Case Title: Burns v. Metz

Citation: 245 Neb. 428, 513 N.W.2d 505

Docket Number: 

State: nebraska

Court: Nebraska Supreme Court

Date: 1994-03-25T00:00:00Z

Document:
513 N.W.2d 505 (1994) 245 Neb. 428 Mary Lou BURNS, Appellant, v. Philip S. METZ, M.D., Appellee. No. S-92-482. Supreme Court of Nebraska. March 25, 1994. *506 James R. Welsh, of Bradford, Coenen, Ashford & Welsh, Omaha, for appellant. James A. Snowden, of Knudsen, Berkheimer, Richardson & Endacott, Lincoln, for appellee. HASTINGS, C.J., BOSLAUGH, WHITE, CAPORALE, FAHRNBRUCH, and LANPHIER, JJ., and GRANT, J., Retired. HASTINGS, Chief Justice. Plaintiff, Mary Lou Burns, brought this action for professional negligence arising from breast reduction surgery performed by defendant-appellee Philip S. Metz, M.D., and his assistant, defendant Richard M. Pitsch, Jr., M.D. Plaintiff assigns as error the failure of the trial court to instruct the jury as to the definition of negligence and its failure to instruct that Dr. Metz was responsible for all negligent acts of his assistant. To establish reversible error from a court's failure to give a requested instruction, an appellant has the burden of showing that (1) the tendered instruction is a correct statement of the law, (2) the tendered instruction is warranted by the evidence, and (3) the appellant was prejudiced by the court's failure to give the tendered instruction. Wilson v. Misko, 244 Neb. 526, 508 N.W.2d 238 (1993); Nichols v. Busse, 243 Neb. 811, 503 N.W.2d 173 (1993). *507 Where a tendered instruction is not an incorrect statement of the law, but is also not wholly correct, the trial court, whether requested or not, has the duty of instructing the jury on issues presented by the pleadings and the evidence. Wilson v. Misko, supra; Professional Recruiters v. Oliver, 226 Neb. 16, 409 N.W.2d 304 (1987). Because of physical discomfort in her neck and shoulder area due to her large breasts, Burns, after an examination and recommendation by Dr. Metz, consented to breast reduction surgery which was accomplished on Friday, September 18, 1987. Dr. Metz had described for her how the reduction would be accomplished, informed her of possible complications, and told her that he always had a surgeon assisting him during any major surgery. Dr. Metz' office manager informed her that Dr. Rick Windle would be assisting with the surgery. Burns was familiar with Dr. Windle and "had no problems with him being in [the operating room] assisting at all." On the following Sunday, Burns had a chance to observe her breasts during a dressing change. She noticed that her breasts were asymmetrical and that the sutures on the right breast were very small and even, while on the left breast the sutures were not as evenly spaced and there were areas where pieces of skin and tissue were "puckering out a little bit." Prior to Burns' next appointment, she received the operative and pathology reports in the mail, attached to an insurance form. After reading the reports, Burns concluded that two different surgeons had performed surgery on her and that this was the reason one breast was so much smaller than the other. The second surgeon was Dr. Pitsch. Burns saw in the report that 186 more grams of tissue were taken from the right breast than the left. She stated that she felt she had been deceived because she had not been told that the other surgeon would do anything but assist. The surgical report stated that "Dr. Pitsch had removed the left and right segments" on the right breast and that he had closed on the left breast, while Dr. Metz closed on the right. Dr. Simon Fredricks testified by deposition as an expert for Burns. He testified that Dr. Pitsch, the assisting surgeon, departed from the appropriate standard of care by failing to object to Dr. Metz' request to resect the breast tissue. However, he also stated that even if Dr. Pitsch had objected, if Dr. Metz had insisted that he do so, Dr. Pitsch should have done what was requested of him. Dr. Fredricks further testified on cross-examination that if Dr. Metz directly supervised Dr. Pitsch in resecting the medial and lateral portions of the breast, then both Drs. Metz and Pitsch had met the standard of care in regard to that issue. He added that as the assistant, Dr. Pitsch was under obligation to do everything he was requested to do by Dr. Metz. Dr. Fredricks stated that Dr. Metz had departed from the standard of care by failing to obtain informed consent, by failing to inform Burns that he intended to permit the assisting surgeon to sculpture breast tissue, by failing to take preoperative photographs to aid him during the surgery, by failing to be personally responsible for sculpturing both breasts, and by failing to evaluate the breasts in the erect position during surgery. However, Drs. William LeWorthy and Colleen Stice both testified that Dr. Metz followed the standard of care in his treatment of Burns. Although he agreed that there was asymmetry, Dr. Metz stated that he had complied with the appropriate standard of care. Both Drs. Fredricks and Metz testified that asymmetry may occur despite the exercise of reasonable care. At the close of Burns' case, Dr. Pitsch moved for a directed verdict. The court sustained the motion and dismissed Dr. Pitsch as a party defendant. Dr. Metz' motion for a directed verdict was overruled. Following completion of the testimony, the case was submitted to the jury on the issues of whether Dr. Metz was negligent in failing to do a proper preoperative workup, in failing to inform Burns that Dr. Pitsch would be removing tissue from her right breast, and in failing to properly remove tissue from her right breast. The jury returned a verdict in favor of Dr. Metz. Burns appeals to this court. *508 Burns first asserts that the court erred in failing to give her proposed instruction defining negligence. Malpractice or professional negligence is defined under the Nebraska Hospital-Medical Liability Act in Neb.Rev.Stat. § 44-2810 (Reissue 1988) as follows: Burns' proposed instruction No. 10, based on the NJI2d Civ. 3.02 definition of ordinary negligence, stated: "Negligence is doing something that a reasonably careful person would not do under similar circumstances, or failing to do something that a reasonably careful person would do under similar circumstances." The trial court refused this instruction, stating that its instruction No. 7 "adequately instructs the jury in this case on that issue." The court's instruction No. 7 stated: The second paragraph of this instruction is taken virtually verbatim from NJI2d Civ. 12.01, which sets out the "duty of a health care provider." However, Burns objects to the first paragraph of the court's instruction, contending that it indicates to the jury that she would have a stronger burden of proof than ordinary negligence. On the contrary, professional negligence does not merely require that the rendered care be judged by what a reasonably careful person would do or not do under similar circumstances, but, rather, requires that the professional's actions be measured by the care, skill, and knowledge ordinarily possessed and used by other comparable professionals in a similar practice. It is Dr. Metz who must measure up to the higher standard of care. The Nebraska Jury Instruction does not use the phrase "reasonable care," as does the definition provided in § 44-2810. However, as noted in NJI2d Civ. 12.01 comment at 688, "`the care, skill, and knowledge ordinarily possessed and used under like circumstances by other [such health care providers] engaged in a similar practice in the same or similar localities' will be reasonable care." (Emphasis supplied.) Thus, the definition of "reasonable care" is inherent in the Nebraska Jury Instruction, and an additional instruction relating negligence to the absence of reasonable care would be redundant and possibly confusing to the jury. Although Burns further argues that the case was tried in "negligence" and that there is no rationale for the court's failure to instruct on this key word, this is clearly an action in professional negligence. As stated in Kortus v. Jensen, 195 Neb. 261, 268, 237 N.W.2d 845, 850 (1976): (Emphasis in original.) NJI2d Civ. 12.01 clearly addresses the standard necessary for *509 a determination of medical negligence as set forth above. The court's instruction as given could have been made more clear by explicitly stating that professional negligence means the failure to "possess and use the care, skill and knowledge ordinarily possessed and used under like circumstances." However, as we have often noted, all jury instructions must be read together and if, taken as a whole, they correctly state the law, are not misleading, and adequately cover issues supported by pleadings and evidence, there is no prejudicial error necessitating reversal. See, Behm v. Northwestern Bell Tel. Co., 241 Neb. 838, 491 N.W.2d 334 (1992); Grote v. Meyers Land & Cattle Co., 240 Neb. 959, 485 N.W.2d 748 (1992). As stated in Carter v. Consolidated Cabs, Inc., 490 S.W.2d 39, 43 (Mo.1973), "`"Although we do not hold that in every case the giving of a negligence definition is required by MAI, it would appear to be a better practice to include such definition where the term `negligence' appears in any of the instructions."'" Here, the jury was given instruction No. 3, which states, in pertinent part, that The latter part of the instruction, beginning with "[b]efore the plaintiff can recover," is the critical portion of the instructions and placed the proper burden upon Burns. The jury was also instructed on the definition of proximate cause. Again, as to Dr. Metz' care and treatment of Burns, the first part of the above instruction fails to explicitly relate his actions to the appropriate standard of care. However, on the issue of informed consent, the latter part of the instruction does relate Dr. Metz' actions to the appropriate standard, as provided in instruction No. 7. The meaning *510 of an instruction and not its phraseology is the important consideration. Where the meaning of an instruction is reasonably clear, it is not prejudicially erroneous. Greenberg v. Bishop Clarkson Memorial Hospital, 201 Neb. 215, 266 N.W.2d 902 (1978). Taken as a whole, the instructions adequately convey to the jury that Dr. Metz would be professionally negligent in departing from the appropriate standard of care, as set out in instruction No. 7, in his treatment of Burns. Burns next contends that the court erred in failing to give the following proposed instruction No. 9: During the instruction conference, counsel for Burns argued that this instruction was necessary to advise the jury that Dr. Pitsch had been dismissed because Dr. Metz had exclusive control and supervision of Dr. Pitsch. Dr. Metz argues that this instruction would have permitted the jury to find that Dr. Pitsch was negligent despite the fact that in dismissing Dr. Pitsch, the court ruled as a matter of law that insufficient evidence of Dr. Pitsch's negligence had been presented. In sustaining Dr. Pitsch's motion for a directed verdict, the court stated: Although these comments reflect the court's consideration of the fact that Dr. Pitsch was under the exclusive control and supervision of Dr. Metz, it was proper to dismiss Dr. Pitsch as a defendant on the basis that the evidence offered by Burns was not sufficient to make out a prima facie case against him. As noted above, in a medical malpractice action, the plaintiff has the burden of establishing by expert medical testimony (1) the generally accepted and recognized standard of care or skill of the medical community in the particular kind of care; and (2) that the physician or surgeon in question negligently departed from that standard in his treatment of the plaintiff. The only evidence offered in this regard was the deposition testimony of Dr. Simon Fredricks. In regard to Dr. Pitsch's responsibilities, Dr. Fredricks testified: *511 A. I did, sir. Dr. Fredricks also stated that Dr. Pitsch would not have the responsibility to perform the procedure such that upon completion the breasts would be symmetrical, nor was it Dr. Pitsch's responsibility to explain the risks and alternatives of the procedure to the patient. Dr. Metz was asked: Burns cited Swierczek v. Lynch, 237 Neb. 469, 466 N.W.2d 512 (1991), as authority for her proposed instruction. However, in Swierczek, res ipsa loquitur was pled, raising the inference of negligence. We stated that "[t]he duty of care owed by a physician is nondelegable, which `means that an employer of an independent contractor ... by assigning work consequent to a duty, is not relieved from liability arising from the delegated duties negligently performed.'" (Emphasis supplied.) Id. at 482, 466 N.W.2d at 520. Here, there is nothing in the record to indicate that Dr. Pitsch departed from the appropriate standard of care in regard to his responsibilities as an assisting surgeon. A litigant is entitled to have the jury instructed only upon those theories of the case which are presented by the pleadings and which are supported by competent evidence. Swartz v. Peterson, 199 Neb. 171, 256 N.W.2d 681 (1977). Furthermore, we have held that unless the servant or agent is liable in negligence, there can be no liability on the master or principal. Plock v. Crossroads Joint Venture, 239 Neb. 211, 475 N.W.2d 105 (1991). Thus, in the absence of evidence of any negligence by Dr. Pitsch, the court properly refused Burns' proposed instruction which would have allowed the jury to consider any negligence of Dr. Pitsch, which evidence did not exist in determining the negligence of Dr. Metz. Finding no prejudicial error having been committed by the district court, we affirm its judgment. AFFIRMED. WHITE, J., concurs in the result.