Z.R., a Minor, By and Through Her Mother and Next Friend, T.R. and By and Through Her Father and Next Friend, R.R. v. Kansas City Pediatrics, LLC, and Scott Dattel, M.D.

CourtMissouri Court of Appeals
DecidedOctober 31, 2023
DocketWD85751
StatusPublished

This text of Z.R., a Minor, By and Through Her Mother and Next Friend, T.R. and By and Through Her Father and Next Friend, R.R. v. Kansas City Pediatrics, LLC, and Scott Dattel, M.D. (Z.R., a Minor, By and Through Her Mother and Next Friend, T.R. and By and Through Her Father and Next Friend, R.R. v. Kansas City Pediatrics, LLC, and Scott Dattel, M.D.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Z.R., a Minor, By and Through Her Mother and Next Friend, T.R. and By and Through Her Father and Next Friend, R.R. v. Kansas City Pediatrics, LLC, and Scott Dattel, M.D., (Mo. Ct. App. 2023).

Opinion

IN THE MISSOURI COURT OF APPEALS WESTERN DISTRICT Z.R., A MINOR, BY AND THROUGH ) HER MOTHER AND NEXT FRIEND, ) T.R. AND BY AND THROUGH HER ) FATHER AND NEXT FRIEND, R.R., ) ) Respondents, ) ) v. ) WD85751 ) KANSAS CITY PEDIATRICS, LLC, ) Opinion filed: October 31, 2023 AND SCOTT DATTEL, M.D., ) ) Appellants. )

APPEAL FROM THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI THE HONORABLE JOHN TORRENCE, JUDGE

Division One: Edward R. Ardini, Jr., Presiding Judge, Anthony Rex Gabbert, Judge and Thomas N. Chapman, Judge

Scott Dattel, M.D., and Kansas City Pediatrics, LLC, (“Defendants”) appeal the

judgment of the Circuit Court of Jackson County granting Z.R.’s motion for new trial. The

trial court granted Z.R.’s motion after a jury found in favor of Defendants on Z.R.’s claim

for medical malpractice. The trial court determined that Z.R. was entitled to a new trial

because a defense expert witness provided trial testimony that “directly contradicted” his

earlier deposition testimony, this change in testimony was not disclosed to Z.R. prior to trial, and the “undisclosed testimony unfairly resulted in substantial prejudice” to Z.R. For

the reasons stated below, we affirm.

Factual and Procedural Background

Z.R. brought this action—through her parents—asserting Defendants negligently

failed to evaluate and treat her bilateral hip dysplasia when she was an infant.

Hip dysplasia

Hip dysplasia—which is “usually seen in infants and young children”—refers to a

spectrum of hip conditions concerning the fit of the femur into the acetabulum (the hip

socket). Milder forms of hip dysplasia include a hip that is “a little bit loose” in the socket;

the most severe form is a dislocated hip. An infant with hip dysplasia can also have

“dislocatable” hips, meaning hips that move in and out of their sockets. Females born in

the breech position have the highest risk of hip dysplasia. Bilateral hip dysplasia means

both hips are affected.

Pediatricians routinely screen newborns for hip dysplasia. Such screening includes

consideration of a child’s risk factors and Ortolani and Barlow testing, which are physical

manipulations of the child’s hips. The Ortolani maneuver tests for a dislocated hip; the

Barlow maneuver tests for a dislocatable hip.

If a pediatrician suspects hip dysplasia, referral to a pediatric orthopedist or

ultrasonography imaging (an ultrasound) is recommended. An ultrasound is used to

confirm or rule out a suspected diagnosis of hip dysplasia until an infant is four to six

months old. After that age, X-rays or CT scans are used to diagnose hip dysplasia. Hip

dysplasia is most often diagnosed while the child is a newborn. 2 Pavlik harnesses are commonly prescribed to treat infants diagnosed early with hip

dysplasia. A Pavlik harness is a soft brace worn by an infant for two to three months, which

“help[s] the joint form normally so that the child won’t be in any elevated risk for hip

surgery.” An infant can begin wearing a Pavlik harness at one day old. Infants who wear

Pavlik harnesses generally do not require surgery to treat their hip dysplasia.

Z.R.’s history

Z.R.—a female—was born in November 2015 in the Frank breech position via c-

section delivery.1 The physician at the hospital documented that, the day Z.R. was born,

she had a left hip click.2 Z.R. was “double diapered” while at the hospital. Double diapering

does not provide any benefit to a child, but indicates the medical provider suspects the child

has hip dysplasia. Z.R.’s parents noticed abnormalities in Z.R.’s hips soon after she was

born, including “problems with movement.”

Z.R. first visited Kansas City Pediatrics when she was three days old. She was

examined by a physician’s assistant who noted a right hip click. The physician’s assistant

also documented “negative Barlow and Ortolani Test.” Z.R. was examined by Dr. Dattel

and physician’s assistants at Kansas City Pediatrics multiple times throughout 2016 and

2017. There were no other notations in Z.R.’s Kansas City Pediatrics records about hip

1 In the Frank breech position, the infant’s “hips are over [her] head.” There was testimony at trial that an infant born in this position has a higher likelihood of having dislocated hips compared to an infant born in the regular breech position, where the infant’s legs “are all kind of curled up.” 2 There was trial testimony that a dislocated hip, where “the ball is not in the socket” but “riding on the back of the pelvis,” might produce “a little click.”

3 clicks, and all subsequent examinations of Z.R.’s hips indicated that they were stable and

had normal, active motion. Defendants’ records did not contain any references to hip

dysplasia or otherwise indicate a concern or suspicion that Z.R. had a hip abnormality.

Defendants’ records did not reference “any consideration of having referred [Z.R.] for

pediatric orthopedist evaluation” or “any consideration of ordering an ultrasound” for Z.R.

In June 2018, Z.R. was seen by a doctor at Children’s Mercy Hospital, who

suspected Z.R. had hip dysplasia. An X-ray showed that both of Z.R.’s hips were

dislocated, confirming a diagnosis of bilateral hip dysplasia. Z.R. underwent two surgeries

in the summer of 2018, one on each hip, to put her hips back in their sockets.3 Z.R.

underwent a third surgery in August 2019 to remove the hardware in her hips.

Litigation

Z.R. initiated this action in January 2020. In July 2021, Defendants deposed Z.R.’s

causation expert (“Z.R.’s Expert”), an orthopedic surgeon who specialized in pediatric

orthopedics. Two months later, Z.R. deposed Defendants’ causation expert (“Defense

Expert”), also an orthopedic surgeon who specialized in pediatric orthopedics. Defense

Expert testified at his deposition that a child can be born with one or both hips dislocated,

and that he could not rule out that Z.R. had been born with dislocated hips. He further

testified that an ultrasound could have been safely performed on Z.R. starting “at the first

day of [her] life” to diagnose her hip dysplasia, an orthopedic referral “could have been

3 Specifically, Z.R. underwent on each hip “an open reduction” and “a pelvic osteotomy and a femoral shortening osteotomy.” An osteotomy is a “[c]utting of the bone.” “[S]hortening of the hip puts the hip back into the socket with the least amount of pressure on it[.]” 4 done” before Z.R. was four months old to diagnose her hip dysplasia, and if Z.R. had been

diagnosed “in an early period, and if treatment had been administered in the form of [a]

Pavlik Harness, much more likely than not [Z.R.] could have avoided surgery on one or

both hips.”

A six-day jury trial commenced in June 2022. Defendants’ theory of the case was

that Z.R. developed late onset hip dysplasia, which was not present or diagnosable during

the time she was a patient of Dr. Dattel. The last time Dr. Dattel examined Z.R. was in

August 2017, when she was 20 months old.

Z.R.’s Expert and Defense Expert testified at trial.4 Z.R.’s Expert opined that it was

most likely Z.R.’s hips were dislocated when she was born and had remained dislocated.

He expected that, had an ultrasound been performed when Z.R. was six to eight weeks old,

it would have established Z.R. had dislocated hips. He testified that if Z.R.’s hips were

“completely dislocated at birth,” he nonetheless would expect her to “have a good

outcome” with the use of a Pavlik harness.

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Z.R., a Minor, By and Through Her Mother and Next Friend, T.R. and By and Through Her Father and Next Friend, R.R. v. Kansas City Pediatrics, LLC, and Scott Dattel, M.D., Counsel Stack Legal Research, https://law.counselstack.com/opinion/zr-a-minor-by-and-through-her-mother-and-next-friend-tr-and-by-and-moctapp-2023.