|November 7, 2013|
Previously published on November 6, 2013
In Hall vs. Rocky Mountain Emergency Physicians, LLC, - P.3d - 2013 West Law 4768310 (September 6, 2013)1, the Idaho Supreme Court reaffirmed that plaintiffs must satisfy strict evidentiary standards when pursuing medical malpractice claims.
FACTS OF THE HALL CASE
The underlying facts in the case are important to summarize. In June, 2009, the Plaintiff, Heather Hall, sought treatment for a severe headache at the Portneuf Medical Center in Pocatello. A physician's assistant, Jeff Johnson, was assigned by the hospital to examine and treat Ms. Hall. According to Ms. Hall, the physician's assistant informed her that she would need to undress from the waist up for the examination to proceed. She removed her shirt and put on a hospital gown but she left her bra on. Mr. Johnson asked her to remove her bra. He needed to check her heartbeat and told her that an underwire in her bra was in his way. Ms. Hall described the subsequent events as follows:
Without consent, Johnson completely then lifted my bra up and over exposing my left breast, looked under my gown and brushed his hand under my left nipple, the [sic] continued with the stethoscope while resting his hand on my left breast for approximately 15-20 seconds, while claiming to check my heart beat.
Based upon the facts alleged by Ms. Hall, claims were brought against the physician's assistant, Johnson and against his supervising physicians, Curtis Holt and Randall Fowler, together with claims against Rocky Mountain Emergency Physicians. Specific claims were asserted for battery, intentional infliction of emotional distress, and invasion of privacy.
DEFENDANTS' SUMMARY JUDGMENT MOTION
The Defendants moved for summary judgment asserting, inter alia, that Ms. Hall's claims were subject to the expert witness testimony requirement set forth in Idaho Code §§ 6-1012 and 6-1013. The Defendants supported their motion for summary judgment with affidavits of the Defendants, each of whom stated that their conduct during Ms. Hall's visit to the Emergency Room met the applicable standard of healthcare practice.
In response to the summary judgment motion, Ms. Hall filed an affidavit from Dr. David Beauman, an Idaho Falls physician. Dr. Beauman stated that he was familiar with the standard of care for physicians and physicians assistants working in emergency rooms in Pocatello. He stated that he obtained such familiarity in light of the fact that he had hired a doctor from Pocatello who had emergency room privileges and based upon his personal observations of the Emergency Room at Portneuf Medical Center. He further stated that he had consulted with a Pocatello emergency room physician about Ms. Hall's case.
Beyond contending that Dr. Beauman's testimony was sufficient to overcome the motion for summary judgment, Ms. Hall also asserted that Idaho Code § 54-1814 (22) established a statewide standard of healthcare practice that the Defendant Johnson had violated. § 54-1814 (22) provides that physicians assistants, such as Defendant Johnson, are subject to discipline for "engaging in any conduct that constitutes an abuse or exploitation of a patient arising out of the trust and confidence placed in the physician by the patient." In his affidavit, beyond referencing the standard for healthcare practice applicable in Pocatello, Dr. Beauman further provided the opinion that every physician within the state of Idaho "knows that fondling a patient in the course of a medical examination or treatment violates this section [§ 54-1814 (22)] of the Idaho Code and subjects him or his physician assistant to discipline.
The District Court concluded that the Plaintiff's claims were in fact subject to and governed by Idaho Code §§ 6-1012 and 6-1013. The Court further held that Dr. Beauman's affidavit did not sufficiently establish his familiarity with the standard of care for Pocatello Emergency Rooms physicians at the time of the incident, thus rendering his opinion inadmissible. Summary judgment was granted to the Defendants2.
THE SUPREME COURT'S DECISION
On appeal, the Supreme Court affirmed the dismissal of the Plaintiff's claims holding as follows:
- Although certain of the claims asserted by the Plaintiff were in the nature of intentional torts, the district court nonetheless held that the "gravaman" of the claim was medical malpractice. Relying on Litz vs. Robinson, 131 Idaho 282, 955 P.2nd 113 (Ct. App 1997), the court agreed that "artfully labeling [her] cause of action as a claim for the intentional infliction of emotional distress," does not insulate the Plaintiff from satisfying the evidentiary requirements of Idaho Code §§ 6-1012 and 6-1013. The Plaintiff did not raise this decision by the District Court as an issue on appeal; therefore, the Supreme Court did not address this specific issue.
- The Supreme Court extensively addressed the provisions of Idaho Code §§ 6-1012 and 6-1013. The Court made clear, throughout its opinion, that each element of the statutory enactment must be met by the Plaintiff in order to satisfy the evidentiary burden that the statutory enactments impose. An expert in any medical malpractice case must be able to demonstrate his/her familiarity with standard of care for the class of medical provider at the time and in the community of the alleged malpractice. It is not a requirement that the expert actually have practiced in the community so long as the out of area expert's affidavit states how he/she became familiar with the local standard of care. Thus an expert may confer with an out of area expert to obtain knowledge of the local standard. See, Dulaney vs. St. Alphonsus Regional Medical Center, 137 Idaho 160, 45 P.3d 816 (2002). Alternatively, the out of area expert may consult with another out of area specialist, so long as the testifying expert establishes that the specialist that has been consulted had sufficient contact with the particular locale in question so as to demonstrate personal knowledge of the local standard. See, Suhadolnick vs. Pressman, 151 Idaho 110, 254 P.3d 11 (2011).
- In his affidavit, Dr. Beauman identified the consultation that he had with another medical doctor in Pocatello who also has privileges to practice emergency medicine in Pocatello. In his affidavit, Dr. Beauman did not identify his own medical specialty. This was not a fatal defect since the Supreme Court has held that the statutory evidentiary requirements in §§ 6-1012 and 6-1013 do not require that the testifying expert be of the same medical specialty as the defendant healthcare provider, so long as the testifying expert establishes familiarity with the standard that is applicable to the defendant physician. See, Pearson vs. Parson, 114 Idaho 334, 757 P.2d 197 (1988).
- However, Dr. Beauman's affidavit was fatally flawed because it did not express familiarity with the standard of care at the time of the incident. Although Dr. Beauman indicated that he had inquired of other physicians having emergency room privileges, he did not state in his affidavit the specific time when those individuals had such privileges. He stated that the individual that he spoke with currently has emergency room privileges in Pocatello, but there was no indication that the physician had knowledge of the standard of care at the specific time period relevant to the case. Based upon this failure, the Supreme Court affirmed the decision of the District Court.
- The overriding impact of the Supreme Court's decision in Hall vs. Rocky Mountain Emergency Physicians et al is that the Supreme Court continues to require strict and detailed compliance with the requirements of Idaho Code §§ 6-1012 and 6-1013 as evidentiary requirements before testimony will be received in any type of case where the "gravaman" of the case is medical malpractice.
- The Plaintiff in Hall, specifically through the affidavit testimony of Dr. Beauman, suggested that Idaho Code § 54-1814 creates a statewide standard of care that was breached by physician assistant Johnson during his examination of Ms. Hall. While the Supreme Court has approved testimony from a medical expert that a statewide standard of care has been adopted and was breached in a particular case (see Grover vs. Smith, 137 Idaho 247, 46 P.3d 1105 (2002)), the court requires that specific proof be established before allowing reliance upon a statewide standard of care. In particular, in Grover vs. Smith, the court held that "standard of care anywhere in Idaho cannot be below the standard required to have the fitness to be licensed." In Grover, the statute at issue, Idaho Code §§ 54-912, 918, and 924 granted to the board of dentistry the authority to establish "a minimum standard of care for practicing dentistry anywhere in Idaho." The expert in Grover vs. Smith was entitled to testify, and therefore met the evidentiary requirement, because the alleged breach by the defendant physician was a breach of a basic, elementary standard that had to be met in order to become licensed as a dentist in Idaho.
- In Hall, however, in analyzing Idaho Code § 54-1814, the Supreme Court held that the statute does not serve the same purpose as did the statute addressed in Grover vs. Smith; rather, § 54-1814 does not establish the requirements or qualifications for obtaining a medical license. To the contrary, the statute identifies the grounds for which a physician maybe disciplined. Of importance, § 54-1814 authorizes disciplinary action against a physician who "fails to meet the standard of healthcare provided by other qualified physicians in the same community or similar communities taking into account his training, experience and the degree of expertise to which he holds himself out to the public." This language is remarkably similar to the evidentiary standard set forth in Idaho Code § 6-1012. Based upon this, the Supreme Court concluded that Idaho Code § 54-1814 (22) did not establish a statewide standard of practice.
- Importantly, although in dicta, the Supreme Court noted that had the Plaintiff identified Idaho Code § 18-919, as establishing a statewide standard of healthcare practice, the Plaintiff's claim would have been allowed to proceed. § 18-919 addresses "sexual exploitation by a medical care provider." This statute clearly provides a statewide standard of healthcare practice that would have been applicable in the Hall litigation had it been plead or referenced in the affidavit of Dr. Beauman.3
In summary, the Hall case is another in the ever increasing line of decisions issued by the Supreme Court strictly construing and enforcing the evidentiary requirements imposed upon parties seeking to pursue medical malpractice claims. An expert must establish not only familiarity with the standard of health care practice, but also that such familiarity is directly tied to the time the alleged malpractice occurred.
1Although the opinion was issued by the Supreme Court, the opinion has not yet been released for publication pending potential motion for reconsideration and/or revision by the Supreme Court.
2The trial court did not address Dr. Beauman's contention that a statewide standard of practice was established by Idaho Code § 54-1814(22)
3Justice Jim Jones specially concurred in the result issued by the Court. Justice Jones noted his belief that the Court's attempt to distinguish between a statute addressing licensure vis-a-vi a statute addressing discipline is a distinction without significant difference. Justice Jones stated his belief that the disciplinary provisions contained in Idaho Code § 54-1814(22) would establish a statewide standard of healthcare practice because "there is no basis for distinguishing between the requirements for obtaining a medical license and those for keeping it."