Baldwin v. Knight

• Decision Date: 07 August 1978
• Citation: 569 S.W.2d 450
• Parties: Claude BALDWIN, Petitioner, v. Dr. Bart KNIGHT and Dr. Lee Myers, Respondents.
• Court: Tennessee Supreme Court

Page 450

569 S.W.2d 450

Claude BALDWIN, Petitioner, v. Dr. Bart KNIGHT and Dr. Lee Myers, Respondents.

Supreme Court of Tennessee.

Aug. 7, 1978.

R. Jerome Shepherd, Colloms, Banks & Shepherd, Cleveland, for petitioner.

William C. Carriger, Strang, Fletcher, Carriger, Walker, Hodge & Smith, Chattanooga, Mayo L. Mashburn, Eddie L. Headrick, Bell, Painter, McMurray, Callaway, Brown & Mashburn, Cleveland, for respondents.

OPINION

FONES, Justice.

This is a medical malpractice case. In directing a verdict in favor of both doctors at the close of the plaintiff's proof, the trial judge held that (1) the formal statement of the Medical Malpractice Review Board (MMRB) was admissible under T.C.A. § 23-3409, but that it could not be used to provide the expert testimony required by T.C.A. § 23-3414(b) to support the three elements of a plaintiff's prima facie case required by paragraph (a) of that section; and (2) that the testimony of the three doctors called by the plaintiff failed to establish the elements of a malpractice case as required by T.C.A. § 23-3414(a). The Court of Appeals affirmed.

We granted certiorari and we are of the opinion that the plaintiff's proof established a prima facie case and that error was committed in granting a directed verdict.

On September 18, 1975, plaintiff, 79-year-old Claude Baldwin, was struck in the calf of his right leg by a piece of wire which had been run over by the lawnmower he was using. Plaintiff was taken to the emergency room of Bradley Memorial Hospital, where he was initially interviewed by a nurse, who wrote on the admitting form that "(t)he patient has a puncture type wound obtained when mowing grass from a broken bottle." Plaintiff was then examined by defendant Dr. Bart Knight, who read the history taken by the nurse, diagnosed the wound as a simple three-quarter-inch laceration, cleaned it, and sutured it. Doctor Knight then released plaintiff, telling him to stay off the leg, keep it clean and dry, and to return to the emergency room or to his private physician if he had problems. Doctor Knight did not x-ray the wound.

The next day, plaintiff returned to the emergency room complaining about the pain in his leg. On this occasion, he was examined by Dr. Lee Myers, who diagnosed plaintiff's condition as cellulitis, prescribed various home treatments for this condition, and released plaintiff. Doctor Myers did not x-ray the wound.

On September 21, plaintiff returned to the emergency room again, and was seen by his personal physician, Dr. Jack Free. Doctor Free x-rayed the wound and discovered a piece of wire slightly over one inch long inside, which he removed.

Plaintiff sued Drs. Knight and Myers, alleging damages resulting from their failure to x-ray his wound, and the claim was referred to the MMRB in accordance with T.C.A. § 23-3403. After a hearing, the MMRB found the claim against Dr. Myers to be without merit; it found the claim against Dr. Knight to be with merit, and made the following formal statement required by T.C.A. § 23-3409:

"The standard of care deemed applicable by the Board is that (1) the physician should obtain a history of how the wound occurred, (2) the physician should inspect the wound, and (3) if the probability of a foreign body exists as being determined from either the history and/or inspection of the wound, appropriate x-rays should be taken.

"CONCLUSION: In the Board's opinion, a proper history was not obtained and with a proper history under the standard of care in this community the Board feels x-rays should have been obtained."

The parties did not settle the claims, and plaintiff proceeded to trial against both doctors.

Plaintiff's assignments of error raise these questions: (1) can the formal statement of the MMRB be used as a substitute for expert testimony; (2) what use, if any, can be made of the formal statement of the MMRB in the examination or cross-examination of experts; and (3) did the Court of Appeals err in sustaining the trial judge's decree directing a verdict for defendants at the conclusion of plaintiff's proof.

I.

This Court is confronted, for the first time, with a Legislatively mandated rule of evidence directing the admissibility of the formal statement of the MMRBs, "as an exception to the hearsay rule." The statute provides as follows:

23-3409. Hearing Reports Board members barred from trial Liability of board. The hearing shall be informal and without a stenographic record. No statement nor any expression of opinion made in the course of the hearing shall be admissible in evidence either as an admission or otherwise in any trial of the action. The board shall prepare a formal statement of its recommendations. If a minority number of the board members do not agree with the statement and recommendations of the majority, a minority statement may be prepared which shall be identified as such.

The formal statement of the board and the minority statement, if any, shall be admissible at a subsequent trial as an exception to the hearsay rule. The formal statement of recommendations of the board or the minority statement shall include, but not be limited to, (1) the standard of conduct applied; (2) the alleged deviation from such standard; and (3) findings and conclusions.

No board member shall participate in the trial either as counsel or witness. Board members shall be immune from civil suit as a result of actions or omissions committed pursuant to duties described in the chapter. Sections 4-507 4-527 shall not apply to the board established by this chapter or the proceedings thereof. (Acts 1975, ch. 299, § 9; 1976 (Adj.S.), ch. 759, § 10.)

This statute marks a radical departure from the rules of evidence applicable to all other types of cases. It dispenses with the traditional right of cross-examination and confrontation. It is likely to be of greater benefit to defendants, when favorable to them, than to plaintiffs, when favorable to that class of litigants, creating a possible imbalance between classes of litigants.

However, we are not authorized to strike down the statute because we consider it unwise or inequitable, only if it violates constitutional requirements or deprives any person of his constitutional rights. See State v. Yardley, 95 Tenn. 546, 565, 32 S.W. 481 (1895); 29 Am.Jur.2d Evidence § 44 (1967). No party to this litigation questions the admissibility of the MMRB's formal statement offered as evidence in this case.

However, plaintiff has insisted at all stages of this litigation that the MMRB's statement should be accepted as evidence establishing a prima facie case against defendant Knight, because it was a unanimous decision, two members of the Board were physicians, and the statement embraces the elements of proof required of a plaintiff by T.C.A. § 23-3414(a).

We think the answer to that contention is to be found by considering T.C.A. § 23-3414 In pari materia with T.C.A. § 23-3409, in light of the avowed legislative purpose in establishing MMRB, to wit, "to facilitate the disposition of all medical malpractice actions." T.C.A. § 23-3403(a).

T.C.A. § 23-3414 provides as follows:

23-3414. Claimant's burden Expert testimony Presumption of negligence Jury instructions. (a) In a malpractice action, the claimant shall have the burden of proving by evidence as provided by subsection (b):

(1) the recognized standard of acceptable professional practice in the profession and the specialty thereof, if any, that the defendant practices in the community in which he practices or in a similar community at the time the alleged injury or wrongful action occurred;

(2) that the defendant acted with less than or failed to act with ordinary and reasonable care in accordance with such standard; and

(3) as a proximate result of the defendant's negligent act or omission, the plaintiff suffered injuries which would not otherwise have occurred.

(b) No person in a health care profession requiring licensure under the laws of this state shall be competent to testify in any court of law to establish the facts required to be established by subsection (a) unless he was licensed to practice in the state or a contiguous bordering state a profession or specialty which would make his expert testimony relevant to the issues in the case and had practiced this profession or specialty in one of these states during the year preceding the date that the alleged injury or wrongful act occurred. The court may waive this subsection when it determines that the appropriate witnesses otherwise would not be available.

(c) In a malpractice action as described in subsection (a) of this section there shall be no presumption of negligence on the part of the defendant. Provided, however, there shall be a rebuttable presumption that the defendant was negligent where it is shown by the proof that the instrumentality causing injury was in the defendant's (or defendants') exclusive control and that the accident or injury was one which ordinarily doesn't occur in the absence of negligence.

(d) In a malpractice action as described in subsection (a) of this section, the jury shall be instructed that the claimant has the burden of proving, by a preponderance of the evidence, the negligence of the defendant. The jury shall be further instructed that injury alone does not raise a presumption of the defendant's negligence. (Acts 1975, ch. 299, § 14; 1976 (Adj.S.), ch. 759, § 15.)

It is readily apparent that the foregoing section of the Act, in paragraph (a), briefly states the requirements of existing case law governing the plaintiff's burden of proof in a medical malpractice action and adds, in paragraph (b) to the present case law requirements relating to expert testimony, (1) the necessity that a medical expert be licensed in this state or a contiguous bordering state; (2) the relevant specialty requirement; and (3) judicial discretion to waive those requirements upon a showing of the unavailability of such witnesses.

We think the...