Court Opinion

ID: 9644161
Source: CourtListenerOpinion
Date Created: 2023-08-22 20:49:07.99199+00
Date Added: 2024-06-11T18:11:09.199632
License: Public Domain

COVINGTON, Judge,
concurring in result.
I concur in result. I agree that appellate review requires that the appellate court give deference to the trial court’s finding that the plaintiff was not prejudiced by the ex parte communications. In most other respects I must respectfully disagree with the majority opinion.
The majority purports to reaffirm State ex rel. Woytus v. Ryan, 776 S.W.2d 389 (Mo. banc 1989), to the extent that Woytus holds that a court may not require a pa*666tient to authorize the treating physician to engage in ex iparte discussions with the defendant. Brandt v. Pelican, 856 S.W.2d 658, 662 (Mo. banc 1993). The majority goes on to make clear, however, that the authorization is unnecessary.
I acknowledge the technical flaws the majority identifies in Woytus. The majority is correct in observing that Woytus, in a sense, commingled the underlying concepts of testimonial privilege and confidential relationship. I read the statutes, however, including § 491.060(5), RSMo Supp.19921, and all statutes that recognize the existence of a patient-physician confidential relationship, §§ 578.353, RSMo 1986, 334.265, 192.067, 191.737, 188.070, RSMo 1986, 191.-743, 191.656, to affirm a clear legislative determination that the patient-physician confidential relationship remains inviolate except in limited circumstances. The majority also properly recognizes the distinction between the legal and ethical duties of physicians. As a practical matter, however, the duties sometimes appear to coalesce, on the one hand, and to be in potential conflict, on the other, as they are applied in the actual practices of law and medicine. I believe the area of confusion will only increase after today and that the process and those who seek its protections, patients and physicians alike, are better served by a clear directive.
My initial inclination was to concur in the majority opinion for the reason that it appears that its effect will be to chill any conversation between the treating physician and defense counsel, and would most certainly protect the principles underlying the physician-patient confidential relationship, a policy given primacy in Woytus. There was another value expressed in Woy-tus, however, that being the need for discovering the truth in the litigation process. Woytus, 776 S.W.2d at 391. Some of the dicta in Woytus, understandably, I confess, appears to have been employed to frustrate that end. It remains well established in our law, however, that a treating physician who possesses information relevant to a lawsuit should be available to testify regarding medical information relevant to the litigation. It is also clear that defense counsel would not normally risk placing a witness on the stand without having discussed the witness’s trial testimony beforehand, and it is not reasonable to expect a defense attorney to disclose his or her trial position by conducting such a discussion in the presence of the patient’s counsel.
After today, the door is open wide to ex parte contact. Yet, at the same time, the most cautious physician, if aware of the Brandt duo, Brandt v. Pelican and Brandt v. Medical Defense Assoc., 856 S.W.2d 667, will be aware that he or she is not forced to participate in discovery except through formal discovery procedures, absent consent of the patient, which surely will not be freely given. This leaves the physician-witness at the mercy of conflicting demands, on the one hand being informed by the patient that the patient desires that there be no contact outside of formal discovery, and on the other hand being advised by the defendant of the myriad of reasons why the physician-witness should “cooperate” with the defense. See Woytus, 776 S.W.2d at 395. As a practical matter, the physician may be subject to threats from both sides, with the patient alluding to a cause of action for breach of fiduciary duty and defense counsel alluding to all of the repercussions that may occur as a consequence of the physician’s failure to “cooperate.” Surely this dilemma is desired by no one.
There is a practical solution to the dilemma. As Woytus emphasized, our rules of discovery say nothing about informal discovery by ex parte communications between attorneys for the defendant and fact witnesses, including the plaintiff’s treating physician. See Woytus, 776 S.W.2d at 392. I believe that the Court should establish a reasonable procedure that would serve to further the interests inherent in both a medical malpractice lawsuit and in the physician-patient confidential relationship. The procedure would prohibit ex parte contact until the obtaining of the physician’s *667deposition as provided by the Rules of Civil Procedure. If the deposition reveals medical information or opinions of benefit to the defendant, the defendant is not thereafter precluded from such ex parte contacts with the physician as may be necessary for trial preparation. Any discussions between the defendant and the physician should be limited to the matters bearing on the issues relevant to the litigation, and plaintiff’s counsel should at that stage of the litigation be able to advise the physician of those limits. For the patient, the deposition may be used, if appropriate, to impeach subsequent testimony. For the physician, the taking of the deposition constitutes a clear line of demarcation after which ex parte discussion may occur within the bounds of the waiver of McNutt v. Keet, 432 S.W.2d 597 (Mo. banc 1968).
In summary, the majority’s determination to leave the final decision to the physician as to whether ex parte communications should occur seems to serve no clear purpose. Either the physician will engage in ex parte communications at the request of the defendant or the defendant’s representatives, under threat of a possibility of ensuing litigation instituted by the patient for breach of fiduciary duty, or the physician will follow the patient’s instructions and refuse all ex parte communication. As a practical matter, neither of these approaches appears to me to be satisfactory; there are no assurances for the patient and there is no guidance for the physician. The practical effect of the Court’s opinion will be not to encourage, but, rather, to discourage both a patient’s communication with his or her physician and disclosure of the truth, the development and discovery of which, as the Court acknowledges, is the primary point of a lawsuit.

. All statutory references are to RSMo Supp. 1992, unless otherwise noted.