IN THE

ARIZONA COURT OF APPEALS

DIVISION ONE

DALTON SCOTT STAFFORD and KRISTINE MAJOR STAFFORD, 

Parents of JESSE TREY STAFFORD, Deceased, Plaintiffs/Appellants,

v.

ANNE M. BURNS, M.D. and JOHN DOE BURNS, husband and wife; 

EMPOWER EMERGENCY PHYSICIANS, P.C., Defendants/Appellees.

No. 1 CA-CV 15-0476

Appeal from the Superior Court in Maricopa County

No. CV2013-000019

The Honorable John Christian Rea, Judge

JURISDICTION ACCEPTED; RELIEF DENIED

COUNSEL

Grysen & Associates, Spring Lake, MI

By B. Elliott Grysen

Co-Counsel for Plaintiffs/Appellants

Knapp & Roberts, P.C., Scottsdale

By David L. Abney

Co-Counsel for Plaintiffs/Appellants

Jones Skelton & Hochuli, P.L.C., Phoenix

By Eileen Dennis GilBride, Cristina M. Chait

Counsel for Defendants/Appellees
STAFFORD v. BURNS et al.

Opinion of the Court

2

OPINION

Presiding Judge Kenton D. Jones delivered the Opinion of the Court, in 

which Judge Randall M. Howe and Judge Donn Kessler joined.

J O N E S, Judge:

¶1 Dalton and Kristine Stafford (the Staffords) appeal the trial 

court’s orders denying their motions for new trial and for relief from 

judgment following a jury verdict in favor of Appellees (collectively, Dr. 

Burns) on the Staffords’ claims for medical malpractice and wrongful death

after their son, Jesse, died of a methadone overdose. 

¶2 The Staffords argue the trial court erred in instructing the 

jury, pursuant to Arizona Revised Statutes (A.R.S.) section 12-572(A),1 that 

the Staffords bore the burden of proof by clear and convincing evidence 

because, they contend, Dr. Burns did not provide medical care “in 

compliance with” the Emergency Medical Treatment and Active Labor Act 

(EMTALA). See 42 U.S.C.A. § 1395dd (West). As set forth below, we hold, 

as relevant here, the heightened standard of proof for claims against a 

health professional set forth in A.R.S. § 12-572(A) applies whenever the acts 

or omissions plaintiff contends were deficient were provided in the course 

of evaluating and treating a patient in a hospital emergency department.

¶3 The Staffords also argue the court abused its discretion in 

denying their motion for new trial based upon various administrative and 

evidentiary rulings, for which we find no error. 

¶4 Finally, the Staffords argue the trial court erred in imposing 

sanctions pursuant to Arizona Rule of Civil Procedure 68(g) because Dr. 

Burns’ pretrial offer of judgment was invalid in that it was not made in good 

faith. We do not reach the merits of the Staffords’ contention because Rule 

68(g) contains no such good faith requirement, and we decline to impose 

one in contravention of the rule’s plain language and purpose. 

 

1 Absent material changes from the relevant date, we cite a statute’s 

current version.
STAFFORD v. BURNS et al.

Opinion of the Court

3

¶5 For the reasons stated below, we treat the Staffords’ appeal as 

a petition for special action, accept jurisdiction, and deny relief. 

Accordingly, the judgment and orders are affirmed.

FACTS2 AND PROCEDURAL HISTORY

¶6 In the early morning hours of February 5, 2012, Jesse 

presented at the emergency room of St. Joseph’s Hospital after having

ingested an unknown quantity of methadone. After several hours of 

testing, evaluation, and monitoring for a possible methadone overdose, Dr. 

Burns took over Jesse’s care until he was discharged around 1:00 p.m. Jesse 

was found dead the following day. 

¶7 In January 2013, the Staffords filed a complaint against Dr. 

Burns, asserting she negligently caused Jesse’s death by wrongfully 

determining his condition was stable and discharging him prematurely. In 

response, Dr. Burns asserted she complied with the standard of care and 

presented evidence suggesting Jesse ingested additional methadone after 

his discharge that ultimately caused his death. 

¶8 After a twelve-day trial, the jury returned a defense verdict. 

The Staffords timely filed motions for new trial and for relief from 

judgment, which were denied. This appeal followed.

JURISDICTION

¶9 This Court has an independent duty to examine whether it 

has jurisdiction to consider an appeal. Stafford v. Farmers Ins. of Ariz., 191 

Ariz. 464, 465 (App. 1997) (citing Davis v. Cessna Aircraft Corp., 168 Ariz. 301, 

304 (App. 1991)). Our appellate jurisdiction is generally limited to issues 

arising from final judgments disposing of all claims and all parties. Musa 

v. Adrian, 130 Ariz. 311, 312 (1981). A notice of appeal filed before entry of 

a signed final judgment or resolution of a time-extending motion is a nullity

unless and until the final order enters. See ARCAP 9(c); Craig v. Craig, 227 

Ariz. 105, 107, ¶ 13 (2011) (citing Smith v. Ariz. Citizens Clean Elections 

Comm’n, 212 Ariz. 407, 415, ¶ 39 (2006), and Engel v. Landman, 221 Ariz. 504, 

509, ¶ 13 (App. 2009)); Tripati v. Forwith, 223 Ariz. 81, 84, ¶ 15 (App. 2009). 

 

2 We view the facts and all inferences to be drawn therefrom in the 

light most favorable to sustaining the jury’s verdict and resulting judgment

for costs. Hyatt Regency Phx. Hotel Co. v. Winston & Strawn, 184 Ariz. 120, 

123 (App. 1995) (citing Bradshaw v. State Farm Mut. Auto. Ins., 157 Ariz. 411, 

414 (1988), and Rhue v. Dawson, 173 Ariz. 220, 223 (App. 1992)).
STAFFORD v. BURNS et al.

Opinion of the Court

4

¶10 Here, the Staffords filed two time-extending motions. See 

ARCAP 9(e)(1)(D) (motion for new trial), (E) (motion for relief from 

judgment). The trial court entered a signed order denying the motion for 

relief from judgment and denied the motion for new trial in an unsigned 

minute entry order. Although this Court re-vested jurisdiction in the trial 

court for the purpose of obtaining a signed, final order corresponding to the 

minute entry denying the motion for new trial, see Eaton Fruit Co. v. Cal.

Spray-Chem. Corp., 102 Ariz. 129, 130 (1967), no such order has been issued. 

Accordingly, we lack appellate jurisdiction over this appeal.

¶11 Although we do not have appellate jurisdiction, we may, in 

our discretion, consider the appeal as a petition for special action. See Grand 

v. Nacchio, 214 Ariz. 9, 17, ¶ 20 (App. 2006) (citing Danielson v. Evans, 201 

Ariz. 401, 411, ¶ 35 (App. 2001), and Lloyd v. State Farm Mut. Auto. Ins., 189 

Ariz. 369, 375 (App. 1996)); see also A.R.S. § 12-120.21(A)(4) (granting court 

of appeals jurisdiction to hear special actions “without regard to its 

appellate jurisdiction”). We elect to do so here. The Staffords present at 

least two issues of first impression and statewide importance likely to recur. 

See Lind v. Superior Court, 191 Ariz. 233, 236, ¶ 10 (App. 1998) (citing Moss v. 

Superior Court, 175 Ariz. 348, 350 (App. 1993)). Additionally, were we to 

dismiss the appeal, nothing that may occur in the trial court would likely 

alter the disposition of the issues raised. Grand, 214 Ariz. at 18, ¶ 24. Not 

wanting to elevate form over substance, we exercise our discretion to treat 

this appeal as a petition for special action and accept jurisdiction but, as set 

forth below, deny relief.

DISCUSSION

I. Application of A.R.S. § 12-572(A)

¶12 A plaintiff must generally prove the elements of his medical 

malpractice claim by a preponderance of the evidence. See Harvest v. Craig, 

195 Ariz. 521, 523, ¶ 10 (App. 1999) (citing Thompson v. Sun City Cmty. Hosp., 

Inc., 141 Ariz. 597, 608 (1984)). In 2009, however, our legislature adopted 

A.R.S. § 12-572(A), which heightened the burden of proving a malpractice 

claim against “a health professional . . . who provides or who is consulted 

to provide services to a patient of a licensed hospital in compliance with 

[EMTALA]” to clear and convincing evidence. EMTALA is a federal statute 

enacted to address the growing concern that hospitals were routinely 

refusing emergency medical treatment to individuals unable to pay for 

services. See Eberhardt v. City of L.A., 62 F.3d 1253, 1255 (9th Cir. 1995) (citing 

H.R. Rep. No. 241, 99th Cong., 1st Sess. (1986), reprinted in 1986 

U.S.C.C.A.N. 726-27); Scottsdale Healthcare, Inc. v. Ariz. Health Care Cost 
STAFFORD v. BURNS et al.

Opinion of the Court

5

Containment Sys. Admin., 206 Ariz. 1, 6 n.6, ¶ 20 (2003) (citing Bryant v. 

Adventist Health Sys./W., 289 F.3d 1162, 1165 (9th Cir. 2002)). The Staffords 

argue the trial court erred in instructing the jury on the clear and convincing 

burden of proof set forth in A.R.S. § 12-572(A) because, they contend, Dr. 

Burns was not providing services “in compliance with EMTALA” as

another physician had already performed the medical screening and 

determined Jesse did not have an emergency medical condition. In 

response, Dr. Burns argues A.R.S. § 12-572(A) applies to “all emergency 

room services.” 

¶13 Although we review a trial court’s denial of a motion for new 

trial and its decision to give a jury instruction for an abuse of discretion, we 

review de novo whether jury instructions accurately state the law. Delbridge 

v. Salt River Project Agric. Improvement & Power Dist., 182 Ariz. 46, 53 (App. 

1994) (citing Suciu v. AMFAC Distrib. Corp., 138 Ariz. 514, 520 (App. 1983)); 

State v. Garcia, 224 Ariz. 1, 18, ¶ 75 (2010) (citing State v. Martinez, 218 Ariz. 

421, 432, ¶ 49 (2008)); see also State v. Rios, 217 Ariz. 249, 250, ¶ 5 (App. 2007). 

The interpretation and application of statutes also present questions of law 

which we review de novo. City of Phx. v. Glenayre Elecs., Inc., 240 Ariz. 80, 

84, ¶ 8 (App. 2016) (citing First Fin. Bank, N.A. v. Claassen, 238 Ariz. 160, 162, 

¶ 8 (App. 2015)). 

¶14 The heightened burden of proof of A.R.S. § 12-572(A) applies

where services are provided “in compliance with EMTALA.” EMTALA 

applies to any individual who comes to a hospital’s emergency department 

for treatment.

3 42 U.S.C.A. § 1395dd(a). Under EMTALA, the hospital is 

required to provide appropriate medical screening to determine if an 

emergency medical condition exists.

4 Id. If the patient has an emergency 

 

3 A person “comes to the emergency department” when he “present[s] 

at a hospital’s dedicated emergency department . . . and requests 

examination or treatment for a medical condition,” “present[s] on hospital 

property . . . other than the dedicated emergency department, and requests 

examination or treatment for what may be an emergency medical 

condition,” or “[i]s in a ground or air ambulance owned and operated by 

the hospital for purposes of examination and treatment for a medical 

condition at a hospital’s dedicated emergency department.” 42 C.F.R. 

§ 489.24(b). 

4 An “emergency medical condition” is a condition “manifesting itself 

by acute symptoms of sufficient severity (including severe pain, psychiatric 

disturbances and/or symptoms of substance abuse) such that the absence 
STAFFORD v. BURNS et al.

Opinion of the Court

6

medical condition, the hospital must either provide “such further medical 

examination and such treatment as may be required to stabilize the medical 

condition,” or, if safe and appropriate, transfer the patient to another 

facility for stabilizing care.5 42 U.S.C.A. § 1395dd(b)(1). For purposes of 

EMTALA, a patient is “stabilized” when “no material deterioration of the 

condition is likely, within reasonable medical probability, to result from or 

occur during the transfer of the individual from a facility.” 42 U.S.C.A. 

§ 1395dd(e)(3)(B). 

¶15 The gamut of services that may be necessary to comply with 

EMTALA cannot readily be distilled into a universally applicable and finite 

list, and therefore, the phrase cannot be read narrowly. To adopt the 

Staffords’ view, the burden of proof against the health care provider would 

shift from clear and convincing to a preponderance of the evidence the 

instant: (1) the screening process is completed and reveals the patient does 

not have an “emergency medical condition” within the meaning of 

EMTALA, or (2) a patient is stabilized to the point that his condition would 

not deteriorate during a transfer. This sort of interpretation is not practical 

in the context of a person seeking emergency medical care. The evaluation 

and treatment of a medical condition is necessarily a fluid process, whereby 

a patient’s status as serious or stable may change from moment to moment. 

This is particularly true where the condition qualifies as an emergency 

under EMTALA — manifesting through acute symptoms, severe pain, and 

the risk of serious dysfunction or bodily impairment. 

¶16 We do not read EMTALA to relieve the hospital emergency 

department from re-screening, re-evaluating, and even possibly re-treating 

a patient if his condition changes after an initial status determination. 

Indeed, federal courts have held a hospital’s duty under EMTALA can 

continue up to and even after a patient is admitted for inpatient care. See, 

 

of immediate medical attention could reasonably be expected to result in —

(i) [p]lacing the health of the individual . . . in serious jeopardy; (ii) [s]erious 

impairment to bodily functions; or (iii) [s]erious dysfunction of any bodily 

organ or part.” 42 C.F.R. § 489.24(b); see also 42 U.S.C.A. § 1395dd(e)(1)(A).

5 Alternatively, if it is clear from the nature of the person’s request for 

services that the medical condition is not of an emergency nature, “the 

hospital is required only to perform such screening as would be appropriate 

for any individual presenting in that manner, to determine that the 

individual does not have an emergency medical condition.” 42 C.F.R. 

§ 489.24(c). The Staffords do not argue Jesse’s request for care falls under 

this exception.
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Opinion of the Court

7

e.g., Bryant, 289 F.3d at 1168 (concluding EMTALA duty ends when a 

patient is admitted in good faith for inpatient care); Thornton v. Sw. Detroit 

Hosp., 895 F.2d 1131, 1134 (6th Cir. 1990) (“[O]nce a patient is found to suffer 

from an emergency medical condition in the emergency room, she cannot 

be discharged until the condition is stabilized, regardless of whether the 

patient stays in the emergency room.”); see also 42 C.F.R. § 489.24(a)(1)(ii), 

(d)(2)(i). 

¶17 We reject the Staffords’ argument that EMTALA was never 

implicated during Jesse’s stay in the emergency department because he was 

not diagnosed with an emergency medical condition. First, the Staffords 

do not identify any record evidence establishing that fact. Furthermore, 

“emergency medical condition” is defined, specifically, to include 

“symptoms of substance abuse.” 42 C.F.R. § 489.24(b). Viewing the 

evidence in the light most favorable to sustaining the verdict, as we are 

required to do, we can reasonably infer otherwise from the evidence that 

the original emergency room physician chose to keep Jesse for observation 

and testing over the course of several hours, rather than immediately 

authorizing his discharge.

¶18 Second, EMTALA applies whenever a person comes to the 

hospital “for what may be an emergency medical condition.” 42 C.F.R. 

§ 489.24(b) (emphasis added). Jesse came to the hospital for this precise 

purpose — seeking evaluation and treatment of what may have been an 

emergency medical condition — after ingesting an unknown quantity of 

methadone, a dangerous narcotic drug. See A.R.S. § 13-3401(20)(k). He was 

kept in the emergency department for almost twelve hours for observation, 

testing, and evaluation of physical and psychological concerns — all 

services required by EMTALA to screen for and stabilize a potentially lifethreatening medical condition. See supra ¶ 14. If Jesse was misdiagnosed 

or discharged prematurely, as the Staffords contend, those actions occurred

in the course of providing EMTALA-mandated services, A.R.S. § 12-572(A) 

is directly applicable, and the Staffords were required to prove their claims 

by clear and convincing evidence. The Staffords cannot both have and eat 

their proverbial cake by arguing the very acts that define the scope of the 

protections afforded by A.R.S. § 12-572(A) — screening and treatment —

remove Dr. Burns from its protections. 

¶19 A broader interpretation is also consistent with the statute’s 

purpose to provide a more inviting legal environment for emergency 

medical providers, see Ariz. S. Fact Sheet, S.B. 1018 (1st Reg. Sess. Jun. 15, 

2009) (noting the heightened burden of proof was recommended “to 

address the state’s shortage of emergency and trauma physicians and the 
STAFFORD v. BURNS et al.

Opinion of the Court

8

problem of access to emergency care”); Ariz. Emergency Med. Servs. Access 

Task Force Rep., at 2-3, 15-16 (2006), https://www.acep.org/

content.aspx?id=5258, as well as the section heading adopted by the 

legislature: “Burden of proof for treatment in emergency departments or 

rendered by on-call providers,” see Bruce v. Charles Roberts Air Conditioning, 

166 Ariz. 221, 225 (App. 1990) (noting that although section headings are 

not part of the law, they may aid in interpreting otherwise ambiguous 

language). Although the legislature certainly could have described the 

extent of the liability protection contained within A.R.S. § 12-572(A) 

without reference to EMTALA, as the Staffords suggest it should have, the

intent of the statute is clear, and the statutory language does not preclude a 

reasonable interpretation consistent with that intent.

¶20 Finally, the Staffords argue A.R.S. § 12-572(A) does not apply 

because they do not specifically reference EMTALA in their pleadings, they

have never asked for a determination whether Dr. Burns complied with —

or violated — EMTALA, and they have no direct right of action against Dr. 

Burns for an EMTALA violation.

6 These facts are irrelevant. The reference 

to EMTALA within A.R.S. § 12-572(A) defines the scope of the liability 

protection. Under the statute, the relevant inquiry is whether the acts or 

omissions the plaintiff contends were deficient were provided in the course 

of evaluating and treating a patient in a hospital emergency department. 

That is clearly the case here, and the clear and convincing standard 

articulated in A.R.S. § 12-572(A) applies. Accordingly, we find no error in 

the trial court’s instructions to the jury regarding the burden of proof.

 

6 The Staffords cite Moses v. Providence Hospital & Medical Centers, Inc., 

561 F.3d 573 (6th Cir. 2009), and Roberts ex rel. Johnson v. Galen of Virginia, 

Inc., 325 F.3d 776 (6th Cir. 2003), to support their argument that EMTALA 

does not apply to their claims. In both cases, the Sixth Circuit Court of 

Appeals held that stabilizing treatment is required only if the medical 

providers “actually recognize that the patient has an emergency medical 

condition.” Moses, 561 F.3d at 582-85; Roberts, 325 F.3d at 786-87. Those

holdings are relevant to whether a plaintiff can maintain a federal cause of 

action for violation of EMTALA, but inapplicable to the question presented 

here — whether the actions forming the basis of the Staffords’ civil 

negligence claim were performed by Dr. Burns “in compliance with

EMTALA.”
STAFFORD v. BURNS et al.

Opinion of the Court

9

II. Jury Misconduct

¶21 The Staffords next argue they were entitled to a new trial 

because Juror 10 violated the admonition not to discuss the case outside of 

the jury room. We review a decision to deny a new trial based upon alleged 

jury misconduct for an abuse of discretion. State v. Fitzgerald, 232 Ariz. 208, 

210, ¶ 10 (2013) (quoting State v. Hall, 204 Ariz. 442, 447, ¶ 16 (2003)).

¶22 Throughout the twelve-day trial, the jurors were admonished 

not to discuss the case outside of the jury room. At the end of the eleventh 

day, the court reporter advised the trial court she had been in the elevator 

with several jurors when she heard Juror 10 say “something like — if the 

parameters were set at 11 to 24, why didn’t the alarm go off.” The court 

reporter told the jurors not to talk about the case, and the conversation

ended. When questioned by the court, Juror 10 remembered making the 

statement in the elevator and confirmed no other discussion occurred. He 

denied having any other conversations about the case outside the jury 

room. The Staffords were given an opportunity to question Juror 10 further 

but declined to do so. 

¶23 The Staffords did, however, move to excuse Juror 10 from 

further service. After concluding the comment “d[id]n’t show that he’s 

made up his mind, . . . [and was] the exact kind of thing [a juror] would say 

in deliberations,” the trial court denied the motion. In denying the 

Staffords’ motion for new trial on the basis of jury misconduct, the court 

reiterated that:

while the court was upset with the jury upon receiving the 

. . . information [regarding Juror 10’s elevator comment], after 

interviewing the juror and learning the details and observing 

the juror’s demeanor, the court concluded that the remark 

was minor, did not influence the other jurors, and did not 

indicate any predetermination of the issues by [J]uror 10. 

¶24 The Staffords now argue Juror 10 “did not belong on the jury 

panel” because his comment was “probably just the tip of the iceberg of his 

misconduct — shamelessly committed in a public elevator in the presence 

of three other jurors and the court reporter,” and because his conduct 

reflects “he was either incapable of following instructions or was 

deliberately obtuse and contrary.” The Staffords also suggest Juror 10 could 

have assumed it was they who had discovered his misconduct, adding a 

“‘get even’ motive to his proven penchant for ignoring the rules.” 
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Opinion of the Court

10

¶25 Not every violation of the court’s admonitions requires 

dismissal of the juror involved, see State v. Trostle, 191 Ariz. 4, 13 (1997), and 

the trial court is in the best position to determine the effect, if any, of a 

juror’s misconduct, see Cota v. Harley Davidson, 141 Ariz. 7, 10 (App. 1984) 

(citing State v. Reynolds, 11 Ariz. App. 532, 535 (1970)). The record reflects 

only that Juror 10 made a single non-committal comment outside the jury 

room and immediately discontinued the conversation when reminded to 

do so. The court determined Juror 10’s comment was isolated and 

innocuous and did not affect his ability to render a fair and impartial 

verdict. We defer to that conclusion, particularly where, as here, there is no 

evidence to the contrary. The Staffords have not demonstrated, beyond

mere speculation, that the comment or the proceedings that followed 

affected Juror 10’s ability to be impartial.

7 See Cota, 141 Ariz. at 10-11

(noting “sheer speculation” regarding the effect of purported jury 

misconduct cannot serve as grounds for a mistrial). 

¶26 That the trial court could have chosen to designate Juror 10 as 

an alternate without disrupting the proceedings is of no consequence. The 

record does not show Juror 10 individually, or the jury generally, was 

biased because of Juror 10’s misconduct. The court did not abuse its 

discretion in denying the Staffords’ requests.

III. Dr. Burns’ Testimony

¶27 At trial, evidence was introduced that Jesse died of 

respiratory distress approximately thirty hours after he reportedly ingested 

the methadone that caused him to present to the emergency room on 

February 5, 2012. Dr. Burns testified she observed Jesse experience a mild 

respiratory depression characteristic of methadone ingestion while he was 

being treated in the emergency department and approved his discharge 

only after his respirations returned to the normal range. Dr. Burns testified 

 

7 The Staffords cite In re Hitchings, 860 P.2d 466, 477 (Cal. 1993), for the 

proposition that violation of the juror admonition is “commonly regarded” 

as serious misconduct that raises a presumption of prejudice. However 

common it may be, this is not a correct statement of Arizona law. See Perez 

v. Cmty. Hosp. of Chandler, Inc., 187 Ariz. 355, 360 (1997) (declining to adopt 

strict rule of presumed prejudice in cases involving ex parte

communications with the jury); see also Trostle, 191 Ariz. at 12-13 (noting the 

party challenging a juror’s inclusion on the panel bears the burden of 

proving “there is reasonable ground to believe that [the juror] cannot 

render a fair and impartial verdict”) (quoting Ariz. R. Crim. P. 18.4(b), and 

citing State v. Lavers, 168 Ariz. 376, 390 (1991)).
STAFFORD v. BURNS et al.

Opinion of the Court

11

she had never seen, either in her education or clinical experience, any data 

suggesting the respiratory effects occur as long as thirty hours after 

ingestion, and, if they did, “pretty much anyone who’s taking methadone 

at all would have to stay in the hospital.” Finally, Dr. Burns added:

[T]he biggest concern with methadone is people who take an 

additional dose. . . . [Y]ou’re at higher risk of having 

respiratory depressant [e]ffects when you take your second 

dose because you still have some in the body. So then you’re 

basically adding, almost like you’re stair-stepping on top of 

that. So that’s the second dose is what is the most concerning. 

¶28 The Staffords argue this testimony transformed Dr. Burns into 

“a second, undisclosed causation expert willing to opine that a purely 

hypothetical second dose of methadone at Jesse’s home contributed to his 

death,” and the trial court erred in denying their motion for new trial on 

this basis. See Ariz. R. Civ. P. 26(b)(4)(D) (“In all cases including medical 

malpractice cases each side shall presumptively be entitled to only one 

independent expert on an issue, except upon a showing of good cause.”);

Ariz. R. Civ. P. 26.1(a)(6) (requiring detailed disclosure regarding the 

qualifications and anticipated testimony of an expert witness). Whether Dr. 

Burns provided expert testimony in violation of Rules 26(b)(4)(D) or 

26.1(a)(6) are questions of law, which we review de novo. See State v. SalazarMercado, 234 Ariz. 590, 592, ¶ 4 (2014) (citing State v. Gutierrez, 229 Ariz. 573, 

576, ¶ 19 (2012)); Solimeno v. Yonan, 224 Ariz. 74, 77, ¶¶ 9-10 (App. 2010). 

¶29 The Staffords acknowledge they were timely advised that Dr. 

Burns would provide expert testimony on the standard of care. The 

testimony identified above was appropriate for that purpose. It provided 

both an illustration of the extent of Dr. Burns’ knowledge of the relevant 

area of medical practice and the basis for Dr. Burns’ opinion that she did 

not violate the standard of care by discharging Jesse after he experienced 

the anticipated effects of methadone ingestion within the anticipated 

timeframe and his respirations returned to the normal range. Although Dr. 

Burns did express concern of “re-ingestion” after observing Jesse’s 

condition and mannerisms in a video taken twelve hours after his 

discharge, she did not provide any opinion about what caused or 

contributed to his death, despite repeated questioning on the issue from the 

Staffords’ counsel. 
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Opinion of the Court

12

¶30 Dr. Burns did not testify as a causation expert and was not 

required to make any additional disclosures; nor did she violate the oneexpert-per-issue presumption articulated in Rule 26(b)(4)(D). We find no 

error.

IV. Expert Testimony Regarding Post Mortem Gastric Methadone 

Levels

¶31 Before trial, the Staffords moved to preclude any expert 

testimony extrapolating the timing of Jesse’s last methadone ingestion from 

his post mortem gastric methadone levels, arguing the method was not 

scientifically valid because of the way the drug redistributes in the body 

after death. Counsel for Dr. Burns explained that the conclusion that Jesse 

re-ingested methadone was based upon the significant amount of 

methadone in his stomach, the rate the stomach empties, and the time that 

passed between his discharge and death. The trial court denied the motion 

and related request for evidentiary hearing after concluding the dispute 

was simply a “difference of opinion” between the experts. 

¶32 On appeal, the Staffords argue that admitting any testimony

based upon this “junk science” was error without holding a hearing 

pursuant to Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993),

to determine its reliability. We review the necessity of a hearing to resolve 

a dispute in the admissibility of expert testimony for an abuse of discretion. 

See Ariz. State Hosp./Ariz. Cmty. Prot. & Treatment Ctr. v. Klein, 231 Ariz. 467, 

474, ¶¶ 31-32 (App. 2013) (citing Kumho Tire Co. v. Carmichael, 526 U.S. 137,

152 (1999)). 

¶33 Although the trial court may hold an evidentiary hearing to 

evaluate proposed expert testimony, it is not required to do so. See id. Here, 

both parties presented lengthy and detailed pleadings, cited supporting 

medical literature, and attached affidavits containing the specific opinions 

of their other disclosed medical and pharmacological experts. There is no 

indication the court required additional information to make a decision on 

the reliability of the methodology, and the Staffords do not articulate 

otherwise in their briefs. We find no abuse of discretion.

V. Cocaine Metabolite

¶34 The Staffords also argue the trial court erred by allowing the 

jury to hear evidence that a postmortem urine sample contained cocaine 

metabolites because the evidence was unfairly prejudicial. Because the trial 

court is in the best position to balance the probative value of challenged

evidence against the danger of unfair prejudice, we review for an abuse of 
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Opinion of the Court

13

discretion and will affirm absent a clear abuse of discretion or legal error 

and prejudice. See State v. Salamanca, 233 Ariz. 292, 296, ¶ 17 (App. 2013) 

(quoting State v. Connor, 215 Ariz. 553, 564, ¶ 39 (App. 2007)); Gasiorowski v. 

Hose, 182 Ariz. 376, 382 (App. 1994) (citing Selby v. Savard, 134 Ariz. 222, 227 

(1982)); see also Ariz. R. Evid. 403.

¶35 The trial court originally granted the Staffords’ motion in 

limine precluding reference to the cocaine metabolite, agreeing the presence 

of cocaine was irrelevant in the absence of some evidence that the cocaine 

contributed to Jesse’s death. But after the court considered the Staffords’ 

evidence attempting to portray Jesse as a person who would not or could 

not have re-ingested methadone after being discharged from the emergency 

department, “giving the jury a pretty sanitized view of Jesse,” the court 

reconsidered its ruling, explaining:

There’s been testimony that Ms. Stafford searched the house 

for drugs before, that, you know, so far the alcohol bottles that 

we saw [in Jesse’s room] were decorative items. What this 

evidence would tend to show is that Jesse had been — had 

been using drugs for some period of time and his parents 

didn’t know, that he knew where to get drugs, that he knew 

how to hide his use from his parents. All of those are 

legitimate items for the jury to consider in determining 

whether his death was caused by the methadone taken before 

the hospital or whether he may have had access and used 

methadone afterwards. . . . [T]he 403 balancing is a lot 

different now that we’ve had two days of testimony than it 

was before trial. And after listening to the testimony that’s 

been presented so far, I think the permissible uses under 404 

B of this evidence, that is to show . . . that Jesse knew where 

to get drugs, that he knew how to hide drugs and hide drug 

use from his parents. And those issues, I think, are directly 

relevant to what the jury has to decide and they are 

permissible under Rule 404 B. 

The court limited the admissibility of the cocaine metabolite evidence to 

those purposes and permitted the Staffords to recall their toxicologist to 

address the issue on rebuttal. After the Staffords moved for 

reconsideration, stressing the prejudicial nature of evidence of illegal drug 

use, the court affirmed its ruling, reiterating that “after listening to the two 

and a half days of testimony, the balancing has shifted considerably.” 
STAFFORD v. BURNS et al.

Opinion of the Court

14

¶36 We find no abuse of discretion. The evidence was relevant to 

rebut the testimony of the Staffords’ witnesses that Jesse did not, could not, 

or would not have sought out additional methadone after his discharge 

from the emergency department. And although evidence of drug use may 

be prejudicial, the danger of prejudice was not so obviously unfair here, 

where it is undisputed that Jesse had previously ingested methadone 

illegally.

VI. Use of Dr. Burns’ Video Deposition

¶37 The Staffords argue the trial court erred by refusing to let 

them play excerpts from Dr. Burns’ video deposition “when and how the 

[Staffords] wanted to play them.” They do not elaborate on when or how 

excerpts from Dr. Burns’ video deposition were used, when or how the 

Staffords wished to use the video, how the court interfered with the 

Staffords’ presentation, or how the court’s restrictions affected the verdict. 

See ARCAP 13(a)(7)(A) (requiring an opening brief to contain “contentions 

concerning each issue presented for review, with supporting reasons for 

each contention . . . and appropriate references to the portions of the record 

on which the appellant relies”). Because the Staffords failed to develop this 

argument in a meaningful way, it is waived, and we do not address it. See

Polanco v. Indus. Comm’n, 214 Ariz. 489, 491 n.2, ¶ 6 (App. 2007) (noting a

party waives an issue on appeal when he fails to develop and support his

argument) (citations omitted).

VII. Judgment as a Matter of Law

¶38 The Staffords argue the trial court erred in denying their 

motions for judgment as a matter of law that: (1) the immediate cause of 

Jesse’s death was methadone intoxication, (2) the mechanism of death was 

respiratory failure, and (3) the manner of death was accidental. Whether a 

trial court should have granted judgment as a matter of law presents a 

question of law, which we review de novo. A Tumbling-T Ranches v. Flood 

Control Dist. of Maricopa Cty., 222 Ariz. 515, 524, ¶ 14 (App. 2009) (citing 

Aegis of Ariz., L.L.C. v. Town of Marana, 206 Ariz. 557, 566, ¶ 34 (App. 2003)). 

We also review de novo the interpretation and application of the Arizona 

Rules of Civil Procedure. See Duckstein v. Wolf, 230 Ariz. 227, 231, ¶ 8 (App. 

2012) (citing Vega v. Sullivan, 199 Ariz. 504, 507, ¶ 8 (App. 2001)).

¶39 Arizona Rule of Civil Procedure 50(a)(1) states:

If during a trial by jury a party has been fully heard on an 

issue and there is no legally sufficient evidentiary basis for a 

reasonable jury to find for that party on that issue, the court 
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Opinion of the Court

15

may determine the issue against the party and may grant a 

motion for judgment as a matter of law against that party with 

respect to a claim or defense that cannot under the controlling 

law be maintained or defeated without a favorable finding on 

that issue.

By its plain language, Rule 50 allows the trial court to enter judgment “with 

respect to a claim or defense.” See also Salica v. Tucson Heart Hosp.-

Carondelet, L.L.C., 224 Ariz. 414, 417, ¶ 11 (App. 2010) (holding judgment as 

a matter of law appropriate where “the facts produced in support of the 

claim or defense have so little probative value, given the quantum of evidence 

required, that reasonable people could not agree with the conclusion 

advanced by the proponent of the claim or defense”) (emphasis added)

(quoting A Tumbling-T Ranches, 222 Ariz. at 524, ¶ 14). 

¶40 Here, the Staffords did not request judgment on their claims 

for medical malpractice or wrongful death; they simply asked the trial court 

to remove from the jury, and instead resolve as a matter of law, particular 

factual issues regarding the cause, mechanism, and manner of Jesse’s death. 

Although seemingly undisputed, a substantive decision on these issues

would not resolve the Staffords’ claims that Dr. Burns was negligent, nor 

quash Dr. Burns’ defense that Jesse’s death resulted from the re-ingestion 

of methadone after discharge. Judgment as a matter of law is not available 

to dispose of issues of fact that do not defeat a claim or defense, and the 

court did not err in denying the Staffords’ motions.

VIII. Rule 68 Sanctions

¶41 Finally, the Staffords argue the trial court erred in imposing 

sanctions pursuant to Arizona Rule of Civil Procedure 68(g) because the 

$10,000 offer of judgment was invalid, as it was not made in good faith. We 

review the interpretation and application of the offer of judgment rule de 

novo. Berry v. 352 E. Va., L.L.C., 228 Ariz. 9, 15, ¶ 31 (App. 2011) (citing Levy 

v. Alfaro, 215 Ariz. 443, 444, ¶ 6 (App. 2007)). We review the trial court’s 

decision to impose Rule 68 sanctions for an abuse of discretion. Id. (citing 

Hmielewski v. Maricopa Cty., 192 Ariz. 1, 4, ¶ 13 (App. 1997)). 

¶42 A party may make an offer “to allow judgment to be entered” 

in a civil case “any time more than 30 days before the trial begins.” Ariz. R. 

Civ. P. 68(a). Rule 68(g) states:

If the offeree rejects an offer and does not later obtain a more 

favorable judgment other than pursuant to this Rule, the 

offeree must pay, as a sanction, reasonable expert witness fees 
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Opinion of the Court

16

and double the taxable costs, as defined in A.R.S. § 12-332, 

incurred by the offeror after making the offer and 

prejudgment interest on unliquidated claims to accrue from 

the date of the offer.

The Staffords argue an offer of judgment must be “at least arguably 

reasonable . . . compared with a lawsuit’s probable damages” to warrant 

imposition of sanctions under Rule 68, and to hold otherwise impermissibly 

allows the offeror to benefit from a “no-risk offer.” We disagree.

¶43 The Staffords rely on a Seventh Circuit Court of Appeals 

decision, August v. Delta Airlines, Inc., 600 F.2d 699 (7th Cir. 1979), to support 

their position. This case is not persuasive for several reasons. First, the 

holding in August, allowing the trial court to exercise discretion whether to 

allow a defendant to recover costs under Federal Rule 68, was specifically 

limited to cases brought under Title VII of the Civil Rights Act of 1964, 42 

U.S.C. §§ 2000e to e-17. See August, 600 F.2d at 700, 702 (“[W]e believe that 

a liberal, not a technical, reading of Rule 68 is justified, at least in a Title VII 

case. We need not decide whether this same approach should be taken in 

other kinds of cases.”). In reaching its conclusion, the Seventh Circuit Court 

of Appeals contraposed the plain language of the rule and the federal policy 

of encouraging aggrieved individuals to seek redress for violations of their 

civil rights, ultimately deciding “not . . . to permit a technical interpretation 

of a procedural rule to chill the pursuit of that high objective.” Id. at 701. 

No similar overarching goal is at issue in this tort action. Additionally, 

Federal Rule of Civil Procedure 68 is materially different than the Arizona 

correlate because it does not authorize an award of costs where judgment 

is entered in favor of the defendant, as occurred in the immediate case. See 

Fed. R. Civ. P. 68(a) (authorizing only “a party defending against a claim” 

to make an offer of judgment), (d) (requiring the offeree to pay costs only if 

he obtains a less favorable judgment than the defending party’s unaccepted 

offer); Goldberg v. Pac. Indem. Co., 627 F.3d 752, 756-57 (9th Cir. 2010) (noting 

Federal Rule 68 does not allow recovery where judgment is entered in favor 

of the defendant). 

¶44 Moreover, Arizona courts have uniformly held, consistent 

with the rule’s plain language, that sanctions imposed by Rule 68(g) are 

both mandatory and punitive. See Ariz. R. Civ. P. 68(g) (stating “the offeree 

must pay, as a sanction, reasonable expert witness fees and double the 

taxable costs”) (emphasis added); Arellano v. Primerica Life Ins., 235 Ariz. 

371, 381, ¶ 48 (App. 2014); Levy, 215 Ariz. at 445, ¶ 8; Davis v. Disc. Tire Co., 

182 Ariz. 571, 573-74 (App. 1995). We are reluctant to stray from this plain 

language. See Robertson v. Alling, 237 Ariz. 345, 347, ¶ 10 (2015) (“When a 
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Opinion of the Court

17

rule’s language is unambiguous, we apply it as written.”) (citing SalazarMercado, 234 Ariz. at 592, ¶ 4). The Staffords urge us to do so as a matter of 

public policy. However, we find the policy behind Rule 68(g) — to promote 

settlement and avoid protracted, unnecessary litigation, see, e.g., Warner v. 

Sw. Desert Images, L.L.C., 218 Ariz. 121, 138, ¶ 57 (App. 2008) (citing Wersch 

v. Radnor/Landgrant-A Phx. P’ship, 192 Ariz. 99, 102 (App. 1997)) — will not 

be served by judicially grafting additional requirements onto the offer. A 

reasonableness requirement would only increase the cost of litigation by 

inviting the expenditure of time to resolve an offer’s validity, driving the 

parties’ settlement positions further apart. See Brown v. Valley Nat’l Bank of 

Ariz., 26 Ariz. App. 538, 540-41 (1976) (“Public policy is better served by 

encouraging settlements in proper cases rather than to encourage 

continuing litigation in the courts.”) (quoting Broadway Plan v. Ravenstein, 

364 S.W.2d 741, 744 (Tex. Civ. App. 1963)).

¶45 Ultimately, it is solely within the purview of the parties to 

prudently evaluate their causes of action and defenses and the potential 

risks and benefits of proceeding to trial. If the defendant/offeror 

underestimates his exposure and the plaintiff/offeree obtains a more 

favorable judgment — even by a single dollar — the offeror stands liable 

for costs and expert witness fees. Likewise, if the plaintiff/offeror 

exaggerates his likelihood of success by presenting an offer the other party 

perceives as too high, the defendant/offeree need only work to obtain an 

award of damages against him that is less than the offer — again, by a single 

dollar. The offeror should not be punished for investing in the necessary 

calculation to determine, correctly, the existence and extent of his financial 

exposure at trial. Nor should the offeree benefit from his failure to properly 

value a case or be permitted, after the verdict is returned, to argue either 

what was “reasonable” so as to justify his refusal to accept the offer or, 

alternatively, to make some belated and collateral assertion of what the jury 

should have awarded.

¶46 Accordingly, we decline to impose a requirement that offers 

of judgment be deemed reasonable before sanctions are imposed under 

Rule 68(g). That other jurisdictions have held otherwise does not vitiate 

Arizona’s interest in encouraging settlement, nor change our analysis. 
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Opinion of the Court

18

CONCLUSION

¶47 For the foregoing reasons, we accept jurisdiction and deny 

relief.