## Facts

- Genevieve Mezzanotte had previously been treated for diverticulitis in 1990.
- In early 1994, she developed symptoms she believed were a recurrence and consulted Robert Hardi, M.D., a gastroenterologist, after being unable to reach her prior physician.
- Hardi noted her prior diverticulitis history, palpated a mass he thought might be gynecological, and referred her to a gynecologist without ordering a CT scan or initiating antibiotics typically used when diverticulitis is suspected.
- The gynecologist ordered cancer-related testing; results did not confirm cancer, and imaging could not determine whether the mass was gastrointestinal or gynecological in origin.
- Mezzanotte underwent further gastrointestinal testing requested by the gynecologist; endoscopic procedures and a barium enema could not be completed due to an obstruction later attributed to diverticulitis.
- Mezzanotte’s condition worsened; during surgery she was informed she had diverticulitis rather than cancer, followed by additional surgeries and a prolonged hospitalization.
- Mezzanotte sued Hardi and his professional corporation for negligent misdiagnosis and related malpractice (the gynecologist was tried separately and obtained a defense verdict).
- A first jury trial resulted in a defense verdict for the gynecologist and a hung jury as to Hardi.
- The parties then proceeded to a bench trial on the record from the first trial; the court found Hardi liable and awarded damages exceeding $900,000, including medical expenses and costs (including costs from the mistrial).

## Issues

1. Whether the trial court properly struck Hardi’s statute-of-limitations defense under the District’s medical-malpractice discovery rule.
2. Whether the evidence was sufficient to support a finding that Hardi’s negligence was a proximate cause of Mezzanotte’s injuries.
3. Whether the damages award improperly included amounts for medical charges later written off or discounted, contrary to the collateral-source rule.
4. Whether the trial court abused its discretion by awarding costs against Hardi, including costs associated with the earlier mistrial.

## Decision

- The District of Columbia Court of Appeals affirmed the judgment for Mezzanotte in all respects.
- The court held the claim was timely under the discovery rule and affirmed summary judgment striking the limitations defense.
- The court held the record supported the trial judge’s finding of proximate cause.
- The court held including written-off or discounted medical charges in damages did not violate the collateral-source rule.
- The court upheld the award of costs, including those incurred in the earlier mistrial, as within the trial court’s discretion.

## Legal Principles

- In District of Columbia medical-malpractice actions, accrual under the discovery rule turns on when the plaintiff knew or reasonably should have known of the injury and its probable cause; summary judgment is proper where the record shows no genuine dispute on that point.
- Proximate cause in malpractice may be established by expert testimony and reasonable inferences that timely diagnosis and treatment would have avoided or reduced subsequent harm; appellate review of a bench-trial causation finding is for clear error.
- Under the collateral-source rule, a tortfeasor generally may not reduce liability based on benefits to the plaintiff provided by third parties; provider write-offs or discounts may be treated as collateral benefits that do not diminish recoverable medical-expense damages.
- Costs awards are reviewed for abuse of discretion; where the plaintiff ultimately prevails, the trial court may include costs from earlier proceedings in the same litigation, including a mistrial, absent a legal bar.

## Conclusion

The court affirmed a malpractice judgment against a gastroenterologist, holding that the claim accrued under the discovery rule when the patient reasonably learned of the injury’s probable cause, the bench-trial record supported proximate cause, written-off medical charges remained recoverable under the collateral-source rule, and the trial court permissibly awarded litigation costs including those from an earlier mistrial.


Hardi v. Mezzanotte, 818 A.2d 974 (D.C. 2003)