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Carney v. Tranfaglia3/26/2003
cations. The sleeping medication that she said worked for her was chloral hydrate, and Dr. Tranfaglia gave her prescriptions which allowed her to accumulate a large supply. Chloral hydrate is dangerous because the difference between a prescribed dose and a lethal dose is small.
2. Exclusion of expert testimony on causation. Counsel for the plaintiff made several attempts to have his expert give an opinion "whether or not Dr. Tranfaglia's treatment contributed to [Poretta's] death." It was the plaintiff's burden, counsel argued, to establish that the defendant's negligence was the proximate cause of the plaintiff's harm -- in this case, Poretta's death. Harlow v. Chin, 405 Mass. 697, 702 (1989). Generally, the causal link is forged by expert testimony. Ibid. Specialized knowledge may be needed to make the link, for example, between a severed nerve and incontinence, a subject about which a jury of lay people could not be expected to have a store of reliable information. When the causal link is one that may be inferred from the evidence already received, the finder of fact does not need help from an expert. See Matteo v. Livingstone, 40 Mass. App. Ct. 658, 663 (1996); Puopolo v. Honda Motor Co., 41 Mass. App. Ct. 96, 98-99 (1996). Here, the plaintiff's expert had been allowed to testify copiously that chloral hydrate was a dangerous drug in the hands of an addictive personality, that Poretta had been an addictive personality, that abuse by her of chloral hydrate was predictable, that it happened, and that she died. It was hardly necessary or helpful to the jury to have the expert witness add a formulaic phrase such as "the negligent treatment caused the patient's death." See Matteo v. Livingstone, supra at 663. The judge's ruling was correct, as well as within the area of the broad discretion conferred on trial judges as to the admission of expert testimony. See Commonwealth v. Woods, 419 Mass. 366, 374-375 (1995).
3. Jury instruction. In the course of her charge to the jury, the trial judge instructed as follows:
"If you find that Patricia Carney Poretta consciously decided to end her own life and that she believed that ingesting the medications the quantities she took was likely to cause her death, then you may find that plaintiff has not met the burden of proof on that issue of causation."
Before closing arguments and charge, the judge discussed this paragraph in the instructions with counsel. The focus of the objection made by plaintiff's counsel, before and after the judge delivered her charge, was less on its substance but that the paragraph was objectionable because it introduced into the case, at the eleventh hour, a subject that was to have been out of the case, namely, whether Poretta had committed suicide.
The plaintiff's view that suicide was off limits was based on a pretrial motion in limine, made by the defense, "to exclude any reference in the medical records or by any other evidence that... Patricia Carney Poretta committed suicide...." At trial and on appeal, the defense argued that the sole object of the motion in limine was exclusion of a reference to suicide as the manner of death in the autopsy report of the office of the chief medical examiner at the University of Massachusetts in Worcester.
That argument is disingenuous. The motion, which, with the agreement of the parties, a judge other than the trial judge had allowed, had a broader reach, namely reference to suicide "by any other evidence."
As the evidence developed at trial, however, there were repeated references to suicide and questions directed at whether Dr. Tranfaglia, exercising the degree of care and skill of the average qualified physician pra
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