Title: Day v. Morrison

State: mississippi

Issuer: Mississippi Supreme Court

Document:

657 So. 2d 808 (1995) Charles M. DAY, Jr. and Elizabeth Ann Day v. Doyle A. MORRISON, M.D. No. 91-CA-00978-SCT. Supreme Court of Mississippi. June 15, 1995. *809 William L. Waller, Jr., Waller & Waller, Jackson, Cotton Ruthven, University, for appellant. Chris J. Walker, Al Nuzzo, Markow Walker Reeves & Anderson, Jackson, for appellee. EN BANC. McRAE, Justice, for the Court: The original opinions are being withdrawn and these opinions are substituted therefor. Charles M. Day, Jr., and his wife, Elizabeth Ann Day, appeal the decision of the Circuit Court of the First Judicial District of Hinds County, finding that Dr. Doyle A. Morrison exercised minimal surgical competence in performing the surgical insertion of a penile prosthesis to correct a sexual dysfunction. Finding that the jury was improperly instructed, we reverse and remand to the lower court for a new trial. The Days appealed to this Court citing the following assignments of error: We address only the issue of whether jury instructions D-11 and D-18 were properly granted by the court. We find all other issues to be without merit. Charles M. Day, Jr. and his wife, Elizabeth Ann Day, filed a Complaint in the Circuit Court of the First Judicial District of Hinds County, Mississippi on March 22, 1989 against Dr. Doyle A. Morrison for damages arising from complications of a penile implant surgery performed November 24, 1986. At the time of trial, the Days had been married for thirty-four years. Day had been married for eight years previously, and through both marriages he fathered four children. Day has a history of health related problems. At age thirteen, Day had the mumps which caused his left testicle to atrophy. In 1972, he had a hernia operation which caused his right testicle to atrophy. In 1986, Day fell off a roof, breaking his left leg in three places above the knee, fracturing his right leg below the knee, and breaking his left arm. Prior to this accident, he fell out of a tree, breaking his right leg below the knee, his back, and his right arm. While Day testified that none of the falls contributed to any of his problems, he testified that he had "pins and things" in the broken areas, a plate in his knee, a pin in his hip, and three lobes in his back "clamped together." In 1972, Day was treated by a Dr. Weiner for sexually related complications of hernia surgery, primarily impotence. Dr. Weiner gave Day testosterone by injection and oral medication. Day testified that he was able to perform sexually for several years after using the medication. He stated financial and family problems in 1978 caused impotency, but the problem cleared and he was able to function normally. However, he continued to see Dr. Weiner until 1984 with his medication adjusted. Day first visited Dr. Morrison on April 16, 1986 because of a curvature of his penis which complicated sexual relations. After several office visits with Day, Morrison met with Day and his wife on October 31, 1986 to discuss methods to treat impotence, including the availability of penile prostheses. Morrison discussed the possibility of having to revise the inflatable prostheses. Morrison testified that he did not guarantee success. *810 The surgery was performed on November 24, 1986 to insert an inflatable penile prosthesis.[1] After surgery, Day visited Morrison to resolve any problems that may have occurred after surgery. Day complained about the pain he experienced. Day testified that Morrison was not able to inflate the prosthesis during the office visits and he alleged that the prostheses were "crossed over".[2] (See Diagram). From December 3, 1986 until December 26, 1986, the notes illustrate Morrison's belief that the prosthesis was in place, but neither Morrison nor Day were able to inflate the device because it caused pain. On December 26, 1986, Morrison wrote that "again the prosthesis is inflated and deflated without difficulty. I cannot feel the device completely in the left corpora, but it feels as though to me that it is in place. His erection is satisfactory to me, and he does have some mild curvature to the left, but it should certainly enable him to have intercourse." On January 9, 1987, the office notes state "everything seems to be going well except that the left corpora cavernosa feels devoid of the penile prosthesis." At this point, Morrison ordered x-rays to determine whether the prosthesis "had fallen back." On January 12, 1987, Morrison wrote that "there is a deviation of the left cylinder medially ... it does not appear that the left cylinder is in the correct corporal body, but I am not 100 percent sure." Morrison referred Day to Dr. Richard Pearson for a second evaluation. Dr. Pearson saw Day on February 4, 1987. Upon examining the prosthesis, Pearson could not tell whether the cylinders were crossed over, although his notes indicated that he believed "that the tips of the cylinders were more to the right side than the left side." Pearson told Day that another surgery was necessary to reposition the cylinders, but the situation was not an emergency. Pearson stated that Morrison followed "the procedure exactly the way it should have been done", and that he "did not find anything in the record that was inconsistent with good medical care." Pearson believed that the crossover occurred after surgery because *811 of "some weakness in the portion of the penis that separates the two halves of the penis." Day's brother, who was also a doctor, recommended Day visit Dr. Larry Weems in March, 1987. Weems performed surgery May 12-13, 1987, six and one-half months after Morrison's operation, to take out and reinsert the prosthesis that Morrison had put in place earlier. By July 1987, after the operation, the right cylinder would not inflate, and Day lost desire for intercourse because of pain. Dr. Weems then referred Day to Dr. William Furlow. Furlow saw Day in September, 1988. Testifying for Day, Furlow stated that a cylinder crossover cannot occur "without a defect in the cylinders." A defect was defined as a hole that is made "in the course of dilating the cylinders, the cavernous bodies and passing the dilator through the septum to the other side, or using the insertion tool and passing the insertion tool through the septum to the other side." Furlow testified that a doctor "should be able to identify cylinder crossover intra-operatively. You have to be able to do that to prevent this complication." Furlow examined Day to determine the possibility of correcting the problems Weems encountered. Furlow testified that the right cylinder would not inflate. He performed a third surgery to correct the crossover problem. Because there was great risk of infection, Furlow performed an operation to divert Day's urination down under the scrotum until the urethra wall could heal. However, Day developed a "full-blown infection" and the device had to be removed. Thus, this lawsuit. The Days opposed two jury instructions, D-11 and D-18, which stated: *812 Instructions D-11 and D-18 in fact preclude the plaintiff from ever recovering because these two instructions, when read together, tell the jury that even though a doctor may be negligent, that he may not have treated a patient according to the minimally accepted standards, or that he was mistaken, then this is acceptable, and the jury is to find for the Defendant doctor.[3] The so-called "bona fide" or "good faith" judgment instruction has been soundly criticized by a number of our sister states. The "mere error of judgment" language in an instruction has been highly criticized and has been found in recent case law to permit too much. Riggins v. Mauriello, 603 A.2d 827, 831 (Del.Supr. 1992) (finding plain error in the giving of such an instruction). "Under this standard, a jury could too readily conclude, incorrectly, that a physician is not liable for malpractice even if he or she is negligent in administering the treatment selected." Id. Delaware has joined numerous other courts in holding that mere error of judgment language is confusing for the jury. Riggins, 603 A.2d at 830 (citing Kobos v. Everts, 768 P.2d 534 (Wyo.Supr. 1989); Leazer v. Kiefer, 120 Idaho 902, 821 P.2d 957 (1991); Logan v. Greenwich Hosp. Ass'n., 191 Conn. 282, 465 A.2d 294 (1983); Magbuhat v. Kovarik, 382 N.W.2d 43 (S.D.Supr. 1986); Ouellette v. Subak, 391 N.W.2d 810 (Minn.Supr. 1986); Rogers v. Meridian Park Hosp., 307 Or. 612, 772 P.2d 929 (1989); Schwab v. Tolley, 345 So. 2d 747 (Fla. 1977); Shamburger v. Behrens, 380 N.W.2d 659 (S.D.Supr. 1986); Sleavin v. Greenwich Gynecology and Obstetrics, 6 Conn. App. 340, 505 A.2d 436 (1986); Somer v. Johnson, 704 F.2d 1473 (11th Cir.1983); Wall v. Stout, 310 N.C. 184, 311 S.E.2d 571 (1984); and Watson v. McNamara, 229 Neb. 1, 424 N.W.2d 611 (1988). Our sister state of Alabama has analyzed the problem and reviewed the approaches taken in other jurisdictions. Shumaker v. Johnson, 571 So. 2d 991 (Ala. 1990). That court reasoned as follows: The trial court gave the following jury charge: It has been noted: In the case of Teh Len Chu v. Fairfax Emergency Medical Associates, 223 Va. 383, 290 S.E.2d 820 (1982), the court stated: Sasser v. Connery, 565 So. 2d 50 (Ala. 1990) (Hornsby, C.J., concurring specially). 571 So. 2d at 993-994. The instructions in the instant case are even less exacting than those found wanting in the cases cited by the Alabama court. See, e.g. Thomas v. Wilfac, Inc., 65 Wash. App. 255, 828 P.2d 597, 602 (1992) (approving an instruction that a "physician is not liable for an error of judgment if, in arriving at that judgment, the physician exercised reasonable care and skill within the standard of care ..."). The history behind the "mere error of judgment" language first crept into our case-law in Hall v. Hilbun, 466 So. 2d 856 (Miss. 1985). In Hall, without citing any authority, this Court proclaimed in dicta that "a competent physician is not liable per se for a mere error of judgment, mistaken diagnosis or the occurrence of an undesirable result." Hall, 466 So. 2d at 866. Hall concerned the question of whether the plaintiff's out-of-state experts should be allowed to testify under *814 our then-existing locality rule which was incorporated in our standard of care and since abolished. Id. The "mere error of judgment" language then found its way in Clayton v. Thompson, 475 So. 2d 439 (Miss. 1985). Clayton did not acknowledge that Hall's comments were dicta and instead, recited the phrase as law. The gist of Clayton was a "loss of chance" of recovery instruction and, the familiar appeal against the qualification of the patient's doctor witness as an expert. Most recently, this Court employed the "mere error of judgment" language in Harris v. Shields, 568 So. 2d 269 (Miss. 1990). Harris used the phrase in the context of dental malpractice. Harris, 568 So. 2d at 272-73 (citing to Hudson v. Taleff, 546 So. 2d 359, 364 (Miss. 1989). Hudson, Harris supposed authority, nowhere uses the "mere error of judgment" language. What Hudson did hold was: Hudson, 546 So. 2d at 364. In Freeze v. Taylor, 257 So. 2d 509, 511 (Miss. 1972), we admonished attorneys against taking language from our opinions and creating jury instructions as was done in this case. This Court "does not review jury instructions in isolation; rather, they are read as a whole to determine if the jury was properly instructed." Payne v. Rain Forest Nurseries, Inc., 540 So. 2d 35, 40-41 (Miss. 1989). In Payne, we held that "where it may be fairly charged that one or more instruction may have been confusingly worded, we should not reverse if other instructions clear up the confusing points ... On the other hand, where we find two or more instructions in hopeless and substantive conflict with each other, we often reverse." Id. (emphasis added). If this Court were to settle for the "mere error of judgment" language as the controlling law in this state for medical malpractice cases, then most injured individuals could forget recovery. A physician or a professional can always claim that he was exercising his own judgment even though he was mistaken or negligent. There are many other ways to instruct the jury such that both sides receive an adequate instruction of the law and the facts as applied to the law. What is expected from a physician is much more clear when viewed in traditional negligence language. In Day's case, there was only one method of correcting the problem, therefore, leaving no room for choice for the physician, and ultimately making a "mere error of judgment" instruction not only unnecessary, but absolutely inapplicable. The definition of "error," as it is generally known, means one of three things: an act, assertion or belief that unintentionally deviates from what is true; the condition of having incorrect or false knowledge; or the act or an instance of deviation from the accepted code of standard. The American Heritage Dictionary of the English Language 445 (1983). None of these three comport with the language in our standard of care requiring a physician to maintain a certain level of competence. Merriam Webster's Collegiate Dictionary 34 (10th ed. 1994) provides a similar definition "an act or condition of ignorant or imprudent deviation from a code of behavior." A patient certainly does not pay a doctor to act imprudently. While it may seem rudimentary to cite to dictionaries, it is necessary to explain the everyday meanings attached to words, reflecting the notions a jury might hold. The Oregon Supreme Court reversed its lower court's use of a similar instruction finding it to be confusing to a jury by stating: Rogers v. Meridian Park Hospital, 307 Or. 612, 772 P.2d 929, 933 (1989). The Rogers Court further stated: Id. Lastly, the Rogers Court said that "if the term `judgment' refers to choices between acceptable courses of treatment, then the term `error in judgment' is a contradiction in itself. Use of any acceptable alternative would not be an `error' ... . such instructions not only confuse, but they are also incorrect because they suggest that substandard conduct is permissible if it is garbed as an `exercise of judgment'." Rogers, 772 P.2d at 933 (footnote omitted). As recently as March, 1994, this Court exhibited a willingness to clarify its explanation of medical malpractice law by defining terms such as "reasonably prudent" and "minimally competent" as they exist within our standard of care: McCarty v. Mladineo, 636 So. 2d 377, 381 (Miss. 1994). In McCarty, Justice Sullivan further stated that jury verdicts are to be based on two things: "the jurors' conclusions of fact, and the court's instructions of law." Id. In this case, the court instructed the jury on the traditional standard of care, but in the same breath, stated that the doctor's mere error of judgment would not make him liable. The jury cannot be expected to separate the two charges. Regardless of Morrison's error of judgment, he either acted as a competent physician would, or he did not. From four short words "mere error of judgment" citizens of our state would virtually be precluded from recovering in medical negligence actions due to a failure to meet the stringent requirement an all encompassing preemptive instruction. This Court now holds that the phrases "a competent physician is not liable per se for a mere error of judgment" and "good faith error in judgment or honest error in judgment" instructions should not be given in medical negligence cases because of their potential for confusing the jury. Negligence that results in injury should support a finding of liability by a jury regardless of whether the act or omission giving rise to the injury was caused by an "honest error in judgment". Because the lower court erred in granting D-11 and D-18, we reverse and remand for a new trial. REVERSED AND REMANDED FOR A NEW TRIAL. DAN M. LEE, P.J., and SULLIVAN, PITTMAN, BANKS and JAMES L. ROBERTS, Jr., JJ., concur. HAWKINS, C.J., dissents with separate written opinion joined by PRATHER, P.J., and SMITH, J. HAWKINS, Chief Justice, dissenting: I respectfully dissent to the denial of the petition for rehearing. *816 Instructions D-11 and D-18, upon which the majority reverses, are set forth in full in the majority opinion (pages 811-812); I will not repeat them here. The record shows that the circuit court amended D-11 as requested by plaintiff's counsel. (R.349-350) D-18 was objected to for including the clause, "a competent physician is not liable per se for a mere error of judgment." This simple statement in D-18 that a mere error of judgment in and of itself does not necessarily mean that a competent physician is legally liable is followed by the following fully explanatory language: Plainly, the first statement about which the majority complains is followed by an explanatory statement fairly setting forth the legal standard under which Dr. Morrison was to be graded. Strangely, the majority gags at the gnat of the first statement, and simply ignores language fully explaining it. Now, let us examine the plaintiff's own instructions: Where then, did defense instruction D-18 say anything differently from the plaintiff's instruction? Clearly, it did not. The only possible objection which could be raised to it would be it was repetitive of the plaintiff's instructions, hardly ground for reversal. Until today if our law recognized anything, it was that the practice of medicine is not an exact science, not subject to the same mathematical certainty as engineering. Good doctors, just as good lawyers, do disagree, and there is no way of knowing prior to an event *817 which choice will be better in a particular case. There was no way in this case for the jury to be misled by this clause in the instruction. The instructions simply state that a competent physician is not liable for a mistake in judgment unless that mistake came from failure to exercise reasonable diligence, skill, competence and prudence which a competent urologist would have exercised under same or similar circumstances. Surely not a day passes in the life of a busy physician in which he does not encounter choices to be made in the treatment of a patient with no way of knowing which is preferable beforehand. Should a physician be held liable if it is only in hindsight that it can be determined which choice was preferable? Of course not. This is all D-18 states. As the majority notes, this Court in Hall v. Hilbun, 466 So. 2d 856, 866 (Miss. 1985), used language embraced in the instruction, and in two later cases approved the language in medical practice instructions. Harris v. Shields, 568 So. 2d 269 (Miss. 1990); Clayton v. Thompson, 475 So. 2d 439 (Miss. 1985). Now, we suddenly brush these decisions aside. See also Hudson v. Taleff, 546 So. 2d 359, 364 (Miss. 1989) (holding that physician not liable for every untoward result and not insurer of success); Dazet v. Bass, 254 So. 2d 183, 187 (Miss. 1971) (holding that bad result does not establish liability). Clearly, this clause in this instruction could not have caused the jury to deviate from the language contained in the plaintiff's own instructions. If there is reversible error in this case, it is not this defense instruction. Defense counsel in this case followed law as enunciated by this Court, and if there was a clause in one of its instructions to which the majority objects, it was clearly harmless because its import was fully explained further in the instruction. Under these circumstances, if the majority has concluded that the clause is objectionable, basic fairness to the bench and bar dictates an admonishment not to use it in future cases, not reversal. Is the majority holding that a competent physician who exercises reasonable professional care in looking after his patient is liable for a mere error in judgment unaccompanied by some negligent treatment? Seemingly so. Until today's decision, it was the failure to exercise that degree of care which a physician should have used which made the physician liable, not the fact that another physician might have chosen a different course, or that in hindsight one choice would appear to have been better than the other. PRATHER, P.J., and SMITH, J., join this opinion. [1] The surgery places an inflatable cylinder on each side of the urethra in the penis. The surgeon inflates the prosthesis to ensure that it creates an erection. This procedure is done two or three times to determine that both cylinders are positioned properly in the left and right corpora. [2] At trial, Dr. Furlow explained in great detail the surgical procedure of the penile implant. The "crossover" of the cylinders is the result of the inflatable prosthesis moving to one side of the penis. Supposedly, this occurs from a defect in the septum wall which divides one side of the penis from the other. Essentially, each cylinder must be positioned on both sides of the penis in order to function properly. [3] Justice Sullivan, in McCarty v. Mladineo, 636 So. 2d 377, 381 (Miss. 1994), defined the adjective "minimally" within the context of a medical professional. "Minimally" does not mean one can be a 20% doctor.