Sheeley v. Memorial Hospital Case Brief

The special case of Medical Malpractice: IN GENERAL:The conduct of a defendant in a negligence suit is usually measured against the conduct of a hypothetical reasonably prudent person acting under the same or similar circumstances Whether a defendant had or has not conformed his conduct to a customary practice is generally only evidence of whether he has acted as a reasonably prudent person MEDICAL MALPRACTICE: In almost all cases the plaintiff must present expert witnesses since the technician complexity of the facts and issues usually prevents the jury itself from determining both the appropriate standard of care and whether the defendant’s conduct conformed to that standard Sheeley v. Memorial Hospital (1998, Supreme Court of Rhode Island) pg. 109 Facts: -Sheeley (plaintiff) gave birth at Memorial Hospital in 1987 (defendant). - During the birth, Dr. Ryder (defendant), a family practice resident, performed a procedure that later caused complications. -Sheeley brought an action against Dr. Ryder and Memorial Hospital for medical malpractice. -At trial, the court excluded the testimony of Sheeley’s expert witness, Dr. Leslie, who would have testified as to the alleged malpractice and the applicable standard of care because of the fact that Dr. Leslie was a board certified (OB/GYN), and not a family practitioner, like Dr. Ryder. - to exclude the expert testimony, defendant’s filed a motion of limine -A motion, heard in advance of jury selection, which asks the court to instruct the defendant (or plaintiff), its counsel and witnesses not to mention certain facts unless and until permission of the court is first obtained outside the presence and hearing of the jury. -Rhode Island law limits expert testimony to someone who is qualified based on knowledge, skill, experience, training or education. P.H.: At trial court, in lack of expert testimony by the plaintiff, the trial court entered a directed verdict for the hospital and Dr. Ryder. Sheeley appealed to the Rhode Island Supreme Court - A directed verdict is a ruling entered by a trial judge after determining that there is no legally sufficient evidentiary basis for a reasonable jury to reach a different conclusion. Issue: To testify as to the applicable standard of care in a medical malpractice case, must a proposed expert medical witness practice in the same specialty and within the same or similar locality as the defendant physician? Rule: a physician is under a duty to use the degree of care and skill that is expected of a reasonable competent practitioner in the same class to which he or she belongs, acting in the same or similar circumstance (113) Define class: any doctor with knowledge of familiarity with the procedure, acquired through experience, observation, association, or education, is competent to testify concerning the requisite standard of care and whether the care in any given case deviated from that standard. Holding:The trial court’s decision is reversed and the case remanded for a new trial. “Hold that a physician is under a duty to use the degree of care and skill that is expected of a reasonable competent practitioner in the same class to which he or she belongs, acting in the same or similar circumstance” (113) Reasoning: BUJA CASE: (110 bottom 111 top) - Case similar to Sheeley where plaintiff brought action against family pract. after complications from delivery of the child caused lasting compilations. They presented a board certified OBGYN to testify and lost at trial. - On appeal, the court held that “relying on… a holding in Marshall, this court reversed the trial justice and stated that even though the proposed expert did not practice in the same specialty as the defendants, he clearly has the prerequisite knowledge, skill, experience, training, or education” [and that] “nothing in the language of the relevant statute required the expert to practice in the same specialty as the defendant” YET D claims D’s claim on Dr. Leslie: 1. Overqualified - Board certified ob gyn does not hold the same knowledge, skill, experience, training, or education as a second year family practice resident in rhode island 2. Clearly outdated - Bc he has not practiced since 1975- therefore not competent 3. Similar locality rule limitation - Bc he lacks any direct knowledge about the applicable standard of care for a family practice resident providing obstetric care in rhode island → D’s claim that Dr. Leslie is not qualified to testify about the applicable local standard of care Courts previous principle: - “When a physician undertakes to treat or diagnose a patient, he or she is under a duty to exercise “the same degree of diligence and skill which is commonly possessed by other members of the profession who are engaged in the same type of practice in similar localities having due regard for the stare of scientific knowledge are the time of treatment” pg 111 bottom - “Same or similar” locality rule is an expanded version of “strict locality” requiring that the expert testifying is from the same community as the defendant - Rationale: a recognition that opportunities, experiences, and conditions may differ between densely and sparsely populated communities “In view of this holding and the striking factual similarities of the instant matter to Buja, there can be little doubt that we must reverse the decision of the trial justice and remand the case for a new trial” PROBLEMS W/ SAME LOCALITIES RULE: 1. Legitimized a low standard of care in certain smaller communities while also failing to address or compensate for the potential so-called conspiracy of silence in the plaintiff’s locality-- precluding any possibility of obtaining expert testimony 2. The rule is old fashioned w/ the presence of “modern systems of transportation and communication” - “In sum, the traditional locality rules no longer fit the present-day medical malpractice case” pg 113 Led to the adoption of “same or similar” rule (allowing for similarly situated communities to provide testimony)- HOWEVER, court feels as though this is still too narrow an approach-arguing for “similar if not, identical education, training, and experience” (pg 112) COURTS IDEA FOR RULE: “The focus in any medical malpractice case should be the procedure performed and the question of whether it was executed in conformity with the recognized standard of care, the primary concern being whether the treatment was administered in a reasonable manner” (112) ***any doctor with knowledge of familiarity with the procedure, acquired through experience, observation, association, or education, is competent to testify concerning the requisite standard of care and whether the care in any given case deviated from that standard. (112) -- *the trial justice should consider factors such are the resources available to the physician, the area of practice, the length of time in deciding the qualification of an expert-NOT one determinative issue --* a board certification should be considered a presumptive qualification except in extreme cases Reasoning: No. A plaintiff asserting a medical malpractice claim must provide expert testimony to prove the applicable standard of care, except where the defendant’s lack of care is so obvious that expert testimony is unnecessary. The trial court in this case relied on Soares v. Vestal, 632 A.2d 647 (R.I. 1993) in concluding that state law requires an expert witness to practice in the same medical specialty as the alleged malpractice. In Soares, this court excluded the expert testimony of a specialist in neurology and internal medicine, where the physician defendant was a family practitioner performing emergency medicine. However, in Buja v. Morningstar, 688 A.2d 817 (R.I. 1997), this court noted that state law does not require that an expert witness practice in the same field or specialty of the defendant, merely that the expert have the necessary knowledge, skill, experience, training or education to testify regarding the field of the alleged malpractice. Based on Buja, the trial court clearly abused its discretion in excluding Dr. Leslie’s testimony, and the matter must be remanded for a new trial. In addition, we note that this court has previously applied the “same or similar locality” rule, under which an expert testifying as to the applicable standard of care must be from a similarly situated community. This rule is no longer applicable, in light of vast improvements to the medical profession and the increasingly national standards of medical care. Moreover, nothing in the state law refers to any such locality rule.