Title: THERESA PIA and JUAN PIA v. L. CHARLES CHRISTENSEN, M.D.

State: wyoming

Issuer: Wyoming Supreme Court

Document:

THERESA PIÑA and JUAN PIA v. L. CHARLES CHRISTENSEN, M.D.2009 WY 64206 P.3d 1298Case Number: No. S-07-0295Decided: 05/13/2009
APRIL 
TERM, A.D. 2009

 
 
THERESA 
PIA and JUAN PIA,Appellants(Plaintiffs),v.L. 
CHARLES CHRISTENSEN, 
M.D.,Appellee(Defendant).

 
 
Appeal 
from the District Court of Park County

The 
Honorable Wade E. Waldrip, Judge

 
 

Representing 
Appellant:

James 
E. Fitzgerald of The Fitzgerald Law Firm, Cheyenne, Wyoming 

 
 

Representing 
Appellee:

Scott 
P. Klosterman of Williams, Porter, Day & Neville, P.C., Casper, Wyoming 

 
 
Before 
VOIGT, C.J., and GOLDEN, HILL, KITE, BURKE, JJ.

 
 

GOLDEN, 
Justice.

 
 
[¶1]      Theresa and Juan 
Pi±a brought an action against Dr. Charles Christensen for medical 
malpractice.  After a jury trial, 
the jury found no negligence on the part of Dr. Christensen.  The Pi±as appeal, arguing the jury 
instructions misled the jury as to the appropriate standard of care.  Finding no error in the jury 
instructions, we affirm.

 
 
ISSUE

 
 
[¶2]      The Pi±as present 
the issue in this case as whether the trial court prejudicially erred when it 
instructed the jury: "Before you may find that [Dr. Christensen] was negligent 
in his care and treatment of [Mrs. Pi±a], you must first find, by a 
preponderance of the evidence, that he failed to act in accordance with the 
standard of care adhered to by the American Board of 
Urology."

 
 
FACTS

 
 
[¶3]      Only minimal 
facts need be set out for context.  
Dr. Christensen is a urologist certified by the American Board of 
Urology.  Dr. Christensen operated 
on Mrs. Pi±a to repair her mild urinary incontinence.  Complications arose, and Mrs. Pi±a now 
suffers from severe urinary incontinence.  

 
 
[¶4]      The Pi±as claim 
Dr. Christensen was negligent in several respects.  The jury trial essentially became a 
battle of experts.  In the end, the 
jury found Dr. Christensen not negligent.  
Further facts will be developed as necessary below.

 
 
DISCUSSION

 
 
General 
Law

 
 
[¶5]      The function of 
jury instructions is to give the jury guidance with respect to the applicable 
law. Instructions are sufficient if they correctly state the law, they are not 
misleading, and they permit the parties to argue their respective theories of 
the case.  Instructions must not be 
extracted piecemeal to establish error, but rather are reviewed in their 
entirety.  Hannifan v. American Nat'l Bank of 
Cheyenne, 2008 WY 65, ¶ 23, 185 P.3d 679, 689 (Wyo. 2008); Three Way, Inc. v. Burton Enterprises, 
Inc., 2008 WY 18, ¶ 23, 177 P.3d 219, 227 (Wyo. 2008).

 

[¶6]      We review the 
legal sufficiency of jury instructions de novo, asking first whether an 
instruction is erroneous, and second whether the error prejudiced a party.  Prejudice is not presumed.  Sellers v. Dooley Oil Transport, 2001 WY 
44, ¶ 9, 22 P.3d 307, 309 (Wyo. 2001); Cervelli v. Graves, 661 P.2d 1032, 1036 
(Wyo. 1983).  The burden is on the 
appellant to show prejudicial error.  
Parrish v. Groathouse Const., 
Inc., 2006 WY 33, ¶ 7, 130 P.3d 502, 505 (Wyo. 2006); Daley v. Wenzel, 2001 WY 80, ¶ 29, 30 P.3d 547, 554-55 (Wyo. 2001).

 
 
[¶7]      In general, this 
Court has stated:

 
 
            
Errors of substantive law contained in the language of an instruction 
require reversal if the error is prejudicial.  Bigley v. Craven, 769 P.2d 892, 895 
(Wyo. 1989) (quoting Cervelli v. 
Graves, 661 P.2d 1032, 1036 (Wyo. 1983)).  In reviewing the content of a challenged 
jury instruction, the charge is considered as a whole.  Kemper Architects, P.C. v. McFall, Konkel 
& Kimball Consulting Engineers, Inc., 843 P.2d 1178, 1182 (Wyo. 
1992).  To measure the degree of 
prejudice, jury instructions are viewed in the light of the entire trial, 
including the allegations of the complaint, conflict in the evidence on critical 
issues and the arguments of counsel.  
City of Cheyenne v. Simpson, 
787 P.2d 580, 581-82 (Wyo. 1990) (quoting Condict v. Whithead, Zunker, Gage, Davidson 
& Shotwell, P.C., 743 P.2d 880, 886 (Wyo. 1987)).  The goal of our review is to determine 
if the charge presents a comprehensive, balanced and fundamentally accurate 
statement of the governing law to the jury.  Kemper Architects, P.C., 843 P.2d  at 
1182; Sims v. General Motors Corp., 
751 P.2d 357, 365 (Wyo. 1988) (quoting Norman v. State, 747 P.2d 520, 523 (Wyo. 
1987)).  The charge is deemed 
adequate if it is not likely to confuse or mislead the jury.  Bigley, 769 P.2d  at 895.  "The fact that an instruction may have 
been more precisely drafted or drafted in a way more favorable to a party does 
not warrant reversal for a new trial."  
Triton Coal Co., Inc. [v. Mobil Coal Prod., Inc.,] 800 P.2d 
[505,] at 512 [(Wyo. 1990)].

 
 

State 
Farm Mut. Auto. Ins. Co. v. Shrader, 
882 P.2d 813, 832 (Wyo. 1994).  See also Frost v. Allred, 2006 WY 155, ¶ 6, 148 P.3d 17, 19 (Wyo. 2006).

 
 
[¶8]      A trial judge 
retains extensive discretion in tailoring jury 
instructions, provided that they correctly state the law and fairly and 
adequately cover the issues presented.  
See Hannifan, ¶ 23, 185 P.3d  
at 689 (a trial court is not obligated to give an instruction offered by a party 
as long as the jury is adequately instructed on the law as it pertains to that 
case); Three Way, Inc., ¶ 23, 177 P.3d  at 227; McGuire v. Solis, 2005 
WY 129, ¶ 23, 120 P.3d 1020, 1026 (Wyo. 2005).  We therefore review the district court's 
decision to give or its refusal to give a particular jury 
instruction for abuse of discretion.

 
 
Propriety 
of challenged instruction

 
 
[¶9]      The jury 
instruction complained of by the Pi±as on appeal states:  

 
 
Wyoming 
Statute § 1-12-601 provides, in relevant part, that:

 
 
(a) 
In an action for injury alleging negligence by a health care provider the 
plaintiff shall have the burden of proving:

 
 
            
(i)  If the defendant is 
certified by a national certification board or association, that the defendant 
failed to act in accordance with the standard of care adhered to by that 
national board or association.  

 
 
Defendant 
Charles Christensen, M.D. is certified by the American Board of Urology.  Before you may find that he was 
negligent in his care and treatment of Plaintiff Theresa Pi±a, you must first 
find, by a preponderance of the evidence, that he failed to act in accordance 
with the standard of care adhered to by the American Board of 
Urology.

 
 
In 
their objection to this instruction, the Pi±as focus on the statutory term 
"adhered to" and claim the term requires proof of written, clear-cut standards 
of care adopted by the American Board of Urology.  While no directly supporting evidence 
was adduced at trial, the Pi±as allege on appeal the Board does not have any 
such written standards.  The Pi±as 
thus argue the instruction is erroneous because it required them to submit proof 
on something that doesn't exist.

 
 
[¶10]   The first question is whether the 
jury instruction correctly states the law.  
The statute is obviously a correct statement of law.  It reflects the legislative directive 
that a medical specialist should be held to national standards of care and 
treatment appropriate to the specialty. Since a doctor may hold himself out as a 
specialist only after certification by a national board on the basis of 
experience, training and national oral and written examinations, his patients 
should have a right to expect that his performance will meet national 
standards.  

                               

[¶11]   As for the Pi±as' argument, nothing 
in the statutory language suggests a national board must adhere to written, 
clear-cut standards of care.  If so, 
then no doctor could be found to have committed malpractice if certified by a 
national board that has no written, published standards.  We will not construe a statute as to 
have an absurd result.  Decker v. State ex rel. Wyoming Medical 
Comm'n, 2008 WY 100, ¶ 16, 191 P.3d 105, 118 (Wyo. 2008).  Section 1-12-601 is clearly not intended 
to immunize board certified doctors from all liability.  

 
 
[¶12]   Even if there was any doubt as to 
the meaning of this particular jury instruction, it must be remembered that 
instructions are not to be extracted individually to 
establish error.  When viewed in 
light of the jury instructions as a whole, we do not believe the jury could be 
confused on the issue of the standard of care.  The jury was instructed that: "A doctor 
has the duty to exercise the skill, diligence, and knowledge utilized by members 
of the profession in good standing and in the same line of practice, and to 
apply means and methods which would reasonably be exercised and applied under 
similar circumstances."  The jury 
was also instructed:

 
 
            
It is the duty of a physician or surgeon who holds himself out as a 
"specialist" in a particular field of medical, surgical, or other healing 
science, to have the knowledge and skill ordinarily possessed, and to use the 
care and skill ordinarily used, by reputable specialists practicing in the same 
field and under similar circumstances.  
One who holds himself out as a specialist in that field and who 
undertakes diagnosis and treatment in such specialty is required to use the 
skill and care required of such a specialist. 

 
 
and

 
 
            
When the word "negligence" is used in these instructions as it applies to 
. . . Dr. Christensen, it means the failure to exercise the skill, diligence, 
and knowledge, and to apply the means and methods that would reasonably be 
exercised and applied under similar circumstances by members of their profession 
in good standing and in the same line of practice.  This you must decide based upon expert 
testimony.  

 
 
These 
instructions effectively neutralized any ambiguity that 
may have lurked in the instruction incorporating the 
statutory language.  We find the 
jury instructions as a whole present a correct statement of law and are not 
misleading.

 
 
[¶13]   The Pi±as earnestly argue that, 
under the facts of this case, the one instruction under review was devastating 
because Dr. Christensen isolated and exploited the instruction in his closing 
argument.  In closing, after quoting 
the instruction, Dr. Christensen's counsel stated to the jury: "So have the 
plaintiffs established what it is, the standard of care is, as adhered to by the 
American Board of Urology?  Ask 
yourself that question.  I would 
submit that they have failed utterly to meet that burden of proof."  Because the American Board of Urology 
does not have written standards of care, the Pi±as argue this one instruction, 
and this three sentence argument made based on this instruction, destroyed their 
case.  

 
 
[¶14]   We admit to being disturbed by the 
manner in which the instruction was emphasized and used in closing argument by 
Dr. Christensen's counsel.  Under 
the facts and circumstances of this case, however, we do not believe the Pi±as 
to be prejudiced.  At least two 
testifying board certified urologists agreed the standard was that of other 
board certified urologists under similar circumstances.  Questions asked of expert witnesses were 
phrased to elicit specifically the standard of care of a board certified 
doctor.  The majority of Dr. 
Christensen's counsel's closing argument regarding the standard of care dealt 
with a recitation of the testimony of the experts.  Finally, there was more than sufficient 
evidence to support the jury verdict.  
Given the evidence at trial and the jury instructions as a whole, we do 
not believe the jury was confused as to the applicable standard of 
care.

 
 
[¶15]   For future reference, however, we 
believe the statutory language is not necessarily appropriate for a jury 
instruction.  The statutory language 
is really an abstract proposition of law, and is not made to apply directly to a 
case on trial.  The district court 
felt compelled to give the instruction because it contained the statutory 
language.  However, as already 
mentioned, a court always has discretion on the language and content of the jury 
instructions submitted.  It is not 
obligated to give an instruction offered by a party if the jury is adequately 
instructed on the law as it pertains to that case.  Hannifan, ¶ 23, 185 P.3d  at 689; Three Way, Inc., ¶ 23, 177 P.3d  at 227; 
McGuire, ¶ 23, 120 P.3d  at 1026.  

 
 
[¶16]   In this case, there were several 
instructions defining the standard of care to which Dr. Christensen was required 
to adhere.  The essence of the 
meaning of the statute was fully embodied in these other instructions given by 
the court.  The instruction based on 
the statutory language was superfluous.  
Further, its use opened the door for Dr. Christensen's counsel to 
highlight the potentially troublesome language of the statute in closing 
argument.  On the whole, we believe 
a jury instruction quoting § 1-12-601 does not provide the same clarity as the 
other instructions given in the instant case, which are based on Wyoming Civil 
Pattern Jury Instructions 14.02 and 14.03.  
We therefore advise against the use of such an 
instruction.

 
 
CONCLUSION

 
 

[¶17]   Under the specific facts of this 
case, the district court did not err in giving the objected to jury 
instruction.  The 
use of the instruction, however, is disfavored.  The jury verdict is 
affirmed.