermined if this Court were to base its decisions on speculation and conjecture instead of relying on the record before us. But we have never required a party to provide us with the entire record of the proceedings below. Rather, a party seeking review by *1099this Court must only provide “so much of the record as may be required to enable this [C]ourt to pass on the error alleged.” Anjoorian v. Kilberg, 836 A.2d 1092, 1094 (R.I.2003) (quoting Kalooski v. Albert-Frankenthal AG, 770 A.2d 831, 833 (R.I.2001)). A party’s failure to provide this Court with part of the record “may result in a dismissal of the appeal.” Id. (quoting State v. Pineda, 712 A.2d 858, 861 (R.I.1998)). However, this rule is not absolute, and the waiver of appellate review always has depended on whether we are able to engage in a meaningful review of the proceedings below. Compare Pineda, 712 A.2d at 861 (failure to provide stenographic record of district court proceedings precluded appellate review), with State v. Udin, 419 A.2d 251, 263 (R.I.1980) (missing portion of transcript “hampered our inquiry,” but the record was nevertheless adequate to assess merits of the appeal).
To support its decision that Riley has waived his right to appeal some of the trial justice’s rulings, the majority cites Anjoo-rian and Pineda. In both cases, the records provided by the respective parties were so lacking that we were unable to assess the merits of their arguments on appeal. In Anjoorian, 836 A.2d at 1095, the appellant failed to provide this Court with a copy of the bench decision from which he appealed, and therefore we were unable to evaluate whether “ ‘the trial justice considered all the evidence and made a reasonable decision.’ ” Likewise in Pineda, 712 A.2d at 861, the appellant did not furnish this Court with a stenographic record of the proceedings below, and therefore we had “absolutely no way of reviewing the decision of the hearing judge.” In my opinion, these cases are inapplicable to this case because the record that Riley furnished to this Court is more than adequate to assess the arguments he raises on appeal.
According to the majority, the record was insufficient to assess the merits of three of the five evidentiary rulings that Riley challenges on appeal: (1) the redaction of a treatment note written by Dr. Duff; (2) the redaction of a note written by Dr. Janecka; and (3) a ruling that prohibited Dr. Rudders from testifying about some of the sources he relied on to form his expert opinion. Apparently, the majority’s expansive application of our appellate rules of waiver flows from Riley’s failure to provide us with a record of a motion in limine that led to the redaction of Dr. Duffs treatment note. There are, in my opinion, too many hats hung on this peg. Because of this sole omission, the majority holds that Riley waived his right to appeal not only the ruling on the motion in li-mine, but also other tangentially related rulings, even though he provided us with a complete record of these other rulings. As outlined below, the three evidentiary rulings deemed waived by the majority are amply discussed in the transcripts that Riley provided for our review, and his arguments should have been addressed on the merits.
Doctor Duffs Note
The majority observes that the trial justice stated that her reason for redacting Dr. Duffs note was that it “ ‘violates the opinion rule.’” The majority then comments that “we do not have a basis for that ruling or even a reference to what ‘opinion rule’ the trial justice adverted.” I most respectfully disagree, however, because the trial justice’s reasoning is crystal clear from the record. Indeed, she restated her rationale for redacting the note on six separate occasions over the course of the trial.15
*1100For example, when ruling on the portion of Dr. Duffs videotaped deposition in which he discusses this note, the trial justice stated as follows:
“[t]he note itself does not indicate even a degree of medical certainty[.]
U * if: *
“[I]t is unclear from the records, as well as [Dr. Duffs] testimony, * * * whether these are opinions that he held to the requisite degree of medical certainty at the time of his examination.” (Emphases added.)
Later, when Riley’s attorney made an offer of proof regarding the testimony of Dr. Rudders, he read the disputed portions of Dr. Duffs note into the record. In the face of the justice’s prior ruling on the motion in limine, the attorney requested that Dr. Duffs note be admitted in full, arguing to the court:
“I think that these are part of the medical record and should be admitted, because the remainder of the record has, I believe, been agreed to by both Dr. Duffs and Dr. Janecka’s records * * *.
“I would ask this Court to reconsider its ruling on Dr. Duffs note, and also allow into evidence the note of Dr. Janecka.”
The justice denied this request, as well as the attorney’s request that Dr. Rudders be permitted to testify about the disputed portion of the note. In so doing, she stated:
“With regard to Dr. Duff, it is clear from his deposition testimony, as well as the language of the note itself, that he is not expressing an opinion about the nature of the mass lesion that he observes on the 1996 brain MRI * * *. He’s not even expressing that opinion in the note, and he clarifies in his videotaped deposition testimony that he does not hold an opinion to a reasonable degree of medical certainty * * *.
“ !|C * *
“It is not even a conclusion that Dr. Duff reaches in the context of that note, and it is an important issue, obviously, for plaintiffs in the case and must be proved to a requisite degree of medical certainty * * *.
“This is a transparent attempt in my view, by the plaintiff, through an expert, to simply try to elevate statements of other physicians, not expressed to a reasonable degree of medical certainty * * *. I will continue to exclude any reference to the matter in those treating notes that were not stated to the requisite degree of medical certainty * * *.” (Emphases added.)
There is no doubt that it would have been prudent for Riley to furnish this Court with a record of the motion in li-mine related to Dr. Duffs note. However, it is very obvious from the highlighted language that the trial justice excluded this evidence because Dr. Duff failed to state his opinion to a requisite degree of medical certainty. I therefore cannot agree with the majority’s holding that the record is insufficient and that there is no way to determine what opinion rule the trial justice referred to. In my opinion, the rationale for the trial justice’s ruling is clearly stated several times.16 This Court itself has held that to be admissible, a doctor’s conclusions must be stated with *1101“reasonable medical certainty,” and it has done so without citation to a specific rule. Morra v. Harrop, 791 A.2d 472, 477 (R.I.2002) (quoting State v. Lima, 546 A.2d 770, 773 (R.I.1988)).
Doctor Janecka’s Note
Unlike the ruling on Dr. Duffs note, Dr. Janecka’s note was not the subject of a pretrial motion, and everything that took place in connection with the justice’s redaction of this note appears in the record before us. I therefore have some difficulty accepting the majority’s conclusory statement that “the trial justice’s ruling on Dr. Duffs note * * * also controlled the admissibility of Dr. Janecka’s records.” In my opinion, it is not necessary to “scour the record” to determine the trial justice’s thought process for redacting this record because the justice’s reasoning is explicitly stated several times.
For example, the trial justice ruled that Dr. Rudders could not testify about certain portions of Dr. Janecka’s note because the note contained opinions that were “not expressed to a reasonable degree of medical certainty.” (Emphasis added.) She further explained that “Dr. Janecka has not been deposed, and there has been no statement given by him subject to cross-examination that he holds such an opinion to a reasonable degree of medical certainty.” (Emphasis added.) She therefore ruled that Dr. Rudders could not testify about the objectionable portions of the note.
The subject of Dr. Janecka’s note was discussed later when the court was considering what exhibits would be presented to the jury. At that point, counsel for defendants requested the redaction of the offending portion of Dr. Janecka’s note. The justice responded as follows:
“Okay, consistent with the Court’s prior rulings, that requested redactions may be made over the plaintiffs’ objection based on the absent requisite opinion testimony regarding those opinions to a reasonable degree of medical certainty.” (Emphases added.)
In light of this exchange, the record before us includes defendants’ request for redaction of the note, plaintiffs objection to that, and the trial justice’s ruling with a clear statement of her reasoning. Even under the most stringent view, this on-the-record exchange complies with our requirements for appellate review.
I therefore respectfully disagree with the majority’s holding that this issue was waived and that a “vague reference in the record to a prior ruling is of no assistance to the plaintiff.” (Emphasis added.)17 The fact that the trial justice incidentally commented on the consistency of that ruling with prior rulings is immaterial because she said on the record that her reason for redacting the note was because it did not state an opinion “to a reasonable degree of medical certainty.” Thus, we need not rely on any prior rulings to ascertain the justice’s rationale. Therefore, I believe that the Court should have weighed the merits of Riley’s appeal on this evidentiary ruling.
Doctor Rudders’ Testimony
The final issue raised by Riley that fell prey to the majority’s waiver decision is his challenge to the trial justice’s ruling that Dr. Rudders would not be permitted to testify about the details of the redacted notes and a telephone conversation with Dr. Janecka. Again the majority says that Riley has failed to provide us with us a *1102“sufficient record to evaluate the trial justice’s decision.”
Specifically, the majority states as follows:
“In his brief to this Court plaintiff suggests that this issue was preserved by an offer of proof set forth on ‘pp. 227-264’ of the trial transcript. The plaintiff did not file an appendix and we are unable to locate this offer of proof.”
I respectfully disagree with this assertion because the plaintiffs offer of proof appears in the record precisely on the pages cited.18 Following this offer of proof, Riley’s attorney and opposing counsel presented arguments concerning the admissibility of Dr. Rudders’ testimony. The trial justice ruled in favor of defendant and stated in part as follows:
“Let me begin with Rule 703, which reads the experts’ opinion may be based on a hypothetical question, facts or data received by an expert at or about the hearing, or facts or data in evidence of a type reasonably and customarily relied upon by experts in the particular field and in forming opinions on the subject.”
After further outlining the requirements of Rule 703 of the Rhode Island Rules of Evidence, the trial justice stated:
“In this case, at rock bottom, what plaintiff is seeking to do through expert examination of Dr. Rudders, is pour into his testimony expert opinion testimony of both Dr. Duff and Dr. Janecka that is not expressed in the medical record or otherwise to a reasonable degree of medical certainty; in effect transforming nonexpert opinion testimony into expert opinion testimony. I believe that that is an improper use of the rule.”
The justice’s reasoning to support this ruling continues for several pages, and she specifically outlines the deficiencies of the proffered testimony. Because Riley took all the steps necessary to preserve this issue for appeal, I believe that the majority should have addressed the merits of his arguments.
II
Evidentiary Rulings
Notwithstanding the majority’s holding that Riley has waived his right to appeal certain issues, I believe that his arguments about the redaction of Dr. Duffs and Dr. Janecka’s records warrant analysis by this Court.19 The merits of Riley’s appeal revolve around his contention that these records should have been admitted without redaction because the parties stipulated before trial that the medical reports were business records. He further maintains that the opinions contained within the doctors’ reports and notes were admissible *1103because they were stated to the requisite degree of certainty.
The Effect of the Stipulation
Riley argues that the trial justice’s exclusion of Dr. Duffs and Dr. Janecka’s treatment notes was error because the parties had stipulated that these records were business records. The stipulation at issue said in part as follows:
“As to the medical records * * * it is also agreed that they shall be deemed business records, prepared and maintained in the ordinary course of business, for purposes of trial. All other objections, as may be interposed, at trial, are preserved, and this does not preclude parties from seeking to admit other records.” (Emphasis added.)
It is significant that this stipulation reserved the parties’ right to raise “[a]ll other objections” at trial. The stipulation effectively precluded hearsay objections by deeming the doctors’ notes to be authentic business records, but it did not affect the parties’ right to raise other objections. Apart from the clear language of this stipulation, the parties’ conduct also demonstrates that they did not intend this document as a stipulation to admissibility. In fact, Riley’s counsel objected himself to the admission of Riley’s medical bills based on relevancy grounds, even though the bills were covered by the stipulation.20 Moreover, the mere fact that the parties agreed that the records satisfied the requirements of Rule 803(6) of the Rhode Island Rules of Evidence has no bearing on whether the records complied with other requirements for admissibility. I am aware of no case that holds that satisfying one rule of evidence precludes the need to comply with other requirements for admissibility. See Ouellette v. Carde, 612 A.2d 687, 692 (R.I.1992) (holding satisfaction of Rule 808(6) did not circumvent the requirements for admitting medical records that contained opinions). The trial justice did not exclude the records from evidence because they were hearsay, but because they did not comply with the requirements for admitting medical opinions. Therefore, the stipulation had no effect on the propriety of these rulings.
Redaction of the Doctors’ Records
Riley next asserts that the trial justice erred when she redacted portions of Dr. Duffs and Dr. Janecka’s notes. He contends that the following excerpt from Dr. Duffs treatment notes should have been admitted:
“Review of prior MRI’s done in February 1996, reveals a soft tissue nasa-pharyngeal [sic] mass lesion which would be quite atypical to be adenoid tissue [for] what was then a 42 y.o.”
He also asserts that redacted portions of Dr. Janecka’s notes were admissible:
“MR (9-98 and '96) reviewed; there is a nasopharyngeal mass on '96 MR localized to the nasopharynx. * * * Patient was unaware of tumor on '96 films.”
The trial justice ruled that these statements were inadmissible because they were not opinions made to a reasonable degree of medical certainty. Riley maintains, however, that the doctors’ opinions satisfied the requisite level of certainty, despite the fact that neither doctor recited the words, “reasonable degree of medical certainty.” Essentially he contends that the trial justice’s rulings placed form over substance.
It is well settled that when doctors offer their expert opinions, their opinions must be stated to a reasonable degree of medical certainty. See, e.g., Morra, 791 A.2d at *1104477; Parrella v. Bowling, 796 A.2d 1091, 1099 (R.I.2002). In lieu of live testimony, G.L.1956 § 9-19-27 allows for admission of a medical opinion through documentation. This statute, however, “in no way relaxes the minimum requirements for the admission of competent medical testimony.” Parrillo v. F.W. Woolworth Co., 518 A.2d 354, 355 (R.I.1986). Moreover, when such evidence is offered to establish that a defendant’s acts or omissions caused the plaintiffs injury, “such testimony must speak in terms of ‘probabilities’ rather than ‘possibilities.’ ” Id. (quoting Sweet v. Hemingway Transport, Inc., 114 R.I. 348, 355, 333 A.2d 411, 415 (1975)). Although the admission of medical opinions does not hinge on the recitation of “talismanic” words, the expert’s opinion nevertheless must be stated with the requisite level of certainty. Morra, 791 A.2d at 477 (“the admissibility of expert testimony does not require the use of ‘magic words’ or ‘precisely constructed talismanic incantations’ ”) (quoting Gallucci v. Humbyrd, 709 A.2d 1059, 1066 (R.I.1998)); accord Bailey v. Cataldo Ambulance Service, Inc., 64 Mass.App.Ct. 228, 832 N.E.2d 12, 17-18 (2005) (admissibility of medical records containing expert opinion does not hinge on the “recitation of ‘magic words,’ ” but the opinion must be stated with “sufficient firmness and clarity”).
Riley argues that the doctors’ statements met the requisite level of certitude required for admission. Doctor Duffs statement that there was a mass in Riley’s 1996 MRI is followed by a statement that “it may be that [the 1996 mass] has progressed in size * * The use of the term “may” underscores his uncertainty. Doctor Janecka’s statements suffered similar infirmities. His note says that a mass appeared in Riley’s 1996 MRI and that Riley was unaware of its presence at that time. Yet there is no indication, to any degree of certainty, whether this mass is the same mass that proved to be cancerous in 1998. Given the equivocal nature of Dr. Duffs and Dr. Janecka’s opinions, I would affirm the trial justice’s rulings, and therefore I concur in the Court’s holding.

. Furthermore, both parties’ briefs present a clear picture of the motion in limine proceed*1100ing; there is no dispute that the trial justice excluded this evidence because Dr. Duff's note contained an opinion that was not expressed in terms of a reasonable degree of medical certainty.

. I am aware of no rule that would fault a party for the justice's failure to offer citation to a specific rule to support her ruling.

. The trial justice stated that the ruling was consistent with prior "rulings” (i.e., plural, not singular). Therefore, even if one of the prior rulings is not in the record before us, there is at least one other ruling that is on the record.

. The majority also faults Riley for not furnishing this offer of proof in a separate appendix. However, sixty pages of documents are appended to his brief, and in my opinion, his citation to the exact pages of the transcript is sufficient.

. Riley also argues that the trial justice erred when she ruled that Dr. Rudders could not testify about the redacted portions of Dr. Duff’s and Dr. Janecka’s notes, as well as the substance of a conversation he had with Dr. Janecka after the trial began. The majority deemed this issue to be waived, but it notes in dicta that even if this ruling was in error, the error was harmless in light of the doctor’s other testimony. Although I believe this issue was properly preserved for appeal, I agree with the majority that the error, if any, was harmless, and I further note that the sources Dr. Rudders relied on did not satisfy the requirements of Rule 703 of the Rhode Island Rules of Evidence because they were not "legally sufficient.” Alterio v. Biltmore Construction Corp., 119 R.I. 307, 312, 377 A.2d 237, 240 (1977) (”[A]n expert's opinion must be predicated upon facts legally sufficient to form a basis for his conclusion.”).

. Counsel for defendants did not oppose this objection.