Court: Mississippi Supreme Court; September 21, 1995; Mississippi; State Supreme Court
In a medical negligence case appealed from the Lee County Circuit Court, the jury ruled in favor of defendants Sanders Clinic for Women, Dr. C.J. Sanders (obstetrician/gynecologist), Dr. W. Carl Kellum, Jr. (gastroenterologist), and Dr. A.S. Kellum (general surgeon). The court affirmed that a specialist can testify about the standard of care related to procedures typically performed by general practitioners. The cross-appeal confirmed that the statute of limitations did not bar Barbara West's claim.
West alleged that from 1982 to 1986, the defendants failed to properly diagnose and treat a cancerous mass in her rectum. Initial complaints of chronic pelvic pain were made to Dr. Sanders in 1982, who diagnosed mild endometriosis and referred West to specialists. A mass was identified by Dr. John Bowlin in 1983, and subsequent evaluations by Dr. Kellum revealed a bloody mass concerning for colon cancer. Multiple tests, including a biopsy in May 1986, returned benign results, identifying the mass as a hyperplastic polyp with moderate dysplasia, which Dr. Kellum acknowledged could indicate carcinoma.
Dr. Sanders performed a total hysterectomy in June 1986, believing it necessary to address both the endometriosis and the rectal mass, although West was under the impression that it was specifically to remove the mass. After surgery, Dr. Sanders communicated that there was no evidence of cancer. Following the procedure, West experienced ongoing symptoms, leading to additional consultations and referrals for further evaluation, including a possibility of a colostomy. The case highlights ongoing concerns about the mass and the adequacy of the defendants' diagnostic efforts throughout the treatment period.
On February 7, 1987, West consulted Dr. William Barnett, a physician recommended by Dr. Sanders, due to persistent tumor issues despite prior benign biopsies. Dr. Barnett admitted her to Baptist Hospital for surgery, which included a colon resection, colostomy, and additional biopsy on February 9, revealing a cancerous tumor in the mid-rectum. Following the diagnosis of Dukes’ C rectal carcinoma, West underwent chemotherapy under Dr. Julian Hill. At trial, Dr. Neil Wolfson, an obstetrics and gynecology expert, criticized Dr. Sanders for not excising the tumor during the hysterectomy and for his failure to provide adequate treatment, asserting that the standard of care was not met. Dr. Sanders defended his actions, claiming he would not remove a benign lesion, and acknowledged uncertainty regarding his endometriosis diagnosis. He observed the tumor over several months without treatment, suggesting that waiting a month was acceptable. Dr. Barnett testified that he could not determine the tumor's cancerous nature immediately after surgery and noted no invasion of the vagina. Dr. Atilla Ertan, a gastroenterologist, confirmed the existence of a tumor during West's treatment, while Dr. Jeremiah Henry Holleman stated that Dr. Kellum’s actions met the standard of care in 1986. The jury ultimately found in favor of the defendants, and the Wests' motion for a new trial was denied on July 31, 1991.
The trial court excluded testimony from expert witnesses Drs. H. Grant Taylor and William Stein regarding the standard of care for a rectal tissue growth, which they argued should have been surgically removed immediately. Dr. Taylor's deposition aimed to illustrate that the defendants did not meet the general practitioner standard of care, as the diagnostic procedures were not specialized. The Kellums objected to Dr. Taylor’s testimony, asserting he lacked qualifications to comment on the standard of care for gastroenterologists or general surgeons, despite having expertise in oncology. Specific portions of Dr. Taylor’s deposition were not presented to the jury, focusing on his oncological perspective and speculative opinions. The trial court upheld the objections, aligning its decision with Hall v. Hilbun, which mandates that a physician must possess relevant medical knowledge common to minimally competent peers in their specialty. The Kellums contended that Dr. Taylor's testimony did not meet this standard, as he acknowledged he was not a gastroenterologist and had no basis to testify on their standard of care. Unlike the Brown v. Mladineo case, where a physician's familiarity with a specialty allowed for testimony, the Wests failed to show Dr. Taylor's knowledge of gastroenterological standards. Consequently, the court found the exclusion of certain parts of his testimony justified.
The deposition testimony related to generalities was admitted, indicating that the Wests were not prejudiced by the exclusion of other deposition parts. In McCarty v. Mladineo, it was established that a physician must adhere to the standard of care provided by minimally competent physicians, and if their actions are unreasonable in meeting this duty, they are deemed negligent. A minimally competent professional meets the skill and knowledge required for their licensure and acts as a reasonably prudent person would in similar circumstances.
In this case, the physician was obligated to use accepted diagnostic procedures, applicable to both general and specialized practices. The Sanders contended that the standard of care should reflect that expected of a general practitioner, allowing any licensed practitioner to testify regarding the defendants’ adherence to this standard, rather than requiring specialist testimony. This interpretation aligns with previous rulings that did not limit the testimony of specialists regarding general practitioners' standards.
Further objections were raised concerning Dr. Taylor's deposition about a hysterectomy, where he identified as a physician-internist in oncology and hematology. The plaintiffs did not successfully demonstrate the qualifications necessary for expert testimony as outlined in Hardy v. Brantley, regarding the relevance of the subject matter, scientific establishment of expertise, and witness qualifications. Despite objections concerning Dr. Taylor's familiarity with resources at the North Mississippi Medical Center, such familiarity was deemed non-controlling for the acceptance of expert testimony.
Ultimately, despite some exclusions, the Wests effectively presented substantial evidence to the jury about the diagnosis and treatment of endometriosis. Similar objections were raised against Dr. William Stein, who acknowledged his unfamiliarity with gynecological standards of care. The trial court sustained objections regarding the scope of his testimony when asked about the minimum standard of care owed to Barbara West during her treatment in Tupelo, Mississippi, in 1986.
The Wests argued that the defendant doctors, as specialists with basic medical degrees, should have removed a mass if a general practitioner would have done so. Drs. Carl and A.S. Kellum objected to Dr. Taylor's testimony, claiming he was unqualified due to his lack of familiarity with the standard of care. Dr. Taylor acknowledged he did not regularly perform the type of endoscopic examination involved. The Wests aimed to use his testimony to illustrate what a general practitioner might do, asserting that Dr. Taylor's comments about the deterioration of West's condition were relevant to causation rather than the standard of care.
The court noted that while the standard of care pertains to medical procedures, a specialist can testify about the standard of care expected from a general practitioner. Dr. Taylor's opinions were largely introduced through his deposition, and since other expert testimony regarding the gastroenterologist/internist's standard of care was available, parts of Dr. Taylor's deposition were deemed cumulative and were properly excluded. The court clarified that evidence exclusion must affect a substantial right to constitute error and ruled that Dr. Taylor's testimony was not speculative, as it was clear in its meaning.
The Wests contended that Drs. Kellum should be held to an oncologist's standard of care due to their treatment of West's cancer. Dr. Stein, a certified internist, indicated that the mass should have been removed as early as April 1986. The court reiterated that a physician could be held to another specialty's standard if they undertook those duties. It also established that if a doctor refers a patient to a specialist and the patient refuses, the doctor is only liable for negligent treatment, not for lack of skill.
The court determined that the Drs. Kellum's overlapping treatment with oncology was not inherently negligent. The trial court has discretion in determining an expert's qualifications, and such decisions are upheld unless there is an abuse of discretion, which was not found in this case. Finally, the Wests argued that the trial court erred in refusing to grant Instruction P-19 regarding Dr. Sanders' alleged deviation in performing a hysterectomy on Barbara West, but the court found that the Wests had not provided sufficient discovery responses for Dr. Sanders to understand that this was part of the claim against him.
Dr. Sanders claimed he was prejudiced by the Wests’ introduction of Dr. Wolfson’s expert testimony regarding the hysterectomy's propriety, as this defense had not been raised in their interrogatory answers. The trial court ruled that under M.R.C.P. 26(f)(2), parties must amend prior responses to interrogatories if new information makes them inadequate. The court noted that the Wests did not indicate an expert would testify that the hysterectomy was unnecessary, leading to the exclusion of the expert testimony and the jury’s lack of instruction on that issue.
The Wests contended that the trial court erred in instructing the jury about the liability of Sanders Clinic for Dr. Sanders' actions, asserting that a partnership can be vicariously liable for its agents even if the agent is not found liable. However, the court clarified that since Sanders and the Clinic were the same entity, any liability attributed to Sanders would also apply to the Clinic. If Sanders was not found liable, the Clinic could not be held liable either, rendering this argument without merit.
On cross-appeal, the doctors argued that the trial judge mistakenly reversed a prior summary judgment ruling that the Wests had not timely filed their lawsuit. The Wests filed their initial complaint on February 10, 1989, and an amended complaint on March 24, 1989, which included additional defendants. The doctors asserted that the statute of limitations barred the claim, as the Wests were aware of the cancerous tumor by February 9, 1987. The Wests countered that they did not know of an actionable claim until fall 1987 and contended that issuing process was not necessary for the lawsuit to be legally filed. The circuit court initially granted summary judgment for the defendants but later vacated that ruling.
The trial court correctly ruled that West's claim was not time-barred, as she acted promptly to assert her claim, serving process within one month and well within the 180-day limit set by the Rules. Relevant case law, including Erby v. Cox and In Re Estate of McClerkin, supports this decision. The Wests presented testimony from four medical experts against Drs. Sanders, Carl Kellum, and A.G. Kellum, though some testimony from Drs. Taylor and Stein was excluded. The jury ultimately sided against the Wests. Additionally, the issue of the appropriateness of a hysterectomy was not adequately presented during discovery, leading to its exclusion from jury instructions. Furthermore, the Wests’ argument for vicarious liability of the Sanders Clinic was dismissed since Dr. Sanders was not individually found liable. The court affirmed the judgment on all issues, with concurring opinions from multiple justices. The complaints against Drs. Bailey and White were dismissed with prejudice.
