Court Opinion

ID: 9583950
Source: CourtListenerOpinion
Date Created: 2023-08-21 22:43:15.449625+00
Date Added: 2024-06-11T15:06:03.469940
License: Public Domain

STEELMAN, Judge,
dissenting.
I respectfully dissent from the majority’s holding that the expert witness which plaintiff tendered sufficiently met the “same or similar community” standard as required by N.C. Gen. Stat. § 90-21.12.
I. Standard of Review
As noted by the majority opinion, our standard of review for the trial court’s exclusion of plaintiff’s expert witness is abuse of discretion. An abuse of discretion occurs only where the trial court’s ruling *200is “manifestly unsupported by reason or one so arbitrary that it could not have been the result of a reasoned decision. Briley v. Farabow, 348 N.C. 537, 547, 501 S.E.2d 649, 656 (1998). Plaintiffs burden to show an abuse of discretion is a heavy one indeed. I do not believe plaintiff has met this burden and therefore, the ruling of the trial court should be affirmed.
II. Similar Community Standard
The trial judge afforded plaintiff not one, not two, but three opportunities to present testimony that met the standard of “similar training and experience situated in the same or similar communities at the time of the alleged act giving rise to the cause of action.” N.C. Gen. Stat. § 90-21.12 (2003). In order to determine whether the trial judge abused his discretion, it is necessary to review in detail the proffered testimony.
Dr. Strickland testified he was familiar with the standards of practice for the performance of laprascopic surgery and follow-up care in Rocky Mount, North Carolina and similar communities. When asked the basis of this familiarity, Dr. Strickland stated:
First of all, I believe that the standard is national, but more than that, if you consider the broad depth of American education, physicians in any area are trained from all over the country. Different medical schools from all over the country, different residencies from all over the country. We generally belong to the same professional organizations. We generally attend the same meetings. We read the same journals. Therefore there’s an integration of medical practice in the United States, in my opinion, and I don’t believe the standard is any different for Rocky Mount than it is for Elkin or Albemarle or West Jefferson.
During plaintiff’s second tender, Dr. Strickland testified he had practiced in Elkin, Albemarle, Lenoir, Mount Airy and Wilkesboro, and that certain of those communities were similar in population to Rocky Mount. He further stated the records used at Nash General Hospital were similar to those he had used elsewhere, but was “not sure what [he could] directly deduce” from them. Following a forty-five minute recess, plaintiff made a third tender. Dr. Strickland testified he had: (1) determined the median income and population of Rocky Mount from the telephone book; (2) deduced the surgical resources available in the Rocky Mount community from the types of equipment listed in the operative report; and (3) driven by the hos*201pital and through Rocky Mount to get an impression of its economic base. He then formed an opinion that Rocky Mount was similar to some of the areas where he had practiced. At the conclusion of the third tender, Dr. Strickland was asked the following questions:
[Defense counsel:] So, to summarize, what you know about the standard of care for OB-GYN surgeons practicing in Rocky Mount is that you’ve practiced in other small towns in North Carolina, you have driven past the hospital here, you have driven around enough to have knowledge in passing of what the industrial base was, and you’ve looked at the telephone book to see what the median income and population is. Is that basically what your basis is, Doctor?
[Dr. Strickland:] My basis for concluding that they are similar?
[Defense counsel:] Is that your basis — is that the basis of what you know about Rocky Mount, North Carolina and the standard of practice here?
[Dr Strickland:] I suppose that’s accurate.
It is not sufficient for an expert witness to merely make the assertion that the medical communities are similar, there must be a reasonable basis for this assertion. Smith v. Whitmer, 159 N.C. App. 192, 196-97, 582 S.E.2d 669, 672-3 (2003) (stating that even though the expert testified he was familiar with the standard of care in that medical community, he gave no basis for his conclusion, and thus his opinion was irrelevant). See also Tucker v. Meis, 127 N.C. App. 197, 198, 487 S.E.2d 827, 829 (1997) (finding the expert doctor “failed to make the statutorily required connection to the community in which the alleged malpractice took place or to a similarly situated community”). The “similar community” standard “encompasses more than mere physician skill and training^]” Henry v. Southeastern OB-GYN Assocs., P.A., 145 N.C. App. 208, 211, 550 S.E.2d 245, 247 (2001). It also encompasses variations in facilities, equipment, funding, and also the physical and financial environment of a particular medical community. Id.
The population and industrial base of a community are not relevant per se to meeting the “similar community” standard. It is not the size of a town or its economic resources that are to be considered, but rather how those resources are reflected in the “conditions, facilities and equipment available to a healthcare professional[.]” Id. at 213, 550 S.E.2d at 248 (Greene, J., concurring in the result).
*202In plaintiff’s third attempt to tender Dr. Strickland as an expert, Dr. Strickland did testify about the surgical resources of the community based on his review of the operative report. However, this testimony appears to conflict with his testimony in the second tender, where he stated he was not sure what he could deduce from those reports.
The majority relies heavily on the case on Cox v. Steffes, 161 N.C. App. 237, 587 S.E.2d 908 (2003), disc. review denied, 358 N.C. 233, 595 S.E.2d 148 (2004). In Cox, the trial court granted defendant’s motion for judgment notwithstanding the verdict and set aside a jury verdict in favor of the plaintiffs. Id. at 238, 587 S.E.2d at 909-10. The trial judge based his ruling on the fact that the plaintiff’s expert witness was not familiar with the standard of care in a similar community. Id. at 239, 587 S.E.2d at 911-12. Dr. Donelly, plaintiff’s expert, testified he, like the defendant doctor, was a board-certified surgeon, and that both his and the defendant’s hospital were Level 2 hospitals. Id. at 244, 587 S.E.2d 913. In addition, “Dr. Donelly also more specifically expressed his view that Reading was similar to Fayetteville with respect to board-certified physicians, sophisticated lab services, x-ray departments, anesthesia services, hospital certification, and access to specialists.” Id. Dr. Donelly thus testifed as to the similarity of specific resources available to the medical community where he and the defendant practiced. Central to the holding in Cox was the testimony that both hospitals in Reading, Pennsylvania and Fayetteville, North Carolina were Level 2 hospitals.
In contrast, Dr. Strickland did not testify concerning the level of any hospitals, nor did he equate the surgical resources available in Rocky Mount to those in any of the other areas where he had practiced medicine. Moreover, Dr. Strickland was a board-certified specialist in obstetrics and gynecology, while Dr. Harris was only board-eligible. Although Dr. Strickland testified he was familiar with the standard of care in North Carolina, “he failed to make the statutorily required connection to the community in which the alleged malpractice took place or to a similarly situated community.” Tucker, 127 N.C. App. at 198, 487 S.E.2d at 829.
Given Dr. Strickland’s testimony in this case, I fail to discern how the trial court’s exclusion of this testimony was “manifestly unsupported by reason” or “so arbitrary that it could not have been the result of a reasoned decision.” I would thus affirm the trial court as to plaintiff’s first assignment of error.
*203Since I would affirm the trial court on plaintiff’s first assignment of error, it is necessary that I address plaintiff’s remaining arguments.
III. National Standard of Care
Plaintiff asserts that laparoscopic surgery is a “revolutionary” and “cutting edge” medical technology requiring specialized training, and that such a technique should be subject to a national standard of care. Defendant, Dr. Harris, testified he had performed a thousand laparo-scopies during his residency in the 1980’s. Dr. Strickland testified he was familiar with “the standards of practice for the performance of laparoscopic surgery and follow-up care in Rocky Mount, North Carolina and similar communities.” However, Dr. Strickland never testified that laparoscopic surgery was a “revolutionary” or “cutting edge” surgical technique or that he had even performed such surgery. Furthermore, he offered no testimony concerning the training necessary to perform laparoscopic surgery. The basis of his assertion that a “national standard of care” applied in this case was not the nature of the procedure. Rather, it was based upon a general characterization of “the broad depth of American education” of physicians. Dr. Strickland stated that “an integration” of the medical practice in the United States had occurred due to physicians in the area being trained at medical schools and performing their residencies all over the country, medical professionals belonging to the same professional organizations, attending the same meetings, and reading the same journals.
This Court has “recognized very few ‘uniform procedures’ to which a national standard may apply, and to which an expert may testify.” Henry, 145 N.C. App. at 211, 550 S.E.2d at 247 (citations omitted). Dr. Strickland’s testimony in this case fails to establish a “uniform procedure” or a “cutting edge” technology for which such a standard might possibly be appropriate. To apply a national standard of care in this case, based upon Dr. Strickland’s testimony, would be to adopt a national standard of care for the practice of medicine in general. This is clearly contrary to the express provisions and intent of the General Assembly, which enacted a “same or similar community” standard in N.C. Gen. Stat. § 90-21.12.
While Dr. Strickland cogently and concisely set forth the case for a national standard of care, it is for this state’s General Assembly, not the courts, to determine the appropriate standard of care in medical negligence cases.
*204IV. Who Is To Determine the Applicable Standard of Care
Plaintiff next contends that whether West Jefferson, Elkin, Albemarle, Boone, Lenoir/Hickory, Mount Airy and Wilkesboro are in fact similar communities is a matter for the jury to determine, not the trial judge. I disagree.
It is the duty of the trial judge to determine whether an expert medical witness can render an opinion under N.C. Gen. Stat. § 90-21.12 and Rule 702 of the Rules of Evidence. Taylor v. Abernethy, 149 N.C. App. 263, 272, 560 S.E.2d 233, 239 (2002), disc. review denied, 356 N.C. 695, 579 S.E.2d 102 (2003). Furthermore, in none of the cases in which this court considered N.C. Gen. Stat. § 90-21.12, was the issue of similar communities left to the jury to decide. Smith v. Whitmer, 159 N.C. App. 192, 582 S.E.2d 669 (2003); Leatherwood v. Ehlinger, 151 N.C. App. 15, 564 S.E.2d 883 (2002); Coffman v. Roberson, 153 N.C. App. 618, 571 S.E.2d 255 (2002), disc. review denied, 356 N.C. 668, 577 S.E.2d 111 (2003); Tucker v. Meis, 127 N.C. App. 197, 487 S.E.2d 827(1997); Henry v. Southeastern OB-GYN Assocs., P.A., 145 N.C. App. 208, 550 S.E.2d 245 (2001). It was for the trial court to determine whether Dr. Strickland was qualified as an expert in the area of his testimony and whether his testimony was relevant. Howerton v. Arai Helmet, Ltd., 358 N.C. 440, 458, 597 S.E.2d 674, 686 (2004). In"this case, without a showing of “same or similar communities,” Dr. Strickland was not qualified as an expert, nor was his testimony relevant on the appropriate standard of care. I would find this argument to be without merit.
V. No Requirement of Expert Testimony
Finally, plaintiff contends it was improper for the court to direct verdict in favor of defendants because the alleged negligence in this case was of a type that the jury could determine without the testimony of an expert. I disagree.
To prevail in a medical malpractice case a plaintiff must show “ ‘(1) the applicable standard of care; (2) a breach of such standard of care by the defendant; (3) the injuries suffered by the plaintiff were proximately caused by such breach; and (4) the damages resulting to the plaintiff.’ ” Smith, 159 N.C. App. at 195, 582 S.E.2d at 671 (citations omitted). Generally, expert testimony is required when the standard of care and proximate cause are matters involving highly specialized knowledge beyond that of laymen. Smithers v. Collins, 52 N.C. App. 255, 260, 278 S.E.2d 286, 289 (1981). However, expert testi*205mony is not necessary in all medical malpractice cases to establish the standard of care or proximate cause. Id. This is true, especially where the jury, based on its common knowledge and experience, is able to understand and judge the actions of the doctor. Id. This rule has been applied in the case of taking and recording a patient’s vital signs and the placement of bedpans. Henry, 145 N.C. App. 208, 211, 550 S.E.2d 245, 247 (2001). This case now before us is not such a case, as it deals with laparoscopic surgery and the post-operative treatment of a surgery patient. This is beyond the “ken of laymen.” I would find this assignment of error to be without merit.
VI. Summary
Appellant has failed to demonstrate that the trial judge abused his discretion in excluding the testimony of Dr. Strickland. Plaintiffs remaining arguments are also equally unavailing. I would affirm the trial court.