Renna v. Schadt

64 A.3d 658, 2013 Pa. Super. 34, 2013 WL 657655, 2013 Pa. Super. LEXIS 81
CourtSuperior Court of Pennsylvania
DecidedFebruary 25, 2013
StatusPublished
Cited by36 cases

This text of 64 A.3d 658 (Renna v. Schadt) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Renna v. Schadt, 64 A.3d 658, 2013 Pa. Super. 34, 2013 WL 657655, 2013 Pa. Super. LEXIS 81 (Pa. Ct. App. 2013).

Opinion

OPINION BY

BOWES, J.:

Mark Schadt, M.D. appeals from October 26, 2011 judgment entered on the jury verdict in favor of Carol Renna following denial of post-trial motions in this medical malpractice action. He alleges that the trial court erred under the Medical Care Availability and Reduction of Error Act (“MCARE”), 40 P.S. § 1303.512, in permitting a pathologist and oncologist to render [661]*661expert testimony regarding the standard of care applicable to a surgeon, and in failing to grant a new trial or remittitur for what he views as an excessive verdict. After careful review, we affirm.

Carol Renna, a forty-six-year-old special education teacher, commenced this civil action against Dr. Schadt, a surgeon, alleging that on May 17, 2004, he deviated from the standard of care in performing a fine-needle aspiration biopsy instead of a computed tomography (“CT”) guided core biopsy, on two lesions in her right breast. She maintained that the CT-guided core biopsy was a more advanced diagnostic technique, and that had Dr. Schadt employed it, she would not have suffered an eleven-month delay in the diagnosis of her breast cancer. Ms. Renna subsequently underwent a bilateral mastectomy on May 6, 2005, followed by chemotherapy and radiation of the right chest wall, treatment that she maintained was more extensive than would have been necessary had she been diagnosed earlier.

On August 20, 2010, Dr. Schadt moved for summary judgment on the ground that Ms. Renna’s experts, John J. Shane, M.D. and Robert B. Sklaroff, M.D., did not possess the necessary qualifications to provide expert testimony regarding the standard of care applicable to a board-certified surgeon under MCARE because neither was a board-certified surgeon. Furthermore, their reports did not contain the requisite opinion, to a reasonable degree of medical certainty, that Dr. Schadt deviated from the applicable standard of care. On October 21, 2010, the Honorable Paula Roscioli denied the motion, concluding that both experts were qualified under MCARE § 512(e) because their fields of medical practice were related to the specific care at issue.

Trial commenced on April 26, 2011 before the Honorable Lawrence J. Brenner and a jury. Ms. Renna described how she noticed two lumps that “felt like gravel” in September 2003. N.T. Trial, 4/26/11, at 53. She told her gynecologist about them, and he referred her for a mammogram and ultrasound, which revealed two cysts. Id. at 54. No follow-up was recommended. Ms. Renna mentioned the lumps to her primary care physician, and he suggested that she follow up with Dr. Schadt. Ms. Renna saw Dr. Schadt in May 2004. He performed an exam and recommended a needle biopsy. Ms. Renna inquired whether the lumps could instead be removed, and Dr. Schadt responded that, “if we did that, then you’ll have breasts that look like Swiss cheese.” Id. at 62. He performed the needle aspiration biopsy and several weeks later, Ms. Renna received a message from the office that the results were negative and everything was fine. She was not told by Dr. Schadt that the specimen submitted was not optimal. Id. at 137.

Ms. Renna testified that she returned to her primary care physician, Dr. Scharle, because she felt a new lump and the two existing lumps were larger. She underwent another mammogram on February 1, 2005. Again, due to very dense breast material, nothing suspicious was seen or noted, but Dr. Scharle was able to locate the lumps very easily. His office arranged for Ms. Renna to be seen again by Dr. Schadt on March 29, 2005. Dr. Schadt recommended and performed a needle biopsy, the results of which were found to be inconclusive. Id. at 68. A month later, on April 22, 2005, Dr. Schadt performed an excisional biopsy under general anesthesia at St. Luke’s Hospital. The following Monday, he advised Ms. Renna that the results revealed cancer. Id. at 73. He recommended a mastectomy of the right breast and reconstruction at the same time. Id. After Dr. Schadt consulted with [662]*662an oncologist and additional testing was performed, he opted instead for a bilateral mastectomy and no reconstruction until later. Surgery was performed on May 6, 2005. Ms. Renna thereafter underwent eight rounds of chemotherapy and then radiation on the right side five days per week for sixty-five treatments. She could not return to teaching until late August 2006. As of trial, there had been no recurrence of cancer. She continued to take oral medications to reduce the risk of recurrence but had not undergone reconstruction. Reconstructive surgery was complicated by the fact that she did not have enough skin as a result of the chest wall radiation she had been required to undergo.

Following an extensive voir dire, the trial court found Ms. Renna’s expert pathologist Dr. Shane to be qualified to opine as to the standard of care as it relates to fine needle aspiration and collection methods of biopsies, recognizing that the litigation did not deal “strictly with a surgical process.” Id. at 57. Dr. Shane described the differences between fine needle aspiration and ultrasound-guided biopsy techniques generally and used radiographic evidence depicting the procedures for the jury’s edification. He then explained Ms. Renna’s pathology report generated on the specimen obtained by Dr. Schadt during the fine needle aspiration procedure. At the outset, he noted that the pathologist identified few epithelial cells present, indicating that the specimen was scanty. Id. at 61-62. He attributed the lack of epithelial cells to dense breast tissue, and explained that when one puts the needle in and draws back, the fibroconnective tissue prevents epithelial cells from being carried into the syringe. If a pathologist is present, he can evaluate the adequacy of the specimen. In the case of scanty epithelial cells, as many as three or four additional passes may be necessary to obtain a sufficient sample. In this case, the pathologist reported “scanty epithelial cells” and characterized the specimen as “less than optimal due to limited epithelial cellular material.” Id. at 64. That meant, according to Dr. Shane, that there were insufficient epithelial cells “to provide an accurate interpretation.” Id. The pathologist reported that “although no malignancy is seen, the findings are not indicative of any specific pathologic energy,” which meant that he was unable to examine those cells and make any diagnosis. Id. at 65. In his opinion, the result of the fine needle aspiration was a limited diagnosis based on a limited specimen. Id. at 66.

In response to questions regarding what other biopsy techniques can be used to obtain a larger specimen, Dr. Shane advised that repeated passes using the needle aspiration method with a pathologist on site evaluating the specimen would achieve that result. He offered, as another alternative, core biopsy, where a piece of tissue is removed and one examines cells invading normal tissues, as providing “the complete picture.” Id. at 67. Ultrasound— guided fine needle aspiration assists the physician in getting the needle to the right spot to avoid false negatives. Dr. Shane testified that the failure to locate the needle properly in Ms. Renna’s case resulted in the negative result, despite the existence of malignant cells. He opined further that a clinician should do fine needle aspiration biopsy under ultrasound or CT guidance, or preferably, CT-guided core biopsy, a technique available to clinicians for more than twenty years. Id. at 72.

Ms.

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Cite This Page — Counsel Stack

Bluebook (online)
64 A.3d 658, 2013 Pa. Super. 34, 2013 WL 657655, 2013 Pa. Super. LEXIS 81, Counsel Stack Legal Research, https://law.counselstack.com/opinion/renna-v-schadt-pasuperct-2013.