Buck v. St. Clair
| Decision Date | 08 May 1985 |
| Docket Number | No. 15074,15074 |
| Citation | 702 P.2d 781,108 Idaho 743 |
| Parties | Mavis BUCK, Plaintiff-Appellant, v. Duane ST. CLAIR, M.D., and Does I through V, fictitiously named, Defendants-Respondents. |
| Court | Idaho Supreme Court |
Allen Ellis, of Ellis, Brown, Sheils & Steel, Boise, for plaintiff-appellant.
James Lynch, of Imhoff & Lynch, Boise, for defendants-respondents.
The issue presented on appeal is whether the trial court correctly excluded pursuant to I.C. § 6-1013 the testimony of a nationally board-certified out-of-state obstetrician-gynecologist in a medical malpractice case. We hold it was error to exclude this testimony and remand for proceedings consistent with this opinion.
The plaintiff called as a witness Dr. Anton Broms, a nationally board-certified obstetrician-gynecologist from Portland, Oregon, to testify regarding the standard of care and the defendant's negligence. The defendant objected to this witness on the basis of I.C. § 6-1013. The trial court reluctantly allowed the testimony of this out-of-state witness, noting that he thought there was insufficient foundation for this witness to testify. At the close of plaintiff's case the defendant moved for a directed verdict. In ruling on the motion, the district judge reversed his earlier decision allowing Dr. Broms' testimony and ruled the testimony inadmissible because this physician did not have actual knowledge of the applicable community standard for a medical malpractice action under I.C. § 6-1013(c). This section requires that the plaintiff's expert witness
possess professional knowledge and expertise coupled with actual knowledge of the applicable said community standard to which his or her expert opinion testimony is addressed; provided, this section shall not be construed to prohibit or otherwise preclude a competent expert witness who resides elsewhere from adequately familiarizing himself with the standards and practices of (a particular) such area and thereafter giving opinion testimony in such a trial.
The trial court concluded that the Portland physician lacked actual knowledge of the Boise standard because he had not practiced in Boise, had not admitted patients to any Boise hospitals, and had not evaluated any area medical facilities, and was not familiar with any local medical literature. A directed verdict in favor of the defendant was granted.
The ruling by the trial court suggests that the local standard of care for board-certified obstetrician-gynecologists differs from the national standard. We believe that for board-certified specialists, the local standard of care is equivalent to the national standard of care. Our reasons for this decision are simple: board-certified medical specialists are highly-trained individuals who become certified after completing a rigorous training program. Medical schools are accredited by a national team of physicians and administrators. The residency training programs are approved by a single board of specialists, and a physician is certified as a specialist only after passing a nationally administered exam consisting of both oral and written components. The board-certified specialists practicing within the state are the product of nationally designed education programs. The standard of care familiar to any board-certified physician in this state is a national standard of care. We see no reason to believe there is local standard of care which deviates from the national standard of care for board-certified physicians. Our ruling today is limited to board-certified doctors practicing in the same area of specialty. Hence, a board-certified physician can testify only against another board-certified physician practicing in the same area of medicine: surgeons against surgeons; obstetrician-gynecologists against obstetrician-gynecologists, anesthesiologists against anesthesiologists, and so forth. Our holding is to be construed so as to allow a board-certified physician to testify regarding the standard of care only in cases involving other doctors who are also board-certified in the same specialty. The trial court's conclusion that the Portland obstetrician-gynecologist lacked actual knowledge of the local standard of care is incorrect.
Our holding today is limited to those physicians who hold themselves out as board-certified specialists. In so doing, we are cognizant of the intent and purpose of the passage of I.C. §§ 6-1012 and 6-1013. Section 6-1012 addresses the proof of community standard of health care practice in malpractice cases, and provides in part:
Such individual providers of health care shall be judged in such cases in comparison with similarly trained and qualified providers of the same class in the same community, taking into account his or her training, experience, and fields of medical specialization, if any.
We believe the legislature enacted the above language in recognition of the very problem we are addressing today: judging health care providers in comparison to other providers with the same background and training. This section specifically lists fields of medical specialization as a factor to be considered in the proof of community standard. By enacting this section we believe the legislature, in its wisdom, recognized that the standard of care for nationally board-certified specialists was the same throughout our nation and that one board-certified specialist could testify regarding the standard of care against another nationally board-certified specialist practicing in the same area of medicine.
We are also mindful of the other elements set forth in I.C. § 6-1012 which require the plaintiff to prove "by a preponderance of all the competent evidence, that such defendant then and there negligently failed to meet the applicable standard of health care practice of the community in which such care allegedly was or should have been provided." Thus, there must be evidence not only on the standard of care, but also on the technology and medical resources available in a particular community. Our ruling today does not impair the burden of proof for the plaintiff. It merely acknowledges that the legislature intended that nationally board-certified specialists can testify regarding the standard of care against other nationally board-certified specialists practicing in the same area of medicine. The residence of a board-certified physician should not be a basis for precluding his or her testimony.
Moreover, the legislature was concerned with the disparity between urban and rural areas in terms of availability of medical facilities, education programs, and other specialists when it passed I.C. §§ 6-1012 and 6-1013. And rightfully so for general practitioners and other physicians who do not hold themselves out as board-certified specialists. Our holding today does not impair the protections inherent in I.C. §§ 6-1012 and 6-1013 for these types of physicians. For a general practitioner it is inherently unfair to compare him or her against a board-certified specialist or against a general practitioner who may have available in another area highly sophisticated equipment and technology. However, for those doctors who have elected to specialize, who profess to be specially trained to practice in a particular area of medicine, and who hold themselves out to the public as nationally board-certified specialists, there can be no doubt that any disparity between rural and urban areas has been erased by the standardized training these doctors receive. See Brune v. Belinkoff, 354 Mass. 102, 235 N.E.2d 793 (1968); Ardoline v. Keegan, 140 Conn. 552, 102 A.2d 352 (1954); McGulpin v. Bessmer, 241 Iowa 1119, 43 N.W.2d 121 (1950).
I.C. § 6-1013 also provides that a competent expert witness who resides elsewhere can testify if he has adequately familiarized himself with the local standard of care. The trial court ruled that Dr. Broms had not adequately familiarized himself with the local standard of care for Boise. We believe this was incorrect. By virtue of their training, board-certified specialists are familiar with the local standard of care which is equivalent to the national standard of care. In order to meet the requirement of I.C. § 6-1013(c) showing adequate familiarization a specialist must demonstrate two elements: first, that he is board-certified in the same specialty as that of the defendant-physician; this demonstrates knowledge of the appropriate standard of care of board-certified physicians practicing in the specialty in question. Second, an out-of-the-area doctor must inquire of the local standard in order to insure there are no local deviations from the national standard under which the defendant-physician and witness-physician were trained. In the instant case, Dr. Broms testified that he was a board-certified obstetrician-gynecologist, that he was familiar with the standard of care through regular reading of regional and national medical journals, and that he was familiar with the local standard of care. Dr. Broms obtained his familiarity with the local standard through his specialty training combined with his questioning of Dr. Roberge, a Caldwell board-certified obstetrician-gynecologist who told Dr. Broms that the local standard of care was equivalent to the national standard of care. At that point Dr. Broms possessed "actual knowledge of the applicable said community standard" as required by I.C. § 6-1013(c). Furthermore, we believe this degree of inquiry was adequate. Had Dr. Broms been told there was not a uniform standard, then further investigation would have been merited. However, Dr. Broms had every reason to believe the statement of a Caldwell obstetrician-gynecologist that there was a national standard of care for physicians practicing in this specialty. Upon learning this, further inquiry was not warranted.
Subsection (c) of I.C. § 6-1013 specifically provides that this section shall not be used to prohibit or preclude a competent witness...
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