In its decision published on December 31, 2013, the Connecticut Supreme Court examined the circumstances under which a treating physician’s medical records can be admitted as evidence of causation in a medical malpractice action. The Connecticut Supreme Court stated that an expert’s opinion is not rendered inadmissible merely because the opinion is based on inadmissible hearsay, so long as the opinion is based on trustworthy information and the expert had sufficient experience to evaluate that information so as to come to a conclusion worthy of consideration by the jury.
The fact that a physician’s report includes hearsay statements, whether from a patient or someone else, would not bar the report’s admission on that basis unless those statements were being offered as substantive evidence (that is, to prove the truth of the matter asserted).
The Underlying Facts
Prior to July 2002, the alleged medical malpractice victim had been a patient in the defendant hospital’s care in connection with the treatment of her stiff man syndrome (SMS), which is a rare and disabling neurological disorder characterized by progressive, severe muscle stiffness or rigidity as well as painful muscle spasms triggered by sensory stimuli.
From July 9, 2002 to July 14, 2002, the patient was admitted to the defendant hospital for treatment relating to her SMS. While in the defendant hospital’s care, the patient suffered severe respiratory dysfunction, during which time her rate of breathing was reduced to two breaths per minute for a period of four minutes.
The Connecticut medical malpractice lawsuit alleged that as a result of the anoxic event, the patient suffered severe injury to her cognitive functioning, including memory loss, loss of motor function, and speech impairment allegedly caused by the defendant hospital’s negligent failure to properly monitor the patient, its negligent failure to respond to her respiratory dysfunction, and its negligent administration of medication that is known to cause respiratory dysfunction when combined with other medications such as Valium.
In April 2003, the patient had sought treatment at the Mayo Clinic for a second opinion regarding her diagnosis of SMS and with regard to her diminished cognitive function since July 2002. The Mayo Clinic doctor reviewed records and documents that the patient had brought with her and thereafter wrote an evaluation report in which the doctor stated that the patient was suffering from a severe neurological disorder, and, although some manifestations suggested SMS, “she obviously has additional deficits and involvement that would not be expected with [SMS] alone.”
The patient returned to the same Mayo Clinic doctor in February 2005 after which the doctor wrote a report that stated, in part, “It is still my clinical impression based on the temporal profile of the onset of her symptoms, that [the patient] has a primary autoimmune disorder consistent with [SMS], which by history was associated with dysarthria but no cognitive impairment, along with a superimposed anoxic encephalopathy which developed by her report of July 10, 2002 . . . .”
Other Mayo Clinic physicians who examined the patient reported that her “cognitive dysfunction appears to be multidomain in nature, and based on the recounted temporal events, this all seems to have occurred because of anoxic encephalopathy suffered during her respiratory arrest in 2002” and “It is my opinion that [the patient’s] cognitive impairment is secondary to whatever event occurred or whatever transpired in 2002. The family member tells me that there was anoxia and that there was a change after that. Therefore, one must conclude that her cognitive impairment was secondary to the event that occurred in 2002. Arguing for this being the process of her cognitive impairment also is the fact that she has not had any significant progression since 2002. The cognitive impairment in my opinion is not related to the patient’s diagnosis [of SMS] and is not in keeping with a neurodegenerative syndrome given the lack of progression.”
In response to the defendant hospital’s argument that the medical reports from the treating physicians were inadmissible as hearsay to prove causation in the medical malpractice case, the Connecticut Supreme Court stated that in a medical malpractice action, expert medical opinion evidence is usually required to show the cause of an injury or disease because the medical effect on the human system of the infliction of injuries is generally not within the sphere of the common knowledge of the lay person and that the facts in the particular case upon which an expert bases an opinion may be those perceived by or made known to the expert at or before the proceeding. The facts need not be admissible in evidence if of a type customarily relied on by experts in the particular field in forming opinions on the subject. The facts relied on are not substantive evidence, unless otherwise admissible as such evidence. Conn. Code Evid. § 7-4 (b).
Furthermore, when the expert witness has consulted numerous sources, and uses that information, together with his own professional knowledge and experience, to arrive at his opinion, that opinion is regarded as evidence in its own right and not as hearsay in disguise.
The Connecticut Supreme Court stated that an expert’s opinion is not rendered inadmissible merely because the opinion is based on inadmissible hearsay, so long as the opinion is based on trustworthy information and the expert had sufficient experience to evaluate that information so as to come to a conclusion which the trial court might well hold worthy of consideration by the jury. The fact that a physician’s report includes hearsay statements, whether from a patient or someone else, would not bar the report’s admission on that basis unless those statements were being offered for substantive purposes, i.e., the truth of the matter asserted.
In the present case, the Connecticut Supreme Court held that the plaintiff was not offering her own statements and those of the patient in the reports relaying the 2002 anoxic incident as substantive evidence of the fact that the patient had in fact suffered anoxia while in the defendant hospital’s care and due to the defendant hospital’s negligence but rather she was offering those statements as evidence of the information on which the Mayo Clinic physicians had based their respective diagnoses of anoxic encephalopathy arising from the 2002 incident as the cause of the patient’s cognitive deficits.
The Connecticut Supreme Court held that the trial court had misapprehended the law in concluding that the patient’s medical reports did not contain competent evidence to create a material issue of dispute as to causation. However, the plaintiff will have to establish, through witnesses with personal knowledge of the circumstances, that the defendant hospital’s acts or omissions actually caused the patient to suffer respiratory distress.
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