Opinion
CV095025795S.
12-07-2012
Dawn WILLIAMS, Administratrix et al. v. VILLAGE MEDICAL ASSOCIATES et al.
UNPUBLISHED OPINION
LINDA K. LAGER, Judge.
This was a wrongful death trial based on a claim of medical malpractice, specifically that the defendant internal medicine physician was professionally negligent when he discontinued the decedent's anticoagulation medication upon discharging him from in-patient treatment at a rehabilitation facility. On March 28, 2012, the jury returned a verdict in favor of the defendants Dr. Bjorn Ringstad and Village Medical Associates after unanimously answering " no" to the first of two interrogatories that had been submitted to them with respect to the standard of care and causation .
The following interrogatories were submitted to the jury:
The central issue in this case was whether Dr. Ringstad was professionally negligent when he did not continue the plaintiff's decedent on anticoagulant medication upon his discharge from an in-patient stay at a rehabilitation facility. The evidence established that the decedent, who was gravely injured in an accident, had been placed on anticoagulant medication for prophylaxis for deep vein thrombosis (DVT) upon his admission to Yale-New Haven Hospital (Yale) and that several days later an inferior vena cava filter was inserted due to concerns about pulmonary emboli. When the decedent was discharged from Yale to the rehabilitation facility, he was maintained on DVT prophylaxis pursuant to instructions in his discharge summary. At the time Dr. Ringstad discharged the decedent from the rehabilitation facility, on August 30, 2005, he discontinued the anticoagulant medication because in his opinion the decedent was ambulatory and had no further need for DVT prophylaxis. On October 16, 2005, the decedent died. The probable cause of his death, according to the testimony of Dr. Michael Kashjarian who performed an autopsy on October 17, 2005, was multiple pulmonary emboli. The plaintiffs maintained at trial that the standard of care required the decedent to remain on anticoagulant medication for a minimum of three months while the defendants maintained that the standard of care did not require continuation of anticoagulant medication in a patient such as the decedent, who was ambulatory and had an inferior vena cava filter to prevent pulmonary embolism in place. By their verdict, the jury agreed with the defendants.
An inferior vena cava filter is used for the prevention of pulmonary embolism.
The plaintiffs filed a timely motion to set aside the verdict (entry # 251) to which the defendants objected (entry # 253). The court heard argument on the motion and objection on November 28, 2012. The plaintiffs claim the court improperly allowed Dr. Alan Dietzek, a board certified vascular surgeon, to testify on behalf of the defense as to the standard of care that applied to Dr. Ringstad, a board certified internal medicine physician, at the time of the claimed negligence in August 2005. As a result, the plaintiffs claim the weight of the expert opinion offered by their expert, Dr. Leonard Horovitz, a board certified internal medicine physician and a board certified pulmonologist, was somehow diluted or diminished so that it was potentially disregarded by the jury in determining the prevailing professional standard of care. The defendants respond that the court properly allowed Dr. Dietzek to testify about the standard of care and, alternatively, that if the court erroneously admitted his opinion it was harmless because it was cumulative to the standard of care opinion of Dr. David Weinshel, a board certified internal medicine physician who testified, unchallenged, as a defense expert.
Dr. Dietzek was offered on the standard of care with respect to the administration and discontinuation of anticoagulant medication for the purpose of DVT prophylaxis. (See entry # 223, Defendant's Amended Disclosure of Expert and entry # 195, Supplemental Disclosure of Expert Witness). The plaintiffs moved to preclude Dr. Dietzek's testimony on the ground that he was not a similar health care provider within the meaning of General Statutes § 52-184c(d). (Entry # 228.) At the court's direction, the defendants submitted an affidavit from Dr. Dietzek in which he averred that in his practice he is held to the same standard of care as internal medicine physicians and that he was " familiar with the standard of care which is applicable to both vascular surgeons and internists regarding DVT prophylaxis, " and specifically the standard of care applicable from August through October 2005. (Entry # 244, ¶ ¶ 4, 6, 7.) The plaintiffs were permitted to conduct a voir dire examination regarding Dr. Dietzek's qualifications to offer standard of care testimony pursuant to § 52-184c(d) before his testimony was offered to the jury. Following the voir dire, the court denied the motion to preclude and allowed Dr. Dietzek to testify before the jury.
There is no disagreement that § 52-184c(d) governs whether Dr. Dietzek could offer his opinion as to the standard of care applicable to Dr. Ringstad. Section 52-184c(d)(2) sets out the qualifications the court must consider to allow standard of care testimony from a physician who is not board certified in the same area of practice as the defendant physician. General Statutes § 52-584c(d)(2) provides that a physician, who is not a similar health care provider within the meaning of § 52-584c(c), may testify about the prevailing professional standard of care if " to the satisfaction of the court" the physician " possesses sufficient training, experience and knowledge as a result of practice or teaching in a related field of medicine" based on the physician's " active involvement in the practice or teaching of medicine within the five-year period before the incident giving rise to the claim."
It is undisputed that Dr. Dietzek, a board certified vascular surgeon licensed in the state of Connecticut, earned his medical degree in 1983 and has been actively involved in the practice and teaching of medicine since that time. In addition, Dr. Dietzek has cared for many patients who received anticoagulant medication for DVT prophylaxis. During the course of the voir dire examination outside of the presence of the jury, Dr. Dietzek testified that the standard of care for the administration of anticoagulant medication for DVT prophylaxis " is not specific to whether you are an internist or a surgeon." He stated that there are general recommendations and guidelines for the administration of DVT prophylaxis that are promulgated every four years based on an extensive review, or meta-analysis, of the surgical and medical literature, that those guidelines are promulgated by a panel that includes surgeons and medical practitioners such as internists and pulmonologists and that the guidelines are recognized as applying to surgeons, internists and pulmonologists. He also testified that he had spoken with internal medicine physicians " numerous times" about the administration of anticoagulant medication for DVT prophylaxis.
In his testimony before the jury, Dr. Dietzek testified that the guidelines are promulgated by a multi-disciplinary board under the auspices of the A.C.C.P. (American College of Chest Physicians) every four years based on a review of world literature.
Dr. Dietzek clearly was qualified to offer expert testimony pursuant to § 52-184c(d)(2). At the time of the alleged professional negligence, August 30, 2005, Dr. Dietzek had been engaged in the active practice of medicine for over twenty years. His affidavit and testimony provided a sufficient foundation for this court's conclusion that he possessed sufficient knowledge, training and experience to offer an opinion regarding the prevailing professional standard of care applicable to Dr. Ringstad for the administration and discontinuation of anticoagulant medication for the purpose of DVT prophylaxis.
The court has considerable discretion in making the determination that a physician who practices in a different field from the defendant physician may nonetheless have sufficient knowledge of the standard of care applicable to the defendant. As the Supreme Court has stated repeatedly, " the crucial question is whether ... [the expert] knows what ... [the standards of practice] are." (Citations omitted; internal quotation marks omitted.) Friedman v. Meriden Orthopaedic Group, P.C., 272 Conn. 57, 69, 861 A.2d 500 (2004); see Pool v. Bell, 209 Conn. 536, 542, 551 A.2d 1254 (1989); Fitzmaurice v. Flynn, 167 Conn. 609, 617, 356 A.2d 887 (1975); Ardoline v. Keegan, 140 Conn. 552, 557, 102 A.2d 352 (1954). " Medical specialties overlap, and it is within the court's discretion to consider that fact in exercising its discretion ... It is not the artificial classification of a witness by title that governs the admissibility of the testimony, but the scope of the witness's knowledge of the particular condition." Marshall v. Hartford Hospital, 65 Conn.App. 738, 758, 783 A.2d 1085 (2001).
Expert testimony may be admitted from a specialist in another field when there is evidence that the treatment or procedure is common to that specialty as well as to the defendant's speciality and that likewise the standard of care for that treatment or procedure is also common. Katsetos v. Nolan, 170 Conn. 637, 646-47, 368 A.2d 172 (1976); Marshall v. Yale Podiatry Group, 5 Conn.App. 5, 8-9, 496 A.2d 529 (1985); Buckley v. Lovallo, 2 Conn.App. 579, 584-86, 481 A.2d 1286 (1984). In his affidavit, during the plaintiffs' voir dire examination and in his testimony before the jury, Dr. Dietzek clearly articulated that there was, at the relevant time, a single and common prevailing professional standard of care for the administration and discontinuation of anticoagulant medication for the purpose of DVT prophylaxis. Based on his review of the facts of the decedent's case, Dr. Dietzek opined that Dr. Ringstad met that standard of care when he discontinued the decedent's anticoagulant medication when he discharged him from the rehabilitation facility.
Dr. Dietzek's opinion was identical to the opinion of Dr. David Weinshel, a board certified internal medicine physician licensed in the state of Connecticut, who testified as to the standard of care on behalf of the defendants without challenge. Like Dr. Ringstad, Dr. Weinshel had worked as a medical director in a rehabilitation facility. Like Dr. Dietzek, Dr. Weinshel had cared for many patients undergoing anticoagulant therapy for DVT prophylaxis. In addition to testifying that Dr. Ringstad met the standard of care when he discontinued the decedent's anticoagulant medication when he discharged him from the rehabilitation facility, Dr. Weinshel contradicted the standard of care testimony of the plaintiffs' expert, Dr. Horovitz, that the decedent should have been maintained on some form of anticoagulant medication for a minimum of three months. Thus, even if the court erred in allowing Dr. Dietzek to testify about the standard of care, Dr. Weinshel's testimony alone provided a sufficient basis for the jury to reject Dr. Horovitz's opinion and return a verdict in favor of the defendants.
For the foregoing reasons, the motion to set aside the verdict is denied.
1. Do you find, by a fair preponderance of the evidence, that the defendant Dr. Ringstad was professionally negligent in discontinuing Lovenox for Mr. Arowojeka on August 30, 2005?
____Yes ____No
If your answer to question 1 is " yes" go to question 2.
If your answer to question 1 is " no" please complete the Defendants' Verdict form.
2. Do you find, by a fair preponderance of the evidence, that the professional negligence of Dr. Ringstad, as found by you in answer to question 1, was a proximate cause of the death of Soliu Arowojeka?
____Yes ____No
If your answer to question 2 is " yes" please complete the Plaintiffs' Verdict form. If your answer to question 2 is " no" please complete the Defendants' Verdict form.