Case Title: Corbitt v. Tatagari

Citation: 

Docket Number: 295, 2001

State: delaware

Court: Delaware Supreme Court

Date: 2002-08-16T00:00:00Z

Document:
IN THE SUPREME COURT OF THE STATE OF DELAWARE 
ROGER B. CORBITT, JR., 
 
§ 
§ 
Plaintiff Below, 
 
§ 
Appellant,  
 
§ No. 295, 2001 
§ 
v. 
 
 
 
 
§ Court Below: Superior Court  
§ of the State of Delaware in and  
VIJAY R. TATAGARI, M.D. and 
§ for Kent County 
BAYHEALTH MEDICAL  
 
§ C. A. No. 98C-09-011 
CENTER, INC., (previously 
 
§ 
known as Kent General Hospital), 
§ 
§ 
Defendants Below, § 
Appellees. 
 
 
§  
 
Submitted: June 4, 2002 
Decided: 
August 16, 2002 
 
Before VEASEY, Chief Justice, WALSH, HOLLAND, BERGER, and STEELE, 
Justices, constituting the Court En Banc. 
 
Appeal from Superior Court.  AFFIRMED. 
 
Stephen A. Hampton, Esquire, Dover, Delaware, for Appellant. 
 
Anne L. Naczi, Esquire (argued) and Rebecca L. Trifillis, Esquire, Griffin & 
Hackett, P.A., Georgetown, Delaware, for Appellee Vijay R. Tatagari, M.D. 
 
Mason E. Turner, Jr., Esquire, Prickett, Jones & Elliott, Wilmington, Delaware, 
for Appellee Bayhealth Medical Center, Inc.  
 
 
 
 
 
WALSH, Justice: 
 
 
3 
In this appeal from the Superior Court, we consider the correctness of jury 
instructions given in a medical malpractice action.  The plaintiff below alleged that both 
his family physician and an emergency room physician breached the standard of care by 
failing to diagnose him with appendicitis before his appendix ruptured.  The jury was 
instructed on the applicable standard of care, as found in 18 Del. C. § 6801(7)*.  The 
jury was further offered an explanation of the standard of care using language not 
found in the statute, but conforming to pattern jury instructions.  It is this explanatory 
language that the plaintiff below objected to, arguing that it gave the impermissible 
impression that the standard of care is subjective in nature, and requires of a physician 
only good faith.  The trial court overruled the plaintiff’s objection, finding that the 
challenged language gave the jury a helpful, informative and accurate explanation of the 
standard of care.  We agree and affirm. 
 
I. 
                                                 
*  This case involves the pre-1998 amendment to 18 Del. C. § 6801(7). 
Appellant/plaintiff below Roger B. Corbitt, Jr. (“Corbitt”) brought this medical 
malpractice action against Dr. Vijay R. Tatagari (“Dr. Tatagari”) and Bayview Medical 
 
 
4 
Center, Inc. (“Bayview”) alleging that they should have diagnosed him with acute 
appendicitis and referred him to a surgeon in time to permit surgery before his 
appendix ruptured.  Corbitt claims that the surgery and recovery time necessitated by 
his ruptured appendix was more extensive than if either Dr. Tatagari or Bayview had 
properly diagnosed his condition prior to his appendix rupturing.  After trial, the jury 
returned a verdict for the defendants, Dr. Tatagari and Bayview.  This appeal followed. 
Corbitt began experiencing intense abdominal pain on the morning of December 
24, 1996.  The pain was such that Corbitt left work and drove two hours to see his 
family doctor, Dr. Tatagari.  Corbitt testified at trial that the pain was so severe that he 
asked to lie down while waiting for Dr. Tatagari to see him.  Dr. Tatagari testified, 
however, that when he saw Corbitt, Corbitt was sitting up and did not appear to be in 
extreme pain.  Dr. Tatagari took a medical history from Corbitt and conducted a 
physical examination.  When Dr. Tatagari examined Corbitt, he found that Corbitt’s 
pain was in the epigastric region of the abdomen, which is located just above the 
stomach, under the rib cage.  Corbitt did not indicate any pain in the right lower 
quadrant of his abdomen, where the appendix is located.  Dr. Tatagari diagnosed 
Corbitt with either acute gastritis or peptic ulcer, which were both consistent with 
Corbitt’s physical exam.  Dr. Tatagari did not believe Corbitt was suffering from 
 
 
5 
appendicitis because of the lack of pain in the right lower quadrant.  Dr. Tatagari 
prescribed Prilosec, a medication for both gastritis and ulcer, and advised Corbitt to go 
to the emergency room if his symptoms worsened. 
Later that same afternoon, Corbitt’s pain increased and he went to the 
emergency room at Kent General Hospital (now Bayview).  At the emergency room, 
Corbitt was seen by Dr. Hamilton Carter (“Dr. Carter”).  Dr. Carter read Corbitt’s 
medical chart, conducted a physical examination, and ordered diagnostic tests, 
including an x-ray.  Again, Corbitt indicated that the pain he was experiencing was 
limited to the epigastric region of his abdomen, not the right lower quadrant.  By this 
time, Corbitt had also vomited blood, an indication that his stomach was bleeding, 
consistent with an ulcer.  Dr. Carter reviewed the results of the  x-ray and saw nothing 
that he felt would indicate an obstruction or appendicitis.  The x-ray did indicate a 
small bit of matter, called a fecalith, in the area of the appendix, however.  Corbitt 
argued to the jury that this indicated a problem with his appendix that should have 
been explored further, but Dr. Carter testified that given the absence of pain in the 
area, he did not believe appendicitis was a reasonable possibility.  Although the x-ray 
technician indicated that consultation may be required, Dr. Carter did not consult 
anyone further regarding the x-ray results until after Corbitt had been discharged.  Dr. 
 
 
6 
Carter testified that consultation did not change his initial diagnosis, which excluded 
appendicitis as the cause of Corbitt’s distress. 
Dr. Carter believed that peptic ulcer was the most likely diagnosis, and he 
prescribed medication accordingly.  Corbitt remained in the hospital and after four 
hours had passed while he was on the medication, Corbitt felt somewhat better.  This 
improvement confirmed the diagnosis in Dr. Carter’s mind and he discharged Corbitt 
with instructions to see his primary doctor within three days and return to the hospital 
if his symptoms worsened.  For the next three days, Corbitt continued to experience 
pain.  On December 27, 1996 a family member telephoned Dr. Tatagari’s office and 
informed Dr. Tatagari’s assistant that Corbitt was still in pain and now had blood in his 
urine.  According to Dr. Tatagari, his assistant told Corbitt to go directly to the hospital. 
 Corbitt denies that he was instructed to go to the hospital. 
Then, on December 30, 1996, Corbitt again made an unscheduled visit to Dr. 
Tatagari’s office.  By this time, Corbitt reported to Dr. Tatagari that he had been 
experiencing fever and constipation for the previous two days.  Also on this visit, for the 
first time, Corbitt indicated pain in the right lower quadrant of his abdomen.  Dr. 
Tatagari suggested that Corbitt go to the hospital for further testing but Corbitt refused, 
so Dr. Tatagari referred him to a surgeon, Dr. Sidney Barnes (“Dr. Barnes”).  Corbitt 
 
 
7 
went to see Dr. Barnes that same day.  Dr. Barnes examined Corbitt but found that he 
did not have a “surgical abdomen,” and, therefore, Dr. Barnes thought it was unlikely 
Corbitt was suffering from appendicitis.  According to Dr. Barnes, he did recommend 
further testing, but Corbitt elected not to pursue that route.   
The following morning, December 31, Corbitt returned to Bayview in extreme 
pain.  Dr. Barnes was called in to examine Corbitt and again did not believe Corbitt was 
suffering from appendicitis, but scheduled immediate surgery to explore the source of 
Corbitt’s pain.  During surgery, it was discovered that Corbitt’s appendix had ruptured, 
probably sometime during the previous night.  As previously noted, Corbitt contends 
that the surgery was more extensive and the recovery time more prolonged because he 
did not have his appendix removed until it had already ruptured.  
In his complaint, Corbitt alleged that both Dr. Tatagari and Dr. Carter breached 
the applicable standard of care on December 24 by failing to take an adequate history 
and performing incomplete physical examinations, particularly in failing to conduct a 
rectal exam.  Corbitt further claimed that Dr. Tatagari had breached the standard of 
care by failing to instruct him to go to the hospital on December 27, and failing to 
diagnose appendicitis on December 30.  Finally, Corbitt alleged Dr. Carter was 
 
 
8 
negligent on December 24 in his reading of the x-ray, which showed the presence of a 
fecalith.       
At the trial in this matter, it was elicited that Dr. Tatagari is an internist, or a 
general physician for adults, and that he is foreign born and foreign educated.  There 
was further testimony that, although the standard for detecting appendicitis is the same 
for all physicians, only a surgeon, such as Dr. Barnes, can render the required treatment 
for appendicitis, which is surgery.  Furthermore, there was evidence that Dr. Carter had 
not passed the certification boards for emergency medicine, despite having taken the 
examination two or three times.  In addition to these attacks on the defendants’ 
competence, both sides presented expert testimony on whether or not Dr. Tatagari and 
Dr. Carter had met the standard of care.  As to the December 27 telephone call, 
Corbitt’s expert indicated that Dr. Tatagari would have met the standard of care if he 
instructed Corbitt to go to the hospital, or if he had told Corbitt to come directly to his 
office.   
At the close of the case, the jury was instructed with the standard medical 
malpractice jury instruction, which reads as follows: 
Under a Delaware statute, a healthcare provider that does not meet 
the applicable standard of care commits medical malpractice: 
The standard of skill and care required of every healthcare provider in 
rendering professional services or healthcare to a patient shall be that 
 
 
9 
degree of skill and care ordinarily employed, under similar circumstances, 
by members of the profession in good standing in the same community or 
locality, and the use of reasonable care and diligence. 
* * * 
Each physician and healthcare provider is held to the standard of care and 
knowledge commonly possessed by members of his or her profession and 
specialty in good standing.  It is not the standard of care of the most 
highly skilled, nor is it necessarily that of average members of this 
profession, since those who have somewhat less than average skills may 
still possess the degree of skill and care to treat patients competently. 
When a physician chooses between appropriate alternative medical 
treatments, harm resulting from a physician’s good faith choice of one 
proper alternative over the other is not medical malpractice. 
 
Corbitt objected to the last three sentences of this instruction, arguing that they 
improperly characterized the standard of care as a subjective determination and that 
there was no evidence to support an alternative treatment instruction.  Corbitt’s 
objection was overruled.  Following the defense verdict, Corbitt moved for a new trial 
on the ground that these three sentences rendered the jury instructions improper.  The 
trial court denied Corbitt’s motion, finding that the sentences provided a helpful 
explanation of the statutory language and that, although not entirely applicable in this 
case, the alternative treatment instruction was proper because the doctors did make 
choices about Corbitt’s treatment. 
II. 
 
 
10 
We review de novo the Superior Court’s decision to issue the challenged jury 
instructions.  North v. Owens-Corning Fiberglas Corp., 704 A.2d 835, 837 (Del. 1997).   
When the correctness of a jury instruction is raised on appeal, our analysis 
focuses “not on whether any special words were used, but whether the instruction 
correctly stated the law and enabled the jury to perform its duty.”  Cabrera v. State, 747 
A.2d 543, 545 (Del. 2000).  Generally, jury instructions must give a correct statement of 
the substance of the law and must be "reasonably informative and not misleading."  Id. 
at 544.  The instructions need not be perfect, however, and a party does not have a right 
to a particular instruction in a particular form.    Haas v. United Technologies Corp., 
450 A.2d 1173, 1179 (Del. 1982); Chavin v. Cope, 243 A.2d 694 (Del. 1968).  In 
evaluating the propriety of a jury charge, the instructions must be viewed as a whole. 
Culver v. Bennett, 588 A.2d 1094, 1096 (Del. 1991). 
The trial court here relied on the pattern civil jury instructions for medical 
malpractice.  While the pattern instructions continue to be a valuable resource and 
should be consulted in the first instance, they are not dispositive.  Cabrera, 747 A.2d at 
545.  As the introduction to the pattern instructions notes, they are intended as 
guidelines and should be used in cases only where they are applicable.  The pattern 
instructions may require modification or supplementation, depending upon the issues 
 
 
11 
of fact and law presented at the trial.  Id.  This is a case in which it would have been 
prudent to modify the pattern instructions to more closely reflect the particular facts at 
issue.  Nonetheless, on the whole, the instructions given by the trial judge were 
calculated to be reasonably informative and were not misleading. 
The first sentence of the jury instructions Corbitt objects to is that “[e]ach 
physician and healthcare provider is held to the standard of care and knowledge 
commonly possessed by members of his or her profession and specialty in good 
standing.”  In particular, Corbitt argues that “knowledge” is not included in the 
statutory definition of standard of care, and its inclusion in the instruction may have 
led the jury to believe that the standard of care is variable, based on a particular 
physician’s level of knowledge.  Further, Corbitt asserts, the reference to “specialty” 
could have misled the jury to assume that only a specialist could have diagnosed 
Corbitt’s appendicitis.  Both of these arguments are rebutted by a fair reading of the 
entire contents of the jury charge, however.  
The substitution of “knowledge” for “skill” does not render the instruction faulty. 
 Although the two words are not entirely interchangeable, one’s knowledge is a function 
of one’s skill level.  See Webster’s Third New International Dictionary 2133 (unabr. 
1993) (defining skill as “the ability to use one’s knowledge effectively and readily in 
 
 
12 
execution or performance”).    Further, although the instruction begins with “each 
physician,” it also makes clear that the relevant standard of care is that “commonly 
possessed” by other physicians in “good standing.”  This is simply a synonym for the 
statutory language referring to the degree of skill and care “ordinarily employed.”  Using 
words other than those found in the statute is permissible, so long as the chosen phrase 
does not contradict the statutory mandate or change its intended meaning.  Restating 
the law using alternate language is helpful to juries who, as laypersons, are trying to 
make sense of often lengthy and sometimes legally phrased instructions.  The 
challenged sentence does not conflict with the statute. 
The insertion of the word “specialty” in the instruction is a recognition of the fact that 
experts specializing in a particular field of study are held to the standard of care 
employed by others in that same field.  Di Filippo v. Preston, 173 A.2d 333, 336 (Del. 
1961).  In this case, Dr. Tatagari did not hold himself out as a specialist.  Dr. Carter, 
however, is an emergency room physician and testified to the standard of care required 
of those in emergency medicine.  Given this testimony, it was not error to include a 
reference to specialty in the jury instructions. 
 
III. 
 
 
13 
The second sentence Corbitt challenges is: “It is not the standard of care of the most 
highly skilled, nor is it necessarily that of average members of this profession, since 
those who have somewhat less than average skills may still possess the degree of skill and 
care to treat patients competently.”  Corbitt argues that this sentence, particularly in 
combination with the first sentence, may have led the jury to believe that the standard 
of care is a sliding scale depending upon the physician’s level of knowledge and skill.  
On the contrary, in our view this sentence imparts to the jury the sense that the 
standard of care is judged by the reasonable physician in similar circumstances.  The 
standard of care has never required that physicians be the most highly skilled in their 
field, indeed, the majority of physicians could not meet such a standard.  The standard 
of care is comparative, however, and this jury instruction was attempting to convey that 
idea to the jury in an understandable fashion.   
 
Additionally, while we do not endorse the above quoted language as universally 
applicable, we cannot say that its inclusion was error in this case.  Corbitt’s case had less 
to do with the standard of care and more to do with proximate cause.  There was little 
dispute about what the standard of care required of Dr. Tatagari and Dr. Carter, the 
question was, given the facts of this case, whether the actions (or inactions) of Dr. 
Tatagari and Dr. Carter caused Corbitt injury by delaying his appendectomy until after 
 
 
14 
his appendix ruptured.  Because Corbitt was referred to a surgeon before his appendix 
ruptured, the jury could have concluded that any deviations from the standard of care 
on the part of physicians who saw him previously were immaterial, and not the 
proximate cause of Corbitt’s alleged injuries.      
 
IV. 
 Corbitt further contends that there was no evidentiary basis to support the following 
jury instruction: “When a physician chooses between appropriate alternative medical 
treatments, harm resulting from a physician’s good faith choice of one proper 
alternative over the other is not medical malpractice.”  Unlike the other two sentences 
challenged, this Court specifically approved the “alternative treatment” instruction in 
Riggins v. Mauriello, 603 A.2d 827, 829-31 (Del. 1992).  Although Corbitt argues that 
many states have abandoned similar instructions because they tend to excuse any 
physician acting in good faith, we do not so read Delaware’s alternative treatment 
instruction.  Indeed, the instruction speaks of “appropriate” and “proper” alternatives, 
not any alternative that exists.  We believe this distinction, in conjunction with the 
remainder of the charge, adequately conveys to the jury that the given alternatives must 
 
 
15 
themselves be reasonable and must meet the standard of care.  Compare Das v. Thani, 
795 A.2d 876 (N.J. 2002).  
Finally, Corbitt’s continual reference to this case as one involving only misdiagnosis, 
not any alternative treatments, is somewhat simplistic.  As with any alleged medical 
malpractice action, the physician defendants had treatment choices to make given the 
facts and symptoms observed.  Initial diagnoses are not always set in stone, but evolve, 
given changes in the patient’s circumstances and response to treatment.  Although Dr. 
Tatagari and Dr. Carter recommended treatment based on their initial misdiagnoses, 
each was making choices about appropriate treatment alternatives.  This is not to say, 
however, that the alternative treatment instruction is appropriate in every case.  We 
merely note that here, the instruction was not so unsubstantiated as to render its 
inclusion reversible error.  Indeed, in light of the evidence presented below, it would 
have been more appropriate for the Superior Court to eliminate the reference to 
alternative treatment from the jury instruction.  We are satisfied, however, that the 
defect in the Superior Court's instruction did not interfere with the jury's ability to 
perform its duty intelligently.  See Asbestos Litigation Pusey Trial Group v. Owens-
Corning Fiberglas Corp., 669 A.2d 108, 113 (Del. 1995) (noting a verdict based upon 
erroneous jury instructions will be set aside only if "deficiencies in the instructions given 
 
 
16 
by the trial judge undermined the jury's ability to perform its duty intelligently in 
returning a verdict").   
In the final analysis, the issue posed at trial was whether the plaintiff satisfied the 
burden of proving that Dr. Tatagari and/or Dr. Carter failed to diagnose and treat him 
in conformity with the standard of medical care of the community in which they 
practiced.  While the jury instructions might have been more specific, they conveyed to 
the jury the appropriate legal basis for assessing the duties of both physicians and were 
thus a correct statement of the law.  The evidence presented at trial posed the factual 
issue of conformity with applicable standards, with expert opinion on each side of that 
dispute.  The jury resolved that issue adverse to the plaintiff.  We are unable to 
conclude that the jury instructions which formed the legal framework for that 
determination were erroneous.  Given our standard of review, we must accordingly 
affirm.