IN THE COURT OF APPEALS OF THE STATE OF MISSISSIPPI
V. NO.
THIS OPINION IS NOT DESIGNATED FOR PUBLICATION AND MAY NOT BE CITED, PURSUANT TO M.R.A.P. 35-B
TRIAL JUDGE:
COURT FROM WHICH APPEALED COUNTY CIRCUIT COURT:
ATTORNEYS FOR APPELLANT:
ATTORNEYS FOR APPELLEE:
NATURE OF THE CASE:
TRIAL COURT DISPOSITION DEFENSE VERDICT: , , , AND , , FOR THE COURT:
Judge rendered a verdict in favor of , following the trial of a professional malpractice
lawsuit brought by . This appeal followed in which argues that the trial court erred in its
handling of admissions made by under Rule 36 of the Mississippi Rules of Civil Procedure,
defense experts were not qualified to provide expert testimony, the verdict of the jury i s contrary
to the overwhelming weight of the evidence, and challenging the quality of the jury's
deliberations. We affirm.
FACTS
Over many years, was an infrequent dental patient of . During that time lost
most of his/her teeth due to inadequate dental hygiene. In the early , diagnosed with
chronic gingivitis and periodontal disease. Ultimately, required an extraction of the last of
his/her teeth in , concurrently with the installation of dentures. Because of the possibility of
infection, prescribed antibiotics as treatment prior to the extraction procedure. The
extractions were made in , though the precise date is contested.
Some time after the extractions, became ill. According to his/her theory of the case,
an infection in his/her mouth had not been entirely abated; the infection was rele ased into
bloodstream following the extraction. The infection spread, allegedly causing damage t o liver
and heart. evidence attempted to refute all those points.
sued for negligence in failing to abate the infection prior to the extraction or in
extracting the tooth despite the presence of an infection. also took issue with non causative
aspects of 's practice, such as the quality of his/her medical record keeping or charting.
Following presentation of the case to a jury, a verdict for was rendered.
DISCUSSION
Withdrawing a Rule 36 Admission
During preliminary discovery in this case, submitted requests for admission to 's
attorneys. When 's attorneys responded to the requests, they admitted that 's last teeth were
extracted on , 20 . That response was filed on , 20 . On , 20 , at
his/her deposition stated that the extraction was made on . Trial began on , 20 .
We will address the significance of the ten day difference in the extraction dat es after first
discussing the legal standards for permitting the withdrawal of an admission.
sought at trial to have the court preclude from contradicting the admission in its
presentation of testimony and other evidence. In response to the trial court's questioning,
attorney acknowledged that since the deposition of , earlier, he/she was aware of the
conflict between the admissions and 's deposition. 's treatment records indicated that the
extraction occurred on . The trial court refused to bar testimony that the extraction
occurred on instead of , but did allow the admission answer to be used to impeach
.
The Mississippi Rules of Civil Procedure provide:
A party may serve upon any other party a written request for the admission of the truth or
falsity of any matters within the scope of Rule 26(b).... Any matter admitted under this rule is
conclusively established unless the court on motion permits withdrawal or amendment of the
admission. The court may permit withdrawal or amendment when the presentation of the me rits
of the action will be subserved thereby and the party who obtained the admission fails to satisfy
the court that withdrawal or amendment will prejudice him/her in maintaining his/her action.
M.R.C.P. 36(a), (13) (emphasis added).
In the principal Mississippi case that cites to us, a trial judge on the hearing date for a
summary judgment motion, allowed the withdrawal of a deemed admission, i.e., one compell ed
by the party's failure to respond timely to a request. See , 568 So. 2d 289, 290 (Miss. 1990).
Two things are instructive. The first is that the Supreme Court held that an admissi on could be
withdrawn if the record supports the reasons for doing so. The second is that if the record is
silent on the basis for the trial court's actions, the Supreme Court will find an a buse of discretion.
, 568 So. 2d at 291.
Our case is procedurally similar, but not identical. Here the admission was withdrawn
during the testimony of the first witness called at trial, while in the withdrawal was on the
day of a hearing on a disparities motion in the case. The parties disagree as to t he appropriate
test to be applied once trial has commenced. No Mississippi cases are precisely on point.
Given the similarity of the federal and Mississippi rule, federal authorities are i nstructive.
See Shell Oil Co. V. Murrah, 493 So. 2d 1274, 1276 (Miss. 1986). Like the Mississippi rule, the
federal version of Rule 36 facilitates conclusive establishment of a matter a nd is meant to end
any dispute. Consequently, the general intent of Rule 36 precludes a party responding to requests
for admission from creating a record contradicting those admissions. See Bryant V. Allstate Ins.
Co., 107 F.R.D. 45, 48 (sic). Conn. 1985). However, we must balance this aspect of Rule 36 with
its provision allowing withdrawal of admissions. "Although an admission should ordinarily be
binding on the party who made it, there must be room in rare cases for a different result, as when
. . . through honest error a party has made an improvident admission" 8A Charles A. Wright, e t
al, Federal Practice and Procedure Sec. 2264 (1994). In such cases, in the absence of prejudice to
the party seeking to make the admission irrevocably binding, the party that made t he improvident
admission should at the very least be afforded an opportunity to explain why it was made a nd
withdrawn. Id.
The prejudice mentioned in the rule is "the prejudice stemming from reliance on the
binding effect of the admission." fiat 577. argues that this Court should not look at prejudice
to him/her, but instead should apply "a more restrictive standard" by considering whether
refusing the withdrawal or amendment of the admission would result in "manifest injustice" to
. Some courts have applied that standard when there has been a pretrial order under Rule 16. See
American Auto. Ass'n v. Legal Clinic, 930 F.2d 1117, 1120 (5th Cir. 1991). Since there was no
pretrial order, with the attendant formalities of creating a stipulation focusing the parties on the
specific agreed facts and contested issues, we find that standard inapplicable.
American Automobile Ass'n describes the prejudice required for denying a party the right
to withdraw an admission as any "special difficulties a parry may face caused by a sudden need
to obtain evidence upon withdrawal or amendment of an admission." Id. at 1120. In light of the
other evidence developed in this case long before trial, the error made by defense counsel in their
response to the requests for admission was obvious to . At the very least, should have
anticipated a dispute concerning the date of the procedure.
It would have been preferable for to amend his/her admission before trial. We
intimate no conclusion on whether the trial court had to allow testifying contrary to the
admission. Indeed, denying this right may well also have been within the trial court's
discretion. Regardless, due to the lengthy period of time knew of the discrepancy between the
admission and the deposition evidence, there was no special difficulty thrust suddenly and
unexpectedly at trial upon a party relying on an admission. Allowing presenting testimony
that contradicted his/her admission was not an abuse of discretion. Sawyer V. Hannan, 556 So.
2d 696, 698 (Miss. 1990) (citations omitted).
Alternatively, we also find that the question of the date of extraction was at most a side
issue to the allegations of malpractice. ' expert, , described as negligent in removing
teeth when the patient's gums were swollen, as the swelling indicated the presence of an
infection. An antibiotic treatment would be necessary. administered antibiotics, on
and . The factual question then becomes whether the antibiotics would have had enough
time to work if the extraction was on , instead of . Neither nor any other witness
for testified that four days was an insufficient time for the antibiotic which administered
to have properly prepared the patient for the extraction. also testified:
There are different types of medications that we can use. There are some that can be used
just an hour prior to dental work. And there are some others that are more slowly absorbed by t he
body, and those should be given at least a day ahead of time
If you have if you would have infection that manifests itself in as swelling, then you
would try to reduce the swelling before any dental work is done. And this is done by
prophylactic antibiotics or antibiotics given.
All that the Plaintiff's expert stated on this issue was that at least a day might be
necessary for some antibiotics. Regardless of which extraction date was used, at least four days
had passed since had been treated on . Second, the key to conclusion about
malpractice was that the patient told him/her that his/her gums were swollen on the day of the
extraction. That suggested the infection was still present and the teeth should not have been
removed. The jury was never given anything to weigh from the Plaintiff that a four-day dela y
between starting antibiotics and then removing teeth was too short. They were told by t he
Plaintiff that regardless of the time that antibiotics were administered, no de ntal work should
have been done until the swelling had abated. Nothing in the discrepancy between e xtraction
dates affected that jury question.
II. Allowing admissions in evidence
also argues that the trial court should have permitted him/her to enter the admissi ons
in evidence, rather than restricting him/her to using them for cross-examination. The admi ssions
were marked only for identification during the impeachment of defense witnesses.
While responses to requests for admissions may generally be admissible, the general rule
does not apply when an admission is subject to defacto withdrawal. Instead, an analysis of
whether the withdrawn admission is admissible must be decided by the rules of evidence
governing the use of documents solely for impeachment purposes. The rules provide that
extrinsic evidence of a prior inconsistent statement by a witness is admissible in circumstances
like those presented here. M.R.E. 613(b). However, the refusal of the count to enter the
admissions in evidence was not an abuse of discretion. See Sawyer, 556 So. 2d at 698. The jury
was duly advised of the fact of the inconsistent admissions. The question is whether the ac tual
inclusion of the document itself in evidence was necessary. The responses to the requests for
admission did not note the admission requested. The jury would have had to read the reque sts for
admission and compare those requests to the admissions made. Because of various objections
and deletions, the original requests and the responses were severely redacted, and the copi es
were consequently in less than optimal form. At most, the documents would have been
cumulative of the testimony, i.e., the jury could have read the word "admitted" inste ad of just
hearing it read to the witness.
The trial court was well-within its discretion to conclude that copies of the request s and
the responses would not aid the jury and that addressing the issue in examination was
sufficient and effective.
III Qualified Experts
contends that all of the experts presented by were unqualified to render the
opinions they presented at trial. challenges two of the experts on the grounds that they were
medical doctors without formal dental training and, as such, could not render opinions
concerning the standards of care in the dental profession. also challenges the expert
testimony of a dentist concerning the causal relationship between ' dental treatment and a
purported heart condition.
A witness with specialized knowledge, skill, experience, training or education may be
qualified to give expert opinions. M.R.E. 702. "The adjudication of whether a witness is
legitimately qualified as an expert is left to the sound discretion of the tria l judge." Couch V City
of D 'Iberville, 656 So 2d 146, 152 (Miss. 1995) (citations omitted). We conclude that the trial
court did not abuse its discretion in permitting the defense experts to give their opinions.
A medical doctor may express opinions concerning the standards of care governing
dentists, despite not having a formal dental degree or a license to practice denti stry. See Harris
V. Shielas, 568 So. 2d 269, 272 (Miss. 1990) (citations omitted). Likewise, a dentist may give
expert opinions concerning matters with the traditional expertise of medical doctors. "The
question is whether the particular witness really is an expert in the field in which he or she is
tendered. Formal education is but one route to expertise." Id. at 271. The appropriate foundation
must be laid to demonstrate that the proffered expert and his/her opinion will be ca pable of
assisting the trier of fact in deciding the case. M.R.E. 702. That foundation is prese nt for each
challenged expert in this case. This is especially so in light of the significa nt overlap that exists
between the medical and dental fields.
One medical doctor testified as an expert in the field of infectious medicine and gave
his/her opinion that the treatment given by was within the standard of care. The doctor was
well qualified by virtue of his/her extensive consultations with dentists to aid in the prevention of
infection during dental procedures, his/her expertise in quelling oral infections, and his/her
significant understanding of whether the action taken by to address infection prior to and
following the extractions was effective.
Another medical doctor, while testifying as an expert, rendered no expert opinion
concerning anything other than his/her opinion that did not suffer from endocarditis-a
condition that attributed to infection from the extractions. This opinion relating to the
etiology of a heart condition was within the doctor's expertise as a cardiologist and e xpert in
internal medicine. The doctor did not render an opinion concerning whether 's treatment was
within the applicable standard of care. He/She did testify that the American Hea rt Association
has stated that there is no need for a dentist to give prophylactic treatment aga inst infection in
cases like that presented by .
Finally, a dentist who was qualified as an expert in dentistry and oral surgery testifi ed.
The dentist gave his/her opinion that treatment was within the standard of care. Contrary to
' assertion, the dentist did not testify concerning the causal relationship between 's purported
endocarditis and the extractions. The dentist did testify concerning what prophylactic t reatment
would be necessary to prevent development of an infection that might lead to endocardit is. The
testimony was narrowly tailored to the dentist's expertise in performing oral surgery with an eye
on preventing infection or other collateral medical risks.
IV Evidentiary Support for Jury Verdict
challenges the validity of the jury's verdict and contends that it was contrary to t he
overwhelming weight of the evidence. We disagree. The evidence presented in this case does not
"point overwhelmingly in favor" of ' position at trial. Burnham V. Tabb, 508 So. 2d 1072,
1075 (Miss. 1987) (citations omitted). "[T]here is substantial evidence of such quality and weight
that reasonable and fair-minded men might reach different conclusions . . . ." Id. Here, beca use
the verdict was not contrary to the substantial weight of the evidence, the trial j udge did not
abuse his/her discretion in denying ' motion for a new trial or jnov. Id
Medical professionals, including dentists, are required as a function of tort law to treat
their patients with "such reasonable diligence, skill, competence, and prudence as are practiced
by minimally competent physicians in the same specialty. . . ." McCarty V. Mladine o, 636 So. 2d
377, 380 (Miss. 1994) (citations omitted). 's duty to was to provide "care consistent with
the level of expertise [ held] himself out as possessing and with the circumstances of the
case." Harris, 568 So. 2d at 272-73 (citations omitted). These standards are tempered by the
understanding that "a dentist is not an insurer of the success of his/her care and treat ment." Id at
273 (citations omitted). In sum, it was ' obligation at trial to "establish the standard of care to
which the dentist is held and then show that the dentist's deviance therefrom caused pl aintiff's
damages." Id (citations omitted).
The question for us is whether met this obligation with proof of such overwhelming
persuasiveness and weight that the jury's verdict cannot be correct. Our review of the record
reveals ample evidence both that satisfied the standard of care and that, even assuming that
was negligent, ' damages were not proximately caused by that negligence. Accordingly, the
jury's verdict was not contrary to the overwhelming weight of the evidence
While presented expert testimony that was negligent and that his/her negligence
resulted in a serious medical condition, contrary proof was provided by the defense. '
witnesses urged the jury to find that pulled teeth in the face of an acute infection without
adequately guarding against the spread of that infection to the rest of ' body. 's witnesses
testified that he/she exceeded the standard of care in treating what they viewe d as a chronic
infection that should not have posed an unusually high risk of spreading. In addition, they
testified that either did not suffer from the medical condition he/she claimed resulted from
's treatment or that the condition probably was not a result of the treatment. In vi ew of this
conflicting evidence, it was for the jury to evaluate the credibility of the wit nesses and weigh the
proof See Mills v Nichols, 467 So. 2d 924, 931-32 (Miss. 1985) (citations omitted). Accordingly,
a new trial or j.n.o.v would have been inappropriate and the trial court did not err in re fusing to
order either
V Quality of Jury Deliberations
The jury in this case heard two days of testimony. On the last day of the case, the jury
retired for deliberations at a.m./p.m. and returned its verdict at a.m./p.m.. contends that
allowing the jury to deliberate at such a late hour was error. While raises the issue before this
Court, he/she failed to do so before the trial court at a moment when the purported ri sk to fair
deliberations could have been effectively addressed. This is an example of an inst ance in which
raising the matter before the trial court is essential. Because it was addresse d to the trial court,
we are precluded from considering the issue. T K Stanley, Inc. V. Cason, 614 So. 2d 942, 954
(Miss. 1992) (citations omitted).
THE JUDGMENT OF THE COUNTY CIRCUIT COURT IS AFFIRMED.
ALL COSTS OF THIS APPEAL ARE TAXED TO THE APPELLANT. , , AND , , , , , ,
, AND , , .
, , NOT PARTICIPATING.