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Fabian v. Bristol Park Medical Group2/13/2003
Appellant Meg Fabian appeals from a judgment in favor of respondent Bristol Park Medical Group (Bristol Park) in this medical malpractice case. At trial, Fabian argued Bristol Park's failure to timely refer her for treatment by a specialist resulted in substantial injury . The sole issue on appeal is whether the trial court should have permitted the introduction of evidence that respondents had a financial motive for failing to refer Fabian to a specialist. Because appellant has failed to meet the high standard for demonstrating either an abuse of discretion or a resulting miscarriage of justice, we affirm the judgment.
I. FACTS
According to the parties, Fabian was first seen at Bristol Park by Dr. Mark Schafer, an internist, in March 1998. She presented with severe headaches, memory loss, difficulty in balance, weight gain, and general weakness. Schafer conducted a physical exam and conducted tests to check her thyroid and her blood count. An MRI of her brain was conducted after these tests came back essentially normal. The MRI was also interpreted as normal.
Between April and October 1998, Fabian was seen on numerous occasions by Schafer and Dr. Cassidy Tsay, another internist. She was treated for headaches, fatigue and associated symptoms as well as weight gain. A variety of treatments, including various medications, were prescribed, but nothing was completely successful. Other tests, including X-rays, did not reveal any abnormalities. Fabian states she requested a referral to a specialist for her headaches, which Tsay denied. She was seen for the last time at Bristol Park on October 2, 1998.
Beginning in March 1999, Fabian sought treatment outside her insurance plan. She was treated by an orthopedic surgeon, who diagnosed migraine headaches and referred her to a pain management specialist, Dr. Gurskis. Dr. Gurskis prescribed medication and on March 10, treated Fabian with a nerve block injection. On March 25, Fabian went to the Saddleback Memorial Hospital emergency room, reporting severe migraine headaches and vomiting. She was given a shot of Demerol for pain and later released. On April 1, Fabian returned to Saddleback and was diagnosed with a right hemisphere stroke caused by dissection of the right internal carotid artery. She was treated thereafter at UCLA Medical Center by a vascular surgeon, who diagnosed potential fibromuscular dysplasia.
II. PROCEDURAL BACKGROUND
Fabian filed the instant complaint on March 9, 2000, alleging a single cause of action for malpractice against Bristol Park and doctors Schaefer and Tsay (who were later dismissed). The essence of Fabian's complaint was that the Bristol Park doctors were negligent, resulting in Fabian's stroke in April 1999. Discovery commenced, including expert witness discovery. Although Fabian asserted Bristol Park's failure to refer her to a specialist was a cause of her injury , at no time during this period did Fabian assert any theory or disclose any witness relating to financial motives for failing to refer her to a specialist.
Bristol Park states that the name of Edward Himes, M.D., was added to the witness list by Fabian on May 21, 2001, two days before the case was scheduled for trial. Himes, a former employee of Bristol Park, would testify that Bristol Park was "over budget" during the relevant time period, and that doctors were told either not to provide referrals or to delay them. This contradicted the treating doctors' deposition testimony, which stated they had no restrictions on referring a patient to a specialist if it was medically indicated.
Bristol Park had already filed a number of fairly standard motions in limine, seeking t
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