Josepha P. CRODA and Antonio Croda v. CARL J. SARNACKI, M.D., Graciano F. Singson, M.D., South Macomb Gynecologists, P.C., Theodore G. Pantos, M.D., and Detroit-Macomb Hospitals Association
Docket No. 43276
Michigan Court of Appeals
Submitted January 14, 1981. -- Decided May 5, 1981.
106 Mich. App. 51
Leave to appeal applied for.
- A record of plaintiffs’ attempt to impeach Dr. Pantos fails to show any contradiction between Dr. Urwiller‘s deposition and Dr. Pantos’ testimony. Therefore, the deposition was not relevant as impeachment evidence, there being no significant difference between the opinions of the two doctors. There was no error in the court‘s ruling as it did.
- The fact that plaintiffs had reached a settlement with Detroit-Macomb Hospitals Association was not introduced into evidence in order to prove the liability of the remaining defendants and the rule relied on by plaintiffs does not require exclusion when the evidence is offered for another purpose. Furthermore, the information pertaining to the settlement was not admitted into evidence at all. Even if it had been, admission of proof of a prior settlement agreement is a matter of judicial discretion. In view of the fact that the hospital association was an active party during the initial days of trial, the court‘s instruction was proper in order to inform the jury of the party‘s dismissal from the suit. The trial court‘s instruction was the only noted mention of the settlement to the jury. There is no reason to assume that, based upon this instruction, the jury concluded that plaintiffs’ claims were without merit. There was no abuse of discretion in the trial court‘s ruling.
- The trial court substantially charged the jury with the standard jury instructions on apportionment. Based upon the evidence presented, there was no error in the charge.
- An expert witness must possess the necessary learning,
knowledge, skill or practical experience that would enable him to competently testify concerning the subject at issue. The trial court told the jurors that they could not determine the standard of care on their own knowledge, but that the proper practice would have to be established by one “learned in urology or gynecology“. Viewing the instructions as a whole, there was no reversible error.
Affirmed.
BRONSON, P.J., dissented from the majority opinion on two points. First, he would hold that the trial court committed reversible error in giving the jury instruction which informed the jury of the earlier settlement and the amount thereof because a substantial possibility existed that the jury would misuse the information concerning the settlement and conclude that plaintiffs’ claims were of dubious validity given the relatively low amount for which the claim against the hospital was settled. Secondly, he would hold that the jury instruction pertaining to the qualifications of an expert witness was incomplete and erroneous and would lead the average juror to conclude that the plaintiffs’ expert witness‘s testimony should be given less weight because he was not a specialist in urology and gynecology and that it was highly probable that the jury‘s verdict was improperly affected by the instruction. He would reverse and remand for a new trial.
1. EVIDENCE — SETTLEMENT AGREEMENTS — ADMISSIBILITY OF AGREEMENTS — DISCRETION.
Admission of proof of a prior settlement agreement between a defendant and the plaintiff is a matter of judicial discretion.
2. DAMAGES — EVIDENCE — SETTLEMENTS — ADMISSIBILITY — JURY.
A trial court in a medical malpractice action against multiple defendants did not abuse its discretion by instructing the jury that the plaintiffs had settled with one defendant for $4,000 and that the jury should deduct that amount from any judgment rendered against the remaining defendants where the instruction was proper in order to inform the jury of the settling party‘s dismissal from the suit, the instruction was the only mention of the settlement to the jury, and there was no reason to assume that, based upon the instruction, the jury concluded that the plaintiffs’ claims were without merit.
3. WITNESSES — EXPERT WITNESSES — MEDICAL MALPRACTICE — QUALIFICATIONS OF WITNESS.
An expert witness in a trial for medical malpractice need not be
4. TRIAL — DISCRETION — FAILURE TO RECOGNIZE OR EXERCISE DISCRETION — ERROR.
It is error for a trial court, where it has the discretion to rule on a matter, to fail to recognize that it has such discretion and, therefore, to fail or to refuse to exercise it.
5. WITNESSES — EXPERT WITNESSES — MEDICAL MALPRACTICE — STANDARD OF CARE.
A witness need not be of the same school or speciality as the defendant in order to be a qualified medical expert in a medical malpractice case; it is sufficient if the witness has expertise in the standard of care imposed by the defendant‘s school or speciality.
6. TRIAL — JURY — JURY INSTRUCTIONS — EXPERT WITNESSES — ERROR.
It was error for a trial court to give a jury instruction on the requisite qualifications for an expert witness where the court stated that an expert witness must be “learned” in a particular field or speciality because the jurors could have construed the instruction to mean that a particular witness must be a specialist in that field or speciality, the instruction could lead the average juror to conclude that that witness‘s testimony should be given less weight because he was not a specialist in that particular field where a very specific objection to the instruction was made, and the trial court, which easily could have rectified the matter, did not.
Lopatin, Miller, Bindes, Freedman, Bluestone, Erlich & Rosen (by Steven G. Silverman), for plaintiffs.
Kerr, Russell & Weber (by James R. Dashiell), for defendants Sarnacki, Singson and South Macomb Gynecologists, P.C.
Before: BRONSON, P.J., and J. H. GILLIS and BASHARA, JJ.
BASHARA, J. Plaintiffs sought recovery of damages incurred as the result of defendants’ alleged medical malpractice. During the first week of trial, defendant Detroit-Macomb Hospitals Association settled with plaintiffs. Subsequently, the jury returned a verdict of no cause of action as to the remaining defendants. Plantiffs now appeal the jury‘s verdict.
Drs. Sarnacki and Singson practiced medicine together as South Macomb Gynecologists, P.C., also a named defendant in the action. On June 8, 1973, plaintiff Josepha Croda consulted with Dr. Sarnacki concerning problems which included a dropped uterus, a herniated rectum, a lacerated cervix, excessive bleeding, pain on intercourse, constipation, and urinary incontinence. Sarnacki informed plaintiff that she needed a hysterectomy and a cystocele-rectocele. She underwent the surgery in the South Macomb Hospital on July 30, 1973. Subsequent to the surgery, plaintiff‘s bladder did not maintain its proper tone. As a result, catheterization was necessary to evacuate urine from the bladder. Two days after her discharge from the hospital, plaintiff went to the office of South Macomb Gynecologists and Dr. Singson removed the catheter. When Mrs. Croda began to notice urine in her vagina, Sarnacki reinserted a catheter and referred her to defendant Dr. Theodore Pantos, a urologist, who treated her from August 21, 1973, to November 2, 1973. As part of his treatment, Dr. Pantos performed a right ne-
Plaintiff alleged that she sustained permanent injuries to her urinary system and right kidney as a result of defendants’ negligence. She averred that she had not been properly informed of the dangers inherent in the surgical procedure of July 30, 1973, and that Dr. Sarnacki had breached a contract to cure. Mrs. Croda further contended that Sarnacki departed from the standard of care in cutting her right ureter during surgery and by discharging her from the hospital prematurely. Plaintiff further averred that Dr. Pantos was negligent in failing to perform the right nephrostomy before September 11, 1973, when he knew that plaintiff had problems with her right kidney on September 4, 1973. Mrs. Croda also alleged that the delay resulted in further damage to her right kidney. She also claimed that, instead of a nephrostomy, Dr. Pantos should have performed a reimplantation of the right ureter on September 11, 1973. Plaintiff Antonio Croda‘s claim was based on loss of consortium.
Plaintiffs initially contend that the trial court erred in restricting the cross-examination of Dr. Pantos. Plaintiffs’ counsel began to ask Dr. Pantos whether he agreed with statements in the deposition of defendants’ expert witness, Dr. Urwiller.
Upon objection by defendants, the trial court ruled that, since the deposition of Dr. Urwiller had not been admitted into evidence and he had not been called as a witness, plaintiffs’ attorney could not specifically refer to the deposition. It was further held that plaintiffs’ counsel could not inquire as to why Dr. Urwiller had not been called as a witness. Plaintiffs’ counsel was allowed, however, to ask Dr. Pantos his frame of reference in
A separate record was made in which plaintiffs attempted to impeach Dr. Pantos. Plaintiffs failed to show any contradiction between Dr. Urwiller‘s deposition and Dr. Pantos’ testimony. Therefore, the deposition was not relevant as impeachment evidence, there being no significant difference between the opinions of the two doctors.1 We find no abuse of discretion in the court‘s ruling. Lorenz Supply Co v American Standard, Inc, 100 Mich App 600, 615; 300 NW2d 335 (1980), People v Strickland, 78 Mich App 40, 54; 259 NW2d 232 (1977).
Plaintiffs allege error in the following jury instruction:
“Now there was an additional defendant in this trial which was South Macomb Hospital [sic] Association and as you recall I instructed you that South Macomb Hospital [sic] Association after a particular point in this trial would no longer be considered a defendant. South Macomb Hospital [sic] Association has settled the claim filed against it by the plaintiffs for the amount of four thousand dollars. If you determine to award Mr. and Mrs. Croda any additional money from the remaining defendants, you should first deduct the sum of four thousand dollars from any sum you feel the plaintiffs should receive as damage.”
Plaintiffs argue that the instruction violated
“Rule 408 Compromise and Offers to Compromise.
“Evidence of (1) furnishing or offering or promising to furnish, or (2) accepting or offering or promising to accept, a valuable consideration in compromising or attempting to compromise a claim which was disputed as to either validity or amount, is not admissible to prove liability for or invalidity of the claim or its amount. Evidence of conduct or statements made in compromise negotiations is likewise not admissible. This rule does not require the exclusion of any evidence otherwise discoverable merely because it is presented in the course of compromise negotiations. This rule also does not require exclusion when the evidence is offered for another purpose, such as proving bias or prejudice of a witness, negativing a contention of undue delay, or proving an effort to obstruct a criminal investigation or prosecution.” (Emphasis added.)
We find
Plaintiffs assert for the first time on appeal that the trial court should have deducted the $4,000 from whatever judgment the jury may have reached rather than advise them to make the deduction themselves. By telling the jury that plaintiffs recovered $4,000 from the hospital, they contend the jury was allowed to speculate that their claim was without merit.
Admission of proof of a prior settlement agreement between a defendant and the plaintiff is a matter of judicial discretion. Wilson v WA Foote Memorial Hospital, 91 Mich App 90, 97; 284 NW2d 126 (1979), lv to appeal held in abeyance 409 Mich 868 (1980), Reno v Heineman, 56 Mich App 509, 512; 224 NW2d 687 (1974). But see, Brewer v Payless Stations, Inc, 94 Mich App 281; 288 NW2d
In view of the fact that the hospital association was an active party during the initial days of trial, the court‘s instruction was proper in order to inform the jury of the party‘s dismissal from the suit. The trial court‘s instruction was the only noted mention of the settlement to the jury. There is no reason to assume that, based upon this instruction, the jury concluded that plaintiffs’ claims were without merit. We fail to find an abuse of discretion in the trial court‘s ruling.
The third instruction challenged on appeal concerns the apportionment of damages among the defendants. The trial court substantially charged the jury with the standard jury instructions on apportionment,
Plaintiffs challenge one final jury instruction:
“Now, the question is, ‘How do you as jurors determine what the standard of practice is and whether or not it has been observed by the defendants in this case?‘”
“Jurors and judges do not know and are not permit-ted arbitrarily to say what are the proper methods of
treating a patient under the circumstances in this case. This is a medical question. What is or is not a proper practice by a urologist or a gynecologist, the treatment of a patient or what is or is not standard of practice of the usual practice in the community is a question for experts and can be established only by their testimony. That is, it is only those learned in urology or gynecology who can say what should have been done or what was done or not to have been done and it is only those learned in urology or gynecology who can say what was done was proper.”
Plaintiffs contend that the phrase “learned in urology or gynecology” could have misled the jury into concluding that, contrary to established law, the expert must be a specialist in those fields in order to be a competent witness. We agree with plaintiffs’ initial premise that an expert need not be a board-certified specialist in the field in order to testify as to the standard of care of that practice. However, it is well-established that the expert witness must possess the necessary learning, knowledge, skill or practical experience that would enable him to competently testify concerning that area of medicine. Siirila v Barrios, 398 Mich 576, 591; 248 NW2d 171 (1976).
It is therefore clear that plaintiffs’ expert, Dr. Miller, was not required to be a gynecologist or urologist in order to qualify as an expert witness. He stated that he was learned in those areas due to his medical training, experience and continuing review of the literature in those fields. The trial court properly allowed Dr. Miller to testify as an expert witness.
However, plaintiffs argue that by giving the above instruction, Dr. Miller‘s credibility was diminished by the court. They read the instruction
We disagree with plaintiffs’ interpretation of the instruction. The trial court told the jurors that they could not determine the standard of care on their own knowledge. Rather, the proper practice may only be established by one “learned in urology or gynecology“. We find the instruction to conform precisely to the requirements of Siirila, supra.
Viewing the instructions as a whole, we find no reversible error. Moore v Foster, 96 Mich App 317, 321; 292 NW2d 535 (1980).
Affirmed. Costs to defendants.
J. H. GILLIS, J., concurred.
BRONSON, P.J. (dissenting). I have two major areas of disagreement with the majority‘s opinion in this case. I therefore dissent.
I
I disagree with most aspects of the majority‘s analysis on the question of whether the trial court erred in instructing the jury to deduct $4,000 from any judgment which it might render in plaintiffs’ favor. Preliminarily, contrary to the majority view, only an extremely technical reading of the transcript can lead one to conclude that plaintiffs assert this issue for the first time on appeal. While most of the discussion at trial was concerned with the propriety of telling the jury about the $4,000 settlement with the South Macomb Hospital when no evidence has been introduced during trial concerning the same, it is patently clear that plaintiffs’ counsel desired that the trial court make a
While the majority prefers the approach used in Wilson v WA Foote Memorial Hospital, 91 Mich App 90, 96-97; 284 NW2d 126 (1979), lv to appeal held in abeyance 409 Mich 868 (1980), allowing the jury to know about the previous settlement, I believe that the reasoning employed in Brewer v Payless Stations, Inc, 94 Mich App 281; 288 NW2d 352 (1979), lv gtd 409 Mich 871 (1980), is far more persuasive. I agree with the majority that, standing by itself,
It is clear that the trial court did not recognize its discretion to refuse the instruction. It is equally apparent that had it been aware of its discretion to reject the instruction, it would have done so. The following pertinent excerpts from the trial court‘s comments on this issue unequivocally establish both facts:
“The Court: First I guess with respect to reference to
the verdict, the settlement between Mr. Vander Male and Mr. Lopatin, South Macomb Hospital, I can‘t find any authority to support Mr. Lopatin‘s proposition that under Michigan law that I am not required under Michigan law to bring that settlement to the jury. I understand your position on it as far as in terms of money being in evidence.
“Michigan differs from maybe every state in the union but my understanding, and you can check me, the most recent cases I could find which I had done research on is in that that matter must be brought to the jury‘s attention and they must do the arithmetic rather than me.
“The last person-I haven‘t talked with Judge Baum. The last person who tried this in Wayne Circuit, to do the arithmetic themselves was Judge Baum and even he, I am quite sure-I can‘t find any authority for the position.
*
“The Court: You may well be right. As I read the cases, I am bound to tell them that they must subtract from the verdict the amount of settlement. As I say if I were sitting in the Supreme Court which I am obviously not, I would not have signed my name to such an opinion of such a rule.
* *
“The Court: It‘s a matter now. It has no probative value with respect to liability. It is a matter of-Michigan law is an anomaly. If I were sitting in the Supreme Court, I wouldn‘t have adopted such a procedure. I think the judge should do the arithmetic but that is not the way the Supreme Court has ruled. They have ruled that the jury must do the arithmetic and therefore the jury must be instructed from any verdict which it renders it must subtract $4,000.00.”
Wilson, supra, relied on by the majority, specifically refers to questions concerning the admission of a settlement with a joint tortfeasor as being a matter within the trial court‘s discretion. Here, the trial judge did not recognize his discretion so
Finally, as concerns this issue, plaintiffs’ argument below that the jury should not be informed of the $4,000 settlement because the fact of settlement was never introduced into evidence is well taken. The two cases relied upon by the majority, Wilson, supra, and Reno v Heineman, 56 Mich App 509; 224 NW2d 687 (1974), both arose in the context of evidentiary rulings made by the trial court. In the instant case, the defense never attempted to admit evidence of the settlement. The jury had not been apprised of the settlement prior to the close of the proofs by either side.
II
I also disagree with the majority‘s conclusion concerning the likely effects of the following instruction:
“Now, the question is, ‘How do you as jurors determine what the standard of practice is and whether or not it has been observed by the defendants in this case?‘”
“Jurors and judges do not know and are not permit-ted arbitrarily to say what are the proper methods of treating a patient under the circumstances in this case. This is a medical question. What is or is not a proper practice by a urologist or a gynecologist, the treatment of a patient or what is or is not standard of practice of the usual practice in the community is a question for experts and can be established only by their testimony. That is, it is only those learned in urology or gynecol-ogy who can say what should have been done or what was done or not to have been done and it is only those learned in urology or gynecology who can say what was done was proper.”
Plaintiffs’ counsel objected to the instruction as follows:
“* * * I object to the Court‘s [c]harge that you have
that where there has been instructional error, unless it is clear that appellant could not have prevailed in any case, the error cannot be deemed harmless. Toledo & AAR Co v Johnson, 49 Mich 148, 150; 13 NW 492 (1882). Additionally, Wilson, supra, which the majority relies on, forthrightly acknowledges the potential for prejudice in admitting evidence of a prior settlement. In Wilson, the settlement amount was $150,000, $75,000 as to each of two settling defendants. Clearly, if a potential for prejudice was apparent in Wilson, it is hard to rebut that the $4,000 settlement here likely did substantial mischief.
to have someone learned in urology or gynecology in order to testify as to the—as to what should or should not have been done. I think the test is if a person is a medical doctor or even an osteopathic doctor who is familiar with the standard of care that is the test to be applied and not that he has to be aware of the specialty of both urology and gynecology.”
Plaintiffs contend that the phrase “learned in urology or gynecology” suggests that the expert had to be a specialist in both of these fields to be considered competent to testify on the appropriate standard of care. Defendants argue that the instruction was correct and that expert testimony on the standard of care requires “more than mere knowledge of a speciality“.
To be a qualified medical expert, the witness need not necessarily be of the same school or specialty as the defendant. It is sufficient if the witness has expertise in the standard of care imposed by the defendant‘s school or specialty. Siirila v Barrios, 398 Mich 576, 590-594; 248 NW2d 171 (1976), Wilson, supra, 101-102.
Dr. George Miller, plaintiffs’ expert, testified that he is not board certified in urology or gynecology. However, he was board certified in surgery and stated that he kept up on the medical literature in obstetrics, gynecology, and urology. Miller testified that he also attended general surgical conferences covering these topics. Finally, he testified that he was familiar with the standard of care as it pertained to specialists in obstetrics, urology, and gynecology, practicing in Detroit, for patients who have problems like those of plaintiff. As regards Dr. Miller‘s status as a medical expert, this case is similar to Wilson, supra. There, this Court rejected the assertion that plaintiffs’ expert need be an expert in obstetrics to give an opinion on the
The question here, however, is not whether Miller was properly qualified to give expert testimony, but whether the trial court‘s instructions would lead the average juror to conclude that his testimony should be given less weight because he was not a specialist in urology and gynecology. I believe that the instruction as given was improper. Although “learned” arguably could be interpreted simply as requiring knowledge of urology or gynecology, which Miller had, the jurors could also have construed the instruction to mean that the witness must be a specialist in those fields.3
Unlike the majority, I think the instruction was incomplete and erroneous. This is particularly true in light of plaintiffs’ counsel‘s very specific objection to the charge and the ease with which the trial court could have rectified the same.
In the instant case, I cannot say that the error was harmless. Defense counsel‘s cross-examination of Dr. Miller constituted a strong attack on his qualifications and credibility. While this attack was proper and within permissible bounds, in combination with the erroneous instruction, the possibility that the jury associated “learned in gynecology and urology” as the equivalent of requiring specialization in these fields was greatly
I would reverse and remand for a new trial.