LAMBERT, Justice.
In this medical negligence case, the issue is whether plaintiff’s evidence of causation was sufficient to withstand defendants’ motions for directed verdict. At the close of plaintiff’s evidence in chief, defendants moved for directed verdict and their motions were sustained. The Court of Appeals affirmed.
Appellant sought to prove that she suffered anaphylactic shock as a result of defendants’ negligence in administering her the drug Keflex. She contended that her hospital records reflected a prior allergic reaction to Keflex and that at the time it was prescribed for her, she told the nurse who took her medical history that she was allergic to penicillin1 According to appellant, on December 19, 1984, she came to the emergency room complaining of stomach problems and with little or no examination or diagnosis, Keflex was prescribed by the doctor. After going home and taking one capsule, appellant collapsed [123]*123and was returned to the hospital in a state of shock.
At the close of plaintiffs evidence in chief, the trial court determined that an essential element of proof had been omitted. The trial court held that plaintiffs expert witness, Dr. Saul Boyarsky, had failed to state his opinion that plaintiffs allergic reaction was caused by her ingestion of Keflex. The court said:
“[T]he ballgame all boils down to one thing, and that is whether or not this Keflex caused the hospitalization and the injury, and somebody has got to say in medical probability, it did, and the parties have to be given the right to cross examination of that expert that says that, either by deposition or by having him here in court.”
Affirming the trial court, the Court of Appeals held that Dr. Boyarsky never expressed his opinion to a reasonable degree of medical probability that the Keflex caused the anaphylactic shock reaction. The Court of Appeals concluded that plaintiffs expert merely reported the content of the hospital record on the element of causation.
Prior to addressing the dispositive issue, it is necessary to briefly discuss a misconception of law which appears to have contributed to the erroneous rulings. In colloquy with counsel, just prior to granting defendants’ motions for directed verdict, the trial court expressed the view that because appellant’s medical record could not be cross examined, its admissibility was doubtful or its significance diminished2.
It is now well settled that the medical record of a patient in a hospital is admissible in evidence under the regular business entries exception to the hearsay rule. Buckler v. Commonwealth, Ky., 541 S.W.2d 935 (1976). There is no longer any requirement that “necessity” be shown as was the case in Whittaker v. Thomberry, 306 Ky. 830, 209 S.W.2d 498 (1948). This Court has adopted the view found in Wig-more, Evidence, § 1707 as follows:
“There is a Circumstantial Guarantee of Trustworthiness; for the records are made and relied upon in affairs of life and death. Moreover, amidst the day-today details of scores of hospital cases, the physicians and nurses can ordinarily recall from actual memory few or none of the specific data entered; they themselves rely upon the record of their own action; hence, to call them to the stand would ordinarily add little or nothing to the information furnished by the record alone.” See Buckler v. Commonwealth, supra at 938.
Upon matters properly included therein, medical records are entitled to the same dignity as other forms of evidence produced at trial. Whittaker v. Thomberry, supra.
This Court has long recognized that the admission of hearsay evidence results in the deprivation of the fundamental right to confront and cross examine witnesses. As such, we have determined that hearsay evidence must possess characteristics or have been made under circumstances which substantially eliminate the possibility of error. Barnes v. Commonwealth, Ky., 794 S.W.2d 165 (1990). We have determined that medical records satisfy these requirements. Therefore, the trial court erred in its view that testimonial evidence was necessary to support the medical record.
This cause is distinguishable from our decision in Young v. J.B. Hunt Transportation, Inc., Ky., 781 S.W.2d 503, 508-509 (1989), in which we affirmed the trial court’s rejection of a large volume of medical records offered into evidence after the [124]*124conclusion of the testimony but before defendant had rested. We held that the trial court’s rejection of the records at the time and under the circumstances of their proffer amounted to a proper exercise of discretion.
Despite the trial court’s view that it was necessary to have the testimony, subject to cross examination, of the physician who recorded his findings on examination, the basis for the ruling on the directed verdict motions appears to be the absence of testimony in terms of medical probability that Keflex caused plaintiff’s allergic reaction. This view was accepted by the Court of Appeals, and in this Court, appellees argue that Dr. Boyarsky merely reported the content of the record and failed to adopt the views expressed therein or state his own opinion as to causation.
Appellant’s testimony and the medical record discloses that on the day in question, she was seen by Dr. Wheeler who prescribed Keflex for her diverticulitis condition. After taking one Keflex capsule, she collapsed and was returned to the hospital emergency room. Upon arrival, she was found to have no blood pressure, but was awake. Epinephrine was administered and her vital signs returned. Dr. Roberts diagnosed anaphalaxis with cardiovascular collapse, gastric ulcer and probable mitral valve prolapse. Dr. Roberts, in his progress record, stated, “It was felt that the patient had had an anaphylactic reaction to the Keflex.”
Prior to giving testimony at trial, appellant’s expert, Dr. Boyarsky, testified that he had reviewed the hospital record and read the deposition testimony. A fair interpretation of the whole of his testimony reveals a view that the causation between the anaphylactic shock and the taking of Keflex was obvious. Instead of directly addressing the question of causation, Dr. Boyarsky’s testimony dealt largely with ap-pellees’ negligence in prescribing this drug to a patient with a known penicillin allergy and a prior reaction to Keflex, and appel-lees’ failure to adequately assess appellant’s condition and review its own records.
It is beyond dispute that causation is a necessary element of proof in any negligence case. William L. Prosser, Handbook of the Law of Torts, 4th ed. (1971). Johnson v. Vaughn, Ky., 370 S.W.2d 591 (1963). It is an accepted principle that in most medical negligence cases, proof of causation requires the testimony of an expert witness3 because the nature of the inquiry is such that jurors are not competent to draw their own conclusions from the evidence without the aid of such expert testimony. Jarboe v. Harting,
Free access — add to your briefcase to read the full text and ask questions with AI
LAMBERT, Justice.
In this medical negligence case, the issue is whether plaintiff’s evidence of causation was sufficient to withstand defendants’ motions for directed verdict. At the close of plaintiff’s evidence in chief, defendants moved for directed verdict and their motions were sustained. The Court of Appeals affirmed.
Appellant sought to prove that she suffered anaphylactic shock as a result of defendants’ negligence in administering her the drug Keflex. She contended that her hospital records reflected a prior allergic reaction to Keflex and that at the time it was prescribed for her, she told the nurse who took her medical history that she was allergic to penicillin1 According to appellant, on December 19, 1984, she came to the emergency room complaining of stomach problems and with little or no examination or diagnosis, Keflex was prescribed by the doctor. After going home and taking one capsule, appellant collapsed [123]*123and was returned to the hospital in a state of shock.
At the close of plaintiffs evidence in chief, the trial court determined that an essential element of proof had been omitted. The trial court held that plaintiffs expert witness, Dr. Saul Boyarsky, had failed to state his opinion that plaintiffs allergic reaction was caused by her ingestion of Keflex. The court said:
“[T]he ballgame all boils down to one thing, and that is whether or not this Keflex caused the hospitalization and the injury, and somebody has got to say in medical probability, it did, and the parties have to be given the right to cross examination of that expert that says that, either by deposition or by having him here in court.”
Affirming the trial court, the Court of Appeals held that Dr. Boyarsky never expressed his opinion to a reasonable degree of medical probability that the Keflex caused the anaphylactic shock reaction. The Court of Appeals concluded that plaintiffs expert merely reported the content of the hospital record on the element of causation.
Prior to addressing the dispositive issue, it is necessary to briefly discuss a misconception of law which appears to have contributed to the erroneous rulings. In colloquy with counsel, just prior to granting defendants’ motions for directed verdict, the trial court expressed the view that because appellant’s medical record could not be cross examined, its admissibility was doubtful or its significance diminished2.
It is now well settled that the medical record of a patient in a hospital is admissible in evidence under the regular business entries exception to the hearsay rule. Buckler v. Commonwealth, Ky., 541 S.W.2d 935 (1976). There is no longer any requirement that “necessity” be shown as was the case in Whittaker v. Thomberry, 306 Ky. 830, 209 S.W.2d 498 (1948). This Court has adopted the view found in Wig-more, Evidence, § 1707 as follows:
“There is a Circumstantial Guarantee of Trustworthiness; for the records are made and relied upon in affairs of life and death. Moreover, amidst the day-today details of scores of hospital cases, the physicians and nurses can ordinarily recall from actual memory few or none of the specific data entered; they themselves rely upon the record of their own action; hence, to call them to the stand would ordinarily add little or nothing to the information furnished by the record alone.” See Buckler v. Commonwealth, supra at 938.
Upon matters properly included therein, medical records are entitled to the same dignity as other forms of evidence produced at trial. Whittaker v. Thomberry, supra.
This Court has long recognized that the admission of hearsay evidence results in the deprivation of the fundamental right to confront and cross examine witnesses. As such, we have determined that hearsay evidence must possess characteristics or have been made under circumstances which substantially eliminate the possibility of error. Barnes v. Commonwealth, Ky., 794 S.W.2d 165 (1990). We have determined that medical records satisfy these requirements. Therefore, the trial court erred in its view that testimonial evidence was necessary to support the medical record.
This cause is distinguishable from our decision in Young v. J.B. Hunt Transportation, Inc., Ky., 781 S.W.2d 503, 508-509 (1989), in which we affirmed the trial court’s rejection of a large volume of medical records offered into evidence after the [124]*124conclusion of the testimony but before defendant had rested. We held that the trial court’s rejection of the records at the time and under the circumstances of their proffer amounted to a proper exercise of discretion.
Despite the trial court’s view that it was necessary to have the testimony, subject to cross examination, of the physician who recorded his findings on examination, the basis for the ruling on the directed verdict motions appears to be the absence of testimony in terms of medical probability that Keflex caused plaintiff’s allergic reaction. This view was accepted by the Court of Appeals, and in this Court, appellees argue that Dr. Boyarsky merely reported the content of the record and failed to adopt the views expressed therein or state his own opinion as to causation.
Appellant’s testimony and the medical record discloses that on the day in question, she was seen by Dr. Wheeler who prescribed Keflex for her diverticulitis condition. After taking one Keflex capsule, she collapsed and was returned to the hospital emergency room. Upon arrival, she was found to have no blood pressure, but was awake. Epinephrine was administered and her vital signs returned. Dr. Roberts diagnosed anaphalaxis with cardiovascular collapse, gastric ulcer and probable mitral valve prolapse. Dr. Roberts, in his progress record, stated, “It was felt that the patient had had an anaphylactic reaction to the Keflex.”
Prior to giving testimony at trial, appellant’s expert, Dr. Boyarsky, testified that he had reviewed the hospital record and read the deposition testimony. A fair interpretation of the whole of his testimony reveals a view that the causation between the anaphylactic shock and the taking of Keflex was obvious. Instead of directly addressing the question of causation, Dr. Boyarsky’s testimony dealt largely with ap-pellees’ negligence in prescribing this drug to a patient with a known penicillin allergy and a prior reaction to Keflex, and appel-lees’ failure to adequately assess appellant’s condition and review its own records.
It is beyond dispute that causation is a necessary element of proof in any negligence case. William L. Prosser, Handbook of the Law of Torts, 4th ed. (1971). Johnson v. Vaughn, Ky., 370 S.W.2d 591 (1963). It is an accepted principle that in most medical negligence cases, proof of causation requires the testimony of an expert witness3 because the nature of the inquiry is such that jurors are not competent to draw their own conclusions from the evidence without the aid of such expert testimony. Jarboe v. Harting, Ky., 397 S.W.2d 775 (1965); Johnson v. Vaughn, supra. While evidence of causation must be in terms of probability rather than mere possibility, we have held that substance should prevail over form and that the total meaning, rather than a word-by-word construction, should be the focus of the inquiry. Walden v. Jones, Ky., 439 S.W.2d 571 (1968); Morris v. Hoffman, Ky. App., 551 S.W.2d 8 (1977). The standard of “totality of the medical testimony” was adopted for use in Workers Compensation cases by the Court of Appeals in Stauffer Chemical Co. v. Greenwell, Ky.App., 713 S.W.2d 825 (1986), wherein the Court held that terms such as “distinct possibility” and “high likelihood” went beyond speculation and amounted to substantial evidence of causation, an inquiry not dissimilar to the question before this Court.
[125]*125The standard to be applied in ruling upon motions for directed verdict is that every favorable inference which may reasonably be drawn from the evidence should be accorded the party against whom the motion is made. Johnson v. Vaughn, supra; National Collegiate Athletic Association v. Hornung, Ky., 754 S.W.2d 855 (1988).
With the foregoing standards and rules of construction in mind, we turn our attention to the testimony which is dispositive. On direct examination and in response to a question which dealt with the proper standard of care, Dr. Boyarsky said:
“My opinion is that a bad mistake was made in giving this lady Keflex.”
When asked how he arrived at that opinion, he answered:
“She was allergic to Keflex and she never should have got it. She had been in that same emergency room before with an allergic reaction to Keflex. There is just no excuse for giving a patient in the same emergency room in the same hospital the same drug that made her allergic before, because there is a danger of almost killing her and it almost did.”
Appellees argue fervently that this testimony went only to the proper standard of care and that Dr. Boyarsky did not offer an independent opinion as to the cause of the alleged injuries. While the answers given may not have been entirely responsive to the questions asked and the questions themselves may have been inartfully stated, in the testimony above, Dr. Boyarsky stated his view that ingestion of Keflex caused appellant’s anaphylactic shock.
Upon careful examination of the record in this case, and with due regard for the principles outlined above, we are unable to accept appellees’ contention. From the testimony given and the circumstances surrounding the onset of anaphylactic shock in appellant, a jury could reasonably have found that appellees’ negligence was a proximate cause of the condition.
Having determined that the court below erred in affirming the trial court’s directed verdict, the judgment is reversed and this cause remanded to the McCracken Circuit Court for trial.
STEPHENS, C.J., and COMBS, LEIBSON, REYNOLDS and SPAIN, JJ., concur.
WINTERSHEIMER, J„ dissents by separate opinion.