In this dental malpractice litigation, we find ourselves in agreement with the court of appeal that the trial court erred in excluding from the jury certain portions of the testimony offered by Dr. Bruce Lovelace, a periodontist who would have testified relative to the standard of care applicable to general dentists practicing in Baton Rouge, Louisiana.
On or about June 13, 1983, Ms. Elaine McLean filed suit against Dr. Raymond K. Hunter, alleging Dr. Hunter committed various acts of dental malpractice in his diagnosis and treatment of a condition known as periodontal disease.
Dr. Lanius diagnosed a "periodontal abscess" in two of Ms. McLean's teeth. He then performed limited oral surgery to insure drainage of the abscess. When Ms. McLean returned on September 9, 1981, Dr. Lanius, after having discussed the case with Dr. Hunter, referred Ms. McLean to Dr. Bruce Lovelace, a periodontist.
Plaintiff subsequently called to the stand two additional periodontists, Dr. Alfred W. Broxson and Dr. Joseph Lawrence, and attempted to qualify the doctors as experts in general dentistry. This move was also rebuffed by the trial court. However, the trial court did accept Dr. Broxson and Dr. Lawrence as experts in periodontistry rather
The trial court also allowed plaintiff's counsel to question the defendant concerning the extent of his dental practice in the field of periodontistry. The trial court then instructed the jury it would have to decide whether Dr. Hunter had held himself out as a specialist in periodontistry. If the jury found Dr. Hunter had held himself out as a specialist, he was to be judged by the standards of a specialist (the latter standards having been attested to by Dr. Broxson and Dr. Lawrence). However, if the jury found Dr. Hunter had not held himself out as a specialist, the trial judge, in effect, instructed the jury to disregard the testimony of Dr. Broxson and Dr. Lawrence, since the testimony elicited from the two periodontists addressed the appropriate standard of care for practitioners of periodontistry, rather than for practitioners of general dentistry.
The jury, in response to written interrogatories provided by the trial court, found Dr. Hunter was to be judged in accordance with the standard of care applicable to a "general practitioner of dentistry" rather than to the standard of care applicable to a "periodontist." The jury further found the defendant's conduct was not below the standard of care applicable to a practitioner of general dentistry. Accordingly, the jury rendered a verdict in favor of Dr. Hunter.
The effect of the trial court's instructions was that none of the three periodontists called by the plaintiff were allowed to express an expert opinion as to the appropriate degree of periodontal care expected of general dentists practicing in the Baton Rouge area, nor were they allowed to express an expert opinion as to whether conduct presumably similar to Dr. Hunter's may have breached that standard. The instructions provided by the trial court served to nullify the opinions of Dr. Broxson and Dr. Lawrence, who were allowed to testify only as to the appropriate standard of care expected from practitioners of periodontistry. Although plaintiff's counsel objected in general to the trial court's rulings relative to the testimony of Dr. Broxson and Dr. Lawrence, he did not proffer the testimony of the periodontists, as he had done previously with the testimony of Dr. Lovelace.
As was previously noted, the court of appeal held the trial court erred in excluding the expert testimony of Dr. Lovelace concerning the appropriate standard of care for general dentists practicing in the Baton Rouge area.
It is this language which prompted our granting writs in this case.
TESTIMONY OF DR. LOVELACE
In excluding the testimony of Dr. Lovelace, the trial court relied on La.R.S. 9:2794(A)(1), which provides, in pertinent part:
As the court of appeal correctly noted, this provision sets forth the requisite burden of proof, but does not specify or set limits on the qualifications of a professional witness who may be presented to sustain the burden.
We now hold it is a specialist's knowledge of the requisite subject matter, rather than the specialty or sub-specialty within which the specialist practices, which determines whether a specialist may testify as to the degree of care which should be exercised by general practitioners. A particular specialist's knowledge of the subject matter on which he is to offer expert testimony should be determined on a case by case basis.
Implicit support for our holding is provided by La.R.S. 9:2794(B), which provides that a party to a malpractice suit has "the right to subpoena any ... dentist ... for trial to establish the ... degree of care ordinarily exercised." A periodontist such as Dr. Lovelace is obviously no less a dentist because he engages in a specialty practice rather than a general dentistry practice.
Although we have not previously addressed this particular issue, we find support for our opinion in the decisions of other state courts. A case with a particularly compelling factual setting is Evans v. Ohanesian, 39 Cal.App.3d 121, 112 Cal.Rptr. 236 (1974). In Evans, a dental malpractice suit was brought against a practitioner of general dentistry. The plaintiff, in order to meet the requisite burden of proof, offered the testimony of a periodontist who examined the plaintiff subsequent to the general practitioner's treatment.
The trial court refused to permit the periodontist to express an opinion as to the standard of practice of general practitioners and would not allow him to express an opinion as to whether the defendant breached that standard. Outside the presence of the jury, the trial court noted "[the periodontist's] standard of practice as a specialist was higher than the standard of practice of general practitioners ... and... it would be unfair to hold the defendant to a higher standard of practice than that possessed generally by other dentists...." Evans, 112 Cal.Rptr. at 239. Thereafter, using language with which we are in agreement, the California Court of Appeal found the trial court had erred in excluding the periodontist's testimony:
A similar decision was reached by the Michigan Supreme Court in Siirila v. Barrios, 398 Mich. 576, 248 N.W.2d 171 (1976). In this case, a medical malpractice suit was brought against a general practitioner and a hospital. When plaintiff's counsel attempted to have a pediatrician testify as to the standard of care applicable to the general practitioner, the trial court instructed the jury the pediatrician's testimony was not to be considered in determining the standard of care applicable to the general practitioner. The Michigan Supreme Court disagreed, and held specialists may testify to the standard of care expected of general practitioners "as long as the specialist is familiar with the applicable standard of the general practitioner." Siirila, 248 N.W.2d at 172.
Turning now to the facts before us, we find Dr. Lovelace was qualified to testify as to the standard of care expected of general dentists practicing in Baton Rouge, Louisiana. Dr. Lovelace's knowledge of the requisite standard of care is evidenced by the following:
In short, we find that Dr. Lovelace was amply qualified to testify concerning the standard of periodontal care required of general dentists practicing in Baton Rouge, Louisiana. The trial court thus erred in excluding the testimony of Dr. Lovelace.
SCOPE OF APPELLATE REVIEW
After finding that the testimony of Dr. Lovelace should not have been excluded, the court of appeal noted the proffered testimony was not "so prejudicial that its omission would have changed the outcome of the trial." The appellate court further noted the jury, if they had been allowed to hear the proffered testimony, could have reached the same result without committing manifest error. Finally, after making an "independent review" of the evidence (including the proffered testimony), the court of appeal noted the result reached by the jury was not "clearly wrong."
At the outset, we disagree with the court of appeal's assessment of the degree of prejudice of the excluded testimony. Given Dr. Lovelace's credentials, his extensive treatment of the plaintiff subsequent to the treatment rendered by Dr. Hunter, and the
Furthermore, the court of appeal examined the record in this case with a view toward deciding whether the result reached by the jury was or was not "clearly wrong." When a jury is given incorrect instructions in the law, or when a trial court makes a consequential error in the exclusion of evidence, no weight should be accorded the judgment of the trial court which implements the jury verdict. See, Thomas v. Missouri Pacific R. Co., 466 So.2d 1280 (La.1985); Otto v. State Farm Mut. Auto. Ins. Co., 455 So.2d 1175 (La. 1984); Ragas v. Argonaut Southwest Ins. Co., 388 So.2d 707 (La.1980); Gonzales v. Xerox Corp., 320 So.2d 163 (La.1975). The jury verdict in this case was "tainted" by the trial court's consequential error in excluding the testimony of Dr. Lovelace. In such situations the jury verdict is simply not entitled to a presumption of regularity. See, Thomas v. Missouri Pacific R. Co., 466 So.2d at 1284.
What an appellate court must do at this juncture is make an independent review of the record before it and decide which party should prevail by a preponderance of the evidence. Gonzales v. Xerox Corporation, 320 So.2d 163 (La.1975).
A court of appeal should not (as was done here) decide whether a tainted jury verdict was "manifestly erroneous" or not "clearly wrong."
FAILURE TO PROFFER
In her second specification of error to this Court, Ms. McLean complains the court of appeal erred in not further considering the "excluded" testimony of Dr. Broxson and Dr. Lawrence. As was previously discussed, the interrogation of the two periodontists was limited to hypothetical questions and the standard of care applicable to practitioners of periodontistry. The trial court would not allow Dr. Broxson and Dr. Lawrence to testify relative to the standard of care exercised by general practitioners. Although plaintiff's counsel objected generally to this line of questioning, he did not proffer the testimony of Dr. Broxson and Dr. Lawrence, as he had done with the testimony of Dr. Lovelace. The court of appeal held that in the absence of a proffer, plaintiff's counsel could not complain "the exclusion of this testimony was error."
La.C.C.P. art. 1636 provides, in pertinent part:
Ms. McLean argues La.C.C.P. art. 1636 is not applicable here, since the trial court did not exclude the pertinent testimony, but rather merely altered it. According to plaintiff's counsel, a proffer would have been "vain and useless," since the proffer would have merely amounted to a substitution of the words "general dentist" for "a practitioner of periodontology." As we understand the argument, a proffer in this case was unnecessary since, according to plaintiff's counsel, Dr. Broxson and Dr. Lawrence would have responded in the same fashion (i.e., treatment similar to that afforded plaintiff by defendant would be below an asserted standard of periodontal care for general dentists in the Baton Rouge area) had the hypothetical questions addressed the standard of care applicable to general dentists, rather than practitioners of periodontistry.
In fact, such a supposition is not at all so evident. The very purpose of requiring a proffer is to preserve excluded testimony so that the testimony (whatever its nature) is available for appellate review. Without a proffer, appellate courts have no way of ascertaining the nature of the excluded testimony. In the case at bar, we have no way of knowing how Dr. Broxson and Dr. Lawrence would have testified in this regard had they been allowed to do so. The court of appeal therefore correctly held that the plaintiff is precluded from complaining of the "exclusion" of Dr. Broxson's and Dr. Lawrence's testimony, inasmuch as she did not proffer that testimony.
For the foregoing reasons, we reverse the judgment of the court of appeal and remand the case to the court of appeal for a reconsideration of plaintiff's appeal consistent with the principles of appellate review set forth in this opinion.
REVERSED; REMANDED TO THE COURT OF APPEAL.
In the lower courts, Ms. McLean complained the Medical Malpractice Act, La.R.S. 40:1299.41 et seq., was unconstitutional as applied to her. Ms. McLean abandoned her constitutional arguments in this Court. Accordingly, plaintiff's assertions of unconstitutionality will not be addressed in this opinion.