Court Opinion

ID: 9780795
Source: CourtListenerOpinion
Date Created: 2023-08-30 02:55:01.104701+00
Date Added: 2024-06-11T07:34:13.822566
License: Public Domain

Justice NEWBY
concurring in part and concurring in the result.
Rule 9(j)(l) of the North Carolina Rules of Civil Procedure requires a plaintiff to have a person who is “reasonably expected” to qualify as an expert under Rule 702 of the North Carolina Rules of Evidence review the medical care at issue prior to the filing of the complaint. N.C.G.S. § 1A-1, Rule 9(j)(l) (2009). Plaintiffs proffered expert in the case sub judice cannot be “reasonably expected” to qualify as an expert under Rule 702 as this Court articulates the meaning of Rule 702 today. However, because plaintiff did not have the benefit of this Court’s interpretation of Rule 702 at the time she filed her complaint in this matter, I believe that her complaint should not be subject to dismissal for a violation of Rule 9(j)(l). Accordingly, I concur in the result that her complaint is reinstated.
Our General Assembly added Rule 9(j) to our Rules of Civil Procedure and the relevant provision of Rule 702 to our Rules of Evidence in a 1995 session law designed “to prevent frivolous med*37ical malpractice actions.” Act of June 20, 1995, ch. 309, 1995 N.C. Sess. Laws 611, 611. The General Assembly essentially imposed two additional requirements on those seeking to pursue a medical malpractice action. Id. First, the legislature mandated that an expert witness must review the conduct at issue and be willing to testify at trial that it amounts to malpractice before a lawsuit may be filed. Ch. 309, sec. 2,1995 N.C. Sess. Laws at 613. Second, the legislature limited the pool of appropriate experts to those who spend most of their time in the profession teaching or practicing. Id., sec. 1, at 611-13. With this second requirement the General .Assembly wanted to ensure that experts would be “qualified practitioners of a competence similar to those of the practitioners who are the object of the suit” and “to eliminate the use of professional witnesses whose careers are dedicated to testifying opposed to those practitioners who practice medicine.” Minutes, Meeting on H. 636 & H. 730 Before the House Select Comm. on Tort Reform, 1995 Reg. Sess. (Apr. 19, 1995) [hereinafter Minutes] (comments by Rep. Charles B. Neely, Jr., Member, House Select Comm, on Tort Reform). Those reasons are behind similar requirements in other jurisdictions. E.g., Seisinger v. Siebel, 220 Ariz. 85, 90, 203 P.3d 483, 488 (2009) (en banc) (observing a legislative desire to prevent retired physicians from testifying against practicing physicians); McDougall v. Schanz, 461 Mich. 15, 25 n.9, 597 N.W.2d 148, 153 n.9 (1999) (noting a legislative intention to exclude “hired gun” expert witnesses, those “who travel the country routinely testifying” (citation and internal quotation marks omitted)).
Rule 9(j) of our Rules of Civil Procedure prevents the filing of a medical malpractice action without the medical care at issue first being reviewed by an appropriate expert. Thigpen v. Ngo, 355 N.C. 198, 203-04, 558 S.E.2d 162, 166 (2002). Rule 9(j)(l), the portion of the rule at issue here, requires a medical malpractice complaint to assert that the medical care at issue has “been reviewed by a person who is reasonably expected to qualify as an expert witness under Rule 702 of the Rules of Evidence and who is willing to testify that the medical care did not comply with the applicable standard of care.” N.C.G.S. § 1A-1, Rule 9Q)(1). A medical malpractice complaint without this statement will be dismissed. Thigpen, 355 N.C. at 202, 558 S.E.2d at 165. Further, because this rule is designed to prevent complaints regarding care that has not been reviewed by an appropriate expert, even complaints containing a Rule 9(j) statement will be dismissed if the statement was unreasonably included. See, e.g., Barringer v. Wake Forest Univ. Baptist Med. Ctr., 197 N.C. App. 238, 255, 677 S.E.2d 465, 477 (2009).
*38Rule 702 of our Rules of Evidence provides that only certain health care providers may serve as expert witnesses in medical malpractice cases. Generally speaking, any person may be an expert witness if his or her “knowledge, skill, experience, training, or education” would be helpful to the jury. N.C.G.S. § 8C-1, Rule 702(a) (2009); State v. Smith, 221 N.C. 278, 288, 20 S.E.2d 313, 319 (1942) (explaining that whether a proffered expert witness is competent to testify depends not “upon the fact that he belongs to a certain profession to which opinion evidence of that character is necessarily confined, but upon a principle that must lie behind the competency of all opinion testimony — the fact that the witness has special experience in matters of the kind, and his conclusions may, therefore, be helpful to the less experienced jury”). However, Rule 702(b)(2)(a), the portion of that rule at issue here, provides that in a medical malpractice action an expert witness must be “a licensed health care provider” who “[d]uring the year immediately preceding the date of the occurrence that is the basis for the action... devoted a majority of his or her professional time to . . . [t]he active clinical practice of the same health profession in which the party against whom or on whose behalf the testimony is offered.” N.C.G.S. § 8C-1, Rule 702(b)(2)(a) (2009).5 This mandate serves as a limitation on the general rule regarding who may be an expert witness. Accordingly, an individual may possess the “knowledge, skill, experience, training, or education,” id. Rule 702(a), that would enable him to serve as an expert in a medical malpractice action but be unable to actually qualify as an expert because of his inability to meet one or more of the requirements of Rule 702(b)(2)(a), see, e.g., Seisinger, 220 Ariz. at 90, 203 P.3d at 488 (explaining that a physician who has not recently practiced may “remain[ ] qualified through ‘knowledge, skill, experience, training, or education’ ” to testify regarding a standard of care that has not materially changed since he left practice but nonetheless be prohibited from serving as an expert by a similar statute).
The majority opinion interprets Rule 702(b)(2)(a) to have three basic requirements. First, the proffered expert must be “in the same health profession as the party against whom or on whose behalf’ he intends to testify “during the year immediately preceding the incident.” The majority opinion does not elaborate on what it means to be “in the same health profession” but ássures that requirement “will *39rarely be at issue and does not warrant discussion here.” Perhaps it is within this statement the majority opinion contemplates Rule 702(b)’s mandate that the proffered witness be “a licensed health care provider in this State or another state.” Second, the proffered expert must have “engaged in active clinical practice during that time period.” The majority opinion defines the word “clinical” as “ ‘actual experience in the observation and treatment of patients’ ” and states that a “continuum exists between active and inactive clinical practice.” Whether an individual’s practice is “active” depends upon a number of circumstances, including the amount of time devoted to it, the type of work being performed, and the regularity of the practice, with no single factor controlling. Third, a majority of the proffered expert’s “professional time” must have been “devoted to that active clinical practice.” This requirement is satisfied if more than half of the time the proffered expert spends “engaged in the profession of which he or she is being proffered as an expert” is devoted to clinical practice.
I agree with the majority opinion’s interpretation of Rule 702 in this case. The requirement that the proffered expert witness is in the “same health profession” as the one for or against whom he intends to testify is consistent with the plain language of the rule. See N.C.G.S. § 8C-1, Rule 702(b)(2). Additionally, the requirement that a proffered expert spend a majority of “Ms or her," as opposed to some hypothetical individual’s, “professional time,” as opposed to personal time, engaged in active clinical practice is consistent with the text of the rule. See id. Rule 702(b)(2)(a) (emphases added). That requirement also preserves the balance struck by the legislature that prevents the use of “hired gun” expert witnesses but nonetheless allows an individual who engages in active clinical practice on a part-time basis possibly to qualify as an expert. Minutes (comments by Rep. Neely).
Perhaps most importantly, by recognizing that the word “active” modifies the phrase “clinical practice,” the majority opinion realizes the legislature’s intention to have qualified practitioners testifying in medical malpractice cases. See N.C.G.S. § 8C-1, Rule 702(b)(2)(a). As the majority opinion explains, ascertaining whether a proffered expert’s clinical practice is “active” depends on a number of factors, none of which is likely to be dispositive. These factors include the amount of time that individual spends observing and treating patients and the frequency and regularity with which the proffered expert engages in those activities. The more infrequently or intermittently the proffered expert observes and treats patients, the more likely that *40individual does not qualify as an expert under Rule 702(b)(2)(a). The most important factor in this inquiry is the type of work the individual is performing. An individual who is not performing the activities of other clinical practitioners of the same health profession likely will not qualify as an expert. For example, an individual who observes or diagnoses patients but who does not regularly perform the various treatments done by other members of that health profession likely would not qualify as an expert under this rule. Allowing an individual who does not function as do the vast majority of the other members of the same health profession to qualify as an expert under this rule would contravene the General Assembly’s intention to ensure that experts in medical malpractice cases would be “qualified practitioners of a competence similar to those of the practitioners who are the object of the suit.” Minutes (comments by Rep. Neely).
When ascertaining whether Rule 9(j) is satisfied a reviewing court must determine whether one who is “reasonably expected” to qualify as an expert under Rule 702 reviewed the medical care at issue prior to filing. Whether that individual actually qualifies under Rule 702 is a different inquiry, as the majority opinion notes. Because Rule 9(j) is a pleading rule, focusing on and regulating the filing of a complaint in a medical malpractice action, Thigpen, 355 N.C. at 203, 558 S.E.2d at 166, compliance is measured by what was known or through the exercise of reasonable diligence should have been known by the pleader at the time the medical malpractice complaint was filed, Trapp v. Maccioli, 129 N.C. App. 237, 241, 497 S.E.2d 708, 711, disc. rev. denied, 348 N.C. 509, 510 S.E.2d 672 (1998). As the majority opinion explains, a court may look to subsequent discovery materials to ascertain what was known and what reasonably should have been known at the time of filing, but should view reasonable factual ambiguities in favor of the plaintiff. With these considerations in mind I now turn to the relevant inquiry in the case sub judice.
At the time of filing the complaint plaintiff knew or should have known that Dr. Dunn practiced dentistry an insubstantial number of days in the year preceding the alleged malpractice. Dr. Dunn retired from the general practice of dentistry in July 1997, some twelve years before the complaint was filed and some nine years prior to the conduct at issue in the case. In the year preceding the alleged malpractice Dr. Dunn practiced dentistry on a “fill-in” basis. As the majority opinion notes, the number of days he actually “filled in” for another dentist in that year is unclear. Dr. Dunn estimated at one point he worked “maybe” thirty days that year but later stated that he *41“covered for one gentleman ... for three — almost two and one-half months” in the “general neighborhood” of the year preceding the alleged malpractice in this case. While the exercise of reasonable diligence requires a determination whether this work actually occurred during the relevant year, this explanation was given prior to our decision today. Accordingly, I, like the majority opinion, will treat this as a reasonable factual ambiguity and assume Dr. Dunn filled in for more than two and one-half months during the year preceding the alleged malpractice. That figure amounts to roughly twenty-five percent of the relevant time period.
Dr. Dunn engaged in the practice of dentistry rarely and with little regularity during the period from January 2005 to January 2006, stating at his deposition that he did “fill-in work for dentists who are on vacation or ill.” Dr. Dunn explained that he was “not in the business of doing” fill-in work and did not “eam[ ] a living doing it.” Instead, he explained that he had a group of “about five or six guys that [he is] friends with” for whom he would perform this fill-in work, but that he does not “want to do anymore than [he has] to.” The days where Dr. Dunn performs this work “are scattered” and “just here and there.” In fact, there are times when Dr. Dunn will go “several months without filling in.” Dr. Dunn seemed to indicate that some of his work occurred when dentists vacationed in the summer but explained that more of his work tended to occur in the winter months “when [dentists would] get sick,” which by its nature is irregular and unanticipated. These facts indicate that Dr. Dunn’s work in the dental profession is sporadic and seldom.
Most importantly, Dr. Dunn performed very few of the activities undertaken by practitioners of general dentistry. In his deposition Dr. Dunn described general dentistry as involving “endodontics, oral surgery, [and] restorative dentistry.” He elaborated, stating these include such activities as performing “root canals,” “fixfing] teeth to crown them, fill them or whatever,” “taking out teeth,” executing “soft tissue surgeries,” and undertaking “apicoectomies.” By contrast, Dr. Dunn described his fill-in work as “just routine dental care, emergency treatment, whatever comes down the road that you need to do.” He explained that when he is filling in he “is mostly checking hygiene patients” and to a lesser extent he “provide [d] emergency dental care[ ] and referred] patients that may need to go to an orthodontist.” He stated that he would not perform much “clinical dentistry,” that is, treatment, mainly because “patients you are filling in for are used to a certain dentist” and “[t]hey don’t feel comfortable with a *42stranger coming in there and working.” Dr. Dunn clarified that if a patient was “comfortable with [him] then [he would] do the work” but acknowledged that “most. . . patients don’t want a dentist they don’t know taking out teeth or doing a lot of stuff.” Given his description both of general dentistry and his own fill-in work it seems Dr. Dunn’s dental activities are not entirely consistent with the activities of general dentistry practitioners.
Dr. Dunn did not engage in “active clinical practice” during the period from January 2005 to January 2006. Resolving factual ambiguities in favor of plaintiff, Dr. Dunn spent approximately twenty-five percent of the work days in the year engaged in the clinical practice of dentistry. Moreover, because when he worked largely depended on the illness or vacation of others, Dr. Dunn did not practice with much consistency or frequency. Finally, Dr. Dunn acknowledged that he spent most of his time in clinical practice checking hygiene patients and did not undertake most of the treatments and procedures normally performed by dental clinicians. Considering these factors together, it is unreasonable to expect Dr. Dunn to be deemed to have engaged in the active clinical practice of dentistry during the relevant time period. And, as a result, he is not “reasonably expected” to qualify as an expert witness under Rule 702.
Nonetheless, the majority opinion concludes that Dr. Dunn is reasonably expected to qualify as an expert under Rule 702. The majority opinion relies principally on Dr. Dunn’s more than thirty-five years of experience as a general dentist, his current license to practice, and the number of days he filled in for other dentists during the period from January 2005 to January 2006 to support its conclusion. Also, the majority opinion notes that “all of Dr. Dunn’s time in the dental profession was spent engaged in clinical practice.” While certainly implicating Rule 702’s third requirement that a proffered expert spend a majority of his professional time in clinical practice, this observation is not particularly relevant to Rule 702’s second requirement, whether the proffered expert engaged in active clinical practice. Moreover, Dr. Dunn’s current license is irrelevant to whether he engaged in active clinical practice. Rule 702 explicitly requires a proffered expert witness to be licensed in order to testify as an expert in a medical malpractice action. N.C.G.S. § 8C-1, Rule 702(b). Finally, while Dr. Dunn’s education and experience practicing general dentistry in the United States Navy and in Asheville, North Carolina, are certainly impressive and instructive as to whether he is in a better position than the jury to understand the applicable stan*43dard of care, a requirement of Rule 702(a), events prior to the year preceding the alleged malpractice simply are not relevant to the inquiry under Rule 702(b)(2)(a). Accordingly, the pertinent factual circumstance supporting the majority opinion’s conclusion that Dr. Dunn engaged in “active clinical practice” during the year preceding the alleged malpractice is the number of days Dr. Dunn spent filling in. In my view, that simply is not enough.
Nonetheless, plaintiff in this case did not have the benefit of today’s decision when choosing an expert witness. Accordingly, while I disagree with the majority opinion’s conclusion that Dr. Dunn satisfies Rule 9(j)’s standard of being “reasonably expected” to qualify as an expert under Rule 702, I concur in the result that plaintiff’s complaint is reinstated.

. Of course there are other activities with which an individual may fill his or her professional time. See, e.g., N.C.G.S. § 8C-1, Rule 702(b)(2)(b). Those are not, however, at issue in this case.