Weaver v. McKnight

• Decision Date: 02 September 2014
• Docket Number: No. 18974.,18974.
• Citation: 313 Conn. 393,97 A.3d 920
• Court: Connecticut Supreme Court
• Parties: Dorothy WEAVER, Coadministrator (Estate of Demarius Douglas Weaver), et al. v. Craig McKNIGHT et al.

313 Conn. 393

97 A.3d 920

Dorothy WEAVER, Coadministrator (Estate of Demarius Douglas Weaver), et al.

v.Craig McKNIGHT et al.

No. 18974.

Supreme Court of Connecticut.

Argued Jan. 16, 2014.

Decided Sept. 2, 2014.

D. Lincoln Woodard, for the appellants (plaintiffs).

Laura Pascale Zaino, Hartford, with whom, on the brief, was Thomas W. Boyce, Jr., New London, for the appellees (defendant Henry Amdur et al.).

ROGERS, C.J., and PALMER, ZARELLA, EVELEIGH, McDONALD, ESPINOSA and VERTEFEUILLE, Js.

ROGERS, C.J.

This appeal arises from the stillbirth of Demarius Douglas Weaver (decedent). The plaintiffs, Dorothy Weaver and Fred Weaver, as coadministrators of the estate of the decedent, and Dorothy Weaver (Weaver), individually, brought an action against the defendants Henry Amdur and Thames Gynecological Group, P.C.,¹ claiming, among other things, that Amdur's negligent failure to diagnose and treat Weaver's gestational diabetes caused the decedent's stillbirth, a claim the defendants dispute.

The dispositive issue in this appeal is whether the trial court properly precluded two of the plaintiffs' expert witnesses, physicians board certified in obstetrics and gynecology, from testifying to their opinion that Weaver's untreated gestational diabetes caused the decedent's stillbirth. The trial court precluded the experts' respective opinions on the grounds that neither witness had any training or experience in determining cause of death and were not board certified in pathology. The preclusion of these causation opinions led to a directed verdict and judgment in favor of the defendants. The plaintiffs appealed from the trial court's judgment to the Appellate Court, which affirmed the judgment. Weaver v. McKnight, 134 Conn.App. 652, 658, 40 A.3d 786 (2012). We granted the plaintiffs' petition for certification, limited to the following question: “Did the Appellate Court properly conclude that the trial court did not abuse its discretion in precluding testimony by the plaintiffs' two experts, both of whom are board certified in obstetrics and gynecology?” Weaver v. McKnight, 305 Conn. 907, 44 A.3d 183 (2012).

We conclude that the trial court's decision to preclude the expert testimony contradicted the facts in the record and applicable law, thus amounting to an abuse of discretion. Accordingly, we reverse the Appellate Court's judgment with direction to reverse the trial court's judgment and to remand the case for a new trial.

Furthermore, we also review certain evidentiary rulings of the trial court that are likely to arise again on remand; see Practice Book § 84–11; namely, whether the trial court properly: (1) precluded a treating physician from testifying about his opinion that Weaver had developed gestational diabetes in the later stages of her pregnancy; (2) precluded a treating nurse from testifying to her suspicion that Weaver had gestational diabetes and her concerns about the treatment given by Amdur; and (3) permitted the defendants to cross-examine one of the plaintiffs' expert witnesses about a censure issued to him by a voluntary membership professional organization. We conclude that the trial court abused its discretion in precluding the opinion from the treating physician and in allowing the cross-examination about the censure, but we sustain the trial court's ruling precluding certain testimony of the treating nurse.

I

We begin with the relevant facts in the record. Weaver, the decedent's mother, received prenatal treatment from the defendants at Lawrence and Memorial Hospital (hospital). Five days before the stillbirth of the decedent, Weaver went in for a weekly visit and was seen by Nancy Hess, an advanced practice registered nurse. Hess detected a fetal heart rate and fetal movement. Weaver also underwentan ultrasound examination to take measurements of the fetus' size and weight. The next day, four days before the stillbirth, Hess reviewed the ultrasound results. The ultrasound showed a large fetus weighing more than eleven pounds. Because of the size of the fetus, and Hess' knowledge of test results showing that Weaver had elevated blood sugar levels, Hess was concerned that Weaver might have uncontrolled high blood sugar levels as a result of gestational diabetes. Hess contacted the treating physician, Amdur, that same day and told him of the fetus' weight, which was larger than expected for his gestational age of approximately thirty-eight weeks. Hess also told Amdur certain facts about Weaver, namely that she was thirty-five years old, she previously had given birth to another child weighing about nine pounds, and she had tested positive for the presence of sugar in her urine during the last three checkups. Amdur determined that the fetus was “macrosomic,” a medical term for a large baby; see Stedman's Medical Dictionary (28th Ed. 2006) p. 1142 (defining “macrosomia” as “[a]bnormally large size of the body”); and told Hess that Weaver should be offered a scheduled cesarean section to deliver the fetus the following week. Amdur did not order any further tests.

Weaver went in for a scheduled cesarean section four days later, on Tuesday, May 16, 2006. The admitting nurse and an attending physician, Craig McKnight, however, were unable to detect a fetal heart rate during a preoperative ultrasound. McKnight confirmed the result with a radiologist and then informed Weaver of the loss of the baby. McKnight also ordered several tests to help determine the cause of the stillbirth, including tests to analyze Weaver's blood sugar levels. McKnight delivered the decedent by cesarean section. Within one day after the delivery, and after reviewing test results, McKnight formed an opinion that Weaver had gestational diabetes and told Weaver that it appeared that she had developed poor blood sugar control in the later stages of her pregnancy.

A pathologist later performed an autopsy of the decedent and the placenta. The pathologist ruled out several possible causes of the stillbirth, including birth defects and infection, but was unable to determine an anatomic cause of death based on her pathological examination. The pathologist later testified during a deposition that she had no opinion about whether gestational diabetes played a role in the stillbirth. She also testified, however, that she would not have been able to see evidence of poor blood sugar control in an autopsy, and she did not know the mother's or the decedent's blood sugar levels. According to the pathologist, determining whether a mother suffered from poor sugar control is more of “a clinical assessment rather than a pathological assessment.”

The plaintiffs later filed this action against the defendants for the loss of the decedent and harm to Weaver. According to the plaintiffs, Amdur should have known from Weaver's test results and the abnormally large size of the fetus that Weaver suffered from uncontrolled gestational diabetes, which created an increased risk of stillbirth. The plaintiffs principally claimed in their amended complaint that Amdur's failure to diagnose and treat Weaver's gestational diabetes caused the decedent's stillbirth. The defendants disputed the plaintiffs' claims that Weaver had gestational diabetes or that Amdur's actions contributed to the stillbirth.

At trial, the plaintiffs offered the testimony of Russell Jelsema, a physician and board certified obstetrician and gynecologist, to establish the cause of the stillbirth. Jelsema testified that he specializes in maternal-fetal medicine, which focuses on the care of the mother and fetus in the womb, and has been a practicing physician since 1990. He completed a four year residency in obstetrics and gynecology and a two year fellowship specializing in the treatment of women with complicated pregnancies. According to his curriculum vitae, Jelsema has authored more than two dozen publications, including peer reviewed articles, abstracts, and book chapters, principally related to obstetrics and gynecology. He currently maintains his own practice with several hospitals, sees patients on consultation from other physicians, and also teaches medical students and residents. Jelsema testified that approximately 25 percent of his patients have pregnancies complicated by diabetes. Jelsema further testified that he has been involved with the delivery of hundreds of stillborn infants. As part of his practice, he routinely reviews information, including autopsy, laboratory, and clinical reports, to try to determine the cause of the stillbirths and then explains his opinion about the cause to the parents of the stillborn infant.

At trial, the plaintiffs offered Jelsema to opine that Weaver had untreated gestational diabetes and that Amdur's failure to diagnose and treat this condition caused the decedent's stillbirth. Jelsema testified that, in his opinion, Weaver had uncontrolled gestational diabetes, a condition that created an increased risk of a stillbirth. According to Jelsema, when a mother has untreated diabetes, the mother's insufficient insulin levels prevent her body from transferring blood sugar to her cells, leaving an abnormally high level of sugar remaining in the mother's blood. This excess sugar is then transferred to the fetus' blood through the placenta. The fetus, which has normal insulin function, then absorbs an abnormally high amount of blood sugar, causing the fetus to grow unusually large. According to Jelsema, the current understanding in the medical field is that the increased level of blood sugar causes acid to build up in the fetus' veins, which can eventually lead to its death. Jelsema testified that, even in the absence of a pathologist's determination of an anatomical cause of death, he can determine cause of death from gestational diabetes by reviewing the autopsy reports along with information not reviewed by the pathologist, including the mother's clinical and blood sugar reports, and by excluding other possible causes of death. The...