In its Opinion dated June 9, 2021, the Rhode Island Supreme Court stated in a medical malpractice case that had resulted in a defense verdict after which the trial judge granted the plaintiff a new trial, “Viewing the entirety of the evidence, therefore, in the light most favorable to Dr. Cassin, the prevailing party, we conclude that there is competent evidence to support a conclusion that Dr. Cassin’s negligence was her failure to refer Mrs. Kinney to a gynecologic oncologist after July 21, 2011, when the final pathology report definitively determined that Mrs. Kinney suffered from ovarian cancer, yet such negligence was not a proximate cause of her death because by that point in time Mrs. Kinney’s cancer was incurable.”
The Underlying Allegations
At trial, the plaintiff argued that the standard of care required Dr. Cassin to refer Mrs. Kinney to a gynecologic oncologist prior to the July 13, 2011 surgery, because Mrs. Kinney had presented with multiple ovarian cancer risk factors. The plaintiff’s expert witness, Julian Schink, M.D., testified that, if Mrs. Kinney’s surgery had been performed by a gynecologic oncologist, the entire mass would have been removed, thus eliminating Mrs. Kinney’s cancer, and Mrs. Kinney likely would not have developed a fistula. Additionally, plaintiff’s expert witness testified that the post-surgery standard of care required Dr. Cassin to refer Mrs. Kinney to a gynecologic oncologist after the surgical pathology reports indicated that Mrs. Kinney’s mass was cancerous.
Dr. Cassin testified that she was not required to refer Mrs. Kinney to a gynecologic oncologist for the initial surgery because Mrs. Kinney’s medical history indicated that the mass was likely an endometrioma. Additionally, Dr. Cassin testified that she had offered Mrs. Kinney the option of referral to a gynecologic oncologist during her initial consultation, but Mrs. Kinney had elected to have Dr. Cassin perform the surgery.
The defendant’s expert witness, Mary Susan Schilling, M.D., testified that Dr. Cassin met the standard of care before, during, and after surgery. In support of this position, Dr. Schilling testified that the intraoperative pathology report indicated that the mass was consistent with an endometrioma and that, therefore, it was reasonable for Dr. Cassin to rely upon those results. With regard to post-surgery care, Dr. Schilling explained that, when Dr. Cassin learned that Mrs. Kinney did in fact have cancer, Mrs. Kinney had already been admitted to South County Hospital under the care of Dr. McAteer. Further, Dr. Schilling testified that, in July and August 2011, Dr. Smythe, a medical oncologist, and Dr. Espat, a surgical oncologist, were both involved in Mrs. Kinney’s care.
At the close of the evidence, the Rhode Island medical malpractice jury returned a verdict in favor of the plaintiff on the issue of negligence, but for Dr. Cassin on the issue of proximate cause, thus resulting in a defense verdict. The trial judge granted the plaintiff a new trial, and the defendant appealed.
Rhode Island Supreme Court Opinion
The Rhode Island Supreme Court held: “Given the evidence presented in this case, it is our opinion that reasonable minds in considering such evidence could have come to different conclusions on the question of whether the plaintiff had met her burden of establishing that Dr. Cassin’s breach was the cause of Mrs. Kinney’s death,” explaining, “During this complex medical-malpractice trial, the jury heard conflicting evidence regarding whether Dr. Cassin had breached her duty of care before, during, or after the July 13, 2011 surgery. Moreover, the jury also heard evidence that Mrs. Kinney was actively being treated by other doctors during the time of each alleged breach. While plaintiff presented multiple theories regarding the allegation that Dr. Cassin had breached the standard of care, the trial justice’s new-trial decision considered only whether Mrs. Kinney would have been cured of her cancer if a gynecologic oncologist had performed the initial surgery … the trial justice did not consider Dr. Schink’s testimony that the mass left behind was approximately four centimeters and that “if you leave a tumor bigger than two centimeters behind, that patient can’t be cured” … Accordingly, we conclude that the trial justice erred by replacing the jury’s determination with her own.”
Source Joplin v. Cassin, M.D., No. 2018-242-Appeal.
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