Grondin v. Curi
| Decision Date | 18 March 2003 |
| Docket Number | (SC 16769) |
| Citation | 262 Conn. 637,817 A.2d 61 |
| Court | Connecticut Supreme Court |
| Parties | KELLY GRONDIN, ADMINISTRATRIX (ESTATE OF ASHLEY M. GRONDIN), ET AL. v. JOSEPH F.J. CURI ET AL. |
Borden, Norcott, Katz, Palmer and Vertefeuille, Js. William R. Moller, with whom was Martha S. Gavenas, for the appellants (plaintiffs).
Augustus R. Southworth III, with whom, on the brief, was John R. Horvack, Jr., for the appellee (named defendant).
The sole issue in this appeal is whether the trial court properly concluded that an expert witness, testifying about the applicable standard of care in a medical malpractice action, must be board certified at the time of the alleged malpractice in order to qualify as a "`similar health care provider'" under General Statutes § 52-184c (c) and (d).1 The plaintiff, Kelly Grondin, individually and as administratrix of the estate of her daughter, Ashley M. Grondin (decedent), appeals2 from the trial court's judgment of nonsuit for failure to establish a prima facie case in a medical malpractice action against the named defendant, Joseph F.J. Curi, a pediatrician.3 We conclude that an expert need not be board certified at the time of the alleged malpractice in order to qualify as a "`similar health care provider'" pursuant to § 52-184c (c) and (d), and that the trial court's preclusion of the plaintiff's expert witness on the standard of care, resulting in the judgment of nonsuit, was improper. Accordingly, we reverse the judgment of the trial court.
The record reveals the following facts and procedural history as undisputed and relevant to the disposition of this appeal. The decedent was born on April 7, 1984. The defendant, a board certified pediatrician, was her primary treating physician from 1984 until 1995. The decedent was plagued by respiratory problems throughout her life. In 1984, the defendant treated her for respiratory ailments including colds, choking and bronchitis. The defendant admitted the decedent to Charlotte Hungerford Hospital in September, 1987, with a diagnosis of "`acute asthmatic bronchitis,'" and took a chest X ray of her at that time. She was admitted again to Charlotte Hungerford Hospital on January 10, 1989, with a diagnosis of "`bronchopneumonia.'" A chest X ray was taken of her on January 10, 1989. In April, 1990, she was treated at Charlotte Hungerford Hospital for an upper respiratory infection. The decedent was relatively symptom-free in 1991, but she was seen by the defendant on April 29, 1992, for what the defendant described as "`a lot of problems, including not wanting to go to school and trying to gag herself.'" She was treated again at Charlotte Hungerford Hospital on June 2, 1993, for respiratory symptoms, specifically lengthy intermittent coughing.
On November 16, 1995, the decedent was admitted to Charlotte Hungerford Hospital with complaints of persistent cough, fever and emesis of blood-tinged A chest X ray was taken at that time. It was the first chest X ray taken of her since 1989. On November 17, 1995, a CAT scan indicated a large tumor in the decedent's lungs and, thereafter, she was transferred to the University of Connecticut Medical Center (UConn) for treatment. At UConn, an examination revealed that the tumor was in the third stage of cancer, which specifically was diagnosed as B-cell non-Hodgkin's lymphoma. She received chemotherapy for her cancer, but died on March 17, 1997.
The plaintiff initially brought this action against the defendant in October, 1997. In her complaint, she alleged that the defendant had breached the prevailing standard of care by failing to diagnose the decedent's lung cancer from June 2, 1993, through November 16, 1995, and by failing to monitor properly her respiratory problems by not ordering chest X rays between January 10, 1989, and November 16, 1995. The plaintiff also alleged that the defendant had failed to undertake an extensive differential diagnosis that was warranted by the decedent's respiratory signs and symptoms. She alleged further that the defendant should have realized that additional specialist consultations and referrals were warranted between June 3, 1993, and November 15, 1995. The plaintiff claimed that these alleged breaches of the standard of care deprived the decedent of the chance to have her cancer diagnosed and properly treated.4
During discovery, the plaintiff disclosed Marc J. Grella, a board certified5 pediatrician who practices primarily in the Boston area, as an expert expected to testify at trial. The defendant deposed Grella on August 10, 2000.6 Following the completion of discovery, the matter was tried to a jury before Agati, J., commencing on September 11, 2001.7
The plaintiff called Grella as her first and only witness. Grella testified on direct examination that he is a physician with a specialty in general pediatrics, practicing at Massachusetts General Hospital in Boston. He attended New York Medical College, and graduated in 1993. After graduating from medical school, he completed a three year pediatric residency at the Children's National Medical Center in Washington, D.C. During his residency, he received training in general pediatrics and the associated subspecialties of, among others, cardiology, hematology, allergy and pulmonology. He completed his residency in June, 1996, and, thereafter, returned to Boston to practice. Grella testified that he is a member of the Massachusetts Chapter of the American Academy of Pediatrics, the Massachusetts Medical Society, the National Organization of the American Academy of Pediatrics and Alpha Omega Alpha, a general national medical academic honor society. He also testified that he has written several articles for medical academic journals. After presenting his credentials, Grella then testified that he was familiar with the general standard of care for the practice of pediatrics in the United States, and had formed an opinion as to whether the defendant deviated from that standard of care in the present case.8
Grella then testified about the information contained in the decedent's death certificate, and the treatments and diagnoses indicated in the defendant's notes regarding the decedent's office visits. He discussed the significance of the pneumonia discovered as a result of the decedent's January 10, 1989 chest X ray. The plaintiff's counsel then asked Grella: "[H]ow soon after January 10, 1989 would proper care require another chest x-ray?" Defense counsel objected to this line of questioning, contending that Grella was not competent to discuss the standard of care for a time when he was not a board certified physician.
Thereafter, outside the jury's presence, the plaintiff then conducted a preliminary examination into Grella's knowledge of the standard of care applicable in 1989. Grella described his knowledge of chest X rays, stating that he knew that the procedure's use predated his medical career, but, that he was not sure by how long. He stated that he had learned, however, while in his first year of medical school, that proper monitoring of a child with symptoms of respiratory distress requires the use of chest X rays.
Following the defendant's continued objections to the plaintiff's inquiry regarding the 1989 X rays, the plaintiff turned the questioning to the 1993 X rays. The defendant objected again, maintaining that the timing change did not alter the basis of his prior objection to Grella's qualifications.
The jury then returned to the courtroom. Grella opined that any patient with pneumonia serious enough to require hospitalization should receive a follow-up X ray "to document its resolution." Grella then noted that his review of the decedent's records from January 10, 1989, to November, 1995, revealed no request by the defendant for a chest X ray during that time period. Grella also stated that he had reviewed the rest of the defendant's records for the decedent's medical history from the remainder of 1989 through June, 1993. Grella noted treatment for bronchitis and fever in June, 1993.9
Discussion then ensued among counsel and the trial court about the relationship between the applicable standards of care in 1993 and 2001. It was at this point that the objection to Grella's qualifications, based upon § 52-184c, resurfaced. The plaintiff's counsel then asked Grella whether he was aware of the standard of care for pediatricians in 1993, a line of questioning to which he gave inconclusive answers.10 Following this exchange, the plaintiff's counsel shifted the line of questioning to the 1995 records. At this point, defense counsel renewed his objection to Grella's qualifications. The trial court then excused the jury and heard legal arguments on Grella's qualifications under § 52-184c to discuss the standard of care in 1995, and at any other point before he became board certified.
The trial court initially ruled that Grella was not a qualified pediatrician under the "`similar health care provider provision'" of § 52-184c (b) because he had not practiced or taught for five years prior to the incident giving rise to the plaintiff's claim. Following additional testimony outside the presence of the jury, the trial court suspended the trial and granted the plaintiff permission to file an interlocutory appeal of its ruling. After a conference in chambers with counsel, the court granted the plaintiff's subsequent motion for reconsideration of its original ruling, noting that under subsection (c) of § 52-184c, which applies to specialists, no time restrictions are prescribed. The trial court then directed the parties to brief the issue of whether Grella was a "`similar health care provider'" and return for argument the following day.
The following day, the defendant filed a motion in limine to preclude Grella from testifying about the standard of care. Following the submission of briefs and oral argument, the trial court ruled that ...
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