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Leiker v. Gafford :: 1989 :: Kansas Supreme Court Decisions :: Kansas Case Law :: Kansas Law :: US Law :: Justia
Justia › US Law › Case Law › Kansas Case Law › Kansas Supreme Court Decisions › 1989 › Leiker v. Gafford
245 Kan. 325 (1989)
778 P.2d 823
SHAWN A. LEIKER, a disabled person, by and through James S. Leiker, her husband and next friend; JAMES S. LEIKER, individually, and as parent and natural guardian of JASON SCOTT LEIKER and JENNIFER ANN LEIKER, minors, and as Special Administrator of the Estate of Shawn A. Leiker, deceased, Appellees and Cross-Appellants, v. WENDELL P. GAFFORD; PROFESSIONAL ANESTHESIA, INC., a corporation; GEORGE W. MARSHALL, M.D.; HARRIS, HODGES & MARSHALL, Chartered, a Professional corporation; and ABBOTT LABORATORIES, a corporation, Appellants and Cross-Appellees.
Charles D. Green, of Arthur, Green, Arthur, Conderman & Stutzman, of Manhattan, argued the cause and was on the briefs for appellants/cross-appellees George W. Marshall, M.D., and Harris. Hodges & Marshall, Chtd.
Larry Shoaf, of McDonald, Tinker, Skaer, Quinn & Herrington, P.A., of Wichita, argued the cause and Vincent A. Burnett, of the same firm, was with him on the briefs for appellant Wendell P. Gafford.
Ronald D. Heck, of Fisher, Heck & Cavanaugh, P.A., of Topeka, appeared for appellant Professional Anesthesia, Inc.
Richard C. Hite, of Kahrs, Nelson, Fanning, Hite & Kellogg, of Wichita, argued the cause and Charles E. Hill and Dennis V. Lacey, of the same firm, were with him on the briefs for appellee/cross-appellant Abbott Laboratories.
Bradley Post, of Post & Syrios, of Wichita, argued the cause and Arden J. Bradshaw, of Wichita, and Robert E. Keeshan, of Hamilton, Peterson, Tipton & Keeshan, of Topeka, were with him on the briefs for appellees/cross-appellants Shawn A. Leiker, James S. Leiker, Jason Scott Leiker, and Jennifer Ann Leiker.
Ronald P. Williams and Susan G. Saidian, of Morrison, Hecker, Curtis, Kuder & Parrish, of Wichita, were on the brief for amicus curiae Kansas Association of Defense Counsel.
Shawn A. Leiker sustained personal injuries on January 28, 1982, as a result of an excessive dose of spinal anesthetic while she was undergoing a cesarean section delivery of her second *328 child. She remained semi-comatose until her death on December 14, 1987. This personal injury and wrongful death action was brought by her husband, James S. Leiker, individually, as a representative of her estate, and on behalf of their two children.
The defendants are Wendell P. Gafford, the certified registered nurse anesthetist (CRNA) who administered the spinal anesthesia, and his professional corporation Professional Anesthesia, Inc.; George W. Marshall, M.D., the obstetrician, and his professional corporation Harris, Hodges & Marshall, Chtd.; and Abbott Laboratories (Abbott), a corporation, the manufacturer of the anesthetic drug. At the close of the plaintiffs' evidence, the trial court entered a directed verdict in favor of Abbott. After defendants Gafford and Marshall presented their evidence, the jury determined that Gafford was 90% at fault and Marshall 10% at fault for Shawn Leiker's injuries and resulting death. The jury also found specifically that Marshall was legally responsible for one or more of the acts of Gafford which caused the injury and death.
(1) Did the trial court err in instructing the jury on the issue of informed consent? (2) Did the trial court err in allowing the jury to award damages for loss of enjoyment of life as a separate category of compensable damages? (3) Did the trial court err in allowing the jury to award damages for pain and suffering under the circumstances of this case? (4) Did the trial court err in failing to grant a new trial on the ground that the jury verdict was excessive and was rendered under passion and prejudice? (5) In the alternative, did the trial court err in failing to grant a substantial remittitur of the award of damages? (6) Did the trial court err in refusing to instruct the jury that *329 there is no presumption of negligence by reason of an adverse result and that a medical practitioner is presumed to have carefully and skillfully treated his patient? (7) Did the trial court err in instructing the jury on the following claims of negligence against Dr. Marshall, on the basis of alleged insufficient expert testimony to support these claims: (a) Whether Marshall failed to supervise administration of the anesthetic as directed by K.A.R. 28-34-17(p); (b) whether Marshall was liable for failure to confer with Gafford on the anesthetic drug and dosage before the surgery; (c) whether Marshall was liable for failing to require adequate fluid preload; (d) whether Marshall was liable for not being present in the operating room when Gafford commenced the anesthesia procedure; (e) whether Marshall was liable for failing to detect, diagnose, and promptly treat his patient's distress resulting from the anesthetic; and (f) whether Marshall was liable for failing to promptly and properly resuscitate his patient? (8) Are Marshall and his professional corporation vicariously liable for Gafford's negligence and, if so, to what extent? (9) Did the jury instructions incorrectly set forth the appropriate duty owed by Gafford and allow the jury to set a standard of its own rather than to rely upon expert testimony? (10) Did the trial court err in applying K.S.A. 1988 Supp. 60-1903 to reduce the award of nonpecuniary damages for wrongful death, on the ground that the statute is unconstitutional? (11) Did the trial court erroneously grant Abbott's motion for a directed verdict at the close of the plaintiffs' case, for any of the following reasons: (a) The trial court's ruling deprived plaintiffs of their right to a jury trial; (b) Abbott Laboratories was negligent per se and the negligence caused plaintiffs' injury; (c) the court erred in holding as a matter of law that *330 Abbott Laboratories had no duty to give an adequate warning regarding its anesthetic drug; (d) the court erred in overlooking evidence in the record opposing the motion and instead searching the record for evidence to support it; (e) the court erred in deciding as a matter of law what Gafford knew or should have known about the anesthetic drug; (f) the court erred in holding as a matter of law that plaintiffs were bound by selected testimony of adverse witnesses; (g) the court erred in holding that the conduct of Marshall and Gafford could insulate Abbott from liability; and (h) the court erred in holding as a matter of law that Abbott had no duty to warn Marshall as the treating obstetrician? (12) Was Abbott Laboratories' 1987 package insert inadmissible pursuant to K.S.A. 1988 Supp. 60-3307? (13) Did the prejudice to Abbott from admitting the 1987 package insert far outweigh any probative value it may have had against Marshall and Gafford?
In the early morning of January 28, 1982, Shawn went into labor. Dr. Marshall verified that Shawn was in active labor at *331 about 10:00 a.m. at his office, and proceeded to schedule the cesarean section with the hospital. Marshall was informed that Dr. Stoskopf was involved in another surgical procedure that would take the rest of the day. He was informed that Gafford, a CRNA, had just finished a case and was available. Marshall went to the hospital, found Gafford, and asked him to handle the Leiker case. Marshall had worked with Gafford before and had confidence in his ability.
*332 Evidence presented by expert testimony and accepted medical texts and treatises overwhelmingly indicated that 15 mg. of tetracaine, administered as a spinal anesthetic in a cesarean section operation, was a massive overdose which caused Shawn Leiker's injuries and ultimate death.
*333 I. APPEAL OF DEFENDANTS MARSHALL AND GAFFORD
"In the absence of an emergency a physician or surgeon has a legal obligation to make a disclosure of the risks and dangers incident to a proposed medical or surgical procedure in order that his patient may make an informed consent thereto, but the duty of the physician is limited to those disclosures which a reasonable medical practitioner would make under the same or similar circumstances. "What is a reasonable disclosure upon which an informed consent may rest depends upon the facts and circumstances of each case. "The burden of proof is upon the plaintiff to establish that sufficient information was not disclosed to the patient upon which to rest an informed consent. It is further their burden, before legal liability can be based on such nondisclosure, to establish that the patient, more probably than not, would have refused the procedure had adequate information been disclosed and that, therefore the injury would not have occurred."
The evidence as to whether Shawn was properly advised of the risks of the proposed anesthesia was disputed. Marshall and *334 Gafford contended Shawn had been properly advised during her prenatal care and at the hospital. On the other hand, James Leiker testified he could not recall either Marshall or Gafford explaining anything about the complications or risks accompanying the proposed procedure, either when James accompanied Shawn to her prenatal care visits or at the hospital. While both James and Shawn signed a consent form shortly before the anesthetic was administered, he testified no one explained anything about the risks involved. The evidence did not conclusively establish that Marshall and Gafford made any disclosures. It was therefore a question for the jury whether ascertainable disclosures had been made by the defendants in the first place. Natanson v. Kline, 187 Kan. 186, 190, 354 P.2d 670 (1960).
Defendants Gafford and Marshall both argue that the trial court erred in instructing the jury that loss of enjoyment of life is compensable under Kansas law as a separate category of nonpecuniary *335 or noneconomic damages for personal injury. Amici Kansas Association of Defense Counsel, Kansas Medical Society, and Kansas Hospital Association also contend that loss of enjoyment of life is not separately compensable under Kansas law. The plaintiffs urge this court to adopt what they call the majority rule by recognizing loss of enjoyment of life as a separate category of compensable harm for which damages may be recovered.
"If it is necessary under the instructions and the directions on the verdict form to fix the loss on the personal injury claims of Shawn A. Leiker, you will then determine the amount of recovery. You should allow such amount of money as will reasonably compensate the Estate of Shawn A. Leiker for her injuries and losses resulting from the occurrence in question, including any of the following shown by the evidence: "a) Pain, suffering, disabilities, or disfigurement, and any accompanying mental anguish suffered by Shawn A. Leiker up to the time of her death. "b) Loss of enjoyment of life and the capacity to enjoy life, suffered by Shawn A. Leiker up to the time of her death. "c) Loss of time and income, and earning capacity, by reason of her disabilities up to the time of her death. "d) The reasonable expenses of necessary medical care, hospitalization, custodial care, and treatment received before her death. "e) Fair and reasonable compensation for the loss and impairment of Shawn A. Leiker's ability to perform services as a wife to her husband, resulting from her injuries, including loss and impairment of plaintiff's services to her husband in the discharge of her domestic and household duties, and the loss and impairment of Shawn A. Leiker's companionship, aid, assistance, comfort, and society to her husband James S. Leiker." (Emphasis added.)
a. Pain and suffering                     150,000
b. Disability                             150,000
c. Disfigurement and any accompanying
mental anguish                         150,000
d. Loss of the enjoyment of life          150,000
e. Loss of time and income, and earning
capacity                               100,000
f. Reasonable expenses of necessary
medical care, hospitalization,
custodial care and treatment           400,000
g. Loss and impairment of services to
husband James S. Leiker                150,000."
"This court, after careful consideration of the entire subject, has concluded to hold that loss of enjoyment resulting from being unable to play the violin is too speculative and conjectural to form a sound basis for the assessment of damages. It is well to bear in mind the jury allowed [$1,000] separately for pain and suffering resulting from the injury. That item is not in dispute. It will also be well to observe the jury allowed nothing for loss of earnings.... "Plaintiff urges that in question 11(6) she might just as well have asked how much the jury allowed for permanent injury, and the element of loss of enjoyment from being unable to play the violin would have been included therein.... Furthermore, question 11(6) leaves this court no room to say the *337 $4,000 or any part thereof was awarded for permanent injury. That question is clear, and an award for permanent injury cannot be read into it. Then, too, even though the court should be inclined to consider the $4,000 item as having been intended to include permanent damages, the court would have no possible way of determining how much thereof was allowed for permanent injuries. It follows the judgment must be modified by a reduction in the sum of $4,000. Otherwise the judgment will be affirmed." 148 Kan. at 729-30.
In other cases, this court has implied in dicta that loss of enjoyment may at least be considered one factor in awarding damages. See Tos v. Handle, 209 Kan. 139, 141, 495 P.2d 896 (1972), and Railroad Co. v. Chance, 57 Kan. 40, 48, 45 Pac. 60 (1896). We conclude that the issue is an open question before this court and that Hogan is not controlling.
*338 (A) Pain and suffering,
(C) disfigurement, and any accompanying mental anguish; (2) reasonable expenses of necessary medical care, hospitalization and treatment received; and (3) economic injuries and losses other than those itemized under subsection (a)(2)."
Much has been written in recent years on the issue of whether *339 damages are recoverable for loss of enjoyment of life, sometimes referred to as hedonic damages, as a separate category of damages or as a component of the more traditional categories of pain and suffering and/or disability. See, e.g., Hermes, Loss of Enjoyment of Life Duplication of Damages Versus Full Compensation, 63 No. Dak. L. Rev. 561 (1987); Hilton and Goldstein, Damages for the Loss of Enjoyment of Life in Personal Injury Cases, 30 For The Defense, Nov. 1988, at 2; Staller, Placing a Value on the Enjoyment of Life, 31 For The Defense, June 1989, at 8; Annot., Loss of Enjoyment of Life as a Distinct Element or Factor in Awarding Damages for Bodily Injury, 34 A.L.R.4th 293.
One of the strongest arguments that has been advanced as a reason for not recognizing loss of enjoyment of life as a separate category of damages is that it duplicates or overlaps other categories of damages, such as permanent disability or pain and suffering. See, e.g., Huff v. Tracy, 57 Cal. App. 3d 939, 943, 129 Cal. Rptr. 551 (1976); Swiler v. Baker's Super Market, Inc., 203 Neb. 183, 187, 277 N.W.2d 697 (1979); Flannery v. United States, 297 S.E.2d 433, 438 (W. Va. 1982). See generally Hermes, 63 No. Dak. L. Rev. 561. However, loss of enjoyment of life is arguably distinct from pain and suffering. Comment, Loss of Enjoyment of Life as a Separate Element of Damages, 12 Pac. L.J. 965, 972-73 (1981). It is also arguably distinct from loss due to disability. In Thompson v. National R.R. Passenger Corp., 621 F.2d 814 (6th Cir.1980), cert. denied 449 U.S. 1035 (1980), the court distinguished some of the different types of damages resulting from physical injury as follows:
Valid arguments can be made to support all three lines of cases *340 which have considered damages for loss of enjoyment of life in personal injury cases. Nothing would be gained by reviewing the various cases, most of which are discussed in the Hermes article and the recent annotation in 34 A.L.R.4th 293. This court must now determine which of the various theories should be recognized in Kansas. We think the more realistic approach as a general rule is that loss of enjoyment of the pleasurable things in life is inextricably included within the more traditional areas of damages for disability and pain and suffering. While it is true that a person may recover from the physical pain of a permanent injury, the resultant inability to carry on one's normal activities would appear to fall within the broad category of disability. In the majority of cases loss of enjoyment of life as a separate category of damages would result in a duplication or overlapping of damages. Our holding on this issue is consistent with what appears to be a slight majority of the cases which have considered the various arguments and it is also consistent with the wording of K.S.A. 1988 Supp. 60-249a. However, we also point out that evidence of loss of enjoyment of life is definitely admissible and proper for the jury's consideration as it relates to disability and pain and suffering, and may certainly be argued by counsel to the jury.
We now turn to the question of whether the instruction in the present case constitutes reversible error. We find that it does not. Shawn Leiker remained in a semi-comatose condition for nearly six years and was totally deprived of all aspects of normal living *341 the entire time. The jury was carefully instructed by the learned trial judge, and the parties argued Shawn's loss of enjoyment of life as a separate and distinct category of damages. The verdict form listed "Loss of enjoyment of life" as a separate item of damages, for which the jury allowed $150,000. In Andrews v. Mosley Well Service, 514 So. 2d 491 (La. App. 1987), an award of $75,000 for "loss of enjoyment of life" was challenged as a duplication of pain and suffering. The appellate court affirmed the judgment and stated as one of its reasons the trial court's instruction on the issue. Under all the facts of this case, we do not think the jury could have possibly been misled or that the itemized verdict included any overlapping or duplication. The jury was instructed to consider loss of enjoyment of life separate and apart from any award for pain and suffering or disability. Considering the horrendous loss suffered by Shawn Leiker, the relatively modest award for six years' loss of any meaningful living belies any duplication in the damages awarded. Under the facts and circumstances of this case, we hold the instruction on the loss of enjoyment of life as a separate category of damages was harmless error which does not require or justify reversal.
A party may not assign as error the giving or failure to give an instruction unless he objects to the instruction and states the specific grounds for the objection. Absent such an objection, an *342 appellate court may reverse only if the trial court's instruction was clearly erroneous. K.S.A. 60-251(b); Nail v. Doctor's Bldg., Inc., 238 Kan. 65, 67, 708 P.2d 186 (1985). K.S.A. 1988 Supp. 60-249a(c) provides that the trial court in a personal injury action shall instruct the jury only on those items of damage upon which there is "some evidence" to base an award. Thus, if there was any evidence to support an award for pain and suffering, it was not clearly erroneous to instruct the jury that it could award such damages in compensation.
Kansas generally follows the majority rule that damages are recoverable only for pain and suffering which is consciously experienced. Nichols v. Marshall, 486 F.2d 791, 793 (10th Cir.1973) (applying Kansas law); Fogarty v. Campbell 66 Exp., Inc., 640 F. Supp. 953, 963 (D. Kan. 1986); Folks v. Kansas Power & Light Co., 243 Kan. 57, 69, 755 P.2d 1319 (1988); Fudge v. City of Kansas City, 239 Kan. 369, 380, 720 P.2d 1093 (1986); Pape v. Kansas Power & Light Co., 231 Kan. 441, 448, 647 P.2d 320 (1982). See generally 22 Am.Jur.2d, Damages §§ 241, 249. The defendants argue that the plaintiffs offered insufficient competent evidence to support an instruction permitting an award for pain and suffering, because of lack of medical or empirical evidence that Shawn Leiker realized or was aware of any pain and suffering.
*343 In Pape v. Kansas Power & Light Co., 231 Kan. 441, the decedent suffered severe injuries as a result of accidental electrocution. He died ten days later. The jury award included $2,000 for pain and suffering. On appeal, the defendant contended that plaintiffs' evidence was insufficient to show the decedent experienced conscious pain and suffering before his death. This court concluded:
In Fudge v. City of Kansas City, 239 Kan. 369, the decedent was injured in a motor vehicle collision and died twenty days later of the injuries he sustained in the accident. His wife and children brought a wrongful death and personal injury survival action against the other driver and the City of Kansas City. The jury award included $50,000 for pain, suffering, disabilities, or disfigurement and any accompanying mental anguish. Defendants contended on appeal that the evidence did not support the $50,000 award. They argued that the decedent lost consciousness a few minutes after the collision and never regained consciousness, and that medical records showed he did not respond to stimuli. The defendants presented testimony by a physician that Fudge was in such a deep state of unconsciousness that he could not have felt pain. Ambulance records showed that Fudge had lapsed in and out of consciousness for a ten-minute period after the accident. Fudge's mother-in-law testified that, three days after the accident, he squeezed her fingers twice in response to things she told him about his children, and that he did so two or three more times before he died. This court concluded that the issue was controverted, presenting a fact issue for the *344 jury. 239 Kan. at 380. It is apparent that the plaintiffs in Fudge satisfied their burden of proof without either medical records or expert medical testimony in their favor.
In Folks v. Kansas Power & Light Co., 243 Kan. 57, the decedent was fatally injured when a metal ladder he was using came into contact with defendant's power line. His surviving spouse and minor children brought a wrongful death and survival action. The jury awarded the estate $10,000 for pain and suffering. On appeal, KPL argued there was no competent evidence that Folks was conscious after the accident, and therefore the award for pain and suffering was improper. This court disagreed, citing Pape for its holding that, under Kansas law, lay witness testimony is admissible on the issue of consciousness. The court concluded:
The plaintiffs presented evidence through Dr. Marshall, as an adverse witness, that Shawn flinched the day following the *345 surgery when he applied skin clips to her incision. Hospital records stated that Shawn opened her eyes when her name was called and in response to physical stimuli. By early April 1982, hospital records revealed that she exhibited "increased response to painful stimuli," and consistently opened her eyes to verbal and tactile stimuli. In July 1982, hospital records indicated that, when presented with a painful stimulus, she would withdraw an extremity, flinch, or vocalize. She frequently smiled when spoken to and in response to pleasant activity and discussions. She exhibited a startled reaction in response to a sudden noise or unexpected touch.
Plaintiffs also presented testimony of Dr. William Cathcart-Rake, an internist who attended Shawn from March 1982 until her death. He testified that, although Shawn had suffered brain damage from lack of oxygen, she did have some brain function, although he could not say how much. On cross-examination, Dr. Cathcart-Rake testified regarding the information he recorded in March 1982, on Shawn's admission to St. John's Hospital. He noted that Shawn had not regained consciousness following resuscitation efforts, and that she was comatose at that time. An EEG was performed on March 29, 1982, showing gross abnormalities consistent with "super coma." On his discharge summary written in July 1982, Dr. Cathcart-Rake again noted that Shawn never regained consciousness following the acute event, and that she would likely remain in a persistent vegetative state. In his neurological examination, he noted "slight responsiveness to painful stimuli." At trial he testified that her response to painful stimuli had included a slight decerebrate movement of the right leg and arm, which he defined for the jury as an *346 involuntary reflex type of movement. He testified that Shawn did not seem to be responsive to outside stimuli, and that, although he was not a neurologist, as far as he knew defense counsel was correct in suggesting "she would not feel a thing on a cognitive level." He also testified that he had not read all of the observations noted in the hospital records by Shawn's nurses and physical therapists.
Defendants argue in this appeal that plaintiffs' lay witness testimony regarding Shawn Leiker's responses is not competent evidence to support a finding that Shawn could consciously experience pain and suffering. As plaintiffs point out in response, however, this court has recently held that lay witness testimony is admissible on the issue of the degree of consciousness required to support damages for pain and suffering. Folks v. Kansas Power & Light Co., 243 Kan. at 69. In Nichols v. Marshall, 486 F.2d at 793, the court held that lay witnesses are competent to report what they observe without offering medical opinions as to the consciousness of the deceased, and where the evidence is conflicting the issue is properly one for the jury. Lay witness testimony was deemed sufficient by this court in Fudge and Folks to create a jury question on the consciousness issue. The evidence of whether Shawn suffered any conscious pain and suffering was clearly conflicting and therefore presented a proper issue for the jury.
Nonpecuniary damages                                         $2,000,000
Pecuniary damages                                             1,000,000
Funeral expenses                                                  3,100
The trial court subsequently reduced the wrongful death award for nonpecuniary damages from $2,000,000 to $100,000 pursuant to K.S.A. 1988 Supp. 60-1903(a). Hence, although the jury verdict *347 totalled $3,003,100, judgment was entered for the heirs in an amount of $1,103,100 on the wrongful death claim.
Based upon the facts presented in the case before us, the amount of the jury verdict does not shock the court's conscience. *348 The jury awarded $1,250,000 to Shawn Leiker's estate to compensate for the personal injuries and accompanying noneconomic losses she incurred throughout the period of nearly six years before she died, as a result of the defendants' negligence. The jury award to her heirs for wrongful death, as remitted by the court pursuant to statute, totalled $1,103,100, including $1,000,000 for pecuniary loss. The amount for pecuniary loss included compensation to the two small children for their loss of parental care and attention, loss of maternal training and guidance, and loss of financial support the decedent would have provided them had she lived. It also included compensation to James Leiker, Shawn's husband, for loss of attention, care, and services, and for loss of earnings she would have provided. Wentling v. Medical Anesthesia Services, 237 Kan. 503, 507-09, 701 P.2d 939 (1985); K.S.A. 1988 Supp. 60-1904. There was testimony by plaintiffs' expert witness that a conservative estimate of the present value of Shawn's anticipated lifetime earning capacity alone exceeded $1,000,000. The expert also testified that the present value of the household and family care services she would have provided between ages 24 and 70 was $556,335. He reduced the totals by $213,303 as the estimated present value of Shawn's lifetime personal consumption, concluding that the total pecuniary loss for earning capacity and household and family care services was $1,633,055. There was sufficient evidence to support the jury verdict of $1,000,000 for pecuniary loss in the wrongful death action. For nonpecuniary loss to the heirs for Shawn's wrongful death, the statutory maximum of $100,000 is not an excessive sum to compensate her husband and two small children for mental anguish, bereavement, loss of society, and loss of companionship resulting from her death.
*349 The plaintiffs in this action suffered a total disruption of their lives for a period of nearly six years. The survivors have continued to suffer the loss of a wife and mother. Shawn remained in a comatose or semi-comatose condition throughout that entire time, and was deprived of every enjoyable element of living. The judgments do not shock the conscience of this court and, as they are amply supported by the evidence, the defendants' requests for a new trial or a substantial remittitur must be denied.
Under these circumstances, an instruction that a "physician or surgeon is presumed to have carefully treated or operated on his *350 patient and there is no presumption of negligence from the fact of an injury or adverse result" could have misled the jury into believing that the plaintiffs' burden of proof was greater than a preponderance of the evidence. The defendants cite no case holding that the failure to so instruct constitutes reversible error, nor has our research disclosed any such case.
`All anesthetics shall be given by a physician or shall be given under the supervision of a physician.' "The word `supervision' in this context is to be given its usual and ordinary meaning. The Random House Dictionary of the English Language - Second Edition - Unabridged - Copyright 1987, gives the following definitions:
`supervising: to oversee (a process, work, workers, etc.) during execution or performance; superintend; have the oversight and direction of.' "In determining whether the defendants complied with the requirements of this law you may consider all the evidence in the case introduced on that point. The burden on this issue is upon the plaintiff. If you find that either or both Marshall or Gafford failed to comply with the requirement, you must further find that had they complied more probably than not, Shawn A. Leiker would not have sustained injury and death."
Gafford timely objected to both instructions before the trial court. However, most of the numerous arguments advanced by *351 Gafford in his brief were not raised below. At trial, Gafford objected to Instruction No. 11 simply as being "too encompassing." Counsel argued that the instruction should have indicated that a nurse anesthetist is to be judged by the same standards as an anesthesiologist, not a "physician or surgeon." When Gafford objected to Instruction No. 17, counsel simply adopted the arguments that had previously been raised about that instruction by Marshall. Marshall objected to Instruction No. 17 on the basis that it provided a dictionary definition of the word "supervision" rather than deferring to expert medical testimony for the purpose of determining whether there was a failure to supervise. To the extent that Gafford raises other arguments not presented to the trial court, they may not serve as the basis for assigning error unless the instruction was clearly erroneous. Tetuan v. A.H. Robins Co., 241 Kan. at 467; K.S.A. 60-251.
The only objection asserted by Gafford to Instruction No. 17 was to adopt Marshall's previous contention that it failed to limit the jury to expert testimony in determining whether Gafford administered the anesthetic under the "supervision" of Marshall. Gafford argues that the "abstract concept" of supervision of *352 one professional by another, within the specialized environment of the hospital operating room, is not within the common knowledge of the public generally. He argues that it was erroneous to provide the jury with a dictionary definition of the term "supervise" instead of directing the jury to consider the question on the basis of pertinent expert testimony, which was plentiful in this case.
The general standard of care required of a doctor is that he possess the reasonable degree of learning and skill ordinarily possessed by members of the profession and of his particular school of medicine in the community where he practices, or in similar communities, and that he will use such learning and skill in treating his patient with ordinary care and diligence. Karrigan v. Nazareth Convent & Academy, Inc., 212 Kan. 44, 49, 510 P.2d 190 (1973); Goheen v. Graber, 181 Kan. 107, ¶ 1. In the instant case, Instruction No. 17 was given on the assumption that K.A.R. 28-34-17(p) imposes a duty on physicians to supervise the administration of anesthesia by non-physicians working under their control. At oral argument before this court, counsel for Dr. Marshall candidly admitted that the regulation was applicable to Marshall.
*353 Marshall concedes there was expert medical evidence on the question of whether he complied with the alleged obligation to supervise Gafford's administration of the anesthesia. However, he argues that expert testimony was needed to indicate the specific obligations imposed on a surgeon by the supervision requirement of the regulation. We disagree. The specific duties falling under the general umbrella of "supervision" did not need to be detailed to the jury in order to permit an intelligent decision on whether Marshall failed to supervise the administration of anesthesia in this case. There was conflicting testimony from expert witnesses as to whether Marshall appropriately supervised Gafford. In addition, it was undisputed that Marshall was waiting in the doctors' lounge while Gafford injected the anesthetic, and Marshall was not even present until after the procedure had been completed.
"The claims against George W. Marshall, M.D., and Harris, Hodges & Marshall, Chartered, are based on the failure of George W. Marshall, M.D. to comply *354 with standard medical practice which caused or contributed to the injuries and death of Shawn A. Leiker in one or more of the following particulars:
"3. Failure to determine the proper amount of tetracaine to be administered for cesarean section and to prevent defendant Gafford from administering an overdose thereof. "4. Failure to be present when defendant Gafford commenced the anesthesia procedure on Mrs. Leiker. "5. Failure to monitor fluid intake and require an adequate pre-load.
"7. Failure to detect, diagnose, and promptly treat Shawn A. Leiker's distress during and after the cesarean section. "8. Failure to promptly and properly resuscitate Shawn A. Leiker."
"The plaintiffs have the burden to prove their claims of medical negligence of the defendants and that they caused or contributed to the injury and death of Shawn A. Leiker before damages can be recovered. To sustain this burden, it is not necessary that they establish each claim of medical negligence only that as to each defendant, one or more of those claims be proved. "The defendants all deny that they committed any acts of medical negligence as alleged by the plaintiffs which caused or contributed to the injury and death of Shawn Leiker."
*355 Instruction No. 2, commonly referred to as the issues instruction, essentially informed the jury that plaintiffs claimed Marshall was negligent for failing to comply with standard medical practice, which in turn allegedly caused injury and death to Shawn Leiker. Marshall has not shown that he was prejudiced just because the instruction listed the specific allegations of fault claimed by the plaintiffs. At the end of the instruction, the jury was informed that the plaintiffs were not required to establish each specific claim of medical negligence in order to meet their burden of proof but that they must prove one or more to the satisfaction of the jury. The jury was also provided Instruction No. 9, which required the jury to defer to expert medical testimony in determining whether the standard of care had been met on questions of a medical or scientific nature. When read in context and in conjunction with the other jury instructions, Instruction No. 2 was not clearly erroneous. We conclude the trial court did not commit error in instructing the jury on the alleged acts of negligence attributed to Marshall.
Vicarious liability is a term generally applied to legal liability which arises solely because of a relationship and not because of any actual act of negligence by the person held vicariously liable for the act of another. It is also referred to as imputed negligence or imputed liability. Vicarious liability depends upon the relationship of the parties, such as employer and employee or principal and agent. In such cases, the employer or principal is held liable for the negligent act of the employee or agent solely by reason of the relationship and not because the employer or *356 principal actually committed an act of negligence. For discussions of the distinction between vicarious liability and the independent liability of an employer or principal see Prosser and Keeton on Torts, ch. 12, §§ 69-71 (5th ed. 1984); 53 Am.Jur.2d, Master and Servant § 404 et seq.
"On your verdict form you will be required to determine whether or not defendant Gafford was the agent or servant of the defendant Marshall. "In determining whether a person is the servant of another, sometimes called the master, it is necessary that he not only be subject to the latter's control or right of control with regard to the work to be done and the manner of performing it, but that this work is to be performed on the business of the master or for his benefit. Actual control, of course, is not essential. It is the right to control which is determinative. "In determining whether or not defendant Gafford was acting as agent for defendant Marshall, you are instructed that an agent is a person who, by agreement with another called the principal, performs or is to perform services for the principal, with or without compensation. The agreement may be written, oral, or implied by the behavior of the parties."
*357 "Instruction No. 14
This court went on to note that the determination of the right of control is a matter for the trier of fact. In addition, as mentioned *358 earlier, Marshall conceded at oral argument that K.A.R. 28-34-17(p) applied to him. We find no merit to this argument of Marshall.
Marshall asked the trial court to instruct the jury that, as a matter of law, Marshall and his professional corporation could not be vicariously liable for the misconduct of Gafford, citing the quoted statute. The trial court correctly noted that the personal injury action arose prior to the effective date of the statute, and therefore the statute, if applicable at all, could only apply to the wrongful death claim. The trial court noted that the issue of Marshall's liability for Gafford's negligence was being submitted to the jury on the theory of principal and agent, and that the parties could address the issue after the jury verdict if it made any difference in the outcome. Marshall argued in his motion for new trial that the statute did apply to the wrongful death claim. As noted earlier, Marshall made no request that the verdict form indicate the particular negligent acts of Gafford for which the jury found Marshall responsible. Likewise, there was no request that the jury specify the separate acts of negligence attributed by plaintiffs to Marshall. Absent any such requests, Marshall is in no position to assert reversible error in the verdict returned by the jury. See K.S.A. 60-249(a); Wozniak v. Lipoff, 242 Kan. 583, 593, 750 P.2d 971 (1988). Even though the jury found that Marshall was legally responsible for one or more acts of Gafford, it also apparently determined that Marshall was 10% at fault based on one or more independent acts of negligence attributed to Marshall. Certainly the evidence would support such findings. It would appear that the answer to the special question would only become relevant in the event Marshall was found 0% liable for his own actions or if Gafford was unable to respond for the fault *359 attributed to him. Then "vicarious" liability could arise based upon the principal and agent relationship discussed in Instruction No. 16 and the jury's finding. Under all of the facts and circumstances of this case, any error which may have occurred on this issue is indeed harmless.
"Amount of damages; jury instructions; itemized verdict. (a) In any wrongful death action, the court or jury may award such damages as are found to be fair and just under all the facts and circumstances, but the damages, other than pecuniary loss sustained by an heir at law, cannot exceed in the aggregate the sum of $100,000 and costs. "(b) If a wrongful death action is to a jury, the court shall not instruct the jury on the monetary limitation imposed by subsection (a) upon recovery of damages for nonpecuniary loss. If the jury verdict results in an award of damages for nonpecuniary loss which, after deduction of any amounts pursuant to K.S.A. 60-258a and amendments thereto, exceeds the limitation of subsection (a), the court shall enter judgment for damages of $100,000 for nonpecuniary loss."
Plaintiffs argue in their brief that the statute violates (1) the constitutional right to equal protection of the law under Sections 1 and 2 of the Bill of Rights of the Kansas Constitution and the equal protection clause of the Fourteenth Amendment to the United States Constitution; (2) the constitutional right to trial by jury as provided by Section 5 of the Kansas Bill of Rights and the Seventh Amendment to the United States Constitution; and (3) the constitutional right to remedy by due course of law under *360 Section 18 of the Kansas Bill of Rights. In their post-trial motion raising the constitutional issue before the trial court, plaintiffs challenged the statute on the basis of §§ 1, 5, and 18 of the Kansas Bill of Rights and the Fourteenth Amendment to the United States Constitution. To the extent that plaintiffs' arguments raise points not presented to the trial court, they are barred from presenting those points for the first time on appeal. Kansas Dept. of Revenue v. Coca Cola Co., 240 Kan. 548, 552, 731 P.2d 273 (1987).
A comparable statute was adopted by the first territorial legislature of the Kansas Territory effective November 1, 1855, and has been the law of Kansas, in one form or another, ever since. For an excellent history of the common law and its adoption and application in the State of Kansas see Clark v. Allaman, 71 Kan. 206, 80 Pac. 571 (1905), where the subject is discussed at length. In Clark, the court stated:
"It will not be denied that in every state particular rules of the common law, as it existed in England prior to the fourth year of the reign of James I, are not consciously regarded as binding; many others are consciously rejected, and new rules, the product of American conditions, departing widely from the English common law in fact, and quite indifferent to it in theory, became established and *361 must be recognized as of controlling authority. Rules of law have their birth, growth and decay, like generations of men, and in order to meet the expanding needs of the inhabitants of the young commonwealth the legislature enacted the statute of 1868 continuing in force the common law only as modified by constitutional and statutory law, judicial decisions, and the condition and wants of the people." 71 Kan. at 229-30.
In Gonzales, Administrator v. Atchison, T. & S.F. Rly Co., 189 Kan. 689, 695, 371 P.2d 193 (1962), the court said:
Plaintiffs' lengthy arguments are not persuasive. Neither the historical roots of the common-law rule precluding civil recovery for wrongful death, nor its possible lack of merit or logical basis, are relevant to the question before this court. For a comprehensive treatment of the subject, readers are directed to 1 Speiser, Recovery for Wrongful Death 2d, ch.1 (1975). Our cases are clear that, right or wrong, Kansas common law did not recognize a civil claim for wrongful death at the time our Bill of Rights was *362 adopted. See Goodyear, Administratrix, v. Railway Co., 114 Kan. 557, 561-62, 220 Pac. 282 (1923); City of Eureka v. Merrifield, 53 Kan. 794, 798-99, 37 Pac. 113 (1894); McCarthy, Adm'r, v. Railroad Co., 18 Kan. 46, 48 (1877). The cause of action for wrongful death is purely a creature of statute in Kansas. Since there was no cause of action for wrongful death at common law, neither § 5 nor § 18 of the Bill of Rights can be invoked to challenge the constitutionality of either the $100,000 limitation on nonpecuniary damages resulting from wrongful death, or the prohibition against informing the jury of the statutory limit.
Nor may plaintiffs invoke the right to jury trial as guaranteed by the Seventh Amendment to the United States Constitution. The Seventh Amendment has not been applied to the states through the Fourteenth Amendment. Colgrove v. Battin, 413 U.S. 149, 169 n. 4, 37 L. Ed. 2d 522, 93 S. Ct. 2448 (1973) (Marshall, J., dissenting), and cases cited therein; Walker v. Sauvinet, 92 U.S. 90, 23 L. Ed. 678 (1875); First Nat'l Bank of Olathe v. Clark, 226 Kan. 619, 622, 602 P.2d 1299 (1979). It therefore applies only to limit actions of the federal government, and does not apply to state court proceedings.
Other parties have failed in their attempts in other jurisdictions to bypass statutory limitations on wrongful death damages by asking the court to recognize a cause of action at common law for wrongful death. See Butler v. Chicago Transit Auth., 38 Ill. 2d 361, 363, 231 N.E.2d 429 (1967); Hall v. Gillins, 13 Ill. 2d 26, 28-29, 147 N.E.2d 352 (1958); Jirsa v. Ice, 88 S.D. 209, 217 N.W.2d 465 (1974).
Equal protection analysis must begin with a determination of the applicable level of judicial scrutiny to be applied to a statute that distinguishes between classes of individuals. State ex rel. Schneider v. Liggett, 223 Kan. 610, 616-17, 576 P.2d 221 (1978). *363 Plaintiffs urge this court to apply a "heightened scrutiny" analysis in this case, as was done in the principal opinion of this court in Farley v. Engelken, 241 Kan. 663, 670-71, 740 P.2d 1058 (1987), apparently on the reasoning that the limit on nonpecuniary damages impinges on the fundamental right to a jury trial. Defendants and amici, however, argue that heightened scrutiny is inappropriate in the instant case. They contend that the traditional rational basis test should be applied. We agree. It may be noted that in Farley only two justices, one of whom is no longer on the court, adopted a heightened scrutiny test, while five justices recognized the rational basis test as being appropriate. We have already concluded that the constitutional right to a jury trial is not impinged by K.S.A. 1988 Supp. 60-1903(a) and plaintiffs offer no other reason for applying heightened scrutiny analysis. The statute does not create the kind of "suspect classification" that has triggered strict or heightened scrutiny by the United States Supreme Court. See Farley v. Engelken, 241 Kan. at 669-70; State ex rel. Schneider v. Liggett, 223 Kan. at 617; cf. Pollock v. Denver, 194 Colo. 380, 572 P.2d 828 (1977). The "reasonable basis" or "rational basis" test traditionally has been applied where equal protection challenges have been brought against social and economic legislation. McGowan v. Maryland, 366 U.S. 420, 425-26, 6 L. Ed. 2d 393, 81 S. Ct. 1101 (1961); Farley v. Engelken, 241 Kan. at 669. A statutory limitation on liability has been held a classic example of economic regulation. Duke Power Co. v. Carolina Env. Study Group, 438 U.S. 59, 83, 57 L. Ed. 2d 595, 98 S. Ct. 2620 (1978). A statutory limit imposed on nonpecuniary damages in wrongful death cases has been said to be designed at least in part to preclude a jury from awarding an excessive amount of damages out of sympathy for a decedent's family and would appear to fall under the general heading of social and economic legislation. Benton v. Union Pac. R. Co., 430 F. Supp. 1380, 1385-86 (D. Kan. 1977); 1 Speiser, Recovery for Wrongful Death 2d §§ 7:1, 7:4.
The "reasonable basis" test is violated only if the statutory classification rests on grounds wholly irrelevant to the achievement of the State's legitimate objective. The state legislature is presumed to have acted within its constitutional power, even if the statute results in some inequality. Under the reasonable basis test, a statutory discrimination will not be set aside if any *364 state of facts reasonably may be conceived to justify it. McGowan v. Maryland, 366 U.S. at 425-26; Farley v. Engelken, 241 Kan. at 669; State ex rel. Schneider v. Liggett, 223 Kan. at 616.
Other jurisdictions have upheld statutes imposing limits on damages for wrongful death over various constitutional arguments. See Pollock v. Denver, 194 Colo. 380 (equal protection); Butler v. The Chicago Transit Auth., 38 Ill. 2d 361 (equal protection); Goldstein v. Hertz Corp., 16 Ill. App.3d 89, 305 N.E.2d 617 (1973) (right to remedy for injuries); Glick v. Ballentine Produce Incorporated, 396 S.W.2d 609, 615-16 (Mo. 1965) (right to remedy for every injury, due process, and equal protection).
We now turn specifically to the argument that the statute violates the right to trial by jury because it prohibits the court from informing the jury about the cap on nonpecuniary damages. *365 Both Illinois and New Hampshire have similar provisions in their wrongful death statutes which provide that a jury shall not be informed of the statutory limitation. Ill. Rev. Stat. ch. 70 ¶ 2 (1987); N.H. Rev. Stat. Ann. § 556.13 (1974). New Hampshire has upheld its statute over various constitutional arguments and the contention that the jury must be advised of the limitations. Gibbs v. Prior, 107 N.H. 218, 220 A.2d 151 (1966). The New Hampshire court reasoned:
"Knowledge of a statutory limitation upon the amount of recovery is not essential to the proper performance of its task by the jury, nor is authority to impart that knowledge to a jury an essential attribute of the judicial power. Jurors may determine the guilt or innocence of a prisoner without being informed of the penalty for guilt. Like the court-made rule which keeps from the jury knowledge of the existence of insurance in automobile cases, the 1963 statute is designed to exclude from the trial considerations which may reasonably be thought unnecessary to performance of the jury's function, ordinarily irrelevant to the issues before it for decision, and sometimes fraught with the risk of misuse. We think the statute valid...." 107 N.H. at 221.
B. Abbott's Cross-Appeal Admission of Evidence
*366 At the close of plaintiffs' case in chief, the trial court sustained Abbott's motion for a directed verdict. Since a directed verdict was entered in favor of Abbott, and as we have determined that the judgment of the trial court must be affirmed, we conclude Abbott has no standing to pursue the cross-appeal. Gigot v. Cities Service Oil Co., 241 Kan. 304, 737 P.2d 18 (1987); Blank v. Chawla, 234 Kan. 975, 678 P.2d 162 (1984); In re Waterman, 212 Kan. 826, Syl. ¶ 7, 512 P.2d 466 (1973). We therefore decline to consider the issue further.