Maher v. Quest Diagnostics, Inc.
| Decision Date | 25 May 2004 |
| Docket Number | (SC 17001). |
| Citation | 269 Conn. 154,847 A.2d 978 |
| Parties | LINDA MAHER v. QUEST DIAGNOSTICS, INC., ET AL. |
| Court | Connecticut Supreme Court |
Borden, Norcott, Palmer, Vertefeuille and Zarella, Js.
Eugene A. Cooney, for the appellants (defendant Ian M. Cohen et al.).
R. J. Weber III, for the appellee (plaintiff).
The defendants, Ian M. Cohen, a physician, and his employer, Associated Women's Health Specialists, P.C. (Associated Women's Health),1 appeal2 from the judgment of the trial court in favor of the plaintiff, Linda Maher, following a jury trial. The defendants claim that the trial court improperly: (1) permitted the plaintiff's expert witness to testify regarding the issue of causation in violation of § 7-4 (b) of the Connecticut Code of Evidence3 and our opinion in State v. Porter, 241 Conn. 57, 698 A.2d 739 (1997), cert. denied, 523 U.S. 1058, 118 S. Ct. 1384, 140 L. Ed. 2d 645 (1998); (2) concluded that the evidence presented by the plaintiff at trial was sufficient to support a jury verdict that the defendants had breached the applicable standard of care; and (3) failed to instruct the jury that its disbelief of a witness' testimony did not permit it to conclude the opposite of that testimony to be true in the absence of other evidence to support the finding of fact. We conclude that the trial court, on this record, improperly admitted the causation testimony of the plaintiff's expert witness. We further conclude, however, that the plaintiff offered sufficient evidence from which the jury reasonably could have found that the defendants had breached the applicable standard of care. Accordingly, we reverse the judgment of the trial court and remand the case for a new trial.4
The plaintiff commenced this medical malpractice action in 1997, alleging that the defendants' negligence caused a delay in the diagnosis and treatment of her cervical cancer such that her condition deteriorated, her treatment options were altered negatively, and her likelihood of recovery was impacted adversely.5 The jury returned a verdict for the plaintiff, and the trial court, after denying the defendants' motions to set aside the verdict and for judgment notwithstanding the verdict,6 rendered judgment thereon. This appeal followed.
The jury reasonably could have found the following facts. Cohen had become the plaintiff's gynecologist in 1978, and he had seen her professionally at various times until January, 1996. The plaintiff visited Cohen for routine annual examinations and also consulted with him periodically regarding various other issues involving her gynecological health. During the plaintiff's annual examinations, Cohen generally performed both a Papanicolau test (Pap smear), a test commonly used to screen females for cancer of the cervix and endometrium, and a pelvic examination. As a matter of course, during her years of consultation with Cohen, the plaintiff had not been provided with the results of her Pap smears and her "understanding [with regard to such a practice] was [that] no news is good news."
On January 6, 1995, during the plaintiff's annual examination, Cohen performed a Pap smear and pelvic examination. In his notes detailing this examination, Cohen described the appearance of the plaintiff's cervix as "friable."7 The January, 1995 examination was the first time in his years of treating the plaintiff that Cohen had used the term "friable" to describe the appearance of her cervix.8 It is undisputed that Cohen did not perform a colposcopic examination of the plaintiff's cervix during this January, 1995 visit.9
Cohen subsequently forwarded the Pap smear specimen taken from the plaintiff to Quest Diagnostics, Inc. (Quest), for analysis and interpretation. Quest thereafter informed Cohen that the plaintiff's test results were within normal limits. In accordance with his past practice regarding the plaintiff's Pap smear results, Cohen did not inform her as to the normal findings of her Pap smear screening.
During the remaining months of 1995, the plaintiff visited Cohen on several occasions in order to discuss and treat various health-related issues. On January 16, 1996, the plaintiff returned to Cohen for her annual gynecological examination. While conducting this examination, Cohen removed a polyp that he discovered in the plaintiff's cervix and ordered a biopsy of the growth. In his notes from this examination, Cohen stated the following: After having received the results of the biopsy, Cohen diagnosed the plaintiff with cervical cancer10 and he made a notation in the plaintiff's records regarding an "enlarged barrel lesion" in the plaintiff's cervix. Cohen informed the plaintiff of the diagnosis on January 24, 1996.
The plaintiff then was referred by Cohen to Peter E. Schwartz, a physician associated with the Yale University Gynecologic Oncology Center. After examining the plaintiff, Schwartz confirmed the plaintiff's diagnosis and recommended that she undergo a radical hysterectomy. Shortly thereafter, the plaintiff underwent a type III radical hysterectomy, an appendectomy, and a pelvic lymphadenectomy to remove a cancerous lymph node. Following her surgery, the plaintiff underwent a long process of therapy, which involved chemotherapy and radiation treatments, and she also suffered from sundry complications arising out of her surgery, including a significant wound infection and prolonged numbness of her lower extremities, which impacted her ability to walk.
Subsequently, the Pap smear specimen taken from the plaintiff in January, 1995, was reanalyzed by Quest, and it was discovered that the specimen had been misinterpreted and, in fact, the specimen did reveal the suspicious presence of abnormal cells. The plaintiff then commenced this medical malpractice action, alleging that her cervical cancer should have been diagnosed in January, 1995, and that the one year delay in diagnosis and treatment required that she undergo a far more serious course of surgery and treatment with increased complications.
At trial, the plaintiff argued that, notwithstanding Quest's indication to Cohen that her January, 1995 Pap smear had not suggested the unacceptable presence of cellular abnormalities, Cohen should have diagnosed the plaintiff's cervical cancer in January, 1995. In advancing this claim, the plaintiff relied principally upon Cohen's use of the term "friable" in describing the appearance of her cervix in January, 1995, a term that he again used in January, 1996, when the plaintiff's cancer was diagnosed. The plaintiff claimed that Cohen's use of this term, for the first time in his eighteen year professional relationship with her, indicated that he had observed a clinical change in the plaintiff's cervical appearance in January, 1995. Once such a clinical change was observed, the plaintiff claimed, the applicable standard of care required that Cohen investigate further by means of a colposcopic examination. See footnote 9 of this opinion. Although Cohen determinedly disagreed with the plaintiff's assertion that he had observed a clinical change in her cervical appearance on January 6, 1995, at trial Cohen conceded that, had he performed a colposcopy at that time, he likely would have been able to recognize the abnormality present in the plaintiff's cervical cells and may have been able to diagnose her cancer.
At the conclusion of the trial, the jury returned a verdict for the plaintiff. The trial court accepted the jury's verdict, denied the defendants' motion to set aside the verdict and for judgment notwithstanding the verdict, and rendered judgment in accordance with the verdict. This appeal followed.
The defendants first claim that the trial court improperly admitted the plaintiff's expert witness testimony of Robert Swan, a board certified gynecologic oncologist, on the issue of causation. Specifically, the defendants contend that the trial court improperly concluded that: (1) pursuant to § 7-4 (b) of the Connecticut Code of Evidence, the plaintiff had met her burden of demonstrating that the facts forming the basis of Swan's testimony were "of a type customarily relied on by experts in the particular field in forming opinions on the subject"; and (2) Swan's testimony satisfied the threshold requirements for the admissibility of scientific evidence as set forth in § 7-2 of the Connecticut Code of Evidence,11 and as articulated in State v. Porter, supra, 241 Conn. 57.
The plaintiff claims, to the contrary, that the trial court properly admitted Swan's testimony because: (1) as an expert qualified in the field of gynecology and oncology, Swan reviewed the relevant medical literature on the subject of cancer growth rates, as well as the plaintiff's medical records, drew conclusions therefrom regarding the evolution of the plaintiff's cancer, and that the facts underlying Swan's opinion testimony were therefore "of a type customarily relied on by experts in the particular field in forming opinions on the subject" and satisfied the requirements of § 7-4 (b) of the Connecticut Code of Evidence; (2) Swan's testimony did not implicate the standard in Porter for the admissibility of certain scientific evidence because the testimony was not based on novel or innovative scientific methodology and, therefore, was admissible upon a showing of relevance; and (3) even if a Porter analysis was required prior to the admission of Swan's testimony, the trial court properly admitted the evidence after its consideration of the various factors articulated in Porter as bearing on the admissibility of scientific evidence. We conclude that Swan's testimony is the type of scientific evidence that requires an individualized Porter inquiry as to its underlying scientific validity prior to being admitted into evidence. We further conclude that, on the basis...
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