Frances Parker, Etc. v. John W. Poole, M.D. , 440 N.J. Super. 7 ( 2015 )


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  •                 NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-1874-12T4
    FRANCES PARKER,
    Individually and as
    General Administratrix
    of the ESTATE OF DALE S.
    APPROVED FOR PUBLICATION
    PARKER,
    March 17, 2015
    Plaintiff-Appellant,
    APPELLATE DIVISION
    v.
    JOHN W. POOLE, M.D.,
    Defendant-Respondent,
    and
    HOLY NAME HOSPITAL and
    DOUGLAS BENSON, M.D.,
    Defendants.
    ————————————————————————————————————————
    Argued October 7, 2014 – Decided March 2, 2015
    Before Judges Yannotti, Hoffman and Whipple.
    On appeal from Superior Court of New Jersey,
    Law Division, Bergen County, Docket No. L-
    7098-09.
    Dennis T. Smith argued the cause for
    appellant (Pashman Stein, attorneys; Mr.
    Smith and David G. White, on the briefs).
    Philip F. Mattia argued the cause for
    respondent   (Mattia    &   McBride,  P.C.,
    attorneys; Mr. Mattia, on the brief).
    The opinion of the court was delivered by
    HOFFMAN, J.A.D.
    Plaintiff Frances Parker, individually and as administrator
    of the estate of her late husband, Dale Parker ("Mr. Parker"),
    appeals from the no cause jury verdict returned in the medical
    malpractice case against her husband's surgeon, defendant John
    W. Poole, M.D., and from the order denying plaintiff's motion
    for a new trial.        Plaintiff contends that the trial court erred
    in excluding certain evidence.          For the reasons that follow, we
    reverse and remand for a new trial.
    I.
    We begin by summarizing the most pertinent trial evidence.
    Mr. Parker was diagnosed with colon cancer when a tumor was
    discovered during a colonoscopy.             A biopsy had revealed that Mr.
    Parker had an invasive adenocarcinoma of the colon,1 and he was
    referred to defendant to immediately undergo surgery to remove
    the tumor.         Defendant, a board-certified general surgeon, saw
    decedent for a surgical consult on February 13, 2009.               Defendant
    performed the surgery, a transverse colon resection, to remove
    the   tumor   on    February   19,   2009.      After   removing   the    tumor,
    1
    According to defendant, invasive adenocarcinoma of the colon is
    a "pathologic diagnosis," which "means the tumor has spread
    beyond the basic membrane of the lining of the intestine,"
    creating "a risk for it to . . . further spread."
    2                                 A-1874-12T4
    defendant performed an open anastomosis, sewing the colon back
    together,       to     close       the   opening.         Defendant       reported       no
    difficulties during the surgery.
    After the surgery, Mr. Parker remained in the hospital.                           At
    some     point       between        February       22   and     23,    he      developed
    complications.           On     February    23,    nurses     observed    blood-tinged
    fluid coming from the surgical site.                     Examination by defendant
    revealed that Mr. Parker had developed a dehiscence.2                           Based on
    the    risk     of     the    incision     re-opening,        defendant       decided    to
    perform a second operation to repair the dehiscence.
    On   February         24,   defendant      performed    the    second    surgery.
    During the procedure, defendant noticed some "murky fluid in the
    abdominal wound."             As a result, he investigated to determine if
    there was an anastomotic leak, a hole or perforation in the
    intestine       that    allows      intestinal      contents     to   leak      into    the
    abdomen.        While defendant testified, "We never saw a hole[,]
    [w]e never saw a perforation," he nevertheless decided to resect
    or     remove    the         anastomosis.         He    explained,       "I    felt     the
    anastomosis was not perfect[;] . . . my job as a surgeon was to
    make the anastomosis perfect."                    Defendant continued to follow
    Mr. Parker after the surgery on the 24th; however, "he had a
    2
    According to plaintiff's surgical expert, David Befeler, M.D.,
    "dehiscence is a failure of the abdomen wall closure," meaning
    "the abdominal wall comes apart."
    3                                   A-1874-12T4
    cataclysmic rapid demise and ultimately expired early on the
    26th."
    Plaintiff's       theory        in     the    case     was       that    defendant
    negligently performed the first anastomosis, creating a leak,
    which led to sepsis, and that defendant then negligently failed
    to address the sepsis.           Specifically, plaintiff contended that,
    because   defendant        encountered       evidence      of     infection       in    the
    second    surgery,    he     should        have   performed       an    ileostomy,         a
    procedure     where    a    loop      of     small    bowel       would      have      been
    externalized to stop feces from coming into the abdomen, and
    then drained the abdomen to remove the purulent fluids, and
    allowed Mr. Parker to heal.               Once healed, Mr. Parker could have
    undergone    a     re-anastomosis.              Defendant       indicated      that       he
    performs such "ostomy" procedures "all the time."3
    The defense disputed the source of the sepsis which caused
    Mr. Parker's death, as well as the timing of the onset of the
    sepsis.      At trial, plaintiff sought to introduce defendant's
    deposition       testimony,      specifically,        an     exchange        in      which
    defendant    responded      to   a    question       about      the    cause      of    Mr.
    Parker's death:
    Q:     Why did Mr. Parker die?
    3
    Defendant explained, "when we externalize the colon, it's a
    colostomy, when we externalize the small bowel, it's an
    ileostomy."
    4                                     A-1874-12T4
    A:   It appears that he got septic, though
    I'm not sure why he had such a rapid
    demise.
    Q:   To what did you attribute the sepsis?
    [Defendant's Counsel]:             Objection,   but
    you can answer.
    A:   I have to assume that it was related to
    the anastomotic leak.
    When plaintiff sought to read this deposition excerpt into
    the record as part of her case, defendant objected, arguing that
    the language he used in response ("I would have to assume") was
    speculative.     Plaintiff argued that it was an admission by a
    party-opponent      and   thus    admissible    under    N.J.R.E.     803(b)(1),
    regardless of any claimed speculative nature.
    The     trial    court   sustained        the   objection,   finding      the
    testimony speculative.           The court also appeared to question the
    propriety   of   plaintiff       attempting    to   elicit   expert    testimony
    from defendant.
    Essentially, what plaintiff urges — it
    converts [defendant] into an expert witness.
    It's asking him to render an opinion when,
    in fact, he's being called as a fact
    witness.    Now we have a number of expert
    witnesses who have opined as to Mr. Parker's
    cause of death.       [I]t's not really a
    [N.J.R.E.] 701 [issue], where we're asking
    for opinion testimony of a lay witness
    because it's not [an] opinion as to . . .
    how fast was he going in your common
    experience.
    5                               A-1874-12T4
    It's    an    opinion     that  requires
    expertise.   The reality, it seems, is that
    the . . . cause of death isn’t so much the
    ultimate question here. . . .            [T]he
    ultimate   question   is,    whether  or   not
    [defendant] departed from the standard of
    care required of him.     And I do think that
    it is asking for, again over the objection
    of [defendant's] attorney, for him to become
    an expert witness against himself.
    And   in   addition   to  that,    it   is
    cumulative and it is calling for speculation
    on his part.     And therefore, I'm going to
    uphold [defendant's] objection and I'm not
    going   to   allow   it  to   be   read    into
    evidence[.]
    On direct examination, defendant testified that "Mr. Parker
    had no evidence of sepsis at the time leading up to the [second]
    surgery, at the time of the surgery, and immediately in the
    recovering      room    after   the    surgery."4            Nevertheless,       in   the
    operative report defendant dictated immediately after the second
    surgery,   he    wrote,    "I   did    not       want   to   take   the   chance      the
    anastomosis      was    leaking       and       would   cause    further        sepsis."
    (Emphasis added).         Defendant attempted to explain this apparent
    contradiction      in     the   following          colloquy,     still     on     direct
    examination:
    4
    According to defendant, "Sepsis is an infection that causes
    systemic changes."     Its symptoms are "increased respiratory
    rate, an increased pulse, . . . an elevated temperature and an
    elevated white [blood cell] count." Sepsis can be diagnosed by
    the presence of two such symptoms as well as a "documented
    source of infection[.]"
    6                                   A-1874-12T4
    Q:     When you said you were concerned it
    would cause further sepsis what did you
    mean by further sepsis?
    A:     I meant at a point in time.     I might
    have actually dictated future sepsis
    but I mean, further down the road.    I
    would – a chance at this would cause
    sepsis.   So unfortunately – I probably
    dictated   like   I   speak  but   they
    transcribe it but –
    Q:     It would have been future as opposed to
    further?
    A:     Well, I'm dictating a medical record
    I'm not a novelist. In my mind, I was
    using – it might not be the most
    eloquent – but I'm trying to say, I
    couldn't take the chance of this would
    – anastomosis would break down and
    cause sepsis in the future, cause
    further sepsis. That was my job to not
    take that chance.
    Q:     Did there come a time that Mr. Parker
    did become septic?
    A:     Yes, there was.
    Q:     When was that?
    A:     He became septic several hours after
    the surgery in the intensive care unit.
    Later     that   day,   during    cross-examination,   defendant
    disputed that he saw evidence of an anastomotic leak during the
    second surgery, despite his operative report listing "[p]robable
    anastomotic leak" among his post-operative diagnoses:
    Q:     Eventually, you determined that there
    was a probabl[e] anastomotic leak that
    7                         A-1874-12T4
    you    encountered    in     the     second
    surgery[,] right?
    A:   That's not true.   What . . . I said —
    and I said yesterday is that when we
    got in there, that putting . . .
    everything   together    .  .  .     the
    anastomosis did not look perfect.    And
    I said it was my job, as the surgeon,
    to make sure that the patient is as
    perfect as I can make [him].      So, I
    made the decision that [I] needed to
    resect that anastomosis.
    Q:   You're   denying  that  you  .   .   .
    determined that there was a probabl[e]
    anastomotic leak?
    A:   Yes, I am.
    . . . .
    Q:   Do you recognize that?
    A:   That's my operating      report   from   that
    day; correct.
    Q:   Mmm-hmm.      And    the   postoperative
    diagnosis that you put down includes
    probabl[e] anastomotic leak[,] right?
    A:   That's correct.    Look, you asked me if
    I   determined   that’s   what  it  was.
    That’s different than a determination
    . . . .     That’s what I'm concerned
    about.    That it wasn't perfect and I
    redid it.
    . . . .
    Q:   I'll jump back to something that we
    actually . . . advanced to before. In
    the final analysis, we did determine
    that there was a probable anastomotic
    leak in this patient, right?
    8                              A-1874-12T4
    A:   No.
    After the completion of defendant's testimony,       plaintiff
    moved for reconsideration of the court's decision to exclude
    defendant's deposition testimony ("I have to assume that it was
    related to the anastomotic leak") regarding the cause of Mr.
    Parker's sepsis.     [T]he court denied the motion, reiterating,
    that "the comment that [defendant] nevertheless articulated was
    speculative.   And, in fact, he said 'I have to assume.'     Which,
    I think, is as great an indication of speculation [as] you're
    going to get, in any case."
    The next day, the jury returned a verdict, finding that
    defendant had not deviated from accepted standards of care and
    was therefore not negligent.5    Plaintiff filed a motion for a new
    trial, arguing that defendant's deposition testimony should have
    been admitted under N.J.R.E. 803(b)(1) as an       admission by a
    party-opponent, and that the exclusion of this evidence resulted
    in a clear miscarriage of justice under the law.         R. 4:49-1.
    The court denied the motion, and this appeal followed.
    On appeal, plaintiff seeks a new trial, contending that the
    trial   court's      erroneous   evidentiary   rulings    regarding
    defendant's deposition testimony constituted reversible error.
    5
    The jury voted six to one that defendant did not deviate from
    accepted standards of care in his treatment of Mr. Parker.
    9                        A-1874-12T4
    Specifically, plaintiff argues that the trial court improperly
    excluded defendant's deposition testimony, and asserts that the
    testimony was admissible under N.J.R.E. 803(b)(1), the hearsay
    exception     for   statements    by     a     party-opponent.       Plaintiff
    contends     that    defendant's        deposition       testimony    is     not
    speculative, but emphasizes that the exception applies even if
    the statement were speculative.              Finally, plaintiff argues that
    the   deposition    testimony    is    not     subject   to   exclusion    under
    N.J.R.E. 403.
    II.
    "In    reviewing   a   trial      court's     evidential    ruling,     an
    appellate court is limited to examining the decision for abuse
    of discretion."       Hisenaj v. Kuehner, 
    194 N.J. 6
    , 12 (2008);
    accord Purdy v. Nationwide Mut. Ins. Co., 
    184 N.J. Super. 123
    ,
    130 (App. Div. 1982).        We are required to disregard an error
    unless, after consideration, we find "it is of such a nature as
    to have been clearly capable of producing an unjust result[.]"
    R. 2:10-2.
    A.
    We first address the trial court's comments suggesting that
    defendant's deposition testimony about the cause of Mr. Parker's
    sepsis might be excludable because "it converts [defendant] into
    10                             A-1874-12T4
    an expert witness[,]" and asks "him to render an opinion when,
    in fact, he's being called as a fact witness."
    "[A] plaintiff in a medical malpractice [action] can ask
    questions of a defendant doctor in a deposition which seek to
    elicit expert opinions relevant to the diagnosis and treatment
    of the plaintiff."         Hutchinson v. Atl. City Med. Ctr.-Mainland,
    
    314 N.J. Super. 468
    , 477 (App. Div. 1998) (citing Rogotzki v.
    Schept, 
    91 N.J. Super. 135
     (App. Div. 1966)).
    It is clear that defendants may be deposed
    as to the facts of the treatment they gave –
    what they did, what they saw, and the
    diagnoses rendered.   It is also clear that
    they may not be asked to respond to purely
    hypothetical questions.    But we think it
    plain that it is not "opinion" to have them
    explain why something was done or not done.
    [Rogotzki, supra, 
    91 N.J. Super. at 152
    .]
    In   Rogotzki,     we    rejected    the    argument     "that   a   treating
    physician   who   is   a    party   defendant    may   not    be   compelled    to
    answer on depositions such questions as call for his expert
    opinions or conclusions related to the treatment he rendered."
    
    Id. at 145
    .
    There is nothing unfair about such a
    practice.    Unlike his counterpart in a
    criminal prosecution, the defendant in a
    civil suit has no inherent right to remain
    silent or, once on the stand, to answer only
    those inquiries which will have no adverse
    effect on his case.     Rather, he must, if
    called as a witness, respond to virtually
    all questions aimed at eliciting information
    11                               A-1874-12T4
    he may possess relevant to the issues, even
    though his testimony on such matters might
    further the plaintiff's case.      We cannot
    agree with the suggestion that it is somehow
    neither sporting nor consistent with the
    adversary system to allow a party to prove
    his   case   through   his  opponent's   own
    testimony but, whatever the merits of this
    view, we prefer to believe that, in a
    situation   such   as  the   present,  [t]he
    ultimate requirement that judicial decisions
    be based on the . . . facts overcomes any
    detriment which might be suffered by the
    adversary system.
    [Id.   at  149   (alterations  in original)
    (quoting McDermott v. Manhattan Eye, Ear &
    Throat Hosp., 
    203 N.E.2d 469
    , 474 (Ct. App.
    1964) (citations and internal quotation
    marks in McDermott omitted)).]
    Our Supreme Court subsequently indicated its approval of
    Rogotzki,    stating,   "Proof   of    deviation   elicited   from   the
    defendants themselves, because they are competent professionals,
    could be relied on by the jury."        Lanzet v. Greenberg, 
    126 N.J. 168
    , 191 (1991) (citing Rogotzki, 
    supra,
     
    91 N.J. Super. at
    148-
    49); see also, Hutchinson, supra, 314 N.J. Super. at 478-81
    (holding that the trial court properly allowed plaintiffs to use
    the defendant doctor's deposition testimony as evidence of the
    applicable standard of care).
    Furthermore, it is well established that a treating doctor
    testifying as a fact witness is permitted to testify about the
    cause of the patient's disease or injury, because causation is
    an essential part of diagnosis and treatment.         See Stigliano v.
    12                           A-1874-12T4
    Connaught Labs., Inc., 
    140 N.J. 305
    , 314 (1995) (holding "the
    characterization          of     [such]   testimony       as       'fact'      or   'opinion'
    creates     an     artificial      distinction").             "[T]estimony          about    the
    likely and unlikely causes of [a patient's condition] is factual
    information, albeit in the form of opinion."                        
    Ibid.
    The questioning of defendant at his deposition reasonably
    sought to ascertain defendant's opinion regarding the timing and
    cause of Mr. Parker's sepsis, two critical issues in the case.
    As   the    surgeon       who    performed    both      operations,            defendant     was
    arguably     in     the    best    position       to   make    these       determinations.
    From his operative report, it would appear that he did, in fact,
    make       these     determinations           by       diagnosing          a     "[p]robable
    anastomotic leak[,]" and his statement that he "did not want to
    take the chance the anastomosis was leaking and would cause
    further sepsis."
    B.
    We next address the trial court's determination to exclude
    defendant's        deposition       testimony      regarding         the       cause   of    Mr.
    Parker's sepsis because it was "speculative."
    N.J.R.E.      803(b)(1)       provides          that    a    "statement         offered
    against a party which is . . . the party's own statement, made
    either in an individual or in a representative capacity," is not
    excluded      by     the        hearsay   rule.           Nevertheless,             testimony
    13                                        A-1874-12T4
    admissible     under       this    rule     is    still     subject     to        other
    restrictions.        Biunno, Weissbard & Zegas, Current N.J. Rules of
    Evidence, comment 1 on N.J.R.E. 803(b)(1) (2014) ("Note that
    [N.J.R.E.]     403    is   not    the   exclusive      means    for   excluding       a
    statement admissible under [N.J.R.E. 803(b)(1)].                   In appropriate
    cases other constitutional, statutory or rule requirements might
    preclude a statement admissible under this Rule.").
    N.J.R.E. 701 generally restricts the subject matter of lay
    witness testimony:
    If a witness is not testifying as an expert,
    the witness' testimony in the form of
    opinions or inferences may be admitted if it
    (a) is rationally based on the perception of
    the   witness   and  (b)   will  assist   in
    understanding the witness' testimony or in
    determining a fact in issue.
    The question is thus whether N.J.R.E. 701 restricts testimony
    otherwise admissible under N.J.R.E. 803(b)(1).                   Our courts have
    not yet addressed this issue.                  Therefore, we look to federal
    precedent interpreting analogous provisions of the Federal Rules
    of Evidence.
    F.R.E.    801(d)(2)(A)       is     the    parallel      provision     to    our
    N.J.R.E. 803(b)(1).         It provides that a "statement . . . offered
    against an opposing party[,] . . . made by the party in an
    individual or representative capacity[,]" is not hearsay.                         Thus,
    the   substance      of    the    provisions      is   essentially     the        same.
    14                                 A-1874-12T4
    Federal courts have addressed the interaction between the party-
    opponent       rule      and     other      provisions.           The     courts      have
    specifically exempted statements under F.R.E. 801(d)(2)(A) from
    the personal-knowledge requirement for testimony.                             See, e.g.,
    United States v. Ammar, 
    714 F.2d 238
    , 254 (3d Cir.) ("[I]t is
    clear       from   the    Advisory       Committee       Notes   that    the    drafters
    intended that the personal knowledge foundation requirement of
    [F.R.E.] 602 should . . .                  not [apply] to admissions               . . .
    admissible under [F.R.E.] 801(d)(2)."), cert. denied, 
    464 U.S. 936
    , 
    104 S. Ct. 344
    , 
    78 L. Ed. 2d 311
     (1983); Mahlandt v. Wild
    Canid Survival & Research Ctr., Inc., 
    588 F.2d 626
    , 630-31 (8th
    Cir. 1978) (holding that the personal knowledge requirement does
    not apply to F.R.E. 801(d)(2)).
    Additionally,           statements     by    a     party-opponent        are    not
    subject to trustworthiness considerations.                       "Trustworthiness is
    not     a    separate      requirement        for       admission     under     [F.R.E.]
    801(d)(2)(A)."           Jewell v. CSX Transp., Inc., 
    135 F.3d 361
    , 365
    (6th Cir. 1998); accord United States v. Pinalto, 
    771 F.2d 457
    ,
    459 (10th Cir. 1985).                 "The admissibility of statements of a
    party-opponent is grounded not in the presumed trustworthiness
    of the statements, but on 'a kind of estoppel or waiver theory,
    that    a    party    should     be    entitled     to    rely   on     his   opponent's
    15                                  A-1874-12T4
    statements.'"       Jewell, 
    supra,
     
    135 F.3d at 365
     (quoting United
    States v. DiDomenico, 
    78 F.3d 294
    , 303 (7th Cir. 1996)).
    In Donlin v. Aramark Corp., 
    162 F.R.D. 149
    , 150 (D. Utah
    1995),    the   district   court   directly        addressed     the   issue     of
    speculation for party-opponent admissions, and found that "the
    fact that the statement is speculative or in opinion form is not
    of   consequence.      Personal    knowledge       of     the   witness   is    not
    required in a party admission circumstance."
    This interpretation echoes 4 Wigmore on Evidence § 1053
    (Chadbourn rev. 1972):
    A primary use and effect of [a party]
    admission is to discredit a party's claim by
    exhibiting     his     inconsistent     other
    utterances.    It is therefore immaterial
    whether these other utterances would have
    been   independently    receivable   as   the
    testimony of a qualified witness. . . . In
    particular,     personal     knowledge,    as
    indispensable to a witness, is not required.
    [Ibid. (emphasis       in        original)    (citations
    omitted).]
    Wigmore goes on to specifically address the lay opinion rule,
    saying that it "does not limit the use of a party's admissions
    [because] [t]he reason for that rule does not apply to a party's
    admissions."     Id. at § 1053(3).
    Thus, federal precedent supports the position that N.J.R.E.
    701 does not independently bar speculative testimony admitted
    under    N.J.R.E.   803(b)(1).     Therefore,        we    conclude    the   trial
    16                                A-1874-12T4
    court     erred    in     excluding          defendant's       deposition      testimony
    regarding the cause of Mr. Parker's sepsis on the basis that it
    was speculative.
    We further note that the record does not provide any actual
    support    that    the    deposition         testimony       was    speculative.       The
    court failed to hold a Rule 104 hearing to explore the issue
    further.          While    it     may        be    possible        the   testimony     was
    speculative,       the    record        lacks       any     evidence     or   convincing
    argument    explaining          how     or    why     the     testimony       constituted
    speculation.
    In summary, we conclude defendant's deposition testimony
    regarding the cause of Mr. Parker's sepsis is admissible under
    N.J.R.E. 803(b)(1).             The statements were made by defendant, a
    party to the action, and were offered by plaintiff against him
    at trial.      Plaintiff's question was not improper, and whether
    defendant was speculating when he answered is irrelevant to the
    statement's admissibility.
    C.
    Finally, we address the application of N.J.R.E. 403.                               The
    trial court's oral opinion on plaintiff's motion for new trial
    did not explicitly address N.J.R.E. 403, but the court stated,
    "I believe . . . the statement by [defendant] was prejudicial
    and not probative, and that's why I excluded it."
    17                                 A-1874-12T4
    N.J.R.E. 403 provides:
    [R]elevant evidence may be excluded if its
    probative value is substantially outweighed
    by   the  risk   of  (a)  undue   prejudice,
    confusion of issues, or misleading the jury
    or (b) undue delay, waste of time, or
    needless    presentation   of     cumulative
    evidence.
    Under      this    test,    "[e]vidence      should     be   barred      if    its
    probative      value   'is     so   significantly       outweighed      by    [its]
    inherently inflammatory potential as to have a probable capacity
    to divert the minds of the jurors from a reasonable and fair
    evaluation of the basic issue[s].'"                  Green v. N.J. Mfrs. Ins.
    Co., 
    160 N.J. 480
    , 491 (1999) (alterations in original) (quoting
    State v. Thompson, 
    59 N.J. 396
    , 421 (1971)).                      "The burden is
    clearly   on    the    party    urging    the    exclusion       of   evidence      to
    convince the court that the N.J.R.E. 403 considerations should
    control."       Rosenblit v. Zimmerman, 
    166 N.J. 391
    , 410 (2001)
    (citation and internal quotation marks omitted).
    Due to the nature of the weighing test, highly prejudicial
    evidence may only be admitted if it has "overwhelming probative
    worth."     Green,     supra,   
    160 N.J. at 491
    .    However,     "'[t]hat
    evidence is shrouded with unsavory implications is no reason for
    exclusion when it is a significant part of the proof.'"                           State
    v. Stevens, 
    115 N.J. 289
    , 308 (1989) (quoting State v. West, 
    29 N.J. 327
    , 335 (1959)).
    18                               A-1874-12T4
    Moreover,     N.J.R.E.         403    concerns       only     undue      prejudice.
    State v. Bowens, 
    219 N.J. Super. 290
    , 297 (App. Div. 1987).
    "The    question     .     .    .    is     not    merely    whether      the    treating
    doctor['s] testimony [was] prejudicial[,] . . . but whether it
    [was]     unfairly       so."        Stigliano,       supra,       140   N.J.    at    317.
    Generally, much of the evidence introduced at an adversarial
    trial is prejudicial to the opposing party, and we "would ill-
    serve the cause of truth and justice if we were to exclude
    relevant and credible evidence only because it might help one
    side and adversely affect the other."                   Ibid.
    Counsel is permitted to attack the credibility of a witness
    on cross-examination.               N.J.R.E. 611(b).         "Cross-examination is
    the greatest legal engine ever invented for the discovery of
    truth."     State v. Silva, 
    131 N.J. 438
    , 444 (1993) (citation and
    internal quotation marks omitted).                    Any witness "may be cross-
    examined with a view to demonstrating the improbability or even
    fabrication    of    his        testimony."           
    Id. at 445
       (citation      and
    internal quotation marks omitted).
    A prior inconsistent statement may also be used to attack
    the credibility of a witness.                     N.J.R.E. 607; Silva, 
    supra,
     
    131 N.J. at 444-45
    ; State v. DiRienzo, 
    53 N.J. 360
    , 383 (1969).
    Deposition testimony of a witness may be used "for the purpose
    19                                   A-1874-12T4
    of contradicting or impeaching" a witness at trial.                                R. 4:16-
    1(a).
    Here,     the    fact    that        defendant      testified          at   deposition
    consistent      with     his     operative          records      but     then      testified
    differently at trial, attempting to discredit his own operative
    reports,      clearly     went        to     the    issue     of       his    credibility.
    Accordingly,      the    trial     court          erred   when     it    did      not   allow
    plaintiff's counsel to impeach defendant's credibility with his
    prior inconsistent deposition testimony.
    Defendant's deposition testimony strikes at the heart of
    this case.      As a statement by the surgeon who actually performed
    the procedures and observed, first hand, Mr. Parker's condition,
    it carries compelling probative worth.                        Stigliano, supra, 140
    N.J. at 317 ("[T]he probative value of the treating doctors'
    testimony outweighs its prejudicial effect under N.J.R.E. 403"
    because    of    their        first        hand    proximity       to    the      patient's
    condition.).          As the trial court noted concerning the expert
    witnesses here, "[t]he people who articulate that there was an
    anastomotic leak were not in the surgery.                          And, really had no
    direct way of making that determination."                          Defendant, however,
    was   necessarily       present       at     the    surgery,       affording        him   the
    ability to make direct observations.
    20                                    A-1874-12T4
    The existence of the anastomotic leak and its effect were
    the   central     issues     at     trial.          While   the    statement       is
    prejudicial, the undue prejudice to defendant is minimal because
    the   statement   at   issue      is   his,   rather    than   a   third   party's
    statement.      "[T]he party who made the out-of-court statement
    cannot complain of his [or her] inability to confront and cross-
    examine the declarant, since he [or she] is the declarant."
    Biunno et al., supra, comment 1 on N.J.R.E. 803(b)(1).
    D.
    Lastly, we must consider whether the trial court's decision
    to exclude defendant's deposition testimony was "clearly capable
    of producing an unjust result[.]"             R. 2:10-2.
    The proofs in this case do not overwhelmingly favor one
    party or the other; hence, the improper exclusion of defendant's
    contradictory deposition testimony could have been the deciding
    factor in his favor.       Cf. State v. Frost, 
    158 N.J. 76
    , 87 (1999)
    (noting that where credibility is the central issue and the
    "jury must choose which of two opposing versions to credit, it
    simply cannot be said that the evidence is overwhelming[ly]"
    against one litigant or the other).              The risk that the jury was
    improperly    influenced       by      the    trial    court's     exclusion      of
    defendant's     deposition     testimony       is     particularly    high     here
    21                                A-1874-12T4
    because defendant's credibility was central to the outcome of
    the case.
    Under the circumstances of this case, we are convinced that
    this    error    was   "clearly   capable   of   producing   an    unjust
    result[.]"      R. 2:10-2.   The excluded deposition testimony bore
    directly on the issue of defendant's negligence and thus could
    readily have been outcome-determinative.         Because the exclusion
    of this evidence could have affected the jury's determination of
    whether defendant was negligent, a new trial is required.
    Reversed and remanded for a new trial.
    22                            A-1874-12T4