Title: BEAVIS v. CAMPBELL COUNTY MEMORIAL HOSPITAL

State: wyoming

Issuer: Wyoming Supreme Court

Document:

BEAVIS v. CAMPBELL COUNTY MEMORIAL HOSPITAL2001 WY 3220 P.3d 508Case Number: 99-235Decided: 03/26/2001
 

 October Term, A.D. 2000

  
 

PAMELA 
LYNN BEAVIS, by SYLVIA M.

BEAVIS 
and RANDY S. BEAVIS, parents

and 
next friends, and SYLVIA M. BEAVIS

and 
RANDY S. BEAVIS,

Appellants(Plaintiffs),

 v.

CAMPBELL 
COUNTY MEMORIAL

HOSPITAL; 
MITCHELL F. HORAN, M.D.;

and 
DEB HAZLETT, EMT,

Appellees(Defendants).

  

Appeal 
from the District Court of Campbell County:

The 
Honorable Terrence L. O'Brien, Judge

Representing 
Appellants:

Walter 
Urbigkit of Frontier Law Center, Cheyenne, WY.

 Representing 
Appellees Campbell County Memorial Hospital and Ms. 
Hazlett:

John 
G. Fenn of Yonkee & Toner, Sheridan, WY.

Representing 
Appellee Dr. Horan:

Robert 
M. Shively and Amy M. Taheri of Shively Law Offices, P.C., Casper, 
WY.

Before 
LEHMAN, C.J., and THOMAS,* MACY,** GOLDEN, and HILL, 
JJ.

   *Concurred 
prior to retirement.

**Retired 
June 2, 2000.

LEHMAN, 
Chief Justice.

 [¶1]     In this medical 
malpractice case, the plaintiffs alleged that an employee of Campbell County 
Memorial Hospital improperly injected allergy medication into Pamela Beavis' 
right buttock, causing tissue damage and residual injuries.   After a five-day trial, a Campbell 
County jury returned a defense verdict.  
On appeal, the Beavises contend the district court erred by refusing 
standard of care testimony; by denying them the opportunity to litigate their 
claims against the hospital and the supervising physician; and in refusing 
evidence that Deb Hazlett, who administered the injection, was not qualified to 
do so.  Finding no error, we 
affirm.

  

ISSUES

 [¶2]     The Beavises present 
three issues for review:

1.  Whether 
the Court committed error in trial time decision to exclude all oral or 
documentary evidence of the lack of training, experience, expertise, or 
qualifying certification as justified by hypothetically creating an untrue 
assumed nurse's status for the hospital employee who administered the injury 
causing medical injection?

2.  Whether 
the Court committed error after having created the artificial status of a nurse 
for the health care provider, Hazlett, to then in trial time decision restrict 
or deny opportunity for Plaintiff's presentation of expert or factual testimony, 
as a standard of care opinion which evidence would have been that even for a 
nurse, that the injection was improperly administered?

3.  Whether the Court committed error in 
decision made immediately before the trial started to bifurcate the case to 
exclude individual liability claims against Campbell County Memorial Hospital 
and Mitchell Horan, M.D. from the first trial and then without pleadings or 
providing any hearing to apply res judicata (or judicial estoppel) to the CCMH 
and Horan bifurcated claims by entry of a general judgment against Plaintiffs on 
all claims based on the adverse Hazlett liability verdict?

 
            
           
             
            
              
           

In their brief, appellees Campbell County 
Memorial Hospital and Deb Hazlett articulate the issues in this 
fashion:

1.  Did the trial court abuse 
its discretion regarding evidentiary rulings immediately prior to and during 
trial?

A.  Did the trial court abuse 
its discretion in bifurcating the claim of negligence against Deb Hazlett from 
claims against Campbell County Memorial Hospital and Dr. Horan for negligent 
supervision and training of Deb Hazlett and thereby limiting irrelevant and 
prejudicial character evidence from being used to establish negligence of Deb 
Hazlett?

B.  Did the trial court abuse 
its discretion in limiting the expert testimony of Sylvia Beavis to what she 
testified to in her deposition and what was set forth in Plaintiffs' witness 
designation?

Appellee Mitchell Horan, M.D. presents 
argument on one issue:

Whether the trial court committed error 
when it bifurcated the trial of a medical malpractice case in order to allow the 
jury to consider the threshold question of whether the standard of care had been 
breached[?]

FACTS

[¶3]      This medical 
malpractice case arises from an allergy medication injection into the posterior 
of Pamela Beavis.  The Campbell 
County Memorial Hospital (CCMH) owns and operates the Wright Clinic in Wright, 
Wyoming.  On June 27, 1995, Sylvia 
Beavis and her 13-year-old daughter Pamela went to the Wright Clinic for allergy 
related conditions, and Dr. Mitchell Horan examined both.  For Pamela Beavis, Dr. Horan prescribed 
30 mg of Kenalog, an allergy medication, to be injected into her right 
buttock.  Deb Hazlett, a medical 
assistant employed at the Wright Clinic, was assigned the task of administering 
the intramuscular injection.  Sylvia 
Beavis, who was present in the examination room when the injection was given, 
observed that, immediately after the injection, some of the drug migrated out of 
the injection site.  

[¶4]      Sylvia and Randy 
Beavis, individually and as their daughter's representatives, instituted this 
action on April 21, 1997.  The 
Beavises alleged the injection was improperly administered, causing their 
daughter immediate tissue damage and residual injuries.  They claimed damages for, inter 
alia, past and future medical expenses as well as pain and suffering.  The Beavises named as defendants Deb 
Hazlett, Dr. Horan, and Campbell County Memorial Hospital.  Against Hazlett, the Beavises alleged 
negligence in administering the injection.  
Against Dr. Horan, the Beavises alleged negligence in failing to properly 
supervise and train Hazlett.  
Finally, the Beavises alleged CCMH had been negligent in using an 
unqualified employee, Hazlett.  

[¶5]      A jury trial was 
held April 5-9, 1999.  Prior to 
trial, the district court bifurcated the claim against Hazlett from the claims 
against CCMH and Dr. Horan.  As a 
result, the issues at trial were limited to whether Hazlett had properly 
performed the injection and what damages, if any, occurred as a 
result. 

[¶6]      The Beavises' 
factual theory was that the injection was given at an improper location and to 
an improper depth.   They 
contended that, because of the location and depth, the Kenalog did not go deep 
into the muscle belly where it could be absorbed without damage.  They asserted the Kenalog instead went 
only superficially into the gluteus muscle, and the protective sheath 
surrounding the muscle, the fascia, was injured as a result.  In addition, the Beavises contended the 
fatty tissue surrounding the injection site was exposed to the Kenalog, causing 
damage.  In closing argument, the 
Beavises' counsel asked the jury to award damages in the amount of 
$385,000.  

[¶7]      After 
deliberations, the jury returned a verdict finding that Hazlett had not fallen 
below the standard of care in administering the Kenalog injection to Pamela 
Beavis.  Judgment was entered in 
favor of Hazlett, CCMH, and Dr. Horan.  
With respect to Dr. Horan, the Judgment provided:  

Plaintiffs' claims against Mitchell Horan, 
M.D. are dependent upon establishing negligence of Deb Hazlett.  Having failed to establish negligence of 
Deb Hazlett, judgment is entered in favor of co-defendant Mitchell Horan, M.D. 

The Beavises objected to the form of the 
judgment and moved for a new trial, but the objection was overruled and the 
motion was denied.  The Beavises 
appealed.  

  

DISCUSSION

 [¶8]     In order to address the 
Beavises' first and third issues, which we will do in that order, we must 
examine the district court's rulings on those issues.  At a pretrial conference held on August 
24, 1998, CCMH admitted liability for the acts of both Deb Hazlett and Dr. 
Horan.  See Wyo. Stat. Ann. § 
1-39-109 & -110 (Lexis 1999).  
In a pre-trial order, the district court 
wrote:

7.  
MISCELLANEOUS:  Campbell 
County Memorial Hospital admits vicarious liability for the acts of both Deb 
Hazlett and Dr. Horan.  Given that 
admission, the propriety of admitting evidence regarding qualifications, 
background and training of Deb Hazlett is challenged by defendants.  [Plaintiffs' counsel] has requested and 
was allowed to respond in writing within forty five (45) days.  

Counsel for the plaintiffs did file a 
memorandum on the issue, arguing that the evidence was relevant and raising 
issues regarding what standard of care would be applied to judge Hazlett's 
actions.  

[¶9]      On the first day 
of the April 1999 trial, these issues were resolved.  Following off-the-record discussions, 
the district court had the following colloquy with 
counsel:

THE COURT:  . . . [T]he hospital has agreed that the 
standard of care for Deb Hazlett is the same as the standard of care would be 
for a registered nurse or a physician or for anybody else appropriately 
qualified and trained to administer a shot.  

And accordingly, the defendants want to bifurcate the 
trial, go forward with a trial on whether or not the plaintiff can prove 
negligence on the administration of the shot and establishing the amount of 
damages that resulted from negligence, if there was any.  And once that is established, and 
apparently the hospital's carrier is in a position to fully pay any damage award 
that would come down, and accordingly would make any issues of training moot. 
 

Given the defendants' posture, I guess I am wondering 
why we ought not go forward on that basis.  
And where we left it is giving [Beavises' counsel] an opportunity to 
respond.  First of all, let me ask 
if I have correctly stated the defendants' 
position?

[COUNSEL FOR CCMH & HAZLETT]:  Yes, the standard of care is to give the 
shot properly, irrespective of the background, and the same will apply to a 
nurse or physician, if it is given properly.  

THE COURT:  And I am not going to hear any argument 
that she met the standard of care, given her 
position?

[COUNSEL FOR CCMH & HAZLETT]:  We are not going to argue that she 
somehow has a lesser standard of care because she does not have the same 
training.  

[BEAVISES' COUNSEL]:  I think you stated the standard of care 
is that of a nurse, and his response is the standard of care is somebody giving 
it properly.  That raises the 
question of who determines the proper way to give the shot.  And the way it was phrased by the Court, 
if that is the direction that it takes, we understand where we are 
going.

And there is one other subject we need to discuss 
briefly, because it relates to the standard of care and determination, but I 
don't want to get into this case now and have them say that somebody that has 
two weeks training and mislocates the shot is free from responsibility if a 
nurse would never have mislocated the spot because of the training the nurse 
has.  If the nurse gives the 
testimony of the standard of care, we expect that to be the standard of care. 
 

THE COURT:  That is what I hear them 
saying.

[COUNSEL FOR CCMH & HAZLETT]:  That is correct, Your Honor. 

THE COURT:  Given that, I don't see much point of 
getting into the issue of training and the supervision by Dr. Horan, and it 
appears what you are claiming is well under the policy limits.  And if it is determined that Deb Hazlett 
was negligent and the jury establishes the damages, your client is going to be 
paid. 

[¶10]   Following jury selection, some 
confusion still existed regarding the course the trial would take.  The Beavises' counsel asked for 
clarification, and the district court indicated nothing had been dismissed and 
that the case was simply bifurcated.  
The effect of the district court's decisions was to permit the plaintiffs 
to proceed with a trial on the issue of Hazlett's negligence before delving into 
the direct liability claims against CCMH for negligent hiring and Dr. Horan for 
negligent training and/or supervision of Hazlett.  In accord with CCMH's admission of 
liability, the jury was instructed that Deb Hazlett was acting as an employee of 
CCMH at the time she treated Pamela Beavis and that CCMH was, therefore, 
responsible for her acts or omissions.  

Exclusion of Hazlett's 
Qualifications

 [¶11]  In their first issue, the Beavises 
contend the district court erred in refusing evidence of Hazlett's alleged lack 
of competency, qualification, or certification to give the Kenalog 
injection.  The Beavises argue it is 
unfair to apply what they consider a nurses' standard of care to Hazlett, yet 
not permit them to establish that Hazlett was not a nurse.  The appellees respond, arguing the 
district court did not abuse its discretion in refusing the evidence because the 
only question for the jury was whether the injection had been properly 
administered and Hazlett's qualifications were thus irrelevant.   

[¶12]   We first look at the standard of 
care, upon which the jury was instructed in part:

Evidence has been received relating to the 
proper technique to be used in administering a Kenalog injection.  Proper technique is the standard of 
care.  It is the same for doctors, 
nurses and other health care professionals.   That is the standard by which Deb 
Hazlett's actions are to be measured.  

The Beavises 
did not object to this instruction.  
Normally, when a party fails to object to instructions in the trial 
court, those instructions become the law of the case, and appellate review is 
precluded unless plain or fundamental error can be found.  Goggins v. Harwood, 704 P.2d 1282, 1298 (Wyo. 1985); 
Matter of Mora's Estate, 611 P.2d 842, 846 (Wyo. 1980); Cox v. Vernieuw, 604 P.2d 1353, 1357 (Wyo. 1980); 
Vinich v. Teton Constr. Co., 518 P.2d 137, 138 (Wyo. 1974). 
 

[¶13]   The standard of care in a medical 
malpractice action is well established.  
In Vassos v. Roussalis, 625 P.2d 768, 772-73 (Wyo. 1981), 
this court wrote:

A malpractice action is usually a form of 
a negligence action.  It is in this 
instance.  Accordingly, the elements 
necessary to sustain a negligence action must be here proven, i.e., a duty on 
the part of the defendant, failure to perform the duty proximately causing 
damage to plaintiff.  The 
determination of the standard of care or duty is a matter of law and not the 
province of the jury.  

In this case, the existence of the 
physician-patient relationship established the duty.  The standard is fixed as that which is 
required of a reasonable person in the light of all the circumstances.  Some circumstances have acquired 
particular legal significance which make it possible for the court to fix a more 
specific standard . . . .  A 
malpractice contention is also one of those circumstances.  The more specific standard for 
malpractice actions is that a physician or surgeon must exercise the skill, 
diligence and knowledge, and must apply the means and methods, which would 
reasonably be exercised and applied under similar circumstances by members of 
his profession in good standing and in the same line of practice.  

. . .

When the circumstances in which the 
fictitious reasonable person acts are within the common knowledge of the jury, 
the jury does not need assistance in comprehending the standard fixed by the 
court.  But when such circumstances 
are not of such common knowledge, the jury must depend upon testimony of experts 
to explain the standard and thus prevent a conclusion based on conjecture and 
speculation.  In other words, an 
additional question of fact must be answered when the circumstances are such 
that the reasonable person standard is not within the common knowledge of the 
jury.

(Citations 
omitted.)  In this case, clearly a 
medical malpractice case, the Beavises present nothing to establish that the 
proper technique for performing an injection is within the common knowledge of 
the jury.  Moreover, they present 
nothing to refute the instruction's premise that the standard of care to be 
applied to assess the propriety of an injection is the same regardless of 
whether the health care professional is a doctor, a nurse, or something 
else.  This distinguishes the 
present case from Parker v. Haller, 751 P.2d 372, 376 (Wyo. 1988), 
where the physician's assistant was to be held to the standard of care of a 
physician's assistant in determining whether his treatment and referral to a 
physician fell below the standard of care.  
Wyo. Stat. Ann. § 1-12-6011 also 
provides support for the standard of care instruction given in this case.  Moreover, by failing to object to the 
standard of care instruction, the Beavises appeared content to hold Hazlett to 
the more exacting standard found in that instruction.  They now argue it was the improper 
standard.  The Beavises cannot have 
their cake and eat it too.  We 
cannot conclude the instruction is an improper statement of the standard of care 
under these circumstances.  

[¶14]   We also disagree with the Beavises' 
premise that the instruction created a false supposition that Hazlett was 
trained as a nurse, placing her in a "non-achieved category of competency," or 
that it created a presumption of due care.  
The Beavises rely on Gilpatrick Constr. Co. v. Wind River Ready-Mix 
Concrete Co., 473 P.2d 586, 
589 (Wyo. 1970), a case where a road contractor argued that placement of 
barricades around a construction site satisfied its duty.  The Gilpatrick court rejected 
that argument because "the law of negligence is predicated upon that which is 
required of a reasonable person in light of all the circumstances present."  Id.  Therefore, whether the barricades "were 
adequate was a question for the determination of the trial court."  Id.  However, the Beavises cannot stretch 
Gilpatrick to fit their case.  
First, nothing in the instruction indicates Hazlett was to be considered 
a nurse.  Instead, the instruction 
is clear that Hazlett would be held to the same standard of care in performing 
the injection as a doctor, a nurse, or any other health care professional, 
regardless of her training or qualifications.   Moreover, nothing in the 
instruction indicates that qualification as a nurse creates a presumption of due 
care, and, in accord with Gilpatrick, the jury in this case was permitted 
to make the determination of whether Hazlett's acts were negligent.  See Wardell v. McMillan, 844 P.2d 1052, 1064 (Wyo. 1992) 
(physicians not entitled to due-care instruction).

[¶15]   In light of the standard of care 
instruction, we turn to the question of whether the district court abused its 
discretion in precluding the testimony at issue.  The Beavises contend Hazlett's training, 
qualification, and certification, or lack thereof, was clearly relevant to the 
question of whether the injection was properly administered, reasoning that if 
Hazlett was not trained or qualified to give the injection in question, it is 
more likely she did it improperly.  
However, this argument is premised on the Beavises' contention that the 
standard of care should be something other than that applied by the district 
court.  As we have previously 
discussed, the standard of care instruction, which is the law of the case, 
indicates that all health care professionals would be held to the same standard 
in analyzing the propriety of an injection, arguably making Hazlett's 
qualifications and training irrelevant.    

[¶16]   Nevertheless, even assuming the 
evidence of Hazlett's qualifications and training was relevant, it would still 
have to satisfy W.R.E. 403, which states:

Although relevant, evidence may be 
excluded if its probative value is substantially outweighed by the danger of 
unfair prejudice, confusion of the issues, or misleading the jury, or by 
considerations of undue delay, waste of time, or needless presentation of 
cumulative evidence.  

"The trial court's authority to exclude 
relevant evidence is discretionary in nature, as it is in a better position 
both to detect and to assess the dangers and considerations enumerated in the 
rule, and to balance these against the probative value of proffered 
evidence.'"  Banks v. 
Crowner, 694 P.2d 101, 104 
(Wyo. 1985) (quoting 2 Louisell and Mueller, Federal Evidence, § 125, 
p.10 (1978)).  The district court's 
ruling indicates it was concerned that evidence of Hazlett's lack of 
qualification would implicate some of the matters listed in W.R.E. 403.  Subsequently, during a lengthy 
discussion concerning admissibility of evidence that Hazlett had committed other 
errors at the Wright Clinic and her ensuing transfer, the district court offered 
the Beavises an opportunity for a hearing, after hours, on evidentiary 
matters.  Although there is some 
question whether this opportunity for a hearing was specific to the present 
evidentiary issue, it is clear the opportunity existed.  Later, prior to Hazlett's testimony, the 
district court again asked whether a hearing was needed on "collateral 
matters."  The Beavises' counsel 
indicated no hearing would be held.  
This court has written:  
"Where a court gives a party seeking to admit evidence the opportunity to 
renew his attempt to have it admitted, the party cannot complain if he fails to 
take the opportunity which is offered."  
Contreras By and Through Contreras v. Carbon County School Dist. No. 
1, 843 P.2d 589, 596 (Wyo. 
1992).  Although not directly on 
point, Contreras provides strong analogous support against the Beavises' 
position.  We cannot find an abuse 
of discretion under these circumstances.

 Bifurcation

[¶17]   As an element of their third issue, 
the Beavises contend the district court erred in bifurcating the negligence 
claim against Hazlett from the negligent hiring claim against CCMH and the 
negligent training/supervision claim against Dr. Horan.  The decision to order separate trials is 
within the discretion of the district court and will not be disturbed on appeal 
unless an abuse of discretion is found.2  
Carlson v. Carlson, 836 P.2d 297, 305 (Wyo. 1992); 
State Farm Mut. Auto. Ins. Co. v. Shrader, 882 P.2d 813, 829 (Wyo. 1994); 
Tremblay v. Reid, 700 P.2d 391, 398 (Wyo. 1985); Thomas v. Roth, 386 P.2d 926, 927 (Wyo. 1963).  In past cases, we have approved of 
district courts' decisions to conduct separate trials on distinct and 
independent issues.  See Matter 
of Adoption of RHA, 702 P.2d 1259, 1264 (Wyo. 1985) (upholding bifurcation of adoption proceedings); 
Tremblay v. Reid, 700 P.2d  at 398-99 (allowing severance of a defamation 
action from a breach of contract action).  
However, we have also recognized a limitation on the district court's 
discretion to order bifurcation.  In 
Carlson v. Carlson, 836 P.2d  at 305-6, we wrote:

A trial may be 
bifurcated only when the issues are clearly distinct and the bifurcation will 
not work a hardship against either party.  
Although bifurcation may result in judicial economy in some cases, it 
often works an injustice and does not achieve judicial economy when trials must 
be conducted again. . . .

. . 
.

            
A fair trial is often thwarted when interwoven issues are tried 
separately.  

When issues 
are "so interwoven" that their independent trial would cause "confusion and 
uncertainty, which would amount to a denial of a fair trial," they must be tried 
together. 

(Citations 
omitted.)

[¶18]   Pursuant to the district court's 
bifurcation decision, the question at trial was simply whether Hazlett had been 
negligent in administering the injection.  
The question of negligence in administration of the injection, when 
combined with the standard of care instruction which is the law of the case, 
presented a distinct issue for the jury, and we fail to see how this issue was 
so interwoven with the claims of negligent training and/or supervision against 
Dr. Horan or negligent hiring against CCMH that an independent trial resulted in 
denial of a fair trial.  Instead, 
the district court's bifurcation decision is consistent with the purposes of 
Rule 42, to avoid prejudice (omitting potentially unfairly prejudicial evidence 
of Hazlett's qualifications and training) and "to further the general objectives 
of the rules and to assist in the just, speedy, and inexpensive determination of 
litigation."  State ex rel. 
Pacific Intermountain Express, Inc. v. District Court of Second Judicial Dist., 
Sweetwater County, 387 P.2d 550, 552 (Wyo. 1963).  We find 
no abuse of discretion in bifurcating the question of Hazlett's negligence from 
the direct claims against Dr. Horan and CCMH.  See Christiansen v. Silfies, 667 A.2d 396, 399 (Pa.Super. 1995) (claim of negligence against driver bifurcated 
from negligent entrustment claim against driver's employer and owner of 
vehicle.)

 Direct Claims Against CCMH and Dr. 
Horan

[¶19]   Also in their third issue, the 
Beavises attack the district court's entry of judgment on the claims against 
CCMH and Dr. Horan.  We begin with 
the claim against CCMH.  As a legal 
matter, the Beavises' negligent hiring theory against CCMH rests upon the 
predicate of Hazlett's alleged negligence.  
See Cranston v. Weston County Weed and Pest Bd., 826 P.2d 251, 258 (Wyo. 1992) 
(accepting definition of this cause of action set forth in Restatement Second of 
Agency § 213 (1958)).  Indeed, 
"[o]ne element of negligent hiring is some form of misconduct by the employee 
that caused damages to the plaintiff."  
McHaffie By and Through McHaffie v. Bunch, 891 S.W.2d 822, 826 
(Mo. 1995).  Thus, even assuming 
CCMH was negligent in the manner the Beavises claim, i.e., breached some 
duty in hiring Hazlett, it is clear such negligence could not be the proximate 
cause of Pamela Beavis' injuries unless the predicate negligence of Hazlett was 
first found.3  We also find Benedict v. St. Luke's 
Hospitals, 365 N.W.2d 499 (N.D. 1985) helpful on this point.  In that case, the North Dakota Supreme 
Court held harmless the trial court's failure to instruct on the hospital's 
independent duty to properly staff its facility.  The court 
explained:

Because the 
jury found that neither Dr. Ellison, the doctor on duty in the emergency room, 
nor Dr. Ehlen, Phillip's personal physician with whom Dr. Ellison conferred, 
acted negligently, the jury could not have found that a breach of duty by St. 
Luke's to provide competent staff in its emergency room was a proximate cause of 
Phillip's injuries.  

365 N.W.2d  at 504-5.  This result also finds support in 
DeWald v. State, 719 P.2d 643, 652 (Wyo. 1986), where this court 
wrote:

Having held the patrolmen not liable, we 
must also hold that the appellee, State of Wyoming, cannot be held liable, the 
reason being that if the conduct of the patrolmen did not amount to negligence 
that caused the accident, then neither could their training by the State nor 
could rules have been a cause of the accident.  Stated another way, it would have had to 
appear that, because of inadequate training or failure to follow departmental 
rules, the officers acted in a negligent manner and caused this accident.  We have held that did not 
occur.

[¶20]   Turning to the claims against Dr. 
Horan, the Beavises are correct in stating that the question of whether Dr. 
Horan breached a duty in his training/supervision of Hazlett has never been 
litigated.   The Beavises, 
therefore, argue their claim against Dr. Horan has never been determined and 
that Dr. Horan should not enjoy the benefits of the no negligence finding in 
Hazlett's favor.  However, as with 
the claim of negligent hiring against CCMH, the Beavises' claims against Dr. 
Horan rest on the predicate of Hazlett's alleged negligence.  Indeed, no allegation was made that Dr. 
Horan should not have prescribed any medicine, that he prescribed the wrong 
medicine, that he ordered an improper dosage, that he ordered it injected into 
an improper location, or anything of the sort.  Instead, the only allegation is that he 
failed to train or supervise Hazlett in administering the injection.  Thus, even assuming Dr. Horan was 
negligent in the manner the Beavises claim, i.e., breached some duty in 
failing to supervise or train Hazlett, it is clear his negligence could not be 
the proximate cause of Pamela Beavis' injuries unless the predicate negligence 
of Hazlett was found.  Benedict 
v. St. Luke's Hospitals, 365 N.W.2d  at 504-5.  We therefore conclude the district court 
did not err in entering judgment in favor of Dr. Horan. 

[¶21]   As for the Beavises' claim that 
they have been denied an opportunity for a hearing on these claims, their 
argument is not well taken.  After 
trial, in addition to filing a motion for new trial, the Beavises filed an 
objection to the form of the judgment in which they argued the claims against 
Dr. Horan and CCMH had not been litigated.  
After holding a hearing, which apparently went unreported, the motion for 
new trial was denied, and the objection to the form of the judgment was 
overruled.  Under these 
circumstances, we do not find a denial of due process.  The issue was apparently considered and 
the objection overruled.  
Nevertheless, any error would be harmless given the preceding 
discussion.

[¶22]   Although the parties spend little 
time discussing comparative fault, we believe this case must be analyzed 
consistently with the Wyoming Comparative Fault Statute, Wyo. Stat. Ann. § 
1-1-109 (Lexis 1999), in order to uphold the legislative mandate on comparative 
fault.  We therefore must address 
the Beavises' contention, which is captured in a pretrial memorandum:  

It is possible 
for the jury in this case to determine that even though Defendant Hazlett 
performed the injective process in the wrong way, that considering her lack of 
qualifications that she was not negligent, but that Defendant Horan and 
Defendant CCMH were negligent and consequently liable in failure of hiring, 
training, qualifications, retention, and supervision . . . . 

This argument does have some logical 
appeal, and we agree that, had the Beavises established that Hazlett performed 
the injective process in the wrong way or was "in any measure negligent," Wyo. 
Stat. Ann. § 1-1-109(a)(iv), they would have later been entitled to establish 
their claims against CCMH and Dr. Horan and been entitled to a jury 
determination on comparative fault.  
However, because the claims against CCMH and Dr. Horan rest on the 
predicate of Hazlett's alleged negligence, we find no error in entry of judgment 
on the claims against those two parties. 

  

Standard of Care 
Testimony

 [¶23]  The Beavises argue the district court 
erred in limiting standard of care testimony from witnesses Sylvia Beavis and 
Baerbel Merrill.  The appellees 
counter that the district court appropriately limited Sylvia Beavis' testimony 
to that contained in her deposition and this limitation was consistent with the 
supplemental expert witness designation.  
After a review of the record, we conclude the district court did not 
abuse its discretion in limiting the standard of care 
testimony.

[¶24]   We first dispose of this issue with 
respect to Baerbel Merrill.  
Merrill, the vice president of patient services at CCMH and a registered 
nurse, met with the Beavises in November or December of 1995 to view the 
injection site.  When Merrill was 
called as a witness in the Beavises' case in chief, an attempt was made to 
elicit testimony regarding the standard for determining the injection site for 
an injection into the buttocks.  
Defense counsel objected, arguing that Merrill had not been designated as 
an expert witness.  The district 
court ruled that, while Merrill could testify about what she saw and what she 
did, she could not offer standard of care testimony if she had not been 
designated as an expert.  The 
Beavises point us to no expert designation in the record, and our review of the 
record reveals no witness designation indicating Merrill would testify as an 
expert witness.  In addition, the 
record on appeal suggests the parties entered into a stipulation regarding 
designation of expert witnesses.  
However, this stipulation is not included in the record, and we thus do 
not know the terms of the parties' agreement with respect to designation of 
expert witnesses.  We are, 
therefore, left without a record to review; and we must conclude the district 
court did not abuse its discretion in respect to this ruling.    

[¶25]   In regard to Sylvia Beavis' 
testimony, a careful review of the procedural history and circumstances of this 
case is necessary.  Mrs. Beavis, who 
was not originally designated as an expert witness, was deposed on January 6, 
1998.  During that deposition, Mrs. 
Beavis testified (1) that she was shocked at the injection site because the 
injection was too low, (2) the injection was improper because it was too low and 
superficial, (3) that, because of improper placement of the injection, it caused 
the drug to go superficially into the muscle and cause damage.  Near the end of the deposition, defense 
counsel for Hazlett and CCMH asked Mrs. Beavis whether she intended to testify 
as an expert witness.  Mrs. Beavis 
responded that she was not aware at that time that she would testify as an 
expert.  Less than a week after the 
deposition, and apparently within the time allotted to make an expert witness 
designation, a supplemental expert witness designation was filed announcing that 
Mrs. Beavis would render expert opinions regarding the proper technique for 
administration of intramuscular shots, including her observations of the 
injection given by Deb Hazlett.  The 
witness designation further provided:

The scope and 
extent of the opinion will be generally similar to the text of answers provided 
during [Sylvia Beavis'] examination at the deposition session on Tuesday, 
January 6, 1998. 

No further 
deposition testimony was taken from Mrs. Beavis.

[¶26]   Prior to trial, a colloquy was had 
concerning the extent of Mrs. Beavis' testimony.  Defense counsel argued Mrs. Beavis 
should not be allowed to offer an expert opinion because she had not provided 
such testimony in her deposition.   
After a review of the expert witness designation, the district court 
ruled that Beavis' expert testimony, in accord with the witness designation, 
would be limited to what she said in the deposition and that she could not offer 
any new opinions.  

[¶27]   At trial, Mrs. Beavis testified 
extensively about her experience as a nurse, about how to properly administer an 
injection, and that the shot was given improperly.  On the fourth day of trial, the 
plaintiffs sought to recall Mrs. Beavis to testify further regarding the 
standard of care.  Specifically, the 
plaintiffs sought to elicit testimony that Hazlett breached the standard of care 
by failing to follow Dr. Horan's order to inject the Kenalog into the gluteus 
medius as opposed to the gluteus maximus muscle.  The defendants objected, arguing that 
such testimony was outside the scope of Mrs. Beavis' deposition.  The district court reiterated its 
original ruling that Mrs. Beavis was limited, because of the expert witness 
designation, to what she said in her deposition.  The plaintiffs eventually recalled Mrs. 
Beavis and made an offer of proof in which she testified the injection fell 
below the standard of care because it was not placed per doctor's orders in the 
correct spot of the muscle.  

[¶28]   To support their contention that 
the district court erred in refusing this testimony, the Beavises rely on the 
case of Winterholler v. Zolessi, 989 P.2d 621 (Wyo. 1999), a recent 
medical malpractice jury trial that resulted in reversal on appeal.  However, Winterholler did not 
turn on the issue presented here.  
The issues in Winterholler were (1) whether the district court 
erred in refusing expert testimony based on unfair surprise and (2) whether the 
district court abused its discretion in limiting the plaintiff to one standard 
of care witness.  Id. at 625, 
628-29.  Unlike Winterholler, 
the issue here is whether the district court erred in determining that the 
testimony offered at trial was outside the scope of the expert designation 
provided for Mrs. Beavis.  We review 
that determination for an abuse of discretion.  Thunder Hawk By and Through Jensen v. 
Union Pacific R. Co., 891 P.2d 773, 779 (Wyo. 1995); Oukrop v. 
Wasserburger, 755 P.2d 233, 
237-38 (Wyo. 1988).

[¶29]   We find the case of Thunder Hawk 
By and Through Jensen v. Union Pacific R. Co., 891 P.2d  at 779 controlling 
on this issue.  There, the district 
court refused to allow the plaintiffs' expert, Dr. Radecki, to testify on a 
matter that was beyond the scope of his expert witness designation.  Id.  The specific issue was whether Dr. 
Radecki would be permitted to testify about how Alex Thunder Hawk's learning 
disability affected his ability to understand warnings.  The expert witness designation indicated 
Dr. Radecki would testify about Alex Thunder Hawk's continuing problems with his 
prothesis and his future medical expenses.  
There, as in this case, the plaintiffs indicated pretrial that Dr. 
Radecki would testify in accordance with his deposition.  Id.  Upon reviewing Dr. Radecki's deposition, 
this court could find no instance where Dr. Radecki was specifically asked about 
his opinion on how Alex Thunder Hawk's learning disability affected his ability 
to understand warnings and thus concluded the district court did not abuse its 
discretion in refusing such testimony.  
Id.  

[¶30]   We have carefully reviewed Sylvia 
Beavis' deposition.  While there is 
deposition testimony from Mrs. Beavis stating the injection was misplaced, she 
did not testify that failure to follow a doctor's order amounts to a breach of 
the standard of care.  Because Mrs. 
Beavis' expert witness designation clearly indicates that her testimony would be 
limited to what she said in her deposition, we conclude the district court did 
not abuse its discretion in refusing standard of care testimony that was beyond 
the scope of the expert witness designation.    

[¶31]   The Beavises are understandably 
disappointed with the jury's verdict.  
However, we find no legal error in the proceedings and therefore 
affirm.

FOOTNOTES

1Wyo. Stat. Ann. § 
1-12-601, Injury by health care providers; burden of proof, 
provides:

 (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 certificating board or association, that the defendant 
failed to act in accordance with the standard of care adhered to by that 
national board or association; or

(ii) If the defendant is 
not so certified, that the defendant failed to act in accordance with the 
standard of care adhered to by health care providers in good standing performing 
similar health care services.

(b) In 
either paragraph (a)(i) or (ii) of this section, variations in theory of medical 
practice or localized circumstances regarding availability of equipment, 
facilities or supplies may be shown to contravene proof offered on the 
applicable standard of care.

 2W.R.C.P. 42 provides in 
pertinent part:

 (b) 
Separate Trials.The court, in furtherance of convenience or to avoid 
prejudice, or when separate trials will be conducive to expedition and economy, 
may order a separate trial of any claim, cross-claim, counterclaim, or 
third-party claim, or of any separate issue or of any number of claims, 
cross-claims, counterclaims, third-party claims, or issues.

 3There is some question, 
in negligent hiring cases, as to what level of misconduct by the employee is 
required to establish a claim for negligent hiring.  McHaffie, 891 S.W.2d  at 
825-26.  However, for purposes of 
this case, we will assume negligence by the employee is sufficient to invoke a 
negligent hiring claim.