[Cite as Schultz v. Mayfield Neurological Inst., 2013-Ohio-4146.]
IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO
JAMES W. SCHULTZ : APPEAL NO. C-120764 TRIAL NO. A-0510837 and :
JULIE ANN SCHULTZ, : O P I N I O N. Plaintiffs-Appellants, :
vs. :
MAYFIELD NEUROLOGICAL : INSTITUTE : and : MAYFIELD SPINE INSTITUTE, : Defendants-Appellees.
Civil Appeal From: Hamilton County Court of Common Pleas
Judgment Appealed From Is: Affirmed
Date of Judgment Entry on Appeal: September 25, 2013
John H. Metz, for Plaintiffs-Appellants,
The Triona Firm, James P. Triona and Paul Vollman, for Defendants-Appellees. OHIO FIRST DISTRICT COURT OF APPEALS
S YLVIA S IEVE H ENDON , Presiding Judge.
{¶1} James W. Schultz and his wife Julie Ann Schultz appeal the trial court’s
judgment in favor of Mayfield Neurological Institute and Mayfield Spine Institute
(hereinafter collectively referred to as “Mayfield”) in their action for medical malpractice
and lack of informed consent. We affirm the trial court’s judgment.
Background
{¶2} In 1998, the Schultzes initiated an action against Mayfield and one of its
practitioners, Stewart Dunsker, M.D. They alleged that as a result of a 1997 cervical-spine
surgery performed by Dr. Dunsker, Mr. Schultz had suffered injury to his recurrent
laryngeal nerve which permanently affected his ability to speak in a normal tone of voice.
{¶3} The Schultzes later voluntarily dismissed and refiled the action two more
times. The most recent complaint was filed in 2005.
{¶4} In 2007, Dr. Dunsker asserted that he was entitled to immunity as a state
employee, so the matter was stayed pending a determination by the Court of Claims.
{¶5} In 2009, the Court of Claims determined that Dr. Dunsker was entitled to
immunity, pursuant to R.C. 9.86 and 2743.02(F), because he was a state employee acting
within the scope of his employment with the University of Cincinnati when the alleged
negligence occurred.
{¶6} In 2011, the Schultzes asked the trial court to find that Dr. Dunsker had
waived the immunity defense. The trial court denied the motion.
{¶7} In 2011, the trial judge denied the Schultzes’ motion for recusal. The
Schultzes then filed with the Ohio Supreme Court an affidavit of bias and prejudice under
R.C. 2701.03 to disqualify the trial judge. The affidavit of disqualification was denied.
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{¶8} Following a bench trial, the court entered judgment in favor of Mayfield. The
Schultzes now appeal, raising eleven assignments of error. None of their assignments of
error challenged the weight or sufficiency of the evidence supporting the judgment.
Motion for a Mistrial
{¶9} In their first assignment of error, the Schultzes argue that the trial court erred
by denying their motion for a mistrial. They contend that the court improperly considered
“evidence outside of the record and [made] determinations before all the evidence [was]
presented.”
{¶10} Generally, a motion for a mistrial in a civil case is treated as a motion for a new trial pursuant to Civ.R. 59(A). See Gugliotta v. Morano, 161 Ohio App.3d 152, 2005-
Ohio-2570, 829 N.E.2d 757, ¶ 10 (9th Dist.). The rule allows a trial court to grant a new trial
if an irregularity in the trial proceedings can be shown to have prevented the moving party
from having a fair trial. Civ.R. 59(A)(1). We review a trial court’s decision to grant or deny a
motion for a mistrial or a new trial for an abuse of discretion. See Savage v. Correlated
Health Servs. Ltd., 64 Ohio St.3d 42, 591 N.E.2d 1216 (1992); Jacobs v. McAllister, 6th Dist.
Lucas No. L-06-1172, 2007-Ohio-2032, ¶ 19.
{¶11} In moving for a mistrial, the Schultzes’ attorney argued that he was concerned by off-the-record remarks made by the trial court. Because any such remarks are not part of
the record, we have no basis to conclude that the trial court abused its discretion in refusing
to grant a mistrial. Consequently, we overrule the first assignment of error.
Commonality of Insurance
{¶12} In their second assignment of error, the Schultzes argue that the trial court erred by precluding them from cross-examining defense expert, Patrick McCormick, M.D.,
about his professional liability carrier.
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{¶13} In an action for medical malpractice, an expert witness having the same malpractice insurer as another defendant is subject to inquiry concerning bias if the witness
testifies favorably for that defendant. Ede v. Atrium South OB-GYN, Inc., 71 Ohio St.3d
124, 642 N.E.2d 365 (1994); Davis v. Immediate Med. Servs., 80 Ohio St.3d 10, 16, 684
N.E.2d 292 (1997); Fehrenbach v. O’Malley, 164 Ohio App.3d 80, 2005-Ohio-5554, 841
N.E.2d 350, ¶ 37 (1st Dist.). We review the trial court’s ruling pursuant to an abuse-of-
discretion standard. Calderon v. Sharkey, 70 Ohio St.2d 218, 436 N.E.2d 1008 (1982),
syllabus.
{¶14} In Ede, the Ohio Supreme Court held that the trial court had erred by finding that the potential for prejudice outweighed the probative value of testimony that a defense
expert and a defendant physician were insured by the same carrier. Ede at 127. The
Supreme Court cited two reasons supporting its conclusion: (1) the trial court had failed to
consider the potential for the expert’s personal bias resulting from the expert’s having the
same insurance carrier as the party for whom he testified; and (2) the trial court had grossly
overestimated the effect of testimony that the defendant was insured would have on the
jury. The Supreme Court stated:
[T]estimony regarding insurance is not always prejudicial. However, too
often courts have a Pavlovian response to insurance testimony -- immediately
assuming prejudice. It is naive to believe that today’s jurors, bombarded for
years with information about health care insurance, do not already assume in
a malpractice case that the defendant doctor is covered by insurance. The
legal charade protecting juries from information they already know keeps
hidden from them relevant information that could assist them in making their
determinations. Our Rules of Evidence are designed with truth and fairness
in mind; they do not require that courts should be blind to reality.
Id.
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{¶15} In this case, Dr. McCormick, an expert witness for the defense, was cross- examined about his fees for case reviews and for testimony as an expert, the number of
malpractice cases he had reviewed or testified in as an expert, the number of times he had
testified for the defense in a malpractice case, and the number of times he had worked with
trial counsel for Mayfield. He was also cross-examined with respect to his having written an
article about the escalation of costs of malpractice policies in Ohio and the fact that fewer
insurers were willing to offer them. He was further cross-examined about his participation
in medical organizations that promoted tort-reform legislation. However, when counsel for
the Schultzes asked Dr. McCormick the identity of his medical liability insurance carrier, the
trial court sustained a defense objection to the question.
{¶16} Following Dr. McCormick’s testimony, counsel and the court had a discussion on the question of the commonality of insurance with respect to Mayfield and Dr.
McCormick. Defense counsel indicated that Mayfield’s insurance carrier for the case had
been out of business for at least five years and that it had been liquidated. So, he argued,
Dr. McCormick could not have been insured “by a company that is out of business.”
Counsel for the Schultzes, however, maintained that he should have been able to question
the doctor on the subject.
{¶17} On appeal, the Schultzes argue that the court’s refusal to allow cross- examination on the question of the commonality of insurance was plain error requiring
reversal. Mayfield counters that in 2008, it had filed in this case a motion for stay on the
grounds that its liability carrier had entered bankruptcy. So, Mayfield argues, there existed
no reasonable likelihood that Dr. McCormick had the same insurance carrier as Mayfield, or
that he would have been motivated by any common pecuniary interest in the viability of a
bankrupt insurance carrier.
{¶18} On the facts of this case, even if the trial court erred by excluding the testimony, we cannot say that the Schultzes’ substantial rights were prejudiced as a result.
The concerns expressed by the Ede court with respect to jury determinations were not
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present here ─ this was a bench trial where both parties had ample opportunity to argue
their positions on the commonality-of-insurance matter directly to the trier of fact. So the
Schultzes cannot demonstrate that the outcome of the trial would have been otherwise had
the testimony not been excluded. Accordingly, we overrule the second assignment of error.
Notice of a Subpoena
{¶19} In their third assignment of error, the Schultzes argue that the trial court erred by allowing the defense to use subpoenaed materials in cross-examining their expert,
because the defense had failed to serve a copy of the subpoena on the Schultzes.
{¶20} Civ.R. 45(A)(3) provides: A party on whose behalf a subpoena is issued under division (A)(1)(b)(ii), (iii),
(iv), (v), or (vi) of this rule shall serve prompt written notice, including a copy
of the subpoena, on all other parties as provided in Civ.R. 5. If the issuing
attorney modifies a subpoena issued under division (A)(1)(b)(ii), (iii), (iv), (v),
or (vi) of this rule in any way, the issuing attorney shall give prompt written
notice of the modification, including a copy of the subpoena as modified, to all
parties.
{¶21} The Staff Notes accompanying the 2005 amendment to the rule state: The notice requirement of amended Civ.R. 45(A)(3), like its counterpart in
Rule 45(B)(1), Federal Rules of Civil Procedure, is intended ‘to afford other
parties an opportunity to object to the production or inspection, or to serve a
demand for additional documents or things.’ Advisory Committee’s Note to
1991 Amendments to the Federal Rules of Civil Procedure; see, e.g., Spencer
v. Steinman, 179 F.R.D. 484, 488 (E.D.Pa. 1998).
No penalty is prescribed for a party’s violation of the notice requirement.
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{¶22} In May 2007, Mayfield issued a subpoena to the American Association of Neurological Surgeons (“AANS”) requesting all documents related to the association’s
proceedings with regard to the Schultzes’ expert witness, Donald Castle Austin, M.D. A copy
of the subpoena was filed with the court but was not served upon the Schultzes.
{¶23} In July 2012, counsel for Mayfield used the subpoenaed materials during the cross-examination of Dr. Austin in his deposition, over the Schultzes’ objection. Defense
counsel questioned Dr. Austin about his having been sanctioned by the AANS in 1995 as a
result of his testimony in a lawsuit against another neurosurgeon. Dr. Austin acknowledged
that, following the disciplinary action, he had filed suit against the AANS in federal court.
{¶24} The trial in this case began in August 2012. After Dr. Austin’s deposition was introduced and reviewed at trial, the Schultzes reiterated their objection to the use of the
AANS materials on the basis that they had not been notified of the May 2007 subpoena
from Mayfield to AANS. The trial court overruled their objection.
{¶25} On appeal, the Schultzes argue that they were unfairly surprised by Mayfield’s use of the AANS materials during the cross-examination of Dr. Austin. They contend that
Mayfield’s failure to notify them of the 2007 AANS subpoena had deprived them of the
opportunity to rehabilitate the witness.
{¶26} However, the Schultzes’ argument that they were unfairly surprised by the subpoenaed materials rings hollow for two reasons. They had retained Dr. Austin in this
case ten years before his deposition took place, so they had ample opportunity to learn of
the AANS information before his July 2012 deposition. More importantly, though, the trial
court stated that it would not consider the AANS proceedings or the resulting federal
litigation for any purpose.
{¶27} Because the Schultzes failed to demonstrate that they were unfairly surprised by Mayfield’s failure to notify them of the AANS subpoena, we hold that the trial court did
not err by allowing Dr. Austin to be cross-examined with respect to the materials. We
overrule the third assignment of error.
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Hearsay
{¶28} In their fourth assignment of error, the Schultzes argue that the trial court erred “by considering hearsay, namely ethical consideration [sic] by the [AANS].” They
contend that they were prejudiced by the court’s consideration of factual determinations by
the AANS.
{¶29} As we have noted, the trial court indicated that it would not consider the AANS proceedings or the resulting federal litigation. Moreover, we are guided by the
presumption that, in a bench trial, the court is presumed to have considered only the
“relevant, material, and competent evidence.” See State ex rel. BDFM Co. v. Ohio Dept. of
Transp., 10th Dist. Franklin No. 11AP-1094, 2013-Ohio-107, ¶ 45; State v. Robbins, 1st Dist.
Hamilton No. C-120107, 2013-Ohio-612, ¶ 14.
{¶30} Because the record does not demonstrate that the trial court improperly considered any evidence of proceedings by the AANS with respect to Dr. Austin, we overrule
the fourth assignment of error.
Immunity of Dr. Dunsker
{¶31} In their fifth assignment of error, the Schultzes argue that the trial court erred by failing to determine whether Dr. Dunsker had waived his defense of immunity. However,
the immunity issue is irrelevant given the uncontested finding of no liability. We overrule
the fifth assignment of error.
Professional Literature
{¶32} In their sixth assignment of error, the Schultzes argue that the trial court erred by permitting Mayfield’s expert witnesses to cite medical literature without providing
a specific citation or source, thereby preventing effective cross-examination.
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{¶33} In Beard v. Meridia Huron Hosp., 106 Ohio St.3d 237, 2005-Ohio-4787, 834 N.E.2d 323, the Ohio Supreme Court held that expert witnesses are allowed to testify that
their opinions are based, in part, on their review of professional literature. In this case, the
trial court properly allowed the defense experts to make general references to the
professional literature in support of their opinions. Neither expert impermissibly acted “as
a conduit for the out-of-court statements of others,” and both were subject to cross-
examination to test their opinions. See id. at ¶ 33. Moreover, we presume that the court, as
the trier of fact, considered only competent evidence. We overrule the sixth assignment of
error.
Nickell v. Gonzalez
{¶34} In their seventh assignment of error, the Schultzes argue that the trial court erred by “applying the Nickell v. Gonzalez ‘reasonable person’ and ‘material’ risk standards
and allowing expert testimony on the ultimate issue.” They contend that the reasonable
person test “turns the doctrine [of informed consent] upon its head and renders it
meaningless.”
{¶35} In Nickell, the Ohio Supreme Court held that the tort of lack of informed consent is established when:
(a) the physician fails to disclose to the patient and discuss the material risks
and dangers inherently and potentially involved with respect to the proposed
therapy, if any; (b) the unrevealed risks and dangers which should have been
disclosed by the physician actually materialize and are the proximate cause of
the injury to the patient; and (c) a reasonable person in the position of the
patient would have decided against the therapy had the material risks and
dangers inherent and incidental to treatment been disclosed to him or her
prior to the therapy.
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17 Ohio St.3d 136, 477 N.E.2d 1145 (1985).
{¶36} In White v. Leimbach, the Ohio Supreme Court held that expert medical testimony is required to establish the first and second elements set forth in Nickell. 131
Ohio St.3d 21, 2011-Ohio-6238, 959 N.E.2d 1033 (2011), syllabus. In other words, expert
testimony is required to: (a) establish the material risks and dangers inherently and
potentially involved with a medical procedure; and (b) establish that an undisclosed risk
actually materialized and caused injury to the patient. Id. at ¶ 34-38. However, expert
medical testimony is not required to establish whether a reasonable person in the plaintiff’s
position would have decided against the procedure had the material risks been disclosed.
Id. at ¶ 40. What a reasonable patient would have done in light of the disclosed risks is
determined by the trier of fact. Id. at ¶ 37 and 41.
{¶37} In this case, the trial court properly applied the law as set forth in Nickell and White. With respect to the first Nickell element, the court concluded that the expert
testimony of Drs. Dunsker and McCormick, who opined that injury to the larnyngeal nerve
was not a significant or material risk, was more credible than that of the Schultzes’ expert.
With respect to the third Nickell element, the court, as the trier of fact, found it
“inconceivable that a reasonable person in plaintiff’s condition” would have decided against
the anterior cervical discectomy surgery if the specific injury to the vocal cord had been
disclosed.
{¶38} Because the trial court properly applied the law with respect to the Schultzes’ claim of lack of informed consent, we overrule the seventh assignment of error.
Untimely Jury Demand
{¶39} In their eighth assignment of error, the Schultzes argue that the trial court erred by denying their request to have their case heard by a jury.
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{¶40} On May 18, 2006, the Schultzes filed a jury demand pursuant to Civ.R. 38 and 39. Upon the defendants’ motion, the trial court struck the jury demand as being untimely.
{¶41} A jury demand may be filed “not later than fourteen days after the service of the last pleading directed to such issue.” Civ.R. 38(B). The failure of a party to timely serve
a demand for a jury trial constitutes a waiver of a trial by jury. Civ.R. 38(D).
{¶42} In this case, the trial court found that the Schultzes’ jury demand had been filed four months late and that they had failed to respond to Mayfield’s motion to strike the
untimely demand. Consequently, we hold that the trial court did not abuse its discretion by
striking the Schultzes’ jury demand. We overrule the eighth assignment of error.
Fairness of the Trial
{¶43} In their ninth assignment of error, the Schultzes argue that the trial court erred by failing to provide a fair and impartial trial. They contend that the trial court had a
“negative opinion” of Dr. Austin and “wanted to disqualify” him as an expert witness. This
assertion is belied by the record; the trial court specifically stated that it accepted Dr.
Austin’s testimony as an expert witness. We overrule the ninth assignment of error.
Applicable Legal Standards
{¶44} In their tenth assignment of error, the Schultzes argue that the trial court erred by applying the wrong legal standards to their claims of medical negligence and lack of
informed consent.
{¶45} The Ohio Supreme Court set forth the requirements for proving a medical malpractice claim:
In order to establish medical malpractice, it must be shown by a
preponderance of evidence that the injury complained of was caused by the
doing of some particular thing or things that a physician or surgeon of
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ordinary skill, care and diligence would not have done under like or similar
conditions or circumstances, or by the failure or omission to do some
particular thing or things that such a physician or surgeon would have done
under like or similar conditions and circumstances, and that the injury
complained of was the direct and proximate result of such doing or failing to
do some one or more of such particular things.
Bruni v. Tatsumi, 46 Ohio St.2d 127, 346 N.E.2d 673 (1976).
{¶46} The Supreme Court explained, “Proof of malpractice, in effect, requires two evidentiary steps: evidence as to the recognized standard of the medical community in the
particular kind of case, and a showing that the physician in question negligently departed
from this standard in his treatment of plaintiff.” Id. at 131.
{¶47} In this case, the trial court determined that the Schultzes failed to prove that Dr. Dunsker’s conduct fell below the standard of care for a neurosurgeon performing that
type of surgery. The court properly applied the Bruni standard and found in favor of
Mayfield.
{¶48} Moreover, as we discussed in our resolution of the seventh assignment of error, the trial court properly applied the Nickell standard in evaluating the Schultzes’ lack-
of-informed-consent claim. We overrule the tenth assignment of error.
Constitutionality of R.C. 2701.03
{¶49} In their eleventh assignment of error, the Schultzes argue that the procedure in R.C. 2701.03 for the disqualification of a common pleas judge violates the Ohio and
United States Constitutions. However, the failure to raise this issue in the trial court waives
the issue on appeal. See State v. Awan, 22 Ohio St.3d 120, 489 N.E.2d 277 (1986), syllabus.
Moreover, we find no constitutional infirmity in the statute. See Bland v. Graves, 99 Ohio
12 OHIO FIRST DISTRICT COURT OF APPEALS
App.3d 123, 650 N.E.2d 117 (9th Dist.1994). We overrule the eleventh assignment of error
and affirm the trial court’s judgment.
Judgment affirmed.
HILDEBRANDT and FISCHER, JJ., concur.
Please note:
The court has recorded its own entry on the date of the release of this opinion.