Kozlowski v. Rush

BAKES, Chief Justice,

dissenting:

The Court concludes that the trial court erred in excluding the testimony of Dr. Friedman, appellants’ expert witness. The trial court found that he had not established that he was adequately familiar with the applicable standard of health care practice in the community of Pocatello, Idaho, and therefore excluded Friedman’s testimony-

Unlike a fact witness, which is one who has personal knowledge concerning a matter relevant to the issue being tried, our cases have historically held that a trial court has much broader discretion in determining whether or not to permit an expert witness to render an opinion. Lowe v. Skaggs Safeway Stores, Inc., 49 Idaho 48, 57, 286 P. 616, 618 (1930) (“The qualifications of a witness to testify as an expert is a matter largely within the discretion of the trial court, and its rulings will not be reversed unless there has been an abuse of that discretion.”); State v. Lowe, 50 Idaho 96, 102, 294 P. 339, 341 (1930) (“[Tjesting the knowledge or experience of such [expert] witness to qualify him is for the court.”); State v. Joblin, 107 Idaho 351, 355, 689 P.2d 767, 771 (1984) (“[T]he competency of a witness to testify concerning a particular matter is for the trial judge to determine ... [and] ... will not be set aside absent an abuse of discretion.”).

The majority opinion acknowledges that the trial court has discretion concerning whether to permit a witness to render an expert opinion. Ante at 856-859. However, the majority reverses without making the abuse of discretion analysis which this Court has said that we must do in order to determine whether the trial court has abused its discretion. Sun Valley Shopping Center, Inc. v. Idaho Power Co., 119 Idaho 87, 803 P.2d 993 (1991). After reciting the trial court’s decision to exclude Dr. Friedman’s testimony, the Court merely states, “We are not persuaded,” as though the decision was up to us. However, the decision was the trial court’s to make. In the Sun Valley case we said that, “Our *838inquiry is: (1) whether the trial court correctly perceived the issue as one of discretion; (2) whether the trial court acted within the outer boundaries of its discretion and consistently with the legal standards applicable to the specific choices available to it; and (3) whether the trial court reached its decision by an exercise of reason.” 119 Idaho at 88, 803 P.2d at 994. The majority has not made the abuse of discretion analysis set out in the Sun Valley Shopping Center case.

Relying on Buck v. St. Clair, 108 Idaho 743, 702 P.2d 781 (1985), the majority makes essentially a trial court analysis and concludes that Dr. Friedman made an adequate determination that the local standard of care did not deviate from the national standard of care, and therefore, Dr. Friedman possessed actual knowledge of the applicable local community standard required by I.C. § 6-1012. The Court then holds that “the trial court erred in striking Friedman’s testimony about the use of biomedical profiles and ultrasound.” Ante at 858-859. However, the record supports the trial court, not the majority’s analysis.

In an attempt to determine what the community standard of care was, Dr. Friedman stated that he reviewed the depositions of the defendant Dr. Rush, and the depositions of several nurses. First, it should be patently obvious that the local community standard of care for a board-certified obstetrician-gynecologist cannot be determined by reviewing the depositions of nurses who are not board-certified obstetrician-gynecologists. The case of Buck v. St. Clair, 108 Idaho 743, 702 P.2d 781 (1985), relied on by the majority, specifically states that. As to the deposition of Dr. Rush, he specifically denied that the community standard of care required the use of biomedical profiles and ultrasound. There is nothing in Dr. Rush’s deposition, and the majority opinion does not point to anything in his deposition, which would support the majority’s conclusion that the failure to do a “biomedical profile” or an “ultrasound” violated the community standard of care.

Next, the majority relies on the fact that Dr. Friedman testified that he “spoke” with another board-certified ob-gyn, Dr. DeSano, who was practicing in Pocatello at the same time Stephanie was born. The Court’s opinion does not state what they “spoke” about. That is because Dr. Friedman did not testify as to what he “spoke” to Dr. DeSano about. The only testimony regarding the content of the conversation which he had with Dr. DeSano came in the cross examination of Dr. Friedman by defense counsel in which Friedman acknowledged that he never asked Dr. DeSano about biophysical profiles:

Q. And your purpose in contacting Dr. DeSano was to determine whether the standards in Pocatello were the same as the national standards, wasn’t it?
A. That’s correct.
Q. And generally you concluded based on that conversation with Dr. DeSano that many of the standards were the same, didn’t you?
A. Yes, sir.
Q. It’s true, isn’t it, though, doctor, that Dr. DeSano did not tell you that your recommendation for a biophysical profile was being done in Pocatello in 1984 and 1985, did he?
A. Correct.
Q. You didn’t even ask him about that, did you?
A. Correct.

(Emphasis supplied.)

Dr. Friedman never did testify affirmatively as to what he “spoke” to Dr. DeSano about, except to admit on cross examination that he never asked Dr. DeSano about biophysical profiles. Therefore, the statement in the majority opinion that Dr. Friedman “spoke” to Dr. DeSano does not establish that he became familiar with the community standard of care in Pocatello, Idaho. In fact it establishes just the contrary because it negates any conversation regarding the local community standard, particularly regarding biophysical profiles.

As the final basis for the majority’s claim that Dr. Friedman had adequately determined what the local community standard of care was, the majority points to the fact *839that Dr. Friedman testified that he reviewed the deposition of Dr. Rufi. The majority finds that as the result of that review Dr. Friedman was qualified to give his opinion that Rush acted below the prevailing local standard of care for board certified ob-gyns because he failed to conduct a biomedical profile or use ultrasound to determine fetal size. Ante at 858., The Court’s opinion quotes from Dr. Rufi’s deposition in which he stated that he was familiar with the Handbook of Standards by the American College of Obstetricians and Gynecologists, and that the handbook was “reflective of what the standard of practice was in this community [Pocatello] in 1985.” The majority concludes that, because “Friedman testified that he was also familiar with the Handbook of Standards,” Friedman was qualified to testify that “Rush acted below the prevailing national standard of care for board certified obgyns because he failed to conduct a biomedical profile or use ultrasound to determine fetal size.” Ante at 858. However, there was not one word of testimony from Dr. Friedman that the Handbook of Standards required a biomedical profile. The Handbook of Standards itself was never introduced as evidence in the case. Therefore, the mere fact that Dr. Rufi, in his deposition, stated that the Handbook of Standards was “reflective of what the standard of practice was in this community in 1985,” did not establish anything with regard to biophysical profiles because there was never any testimony from Dr. Friedman or anyone else that the Handbook of Standards even addressed biophysical profiles. All of the other expert witnesses who testified stated that biophysical profiles were not part of the local standard of practice in Pocatello, Idaho, in 1985.

The record does not support the majority’s conclusion that Dr. Friedman was sufficiently qualified to testify concerning the local community standard of care regarding the use of ultrasound. The only mention which Dr. Friedman made in his testimony regarding ultrasound and the Handbook of Standards consists of two short comments. After discussing at some length what the Handbook of Standards required of a hospital regarding Caesarean sections, the following examination of Dr. Friedman took place:

Q. Doctor, I think you are reading something on another subject in there. Are there any other aspects of those rules which you feel were violated by any defendant in this case?
A. There is another reference on page 30 to the fact that obstetric services caring for high risk patients, such as Mrs. Skiba, should be equipped to provide ultrasonography during labor and on a 24-hour basis.
Q. But I think there is evidence that the hospital had an ultrasound facility, which could have been used but wasn’t.
A. Correct.

While Dr. Friedman does testify to a reference on page 30 of the handbook that “obstetric services” should be equipped to provide ultrasonography during labor and that the hospital was equipped with an ultrasound facility, Dr. Friedman does not state whether page 30 of the handbook imposed any obligation or standard on an ob-gyn doctor to perform an ultrasound or, if so, under what conditions. He only states, “There is another reference on page 30 to the fact that obstetric services caring for high risk patients, such as Mrs. Skiba, should be equipped to provide ultrasonography during labor and on a 24-hour basis.”

In his cross examination, Dr. Friedman acknowledged that he was told by both Dr. DeSano and Dr. Rush that ultrasounds for the purpose of determining fetal weight in cases of suspected macrosomia were not being done as part of the local standard of care in Pocatello, Idaho. That testimony was as follows:

Q. And isn’t it true, also, doctor that Dr. DeSano told you at the time you talked to him on the telephone that in Pocatello, Idaho, in 1984 and 1985 ultrasounds for the purpose of determining fetal weight in cases of suspected macrosomia were not being done as part of the standard of care; isn’t that correct?
A. He indicated to me that the use of ultrasound was available and being used *840for assessing gestational age and fetal size, but specifically did not say that it was being used for macrosomic infants. And I have already testified yesterday to the effect that that didn’t make any sense to me since the technique for fetal size was the technique for fetal size regardless of the size of the baby, it’s the same technique.
Q. So he told you that if one suspected a macrosomic baby, it would not be the standard of care in Pocatello, Idaho, to do an ultrasound, didn’t he?
A. No, he indicated that it was not being used, he didn’t say it could not be used.
Q. No, I didn’t ask you that question. I said did he tell you that it was not the standard of care in 1984 and 1985 to use ultrasound for the purpose of determining fetal size with regard to an assessment for macrosomia?
A. I have already indicated that is what he said, yes.
Q. And Dr. Rush said that same thing in his deposition, didn’t he?
A. Correct.
Q. And Dr. Rufi said it was not routinely done, didn’t he?
A. He said it was being done under certain circumstances.

A careful review of Dr. Friedman’s testimony, which the trial court made before ruling on his motion to strike his testimony, demonstrates that Dr. Friedman did not establish that the Handbook of Standards for ob-gyn certified doctors required either a biophysical profile or an ultrasound in cases of suspected macrosomia. Dr. Friedman acknowledged on cross examination that Dr. DeSano told him personally on the phone, and Dr. Rush testified in his deposition, that ultrasounds for the purpose of determining fetal weight in cases of suspected macrosomia were not being done as part of the standard of care in Pocatello, Idaho, in 1985.

The trial court had the benefit of personally evaluating Friedman as a witness, and carefully reviewed both his testimony and the deposition testimony of Dr. Rufi and Dr. Rush before he exercised his discretion and concluded that he would not allow the expert opinion testimony of Dr. Friedman because he was not adequately familiar with the local standard of care. Our cases have all held that the trial court is in the best position to judge whether or not to permit an expert witness to render an opinion, considering all the factors in the case. I.R.E.' 702 states that the trial court must determine whether such opinion evidence will “assist the trier of fact to understand the evidence or determine a fact in issue.” That role is uniquely one for the trial court, not this Court. The Court today confuses the role of this Court under the Sun Valley case, and the role of the trial court under I.R.E. 702. State v. Joblin, 107 Idaho 351, 689 P.2d 767 (1984); Lowe v. Skaggs Safeway Stores, Inc., 49 Idaho 48, 57, 286 P. 616, 618 (1930) (“The qualifications of a witness to testify as an expert is a matter largely within the discretion of the trial court, and its rulings will not be reversed unless there has been an abuse of that discretion.”). Our cases state that we will not presume error on appeal. See Rohr v. Rohr, 118 Idaho 689, 800 P.2d 85 (1990); Carpenter v. Double R Cattle Co., Inc., 108 Idaho 602, 701 P.2d 222 (1985); Rutter v. McLaughlin, 101 Idaho 292, 612 P.2d 135 (1980). The majority, having made no abuse of discretion analysis as set out in our Sun Valley case, should apply our longstanding rule that no error will be presumed by the trial court. Rohr v. Rohr supra. The Court errs in reversing the trial court’s ruling and the jury’s verdict.

As to Part II of the Court’s opinion, which states that the trial court should permit voir dire examination about the effect of insurance company advertisements regarding the so-called “medical malpractice crisis,” the Court’s opinion acknowledges that, “There has not been a sufficient showing here that the potential jurors may have been exposed to such advertisements.” Ante at 859. If there is nothing in the record to show such advertisements in this case, why is the Court pronouncing on an issue which does not exist in this case? Part II of the Court’s opinion is unfortunate dicta.