Manning v. Bellafiore

• Decision Date: 24 June 2016
• Docket Number: No. 2013–14–Appeal , No. 2013–16–Appeal.,2013–14–Appeal
• Parties: Kathryn MANNING et al. v. Peter J. BELLAFIORE, M.D., et al.
• Court: Rhode Island Supreme Court

139 A.3d 505

Kathryn MANNING et al.

v.Peter J. BELLAFIORE, M.D., et al.

No. 2013–14–Appeal

No. 2013–16–Appeal.

Supreme Court of Rhode Island.

June 24, 2016.

Miriam Weizenbaum, Esq., Amato A. DeLuca, Esq., Shad Miller, Esq., Candace Brown Casey, Esq., Providence, for Plaintiff.

Lauren E. Jones, Esq., Eric F. Eisenberg, Pro Hac Vice, Adam M. Ramos, Esq., Providence, Defendant.

Present: SUTTELL, C.J., GOLDBERG, FLAHERTY, and ROBINSON, JJ.

OPINION

Chief Justice SUTTELL, for the Court.

This case originated as a negligence and wrongful death action brought by Kathryn Manning (Mrs. Manning or plaintiff), individually and as administratrix of the estate of Michael Manning (Manning) and on behalf of her four minor children, against Peter J. Bellafiore, M.D. (Dr. Bellafiore or defendant), but has since evolved into extensive litigation regarding sanctions.¹ The trial justice sanctioned both Dr. Bellafiore and the law firm that represented him at trial, White & Kelly, P.C. (WCK),² for their failure to make pretrial disclosures. The latter parties each appealed from the order awarding sanctions and the matters were consolidated by this Court. The overriding issue to be decided in both appeals is whether the trial justice properly imposed sanctions. For the reasons set forth herein, we affirm in part and reverse in part the judgment of the Superior Court.

IFacts and Procedural History

AOverview

This Court is familiar with the facts in this case as set forth in Manning v. Bellafiore, 991 A.2d 399 (R.I.2010) (Manning I ). To briefly summarize, on March 4, 1998, Manning was taken to the emergency care unit at South County Hospital (SCH) after he lost consciousness and fell at his home. Manning was admitted to SCH and, over the course of four days, Dr. Bellafiore was the treating neurologist responsible for Manning's care. During this time, Dr. Bellafiore also consulted with Donald M. McNiece, M.D. (Dr. McNiece), Manning's primary-care physician. Doctor Bellafiore established a differential diagnosis³ for Manning of complex migraine, aneurysm, tumor, and stroke, and he recommended that Manning undergo a magnetic resonance imaging (MRI)/ magnetic resonance angiography (MRA) to determine whether Manning was suffering a stroke and, if so, to locate the blockage of blood flow to his brain.⁴

On the first day he was admitted to SCH (March 4 or day 1), Manning attempted to undergo an MRI/MRA on two occasions. The first attempt was unsuccessful, however, because he had a claustrophobic reaction. Doctor Bellafiore prescribed the antianxiety medication Ativan and the antinausea medication Compazine for Manning, but a second attempt to undergo the MRI/MRA was also unsuccessful. The next day (March 5 or day 2), Dr. Bellafiore contacted the MRI Network of Rhode Island to set up an “open architecture MRI” for Manning in the hope of mitigating Manning's claustrophobia. The MRI Network of Rhode Island directed Dr. Bellafiore to the open MRI machine at Rhode Island Hospital (RIH). However, Dr. Bellafiore learned that the open MRI machine at RIH was under repair and would not be available.

On March 6 (day 3), a computerized tomography (CT) scan, conducted and ordered by Dr. Bellafiore after Manning complained of a headache, revealed that Manning had indeed suffered a stroke on March 4. Doctor Bellafiore again attempted to schedule an open MRI at RIH; however, he was informed that the machine was still down for repair but that it would possibly be fixed by the end of the day. On March 7 (day 4), Dr. Bellafiore spoke with a radiology fellow at RIH, who opined that an open MRI machine would not give as good an image as a closed one. At that juncture, the decision was made for Manning to try the closed MRI machine under general anesthesia on March 9, the next day the MRI machine would be available at SCH.⁵ Tragically, however, Manning suffered a second stroke on March 7. He was airlifted to Massachusetts General Hospital, where a blood clot led to steadied loss of brain function. Manning's life support was withdrawn on March 9 and he passed away.

On January 6, 2000, plaintiff filed a negligence and wrongful death suit against Drs. Bellafiore and McNiece, as well as against SCH. As the case progressed, an important component of plaintiff's malpractice claim against Dr. Bellafiore was his failure to conduct the MRI during the first three days of Manning's hospitalization and his failure to present Manning with alternatives to obtaining the MRI in light of Manning's claustrophobia. One of plaintiff's main contentions was that Manning's death could have been avoided if defendants had administered or obtained an MRI test immediately after Manning's admission to the hospital, either at SCH or by transferring him to a different facility.

BDiscovery

The parties engaged in discovery from the commencement of the action in January 2000 to January 2004, when the case went to trial. During discovery, there was a great deal of evidence and testimony relating to Dr. Bellafiore's treatment of Manning. Specifically, the evidence presented focused on Dr. Bellafiore's attempts to have Manning undergo an MRI and discussions regarding sedation to assist him in undergoing the procedure.

In plaintiff's interrogatories, plaintiff asked Dr. Bellafiore to “state to the best of [his] recollection any and all conversations [he] had with any person concerning the care and/or treatment of * * * Manning from March 4, 1998 to date * * *.” The plaintiff asked Dr. Bellafiore to provide information regarding “the person with whom [he] had each conversation,” “the time and date of each conversation,” and “the content of each conversation.” (Interrogatory No. 18.) Doctor Bellafiore raised several objections but ultimately directed plaintiff to his answer to interrogatory No. 7 and attested that “[he] spoke with [Manning] and [Mrs. Manning] during [Manning's] admission regarding his treatment,” without specifying the content of those conversations. The answer to interrogatory No. 7 also did not specify any conversation Dr. Bellafiore had with Manning, instead, it provided a brief overview of Manning's hospital stay. It does not appear from the record that plaintiff sought to compel more responsive answers to interrogatories No. 7 or 18. However, following Dr. Bellafiore's deposition, plaintiff filed a motion to compel Dr. Bellafiore to file a more responsive answer to plaintiff's interrogatory No. 16, which asked for all facts relating to defendant's assumption of the risk defense. In Dr. Bellafiore's supplemental answer, he averred that in

“the event that plaintiff asserts that an MRI would have changed * * * Manning's outcome in this case, * * * Manning refused to be sedated to undergo a ‘closed’ MRI, when the ‘open’ MRI at [RIH] was inoperable, despite being repeatedly informed that he might have a life threatening condition, which might be detectable by MRI.”⁶

During his deposition, Dr. Bellafiore was questioned regarding the sequence of events, including his conversations with Manning regarding the MRI and sedation. When asked what he gives to patients experiencing claustrophobia to make them capable of completing an MRI, Dr. Bellafiore replied, “I use Ativan.” He further explained that the amount of Ativan is “dependant [sic ] on [the patients'] size, their weight but also the effect that the medication has on them.” The questioning then proceeded to the situation where sedation equipment was brought into the MRI suite; Dr. Bellafiore testified that he was aware of that possibility, and discussed his experiences. When asked if there was “any reason why * * * Manning couldn't have been sedated with the assistance of anesthesiology on March 4th in order to accomplish the MRI,” Dr. Bellafiore answered yes, “[b]ecause it's a dangerous procedure to give someone general anesthesia or anesthetic who is having a potential stroke.”

Doctor Bellafiore testified that he had not called the anesthesia department to ask what kind of sedation could be performed on Manning “because it's dangerous or it would put him at risk,” which Dr. Bellafiore did not wish to do “unless [they] couldn't get the study in the open [MRI] machine.” He was asked what options there were for sedation in a closed machine at RIH, to which he responded that he had assumed they were the same as at SCH: “There are a variety of things you can do including Ativan or other benzodiazepines, there are antipsychotics that they may use, the general things an anesthesiologist would do.” At this point, Dr. Bellafiore explained that sedation posed a risk to Manning because “it [could] alter blood pressure, respiratory function, it also [could] affect the neurologic exam making it difficult to assess the patient for integral changes. It [could] cause them to aspirate, it [could] have technical/mechanical difficulties, all the risks that you [would] have with general anesthesia.”

Doctor Bellafiore testified that on day 1 he told the Mannings “that it would be difficult to treat [Manning] unless [they] had [the MRI and MRA] done.” He recalled that he asked Manning on day 2 whether Manning would undergo an MRI if he had more sedation. When asked what he told Manning about sedation, Dr. Bellafiore testified that “[he] said [they] could try giving [Manning] more Ativan to make him a little sleepier to see if [Manning] could tolerate the test,” however, he testified that Manning “said there was no way that he wanted to try that. He just couldn't do it he said. Those were his words. He just [could not] do it. And he apologized. He felt bad about it but he said he didn't want to try.” When asked if it was Dr. Bellafiore's “testimony that [Manning] refused to attempt this test after [he] told [Manning] that he had a life[-]threatening condition * * *,” Dr. Bellafiore stated “[a]bsolutely.” Doctor Bellafiore also testified that he spoke to Dr. McNiece “[e]ssentially [about] * * * Manning * * * refusing the MRI * * * even with more sedation in the closed...