Opinion
This certified appeal and cross appeal
The jury reasonably could have found the following facts.
Sometime in late 1992 or early 1993, the plaintiff saw or heard an advertisement for the defendant’s ophthalmology practice. The advertisement indicated that the defendant was offering the RK procedure, and that this procedure could cure nearsightedness. On the basis of this advertisement, the plaintiff consulted with the defendant regarding the possibility of RK surgery. He told the defendant that his goal was to be able to see clearly without the aid of eyeglasses or contact lenses. The defendant indicated his confidence that, due to recent advancements in the field, RK could improve the plaintiffs uncorrected vision to 20/40 or 20/50 in his left eye and 20/20 in his right eye. The defendant explained that he successfully had performed a variation of RK on several patients with severe myopia, and that he believed that the plaintiff was a candidate for this procedure.
The defendant recommended a “monovision” approach to the plaintiffs treatment. Under this approach, one eye is designated as the “near vision” eye, while the other eye is designated as the “distance vision” eye. The defendant determined that, because the plaintiffs myopia was worse in his left eye, his left eye would become the plaintiffs near vision eye while his right eye would become the distance vision eye.
Approximately one week later, on May 21, 1993, the defendant performed the RK procedure on the plaintiffs left eye. Postoperative examinations in May, July and August of that year revealed that the plaintiffs uncorrected near vision in that eye had improved to 20/40. A subsequent examination in September, 1993, revealed that this improvement had regressed, however, possibly as a result of the healing process. In addition, the plaintiffs left eye vision had become distorted, and he experienced a glare effect that impeded his ability to drive.
The defendant examined the plaintiff eight times between September, 1993, and September, 1994. During this time, the plaintiffs corrected vision in his left eye ranged from 20/25 to 20/80. On March 20, 1995, an optometrist in the defendant’s office reported that the plaintiffs left eye vision was “stable.” Four days later, however, the plaintiff told the defendant that both the near and distance vision in his left eye was distorted. The defendant fitted the plaintiff with reading glasses. The defendant continued to treat the plaintiff through the end of 1995. As a result of his dissatisfaction with the result of his surgeries, the plaintiff consulted with two other ophthalmologists, and thereafter terminated his treatment with the defendant. The defendant refunded the plaintiffs prepayment, with interest, for the surgery that never was performed on the plaintiffs right eye. Additional facts will be provided as necessary.
The plaintiff brought this action against the defendant seeking damages for the impairment to his vision. The plaintiff subsequently withdrew five of the eight counts of his revised complaint. The remaining counts alleged: (1) medical malpractice and lack of informed consent; (2) breach of contract; and (3) a violation of CUTPA. Specifically, the medical malpractice claim was predicated on the representations allegedly made by the defendant regarding the results that the plaintiff could expect and the defendant’s alleged misdiagnosis of the plaintiffs suitability for RK.
The plaintiff subsequently appealed to the Appellate Court, challenging, inter alia, the trial court’s judgment based on the granting of directed verdicts on the breach of contract and CUTPA claims.
As a preliminary matter, we note that this appeal is before us pursuant to the granting of a directed verdict. The standards for appellate review of a directed verdict are well settled. “Directed verdicts are not favored. ... A trial court should direct a verdict only when a jury could not reasonably and legally have reached any other conclusion. ... In reviewing the trial court’s decision to direct a verdict in favor of a defendant we must consider the evidence in the light most favorable to the plaintiff.” (Citations omitted; internal quotation marks omitted.) Godwin v. Danbury Eye Physicians & Surgeons, P.C.,
I
We first consider the defendant’s claim that the Appellate Court improperly reversed the judgment of the trial court granting a directed verdict for the defendant on the breach of contract claim. Specifically, the defendant contends that the plaintiff is not entitled to a new trial on the issue of breach of an implied in fact contract because the plaintiff waived that theory by not pursuing it at trial. The plaintiff contends that he tried his case on neither an express nor implied contract theory, but merely as a breach of contract.
“Whether [a] contract is styled express or implied involves no difference in legal effect, but lies merely in the mode of manifesting assent.” (Internal quotation marks omitted.) Boland v. Catalano,
The record reflects that the plaintiff tried his breach of contract claim under an express contract theory. The plaintiffs revised complaint specifically alleged that the defendant had “guaranteed to [the plaintiff] that the result would be 20/20 right uncorrected and 20/50 left uncorrected.” The plaintiff further alleged that the “difficulties and effects [from the surgeries] are the result of [the defendant’s] breach of his contractual promise, guarantee or warranty to correct [the plaintiffs] vision to 20/20 uncorrected in his right eye and 20/50 uncorrected in his left eye.” At trial, the plaintiff testified that the defendant had represented that he could improve the plaintiffs uncorrected vision to 20/40 or 20/50 in the left eye and 20/20 in the right eye.
Moreover, the defendant’s motion for a directed verdict on the breach of contract claim was based on his contention that the evidence was insufficient to support the finding of an “expressed promise,” thereby evincing that the defendant understood the claim as one of
It equally is clear that the plaintiff did not pursue an implied contract theory at trial.
Our law is well settled that a party “may not try its case on one theory and appeal on another.” Mellon v. Century Cable Management Corp.,
The plaintiffs breach of contract claim was neither tried nor decided in the trial court under an implied
II
We turn next to the plaintiffs claim that the Appellate Court improperly affirmed the portion of the trial court’s judgment directing a verdict for the defendant on the CUTPA claim. The plaintiff claims that the evidence presented at trial pertained to an entrepreneurial aspect of the defendant’s medical practice, under Haynes v. Yale-New Haven Hospital, supra,
We previously have concluded that, although physicians and other health care providers are subject to CUTPA, they may be hable only for “unfair, unconscionable, or deceptive methods, acts, or practices in the conduct of the entrepreneurial, commercial, or business aspect” of the practice of medicine. (Internal quotation marks omitted.) Id., 37, quoting Nelson v. Ho, 222 Mich.
“[T]he touchstone for a legally sufficient CUTPA claim against a health care provider is an allegation that an entrepreneurial or business aspect of the provision of services is implicated, aside from medical competence or aside from medical malpractice based on the adequacy of staffing, training, equipment or support personnel. Medical malpractice claims recast as CUTPA claims cannot form the basis for a CUTPA violation. To hold otherwise would transform every claim for medical malpractice into a CUTPA claim. Accordingly, within this framework, we must review the plaintiffs allegations of CUTPA violations and look to the underlying nature of the claim to determine whether it is really a medical malpractice claim recast as a CUTPA claim.” Haynes v. Yale-New Haven Hospital, supra,
In Haynes, this court addressed a CUTPA claim in the context of a medical malpractice action against a hospital. The plaintiffs decedent had died while undergoing emergency surgery at Yale-New Haven Hospital (Yale-New Haven). Id., 20. The plaintiff thereafter had brought an action for damages against Yale-New Haven claiming medical malpractice and a violation of CUTPA. The gravamen of the plaintiffs CUTPA claim was that Yale-New Haven had committed an unfair trade practice in deceptively holding itself out as a major trauma center. Id., 21. Although Yale-New Haven actually was certi
In the present case, the defendant presented the plaintiff with informational materials, including a brochure that described the defendant as “one of the country’s leading doctors in his field.”
Moreover, the defendant made representations, within the course of treatment, that implicate the doctrine of informed consent. Informed consent requires a physician “to provide the patient with the information which a reasonable patient would have found material for making a decision whether to embark upon a contemplated course of therapy.”
Nevertheless, the plaintiff contends that the defendant violated CUTPA through “aggressive” marketing techniques aimed at transforming the defendant’s medical practice into a “profit center.”
The judgment of the Appellate Court is affirmed in part and reversed in part, and the case is remanded to that court with direction to affirm the judgment of the trial court.
In this opinion the other justices concurred.
Notes
We granted the defendant’s petition for certification to appeal, limited to the following issue: “Did the Appellate Court properly conclude that the plaintiff was entitled to a new trial on an implied contract theory?” Janusauskas v. Fichman,
Although this case was tried to a jury, the issues on appeal center on the trial court’s granting of a directed verdict. “In reviewing the trial court’s
The quiz included the following true/false statements: “RK surgery is a COMPLETELY safe surgical procedure and is NOT subject to risk associated with other types of surgery.” The correct answer is “False.”
“During stabilization the quality of my vision may vary from morning to night and day to day.” The correct answer is “True.”
“At night I will probably experience a starburst like effect when looking at lights.” The correct answer is “True.”
“I could experience significant changes in vision for three or more months after the surgery.” The correct answer is “True.”
“The information I’ve received contained a COMPLETE list of complications and side effects that could occur with RK surgery.” The correct answer is “False.”
The consent form also stated the potential complications of the RK procedure, including, but not limited to: impaired vision; blindness; a permanent increase in sensitivity to light, glare or variation in vision; and “starburst like images around lights . . .
The plaintiff also claimed that the trial court improperly had: (1) denied him his right to cross-examine the defendant’s expert witness; and (2) charged the jury on the law of negligence and informed consent. Janusauskas v. Fichman,
We feel constrained to note that the appendix accompanying the plaintiffs brief contains a summary paraphrasing trial testimony, and that the plaintiff cites to this summaiy throughout his brief. Although Practice Book § 67-8 authorizes the use of an appendix “to excerpt lengthy exhibits or quotations from the transcripts,” nothing in the rules of practice authorizes a paraphrased summary of testimony at trial. A party may paraphrase portions of the trial transcript only within the confines of the party’s brief. Accordingly, we shall disregard those portions of the plaintiffs appendix that do not conform to the guidelines set forth in the rules of practice. See Practice Book § 60-2 (reviewing court may, “on its own motion or upon motion of any party ... [3] order improper matter stricken from the record or from a brief or appendix”).
We previously have not addressed the issue of whether an implied in fact contract claim can arise against a physician with respect to medical treatment. Cf. Toppino v. Herhahn,
On cross-examination, the plaintiff admitted that the defendant never had promised or guaranteed that the plaintiffs vision would improve to any specific level on an eye chart. The plaintiff also admitted that the defendant never had used the words “guarantee” or “warranty.” Rather, the plaintiff testified that the defendant had discussed the RK procedure with such confidence that the plaintiff understood his words as a promise.
Nevertheless, we recognize that there was an express contract between the parties, albeit not the one that the plaintiff sought to prove at trial. The parties expressly contracted for the defendant to perform the RK procedure on the plaintiff for a fee. This express contract was predicated partly on the consent form signed by the plaintiff, which specifically provided that “[t]he results of surgery cannot be guaranteed.” Where there is a controlling express contract, the parties will be bound by that contract to the exclusion of inconsistent implied contract obligations. H. B. Toms Tree Surgery, Inc. v. Brant,
“[I]n determining whether a practice violates CUTPA we have adopted the criteria set out ... by the federal trade commission for determining when a practice is unfair: (1) [W]hether the practice, without necessarily having been previously considered unlawful, offends public policy as it has been established by statutes, the common law, or otherwise—in other words, it is within at least the penumbra of some common law, statutory, or other established concept of unfairness; (2) whether it is immoral, unethical, oppressive, or unscrupulous; [or] (3) whether it causes substantial injury to consumers, [competitors or other businesspersons]. . . . All three criteria do not need to be satisfied to support a finding of [a violation of CUTPA]. ” (Internal quotation marks omitted.) Macomber v. Travelers Property & Casualty Corp.,
Although the plaintiff claims in his brief to this court that he read this brochure during a visit to the defendant’s office, the evidence is unclear as to when or if the plaintiff actually did read the brochure. The defendant testified that he had created the brochure six months after performing the RK procedure on the plaintiff.
“[I]nformed consent involves four specific factors: (1) the nature of the procedure; (2) the risks and hazards of the procedure; (3) the alternatives to the procedure; and (4) the anticipated benefits of the procedure.” Alswanger v. Smego,
The plaintiff also contends in his brief, along a similar vein, that “a doctor’s actions are entrepreneurial if undertaken in order to gain patients or to increase profits.” We previously have stated, however, that with respect to the practice of law, “[m]any decisions made by attorneys eventually involve personal profit as a factor, but are not considered part of the entrepreneurial aspect of practicing law.” Suffield Development Associates Ltd. Partnership v. National Loan Investors, L.P.,
