Moonan v. Louisiana Medical Mutual Insurance Co.

Citations: 202 So. 3d 529; 16 La.App. 5 Cir. 113; 2016 La. App. LEXIS 1742Docket: NO. 16-CA-113

Court: Louisiana Court of Appeal; September 22, 2016; Louisiana; State Appellate Court

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In the medical malpractice case involving Noemie I. Moonan and her son Michael Andrew Moonan against Dr. Frank J. Monte and Louisiana Mutual Medical Insurance Company, the court affirmed the trial court's judgment in favor of the defendants and denied the Moonans' motion for a new trial. The case arose following the death of Andrew Vincent Moonan, III, after he suffered two fractured ribs from a fall on October 17, 2009. After being discharged from East Jefferson General Hospital with instructions for follow-up care, Mr. Moonan remained bedridden and made multiple calls to his doctors, including Dr. Monte, expressing a desire to return to the hospital. Despite these calls, Mr. Moonan did not seek further medical attention until he collapsed on October 22 and was subsequently taken to University Hospital, where he died from a pulmonary embolism on October 23.

A complaint was filed against Dr. Monte less than a year later, claiming he was negligent in failing to inform Mr. Moonan about the risks of immobility, allowing misleading information to be conveyed by his medical technologist, and not instructing Mr. Moonan to return to the emergency room. The Medical Review Panel found no negligence on Dr. Monte's part. The Moonans' lawsuit, filed in the 24th Judicial District Court, centered on the assertion that Dr. Monte's negligence was so apparent that expert testimony was unnecessary. During a four-day jury trial, the Moonans presented testimonies primarily from Mrs. Moonan and Mr. Banks, who recounted Mr. Moonan's phone call with Dr. Monte, indicating they believed insurance issues prevented emergency services without prior authorization. However, they acknowledged they could not hear Dr. Monte's responses during the call, limiting their testimony's effectiveness.

Neither witness recalled Mr. Moonan mentioning "emergency room." Mrs. Moonan testified he complained of shortness of breath to Dr. Monte, a warning sign of an emergency. The Moonans presented a timeline of events leading to Mr. Moonan's death, created by Mrs. Moonan weeks later for personal use, not for litigation. They also included a deposition from Dr. William Nelson Grant, III, who opined that Dr. Monte breached the standard of care, although he had no direct knowledge of the case. The defendants called Dr. Monte, Dr. Nicholas Pappas, and Dr. Richard Diechmann to testify. Dr. Monte stated Mr. Moonan requested direct hospital admission, not to return to the emergency room, and he could not grant admission without an in-person evaluation, advising Mr. Moonan to either see him or go to the emergency room. Dr. Monte asserted Mr. Moonan did not express urgent symptoms. He noted Mr. Moonan's history of not adhering to medical advice, including refusing blood-thinning medication. Dr. Pappas, who also treated Mr. Moonan, reiterated the lack of emergency complaints during their October 19th phone conversation, where Mr. Moonan declined to come in for an EKG. Dr. Diechmann supported that Dr. Monte met the standard of care and highlighted that doctors cannot diagnose via phone and that patients can go to the emergency room without formal approval. The jury unanimously favored Dr. Monte, with the trial court finalizing the decision on April 20, 2015. The Moonans' motion for a new trial was denied on June 15, 2015, leading to their appeal, which raised two errors: 1) Allowing Dr. Diechmann's testimony as a retained expert contrary to the court's Scheduling Order, and 2) Redacting parts of Mrs. Moonan's timeline that impacted credibility.

The trial court has significant discretion in enforcing pre-trial orders under La. C.C.P. art. 1551, aiming to prevent surprises and facilitate orderly case management. If a party disregards a pre-trial order, the court can impose just orders, potentially barring the offending party from using specific evidence (La. C.C.P. art. 1551(C)). While a trial judge can decide whether to admit testimony that violates pre-trial orders, any uncertainty should favor admitting the evidence (Alix v. E-Z Serve Corp., 03-24). The court found no abuse of discretion in allowing Dr. Diechmann, a medical review panel member, to testify despite the defense's failure to provide a required expert report under La. C.C.P. art. 1425. The Moonans had prior knowledge of Dr. Diechmann’s opinions, having listed him as a witness and engaged with him before trial. The Louisiana Supreme Court clarified that members of the medical review panel can be called as expert witnesses in medical malpractice trials post their panel duties (Medine v. Roniger, 03-3436). Thus, the Moonans' objection to Dr. Diechmann’s testimony was found to lack merit.

Regarding the timeline submitted by Mrs. Moonan, the defendants sought to exclude it as hearsay. The trial court permitted its introduction but redacted two specific statements concerning a phone call about hospital admission. The Moonans contended these redacted statements should not have been excluded as hearsay under La. C.E. art. 801(D)(1)(b), which allows statements made by a testifying declarant, subject to cross-examination, if they are consistent with the declarant’s testimony and aimed at rebutting claims of recent fabrication.

The trial court possesses broad discretion in evidentiary rulings, which are upheld on appeal unless there is a clear abuse of discretion. A motion in limine is subject to this discretion. On appeal, it must be determined if an error occurred in the ruling and if it prejudiced the plaintiff's case; otherwise, reversal is not justified. The appellant carries the burden to demonstrate that the error significantly affected the case's outcome. In this instance, the trial court’s decision to redact two statements from Mrs. Moonan’s timeline was not an abuse of discretion, as the redacted statements were classified as hearsay. Hearsay is defined as a statement offered to prove the truth of the matter asserted, which applies to statements attributed to Dr. Monte that Mrs. Moonan did not directly hear. The Moonans presented the timeline to support their claim against Dr. Monte for breaching the standard of care, but the trial court rightly excluded the hearsay statements. The Moonans’ second assignment of error was found to lack merit. The trial court did not err in allowing Dr. Diechmann's testimony or in its redaction decision, providing no grounds to overturn the jury’s unanimous verdict favoring the defendants. Consequently, the trial court's decisions are affirmed.