Court Opinion

ID: 9796034
Source: CourtListenerOpinion
Date Created: 2023-08-31 03:46:18.041612+00
Date Added: 2024-06-11T08:44:32.249545
License: Public Domain

Greene, J.,
concurring in part and dissenting in part: I concur with my colleagues’ analysis on the erroneous jury instruction and the need for a new trial, but I respectfully disagree with their holding on the cross-appeal. My review of the plaintiff s expert’s testimony reveals that his opinion on causation was undermined on cross-examination and that the defendants were entitled to a partial directed verdict.
This case presents a situation where the only witness supporting causation testifies on direct examination in a manner sufficient to establish causation, but his testimony on cross-examination clearly and unequivocally “delinks” most of the plaintiff s claimed damages from any negligence by the defendants. Where the plaintiff s sole causation witness is unable to support his own opinion as to causation, the result is not “conflicting” evidence that must be weighed by the factfinder, but rather a defect in proof that has legal consequences. See Stormont-Vail Healthcare, Inc. v. Cutrer, 39 Kan. App. 2d 1, 178 P.3d 35 (2007) (plaintiff s expert on causation disclaimed prior opinion, thus entitling defendants to summary judgment).
Here, plaintiff s fundamental claim was that the defendants misdiagnosed an infected foot as mere gout as early as June 5, 2003, thus causing the infection to worsen and resulting “in more pain, suffering, disability and accompanying mental anguish, medical bills and lost time from employment” until osteomyelitis was diagnosed and treated on June 17, 2003. The plaintiff called as his expert witness Dr. Joseph Donnelly, who supported causation on direct examination with the following testimony:
“Q. What is your opinion, sir?
“A. I felt that [defendant Dr. Felts] had not excluded the main thing that you are concerned about when a diabetic comes in with a red foot, which is the infection, and had failed to diagnose that.
“Q. And was there any lost opportunity by reason of that that you believe had any impact on the patient?
“A. I believe the delay allowed the infection to spread, become more severe, and would have been much more easily treated sooner rather than later.
*1014“Q. . . . Do you have an opinion as to whether any of the treatment received by Mr. LaShure could have been avoided if proper diagnosis and treatment regimen had been implemented on the June 5th —
“A. I think, more likely than not, he would have gotten better with an oral antibiotic.
“Q. . . . Do you have an opinion as to whether or not the surgery to his foot could have been avoided, more probably than not, had he been diagnosed and treated correcdy on the night of June 5th as you’ve explained?
“A. Yes, I think he could have avoided that.
“Q. Could he have avoided the IV antibiotics and the installation of the Hickman catheter if he had been properly examined and treated on the night of June 5th? “A. Yes.”
Similar testimony was elicited as to the consequences of a subsequent misdiagnosis on June 8, 2003, by the codefendant. The problem with all this testimony, however, is that Donnelly admitted on cross-examination that he could not state within a reasonable degree of medical probability whether the plaintiff already had osteomyelitis at the time of the initial diagnosis. He further testified that once osteomyelitis is diagnosed, the appropriate treatment would have been the same as plaintiff received, i.e., hospitalization, surgical debridement, and intravenous antibiotics. This testimony was clear and unequivocal:
“Q. Doctor, would you agree that, if a diagnosis of osteomyelitis had been made on June 6th . . . that the treatment, likely for that condition would have been hospitalization, surgical debridement and IV antibiotics?
“A. If they had diagnosed osteomyelitis on that occasion, that would have been tire appropriate treatment.”
Although defendants broaden their argument on appeal, their motion before the district court was for a partial directed verdict on this ground:
“[T]here was a second basis for the second motion for directed verdict — and I will acknowledge it really probably is for partial directed verdict — and that was on the basis that there was no evidence in plaintiffs case that Mr. LaShure, within a reasonable degree of medical probability, did not have osteomyelitis at the time [of the initial diagnosis] . . . , [and] that he would have had to have had surgical treatment and IV antibiotics, essentially the same treatment that he ultimately obtained.
*1015“We would ask for a directed verdict on the basis of causation to eliminate those elements of damage from the plaintiff. And I think I indicated on the record that, candidly, I will acknowledge and an argument probably can be made that if a diagnosis of and treatment had been initiated earlier, there may have been a shorter delay from the standpoint there may have been some additional pain and suffering of the plaintiff during the eight, ten-day period of time. But that’s the only element of damages that I believe the plaintiff s case at that point in time was supported from an expert testimony standpoint.”
LaShure responds to the defendants’ arguments on appeal by contending that Donnelly’s failure to give specific testimony as to whether LaShure had osteomyelitis at the time of the initial diagnosis is immaterial, because the determination of the necessaiy treatment did not depend on whether LaShure had osteomyelitis at the time of the initial diagnosis. LaSure contends that Donnelly testified that LaShure had an infected foot that likely would have improved with oral antibiotics, and LaShure asserts the defendants’ failure to diagnose this infection resulted in “prolonged medical treatment, pain and suffering, and expenses.”
The flaw in LaShure’s response is that it relies on testimony that was completely undermined by the cross-examination. If LaShure’s foot infection had already advanced to osteomyelitis at the time of the initial presentment (a possibility that Donnelly could not rule out), the treatment was not oral antibiotics and hopeful improvement. In fact, treatment by oral antibiotics would have masked the severity of the infection, resulting in chronic osteomyelitis — an even more serious problem for the patient. Donnelly specifically stated:
“Q. And so, doctor, if Mr. LaShure had osteomyelitis on June 6th, and he had been given oral antibiotics by Dr. Felts and then Dr. Darabant continued that prescription, he may have improved his symptomatology to cellulitis, but it would not have cured his osteomyelitis; correct?
“A. Given those assumptions, yes.
“Q. ... If Mr. Lasure had been — had osteomyelitis, the increase in pain that he’d had in those three or four days due to the increasing edema and his bone in that confined space causing a similar exquisite pain that a person experiences with gout, and instead of making the diagnosis of gout, they had given, as you said, oral antibiotics, the oral antibiotics may have improved his symptomatology related to *1016his soft tissue, but it would likely then have delayed the discovery of his osteomyelitis; isn’t that correct, doctor?
“A. They may have never discovered it.
“Q. Now my question after that is, is that, therefore, what very well could have happened was to convert what you believe an acute osteomyelitis to a chronic osteomyelitis; correct?
“A. He could have developed a chronic osteomyelitis.
“Q. Yes. Because his symptomatology was masked because of the oral antibiotics; correct?
“A. That’s the goal.
“Q. And tell me, would you tell the jury, doctor, what’s harder to treat, acute osteomyelitis or chronic osteomyelitis?
“A. Harder in what regard?
“Q. Harder to treat to the extent of preventing amputation.
“A. I think that you would rather have an acute. Something that happens quickly will resolve more quickly, most likely. If you’ve had it a long time, it’s going to be harder to treat.
“Q. Indeed, would you agree, doctor, a chronic osteomyelitis in indeed much more difficult to treat than acute osteomyelitis?
“A. Yes.”
This testimony, viewed as a whole, and in favor of the plaintiff, does not leave room for a reasonable mind to conclude that any purported negligence of defendants caused the damages claimed by plaintiff, other than pain and suffering between June 6 and 17, 2003. In fact, in the absence of reasonable certainty that osteomyelitis was not present at the time of initial diagnosis, the only consequence of the failed diagnosis was some additional pain and suffering from that time until the correct diagnosis was made. In summary, unless osteomyelitis was not present on June 6 and developed due to improper diagnosis and treatment, the misdiagnosis did not cause the ultimate hospitalization and surgeiy.
Donnelly maintained his opinion that he did not “think” LaSure had osteomyelitis at the initial diagnosis, but his testimony was consistent that he could not say within a reasonable degree of medical certainty that osteomyelitis was not already present at that time. Expert witnesses should confine their opinions to relevant matters which are certain or probable, not those which are merely possible. George v. Pauly, 30 Kan. App. 2d 444, 450, 45 P.3d 1 (2001).
*1017With due respect to my colleagues, when the sole expert on standard of care and causation in a medical malpractice case clearly and unequivocally undermines on cross-examiriation his or her own opinion as to causation, there is no evidence to be “weighed” by a factfinder. Weighing evidence implies conflicting testimony; here there was no conflict after the cross-examination. Where the only expert has, by his own testimony, logically defied any nexus between his opinion of negligence and most of the claimed damages, there is nothing to be weighed. I would reverse and remand for new trial, but I would limit damages on remand to the additional pain and suffering between June 6 and June 17, 2003.