Hanson v. Singsen

• Court: Rhode Island Supreme Court
• Writing for the Court: Williams
• Citation: Hanson v. Singsen, 898 A.2d 1244 (R.I. 2006)
• Decision Date: 12 June 2006
• Docket Number: No. 204-301-Appeal.,204-301-Appeal.
• Parties: Virginia HANSON et al. v. Edwin SINGSEN, M.D.

898 A.2d 1244

Virginia HANSON et al. v. Edwin SINGSEN, M.D.

No. 204-301-Appeal.

Supreme Court of Rhode Island.

June 12, 2006.

R. Park Palmer, Jr., for Plaintiffs.

Robert P. Landau, Providence, for Defendant.

Present: WILLIAMS, C.J., GOLDBERG, FLAHERTY, SUTTELL, and ROBINSON, JJ.

OPINION

Chief Justice WILLIAMS, for the Court.

Virginia Hanson (Hanson) and her husband, Francis Hanson (collectively plaintiffs), appeal from a judgment in the Superior Court granting a motion for judgment as a matter of law in favor of Edwin Singsen, M.D. (Dr. Singsen or defendant),¹ on the grounds that the plaintiffs failed to prove proximate causation in their medical malpractice claim, that the plaintiffs failed to prove their informed consent claim, and that the statute of limitations barred the plaintiffs' claims. For the reasons discussed herein, we affirm the judgment of the Superior Court.

I Facts and Travel

On February 2, 1990, Hanson tore her anterior cruciate ligament (ACL) when she slipped on a clam shell while working as a federal police officer on the United States Naval Base in Newport. She sought medical treatment for her injuries from defendant. On December 23, 1998, Hanson filed a tort claim for medical malpractice against defendant. The events of the eight intervening years were recounted at a jury trial in 2004.²

Hanson testified that she first met with Dr. Singsen in February 1990, shortly after her accident. He examined her knee, said she had probably damaged her ACL, and told her that she was a good candidate for ACL reconstruction surgery because she was physically fit and healthy. Doctor Singsen performed the ACL reconstruction surgery on March 2, 1990, at Newport Hospital. During the surgery, Dr. Singsen implanted a Dacron graft, known as a Kennedy Ligament Augmentation Device, in Hanson's knee.³ After the surgery, Hanson continued to experience great pain and swelling, as well as inhibited movement, and repeatedly sought Dr. Singsen's assistance with this pain. During this period, Hanson regularly attended physical therapy sessions, which caused her extreme pain. On July 6, 1990, Hanson met with Dr. Singsen to discuss the possibility of his performing a manipulation⁴ on her leg to improve its condition.

Hanson testified that Dr. Singsen did not discuss with her the risks of this procedure, although she did sign a consent form that contained both her signature and a list of risks associated with the manipulation procedure. According to Hanson, Dr. Singsen told her that he planned to clear the adhesions and scar tissue produced from the first operation. After the manipulation, however, Hanson continued to experience serious pain and lose more range of motion. She testified that Dr. Singsen refused to perform X-rays. Doctor Singsen told Hanson he was going to stop the physical therapy because she had reached a "plateau." When she asked him what to do about the pain, he told her that the pain was in her head. At that point, Hanson discontinued treatment with Dr. Singsen. Hanson said that at the time she did not suspect that Dr. Singsen had done anything wrong when performing her surgery, but that she discontinued his treatment because she felt humiliated by the way he had spoken to her in his office.

Hanson testified that the next day she made an appointment with her former doctor, Dr. Elie Cohen (Dr. Cohen), to ask for help alleviating the pain. Directly after this visit, Hanson tried to make an appointment to see a sports specialist in Boston. When she returned home from the visit, she began what would become a years-long process: attempting to secure permission from the United States Department of Labor, Office of Workers' Compensation Programs (OWC), to see a specialist. She left the OWC one message, then, when no one returned her call, she called again a few days later and explained the situation. The OWC told her that it would get back to her.

Hanson testified that by June 1991, her pain, swelling and imbalance had increased to the point that she could no longer work at all. Doctor Cohen wrote an initial letter to the OWC on her behalf explaining that she was not capable of working even "light duty." In another letter dated September 9, 1993, Dr. Cohen stated that Hanson "should have an arthoscope and [magnetic resonance imaging] in order to determine if there is any impingement or abnormal tissue or reaction in her knee." Permission was not forthcoming.

At the same time, Hanson continued writing letters to the OWC requesting permission and funding to seek a second medical opinion. The OWC eventually called Hanson. Over defendant's motion to strike, Hanson was permitted to testify that she made several different telephone calls to the OWC to find out why it would not grant her requests. She said she was told that she could not see another doctor without the OWC's permission, or she would lose all her benefits. Doctor Cohen continued to write letters to the OWC requesting this permission; she did not seek or obtain care from any other doctors.

In 1994, the OWC sent Hanson to Dr. Louis Meeks (Dr. Meeks). Hanson originally equated this with permission to see a specialist, but upon meeting with Dr. Meeks, discovered that he was only to evaluate Hanson to determine whether she could return to work. When Hanson realized that Dr. Meeks had no questions for her regarding her history or her pain, she left. The OWC warned Hanson to comply with its requirements to see particular doctors. Later that same year, the OWC sent Hanson to another doctor, who again evaluated Hanson regarding her possible return to work, and recommended in his report that she see a specialist for a second opinion. In 1995, the OWC sent Hanson to yet another doctor, who yet again evaluated her for the purposes of determining her fitness for work, and who approved her for light duty in a sedentary position. Despite continuing pain and limited mobility, Hanson continued to await permission from the OWC to see a specialist.

In December 1995, Hanson finally received permission from the OWC to see a specialist, Dr. William Mitchell (Dr. Mitchell). Doctor Mitchell ordered X-rays and a magnetic resonance imaging (MRI), and also performed an arthroscopy of Hanson's knee. Doctor Mitchell's reports indicate, as he told Hanson at the time, that the MRI revealed that Dr. Singsen had misplaced the graft during the ACL reconstruction surgery. In addition, the arthroscopy revealed that as a result of the extreme force used in the manipulation— necessary because the misplaced graft made movement of the knee more difficult—a piece of bone had broken off and scar tissue had grown over and around it, exacerbating Hanson's knee pain and further immobilizing her knee.

Doctor Mitchell's diagnosis was a failed ACL surgery. Doctor Mitchell performed a second knee surgery on Hanson, in which he excised the graft and removed it completely from her knee, along with the piece of bone that had detached during the manipulation. Hanson testified that this second surgery greatly reduced her pain and that she regained some motion. Doctor Robert Dunn (Dr. Dunn), an expert witness who reviewed Dr. Mitchell's reports, testified for plaintiffs that if Dr. Singsen had complied with the standard of care when he performed the original ACL surgery, Hanson would not have needed the subsequent surgery.

At the close of testimony, pursuant to Rule 50 of the Superior Court Rules of Civil Procedure, defendant made a motion for judgment as a matter of law on the following grounds: (1) The plaintiffs failed to prove causation and damages; (2) plaintiffs failed to prove their informed consent claim; (3) Hanson assumed the risk and exacerbated any surgical deficiencies by not following through with physical therapy and by delaying the performance of the manipulation; and (4) the statute of limitations barred recovery, since the discovery rule did not apply in this case of non-latent injury. The trial justice granted defendant's motion with respect to the first second, and fourth grounds, and she declined to address the third ground. The plaintiffs now appeal.

II Analysis

On appeal, plaintiffs assert that the trial justice committed three instances of reversible error when she granted defendant's motion for judgment as a matter of law on the first, second, and fourth grounds above.

"When reviewing a trial justice's decision on a motion for judgment as a matter of law, `this Court is bound by the same rules and standards as the trial justice.'" Tedesco v. Connors, 871 A.2d 920, 927 (R.I.2005) (quoting Mills v. State Sales, Inc., 824 A.2d 461, 472 (R.I.2003)). A trial justice may grant such a motion only after "a party has been fully heard on an issue and there is no legally sufficient evidentiary basis for a reasonable jury to find for that party on that issue * * *." Super. R. Civ. P. 50(a)(1). We will reverse a trial justice's issuance of judgment as a matter of law where the trial justice has "invaded the province of the jury by impermissibly finding facts." Martino v. Leary, 739 A.2d 1181, 1183 (R.I.1999).

The plaintiffs assert that the trial justice erred when she found as a matter of law that the statute of limitations served to bar plaintiffs' claim. "The application of the statute of limitations is a matter of law for the trial justice to determine." Ashey v. Kupchan, 618 A.2d 1268, 1270 (R.I. 1993). The statute of limitations for a claim of this type is provided by G.L.1956 § 9-1-14.1, which reads, in pertinent part:

"[A]n action for medical * * * malpractice shall be commenced within three (3) years from the time of the occurrence of the incident which gave rise to the action; provided, however, that:

"* * *

"(2) In respect to those injuries or damages due to acts of medical * * * malpractice which could not in the exercise of reasonable diligence be discoverable at the time of the occurrence of the incident which gave rise to the action, suit shall be...