Title: Chater v. Central VT Hospital

State: vermont

Issuer: Vermont Supreme Court

Document:

NOTICE:  This opinion is subject to motions for reargument under V.R.A.P. 40
as well as formal revision before publication in the Vermont Reports.
Readers are requested to notify the Reporter of Decisions, Vermont Supreme
Court, 111 State Street, Montpelier, Vermont 05602 of any errors in order
that corrections may be made before this opinion goes to press.


                                No. 88-576


Maude and Michael Chater                     Supreme Court

                                             On Appeal From
     v.                                      Washington Superior Court

Central Vermont Hospital                     November Term, 1989


Stephen B. Martin, J.

Robert D. Rachlin, Robert B. Luce and Ernestine G. Abel of Downs Rachlin
  & Martin, Burlington, for plaintiffs-appellants

Peter B. Joslin and Jeffrey W. White of Theriault & Joslin, P.C.,
  Montpelier, for defendant-appellee


PRESENT:  Allen, C.J. and Dooley, J., and Barney, C.J. (Ret.) and Springer,
          J. (Ret.), Specially Assigned

     ALLEN, C.J.   Plaintiffs, the parents of a child born at the Central
Vermont Hospital, sued the hospital on their own behalf and for the child,
alleging that the hospital's negligence during the child's birth resulted in
the child's cerebral palsy and spastic quadriplegia and caused the parents
to suffer emotional distress.  The jury returned a verdict in defendant's
favor, and plaintiffs appeal on the grounds that the court gave erroneous
jury instructions, limited the child's appearance in court, and refused to
grant a new trial.  We affirm.
     Plaintiff Maude Chater was an obstetrical patient of Dr. Arthur G.
Spector, a member of the medical staff at defendant hospital.  Prior to the
expected delivery date, a sonogram revealed that the fetus was in the breech
position, and a caesarean section was planned.  Mrs. Chater went into labor
two days before the planned delivery and was admitted to the hospital at
1:55 p.m.  Despite increasing labor and some signs of fetal distress, no
fetal monitor was employed until 5:50 p.m., at which time, in plaintiffs'
view,  it indicated acute distress.  The caesarean was not performed until
6:35 p.m., and the child Benjamin Chater was born asphyxiated, with no
respiration or heartbeat.  He was subsequently diagnosed as having cerebral
palsy and is confined to a wheelchair for life, with multiple disabilities.
     Plaintiffs' case against defendant hospital (FN1) was based on their
contentions that a mother with a fetus in the breech position  is considered
to be in "high risk" labor, that Mrs. Chater's amniotic fluid indicated
particular difficulties shortly after her admission to the hospital, and
that numerous hospital practices and procedures failed to meet appropriate
standards of care.  Specifically, plaintiffs sought to prove that defendant
hospital ignored national standards regarding the use of electronic fetal
heart monitoring; that the hospital had a policy of not opening a second
operating room except in case of emergency, so that Mrs. Chater's delivery
was unduly delayed; that the hospital allowed Dr. Spector to practice alone,
without providing for, or insisting on, alternative coverage when he was not
available; that hospital nurses did not respond after noting the fetus's
accelerated heart rate, as required by national standards, or take any of
the numerous steps that plaintiffs contend are mandated in such
circumstances; and that the hospital's chief of obstetrical services, though
aware of the emergency, refused to assist in the delivery.
     There is no dispute that the child's condition resulted from brain
damage caused by severe oxygen deprivation in the last minutes before he was
born.  Paintiffs' contend that the hospital could have prevented the delay
that resulted in the permanent impairments.
     Following presentation of evidence, the jury was asked to answer two
questions on the verdict form.  In response to the first question, the jury
found the hospital negligent in its care of the mother and unborn child.  On
the second question, the jury found that this negligence had not proximately
caused the child's injuries.                 
                                    I.
     On appeal, plaintiffs first argue that the trial court erred in
instructing the jury on proximate cause.  The instruction was given as
follows:
            If you should determine, by a preponderance of the
         evidence, that there was a breach of duty owed to
         Plaintiffs as I have instructed, you must then determine
         whether that breach or breaches of the standard of care
         was or were the proximate cause of the Plaintiffs'
         injuries.  You cannot find the Defendant liable simply
         because you may find that the Defendant breached a duty
         or standard of care.  In other words, there must be some
         connection between the Defendant's actions and the
         Plaintiffs' injuries.  This connection is called
         proximate cause.  For example, if you should find that
         the Defendant failed to follow some applicable standard
         but that the failure to do so had no impact on what
         happened to the Plaintiffs, then you have not found
         proximate cause and you must find for the Defendant.
         Simply put, the mere failure to do something is not a
         basis for recovery unless it was a negligent failure and
         legally caused the injury or damage.  The Plaintiffs
         must prove that the conduct complained of was a cause in
         fact of the allege[d] injuries.

            You have found proximate cause if it appears to you
         from the evidence in the case that the Defendant's
         negligence played a substantial part in bringing about
         the Plaintiffs' injuries and that the injuries to the
         Plaintiffs were in whole or in part a direct result or a
         reasonably probable or natural consequence of the
         Defendant's actions.  In a medical malpractice case, you
         may not presume that the hospital was negligent solely
         because the patient had a bad outcome from the physi-
         cian's treatment.

            Where two or more proximate causes combine to produce
         an injury, a recovery may be had if the Defendant is
         responsible for any one of them, though it may not be
         responsible for the others.   As you know, the Plain-
         tiffs originally sued both Dr. Arthur Spector and the
         Central Vermont Hospital.  The Plaintiffs have settled
         with Dr. Spector.  The Plaintiffs claimed that both Dr.
         Spector and the Central Vermont Hospital were negligent.
         If you find that the negligent action or negligent
         inactions of the Central Vermont Hospital was a prox-
         imate cause, in any part, of injury on the part of the
         Plaintiffs, then you should find in favor of the Plain-
         tiffs even if you find that Dr. Spector was also
         responsible for the Plaintiffs' injury.

     Plaintiffs contend first that "[b]y using the term 'substantial part'
without elaboration, the court improperly suggested that proximate cause was
related to a 'quantity' of conduct.  This was extremely prejudicial to
Plaintiffs' case."  Plaintiffs concede that the phrase "substantial factor"
would have been acceptable, but that "substantial part" implies a particular
fraction of the total causative factors.
     Defendant responds, and the record confirms, that plaintiffs' counsel
objected to the use of the word "substantial," but never complained about
the use of the word "part."  The following discussion took place during the
in-chambers conference on jury instructions:
            [Counsel for plaintiffs]:  I think, first of all,
         what we lawyers mean by a substantial part may not be
         what a lay person understands by that term.  They may
         take "substantial" to mean that it was more than 50
         percent.  I would say that you might say "play a
         material part" or "played a significant part."  I think
         "significant" says the same thing without having the
         implication of mass that "substantial" has.

            . . . .

            THE COURT:  I always use the word "substantial."  I
         guess I'll stick with it.

            [Counsel for plaintiffs]:  Well, we would indicate
         our respectful objection to the word, despite the fact
         that it is time honored. (Emphasis added).

     Although no objection to the word "part" has been preserved, our
consideration of the word "substantial" leaves us convinced that no error
occurred in any event.  In the context of the entire instruction, the use of
the phrase "substantial part" did not connote any particular quantum of
proximate cause.  This distinguishes the instant instruction from that given
in McDowell v. Davis, 104 Ariz. 69,