Estate v. Mastroianni

• Decision Date: 05 May 2020
• Docket Number: SCWC-14-0001030
• Citation: 463 P.3d 1197
• Parties: ESTATE OF Robert FREY, Petitioner/Plaintiff-Appellant, v. Robert P. MASTROIANNI, M.D., Respondent/Defendant-Appellee.
• Court: Hawaii Supreme Court

463 P.3d 1197

ESTATE OF Robert FREY, Petitioner/Plaintiff-Appellant,

v.Robert P. MASTROIANNI, M.D., Respondent/Defendant-Appellee.

SCWC-14-0001030

Supreme Court of Hawai‘i.

May 5, 2020

Anthony L. Ranken, Samuel P. Shnider, Wailuku, for Petitioner

Thomas E. Cook, Honolulu, Brandford F.K. Bliss, for Respondent

RECKTENWALD, C.J., NAKAYAMA, McKENNA, POLLACK, AND WILSON, JJ.

OPINION OF THE COURT BY WILSON, J.

Following the death of Robert Frey ("Frey") in 2004, his estate and several family members initiated proceedings against Dr. Robert Mastroianni ("Dr. Mastroianni") before a medical claim conciliation panel ("MCCP"), claiming that Dr. Mastroianni's negligence was the cause of Frey's death. The case eventually led to a 2014 trial in the Circuit Court of the Second Circuit ("circuit court"). After the sole remaining plaintiff, the Estate of Robert Frey ("the Estate"), rested its case, the circuit court granted judgment as a matter of law to Dr. Mastroianni.

The circuit court held that it had no jurisdiction over the Estate's "loss of chance" claim—that is, its claim that Dr. Mastroianni's negligence caused Frey to lose a chance of recovery or survival—because such a claim was not raised before the MCCP. And it held that the Estate had failed, as a matter of law, to present sufficient evidence of causation to make out a claim. The Intermediate Court of Appeals ("ICA") affirmed. Estate of Frey v. Mastroianni, No. CAAP-14-0001030, 2018 WL 3199216, at *12 (App. June 29, 2018) (mem.). The ICA concluded that "loss of chance" claims seek recovery for a "separate compensable injury[,]" and that the Estate's failure to raise loss of chance before the MCCP deprived the circuit court of jurisdiction. Id. at *7. It also concluded that, during trial, the Estate had "failed to provide any expert medical testimony establishing that Dr. Mastroianni caused Frey's death ‘to a reasonable degree of medical probability.’ " Id. at *11.

We accepted certiorari to resolve the question of whether the "loss of chance" doctrine is consistent with Hawai‘i law and to provide additional guidance regarding the MCCP pleading process. In brief, we hold that while a "loss of chance" is not a separate compensable injury under Hawai‘i law, a factfinder in a medical malpractice case involving the death of a patient may consider a loss of chance theory in determining legal causation under our traditional framework for negligence, which considers whether an actor's conduct was a substantial factor in bringing about the harm. See Mitchell v. Branch, 45 Haw. 128, 132, 363 P.2d 969, 973 (1961). We also clarify that the pleading requirements before MCCPs, now renamed MICPs, are intended to be relatively simple, requiring only a brief description of the facts underlying the claim, not a detailed legal theory of the case. Thus, we hold that the circuit court had jurisdiction over the Estate's negligence claim, including its loss of chance arguments, in the present case. We hold further that the circuit court erred in holding that the Estate failed as a matter of law to present sufficient evidence of causation to make out a claim. We remand the case for a new trial in light of this opinion.

I. BACKGROUND

A. Medical Claims Conciliation Panel Proceedings

On June 13, 2006, the Estate and several of Robert Frey's family members (collectively, "the Claimants") submitted a letter ("the Claim Letter") to a medical claim conciliation panel.¹ In the Claim Letter, the Claimants alleged that Frey died as a result of the negligence of his treating physician, Dr. Mastroianni. The Claim Letter made the following factual and legal allegations and demand:

Pursuant to Hawaii Revised Statutes, 671-1, et seq., Claimants ... hereby present a claim for damage resulting from Robert Frey's death, which occurred as a result of the negligence of the following respondent:

Robert P. Mastroianni, M.D.

...

The Claimants are the estate of Robert Frey, and his parents, brother, and sisters as individuals. Robert Frey was born on March 2, 1946. He died on June 15, 2004. He was fifty-eight years old at the time of his death. Respondent Robert P. Mastroianni, M.D., is a medical doctor who provided care to Robert Frey.

The background and circumstances of this claim are as follows: On June 11, 2004, Robert Frey was visiting Maui and staying with a friend. Sometime during that day Mr. Frey inadvertently ingested an immense dose of gamma hydroxy butyrate (GHB). The GHB was contained in a juice bottle in the refrigerator of his friend's home and Mr. Frey used it, thinking that it was just juice, to make a smoothie in the blender. Thereafter, as a result of the effects of the GHB, Mr. Frey fell while within the residence, apparently hitting his head on a table. He was found unconscious by his friend and another person. An ambulance was eventually called and Robert Frey was taken to the emergency room at the Maui Memorial Medical Center. From the emergency room, Mr. Frey was transferred to the intensive care unit. Respondent Robert P. Mastroianni, M.D. was his treating physician. Over the next two days, Mr. Frey emerged from his coma and began to recover. On June 13, 2004, Dr. Mastroianni discharged Mr. Frey in "stable condition," on oral antibiotics with a diagnosis of "bronchitis," despite the facts that (1) it was documented that Mr. Frey had vomited several times while unconscious, (2) his most recent chest x-ray (of the day before) showed evidence of developing pneumonia, (3) he had a fever of 102 degrees, and (4) he was coughing. Dr. Mastroianni did not order new x-rays on the day of Mr. Frey's discharge. During the evening of June 13th Robert developed difficulty breathing, and the next morning he was rushed back to the hospital. Following treatment in the emergency room, he was admitted with a diagnosis of pneumonia, hypoxia, sepsis, and severe metabolic acidosis. His condition quickly deteriorated, and at 11:05 a.m. on Tuesday June 15, 2006 [sic], Mr. Frey died. The pathologist who conducted the autopsy listed the immediate cause of death as severe necrotizing pneumonia, with contributing conditions of sepsis and gamma hydroxy butyrate intoxication.

Claimants allege that Robert P. Mastroianni, M.D., fell below the applicable standard of care in multiple respects, including but not limited to the following: (1) failing to start Mr. Frey on broad spectrum intravenous antibiotics soon after the first admission, when it became clear that he had pneumonia ; (2) discharging the patient on June 13th without determining the reason for his fever; (3) not repeating the chest X-ray on June 13th, which would clearly have shown pneumonia ; and (4) misdiagnosing Mr. Frey's condition as bronchitis, despite the evidence of his chest x-rays, his fever of 102, and his probable aspiration of vomit while he had been unconscious.

If Dr. Mastroianni had administered antibiotics in the hospital on June 11th or 12th, repeated the chest x-ray on June 13th, and kept Mr. Frey in the hospital for further observation and treatment, then with the benefit of closer observation and care it is likely that he would have survived.

Wherefore, Claimants demand judgment against the above-stated respondent for such general and special damages to which Claimants shall be entitled pursuant to the proof adduced at the hearing which is sufficient to invoke the jurisdiction of the Circuit Court of the State of Hawaii, together with costs of suit, pre-judgment and post-judgment interest, and such further relief, both legal and equitable, as this panel deems appropriate.

On February 28, 2007, the Claimants submitted a pre-hearing statement to the MCCP which repeated these allegations.

In April 2007, the MCCP decided in favor of the Claimants. After the MCCP's decision, Dr. Mastroianni took the position that he would not pay the award.²

B. Circuit Court Proceedings

1. Pleadings

On June 12, 2007, the Claimants filed a complaint in the circuit court against Dr. Mastroianni. The complaint alleged one count of "Negligen[c]e (Medical Malpractice)" and one count of "Wrongful Death[.]" As to the negligence count, the complaint alleged facts mirroring those in the Claim Letter and claimed that "[t]he medical care rendered by [Dr. Mastroianni] to Robert Frey fell below the applicable standard of care, and constituted a lack of due care and a negligent act on the part of [Dr. Mastroianni.]" The complaint alleged that, "[h]ad [Dr. Mastroianni] not violated the applicable standard of medical care ..., Mr. Frey's life could have been saved[,]" and that, "[a]s a direct result of [Dr. Mastroianni's] negligence, Robert Frey experienced severe pain and suffering and then died." As to the wrongful death count, the complaint claimed that Dr. Mastroianni's "negligent actions were a substantial factor in causing Robert Frey's death[,]" or, in the alternative, that "[Dr. Mastroianni's] negligent treatment deprived Robert Frey of a significant improvement in his chances for recovery, and/or resulted in a loss of an increased chance of recovery, which loss of chance is compensable in and of itself." The complaint alleged that Dr. Mastroianni was liable to the Estate for Frey's "pain and suffering, loss of enjoyment of life, economic loss, and other damages" and to the other Claimants for "their loss of consortium, emotional distress, economic loss, and other damages."

Dr. Mastroianni filed an answer on July 27, 2007 in which he denied all allegations of negligence. The trial date was continued multiple times over the following years, during which time all of Frey's family members’ claims against Dr. Mastroianni were dismissed with prejudice, leaving the Estate as the sole plaintiff.

2. Trial Testimony

Jury trial commenced on July 7, 2014.³ Along with two lay witnesses, the Estate called three expert witnesses: Dr. Peter Schultz, Dr. Bradley Jacobs, and Dr. Darvin Scott Smith.⁴

The Estate's first expert witness was Dr. Peter Schultz, an internal medicine doctor from California....