Shea v. Esensten, C1-00-366.

• Decision Date: 06 February 2001
• Docket Number: No. C1-00-366.,C1-00-366.
• Citation: 622 N.W.2d 130
• Parties: Dianne L. SHEA, individually and as trustee for the Heirs of Patrick Joseph Shea, decedent, Appellant, v. Sidney ESENSTEN, et al., Respondent.
• Court: Minnesota Court of Appeals

622 N.W.2d 130

Dianne L. SHEA, individually and as trustee for the Heirs of Patrick Joseph Shea, decedent, Appellant, v. Sidney ESENSTEN, et al., Respondent.

No. C1-00-366.

Court of Appeals of Minnesota.

February 6, 2001.

Corey J. Ayling, McGrann Shea Franzen Carnival Straughn & Lamb, Minneapolis, and John R. Schulz, Collins Buckley Sauntry & Haugh, St. Paul, for appellant.

J. Richard Bland, Cecilie Morris Loidolt, Meagher & Geer P.L.L.P., Minneapolis, for respondents.

Considered and decided by HARTEN, Presiding Judge, KLAPHAKE, Judge, and ANDERSON, Judge.

OPINION

G. BARRY ANDERSON, Judge

Following the death of her husband, appellant Dianne Shea brought an action against respondents, alleging medical malpractice. Appellant challenges the district court's decision excluding (1) evidence of the managed-care structure in place at respondent clinic and (2) evidence of past professional misconduct by one of the respondent physicians. Appellant also claims the district court abused its discretion by submitting the question of comparative fault to the jury. Because appellant did not show that the offered evidence was relevant to the question of medical malpractice, and because the evidence was prejudicial, we hold that the district court acted within its broad discretion by excluding the evidence. We also hold that the district court properly instructed the jury. Accordingly, we affirm.

FACTS

Drs. Sidney Esensten and Jeffrey Arenson, respondents, are family-practice physicians who treated the decedent, Patrick Shea, for more than a decade before his death in 1993. Shea had a family history of heart disease. Appellant Dianne Shea, Shea's widow, testified that Shea had chest pain as early as 1991 but she did not know whether the chest pain was reported to his doctors. Dr. Arenson administered an exercise stress test in early 1992; Shea passed. In June 1992, Shea felt chest tightness while on business in Thailand and sought medical treatment. A cardiologist at Bangna General Hospital performed blood tests, an electrocardiogram test, and a stress test. Based on the results of these tests, the Thai cardiologist ruled out a cardiac cause for Shea's symptoms.

After returning from Thailand, Shea sought treatment for continuing chest pain, abdominal pain, and dizziness. According to the medical records and Dr. Esensten's testimony, on July 6, 1992, Shea did not complain of any chest pain or discomfort but reported abdominal problems. Dr. Esensten testified that he spoke to the Thai cardiologist and learned that Shea's electrocardiogram and stress tests completed there were normal. Dr. Esensten saw Shea again on July 8, 1992 to review a stomach X-ray, and again on July 22 and August 10, 1992 to follow up on the effectiveness of medications prescribed to alleviate Shea's stomach pain. Shea saw Dr. Arenson in August 1992 and again on September 17, 1992. Dr. Arenson testified that during those visits Shea complained of abdominal pain and chest discomfort, and told of his medical treatment in Thailand. Although appellant testified that her husband asked to see a cardiologist, the medical records do not show that Shea asked for a specialist referral. Dr. Arenson testified that, had Shea insisted on seeing a cardiologist, he would have made the referral. Instead, based on his complaints, Shea's doctors referred him to a gastroenterologist. The results of a September 1992 colonoscopy showed nothing out of the ordinary. Drs. Esensten and Arenson concluded that Shea's symptoms were anxiety-related and prescribed sedatives. Dr. Arenson saw Shea again on October 6; Shea complained of the same symptoms but had not taken all the medication prescribed to him. Dr. Arenson diagnosed Shea as suffering from hyperventilation and prescribed a sedative.

Shea did not visit his doctors again until February 1, 1993, when he complained to Dr. Arenson of shortness of breath, dizziness, and heartburn. Dr. Arenson administered an electrocardiogram test; the results were normal. Dr. Arenson prescribed medication to lower Shea's cholesterol. On March 5, 1993, Shea telephoned his wife and told her he was suffering from chest pain. On his way to the clinic, Shea drove past two hospitals. Shea was found dead, slumped over the wheel of his car several blocks from the clinic. The autopsy showed Shea's left anterior descending coronary artery was 80-85% blocked and the right coronary artery was 50-60% blocked. Shea had arteriosclerotic heart disease and suffered sudden cardiac death.

In June 1994, appellant, individually and as trustee for her husband's heirs, commenced a medical-malpractice action against doctors Esensten and Arenson; their employer, Family Medical Clinic (clinic); and Shea's insurer, Medica. The case was removed to and returned from federal district court several times because appellants changed defendants and legal theories. The state medical-malpractice claim was tried to a jury in October 1999. Appellant moved for the admission of managed-care evidence to show Drs. Esensten and Arenson had financial motives that interfered with their treatment of Shea. Appellant sought to introduce evidence to show that managed-care incentives discouraged specialist referrals.

Appellant offered financial evidence to show why Shea had not been referred to a cardiologist. Distilled to its essence, Shea's health-insurance plan included specialist treatment if a referral to the specialist was made by a primary-care doctor. The more specialty referrals made, the less income the referring clinic received. The less income the clinic received, appellant argued, the fewer doctors they could employ, and, thus appellant contended, this contractual arrangement discouraged specialist referrals. As support, appellant pointed to 1988 meeting minutes showing that Dr. Arenson expressed concern about the capitation contract between the clinic and Medica.¹

Appellant also sought to introduce Dr. Esensten's professional-discipline history for impeachment purposes. Dr. Esensten was professionally disciplined in 1989 for prescribing medication to himself. Dr. Esensten and the Minnesota Board of Medical Examiners entered into a stipulated agreement restricting Dr. Esensten's practice. In 1991, following a period of compliance, the Board removed all conditions on Dr. Esensten's medical license. The district court excluded this proffered evidence on grounds of irrelevance, prejudice, and improper impeachment. Medical experts who testified on behalf of appellant agreed that Shea should have been referred to a cardiologist. But when asked whether respondent's diagnosis was a fatal mistake, one expert answered, "I don't know. I really don't know." Respondents produced three medical experts who testified that Shea's medical records did not show he suffered from a cardiac condition but rather gastrointestinal problems. Respondent's experts did not think Shea's symptoms should have resulted in a referral to a cardiologist. One expert testified that even had a referral been made, the outcome would not have been any different because a cardiologist would have treated the risk factors of smoking and high cholesterol just as Drs. Esensten and Arenson did. Another expert stated that Shea's death was unpredictable and unpreventable.

The district court's jury instructions included an instruction on comparative fault. The jury returned a unanimous special verdict attributing all fault to Shea and no fault to Drs. Esensten and Arenson. The district court denied appellant's motion for new trial. This appeal followed.

ISSUES

I. Did the district court abuse its discretion by excluding, as irrelevant, prejudicial, and improper impeachment, evidence of managed-care contracts and prior professional discipline?

II. Did the district court abuse its discretion by instructing the jury on the legal theory of comparative fault?

ANALYSIS

I.

Appellant first argues that the district court abused its discretion by excluding evidence that, if admitted, would have (1) shown the managed-care agreement between Medica and the clinic discouraged Drs. Esensten and Arenson from providing proper care and (2) impeached the physicians' testimony. When reviewing evidentiary rulings, we must determine whether the district court has based the decision on an erroneous view of the law or abused its discretion. Kroning v. State Farm Auto. Ins. Co., 567 N.W.2d 42, 45-46 (Minn. 1997).

That a reviewing court disagrees with a district court's ruling and would have reached a different result is not a sufficient basis for reversal. Williams v. Wadsworth, 503 N.W.2d 120, 123 (Minn. 1993). To constitute reversible error, an evidentiary ruling must be prejudicial. Uselman v. Uselman, 464 N.W.2d 130, 138 (Minn.1990). Before an error in the exclusion of evidence may be grounds for new trial, it must appear that such evidence might reasonably have changed the result of the trial if it had been admitted. Poppenhagen v. Sornsin Const. Co., 300 Minn. 73, 79, 220 N.W.2d 281, 285 (1974).

A. Exclusion of Managed-Care Evidence

Appellant sought to admit evidence to prove managed-care contracts affected Shea's medical care. The district court determined that the evidence concerning the contracts and other managed-care evidence was not relevant to the determination of the malpractice claim but was "potentially very prejudicial" and did not constitute proper impeachment evidence. The district court reasoned that the issue of malpractice turned on the medical evidence, not the managed-care contracts.

Relevant evidence is evidence having "any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence." Minn.R.Evid. 401. "Reduced to simple terms, any evidence is relevant which logically tends to prove or disprove a material fact in issue." Boland v. Morrill, 270 Minn. 86, 98-99, 132 N.W.2d 711, 719 (1965). To...