NORMAND CARON ET AL. v. CONNECTICUT PATHOLOGY GROUP, P.C.
AC 40462
Appellate Court of Connecticut
Argued September 20, 2018—officially released January 29, 2019
Lavine, Prescott and Harper, Js.
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Syllabus
The plaintiffs, C and D, sought to recover damages from the defendant medical practice for, inter alia, alleged medical malpractice in connection with the false positive cancer diagnosis of C by pathologists employed by the defendant. C had undergone an endoscopy at a hospital during which a biopsy was performed. Tissue samples from the biopsy were placed on a slide by hospital personnel and sent to the defendant for analysis. The defendant‘s pathologists incorrectly determined that C had cancer on the basis of their interpretation of a contaminated sample. In bringing their action, the plaintiffs, pursuant to the statute (
Argued September 20, 2018—officially released January 29, 2019
Procedural History
Action to recover damages for, inter alia, medical malpractice, and for other relief, brought to the Superior Court in the judicial district of Middlesex, where the court, Domnarski, J., granted the defendant‘s motion to dismiss and rendered judgment thereon, from which the plaintiffs appealed to this court. Affirmed.
James F. Biondo, with whom, on the brief, was Diana M. Carlino, for the appellee (defendant).
Opinion
PRESCOTT, J. This appeal arises out of a medical malpractice action brought by the plaintiffs,
The following facts, as alleged in or necessarily implied from the plaintiffs’ complaint and affidavits submitted by the plaintiffs and the defendant, and procedural history are relevant to our resolution of the plaintiffs’ claim. On March 25, 2014, Caron underwent an endoscopy at Middlesex Hospital in Middletown. During the endoscopy, a biopsy was performed. Tissue samples extracted during the biopsy were placed on a slide by Middlesex Hospital personnel.2 The slide containing the tissue samples was then sent to the defendant for analysis. On the basis of their interpretation of the samples, physicians employed by the defendant determined that Caron had cancer. Caron was then informed of the diagnosis.
From March 25 to August 15, 2014, Caron underwent medical treatment for cancer. On August 15, 2014, Caron was informed that the sample upon which his cancer diagnosis was based had been contaminated and that he did not, in fact, have cancer.
The plaintiffs commenced the present action on August 30, 2016. In paragraph 6 of their complaint, the plaintiffs alleged: “The conduct of the defendant . . . its agents, servants, and/or employees, including, but not limited to, its pathologists and other professional staff, violated the applicable standard of care . . . in the following ways: (a) in that pathologists employed by [the defendant] failed to consider contamination error in the initial pathology finding or in subsequent consultations when, in the exercise of reasonable care, they could and should have done so; (b) in that pathologists employed by [the defendant] failed to diagnose a contamination error in a timely manner when, in the
exercise of reasonable care, they could and should have done so; (c) in that pathologists employed by [the defendant] failed to perform or request a nucleic acid identification of the tissue from the initial biopsy, when, in the exercise of reasonable care, they could and should have done so; and (d) in that pathologists employed by [the defendant] failed
As required by
On October 26, 2016, the defendant filed a motion to dismiss the action for lack of personal jurisdiction because the opinion letter that the plaintiffs attached to their complaint was not authored by a similar health care provider as required by
In support of the motion to dismiss, the defendant attached an affidavit from Jonathan Levine, a board certified clinical and anatomic pathologist, averring: “Clinical [p]athology and [a]natomic [p]athology are primary board certifications, each with their own separate and distinct training protocol and board examinations. They are not sub-specialties of one another. . . . Anatomic [p]athology involves the examination of surgical tissue specimens to diagnose disease. . . . Prior to becoming eligible to sit for the [a]natomic [p]athology board examination, a physician must complete specialized training in [a]natomic [p]athology. . . . Clinical pathology involves the direction of divisions of the laboratory which may include the blood bank, clinical chemistry, microbiology, hematology, and other special divisions. . . . Prior to becoming eligible to sit for the [c]linical [p]athology board examination, a physician must complete specialized training in [c]linical [p]athology. . . . The examination of the tissue samples as set forth in their [c]omplaint, concerns the examination of tissue specimens for the purpose of diagnosing cancer, and thus fall within the field of [a]natomic [p]athology.”
On December 9, 2016, the plaintiffs filed an objection
to the motion to dismiss. In support of their objection, the plaintiffs submitted an affidavit from Reichberg. Reichberg did not contradict the definitions of clinical and anatomic pathology
On January 17, 2017, the court heard oral argument on the defendant‘s motion to dismiss. At oral argument, the defendant again explained that clinical pathology and anatomic pathology are separate and distinct specialties. In response, the plaintiffs argued that there was nothing beyond Levine‘s affidavit to “delineate distinctly the differences between [clinical and anatomic pathology].” They did not, however, provide their own definitions of the specialties. Moreover, neither party moved for an evidentiary hearing at this point, despite the fact that the plaintiffs later argued that such a hearing was necessary to the adjudication of the motion. In fact, the plaintiffs did not move for an evidentiary hearing until after the court granted the defendant‘s motion to dismiss.
On February 16, 2017, without holding an evidentiary hearing, the court issued a memorandum of decision granting the defendant‘s motion to dismiss. The court, relying on Levine‘s affidavit and Stedman‘s Medical Dictionary, found that anatomic and clinical pathology are distinct subspecialties of pathology. Specifically, the court stated: “Reichberg‘s affidavit . . . does not contradict [Levine‘s] characterization [of anatomic and clinical pathology]; indeed, these definitions are in line with those provided in Stedman‘s Medical Dictionary. . . . Stedman‘s Medical Dictionary defines anatomic pathology in relevant part as ‘the subspecialty of [pathology] that pertains to the gross and microscopic study of organs and tissue removed for biopsy . . . and also the interpretation of the results of such study’ . . . Stedman‘s Medical Dictionary (28th Ed. 2006) p. 1442; whereas clinical pathology is defined in relevant part as ‘the subspecialty in [pathology] concerned with the theoretical and technical aspects (i.e. the methods or procedures) of chemistry . . . and other fields as they pertain to the diagnosis of disease.’ . . . Stedman‘s Medical Dictionary, supra, p. 1442.” (Citation omitted; emphasis in original.)
In its memorandum of decision, the court also concluded that the plaintiffs’ complaint alleged negligence within the province of anatomic pathology, stating: “What the [plaintiffs] [are] essentially alleging is that the defendant‘s pathologists, in endeavoring to interpret
the samples, failed to recognize and, consequently, failed to investigate, the possibility that one or more of the samples may have been contaminated and thus failed to ultimately conclude that one of the samples was indeed contaminated. These allegations fall within the defined province of anatomic pathology.” On the basis of these conclusions, the court granted the defendant‘s motion to dismiss.
On February 28, 2017, the plaintiffs filed two motions: a motion to vacate and/or reargue the judgment of dismissal and a motion for an evidentiary hearing.5 On
On appeal, the plaintiffs claim that the court improperly granted the defendant‘s motion to dismiss on the basis of its determination that the opinion letter was legally insufficient pursuant to
We begin with our standard of review and other applicable principles of law. “A motion to dismiss tests, inter alia, whether, on the face of the record, the court is without jurisdiction. . . . [O]ur review of the court‘s ultimate legal conclusion and resulting [determination] of the motion to dismiss will be de novo. . . . When a . . . court decides a . . . question raised by a pretrial motion to dismiss, it must consider the allegations of the complaint in their most favorable light. . . . In this regard, a court must take the facts to be those alleged in the complaint, including those facts necessarily implied from the allegations, construing them in a manner most favorable to the pleader. . . . The motion to dismiss . . . admits all facts which are well pleaded, invokes the existing
“[I]f the complaint is supplemented by undisputed facts established by affidavits submitted in support of the motion to dismiss . . . other types of undisputed evidence . . . and/or public records of which judicial notice may be taken . . . the trial court, in determining a jurisdictional issue, may consider these supplementary undisputed facts and need not conclusively presume the validity of the allegations of the complaint.
Rather, those allegations are tempered by the light shed on them by the [supplementary undisputed facts]. . . . If affidavits and/or other evidence submitted in support of a defendant‘s motion to dismiss conclusively establish that jurisdiction is lacking, and the plaintiff fails to undermine this conclusion with counteraffidavits or other evidence, the trial court may dismiss the action without further proceedings.” (Citations omitted; emphasis omitted; footnote omitted; internal quotation marks omitted.) Conboy v. State, 292 Conn. 642, 651-52, 974 A.2d 669 (2009).
“The interpretation of pleadings is always a question of law for the court . . . Our review of the trial court‘s interpretation of the pleadings therefore is plenary. . . . [W]e long have eschewed the notion that pleadings should be read in a hypertechnical manner. Rather, [t]he modern trend, which is followed in Connecticut, is to construe pleadings broadly and realistically, rather than narrowly and technically. . . . [T]he complaint must be read in its entirety in such a way as to give effect to the pleading with reference to the general theory upon which it proceeded, and to substantial justice between the parties. . . . Our reading of pleadings in a manner that advances substantial justice means that a pleading must be construed reasonably, to contain all that it fairly means, but carries with it the related proposition that it must not be contorted in such a way so as to strain the bounds of rational comprehension. . . . [E]ssential allegations may not be supplied by conjecture or remote implication . . . .” (Citations omitted; internal quotation marks omitted.) Grenier v. Commissioner of Transportation, 306 Conn. 523, 536, 51 A.3d 367 (2012).
Turning to the substance of the issue before us, “[§] 52-190a (a) provides . . . that, prior to filing a personal injury action against a health care provider, the attorney or party filing the action . . . [must make] a reasonable inquiry as permitted by the circumstances to determine that there are grounds for a good faith belief that there has been negligence in the care or treatment of the claimant. . . . To show the existence of such good faith belief that there has been negligence in the care or treatment of the claimant. . . . To show the existence of such good faith, the claimant or claimant‘s attorney . . . shall obtain a written and signed opinion of a similar health care provider, as defined in [General Statutes §] 52-184c . . . that there appears to be evidence of medical negligence and includes a detailed basis for the formation of such opinion. . . . Failure to attach to the complaint a legally sufficient opinion letter authored by a similar health care provider mandates dismissal because the court lacks personal jurisdiction over the defendant. . . .”
“Section 52-184 defines similar health care provider. Pursuant to that provision, the precise definition of
similar health care provider depends on whether the defendant health care provider is certified by the American board as a specialist, is trained and experienced in the medical
“If the [plaintiff] [alleges] in his complaint that the defendant [is a specialist] . . . the opinion letter . . . ha[s] to be . . . authored by a similar health care provider as defined by
“Our precedent indicates that under
In the present case, the court interpreted the complaint as alleging negligence by the defendant in its interpretation of the tissue samples, which is within the province of anatomic pathology. We agree and are unable to see, even construed in the manner most favorable to the plaintiffs, how the complaint alleges anything other than negligence in the defendant‘s interpretation of the tissue samples.
The plaintiffs’ complaint clearly revolves around the defendant‘s interpretation of the tissue samples they received from Middlesex Hospital. The interpretation of the samples falls within the specialty of anatomic pathology. Paragraph 2 of the complaint expressly frames the issue as one of negligent interpretation by the defendant, stating: “On or about March 25, 2014, [Caron] underwent an endoscopy . . . The biopsy results from the endoscopy were interpreted by physicians employed by, and acting in the course of their employment with, [the defendant], as positive for cancer. The interpretation of the biopsy samples by the physicians [employed by the defendant] led [Caron‘s] treaters to conclude that he was suffering from cancer.” (Emphasis added.)
Similarly, the specific instances of negligence alleged by the plaintiffs in paragraph 6 (a) through (d) of their complaint all relate to the defendant‘s interpretation of the tissue samples, which is within the province of anatomic pathology, not clinical pathology. Paragraph
6 (d) of the complaint expressly alleges that the defendant‘s pathologists “failed to properly interpret [Caron‘s] biopsy sample.” (Emphasis added.)
The plaintiffs argue that paragraph 6 (a) through (c) of their complaint alleges negligence by the defendant in its operation of the laboratory, which arguably could be interpreted as falling within the field of clinical pathology. We are not persuaded. Although these subparagraphs do not expressly use the term interpretation, the allegations clearly relate to the standard of care used in analyzing a sample in order to diagnose the presence, if any, and type of disease after it is placed on a slide. This function is within the province of anatomic pathology. Similarly, paragraph 6 (a) alleges that the defendant “failed to consider contamination error in the initial pathology finding . . . .” Because the defendant received the tissue samples after they were handled by Middlesex Hospital, the defendant‘s consideration of contamination
Nowhere in their complaint do the plaintiffs allege that the defendant operated a laboratory or played any role in the preparation, handling or contamination of the tissue samples, all of which is conduct related to clinical pathology. Indeed, at oral argument on the plaintiffs’ motion to vacate and/or reargue, the plaintiffs’ counsel stated: “There‘s nothing in the complaint that I see that directly says that [the defendant ran a laboratory].” Additionally, at oral argument before this court, the plaintiffs were unable to point to any part of their complaint that alleges that the defendant operated a laboratory and, therefore, breached its duty of care in the realm of clinical, rather than anatomic, pathology.
Because the plaintiffs’ complaint sounds in negligence predicated on the defendant‘s interpretation of the tissue samples, and the interpretation of samples falls within the expertise of anatomic pathologists, the plaintiffs were required to attach to their complaint
an opinion letter authored by an anatomic pathologist. Specifically, the plaintiffs were required to attach an opinion letter from a physician (1) trained and experienced in anatomic pathology, and (2) board certified in anatomic pathology. See, e.g., Bennett v. New Milford Hospital, Inc., 300 Conn. 1, 14, 12 A.3d 865 (2011). It is undisputed that Reichberg has specialized training in clinical, not anatomic, pathology. Reichberg averred on two occasions that he is “a board certified clinical pathologist with forty years of experience in clinical laboratory medical and managerial direction.” He is not, however, board certified in anatomic pathology.
The plaintiffs argue that Reichberg‘s opinion letter is sufficient because he is qualified to assess the duty of care of anatomic pathologists. In support of this, Reichberg averred: “I am cognizant of the overall responsibility of the [defendant‘s] [d]irector for the operation of the whole laboratory, regardless of subspecialty, and I [am] well qualified to assess the operational aspects of the histology laboratory [operated by the defendant].” Again, it is undisputed that Reichberg is not board certified in anatomic pathology and, therefore, regardless of his ample experience in clinical pathology, he is not a similar health care provider as that term is defined by
On the basis of the foregoing, we conclude that the court properly interpreted the plaintiffs’ complaint to allege negligence by the pathologists employed by the defendant in their capacity as anatomic pathologists and that the opinion letter, therefore, was not authored by a similar health care provider, as required by
The judgment is affirmed.
In this opinion the other judges concurred.
to be evidence of medical negligence and includes a detailed basis for the formation of such opinion. . . .”
Notes
We caution, however, that when courts are faced with genuine factual disputes in deciding motions to dismiss, an evidentiary hearing is required. See, e.g., Conboy v. State, 292 Conn. 642, 652-54, 974 A.2d 669 (2009) (“where a jurisdictional determination is dependent on the resolution of a critical factual dispute, it cannot be decided on a motion to dismiss in the absence of an evidentiary hearing to establish jurisdictional facts“).
