Crandell v. United States

703 F.2d 74, 12 Fed. R. Serv. 1808
Court of Appeals for the Fourth Circuit·Decided March 14, 1983·No. No. 82-1416·Published·Cited by 17 cases

Opinion

SPROUSE, Circuit Judge:

Scott and Linda Crandell, and their infant daughter, Jennifer Crandell, (“the Crandells”), appeal from a judgment the district court entered following a bench trial, dismissing their medical malpractice suit against the United States. The Crandells alleged that medical personnel at Quantieo Naval Hospital failed to provide medical care to Jennifer in accordance with generally accepted standards of medical care, resulting in permanent injuries to Jennifer.

On June 26, 1977, seven-month-old Jennifer, just recovering from a cold, suffered a convulsion and immediately was taken to Quantieo Naval Hospital. There, her temperature registered 104 degrees, and a warrant officer, who was a physician’s assist[75] ant, diagnosed Jennifer’s condition as an upper respiratory infection. He gave her tylenol to reduce the fever and sent her home. Jennifer’s condition did not improve, and on June 28, 1977, Dr. Krenytzky examined her at the Naval Hospital. He diagnosed her condition as a severe ear infection and prescribed ampicillin and actifed. It is disputed whether the Crandells informed the warrant officer or Dr. Krenytzky about Jennifer’s seizure. Jennifer’s condition deteriorated, and on July 1,1977, Dr. Hammer examined her at the Naval Hospital; he immediately noted symptoms of meningitis. Dr. Hammer, attempting no treatment, sent her to Walter Reed Hospital, where doctors diagnosed her condition as meningitis. Jennifer presently suffers from severe sequelae, including severe retardation.

The principal issue at trial was whether the medical personnel at Quantico Hospital breached the applicable medical standards of care in failing to timely diagnose and treat meningitis. Assuming a breach, there was also a serious question of causation— whether Jennifer’s permanent injuries were a proximate result of the negligence.

The Crandells on appeal challenge the trial court’s findings on the substantive medical malpractice issues, and contend that the trial judge’s conduct deprived them of a fair trial. We agree with the latter contention, and reverse and remand for a new trial.

The Crandells essentially argue that the trial judge decided this case before hearing all of the evidence and adhered to that prejudgment throughout the trial. They contend that this is evident from the judge’s numerous improper interjections during the trial and his preclusion of plaintiffs from adequately presenting their case. As evidence of his prejudgment, the Crandells point specifically to the judge’s remarks concerning (a) their refusal to settle and (b) financial considerations extraneous to the issues. They further point to (c) the judge’s badgering of their expert witnesses and (d) his interference with the Crandells’ counsel’s attempts to cross-examine the key defense witness, as demonstrations of the judge’s determination to prevent them from developing their evidence.

Public policy, of course, favors private settlement of disputes. A trial judge if possible should assist parties in their attempts at settlement, even to the point of encouraging them. As with his trial conduct, however, the judge’s actions must be perceived as just and impartial. There is necessarily a broad line between commendable advancement of judicial economy and undue court meddling. The trial judge in this case suggested during a bench trial that plaintiffs unreasonably refused to settle their suit.1 The comments were disparaging, indicating possible judicial prejudice against plaintiffs’ case. The judge’s comments were improper and certainly were not in the tradition of a fair, impartial presiding judge assisting both parties to reach a just private settlement.

Prejudgment is further indicated by judicial comments about the possible financial ramifications of the trial — considerations which were irrelevant to proper deliberation of the issues. The judge indicated his concern about the effect of a verdict in favor of plaintiffs on the cost of medical malpractice insurance.2 On another occasion, he commented that “taxpayers” might [76] be the ones to pay damages if the United States was found liable.3 The trial judge, with possible pejorative connotations, also remarked that the Crandells received free medical care from the Naval Hospital.4

The trial judge’s interference with the Crandells’ expert witnesses is even more clearly a demonstrable error. The judge on one occasion ridiculed one of plaintiffs’ experts while contorting his testimony.5 Although the issues were tried to the judge alone, the possible inhibitive effect on witnesses and counsel presented as much a danger as it would have in a jury trial.6

Finally, the trial judge prevented effective cross-examination of the most important defense witness. At the conclusion of the trial, the judge based his opinion almost exclusively on the testimony of the government’s expert, Dr. Lehman. All of the findings in the court’s memorandum opinion, on the issue of whether the Naval Hospital personnel breached the standard of care and on the issue of medical causation, were lifted virtually verbatim from a report prepared by Dr. Lehman. The court precluded the Crandells’ counsel, however, from effectively cross-examining Dr. Lehman on facts in evidence, including the records which Dr. Lehman relied on in forming his opinion.7 This action by the trial judge was particularly glaring since [77] the defendant’s counsel never objected to the form or appropriateness of the questions — the court simply assumed the role of an advocate.

The trial court also, again sua sponte, prevented the Crandells’ counsel from exploring Dr. Lehman’s change of opinion on the causation issue. Dr. Lehman in his deposition and pretrial report stated unequivocally that hypothyroidism overwhelmingly caused Jennifer’s permanent injuries, discounting the meningitis almost entirely as a contributing factor. Dr. Lehman testified at trial, however, that it was impossible to isolate the damages attributable to meningitis from those allegedly caused by hypothyroidism.8

It is true that a trial judge functions not merely as an umpire, but as a governor to see that justice is done. Pollard v. Fennell, 400 F.2d 421, 423-24 (4th Cir.1968). The judge, for example, is entitled to propound questions pertinent to a factual issue which requires clarification. [78] He may intercede because of apparent inadequacy of examination or cross-examination by counsel, or to draw more information from relevant witnesses or experts who are inarticulate or less than candid. United States v. Cassiagnol, 420 F.2d 868, 879 (4th Cir.), cert. denied, 397 U.S. 1044, 90 S.Ct. 1364, 25 L.Ed.2d 654 (1970). This privilege or duty, however, is subject to reasonable limitations.

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Crandell v. United States, 703 F.2d 74, 12 Fed. R. Serv. 1808 (4th Cir. 1983).

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