Court Opinion

ID: 9720374
Source: CourtListenerOpinion
Date Created: 2023-08-26 08:28:28.306463+00
Date Added: 2024-06-11T13:03:24.371072
License: Public Domain

Levin, J.
(dissenting). The majority concludes that the circuit judge properly refused to allow Ericca Dacon to introduce expert testimony that Drs. Mon K. Kim and Thomas E. Lee violated the standard of care when they failed to direct that appropriate medication be administered to her within one hour following her admission to St. John Hospital on a diagnosis of suspected bacterial meningitis. The majority so concludes ”[b]ecause plaintiff did not plead that the standard of care was breached with respect to the hour at which *344treatment should have begun . . . -”1 (Emphasis added.)
The majority ignores that while Ericca did not so plead, Drs. Kim and Lee and St. John Hospital learned, in May, 1985, when the deposition of Ericca’s expert witness, Dr. Mark Thoman, was taken, over a year before the trial, that Ericca would offer expert testimony that the standard of care required that appropriate medication — "multiple antibiotics;” chloramphenicol or other medication in addition to the ampicillin that was administered — be administered within one hour after Ericca was admitted to the hospital. Dr. Thoman testified on deposition:
That’s why I say multiple antibiotics are started initially. Ideally, within the ñrst hour after the patient presents to the hospital. At that time spinal tap is done, history, and physical gram stain, lab tests are ordered, and antibiotics are started within that ñrst hour. [Emphasis added.]
*345Dr. Thoman also testified on deposition that chloramphenicol and other medications, not ampicillin alone, should have been administered "[o]n admission” to the hospital.2 Dr. Thoman added: "Usually when you have a meningitis and you get cloudy fluid, you make the fastest diagnosis possible. You pull out all the stops and start the antibiotics together . . . .” (Emphasis added.)
In precluding Ericca from introducing expert testimony that "time is of the essence” in treating a child suffering from bacterial meningitis, the majority ignores that Ericca’s mediation statement stated that "time is of the essence in initiating appropriate antibiotic therapy in the treatment of meningitis.”3
Chloramphenicol was administered to Ericca, in addition to ampicillin, twenty-four hours after she was admitted to St. John, and saved her life, but left her with the sequelae, right-sided hemiparesis and seizures.4 Since chloramphenicol was eventually administered to Ericca and arrested the progress of the disease, the "timeliness” of the administration of chloramphenicol was necessarily an issue, and defendants were necessarily on notice that timeliness was an issue.
i
The judge ruled that choice of medicine — chlo*346ramphenicol or ampicillin — but not timing, was an issue in the case stating: "You may talk about the correct medication, the proper medication, but you may not get into timeliness.”
The judge was apparently under the impression that "choice of medicine,” but not timeliness of administration of correct medicine,5 was the only issue pleaded. The majority proceeds on the same erroneous premise in stating: "Plaintiff’s complaint does allege that Ericca should have received chloramphenicol instead of ampicillin.”6 In actuality, the complaint made no specific allegation concerning the administration of chloramphenicol, or concerning timing or delay.
The complaint stated with some specificity why ampicillin was incorrect medication, but did not spell out what would have constituted correct therapy. It stated generally, I agree, that a pediatrician presented with a patient exhibiting the signs, symptoms, and history demonstrated by Ericca "had a duty to administer appropriate treatment and/or medication in appropriate dosage and/or duration.” (Emphasis added.)
The complaint thus did not, indeed, particularize, except in general terms, that timing and delay was an issue. But neither did it particularize, except in general terms, that choice of medicine was an issue. Whatever may have been the deficiencies in pleading, one cannot properly differentiate in that regard between the pleading of choice of medicine as an issue and the pleading of timing and delay in administering medicine as an issue. The pleading as to one issue suffers from the same deficiency as the pleading of the other._
*347Nor does the word chloramphenicol appear in Ericca’s mediation summary, dated March 21, 1985, which again stated generally that "Eric[c]a was not provided with appropriate antibiotic therapy. Instead, she was prescribed Ampicillin; a drug the Defendant doctors knew or should have known, would be ineffective in treating Eric[c]a’s meningitis.”
The mediation statement was actually more specific regarding timing than choice of medicine in that it stated that "the longer a child with meningitis goes without appropriate antibiotic therapy, the greater the potential for central nervous system complications,” and "time is of the essence in initiating appropriate antibiotic therapy in the treatment of meningitis.” (Emphasis added.)
The defendants did not have notice of the specifics of Ericca’s criticism of the therapy until Dr. Thoman’s deposition was taken by the defendants’ lawyers. They then learned about the claimed errors in both choice of medicine and in timing in the administration of, and the importance of avoiding delay in, medication.
Since the source of the notice to the defendants of the specifics of Ericca’s claim concerning choice of medicine was Dr. Thoman’s testimony on deposition, and, in the very same deposition, he testified concerning the importance of timing and avoiding delay in administering correct medication —chloramphenicol, not ampicillin alone — it is, I believe, unfathomable how one could conclude that the defendants were on notice that choice of medicine — chloramphenicol, or ampicillin alone — was an issue, but were not on notice that timing and avoidance of delay in administering correct medication7 was an issue. The conclusion that the *348defendants were not on notice that timing and avoidance of delay in administering correct medication was an issue is especially difficult to understand under the circumstance that chloramphenicol was eventually administered.
The same good judgment that persuades the majority to read "appropriate treatment and/or medication in appropriate dosage and/or duration” (the language of the complaint) as including "failure to select an effective antibiotic”8 (emphasis added), should enlighten it to read those words as including "failure to select an effective antibiotic timely administered.” Surely, "timely administration” would include timely "initial” administration as well as timely "subsequent” administration.
ii
Simonelli v Cassidy, 336 Mich 635; 59 NW2d 28 (1953), is distinguishable because in that case the defendant physician was not on notice before the trial of the omissions claimed to constitute malpractice. Simonelli was decided before discovery depositions of an opponent’s expert witness were generally available and taken, and before parties exchanged mediation statements.
A
The defendant physicians and hospital served on Ericca interrogatories asking that she set forth specifically what was meant by "appropriate treat*349ment and/or medication in appropriate dosages and/or duration.” Ericca responded that the inquiry called for expert testimony, that discovery had not progressed to the point where expert witnesses could be identified, and that after expert witnesses had been "selected for purposes of testifying,” she would "further timely supplement answers to these Interrogatories.”
Although the defendant hospital moved to require Ericca to respond to certain interrogatories and obtained an order directing her to do so, the defendants did not seek to compel her to supplement the answers as she had promised, and she did not do so.
The majority’s recitation is incomplete. While the majority stresses the ambiguity of Ericca’s pleading, and her failure to supplement her answers to the interrogatories, it does not consider, as part of the crucible, that Dr. Thoman’s one hundred seventy-page deposition was taken on May 21, 1985, over a year before the trial, or the defendants’ failure to seek an order directing Ericca to supplement her answers to the interrogatories or directing her to file a more definite statement.
It does not appear why the defendants did not move to compel Ericca to keep her promise to supplement her answers to the interrogatories. The likely explanation is that defendants recognized that little was to be gained by requiring a fuller answer to the interrogatories under the circumstance that defendants had taken a lengthy deposition of Dr. Thoman. They may well have concluded that the one hundred seventy-page deposition made superfluous filing a supplemental answer to the interrogatories, and that the judge would also have so concluded had they made such a motion.
*350B
The majority’s generalizations regarding the need to provide defendants with adequate notice of the specifics of Ericca’s claim so that they would have a full and fair opportunity to present a defense on the merits are obviously indisputable. The court rules do indeed provide for fact-specific pleading. But they also provide that a defendant may move for a more definite statement before filing a responsive pleading if the defendant claims that the pleading is so vague or ambiguous that it fails to comply with the requirements of the rules.9
Both the treating physicians and the hospital filed answers to the complaint. Neither asserted that the complaint failed to contain a statement of the facts with the specific allegations necessary reasonably to inform them of the nature of the claims they were called on to defend. Neither, claiming that the complaint was vague or ambiguous or otherwise failed to comply with the requirements of the rules, moved for a more definite statement either before or following the filing of their answers.
Just as it might be unfair to a defendant to introduce a new issue at the trial, so, too, it is unfair to a plaintiff to ignore the actual notice of plaintiff’s claims that the defendant has received in discovery depositions, answers to interrogato*351ries, mediation statements, or other documents filed before the trial.
One needs only to examine the excerpts from the deposition testimony of Dr. Thoman set forth in appendix a, to see that greater detail regarding the specifics of Ericca’s claim are there set forth than could possibly be set forth in a pleading that would not run afoul of the court rule providing that "[e]ach allegation of a pleading must be clear, concise, and direct.”10
To deny a plaintiff an opportunity to present evidence in support of a theory of recovery of which the defendants have been fully and fairly notified in discovery depositions, mediation statements, answers to interrogatories, or other documents filed before the trial simply because the plaintiff failed to plead the specific facts later developed in the pretrial discovery and other pretrial processes, is, in the words of the majority, to reintroduce "[e]xtreme formalism” tantamount to "the straightjacket of ancient forms of action.”11
c
In many cases, particularly a case where expert testimony is required, the specific facts will be fully developed12 only through discovery long after the complaint has been filed and answered.
If, as the majority opinion appears to require, specific facts developed in the discovery process must be fully stated in the complaint to avoid the peril of exclusion of evidence in support of a theory of recovery adequately appearing in the *352discovery process on deposition or in response to interrogatories, it will become necessary for plaintiffs, after discovery has been completed, to seek to amend their complaints to set forth the specific facts developed in the discovery process.
While this additional paperwork might tidy things up somewhat, it means additional work for lawyers representing plaintiffs and defendants, and more billable hours to be charged to clients. In the hard-fought areas of employment discharge/ discrimination, medical malpractice, and product liability, the majority’s approach encourages resistance to a motion to amend. And the plaintiff, in preparing the motion to amend his complaint, had better be letter-perfect lest, if something is omitted, defendant claim that the omission constitutes an abandonment of a claim fully developed in the discovery process.
The regime that I am describing, and which the majority opinion seems to call for, is alien to the practice. Bench and bar rely on the discovery process, mediation statements, and status conferences to narrow the issues and flush out whatever ambiguities there might be in the complaint and answer.
D
This case was filed before the Wayne Circuit Court adopted the individual docket system. This case was originally assigned to the docket of a circuit judge other than the judge who tried the case. Four years later, it was spun off to be tried by another circuit judge in August, 1986. The trial judge, thus, was not familiar with the pretrial history of the case, and the knowledge of what the case is about that a judge who decides pretrial motions picks up in deciding such motions.
*353In this case, it was not the defendants’ lawyers, but rather the judge, see appendix b, who raised the question whether delay in treatment had been pleaded. It is clear from the opening statements that, although the defendants’ lawyers eagerly exploited the opportunity to undermine Ericca’s case presented when the judge raised the timing question, it did not independently occur to them that whatever ambiguity there might have been in the complaint regarding the deficiencies in treatment and medication of Ericca justified the exclusion of evidence developed in the discovery depositions.
I am confident that if Wayne Circuit Court had adopted an individual docket system before this case was filed, the trial judge would not have been in doubt that timing and delay were as much a part of Ericca’s claim as choice of medication.
E
The majority needlessly reconsiders Simonelli. The mischief that will ensue will take some time to undo. Simonelli was decided almost forty years ago. Practitioners have been doing quite well in the interim without another opinion from this Court expounding on Simonelli.13 They will, I expect, with the assistance of trial judges who have no time or patience for empty exercises, find a practical means of obviating, in many cases, the injustice that today’s opinion will cause in other cases where the judge is less adept at case management and counsel are entirely adversary in their approach._
*354P
To be sure, Ericca’s lawyer did move, after the judge’s adverse rulings at the trial, to amend her complaint after the judge ruled that her complaint was deficient, under Simonelli, because there was "no allegation as to a delayed treatment.” It does not follow that there was any need to move, during the trial, to amend, and thus it does not follow that there is any need for this Court to consider either Simonelli or whether the motion to amend should have been granted.
In this case, a central issue, we all agree, is whether the judge erred in barring the introduction of evidence that appropriate medication should have been administered to Ericca within one hour of her admission to St. John Hospital. Because the defendants were fully and adequately informed, by Ericca’s mediation statement and Dr. Thoman’s one hundred seventy-page deposition, that her theory was that Drs. Kim and Lee violated the standard of care in failing to administer correct medication — chloramphenicol in addition to ampicillin — within one hour of her admission to St. John Hospital because time is of the essence in treating a child with bacterial meningitis, her failure to seek, before the trial, to amend her complaint to so state does not justify excluding expert testimony supportive of her theory.
There is thus, in my opinion, no need to reconsider Simonelli, concerning specificity in fact pleading, or whether the motion during the trial to amend the complaint should have been granted.
hi
As set forth in the majority opinion, Ericca was examined in Dr. Kim’s office on the morning of *355April 29, the day she was admitted to the hospital. Dr. Kim did not observe symptoms of meningitis until, as he was about to send Ericca home with a relatively "ordinary” antibiotic prescription,14 Eric-ca’s mother mentioned that she cried whenever her neck was pushed forward. So alerted, Dr. Kim recognized that such rigidity was a symptom of meningitis and ordered a complete blood count for Ericca, "stat.,” which meant that he wanted the results within the hour. Mrs. Dacon testified that Dr. Kim said that he suspected meningitis.
Within the hour, the blood count came back with a highly elevated white blood cell count. Dr. Kim telephoned Mrs. Dacon to take Ericca to St. John Hospital as soon as possible. She was admitted on a preliminary diagnosis of bacterial meningitis at 2:40 p.m., twenty minutes after Dr. Kim telephoned Mrs. Dacon. An intern or a resident performed a spinal tap before 3:00 p.m., which immediately revealed, on visual examination, "grossly cloudy” spinal fluid.
This was tantamount to confirming meningitis, and, because of the white blood cell count, bacterial meningitis. The fluid was sent to the laboratory for further analysis which would not come back for at least twenty-four hours.
Neither Dr. Kim nor Drs. Transue or Lee, the other doctors in the clinic, visited Ericca on the 29th at the hospital. Orders to administer ampicillin were given by telephone sometime before 6:00 p.m.
When asked at trial why he did not visit Ericca at the hospital on the day she was admitted, Dr. Kim said that the doctors in his medical group changed responsibility weekly for making rounds at the three hospitals that the group covered, and *356that, during the week of April 29, 1974, it had been one of the other doctor’s turn.
When Ericca was visited by Dr. Lee the following day and he observed her condition, he ordered another spinal tap and that chloramphenicol be added to the ampicillin started the day before — the multiple therapy that Ericca’s expert witness claimed was the standard of care. Ericca was medicated with chloramphenicol between 2:30 and 3:00 p.m. on April 30 — twenty-four hours after she was admitted — and thereafter until the meningitis was repressed.
iv
The majority states that Ericca’s lawyer advanced a new theory on the third day of trial. The "new” theory suggested — for the first time, says the majority — that the failure to initiate medication before 3:40 p.m. on April 29, 1974 (one hour after Ericca’s admission to St. John Hospital) caused harm to Ericca. The majority states that this new, "unpleaded” theory, "criticizes the failure to do anything between 2:40 p.m. and 6:00 p.m. on April 29, 1974. ”15 The asserted delay in advancing this theory is attributed to Ericca’s lawyer’s misreading Ericca’s medication chart as stating 1500 (3:00 p.m.) when it actually stated 1800 (6:00 p.m.).
The majority states that Ericca sought to recover under her first theory — deemed by the majority to have been "pleaded”16 — for harm suffered because she did not receive chloramphenicol until nearly twenty-four hours after entering the hospital, and under her second, "unpleaded” theory, for harm suffered because she did not receive medica*357tion for the first three and one-half hours in the hospital.17
The majority’s recitation of Ericca’s first theory omits that part of her first theory was that — because time is of the essence in medicating for bacterial meningitis — chloramphenicol should have been administered within one hour of her admission to the hospital, and that she suffered harm because of the failure to administer chloramphenicol during each of the ensuing twenty-three hours of delay, which included the first two and one-half hours following the first hour after she was admitted to the hospital.
It was of little or no importance whether Eric-ca’s lawyer misread Ericca’s medication chart, or "made a startling discovery”18 when he observed that medication did not begin at 3:00 p.m., but rather commenced at 6:00 p.m., on the day she was admitted to the hospital. Ericca’s first theory, completely stated, was that correct medication should have been administered within one hour of her admission to the hospital, whenever she was admitted.
Ericca’s one and only theory was that every hour of delay in administering correct medication, chloramphenicol, and other antibiotics rather than ampicillin alone, beyond one hour after admission to the hospital, was a departure from the standard of care.
A
The majority describes Ericca’s "new” theory,
*358"discovered three days” before the trial, as seeking to recover for harm caused "to Ericca” as a result of "failure to initiate medication before 3:40 p.m. on April 29, 1974 . . . .”19 The majority states that this, the "new” theory, seeks to recover for the three hours, twenty minutes "failure to do anything between 2:40 p..m. and 6:00 p.m.....”
This "new” theory has been described as the "delay in administering ampicillin” theory. It is now recognized that there could not have been such a theory, that Ericca did not seek, nor could she have sought, to recover for harm caused as a result of delay in administering an ineffective drug, ampicillin, unless there was an effective drug, chloramphenicol, that could and should have been administered.20 Thus, the "new” theory criticizes, not the "failure to do anything” between 2:40 p.m. and 6:00 p.m., but rather the failure to administer chloramphenicol before 6:00 p.m. on the 29th or during the ensuing twenty hours, forty minutes — Ericca’s "one and only theory.” There was no "new” theory._
*359The majority states that "plaintiff sought to recover for harm Ericca may have suffered because she did not receive medication for the first three and one-half hours in the hospital.”21 As set forth earlier, all agree that the defendants were on notice that Ericca claimed that they had failed to provide an "effective antibiotic.”22 Implicit in such a claim is the claim that an effective antibiotic should have been timely administered, initially and subsequently. The judge’s rulings striking and barring testimony concerning the urgency of timely administration of effective antibiotic therapy not "only” excluded evidence concerning the urgency of avoiding delay in administering antibiotic therapy during the first three and one-half hours Ericca was in the hospital, but also excluded evidence concerning the urgency of avoiding delay in administering antibiotic therapy during the ñrst twenty-four hours she was in the hospital.
B
The judge did not confine the exclusion of evidence to evidence bearing on the "short delay”23— 3:40 p.m. (one hour after Ericca was admitted at 2:40 p.m.) and 6:00 p.m., when medication with ampicillin was actually commenced. She struck all of Dr. Thoman’s trial testimony, including the following testimony admitted without objection sometime before the judge raised the question whether "timeliness” was pleaded:
If the spinal fluid is cloudy, then that’s a very high indication that this is in fact a meningitis and treatment must begin actually from the time *360you think of meningitis. The spinal tap, i.v. and antibiotics, everything must begin actually within an hour after all this transpires. So once the initial diagnosis is considered, the tests and the medications are started in order to treat that. And generally, and for the last well over two decades since I was an intern, it’s been within an hour after that’s considered the treatment has to begin. [Emphasis added.]
After the judge struck Dr. Thoman’s testimony, Ericca’s lawyer attempted to ask Dr. Kim, one of the defendant treating physicians, "what the standard of care calls for with respect to mode and timing of therapy,” and whether "time is of the essence in treating a child suffering from bacterial meningitis?” (Emphasis added.) The judge sustained objections stating that she had "ruled timeliness is not an issue in the case, but you may ask about the mode of treatment that would be proper once the condition is expected.”
Ericca’s lawyer later asked Dr. Kim whether "the standard of care is to promptly administer[] appropriate antibiotic treatment.” The judge barred the testimony stating: "Promptness, the timeliness, however you want to express it, I have ruled is not an issue in the case . . . .”
Ericca’s lawyer, still later, directed Dr. Kim’s attention to the complaint. When asked the relevance, he stated: "Two points: The appropriate treatment of bacterial meningitis to a medical professional who should not be misunderstood involves two things: Timeliness — ,” the "t” word. The judge excused the jury and said:
Mr. Bleakley, I’m going to make this statement and I hope you understand it. I have made a ruling, I have repeated that ruling. I have listened to your ways of trying to get around that ruling. I *361indicate to you now, if you mention timeliness one more time, I will hold you in contempt of court. [Emphasis added.]
Ericca’s lawyer, nevertheless, sought to be creative in finding another way to present evidence on the importance of timely administration of drug therapy when, in the course of cross-examining Dr. Adnan Dajani, the expert witness for the defendants, he called his attention to his testimony that Drs. Kim and Lee had treated Ericca in "exemplary fashion,” and asked whether the witness "would agree as a general proposition that time is of the essence in treating individuals with bacterial meningitis.” He responded "Yes,” but got no further when the lawyer for the hospital objected.
The judge then asked Ericca’s lawyer "why did you ask that question?” He responded that he was seeking to challenge the witness’ credibility. The judge said: "What difference does his testimony in this case, or any other case, as to time being of the essence, have to do with the issues in this case?” The judge added that she would permit questions concerning the administration of ampicillin and chloramphenicol "but not as to the timeliness of it, not as to credibility, or whatever else you might call it.” The jury was told to disregard the question.
It is thus clear that the judge’s rulings, excluding both "time essence” and "within one hour” testimony, excluded evidence concerning the urgency of timely administration of effective antibiotic therapy, not only during the "short” two-three hour, twenty minute delay encompassed by the assertedly "new theory,” but also excluded evidence concerning the urgency of timely administration of effective antibiotic therapy during the *362ensuing twenty hours and forty minutes between the administration of the ineffective drug, ampicillin, and the effective drug, chloramphenicol.
The effect of the judge’s ruling was not limited to two hours and twenty minutes. Her ruling, excluding testimony concerning the urgency of immediate administration of correct therapy, was not limited to the "short delay,” two hours and twenty minutes, between 3:40 p.m. and 6:00 p.m. on April 29, but applied as well to the longer delay of approximately twenty-four hours, from 2:40 p.m. on April 29, when Ericca was admitted, to 2:30-3:00 p.m. on April 30 when the therapy was corrected by adding chloramphenicol to the medication. The judge said:
Let me make it clear. Whether we’re talking five minutes, one hour, seven hours, 24 hours or two years, when we talk about time, as far as I’m concerned, we’re talking about timeliness.
There is no issue any longer and there never was timeliness in this case.
You may talk about the correct medication, the proper medication, but you may not get into timeliness.
Understood?
C
The majority notes that Dr. Lee and the defendants’ expert witness, Dr. Dajani, testified that "the longer a patient goes without appropriate antibiotic treatment, the greater the likelihood that complications such as Ericca’s would occur.”24 This testimony was indeed supportive of Ericca’s claim that delay in administering appropriate antibiotic therapy caused the sequela that she suffered, right-sided hemiparesis and seizures.
*363The admission of such testimony does not, however, render harmless striking all the testimony of Ericca’s expert witness, Dr. Thoman, concerning the urgency of immediate administration of correct medication, or the exclusion of further testimony from Dr. Thoman regarding the importance of timely administration of correct therapy, or barring cross-examination of defendants’ expert witness whether time was of the essence, or other cross-examination of Drs. Dajani, Kim, and Lee concerning the urgency of timely administration of correct medication.
It is apparent from the responses of Drs. Dajani, Kim, and Lee to questions concerning delay in administering correct antibiotics, that had the judge permitted Ericca’s lawyer to cross-examine them more specifically whether antibiotics should be commenced within one hour — if not, within how many hours doctor? — and whether time is of the essence, as Dr. Dajani acknowledged before the lawyer for the hospital objected, that Ericca may very well have obtained concessions from the treating physicians and their expert witness that timely treatment is imperative. Statements that the longer a patient goes without appropriate antibiotic treatment, the greater the likelihood that complications will occur, do not convey the same sense of urgency.
Without expert medical testimony, that timely administration of correct therapy is imperative (that time is of the essence), that, as Dr. Thoman testified on deposition, when a spinal tap (made immediately after Ericca was admitted to the hospital) shows a cloudy fluid "you pull out all the stops and start the [multiple] antibiotics together,” within the hour of admission, the jury did not have — despite the concession that the longer the patient goes without appropriate antibiotic treat*364ment, the greater the likelihood of complications— all the evidence that it should have had to assess whether the twenty-four-hour delay in administering the correct medication, chloramphenicol, may have been responsible for the right-sided hemiparesis and seizures.
D
As set forth in the majority opinion, the jury found that Ericca was improperly medicated, with ampicillin, by Drs. Kim and Lee, but that the delay in administering chloramphenicol — which arrested the progress of the disease and saved her life — until twenty-four hours after her hospitalization was not the proximate cause of the right-sided hemiparesis and seizures.
The majority attempts to draw a distinction between evidence on standard of care and evidence on causation, stating that the judge "made it clear that only standard of care evidence regarding the hour at which antibiotics should have begun was inadmissible,” but indicated that Ericca could present "causation evidence linking Ericca’s injuries to untreated meningitis.”25
I have read substantial portions of the transcripts. Neither the judge nor the lawyers for the defendants drew a distinction between evidence on standard of care and evidence concerning causation, although, after the judge had ruled and plaintiff’s proofs had been largely completed there was some minimal recognition that causation was an issue. It is unclear on what basis the majority perceives that the judge "indicated,” when she ruled, that Ericca could present causation evidence.
In all events, the evidence that was stricken, *365"regarding the hour at which antibiotics should have begun,” was probative not only of the standard of care but also on the issue of causation. In excluding such evidence, in striking Dr. Thoman’s trial testimony concerning the hour when the administration of antibiotics should have begun, and in barring cross-examination of defendants’ expert witness and of defendant treating physicians concerning the hour when the administration of antibiotics should have begun, the judge effectively barred Ericca from introducing probative evidence concerning the issue of causation, evidence that may have persuaded the jury that the twenty-four hour delay in administering chloramphenicol caused the right-sided hemiparesis and seizures.
v
The majority states that on the fifth day of trial the judge instructed the jury as follows:
" 'The timing as to when the initial antibiotic therapy was administered at St. John’s [sic] Hospital on April 29, 1974 is not an issue in the case. You may consider, however, the Plaintiff’s claim that the appropriate antibiotic therapy was not started on April 29, 1974.’ ”[26] [Emphasis added.]
The majority’s reliance on this instruction ignores that the judge during the course of Dr. Thoman’s testimony, had instructed the jury that "timeliness of the administration of medication is not going to be an issue in this case,” and that the instruction on the fifth day of the trial ("[y]ou may consider” Ericca’s "claim that the appropriate antibiotic therapy was not started on April 29”) did not *366retract the earlier instruction that "timeliness of the administration of the medication” is not an issue. The majority’s reliance on this instruction also ignores that expert testimony concerning the urgency of timely administration of appropriate antibiotic therapy had been stricken and barred.
In agreeing to this instruction, Ericca’s lawyer did not thereby agree that the judge had correctly stricken the testimony of Ericca’s only expert witness, and had correctly barred further examination of Ericca’s expert witness and cross-examination of the defendant treating physicians concerning the urgency of timely treatment. In agreeing to such an instruction — after seemingly endless argumentation concerning the "short” two-three hour, twenty minute delay in administering the ineffective medicine, ampicillin — Ericca’s lawyer did not agree that the judge properly excluded evidence concerning the urgency of avoiding further delay, during the ensuing twenty hours, forty minutes, in administering an effective drug, chloramphenicol.
In all events, the jury apparently was in doubt after the judge had instructed the jury shortly before it retired to consider its verdict. The jury sent notes inquiring whether timing was an issue. The jury thereby indicated that it did not understand the instructions concerning timing in administering medication.
In responding to the notes from the jury, the judge said:
I have been trying to convey to you that timing is an issue in this case only when you distinguish between April 29th and April 30th. Plaintiff claims that the appropriate antibiotic was not administered — antibiotic, singular or plural — was not administered on April 29th.
*367I’m saying you may consider that it was not started until April 30th, if you agree that that was appropriate to start it on April 30th. That’s the only way that you may consider time in this case, is when you distinguish between what was done on the 29th as opposed to what was done on the 30th or later. And it relates to the administration of the appropriate antibiotic, not to the timing of diagnosis or any other situation. [Emphasis added.]
In stating that "the only way that you may consider time in this case, is when you distinguish between what was done on the 29th as opposed to what was done on the 30th or later,” the judge was saying — as appears from colloquy with counsel before she responded to the jury’s notes:
I have to make it clear to the Jury — I have tried to do so — that the issue of time for administering the appropriate* treatment has to be limited to April 30th as opposed to April 29th.
The judge thus was saying that timing — and delay in administering effective medication — could not be considered until the day after Ericca was admitted to the hospital. This was more than one hour, more than two-three hours twenty minutes, more than nine hours twenty minutes (between 2:40 p.m. April 29 and midnight). What the judge meant, and the jury may have understood, was that timing could not be considered until Dr. Lee appeared on the 30th and actually ordered that chloramphenicol be added to the antibiotic therapy, in addition to ampicillin.
Clearly, timing and delay on the 29th was an issue respecting at least whether there was a causal relationship between the delay from 6:00 p.m. on the 29th until 2:30-3:00 p.m. on the *36830th in adding chloramphenicol and the right-sided hemiparesis and seizures suffered by Ericca.
The jury’s understandable inability to comprehend what the judge was saying, the thin distinction between choice of medicine and timing of medication, coupled with the judge’s decision to strike the evidence that had been adduced, concerning the importance of timing and avoiding delay, and to bar further evidence respecting timing and delay in administering medication, may explain the jury’s finding that the treating physicians erred in the choice of medicine, but that the error was not the cause of the right-sided hemiparesis and seizures.
VI
Indisputably, ampicillin was ineffective, and chloramphenicol saved Ericca’s life. Clearly, ampicillin was the wrong medicine and chloramphenicol the right medicine without regard to whether there was a departure from the standard of care in choice of medicine — in initially administering ampicillin and in delaying the administration of chloramphenicol until the next day.27
Unless the delay in administering chloramphenicol was causally related to the right-sided hemiparesis and seizures, it was of no importance whether medicating Ericca with ampicillin rather than chloramphenicol was a breach of the standard of care. Timing in medicating necessarily was an issue.
The question of choice of medicine and the question of timing and delay in medicating Ericca *369were, thus, inextricably interrelated. Timing in medicating, once again, was necessarily an issue.
Entirely apart from whether the defendants were on notice that timing and delay in medicating Ericca was an issue — and the record shows that they were on notice, and did not claim otherwise until the judge raised the question whether they were on notice — implicit, as the judge apparently ultimately recognized, and the majority also recognizes, in the issue of choice of medicine is the issue whether effective medicine was timely administered.
The majority appears to recognize that the issues are interrelated when it states that evidence concerning what happens to a person suffering from meningitis who receives the wrong medication "is the proximate cause component” of the "wrong choice of medication” theory.
There was no point in exhaustingly trying at great length (ten trial days) and at great, sometimes tedious, detail every possible aspect of the issue of choice of medicine without also trying — by allowing Ericca to introduce evidence concerning— the issue of timing and delay.
Ultimately, the only issue that there could have been in this case — the issue on which the jury found against Ericca, the issue respecting which evidence was stricken and barred — was whether any departure from the standard of care found by the jury in choice of medicine, in delaying until the second day of hospitalization the administration of chloramphenicol, the medication that saved Ericca’s life, was a cause of the right-sided hemiparesis and seizures.
It was extraordinary to rule, as did the judge, that the issue of choice of medicine should be tried, but — by refusing to allow Ericca to put in evidence respecting timing or delay — to bar her *370from effectively trying the issues of standard of care and causation. The defendants assuredly did not concede causation, and the jury, by its verdict, found against Ericca on that very issue.
The judge, in a belated reversal of direction, instructed the jury immediately before it retired to consider its verdict that plaintiff’s theory of liability included the contention that the delay in administering chloramphenicol until the second day of hospitalization caused the right-sided hemiparesis and seizures28 — the issue the judge had found, when the expert witnesses and treating physicians were in the witness chair, the physicians and hospital did not have notice of. By then, however, the judge had, in repeated rulings during the trial, excluded evidence respecting timing and delay in administering antibiotics and, thus, evidence tending to support Ericca’s claim that the delay in administering chloramphenicol caused the right-sided hemiparesis and seizures.
VII
At the new trial to which Ericca is entitled, a trial at which her expert witness is permitted to testify respecting timing and the importance of avoiding delay in administering chloramphenicol, and at which her lawyer is permitted to cross-examine the treating physicians and their expert *371witness regarding timing and delay, and at which the jury is instructed that delay in medicating Ericca with chloramphenicol was the theory on which she sought to recover — as this jury was ultimately and belatedly instructed, after evidence supporting the delay-in-administering-cMoramphenicol theory was stricken and excluded — the jury might again conclude that there was malpractice in failing to administer chloramphenicol and other medication in lieu of ampicillin, and also conclude that such malpractice was the proximate cause of the right-sided hemiparesis and seizures.
I would reverse and remand for a new trial.
Mallett, J., concurred with Levin, J.
APPENDIX A
The following are excerpts from Dr. Thoman’s deposition testimony.
Q. What was the treatment of choice by yourself at that time?
A. The treatment generally was what we call multiple therapy where we use two or even three antibiotics in substantial dosages. The three antibiotics or the two antibiotics, one antiseptic which was appropriate in the early to mid ’70s was Chloromycetin, ampicillin, and sulfa. Gantrisin is one sulfa that was used at the time.
Q. Sulfa being the antiseptic?
A. That’s correct.
Q. Is it your testimony that as of April of ’74, Chloromycetin could have been the treatment of choice in and of itself?
A. Not alone.
Q. You stated that Doctor Gavin or Savin [the intern or resident], whoever signed this order on *372April the 29th of ampicillin, that that was inappropriate treatment at that time, is that correct?
A. That’s correct.
Q. And in lieu of that he should have ordered a Cephalosporin or Chloromycetin?
A. If that had been ordered, it has to be taken different ways. If ampicillin had, in fact, been started assuming that they never had one in Michigan that ever was resistant to ampicillin, then other antibiotics had to be started at the same time with the ampicillin, which would have included the Chloromycetin and the sulfa, for example.
Q. So you’re saying it was appropriate to administer ampicillin in this case as long as it was administered along with another antibiotic, such as Cephalosporin or Chloromycetin?
A. No. Let me clarify this. If ampicillin had been started, and as I said, my main criticism is that ampicillin and penicillins had been given for two weeks and the child was getting sicker, you don’t use the same thing that didn’t make the child well.
So if one were to use this in higher dosages, which is a massive dose, much more than the textbook recommends at that time and present, then it would also be imperative that other antibiotics be used or technically antiseptics be used in conjunction with that ampicillin in higher dosages, such as Chloromycetin and sulfa. I’ll stop there.
Mr. Roth: Could you read that answer back. (The requested portion of the record was read.)
Q. Doctor, I want you to tell me what antibiotics you would have ordered on Eric[c]a Dacon at this point in time.
Mr. Bleakley: At this point in time meaning April 29th?
Mr. Roth [hospital’s lawyer]: April 29th, 1974.
Mr. Bleakley [Ericca’s lawyer]: On admission?
Mr. Roth: Right.
A. I would have used Chloromycetin intravenously and some type of sulfa preparation, such as Gantrisin.
*373Q. In what dosages?
A. The Chloromycetin would range from 100 to 200 milligram per kg. One hundred milligram per kilogram. She was 7.4 kilograms so 750 milligram would have been an appropriate dose.
Q. Per . . .
A. In a 24-hour period. She’s 7.4 kilograms so if you were to go — some would use 200 milligrams per kilogram the first day as a loading dose in the early ’70s, which in that case would have been one and a half grams of Chloromycetin.
So if one were to take the average of what we would do 11 years ago, we would use about a gram Chloromycetin particularly the first day along with sulfa.
Q. How much sulfa?
A. Of the Gantrisin 100 milligrams per kg could be used and that would be essentially 750 milligrams.
Q. In a 24-hour period?
A. That’s correct, iv.
Q. What other antibiotic therapy initially at this stage would have been appropriate?
A. One could have used penicillin in the penicillin G or the aqueous penicillin, but since she had been on it before one might elect to use some other type of antibiotic, such as Cephalosporin.
Q. What are those?
A. I don’t know whether Kefzol was marketed. Let’s say that Cephalosporins Keflex, Kefzol. We’re talking about, say, 100 milligrams per kilogram. It would have been the type of dosage that one might give within the first 24 hours. So we’re talking about a 7.4 kilogram child. So 750 milligrams.
Q. A day again?
A. That’s correct.
Q. That would have been true with the Keflex and Kefzol?
A. The Cephalosporins taken as a group. There were several. I don’t know when one brand came out. We’re in the third generation [of] Cephalosporins now.
*374Q. So it would have been appropriate either to have administered one of the Cephalosporins you have indicated?
A. That would have been one option, yes.
Q. With what? Anything with the Cephalosporins?
A. Yes. You could use the Chloromycetin with the Cephalosporins. The problem is . . .
Q. What dosage?
A. I had given you that.
Q. The same dosage as you told me before?
A. That’s correct, 100 to 200 milligrams per kg.
Q. And the other appropriate mode would have been just the Chloromycetin with the sulfa?
A. And one could elect to use ampicillin at 200 milligrams per kg or penicillin, but alone particularly since it hadn’t worked before wasn’t appropriate in my opinion.
Q. If ampicillin was utilized, as in this case, in your opinion it would have had to have been accompanied by what else?
A. Sulfa and Chloramphenicol.
Q. Sulfa and the Chloromycetin?
A. That’s correct, the triple therapy. Chloramphenicol and Chloromycetin are interchangeable terms.
Q. Other than the timing of giving it, was it appropriate to give it.
A. I thought it was appropriate.
Q. Together with the ampicillin, no problem?
A. Save for the problems I have already discussed.
Q. Well, the problem you discussed at length earlier was ampicillin in and of itself.
A. That’s correct.
Q. Together with the Chloramphenicol, is there any problem?
A. The ampicillin with the qualification of the dosage and the sodium we have discussed, if ampicillin had been given, it shouldn’t have been given alone. It should have been given with Chloromy*375cetin. My problem here is giving it more than 24 hours after admitting.
APPENDIX B
The majority errs in stating that when Dr. Thoman testified that "treatment should begin within an hour of diagnosis,” "[defendants immediately objected, arguing that choice of medication, not delay in making a diagnosis, had always been the issue in the case.”29
A
Defendants’ lawyers did not object when Dr. Thoman testified that treatment should begin "within an hour after” an "initial diagnosis” of meningitis "is considered.” They objected when, thirty to forty minutes later, Dr. Thoman said, "diagnosis must be made as rapidly as possible.” The objection was that delay in making a diagnosis of meningitis was not an issue, not that "delay in making a diagnosis” was not an issue.
It was the judge — not defendants’ lawyers — who raised the question whether Ericca had alleged delay in treatment.
The lawyers’ objection to trying the issue of delay in diagnosis was transformed by the judge into an objection to trying the issue of delay in treatment. This was further transformed, through mischaracterization, into an objection to trying the "new” issue of delay in administering ampicillin.30
B
Ericca’s expert witness, Dr. Thoman, was asked at the trial at what point in time treatment should begin when "the spinal fluid is cloudy but you *376don’t have all of these other tests back?”31 He responded without objection:
If the spinal fluid is cloudy, then that’s a very high indication that this is in fact a meningitis and treatment must begin actually from the time you think of meningitis. The spinal tap, i.v. and antibiotics, everything must begin actually within an hour after all this transpires. So once the initial diagnosis is considered, the tests and the medications are started in order to treat that. And generally, and for the last well over two decades since I was an intern, it’s been within an hour after that’s considered the treatment has to begin. [Emphasis added.]
Dr. Thoman’s testimony continued for another thirty to forty minutes when, in responding to the question why he was of the opinion that the standard of care was breached by Dr. Kim, he said that "diagnosis must be made as rapidly as possible.” The physicians’ lawyer objected that "[d]eiay in making a diagnosis of meningitis had not been an issue in this case . . . .”
The judge asked Ericca’s lawyer whether he had ever claimed that the doctors violated the standard of care by delay in making a diagnosis. He responded that he "did not understand Dr. Tho-man’s opinion to state that the diagnosis was delayed, but that treatment was delayed.” He added that Dr. Thoman’s testimony was "that *377there was a delay in treatment once that diagnosis had been obtained.”
The judge then turned to the physicians’ lawyer and asked, "Are you claiming that there is no allegation as to a delayed treatment?” She responded: "Yes, in this with respect, yes.”
From that moment on, the inquiry became whether delay in treatment, timeliness in medication, not delay in diagnosis, was an issue, and Ericca’s lawyer was prevented from presenting evidence concerning the importance, indeed urgency, of medicating Ericca with chloramphenicol.
The judge then instructed the jury that "timeliness of the administration of medication is not going to be an issue in this case,” and struck Dr. Thoman’s testimony concerning timeliness of medicating Ericca with chloramphenicol.
The testimony stricken was not that administration of ampicillin — the ineffective drug — should have been begun within an hour, but rather that chloramphenicol, or other appropriate medicine, should have been administered within the hour.
c
In stressing that it was the judge who introduced the issue whether delay in administering chloramphenicol was an issue, I do not wish to be understood as saying that a judge may not raise issues, and must sit like the proverbial bump on the log. My point, rather, is that it was not until the judge raised the issue that the defendants claimed that timeliness/delay were not issues.
The failure of defendants’ lawyers to object on the basis that timeliness/delay in treatment was not an issue until the judge raised the issue suggests that they were on notice that timeliness/ delay was an issue. The record shows that they *378were indeed on notice through Dr. Thoman’s deposition and the mediation statement.

 The majority states:
Because plaintiff did not plead that the standard of care was breached with respect to the hour at which treatment should have begun, facts tending to show that the standard of care required treatment at a certain hour were irrelevant. By this reasoning, exclusion of evidence relating [to] the standard of care and the hour at which medication should have been administered would have been proper. [Ante, p 339.]
The court made it clear that only standard of care evidence regarding the hour at which antibiotics should have begun was inadmissible. [Id., pp 324-325.]
After this, plaintiff sought to make a special record, apparently to show that antibiotics should have begun within an hour of admission. [Id., p 335.]
[T]he court excluded only such evidence that described the standard of care as it related to what hour treatment should have started. [Id., p 336. Emphasis in original.]

 Q. Doctor, I want you to tell me what antibiotics you would have ordered on Erica [sic] Dacon at this point in time.
Mr. Bleakley [Ericca’s lawyer]: At this point in time meaning April 29th [the date Ericca was admitted to St. John Hospital]?
Mr. Roth [hospital’s lawyer]: April 29th, 1974.
Mr. Bleakley: On admission?
Mr. Roth: Right.

 Mediation summary dated March 12, 1985, over one year before the trial in August, 1986.

 Dr. Thoman testified on deposition that administering chloramphenicol twenty-four hours after admission was "too late.”

 Chloramphenicol, the medication that Ericca claimed should have been administered on her admission to the hospital, not twenty-four hours later.

 Ante, pp 330-331.

 Chloramphenicol, Ericca claimed.

 The majority states:
In response to the trial court’s ruling, plaintiff argued, not that the complaint alleges the delay theory, but that the theory actually pleaded, failure to select an effective antibiotic, included the delay in the initial administration of antibiotics theory. [Ante, p 330. Emphasis added.]

 The court rules provide that a complaint must contain a "statement of the facts” on which the pleader relies in stating a cause of action "with the specific allegations necessary reasonably to inform the adverse party of the nature of the claims the adverse party is called on to defend . . . MCR 2.111(B)(1).
The court rules also provide that if a pleading is "so vague or ambiguous that it fails to comply with the requirements of these rules, an opposing party may move for a more definite statement before filing a responsive pleading.” If the motion for a more definite statement is granted and is not obeyed, the court may strike the pleading. MCR 2.115(A).

 MCR 2.111(A)(1). (Emphasis added.)

 Ante, p 329.

 In such a case, this case, the "studied ambiguity,” referred to by the majority (id., p 321) may be unavoidable at the time the complaint is or must be filed, as in a case where the statute of limitations may bar the action unless it is filed without further delay.

 There have been Court of Appeals opinions. See O’Toole v Fortino, 97 Mich App 797; 295 NW2d 867 (1980), Bryson v Stone, 33 Mich App 512; 190 NW2d 336 (1971), Haase v DePree, 3 Mich App 337; 142 NW2d 486 (1966), Hill v Freeman, 117 Mich App 788; 324 NW2d 504 (1982), and Martinez v Redford Community Hosp, 148 Mich App 221; 384 NW2d 134 (1986).

 Pediamycin.

 Ante, p 331.

 Footnote 3 and accompanying text.

 Ante, pp 331-332.

 Id., p 322.
The majority adds: "Plaintiff’s counsel kept this information and its implications to himself.” Id., p 323.
Since I see little or no importance in the "startling discovery,” I am not surprised that Ericca’s lawyer did not perceive "implications” requiring some sort of disclosure.

 Ante, p 331.

 Having postulated at the trial that Ericca’s lawyer was seeking to recover for delay in administering ampicillin, the physicians’ lawyer correctly states on brief in this Court that such a theory would seek to recover on the basis "that the wrong drug was not started at the 'right’ time.”
Ericca’s lawyer in fact advanced no delay in administering ampicillin theory. Ericca’s lawyer attempted, without success, to make clear that Ericca was not attempting to recover for delay in medicating her with ampicillin:
There’s never been an issue that the inappropriate antibiotics [ampicillin] should have been given.
The judge responded that Ericca’s lawyer could not introduce evidence regarding the timeliness of administration of medication— any discussion of timeliness was forbidden.
Timing and timeliness became a "t” word, that, once the defendant’s lawyers perceived the direction of the judge’s rulings, touched off objections and rulings adverse to Ericca, excluding evidence regarding the timeliness of the administration of chloramphenicol.

 Ante, p 331.

 See n 4 and accompanying text.

 Ante, p 324.

 Ante, p 338.

 Ante, p 325.

 Id., p 326.

 The factual questions were whether there was a departure from the standard of care in medicating Ericca with the ineffective drug, ampicillin, rather than the effective drug, chloramphenicol, and whether the delay in administering chloramphenicol was causally related to the right-sided hemiparesis and seizures.

 The judge instructed the jury:
It is Plaintiff’s claim that it is well-recognized that the longer one goes without appropriate treatment when suffering from bacterial meningitis, the greater the likelihood of complications. It is contended that the delay in administering chloramphenicol until April 30th caused the right-sided hemiparesis and seizures now present in Ericca. It is contended that these problems are permanent in nature and have rendered her permanently disabled.

 Ante, p 323 and n 7 (emphasis added).

 See n 20 and accompanying text.

 The majority characterizes this inquiry as "a general statement of good medical practice” and asserts that "good medical care” is not a description of the "applicable standard of care,” and argues: "When plaintiff did suggest that Dr. Kim violated the standard of care in this regard, defense counsel moved to strike the answer.” Ante, p 323, n 7.
I do not understand on what basis the majority seeks to distinguish between "good medical practice” and "standard of care.” Any motion to strike was not addressed to Dr. Thoman’s response to this inquiry, and, in all events, was made after the judge, not the lawyer, raised the question whether there was an "allegation as to a delayed treatment.”