## Facts

- Howard Scott Berry, Sr. was treated for serious coronary artery disease by Andrew Doorey, M.D., a cardiologist employed by Cardiology Consultants, P.A., for about 12 years before Berry’s death.
- Berry had significant cardiac history, including severe coronary disease and multiple risk factors, and ultimately required coronary artery bypass surgery in November 2002.
- After the bypass procedure, Berry developed postoperative atrial fibrillation. Around the first episode, the hospital’s surgical team ordered Amiodarone.
- Doorey reviewed the Amiodarone treatment decision the next day after Berry had another atrial fibrillation episode.
- At a scheduled postoperative visit, Doorey gave Berry a prescription for Amiodarone, but Berry never filled the prescription.
- Approximately two months later, Berry returned to the hospital with pulmonary complaints. Another cardiologist evaluated him and noted in the medical record that Berry’s symptoms might have been caused by Amiodarone use and recommended stopping it.
- Berry died several weeks later. His death certificate listed Acute Pneumonitis and Amiodarone Toxicity as causes of death.
- Berry’s estate and family sued Doorey and Cardiology Consultants for medical negligence and wrongful death, alleging negligent postoperative management, including improper Amiodarone dosing and related care.
- At the jury trial, plaintiffs presented two medical witnesses who testified that Berry received Amiodarone in an amount more than double what the standard of care allowed.
- Plaintiffs introduced the hospital’s Cardiac Surgery Service Manual (CSSM), which included an algorithm for Amiodarone dosing for post–cardiac surgery atrial fibrillation (400 mg for 5–7 days, then 200 mg per day).
- Defendants presented a medical witness who testified that a separate American College of Cardiology (ACC) algorithm reflected acceptable practice and supported the treatment approach; the trial court admitted that ACC algorithm into evidence.
- The jury returned a verdict for Doorey and Cardiology Consultants.
- Plaintiffs moved for post-trial relief seeking a new trial, arguing (among other points) that admitting the ACC algorithm was error and that the verdict was against the weight of the evidence.

## Issues

1. Whether the trial court erred in admitting into evidence the ACC algorithm offered through the defense medical witness regarding management of postoperative atrial fibrillation and Amiodarone use.
2. Whether the jury’s defense verdict was against the great weight of the evidence such that a new trial was required.

## Decision

- The court denied plaintiffs’ motion for post-trial relief and left the defense verdict in place.
- The court held that admitting the ACC algorithm through the defense medical witness was not error warranting a new trial, where it was used in connection with the witness’s testimony explaining accepted practice and plaintiffs were able to challenge it through cross-examination.
- The court held that the verdict was not against the great weight of the evidence because the record contained competent evidence supporting defendants on standard of care and causation, and resolving conflicts in medical testimony was the jury’s task.

## Legal Principles

- A trial court has broad discretion over evidentiary rulings, including whether to allow a medical witness to use clinical guidelines or algorithms in explaining an opinion on the standard of care.
- Materials referenced by an expert to explain an opinion may be admitted or used as an explanatory aid when tied to the testimony and when their probative value is not substantially outweighed by a risk of unfair prejudice or juror confusion under Rule 403.
- A new trial based on the weight of the evidence is granted only when the verdict is against the great weight of the evidence and letting it stand would result in a miscarriage of justice; the court does not reweigh credibility merely because the parties presented conflicting medical testimony.
- When qualified medical witnesses offer competing accounts of standard of care and causation, the jury decides which testimony to accept so long as the verdict has record support.

## Conclusion

In Berry v. Cardiology Consultants, P.A., the Delaware Superior Court refused to set aside a defense verdict in a medical negligence and wrongful death case arising from postoperative atrial fibrillation treatment and alleged Amiodarone-related pulmonary injury. The court ruled that the defense expert’s ACC treatment algorithm was properly admitted in connection with the expert’s explanation of accepted cardiology practice and that, given the conflicting testimony and evidentiary support for defendants on standard of care and causation, the jury’s verdict was not against the great weight of the evidence.


Berry v. Cardiology Consultants, P.A., 909 A.2d 611 (2006)