Braun v. AhmedBraun v. Ahmed
Lead Opinion
OPINION OF THE COURT
The primary issue on this appeal is one of first impression in this Department, namely, whether, in a medical malpractice action, the plaintiffs’ counsel in summation may request a specific dollar figure for damages. Because we believe that counsel may as a matter of fair comment make such a request and since that request was denied by the trial court in this instance, we reverse and direct a new trial on the issue of damages only.
The plaintiff Willi Braun came under the care of the defendant Dr. Naseer Ahmed in 1976, primarily for the treatment of diabetes. During a visit in May 1978, Braun complained of
While Braun arranged with a surgeon to undergo such surgery in January 1979, he thereafter canceled the procedure and continued under the defendant’s care. He was eventually circumcised in January 1980 after his condition worsened. A biopsy revealed cancerous cells, necessitating a partial penectomy in February 1980.
Braun and his wife subsequently brought this action against Dr. Ahmed on the ground that he had failed to warn Braun of the possibility of penile cancer, and had further led Braun to believe that his condition did not require immediate surgery. After trial, the jury returned a verdict against Dr. Ahmed apportioning his fault at 65% and that of the plaintiff Willi Braun at 35%, and awarding damages totaling $147,000.
The parties raise three issues on their respective appeal and cross appeal which warrant discussion. The defendant contends that the plaintiffs did not establish a prima facie case in that they failed to call a medical expert and relied instead upon the defendant’s testimony to establish liability. The plaintiffs contend that the trial court erred both in refusing to permit the plaintiffs’ counsel to request a specific dollar amount during summation, and in refusing to set aside the jury award as inadequate.
With respect to the issue of the defendant’s liability, the trial court did not err in denying the defendant’s motion to dismiss the complaint. While "it is incumbent upon the plaintiff to present expert testimony in support of the allegations to establish a prima facie case of malpractice” (Keane v Sloan-Kettering Inst. for Cancer Research,
We now address the principal issue raised on this appeal —whether counsel in summation in a medical malpractice action may request a specific sum from the jury for damages.
This issue may be resolved by reviewing both the role of the jury and of counsel in summation and relating their functions to the 1976 medical malpractice legislation and to the determination in Tate v Colabello (
The jury is sworn to render a verdict based upon the evidence, and if liability is established, the jurors must ascertain and award damages. The evidence determines the amount (Williams v Brooklyn El. R. R. Co.,
Regarding the role of counsel, as a general principle there exists a right of fair comment on the evidence, described as follows: "It is the privilege of counsel in addressing a jury to comment upon every pertinent matter of fact bearing upon the questions which the jury have to decide. This privilege it is most important to preserve and it ought not to be narrowed by any close construction, but should be interpreted in the largest sense * * * The jury system would fail much more frequently than it now does if freedom of advocacy should be unduly hampered and counsel should be prevented from exercising within the four corners of the evidence the widest
Distinct from the right of fair comment is counsel’s right to place the contentions of the parties, as stated in the pleadings, before the jury. The "[statements, admissions and allegations in pleadings are always in evidence for all the purposes of the trial of the action. They are made for the purpose of the trial, and are before the court and jury, and may be used for any legitimate purpose” (Holmes v Jones,
Narrowing our focus to counsel’s right to argue a specific monetary amount, New York has long permitted mention of the figure stated in the ad damnum clause (Tisdale v President of Del. & Hudson Canal Co., supra). However, a recent determination permits mention of a lesser lump-sum figure, apparently based upon the evidence, as it clearly does not come from the pleadings (see, Tate v Colabello, supra). Of course, counsel still may not ask for damages in an amount exceeding the sum demanded in the ad damnum clause (Tate v Colabello, supra).
A review of decisions in our sister States reveals that a majority of jurisdictions permit presentation of some figure representing damages for pain and suffering, whether as fair comment on the evidence, as presentation of the pleadings, or as argument of a unit-of-time or per diem formula
Although the following excerpts refer to a discussion of a unit-of-time or per diem formula to the jury, they nevertheless reflect the conflicting positions on the larger issue of comment as to any figure:
"For hundreds of years, the measure of damages for pain and suffering following in the wake of a personal injury has been 'fair and reasonable compensation.’ This general standard was adopted because of universal acknowledgement that a more specific or definitive one is impossible. There is and there can be no fixed basis, table, standard or mathematical rule which will serve as an accurate index and guide to the establishment of damage awards for personal injuries. And it is equally plain that there is no measure by which the amount of pain and suffering endured by a particular human can be calculated. No market place exists at which such malaise is bought and sold. A person can sell quantities of his blood, but there is no mart where the price of a voluntary subjection of oneself to pain and suffering is or can be fixed. It has never been suggested that a standard of value can be found and applied. The varieties and degrees of pain are almost infinite. Individuals differ greatly in susceptibility to pain and in capacity to withstand it. And the impossibility of recognizing or of isolating fixed levels or plateaus of suffering must be conceded * * *
"As has been indicated, pain and suffering have no known dimensions, mathematical or financial. There is no exact correspondence between money and physical or mental injury or suffering, and the various factors involved are not capable of proof in dollars and cents. For this reason, the only standard for evaluation is such amount as reasonable persons estimate to be fair compensation” (Botta v Brunner, supra, at 92-95, at 718, 720; emphasis supplied; Annotation, 60 ALR2d 1347).
The inherent weakness in this analysis is that it posits the jurors’ duty as having to do the impossible, i.e., from evidence which is "not capable of proof in dollars and cents” they must fix dollars and cents damages, and, under the New Jersey rule, must do so without guidance.
On the other hand, the following arguments are offered in support of guidance: " 'Authorities approving such arguments give numerous reasons: (1) that it is necessary that the jury be
The foregoing represents the background against which we must make our determination as to whether counsel in a medical malpractice action in this State may mention a figure to the jury. To recapitulate, the possible bases for counsel’s argument to the jury on damages are the amount prayed for in the pleadings, a lump sum or fair comment on the evidence, and a per diem or other unit-of-time formula. We are not called upon to decide which of these bases are available in New York in the ordinary negligence action, for presentation. to the jury of the ad damnum and a lesser lump-sum figure has been approved, and use of time formulas remains undecided by our highest court (see, Tate v Colabello,
Having examined the history of the 1976 medical malpractice legislation and finding no reason to conclude that the Legislature intended to curb comment to the jury, we conclude that counsel in a medical malpractice action may argue a lump-sum figure based upon the evidence. Counsel is, however, circumscribed by the pleadings and may not argue a figure which cannot be considered reasonable.
Turning to the legislation,
It is clear that the 98-year-old right to read the pleadings to the jury (see, Tisdale v President of Del. & Hudson Canal Co., supra), is affected by
Without knowledge of the legislative history, one would presume that the purpose of removing the dollar figure from the ad damnum (
As part of the short-term package of recommendations to meet the immediate insurance crisis, the panel recommended a $100,000 ceiling on pain and suffering awards, itemized verdicts, abolition of the collateral source rule,
In stark contrast, the recommendation concerning the ad damnum clause unequivocally stated, "the elimination of the ad damnum clause will not reduce insurance premiums” (McGill Report, at 45). The full text indicates that the purpose was solely to avoid adverse publicity, to wit:
"5. Ad Damnum Clauses
"The ad damnum clause is the final paragraph in plaintiff’s complaint and has been considered an essential part of his pleading. In fact, the clause serves very little legal purpose other than to set the upper limit of recovery. Because the plaintiff is free to assert any amount of damages he chooses, ad damnum clauses in medical malpractice actions have frequently alleged damages in very high amounts. Because such figures are often picked up by the news media and form the basis for adverse publicity, ad damnum clauses have become a special irritant to the medical profession. The fact that a case in which a high figure was asserted in the ad damnum clause is subsequently settled for a relatively low amount or ends with a judgment for the defendant is not commonly given equal media coverage.
The staff papers reinforce this conclusion, as they state: "Elimination of the ad damnum clause will not reduce insurance premiums, and none of the health care providers have argued that it would. Its elimination, which has also been recommended by the City Bar Association Report, however, will do away with an unnecessary irritant” (McGill Report, at 201).
The legislative bill jacket for the 1980 amendment to
From the legislative bill jacket for
A by-product of the amendment not considered by the McGill Report was that there was no longer a specific dollar demand to be placed before a jury in summation. Thus, the Appellate Division, Third Department, was not on solid ground when it stated in Bechard v Eisinger (
Our dissenting colleagues argue that the plaintiff in an ordinary negligence case is bound by the "upper limit” demand in the complaint and that a medical malpractice plaintiff is not so bound. Our answer to this argument is that a plaintiff in a medical malpractice action is more likely to be bound by a demand for reasonable damages than is a plaintiff in a negligence action who may demand any figure at all, reasonable or otherwise. It is this reality which most readily explains the departure by the Court of Appeals from the former rule limiting a plaintiff to that figure demanded in the complaint. Once the departure from the figure demanded in the complaint is made, and counsel is permitted to argue a figure based on the evidence, there exists no reason to prohibit medical malpractice plaintiffs from suggesting a sum to the jury. To prohibit comment may result in inadequate awards to those who have severe injuries — a result never intended by the McGill Panel or the Legislature. Medical malpractice plaintiffs should not be treated differently at the advocacy stage of summation. They should be able to suggest a reasonable figure to the jury although they are no longer permitted to place a figure in the complaint.
Aside from Bechard v Eisinger (supra), the only other case to address the issue since Tate (
Our dissenting colleagues argue that by permitting counsel in summation, and, inevitably, at earlier stages of the trial as well, to suggest a sum of money that the jury ought to award, we are thereby requiring the Trial Judge to conduct an unprecedented and unduly burdensome pretrial procedure whereby he must evaluate the damage claims in the case and determine what constitutes a reasonable figure for purposes of fair comment at appropriate stages of the ensuing trial. This argument is, however, unfounded, because the sole issue presented on appeal in this case is whether the Trial Judge should have permitted the plaintiffs counsel to suggest a dollar figure in the course of his summation. When the trial reaches the point where summations are about to be delivered, all of the evidence in the case has been presented, and the trial court is therefore in a position to adequately determine a reasonable figure upon which counsel may comment during their respective summations, and to determine the appropriate manner in which the remaining aspects of the case are to be submitted to the jury. Thus, we hold only that counsel in a medical malpractice action may suggest a reasonable figure for damages in summation, and we express no view as to whether counsel may offer such suggestions during voir dire, opening statements and at other stages of the trial.
In sum, the Legislature in the 1976 legislation never intended to relegate medical malpractice victims to lesser awards by eliminating ad damnum clauses from their complaints, and Tate authorized counsel to suggest the amount of a damage award to the jury, thus permitting reasonable
Before reaching the plaintiffs’ claim that the jury award was inadequate, we find it necessary to comment upon several further points made by our colleagues.
First, we perceive no basis for the apparent distinction drawn by our colleagues between economic damages, e.g., medical expenses and loss of earnings, and damages for non-economic loss, e.g., pain and suffering. They concede that counsel have an absolute right to comment to the jury about the sums proven for economic damages, just as they may comment upon the other evidence in the case, but they would absolutely prohibit counsel from commenting about the value of damages for pain and suffering. However, because the dissenters adopt the view that the right to suggest a specific sum of money is derived solely from the ad damnum clause of the complaint, and because
We next refer to the Governor’s Special Message to the Legislature, from which our colleagues wrote: "It is also contended that, especially in medical malpractice cases, exaggerated demands are used to precondition the jury and result in excessively high awards” (1976 McKinney’s Session Laws of NY, Governor’s Special Message, at 2428). Focusing on use of the words "the jury”, our colleagues imply that a specific jury in a specific case is the subject and target of "pre-conditionting]” by comments as to dollar amounts. We cannot subscribe to this view as it departs from the analysis in the McGill Report and cannot explain use of the word "pre-condition”. Preconditioning does not come from a single exposure during trial, and can only result from repeated exposure. Use of the word "pre-condition” suggests that it happens long before jurors are sworn as a result of newspaper accounts of excessive demands in other medical malpractice cases which may set the going rates for particular injuries in the minds of those who later serve on juries. Under these circumstances, use of the words "the jury” was merely imprecise, and cannot be read to have any reference to a particular convened jury.
In closing, we simply note that we find this position untenable.
Finally, the plaintiffs contend that the jury award totaling $147,000 was grossly inadequate. Because we are reversing and ordering a new trial on the issue of damages, we do not reach this question of inadequacy. The judgment should be reversed, and a new trial granted limited to the issue of damages only.
Notes
. Under a unit-of-time or "per diem” formula "small units of time of pain and suffering are given a specific monetary value and multiplied at this rate for the entire time for which it might be endured” (Tate v Colabello,
. "The collateral source rule is a rule in common law that provides that in setting an award the court or jury may not take into account the fact that part of the plaintiffs damages are already covered from other sources, such as his own health insurance, disability compensation, and the like” (McGill, Report of the Special Advisory Panel on Medical Malpractice, at 38-39).
. It is noted that the Association of the Bar of the City of New York did refer to jury reaction when recommending elimination of ad damnum specifics. However, it did so only because of its belief that "reading of the ad damnum to the jury by plaintiff’s counsel in summation may appear to add some official sanction to the sum sued for” (emphasis supplied). Such danger is not present when counsel "suggests” a sum to the jury rather than reading the complaint.
Concurrence in Part
(concurring in part and dissenting in part). I concur to affirm the jury’s findings of fact as to liability for the reasons stated in the majority opinion. As to the summation issue, I disagree with the determination of the majority and would hold that in a medical malpractice case, the plaintiff’s counsel cannot request a specific dollar amount for general damages for pain and suffering and permanent injuries. In my view, such a practice is impermissible under the statutory and common law of this State.
At the outset, it is clear that, in a medical malpractice case, as in any other civil lawsuit, counsel have an absolute right to discuss the evidence in the case, which may include the sums set forth in the bill of particulars and proven for medical expenses and loss of earnings, past and future, and other special damages, just as they may discuss any other evidence in the case before the jury. As to those damages, counsel may, of course, request specific sums in summation. The discussion here concerns counsel’s request of a specific monetary amount from the jury for pain and suffering and permanent injuries. In a medical malpractice case, this practice is impermissible on two separate but related grounds: namely, (1) the common law of this State only permits comments on the amount sued for in the pleadings, and (2) such comments in a medical malpractice case would be contrary to the legislative intent underlying
In Rice v Ninacs (supra), the Appellate Division, Third Department, clearly stated the rule in this regard, as follows:
"In any event, there is no merit to defendant’s contention that it was improper for plaintiffs counsel to state on summation the amount demanded in the complaint. 'Pleadings are always before the court without being formally offered in evidence. They may be referred to by counsel during the trial and their contents may easily be brought to the attention of the jury.’ (Newton v. Livingston County Trust Co.,
"The extent of damages sustained by an injured plaintiff and the compensation due therefor is one of the principal issues in a personal injury action. Under the rule, of the Tisdale case, plaintiff’s counsel is entitled to place before the
In 1983, the Court of Appeals again addressed this issue in Tate v Colabello (
Other cases which have similarly relied upon the ad damnum clause as a basis for a monetary request to the jury are Rush v Sears, Roebuck & Co. (
In a similar vein, the Court of Appeals in Loomis v Civetta Corinno Constr. Corp. (
The plaintiff’s counsel is entitled to place before the jury his clients’ contentions as to the amount of damages set forth in the complaint at various stages of the trial: during voir dire (Pratt v Susquehanna Val. Cent. School Disk,
Thus, prior to 1976, when
The Legislature enacted
The statute is silent as to the propriety of stating a specific sum to the jury in summation or at any other stage of the trial. There is nothing in the legislative history or the judicial gloss which indicates that the Legislature ever considered the issue, of specific monetary requests to a jury in summation. Therefore, it is necessary to review the legislative history and surrounding circumstances to attempt to ascertain the legislative' intent (McKinney’s Cons Laws of NY, Book 1, Statutes § 92). This court should consider the problems the Legislature sought to ameliorate and construe the statute in question so that it provides a remedy for those problems.
"This legislation would require that a pleading in a medical malpractice case contain a prayer for general relief, rather than a demand for a specific amount of dámages.
"Presently, demands in medical malpractice cases may be alleged by the plaintiff in any amount and are generally well in excess of the ultimate recovery. The amount demanded, however, very often receives extensive publicity in the news media, thereby unfairly damaging the reputation of the doctor or hospital involved. It is also contended that, especially in medical malpractice cases, exaggerated demands are used to precondition the jury and result in excessively high awards” (1976 McKinney’s Session Laws of NY, Governor’s Special Message, at 2428; emphasis supplied).
Clearly, one of the problems sought to be remedied by this statute was to negate the use of alleged "exaggerated” demands to "precondition the jury”. Presumably, "the jury” refers to the particular jury to whom such a demand is made, which could result in "excessively high awards”. The material included in legislative bill jacket is not enlightening on this issue. Most commentators simply noted that
In his 1976 Practice Commentaries to
The legislative history with regard to the addition of municipal corporations to the shelter provided by
Our colleagues stress the importance of preventing "adverse publicity” as underlying the legislative intent in enacting
Surprisingly, since
In 1981, in Vargas v Rosal-Arcillas (
On appeal in Thornton, the Appellate Division, First Department, further reduced the award to $484,480 and did not address the issue of the plaintiff’s monetary request in summation (see, Thornton v Montefiore Hosp.,
In the first direct appellate review of the effect of
Although specific legislative intent as to whether, in a
To hold that a medical malpractice complaint which can contain no specific monetary demand permits the plaintiff’s counsel to make any monetary request to the jury deemed appropriate by counsel would give greater rights to a plaintiff in a medical malpractice case than in any other type of civil tort litigation wherein counsel is held within the bounds of the amount specified in the complaint. The Legislature certainly never intended such a result. However speculative, artificial and unrealistic the amount demanded in a complaint may be, it nevertheless serves as a self-created cap that the monetary request and verdict cannot exceed and thus acts as some guideline for counsel and the court. Significantly, this limiting figure has been the only basis used by our courts in giving counsel the right to place a monetary figure for general damages before a jury. Without the "amount in the complaint” doctrine enunciated in the Tisdale, Rice and Tate line of cases, there is no authority in our law for such a practice, and we are bound by these precedents. Further, there are remedial procedures which may be taken to correct either grossly inadequate or excessive verdicts at the trial and appellate levels. In fact, this case presents a proper case for the application of such a remedial procedure.
My colleagues in the majority suggest an unprecedented
Also unclear is whether this new procedure would permit counsel to place before the jury at other stages of the trial such as the voir dire and openings their contentions as to the amount of general damages. The majority opinion discusses this issue only in the context of attorneys’ summations, and states that the Trial Judge could make a "reasonable figure” determination prior to summations based upon the evidence. Pursuant to this proposed procedure, the Trial Judge would have to determine what is a "reasonable figure” either prior to the commencement of the trial to permit counsel to place this monetary amount before the jury in the voir dire and their openings, or, if this rule is intended to preclude counsel from mentioning any figure during any prior stages of the
Further, the court’s determination of the "reasonable figure” could lead to additional problems such as the potential of disparate determinations by different Trial Judges as to a "reasonable figure” for similar injuries, the manner and timing of appellate review, and the effect of such a determination by the Trial Judge upon a motion to set aside a verdict as either excessive or inadequate. Also, the spectre of an appellate reversal or modification of the "reasonable figure”, a subject which undoubtedly will attract the attention of appellate counsel, would place the ultimate verdict in the usual lengthy medical malpractice trial in greater jeopardy.
In sum, I decline to adopt the imposition of a new procedural "reasonable figure” determination by the Trial Judge on the grounds that (1) it is an unnecessary departure from the established Tisdale, Rice and Tate "amount in the pleadings” precedent in this State, (2) such a procedure is unauthorized by statute, rule or common-law precedent, and (3) such an additional step would present new and unusual trial and appellate problems not envisioned by the Legislature or previously sanctioned by our courts.
I am not inclined to depart from the common-law rule of confining the amount requested in summations to the monetary limitation in the pleadings. To do otherwise would not only be contrary to the legislative intent and purpose in medical malpractice cases, but it would create a class of litigants with different and arguably greater rights than all others in civil litigation. Thus, in this case, the trial court properly refused to grant the plaintiffs’ application to request a specific monetary sum for general damages during summation.
Finally, the plaintiffs contend that the jury award totaling $147,000 was grossly inadequate. I agree. Therefore, the judgment should be reversed and a new trial granted limited to the issue of damages only, unless the defendant stipulates to increase the verdict in favor of the plaintiff Willi Braun to $300,000 and Melitta Braun to $50,000, to be reduced by 35%
Brown and Rubin, JJ., concur with Bracken, J.; Spatt, J., concurs in part and dissents in part and votes to reverse the judgment, on the facts and in the exercise of discretion, and to grant a new trial on the issue of damages only, unless the defendant stipulates to increase the verdict in favor of the plaintiff Willi Braun to $300,000 and in favor of the plaintiff Melitta Braun to $50,000, to be reduced by 35% representing Willi Braun’s comparative negligence, and to the entry of an amended judgment accordingly, and in the event he so stipulates, to affirm the judgment as so increased and amended, with an opinion in which Mangano, J. P., concurs.
Justice Rubin has been substituted for the late Justice Gibbons (see,
Ordered that the judgment is reversed, on the law, and a new trial is granted limited to the issue of damages only, with costs to abide the event. The findings of fact on the issue of liability are affirmed.