The case of Sheeley et al v. Memorial Hospital et al involved a birth at Memorial Hospital in Pawtucket, Rhode Island in May, 1987. A second-year family practice resident under the supervision of an attending obstetrician delivered the baby. The resident performed an episiotomy on the mother and, following delivery, stitched the incision previously made in the perineum. After discharge from the hospital, however, the patient developed complications and ultimately developed a rectal-vaginal fistula.
Despite surgery to correct this condition, the patient continued to experience pain and discomfort. She sued the physicians, alleging that they incorrectly performed the episiotomy, and failed to properly repair the incision when complications developed.
At trial, the plaintiff sought to introduce the expert medical testimony of a board-certified obstetrician/gynecologist regarding the standard of care that applies to the performance of the episiotomy. The defense moved to exclude the expert's testimony. They argued that an obstetrician/gynecologist was not qualified to testify about the standard of care that applies to a family practice resident. At a hearing on the motion, the OB/GYN revealed that he had been retired from the practice of obstetrics since 1975. However, he had maintained his board certification, and continued to hold the position of Clinical Professor of Obstetrics and Gynecology at a medical school in Syracuse, New York. The expert had delivered approximately 4,000 babies in his career, and was still serving on a state-wide professional standards review counsel. He was also currently on the credentials and certification committee of a New York hospital where his responsibilities included drafting standards for family practice physicians.
The trial judge refused to allow the expert to testify, holding that to testify as an expert, the physician was required to be certified in the same medical field as the defendant physician.
The plaintiff was unable to get a new expert within the time period allowed, and the trial court dismissed the case in favor of the defendant physicians for lack of expert testimony against them.
The plaintiff appealed, arguing that the trial judge had abused her discretion by refusing to allow the expert to testify. The plaintiff argued that the obstetrician's training, experience, and familiarity with this procedure amply qualified him to testify about what appropriate care was and whether the defendants met the standard.
On appeal, the defendants argued that a board-certified OB/GYN does not possess the same knowledge, skill, experience, training, or education as a second-year family practice resident performing obstetrics. The defendants also claimed that, because the witness had not actually practiced obstetrics since 1975, his experience in providing obstetrical care was outdated, so he could not testify about the appropriate standard of care in 1987. However, the defendants acknowledged that the standard of care for this procedure had changed little over the past 30 years.
The Rhode Island Supreme Court allowed the witness to testify. It ruled that the general standard of care is that a physician must exercise the same degree of diligence and skill commonly possessed by other members of the profession engaged in the same type of practice in similar localities, with due regard for the state of scientific knowledge at the time of treatment. According to this court, the primary concern is whether the treatment was being administered in a reasonable manner.
In the court's view, the appropriate standard of care in any given procedure should not be limited by a physician's area of professional specialization or certification. On the contrary, the court stated that the focus in any medical malpractice case should be the procedure. The expert would not have to be trained in the defendant physician's specialty, but needs to be familiar with and trained in the procedure at issue. Commonly, the trial judge rules that such witnesses can testify, and that challenges to their knowledge-base and actual experience with the procedure are appropriate for cross-examination.
This is similar to decisions by the Massachusetts Supreme Judicial Court, which determined that resident physicians are to be held to the same standard of care as those who have finished their training.
Interestingly, the Rhode Island court looked at whether care was reasonable. This is not generally the stated legal standard of care put forth in jury instructions at the conclusion of a medical malpractice trial. But it is an accurate statement of a jury's perception when listening to the evidence during the trial. The jury is really attempting to learn whether or not the doctor acted in a reasonable, responsible, and professional manner in the course of treating the patient. Sometimes juries see the hired expert witnesses for both sides as canceling each other out. So the individual most able to convince a jury that treatment was appropriate is the physician who performed the treatment. The defendant must educate the jury about the information that led him to arrive at his diagnosis, including why he recommended a particular course of treatment, assuring the jury that the treatment was caring and appropriate.
If the physician is successful in convincing the jury in this regard, the lay people who make up the jury will feel much more confident in the defendant's abilities, and more readily determine that the care and treatment of the patient was not negligent.
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