Court Opinion

ID: 9741316
Source: CourtListenerOpinion
Date Created: 2023-08-26 20:53:16.228067+00
Date Added: 2024-06-11T07:24:23.379592
License: Public Domain

Gillerman, J.
(dissenting). I dissent, respectfully, because I conclude that the claims against the appellees are frivolous, and that permitting the prosecution of such claims defeats the legislative purpose in enacting G. L. c. 231, § 60B. See Paro v. Longwood Hosp., 373 Mass. 645, 651 (1977); Denton v. Beth Israel Hosp., 392 Mass. 277, 280 (1984).
1. Dr. Sussman. Dr. Buscho writes that “[h]ad . . . [Dr. Sussman] performed a thorough and systematic exam [of the child] it is possible they would have found the scalp contusion indicating that the child had a head injury.” The fact is that this record does not reveal any direct evidence that there was a head injury prior to the time the child was admitted to the North Adams Regional Hospital (NARH), or that any contusion, if there was one on August 6, was observable on that day.
Sussman, the child’s regular pediatrician, conducted a physical examination of the child in the early morning hours of August 6, 1988. The plaintiffs offer of proof admits it, and the hospital records substantiate it. No clinical evidence of a head injury is recorded. Sussman also took a history from the child’s father, the plaintiff in this case. The father said that the child had taken his formula at 11:30 p.m. A *730short while later the father noticed that the child was having difficulty breathing. As he lifted the child out of bed, the child stopped breathing, and the father began mouth-to-mouth resuscitation. The child vomited cereal, and the police were called. There is nothing of a head injury in this history; Buscho’s speculation of a head injury is contradicted by his client, the plaintiff.
The child was examined again upon arrival at the Baystate Medical Center by Dr. Marz. He testified before the grand jury (the transcript of a portion of which is in the plaintiff’s offer of proof) that he found that there “were no outside marks to indicate any head trauma. . . .”
Dr. Buscho does not identify the source for his statement that there was a “scalp contusion” to be seen on August 6, 1988, but the majority of the panel speculates in note 5, supra, that Buscho may have referred to a “scalp contusion” which appears in the report of the autopsy conducted on August 11, 1988, one day after the date of death and six days after the date of the original injury. The report states a finding of “a faint contused zone measuring VA x 2 inches.”
Solely on the basis of the August 11 autopsy report establishing a “faint contused zone” as of that date, Buscho constructs his edifice of malpractice: the contusion noted on August 11 means there was a head injury on or before August 5, 1988; the contusion was there to be seen by Sussman on August 6, but Sussman negligently failed to see it; had Suss-man seen the contusion he would have “appreciated that the child had had a head injury”; that information was enough to call for a CT scan; the scan would have shown an in-tracranial bleed, and that would have “changed the entire therapeutic care of the baby,” for the intracranial bleed is what causes increased intracranial pressure which, in turn, causes brain damage, and ultimately, death.
Quite aside from the fact that the child’s father did not report any head injury, and that neither Sussman nor Marz saw a contusion (if it was there on August 6), what is missing is any reason to believe that the characteristics of the contusion seen on August 11 lead to the conclusion that *731(i) the contusion probably existed, and could have been seen, on August 6, and (ii) that the contusion probably reflected a head injury on August 5 or earlier. Buscho did not opine as to this in his report. And certainly the majority is not qualified to draw the inferences.
Marz testified that the first indication of the possibility of any head trauma was revealed by the lumbar puncture on August 6; the lumbar puncture is what prompted the CT scan done at 8 a.m. on August 6. But this scan on August 6 showed no evidence of any increased pressure within the infant’s brain. The increased intracranial pressure did not appear until the CT scan done on August 7 at 9:30 a.m. Thus, Buscho’s charge that there were “strong indications” that a scan on August 6 at NARH would have revealed increased intracranial pressure has no basis in the record.1 The majority replies that had Sussman diagnosed the intracranial bleeding early on August 6, the later developing increased intracranial pressure “would have been anticipated and treated preventively.” But the assumption of intracranial bleeding in the early morning hours of August 6 at NARH (before the lumbar puncture at Baystate) is the purest conjecture; it is based on the further assumption that there had been a serious head injury prior to August 6, which, in turn, is based on the assumption that the contusion seen on August 11 was evidence of that serious, prior head injury. This is not a “grudging” reading of Buscho’s letter. It is, perhaps, a *732careful reading, but that, I believe, is what the statute calls for.
Buscho makes the additional charge against Sussman that the child was transferred to Baystate before he had been “stabilized.” The difficulty, according to Buscho, was that the “increased intracranial pressure had not been diagnosed, was not being treated, and probably was worsening . . . .” But, again, there was no evidence in this record of any increased intracranial pressure until one full day after the transfer to Baystate. Buscho clings to his assumption that there had been an early serious head injury, but the plaintiff himself refutes Buscho’s gratuitous claim, and there is nothing in the record that supports Buscho’s position.
Buscho also charges that the medical records from NARH were not transferred with the child, and that this is “below the standard of care.” Nowhere does Buscho identify who was responsible for making certain that the records were on board with the child, but because the charge is included in the paragraphs of the letter dealing with Sussman we are left to surmise that Sussman must be the one who failed. But conjecture as to professional responsibility is precisely what is not permitted.2
2. Dr. Muse and nurse LaPlante. The offer of proof as to these two defendants is alleged to be their failure to make sure that the medical records were on board the helicopter flight. Assuming the records were not on board — an issue left vague in this record — Buscho’s argument is that with the records in hand the Baystate physicians “would have appreciated the possibility that the baby had increased in-tracranial pressure.” What in the records creates that possibility? Even the majority looks to the autopsy report of August 11 for evidence of a head trauma, and there is simply nothing else. Indeed, Buscho faults Sussman for not discovering the supposed increased intracranial pressure.
*7333. Dr. Marz, Dr. Lieberman, and Bay state. The majority, conceding difficulties with Buscho’s opinion, in the end faults Marz and Lieberman only for the delay of several hours in the performance of a CT scan. This charge cannot be sustained. The plaintiffs written offer of proof notes that the lumbar puncture was performed between 3:30 a.m. and 5 a.m., following which “Dr. Marz requested a CAT scan, ‘as soon as possible.’ ” In fact the scan was not performed until 8 a.m. What reason is there to believe that either Marz or Lieberman was responsible for the delay? What reason is there to believe that the scan was not done “as soon as possible?” If there were answers to these questions they are not to be found in this record, in Buscho’s opinion letter, or in the opinion of the majority.3
The medical tribunal rightly concluded that the plaintiffs offer of proof failed as to the appellees, and I would affirm the judgment.

 Buscho’s letter states that there were “strong indications to perform an emergency CT scan at North Adams Hospital” based upon the “clinical evidence of a head injury that was not appreciated, but also in any unconscious and unresponsive child . . . .” The NARH hospital record states the following: “Admitted in arms of EMT w/oral airway in place. Infant flacid — cried very small amount. Did attempt to withdraw when IV was — tube inserted by Dr. Burke.” It is plain that the child was neither unconscious nor unresponsive upon admission — and I have discussed the absence of any clinical evidence of a head injury in the text. Finally, the statement that there were “strong indications to perform an emergency CT scan” is hardly a statement that Sussman failed to conform to the required standard of care. See Bradford v. Baystate Med. Center, 415 Mass. 202, 206 n.5 (1993) (physician liability cannot be based upon generalities in the reports of the plaintiffs expert).

 The majority attempts, in note 9, supra, to resolve the difficulty by relying on testimony which suggested that the responsibility was Sussman’s “in a general way.” That is hardly a basis upon which a medical malpractice suit should be prosecuted.

 This case is not controlled by Booth v. Silva, ante 16, 21 & n.7 (1994). In Booth, the opinion of the expert was not substantiated by the evidence in the offer of proof; in this case the expert’s opinion is contradicted by the evidence in the offer of proof.