Eng v. Klein

Citation: 110 P.3d 844Docket: 54217-6-I

Court: Court of Appeals of Washington; April 25, 2005; Washington; State Appellate Court

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In the case of Pon Kwock Eng v. Steven L. Klein, M.D., et al., the Washington Court of Appeals addressed the admissibility of expert medical testimony in a medical malpractice lawsuit concerning the alleged failure to timely diagnose and treat acute bacterial meningitis in Ping S. Eng, who subsequently died. The court emphasized that a witness's knowledge, rather than their professional title, determines the admissibility of expert testimony. Dr. Vincent Quagliarello, despite not being a specialist in the relevant field, was deemed qualified to testify because he possessed sufficient knowledge about the medical issue and the treatment methods were not confined to a specific specialty. Consequently, the court found that the lower court improperly granted summary judgment.

The case details that after undergoing neurosurgery on October 1, 1999, Ping S. Eng was discharged without complications. However, on October 8, her husband reported a high fever to Dr. Klein, who instructed them to go to the emergency department. At the hospital, Dr. Goldman noted significant symptoms and ordered tests that revealed abnormal results indicating a potential infection. Dr. Klein evaluated Ping but did not suspect an infection related to the surgery. He later consulted with Dr. Moss, an infectious disease specialist, but ultimately decided no further immediate investigation was necessary before Dr. Moss's scheduled rounds, and he left the hospital.

Dr. Moss first examined Ping on October 9, 1999, and conducted tests to identify the infection, administering antibiotics. A lumbar puncture performed on October 10 revealed a rare form of meningitis, which experts agreed was likely unrelated to Ping's previous neurosurgery. Although Dr. Moss provided appropriate antibiotics, Ping died from the infection on October 21. Following this, Pon filed a complaint against Dr. Goldman, Dr. Moss, Dr. Klein, and Swedish, with Swedish later dismissed by stipulated order and claims against Dr. Goldman being dismissed via summary judgment. Dr. Klein also sought summary judgment.

In opposition, Pon submitted the declaration and deposition of Dr. Vincent Quagliarello, an infectious diseases specialist. Dr. Quagliarello acknowledged he was unfamiliar with Washington's neurosurgery standards but based his opinions on national standards for meningitis diagnosis and treatment. He did not assert that Dr. Klein deviated from the standard of care as a neurosurgeon in Washington. However, he indicated that Dr. Klein, as a neurosurgeon, should recognize meningitis symptoms and the necessity of a spinal tap, particularly given Ping's presentation after a normal CT scan. Evidence suggested that the standards for diagnosing meningitis are nationally recognized and that medical training includes performing spinal taps. 

Despite this, the superior court ruled in favor of Dr. Klein, concluding that Dr. Quagliarello was not qualified to testify regarding the standard of care for a Washington neurosurgeon. Pon subsequently petitioned for immediate appellate review, which was granted. The applicable Washington statutes require proof that a healthcare provider failed to meet the standard of care expected in similar circumstances, typically necessitating expert testimony. Generally, practitioners from different medical specialties are deemed incompetent to testify against one another in malpractice cases, although exceptions exist.

Exceptions to the admissibility of expert witness testimony in malpractice cases include situations where: 1) the treatment methods of the defendant's and witness's schools are the same; 2) they should be the same; or 3) the witness's testimony is derived from knowledge of the defendant's school. In the Miller case, the court allowed a practitioner from one medical school to testify against a practitioner from another, provided their treatment methods are comparable. In the White case, the court ruled that a specialist could offer testimony on the standard of care for a general practitioner, emphasizing that a physician's qualifications should be based on their knowledge and familiarity with the medical issue rather than their title.

The current case involves whether Dr. Quagliarello, an expert on infectious diseases, is qualified to testify about diagnostic procedures related to Ping's symptoms. Pon claims Dr. Klein was negligent for not continuing a differential diagnosis for Ping, who potentially exhibited symptoms of meningitis. He argues Dr. Klein should have ordered a spinal tap before leaving for the night, rather than waiting for an infectious disease specialist.

Dr. Quagliarello stated that a patient with symptoms like Ping's should have raised enough suspicion of meningitis for Dr. Klein to warrant a spinal tap. His expertise in the matter is undisputed. Additionally, there is no evidence indicating that Dr. Klein's failure to perform a differential diagnosis or order a spinal tap is specific to his neurosurgical specialty. Dr. Quagliarello noted that neurosurgeons should be well-versed in recognizing symptoms and diagnosing meningitis, as it is a known complication of neurosurgery. He concluded that Dr. Klein should have been aware of the need for timely diagnosis and treatment of meningitis, which includes performing a lumbar puncture.

Dr. Quagliarello's testimony is based on national standards of care for diagnosing and treating meningitis, indicating no geographic variation in diagnostic methods. Dr. Klein failed to provide evidence that diagnostic standards differ between neurosurgeons and infectious disease specialists, relying instead on evasive depositions from physicians who claimed lack of relevant specialty knowledge. The only supporting testimony for Dr. Klein's position came from Dr. Peter Marsh, who speculated that different specialties might have varied standards but did not establish a factual difference. Additionally, Dr. Klein's experts agreed that the standard of care among infectious disease doctors is nationally consistent. The court found Dr. Quagliarello qualified to testify about diagnostic procedures relevant to the case and determined that treatment methods were not specialty-specific, allowing him to testify on the standard of care. The superior court's summary judgment was reversed, and the case was remanded for trial.