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Takayama v. Kaiser Foundation Hospital8/30/1996
OPINION OF THE COURT BY MOON, C.J.
Following a jury trial in this medical malpractice case, plaintiff-appellant Darlene K. Takayama appeals from the judgment entered in favor of defendants-appellees Kaiser Foundation Hospital, Kaiser-Permanente Medical Care Program, Hawai'i Permanente Medical Group, Kaiser Foundation Health Plan and Bernard Robinson, M.D. [hereinafter, collectively, Kaiser]. On appeal, Takayama argues that the trial court: (1) abused its discretion in granting Kaiser's motion in limine regarding rebuttal evidence and in refusing to permit Takayama to present certain rebuttal evidence; (2) abused its discretion in denying Takayama's motion in limine to exclude evidence or argument by Kaiser on the issue of causation of Takayama's injuries; (3) erred in denying Takayama's motion for a directed verdict on the issue of causation of Takayama's injuries; and (4) erred in denying Takayama's motion for judgment notwithstanding the verdict and/or for a new trial. For the following reasons, we affirm.
I. BACKGROUND
In 1985, at the age of thirty-eight, Takayama began experiencing recurrent headaches, increasing stiffness and pain in her neck, and difficulty swallowing. She sought medical advice and treatment at Kaiser. After being initially treated by another Kaiser physician, Takayama was treated by Meredith Olds, M.D., a Kaiser neurosurgeon. On November 25, 1985, Dr. Olds diagnosed Takayama as suffering from Diffuse Idiopathic Skeletal Hyperostosis, or DISH, a congenital condition that causes excess bone to develop on the outer surface of the spine. Dr. Olds noted that Takayama's neck was very restricted in motion and suspected that Takayama would eventually need to undergo a cervical decompression procedure.
In November 1986, Dr. Olds consulted with Dr. Robinson, the chief of the neuroscience department at Kaiser, on Takayama's case. Dr. Robinson examined Takayama and determined that, in addition to the DISH condition, Takayama was also suffering from one of the most severe cases he had seen to that date of a condition called "OPLL," or Ossified Posterior Longitudinal Ligament.
OPLL is a relatively rare disease process whereby the posterior longitudinal ligament, a normally thin, leathery structure that runs along the inside of the spinal canal, slowly "ossifies," or turns to bone, thereby occupying more space in the spinal canal and causing "stenosis," a narrowing of the spinal canal, which, in turn, may cause compression of the spinal cord.
Because of the severity of Takayama's OPLL condition, Dr. Robinson surmised that, without an operation to alleviate the spinal compression caused by the OPLL, Takayama would be at dire risk of death or severe neurologic compromise from as little as a simple slip and fall or some other minor trauma.
Taking into account Takayama's physical and medical condition and history, including diabetes mellitus, bipolar manic-depressive disorder, high blood pressure, and obesity, Dr. Robinson formulated a two-stage surgical plan to treat Takayama's OPLL condition consisting of two separate surgical procedures. The first procedure, a "posterior fusion and bone graft," would strengthen and stabilize Takayama's neck by the grafting of bone tissue harvested from Takayama's rib onto Takayama's vertebrae at the C2, C3, and C4 levels. The second procedure, a series of "anterior cervical corpectomies," was to be performed several weeks after the first procedure and would involve: (1) removal of the vertebral bodies of multiple levels of Takayama's spine; (2) removal of the abnormal bone growth on the external anterior surface of the spine due to the DISH condition; (3) removal of the OPLL develop
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