Beeler v. Downey

• Citation: 387 Mass. 609,442 N.E.2d 19
• Parties: Jean M. BEELER, administratrix, v. William S. DOWNEY et al. 1
• Decision Date: 12 November 1982
• Court: United States State Supreme Judicial Court of Massachusetts

Page 19

442 N.E.2d 19

387 Mass. 609

Jean M. BEELER, administratrix, v. William S. DOWNEY et al. ¹

Supreme Judicial Court of Massachusetts,

Bristol.

Argued April 8, 1982.

Decided Nov. 12, 1982.

James B. Krasnoo, Boston, for plaintiff.

John J. McQuade, Boston, for defendants.

Before HENNESSEY, C.J., and WILKINS, LIACOS, ABRAMS, NOLAN and O'CONNOR, JJ.

LIACOS, Justice.

The plaintiff brought this action as administratrix of the estate of her deceased infant daughter. Her complaint alleged that her daughter's death was the result of respiratory suppression and other injuries proximately caused by the negligence of the defendants.

At the medical malpractice tribunal hearing held pursuant to G.L. c. 231, § 60B, the plaintiff submitted an offer of proof consisting of the following: an affidavit by her; a file review prepared for her attorney by a Dr. Baker, whose curriculum vitae was included; abstracts of the birth and death records of her daughter; portions of hospital records, including a report of death; a post mortem report; a provisional anatomical diagnosis; office visit notes prepared by one of the defendants, Dr. Downey; and excerpts from the product information section of the Physician's Desk Reference as to the three drugs prescribed by Dr. Downey for the child.

After a hearing on December 13, 1979, the tribunal determined, in the words of the statute, that "the offer of proof and the evidence, if properly substantiated, is sufficient to raise a legitimate question of liability appropriate for judicial inquiry." Prior to trial, the defendants submitted a motion in limine which sought the exclusion of the "finding" of the tribunal from jury consideration. The trial judge held the statute to be unconstitutional in so far as it required the admission of such "finding" in evidence. Hence, the motion was granted. Trial of the matter resulted in a jury verdict for the defendants.

The plaintiff's subsequent, unsuccessful motion for a new trial was based, in part, on the exclusion of the tribunal "finding." Her notice of appeal incorporates that portion of her motion for a new trial in its sole claim of error. We granted the plaintiff's application for direct appellate review. We conclude that the exclusion from evidence of the determination of the tribunal was not error, but for reasons distinct from those stated by the trial judge. We affirm the judgment.

In "[e]very action for malpractice, error or mistake against a provider of health care," a prospective plaintiff must, shortly after the filing of the defendant's answer, appear before "a tribunal consisting of a single justice of the superior court, a physician licensed to practice medicine in the commonwealth [or a representative of the appropriate field of medicine] ... and an attorney authorized to practice law in the commonwealth." G.L. c. 231, § 60B, inserted by St.1975, c. 362, § 5. Upon being presented with the plaintiff's offer of proof, the tribunal, which is in essence a screening body, is charged with determining whether "the evidence presented if properly substantiated is sufficient to raise a legitimate question of liability appropriate for judicial inquiry or whether the plaintiff's case is merely an unfortunate medical result." ² The fifth paragraph of the statute provides, inter alia, that "[t]he tribunal may upon the application of either party or upon its own decision summon or subpoena any such records or individuals to substantiate or clarify any evidence which has been presented before it and may appoint an impartial and qualified physician or surgeon or other related professional person or expert to conduct any necessary professional or expert examination of the claimant or relevant evidentiary matter and to report or to testify as a witness thereto.... The testimony of said witness and the decision of the tribunal shall be admissible as evidence at a trial."

In most respects, any challenges, constitutionally based or otherwise, to the tribunal procedure for medical malpractice suits were answered in Paro v. Longwood Hosp., 373 Mass. 645, 369 N.E.2d 985 (1977). The question of the admissibility at a subsequent trial of the determination of the tribunal, which is argued before us in this case, was not, however, presented in that case. Id. at 652 n. 9, 656, 369 N.E.2d 985. It is an issue which has been the subject of no small amount of controversy and criticism, since the probative worth of the finding is, on its face, minimal to be sure, while the potential for unfair prejudice arising from its admission is unquestionably great. See Cohen, Medical Malpractice Tribunals, Part II, Problems of Construction with a Proposal for Revision, 62 Mass. L.Q. 105, 107-108 (1977); McLaughlin, A Look at the Massachusetts Malpractice Tribunal System, 3 Am. J.L. & Med. 197, 205 (1977); Note, The Massachusetts Medical Malpractice Statute: A Constitutional Perspective, 11 Suffolk U.L.Rev. 1289, 1307-1308 (1977); Barshak, The President's Page, 19 B.B.J. No. 9 at 3, 4-5 (1975). ³

At the hearing on the motion in limine, the judge accepted the contention of the plaintiff's attorney that the statute does not allow judicial discretion in the admission of the tribunal "finding." The judge apparently assumed that the words "determination" and "decision," found in the first and fifth paragraphs of the statute, refer to a "finding" that no bond was required of plaintiff because the offer before the tribunal was "sufficient to raise a legitimate question of liability appropriate for judicial inquiry." His refusal, nevertheless, to admit the "finding" was based in part on his belief that the admissibility provision of § 60B violates fundamental due process considerations in admitting a decision which is based on evidence not subject to cross-examination at the tribunal hearing. He ruled in addition that the tribunal decision is not evidence of negligence, that it has no probative value on the question, and that it therefore ought not to be presented to the jury.

The defendants, in challenging the validity of the statutory provision, argue that introduction of the tribunal finding violates the jury trial guarantees of the Massachusetts Declaration of Rights because the finding may be based on "suspect evidence introduced at a nonadversarial, unilateral hearing which is not reviewable by the trial court before admission." Admission of such "evidence," they claim, is likely to divert the jury from facts which should rightfully affect their verdict because of the undue deference typically given to a determination made by "professionals." Alternatively, the defendants argue that the word "decision" in the fifth paragraph of the statute does not apply to the tribunal's "determination" (described in the first paragraph) that the evidence presented to it, if properly substantiated, is sufficient "to raise a legitimate question of liability appropriate for judicial inquiry."

We begin with the proposition that it is our duty, if reasonably possible, to interpret statutes in a manner that avoids unnecessary decision of a serious constitutional question. ⁴ Fazio v. Fazio, 375 Mass. 394 405-406, 378 N.E.2d 951 (1978). Commonwealth v. Bartlett, 374 Mass. 744, 748-749, 374 N.E.2d 1203 (1978). Rugg v. Town Clerk of Arlington, 364 Mass. 264, 268, 303 N.E.2d 723 (1973). See also Ashwander v. Tennessee Valley Auth., 297 U.S. 288, 347-348, 56 S.Ct. 466, 483, 80 L.Ed. 688 (1936) (Brandeis, J., concurring). As construed by the judge, the language of G.L. c. 231, § 60B, raises a serious question of constitutional law.

We have held that the introduction of an auditor's report as prima facie evidence at trial does not violate the right to a jury trial in a civil case. Baldassare v. Crown Furniture Co., 349 Mass. 183, 189-190, 207 N.E.2d 268 (1965). Holmes v. Hunt, 122 Mass. 505 (1877). Masters reports are also admissible by virtue of Mass.R.Civ.P. 53(e), as amended, --- Mass. --- (1982). Both such reports are "made after full hearing of both parties." Holmes v. Hunt, supra at 519. And see Lubell v. First Nat'l Stores, Inc., 342 Mass. 161, 163-165, 172 N.E.2d 689 (1961) (decision or finding by District Court for or against plaintiff after a trial is admissible). Similarly, statutes analogous to § 60B, which have been upheld in other jurisdictions, generally provide for a full hearing. See, e.g., Seoane v. Ortho Pharmaceuticals, Inc., 660 F.2d 146, 148-149 (5th Cir.1981); DiAntonio v. Northampton-Accomack Memorial Hosp., 628 F.2d 287, 289-290 (4th Cir.1980); Beatty v. Akron City Hosp., 67 Ohio St.2d 483, 487, 424 N.E.2d 586 (1981).

If we assume the Legislature has mandated admission of the tribunal determination, it could be said that the Legislature has merely provided a means for allowing in evidence matter which would be otherwise inadmissible as hearsay. "The constitutional power of the Legislature to prescribe rules of evidence is well settled," and is often exercised "to change the burden of proof, or to affect the question what shall be deemed prima facie evidence at the trial before the jury." Holmes v. Hunt, supra at 516-517. See 1 J. Wigmore, Evidence § 7 (1940 & Chadbourn rev.ed. 1982). Under this view of the statute, the Legislature would have blocked the application of both the hearsay and opinion evidence rules. At the same time, we would have to assume that, as regards relevance, a balance has been struck by the Legislature in favor of affording at least marginal probative value to the "evidence." See Green v. Richmond, 369 Mass. 47, 59, 337 N.E.2d 691 (1975). McCormick, Evidence § 185, at 437 (2d ed. 1972); Proposed Mass.R.Evid. 401, 402. Were such "evidence" to be admitted and insulated from further comment by either the trial judge or opposing counsel, however, the likelihood of unfair prejudice flowing from this result might well reach constitutional limits. We do not construe the statute to require this result. Lubell v. First Nat'l Stores, Inc., s...