FILED: July 15, 1998
BOBBETTE SANDERSON,
Appellant,
v.
SUSAN L. MARK, M.D.,
Respondent,
and
PACIFIC COMMUNITIES HOSPITAL,
a public body, DOUGLAS J. KIMMEL,
M.D., MARCUS P. JOHNSON, M.D.,
Defendants.
Appeal from Circuit Court, Lincoln County
Charles P. Littlehales, Judge.
Argued and submitted January 15, 1998.
Jeffrey B. Wihtol argued the cause for appellant. On the briefs were
Kathryn H. Clarke and Maureen Leonard.
Janet M. Schroer argued the cause for respondent. With her on the brief
were Marjorie A. Speirs and Hoffman, Hart & Wagner.
Before De Muniz, Presiding Judge, and Haselton and Linder, Judges.
HASELTON, J.
Affirmed.
HASELTON, J.
Plaintiff appeals from an adverse judgment, following a jury trial, in a
medical malpractice action arising out of defendant's(1) alleged misdiagnosis and related
failure to treat plaintiff's breast cancer. Plaintiff assigns error, inter alia, to the trial
court's evidentiary rulings that culminated in the exclusion of the testimony of plaintiff's
expert witness, Dr. James Gallant. We conclude that, on the totality of the record, any
error in the predicate rulings and in the ultimate exclusion of Gallant's testimony was
harmless. Plaintiff's other assignments of error lack merit. Accordingly, we affirm.
The parties strongly dispute issues of breach of the standard of care and
causation. However, except as expressly noted, the material historic facts that underlie
those disputes are largely undisputed. In May 1992, plaintiff, who was then 59 years old,
first consulted defendant, a board-certified internist practicing in Newport. Plaintiff had
recently moved to Oregon from California, where she had been treated by Kaiser
Hospital physicians. Before her first appointment with defendant, plaintiff completed a
four-page personal history questionnaire and checked "yes" to the question, "Have you
had any discharge from your nipples?" Defendant then conducted a complete physical
examination, which included taking an oral history from plaintiff, in which plaintiff
stated that her mother had died of breast cancer. Defendant also noted that plaintiff had
"chronic eczematous changes of the left nipple with fibrocystic changes in both breasts."
Defendant referred plaintiff to Dr. Douglas Kimmel, a radiologist, for a mammogram.
The referral form listed only "hormone repl[acement] therapy" under
"diagnosis/symptoms." Kimmel performed the mammogram and, in interpreting the
results, identified "fibrous stroma" and "benign appearing stromal calcifications."(2)
Defendant reviewed Kimmel's report, noting on it that it "looks OK," and did not refer
plaintiff for further evaluation or treatment.
Plaintiff visited defendant for unrelated problems on October 15, 1992 and
February 17, 1993, and the condition of plaintiff's left breast was not discussed at either
of those appointments. On April 15, 1993, plaintiff visited defendant for an annual
physical. Defendant made the following chart note entry: "BREASTS: Reveal no
dominant masses but induration[(3)] and tenderness over the left nipple and diffuse
fibrocystic changes." Under the heading "ASSESSMENT AND PLAN," defendant
wrote:
"3) The nipple change is fairly chronic and may just be eczematous.
She is due for a mammogram and we will need to consider referral to
Dr. Ryan for biopsy of this area. She will be returning in 3 weeks for
recheck on this and discussion of her mammogram."
Defendant referred plaintiff to Dr. Marcus Johnson, a radiologist, for the mammogram.
The parties dispute whether defendant told plaintiff to return in three weeks for further
discussion of the condition of her left breast.
The referral form to Johnson listed only "fibrocystic br[east] dis[ease]"
under "diagnosis/symptoms." Johnson interpreted the mammogram as follows:
"Patient has a somewhat asymmetric fibrotic benign appearing breast
pattern. There is again noted to be some subareolar fibrotic density on the
left greater than the right which has a somewhat stellate appearance. If the
patient has any suspicious lesion of the left areolar area further evaluation
clinically is suggested. * * * The patient has developed linear and punctate
calcifications which appear to be along the course of a vessel in the left
periareolar region superolaterally for which I do not think follow-up is
necessary. No other changes occurred.
"CONCLUSION: No significant change. See discussion above."
Defendant reviewed that report, again noting on it only that it "looks OK."
Plaintiff testified that, after the April 1993 mammogram, she received a
call from defendant's nurse informing her that her mammogram looked "okay."
According to plaintiff, the nurse did not tell her that she needed to come in for further
discussion of her condition or have a biopsy. Defendant's nurse testified that, although
she did not remember the conversation with plaintiff, her normal procedure was always
to give patients the information defendant had written on the radiologist's report and
sometimes to read the radiologist's conclusion, but not the entire report, to patients.
Defendant next returned to see plaintiff 10 months later, on February 15,
1994, complaining of an unrelated problem. The condition of plaintiff's left breast was
not discussed at that appointment. On February 22, 1994, plaintiff visited defendant for
an annual physical. Following that visit, defendant noted "pronounced thickening and
eczema in the area of the left nipple with some inversion of the nipple." Under a chart
entry denominated "Assessment and Plan," defendant noted:
"I am very concerned about the changes in the left breast contrary to her
assertion. This is a definite change from her previous exam. After her
mammogram last year she did not return for the reevaluation and
discussion that had been scheduled. But at this point, referral is definitely
indicated."
Defendant referred plaintiff to Dr. Ryan, a general surgeon, who
recommended and performed a biopsy on March 1, 1994. The pathology report on the
biopsy indicated "findings [that] are characteristic of an invasive ductal carcinoma of the
breast[.]" On March 16, 1994, Ryan performed a mastectomy of plaintiff's left breast.
Ryan started plaintiff on tamoxifen hormone therapy.
On May 24, 1994, plaintiff began seeing Dr. Norek, an oncologist in
Corvallis, for cancer treatment. After tests revealed that the cancer had metastasized to
other parts of plaintiff's body, including her spine, Norek classified patient's breast cancer
at Stage IV.(4) Norek recommended, and plaintiff underwent, radiation therapy and
continuation of tamoxifen. Although plaintiff's response to treatment was very good,
curing a patient with plaintiff's symptoms is highly unlikely and, in plaintiff's
circumstances, therapy is directed at controlling her disease as long as possible and
giving her the best possible quality of life.
In January 1995, plaintiff filed a complaint against Kaiser Foundation
Hospitals(5) and defendant, alleging that, as a result of their negligence, diagnosis of
plaintiff's breast cancer was delayed past the time when she could be cured. In March
1995, plaintiff amended her complaint to add as defendants Drs. Kimmel and Johnson,
the radiologists who interpreted her 1992 and 1993 mammograms, and Pacific
Communities Hospital, their employer. Thereafter, and before trial, plaintiff entered into
stipulated judgments of dismissal with Kaiser, Kimmel, Johnson, and Pacific
Communities Hospital.
In July 1996, plaintiff filed a third amended complaint against defendant
only. That complaint, on which the case was tried, alleged that defendant had been
negligent in three particulars:
"(A) In failing to diagnose the cancer in plaintiff's left breast until
in or about March of 1994; and
"(B) In failing to recommend and/or refer plaintiff for a biopsy of
her left breast until in or about March of 1994; and
"(C) In failing to communicate to defendants Pacific Communities
Hospital, Kimmel, and Johnson the history and clinical findings of the left
nipple area in connection with the mammograms of 1992 and 1993."
The case was tried to a jury over ten days in July and August 1996.
Plaintiff presented the testimony of nine expert witnesses, six of whom rendered opinions
that defendant had breached the "standard of care"(6) with respect to her conduct
underlying each of the three specifications of negligence and two of whom rendered
opinions that, because of those breaches, plaintiff's life expectancy had been substantially
shortened.(7) See ___ Or App at ___ (slip opinion at 13-18) (describing testimony more
fully). Conversely, defendant presented the testimony of five expert witnesses,
controverting the testimony of plaintiff's experts. The jury returned a general verdict for
defendant.
On appeal, plaintiff raises four assignments of error: (1) The trial court
erred in denying plaintiff's motion in limine to exclude references to plaintiff's claims
against the defendants--i.e., Kaiser Foundation Hospitals, Kimmel, Johnson, and the
Pacific Communities Hospital--who had been previously dismissed. (2) The court erred
in denying plaintiff's in limine motion to preclude defense counsel from cross-examining
one of plaintiff's expert witnesses, Dr. Gallant, about matters before the Oregon Board of
Medical Examiners ("BME") in which defense counsel's law firm was representing
Gallant. (3) The court erred in subsequently excluding Gallant's testimony. (4) The
court erroneously ruled that plaintiff's claim for loss of future income must be reduced by
projected future personal consumption.(8)
As amplified below, we reject the first assignment of error and conclude
that any error pertaining to the second and third assignments was harmless. That
disposition obviates consideration of the fourth assignment of error.
Plaintiff asserts that the trial court erred in denying her in limine motion to
preclude references to her claims against the dismissed defendants, because such
references were irrelevant and, in all events, were more prejudicial than probative.
Defendant responds, in part, that, whatever the putative merits of the court's ruling,
plaintiff's counsel "opened the door" for such references to Kimmel, Johnson and Pacific
Communities Hospital. For the reasons that follow, we agree with defendant.
Before trial, plaintiff moved to exclude any "mention of the existence or
resolution of any claim by plaintiff against any defendant dismissed from this case."
Plaintiff argued that such information was irrelevant, but, even if it were relevant, its
probative value would be outweighed by the danger of unfair prejudice, confusion of the
jury, and tendency to prolong the trial by the introduction of collateral issues. OEC 401;
OEC 403. Defendant contended that prior pleadings were relevant, in that they stated,
inconsistently with the third amended complaint, that plaintiff's disease began years
before her treatment with defendant began. The trial court denied the motion:
"I'm going to rule that the prior pleadings are admissible. I'm not
going to balance; it's rebuttable, and plaintiff may do what they [sic]
choose to rebut any matter brought up by the filing against Kaiser or any of
the other parties that are outside the context of this case at this time."
Defense counsel then stated:
"[T]he contention that the cancer existed at the time of the Kaiser treatment
is something that will be on the table from the beginning, in light of your
ruling. Whether or not it is tactically appropriate for me to comment on
these other claims [i.e., against Kimmel, Johnson, and Pacific
Communities Hospital], I don't know, until I hear their opening and hear
their case.
"* * * * *
"[A]t this point the malpractice claims against Kimmel, Johnson and
[Pacific Communities Hospital], I don't intend to mention those claims
unless I believe that [plaintiff's] Counsel raises that issue, and I will then
raise it in court. I'm certainly not going to in opening statement in front of
the jury without further discussion."
(Emphasis supplied.)
Thereafter, in opening statement, plaintiff's counsel stated:
"This case originally * * * included Kaiser of Northern California
* * *. Mrs. Sanderson had been a patient of Kaiser for years before
coming here to Newport and establishing care with Dr. Mark in 1992.
Kaiser was originally included because of the fear of the statute of
limitation, as well (inaudible) the lawsuit might not be (inaudible) but as
investigation was undertaken (inaudible) no claim against Kaiser
(inaudible) cancer, because Kaiser was not at fault.
"And as the case proceeded there was concern about the
radiologist[s] who had done the mammogram here in Newport at Pacific
Communities Hospital. And they were defendants in this case as well.
And when it became apparent through the work-up on the case, the fault
truly laid with Dr. Mark. * * * And she's now the sole remaining defendant
in this case."
Given that sequence--defense counsel's statement that, despite having
prevailed against the in limine motion, he would not mention the claims against Kimmel,
Johnson, and Pacific Communities Hospital unless plaintiff's counsel did so first, and
plaintiff's counsel's election, notwithstanding defense counsel's pledge, to refer to those
dismissed defendants in opening statement--plaintiff's counsel "opened the door" and,
effectively, waived any objection to the in limine ruling. As defendant observes on
appeal, "having made a tactical decision not to wait to see if defendant would go into this
matter, and instead taking the more aggressive 'preemptive strike' approach, plaintiff
cannot now be heard to complain * * *." Cf. State ex rel Juv. Dept. v. Cook, 325 Or 1,
932 P2d 547 (1997) (holding that party's choice to testify about substance of statements
that he had earlier sought to have suppressed eliminated possibility that denial of motion
to suppress harmed him); State v. Lopez, 147 Or App 314, 318, 936 P2d 386, rev den
326 Or 58 (1997) (same).
The corollary to that conclusion is that, whatever the merits of the in limine
ruling as applied to the other dismissed defendant, Kaiser, any error in that respect was
harmless. Plaintiff identifies no prejudice flowing from the references to Kaiser that was
distinct from that allegedly resulting from the references to Kimmel, Johnson, and Pacific
Communities Hospital.(9) Consequently, we reject that assignment of error.
We address together the two assignments of error pertaining to the
testimony of Gallant. Two or three months before trial, in May or June 1996, plaintiff
retained Gallant, a Corvallis internist, as an expert witness. At that time, the Board of
Medical Examiners (BME) had begun an investigation concerning Gallant, and Gallant
had retained Portland attorney Robert Wagner to represent him in that matter. Robert
Wagner and defendant's trial counsel, Mark Wagner, are both members of the law firm of
Hoffman, Hart & Wagner. Robert Wagner was, apparently, unaware that Gallant had
been retained as an expert in this matter, and Mark Wagner was unaware of his firm's
ongoing representation of Gallant before the BME. Plaintiff's counsel, Jeffrey Wihtol,
was aware of Hoffman, Hart and Wagner's representation of Gallant.
At the time that plaintiff retained Gallant, the BME's investigation was
"inactive" and, because the BME had not issued a complaint, the matter was confidential.
In late July, approximately one week before trial, the BME filed its complaint, making
the matter public.(10) At the beginning of plaintiff's case-in-chief, before calling Gallant as
plaintiff's first witness, plaintiff's counsel moved in limine as follows:
"Plaintiff's first witness is Dr. Gallant. Dr. Gallant has been a client
of [defendant's counsel's] law firm * * *. And additionally, Dr. Gallant has
recently received some press regarding some preliminary activities in the
Board of Medical Examiners * * * involving a patient's death in Corvallis.
And we would move in limine to preclude any mention of anything
involving extraneous legal matters that Dr. Gallant may be involved in that
are not pertinent to this case, and any mention whatsoever of anything to
do with the patient's death in Corvallis or preliminary proceedings before
the Board of Medical Examiners. Those matters have absolutely no
relevance to this case."
Defense counsel, after stating "this is absolutely hitting me cold," expressed concerns
about possible ethical problems arising out of his firm's representation of Gallant and
requested an OEC 104 hearing to ascertain the nature of Gallant's testimony and to
explore those concerns. After Gallant testified pursuant to OEC 104(3), defendant
moved to disqualify Gallant as a witness "because of the appearance of impropriety that
it creates and the potential of a mistrial that it creates":
"I'm concerned about the appearance of things in cross-examining the
firm's client, especially when this--if this were a situation where he'd been
a long-standing family doctor and was kind of a captive witness, that
would be one thing. But he's selected at a time when he's a current client
of the office and everybody knows who the players are, and it creates an
unnecessary problem.
"* * * * *
"And I--you know, this has nothing to do with the merits or the
demerits of the BME complaint, and that probably won't even be
mentioned, that's not really the point. The point is, we're going to be
making an official record where this gentleman will be on record under
oath, and the record may come back to haunt him for other reasons in other
proceedings. And it would come in through questions of an attorney in his
own firm. I just find that unseemly and uncomfortable. That's my
concern."
Plaintiff's counsel responded that the BME matter was "completely
extraneous" to any proper subject of cross-examination and, consequently, if plaintiff's in
limine motion were granted, any ethical concerns would be obviated. After hearing
arguments from the parties, the trial court ruled, "I think it creates a potential conflict and
* * * [t]he doctor will not be authorized to testify period."
Plaintiff then made an offer of proof. Gallant testified that he is a
physician specializing in internal medicine in Corvallis. Gallant rendered an opinion that
defendant had breached the standard of care with respect to each of the three
specifications of negligence. Of particular significance to our review and our assessment
of defendant's "harmless error" argument, Gallant testified that many medical
professionals--internists, family practitioners, general practitioners, nurse practitioners,
physician's assistants, nurses--perform breast examinations, and that the principles and
practices for conducting such exams and standard of care for breast exams is the same
"irrespective of the medical provider involved." Gallant further testified that the standard
of care required defendant, at the 1992 physical, to be aware that plaintiff had indicated
that she had had nipple discharge, to ask plaintiff about it, and to make a chart note of
plaintiff's response. Gallant further testified that, according to defendant's deposition
testimony, defendant stated that sometimes five days could elapse between a patient visit
and defendant's dictation of chart notes for that patient and that, soon after transcription,
her handwritten notes were discarded. Gallant testified that that lapse in time between
seeing patients, dictating chart notes, and reviewing the chart notes for accuracy
"increases the risk of error" in chart notes. Gallant did not, however, identify a generally
accepted practice as to the recording of chart notes--i.e., a maximum acceptable time
between an examination and dictating chart notes--much less testify that defendant had
violated such accepted practice.
At the conclusion of the offer of proof, plaintiff asked the trial court to
reconsider its ruling. The trial court declined, stating:
"I do it on a broad, general basis and not specifically, that there is a
potential for ethical conflict and that I think this could have been resolved
pretrial; it was not. * * * [T]he general ethical questions of counsel for the
defense * * * representing [defendant] * * * in this case and his law firm
for representing the doctor who is potentially being called to testify * * *
it's the basis for this Court excluding it."
Plaintiff then presented her case, which included testimony from nine
medical expert witnesses: (1) Susan Schenk, M.S.N., a certified nurse practitioner who
practices with the internal medicine clinic at Oregon Health Sciences University (OHSU)
in Portland; (2) Clinton Sayler, M.D., a radiologist who, before to his retirement in 1995,
practiced at Good Samaritan Hospital in Portland; (3) Harry Moore, M. D., a general
practitioner who practices in Albany; (4) Cynthia Ferrier, M.D., a board-certified
internist who practices at Providence Hospital in Portland; (5) Kathleen Folk, M.S.N., a
nurse practitioner who practices with the Internal Medicine Division at OHSU; (6)
Rodney Pommier, M.D., a general and oncology surgeon associated with OHSU's Multi-Disciplinary Breast Clinic; (7) Robert Craven, M.D., a board-certified radiologist who
practices in Portland; (8) Michael Lagois, M.D., a board-certified clinical and anatomical
pathologist who is medical director of the breast cancer consultation service at St. Mary's
Medical Center in San Francisco; and (9) David Newman, M.S.N., a nurse practitioner
who practices with the Department of Family Medicine at OHSU. Plaintiff asked six of
those nine experts--Schenk, Moore, Ferrier, Folk, Craven, and Newman--questions about
whether defendant had breached the standard of care in treating plaintiff, and all six
responded that she had. Defendant countered with a similarly imposing array of experts.
On appeal, plaintiff reiterates that her motion in limine should have been
granted and that the allowance of that motion would have eliminated the "potential for
ethical conflict" that underlay the court's preclusion of Gallant's testimony. Defendant
disputes those assertions and asserts that, in all events, any error by the trial court did not
affect any "substantial right" of the plaintiff. OEC 103(1); ORS 19.415(2). In asserting
"harmless error," defendant emphasizes that plaintiff presented extensive testimony of
medical experts other than Gallant and invokes the principle that erroneous exclusion of
evidence will be deemed harmless if the finder of fact otherwise receives substantially
the same evidence that was presented in the offer of proof. See, e.g., Sneath v. Phys. and
Surg. Hospital, 247 Or 593, 599, 431 P2d 835 (1967) (exclusion of testimony of
microbiologist was harmless where jury heard substantially similar testimony from two
physicians); Bremner v. Charles, 123 Or App 95, 104, 859 P2d 1148 (1993), rev den 318
Or 381 (1994) (stating principle).
Based on our review of the trial record, and particularly the testimony of
plaintiff's other medical witnesses, we conclude that, even assuming that the trial court
erred in precluding Gallant's testimony, that error was not reversible error. An extended
comparison of Gallant's putative testimony with the testimony of plaintiff's other experts
would serve little purpose. However, we do specifically address, and reject, plaintiff's
contention that Gallant was a unique witness whose testimony on two issues--the
standard of care for an internist in a small-to-medium-sized Oregon town and practice
pertaining to chart notes--was essentially irreplaceable.
Plaintiff first contends it is likely that any error in excluding Gallant's
testimony was prejudicial because Gallant's practice and specialty were most like those of
defendant:
"Dr. Gallant was that rare and difficult witness for plaintiffs in
medical negligence cases, particularly those tried outside the metropolitan
area: a physician with a similar practice, in a similar and nearby
community. By statute, codifying a well-accepted common law principle,
[defendant's] conduct is to be judged by the standard of medical practice 'in
the same or similar community.' ORS 677.095. Only two other physicians
were critical of [defendant's] care: one who practiced in a different
specialty, and one from Portland. While scholars and professionals may
believe, and plaintiff's attorneys may urge, that the relevant 'community' is
a national one, jurors hearing these words may well interpret them more
narrowly, taking a more parochial view which is often encouraged by
defense counsel in medical negligence actions * * *."
(Footnote omitted.) Plaintiff further contended that Dr. Moore, one of those two
physician witnesses, "fizzled" on the stand, testifying that defendant did meet the
standard of care with respect to the 1992 physical. Because of that shortfall in Moore's
testimony, plaintiff asserts, Gallant was the sole "same or similar community" witness
who would have provided unequivocal testimony that defendant breached the standard of
care.
The short answer to plaintiff's argument is that each of plaintiff's medical
experts, including Gallant, and defendant's expert witnesses,(11) agreed that there was a
uniform (i.e., non-"local" standard) "standard of care." Accord Mosley v. Owens, 108 Or
App 685, 691, 816 P2d 1198, rev den 312 Or 527 (1991) ("Oregon's 'locality rule' does
not preclude the possibility that certain standards of care are uniform throughout the
nation."). No one disputed the uniformity of the "standard of care." Accordingly,
Gallant's "local" testimony in that regard would merely have reiterated what was
uncontroverted.
Nor was Gallant's putative testimony that defendant breached the standard
of care with respect to all three specifications of negligence qualitatively different from
testimony plaintiff adduced from her other witnesses. Six of plaintiff's nine medical
experts offered an opinion as to whether defendant had breached the standard of care;
each testified that she had. Of those six, one--Moore--did acknowledge on cross-examination that he believed that defendant met the standard of care as to the 1992
physical. However, even without Moore's testimony, plaintiff presented unqualified
testimony from five medical experts that defendant had breached the standard of care.
The addition of Gallant's testimony to the same effect is not likely to have made any
difference. See Sneath, 247 Or at 599.
Plaintiff alternatively contends that exclusion of Gallant's testimony was
prejudicial because Gallant was the only physician expert who would have testified about
deficiencies in defendant's charting method. The only reference to charting in Gallant's
offer of proof was as follows:
"Q. [By plaintiff's counsel.] Dr. Gallant, did you review Dr. Mark's
description in her deposition of her method of preparing the typewritten
chart notes for her patients?
"A. Yes.
"Q. Does Dr. Mark dictate her chart notes concurrently with the
patient visit?
"A. No, it was stated at times it could be up to five days from the
visit to the dictation, and that the handwritten notes were discarded.
"Q. Do you recall from Dr. Mark's deposition whether Dr. Mark
had her handwritten notes of the patient visit available to her at the time
that the typewritten notes came back from the transcriptionist?
"A. She did not, according to the testimony, have any handwritten
notes available at the time the transcription notes were returned.
"Q. And, Dr. Gallant, based on your education and training and
experience in caring for patients over the years, do time lapses between
seeing the patient, dictating the chart notes, and then reviewing the chart
notes for accuracy, create increased possibility for error in chart notes?
"A. Each one of those increases the risk of error."
Significantly, Gallant did not identify a standard for the acceptable time period between
the patient's examination and dictating chart notes, much less testify that defendant had,
in fact, breached such a standard with respect to plaintiff.
After the exclusion of Gallant's testimony, plaintiff presented expert chart
note testimony through Schenk, a certified nurse practitioner, who testified that she had
reviewed defendant's deposition in which defendant stated that she sometimes waited up
to five days before dictating chart notes and that that, in Schenk's opinion, was not
"consistent with the standard of care." Defense counsel did not cross-examine Schenk on
that "standard of care" testimony. Defendant subsequently testified that, at the relevant
time, her practice was to dictate chart notes at the end of the day or the first thing the next
morning, although sometimes it was a day or two later, and that it was unlikely that she
waited five days to dictate plaintiff's chart notes.
Given that juxtaposition of proof, the exclusion of Gallant's incidental, and
largely inconclusive, references to charting practices, ultimately did not prejudice
plaintiff. Gallant did not render an opinion that defendant's alleged standard practice,
much less her particular conduct with respect to keeping plaintiff's chart notes, was
improper. Rather, he merely stated the unexceptional proposition that the greater the
delay between observation and recordation, the greater the risk of imperfect recollection.
Conversely, Schenk went far beyond that "risk of error" truism and explicitly testified
that defendant's alleged general charting practices violated the standard of care. Any
error in precluding Gallant's testimony was harmless.
Affirmed.
1. "Defendant" in this opinion refers solely to Susan L. Mark, M. D. Other
individuals and entities were parties to the action but were dismissed before trial.
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2. "Stroma" means "[t]he framework, usually of connective tissue, of an
organ, gland, or other structure; distinguished from the * * * specific substance of the
part." Stedman's Medical Dictionary, 1348 (23rd ed 1976). "Calcification" means "[a]
process in which tissue or noncellular material in the body becomes hardened as the
result of precipitates or larger deposits of insoluble salts of calcium[.]" Id at 210.
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3. "Induration" means "[t]he process of becoming extremely firm or hard, or
having such physical features." Stedman's Medical Dictionary at 703.
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4. Physicians assign a "stage" to a patient's breast cancer based on a number
of factors, including the metastatic involvement of areas of the body other than that
where the primary cancer is located. Generally, a lower stage indicates a better
prognosis, while a higher stage indicates a poorer prognosis. Stage IV is the highest
stage.
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5. Kaiser, which provided plaintiff's medical care in California from 1984
through 1991, was later dismissed from the case.
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6. The proper area of inquiry for an expert witness is not "standard of care," a
legal concept, but, rather, "knowledge of the methods of customary and proper medical
treatment in that or a similar community." Creasey v. Hogan, 292 Or 154, 166, 637 P2d
114 (1981); see also Mosley v. Owens, 108 Or App 685, 690, 816 P2d 1198, rev den 312
Or 527 (1991).
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7. Plaintiff's ninth expert witness was an economist.
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8. In general, the dispute over the measure of recovery concerned whether
plaintiff's recovery for loss of future pension income should be a "gross" or a "net"
recovery. The former corresponds to the measure commonly employed in personal injury
cases; the latter approximates the measure of recovery in wrongful death cases. See, e.g.,
Meier v. Bray, 256 Or 613, 614, 475 P2d 587 (1970).
Although this is not a wrongful death case, the gravamen of plaintiff's
complaint is that her life expectancy has been dramatically shortened as a result of
defendant's alleged negligence. Some courts have held that, in such "shortened life
expectancy" cases, the "gross" measure of recovery applies--i.e., the recovery for future
loss of income should not be reduced for projected personal consumption. See, e.g.,
Burke v. United States, 605 F Supp 981, 989-90 (D Md 1985).
No Oregon appellate opinion has ever addressed that issue. Given our
disposition of plaintiff's other assignments, we do not address the propriety of the trial
court's endorsement of a "net" approach.
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9. For example, plaintiff points to defense counsel's three references in closing argument to plaintiff suing Kimmel and Johnson for "three-and-a-half million bucks" as exemplifying the inflammatory effect of references to the dismissed defendants.
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10. The only reference to the subject of the BME proceedings was an allusion by counsel to "euthanasia."
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11. Except for defendant's own testimony, the defense did not present testimony from an internal medicine specialist in a similarly-sized community.
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