Florida's Handbook on Civil Discovery
Chapter 7
Compulsory Medical Examinations and Discovery of CME Examiner Bias
7.00 | CHAPTER 7 INTRO
Rule 1.360 does not specify where the examination is to be performed. The Rule requires that the time, place, manner, conditions, and scope be “reasonable.” The determination of what is reasonable depends on the facts of the case and falls within the trial court’s discretion under McKenney v. Airport Rent-A-Car, Inc.5 Rule 1.360 is based on Fed. R. Civ. P. 35, which has been interpreted as permitting the trial court to order the plaintiff to be examined where the trial will be held because this was the venue selected by the plaintiff and it would make it convenient for the physician to testify. In McKenney, an examination of the plaintiff in the county in which the trial was to be held was not an abuse of discretion, even though the plaintiff resided in a different county. In Tsutras v. Duhe,6 it was held that the examination of a nonresident plaintiff, who already had come to Florida at his expense for his deposition, should either be at a location that had the appropriate medical specialties convenient to the nonresident plaintiff, or the defense should be required to cover all expenses of the plaintiff’s return trip to Florida for examination. In Goeddel v. Davis, M.D.7 a trial court did not abuse its discretion by compelling the plaintiff, who resided in another state, to submit to a compulsory medical examination in the forum state where the compulsory medical examination was to be conducted during the same trip as a deposition the plaintiff was ordered to attend, and the defendants were ordered to contribute to the cost of the plaintiff’s trip. In Blagrove v. Smith,8 a Hernando County trial court did not abuse its discretion by permitting a medical examination in neighboring Hillsborough County because of the geographical proximity of the two counties. However, a trial court did abuse its discretion where the court sanctioned a plaintiff with dismissal after finding the plaintiff willfully violated a court order in failing to attend a second CME despite the fact that the plaintiff had moved to a foreign state, advised counsel two days prior that he was financially unable to attend, and filed a motion for protective order with an affidavit detailing his finances and stating he had no available funds or credit to travel to Florida. Littlefield v. J. Pat Torrence.9
The discovery of the examination report and deposition of the examiner for use at trial is permissible under Rule 1.360, even though the examination was prepared in anticipation of litigation by an expert who was not expected to be called at trial. Dimeglio v. Briggs-Mugrauer10 involved a claim for uninsured motorist benefits. The insurance contract provided that the claimant would consent to an examination by the insurer’s chosen physician if a claim was filed. Before initiation of the lawsuit, the insurer scheduled a medical examination that was attended by the claimant, and the examiner confirmed that the claimant had suffered injury. After suit was filed, the plaintiff sought to take the videotape deposition of the examiner for use at trial. The insurer filed a motion for a protective order, claiming that the examination and report were protected as work product, and the trial court agreed. The Dimeglio court reversed, holding that although the examination was prepared in anticipation of litigation, Rule 1.360 applied, and the insurer could not claim a work product privilege for a physician examination of the plaintiff by the insurance company’s chosen physician.
Footnotes
2 Schagrin v. Nacht, 683 So. 2d 1173 (Fla. 4th DCA 1996).
3 Royal Caribbean Cruises, Ltd. v. Cox, 974 So. 2d 462, 466 (Fla. 3d DCA 2008).
4 Goicochea v. Lopez, 140 So. 3d 1102 (Fla. 3d DCA 2014).
5 686 So. 2d 771 (Fla. 4th DCA 1997). See also Leinhart v. Jurkovich 882 So. 2d 456 (Fla. 4th DCA 2004) where request for CME 10 days before trial was denied and upheld on appeal as being within Trial Court’s discretion.
6 685 So. 2d 979 (Fla. 5th DCA 1997).
7 993 So. 2d 99, 100 (Fla. 5th DCA 2008).
8 701 So. 2d 584 (Fla. 5th DCA 1997).
9 See Littelfield v. J. Pat Torrence 778 So. 2d 368 (Fla. 2d DCA 2001). See also Wapnick v. State Farm Mutual Automobile Insurance Co., 54 So. 3d 1065 (Fla. 4th DCA 2011) (requiring plaintiff to travel approximately 100 miles from county of residence where defendant offered to reimburse travel expenses, although reversing denial of coverage).
10 708 So. 2d 637 (Fla. 2d DCA 1998).
7.01 | ISSUE 1
Footnotes
12 See State Farm Mutual Auto Insurance Company v. Shepard, 644 So. 2d 111 (Fla. 2d DCA 1994).
7.02 | ISSUE 2
Without a valid reason to prohibit the third party’s presence, the examinee’s representative should be allowed.16 In making the decision about third-party attendance at the examination, the trial court should consider the nature of the examination, the function that the requested third party will serve at the examination, and the reason why the examining doctor objects to the presence of the third party. A doctor must provide a case-specific justification to support an objection in an affidavit that the presence at the examination of a third party will be disruptive.17 Once this test is satisfied, the defendant must prove at an evidentiary hearing that no other qualified physician can be located in the area who would be willing to perform the examination with a third party (court reporter, attorney, or other representative) present.18 This criteria applies to compulsory examinations for physical injuries and psychiatric conditions.19
The rationale for permitting the presence of the examinee’s attorney is to protect the examinee from improper questions unrelated to the examination.20 Furthermore, the examinee has a right to preserve by objective means, the precise communications that occurred during the examination. Without a record, the examinee will be compelled to challenge the credibility of the examiner should a dispute arise later. “Both the examiner and examinee should benefit by the objective recording of the proceedings, and the integrity and value of the examination as evidence in the judicial proceedings should be enhanced.”21 The rationale for permitting a third party’s presence or recording the examination is based on the examinee’s right of privacy rather than the needs of the examiner. If the examinee is compelled to have his or her privacy disturbed in the form of a compulsory examination, the examinee is entitled to limit the intrusion to the purpose of the examination and to have an accurate preservation of the record.
Courts may recognize situations in which a third party’s presence should not be allowed. Those situations may include the existence of a language barrier, the inability to engage any medical examiner who will perform the examination in the presence of a third party, the particular psychological or physical needs of the examinee, or the customs and practices in the area of the bar and medical profession.22 However, in the absence of truly extraordinary circumstances, a defendant will not be able to satisfy its burden of proof and persuasion to prevent the attendance of a passive observer.23 It has been held that a court reporter’s potential interference with the examination or inability to transcribe the physician’s tone or facial expressions are invalid reasons.24 The examiner’s refusal to perform the examination in the presence of third parties also is an insufficient ground for a court to find that a third party’s presence would be disruptive.25 Excluding a court reporter because of a claimed chilling effect on physicians and the diminishing number of physicians available to conduct examinations also is insufficient.26 However, it would take an exceptional circumstance to permit anyone other than a videographer or court reporter and the plaintiff’s attorney to be present on behalf of the plaintiff at a Rule 1.360 compulsory examination.27 For example, defendants in a personal injury lawsuit were not entitled to have a videographer record the examination even though the examinee had her own videographer present. Prince v. Mallari.28 The Second and Third DCAs follow this opinion.
In most circumstances, the examinee’s desire to have the examination videotaped should be approved. There is no reason that the presence at an examination of a videographer should be treated differently from that of a court reporter. A trial court order that prohibits videotaping a compulsory examination without any evidence of valid, casespecific objections from the complaining party may result in irreparable harm to the requesting party and serve to justify extraordinary relief.29 Similarly, an audiotape may be substituted to ensure that the examiner is not asking impermissible questions and that an accurate record of the examination is preserved.30 Video or audio tape of the CME obtained by the examinee’s attorney should be considered work product as long as the recording is not being used for impeachment or use at trial. See McGarrah v. Bayfront Medical Center.31
In McClennan v. American Building Maintenance,32 the court applied the rationale in Toucet, supra, and Bartell, supra, to workers’ compensation disputes, and held that third parties, including attorneys, could attend an independent medical examination given under F.S. § 440.13(2)(b).
In U.S. Security Ins. Co. v. Cimino,33 the Florida Supreme Court held that, for a medical examination conducted under F.S. § 627.736(7) for personal injury protection benefits, “the insured should be afforded the same protections as are afforded to plaintiffs for Rule 1.360 and workers’ compensation examinations.”
There are limitations on discovery of an examiner performing a CME. For example, an examiner will not be compelled to disclose CME reports of other non-party examinees or to testify about findings contained in those reports.34 In Allstate Insurance Co. v. Boecher,35 the Supreme Court held that neither Elkins v. Syken36 nor Rule 1.280(b)(4)(A) prevents discovery of a party’s relationship with a particular expert when the discovery is propounded directly to the party. In Boecher, the court held that the jury was entitled to know the extent of the financial connection between the party and the expert witness. Boecher and Elkins have spawned dozens of cases on the general issue of medical experts and their bias. However this section deals exclusively with the CME expert. (Commonly referred to by the Plaintiff’s Bar as the “Insurance Company’s Doctor.”).
Fla. R. Civ. P. 1.280(b)(5) establishes the parameters of discovery directed to a non-party retained expert. It is critical that the trial judge read the Rule in every instance and not get distracted by issues that simply do not relate to CME experts.
2. The expert’s general litigation experience, including the percentage of work performed for plaintiffs and defendants.
3. The identity of other cases, within a reasonable time period, in which the expert has testified by deposition or at trial.
4. An approximation of the portion of the expert’s involvement as an expert witness, which may be based on the number of hours, percentage of hours, or percentage of earned income derived from serving as an expert witness; however, the expert shall not be required to disclose his or her earnings as an expert witness or income derived from other services.
[T]he discovery order which compels [the defendant] and the independent medical expert to answer interrogatories regarding the expert’s financial remuneration for past examinations, depositions, and courtroom testimony must be quashed. The trial court departed from the essential requirements of law in compelling this discovery, and in requiring the expert to produce his billing/payment records and 1099s regarding his prior work as an expert in other cases.A subpoena may not be used to secure discovery of financial or business records concerning a litigation expert unless “unusual or compelling circumstances” have been shown. Smith v. Eldred, 96 So. 3d 1102, 1104 (Fla. 4th DCA 2012); Miller v. Harris, 2 So. 3d 1070, 1073 (Fla. 2nd DCA 2009).
There are additional third party privacy concerns for the Court to consider when deciding CME Examiner bias discovery issues. Section 456.057(7)(a), Florida Statutes requires notice to patients whose medical records are sought before issuance of a subpoena for the records by a Court of competent jurisdiction. Simply redacting the non-party patients’ information is not enough. Coopersmith v. Perrine, 91 So. 3d 246 (Fla. 4th DCA 2012). Consider Judge May’s concurring opinion in Coopersmith relative to the Court’s frustration with this type of discovery practice.
I concur with the majority in its reasoning and result, but write to express my concern over recent discovery issues we have seen. We are increasingly reviewing orders on discovery requests that go above and beyond those relevant to the case. Attorneys are propounding interrogatories and making requests for production, which require physicians to divulge private, confidential information of other patients, and to “create” documents.
In an effort to discredit medical witnesses for the other side, attorneys for both plaintiffs and defendants are exceeding the bounds of the rules of civil procedure, confidentiality laws, and professionalism by engaging in irrelevant, immaterial, burdensome, and harassing discovery. Parameters have already been expanded to allow both sides to explore financial interests of medical witnesses and the volume of referrals to those witnesses. See Elkins v. Syken, 672 So. 2d 517 (Fla. 1996). And now, attempts to expand the scope of that discovery to treating physicians as well as retained experts are usurping the limited resources of our trial courts. This not only creates unnecessary burdens on our over-strained justice system, it further taints the public’s view of our profession.
Footnotes
14 Wilkins v. Palumbo, 617 So. 2d 850 (Fla. 2d DCA 1993).
15 Broyles v. Reilly, 695 So. 2d 832 (Fla. 2d DCA 1997); Wilkins; Stakely v. Allstate Ins. Co., 547 So. 2d 275 (Fla. 2d DCA 1989).
16 See Broyles (videographer and attorney); Palank v. CSX Transportation, Inc., 657 So. 2d 48 (Fla. 4th DCA 1995) (in wrongful death case, mother of minor plaintiffs, counsel, and means of recording); Wilkins (court reporter); McCorkle v. Fast, 599 So. 2d 277 (Fla. 2d DCA 1992) (attorney); Collins v. Skinner, 576 So. 2d 1377 (Fla. 2d DCA 1991) (court reporter); Stakely (court reporter); Bartell (representative from attorney’s office); Gibson v. Gibson, 456 So. 2d 1320 (Fla. 4th DCA 1984) (court reporter).
17 See Wilkins, supra.
18 See Broyles, supra.
19 Freeman v. Latherow, 722 So. 2d 885 (Fla. 2d DCA 1998); Stephens v. State of Florida, 932 So. 2d 563 (Fla. 1st DCA 2006) (the DCA held that the trial court did not deviate from the law when it denied plaintiff’s request that his expert witness be permitted to accompany him on a neuropsychological exam by a state-selected medical professional).
20 See Toucet, supra.
21 Gibson v. Gibson, 456 So. 2d at 1320, 1321 (Fla. 4th DCA 1984).
22 See Bartell, supra.
23 See Broyles, supra; See Wilkins, supra.
24 See Collins, supra.
25 See McCorkle, supra; See Toucet, supra.
26 Truesdale v. Landau, 573 So. 2d 429 (Fla. 5th DCA 1991). See also Broyles, supra.
27 See Broyles, supra.
28 36 So. 3d 128 (Fla. 5th DCA 2010).
29 Lunceford v. Florida Central Railroad Co., Inc., 728 So. 2d 1239 (Fla. 5th DCA 1999).
30 Medrano v. BEC Const. Corp., 588 So. 2d 1056 (Fla. 3d DCA 1991).
31 McGarrah v. Bayfront Medical Center, 889 So. 2d 923 (Fla. 2d DCA 2004).
32 648 So. 2d 1214 (Fla. 1st DCA 1995).
33 754 So. 2d 697, 701 (Fla. 2000).
34 Crowley v. Lamming, 66 So. 3d 355 (Fla. 2d DCA 2011); Coopersmith v. Perrine, 91 So. 3d 246 (Fla. 4th DCA 2012) (sustaining objections to interrogatories directed to the examiner’s “opinions and basis of the opinions” of other non-party examinees as same constituted an intrusion into those non-parties’ privacy rights).
35 733 So. 2d 993 (Fla. 1999).
36 672 So. 2d 517 (Fla. 1996).
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