Case Name: Yata JACKSON, Individually, Troy Jackson, Individually, and Yata Jackson and Troy Jackson on Behalf of their Minor son, Troy Williams, II v. TULANE MEDICAL CENTER HOSPITAL AND CLINIC and its Employees, and Dabney J. Hamner, Jr., M.D. and ABC Insurance Company
Court: Louisiana Supreme Court
Jurisdiction: Louisiana
Decision Date: 2006-10-17
Citations: 942 So. 2d 509
Docket Number: No. 2005-C-1594
Parties: Yata JACKSON, Individually, Troy Jackson, Individually, and Yata Jackson and Troy Jackson on Behalf of their Minor son, Troy Williams, II v. TULANE MEDICAL CENTER HOSPITAL AND CLINIC and its Employees, and Dabney J. Hamner, Jr., M.D. and ABC Insurance Company.
Judges: CALOGERO, C.J., dissents for reasons assigned by WEIMER, J.
Reporter: Southern Reporter, Second Series
Volume: 942
Pages: 509–520

Head Matter:
Yata JACKSON, Individually, Troy Jackson, Individually, and Yata Jackson and Troy Jackson on Behalf of their Minor son, Troy Williams, II v. TULANE MEDICAL CENTER HOSPITAL AND CLINIC and its Employees, and Dabney J. Hamner, Jr., M.D. and ABC Insurance Company.
No. 2005-C-1594.
Supreme Court of Louisiana.
Oct. 17, 2006.
Rehearing Denied Dec. 15, 2006.
Weiss & Eason, Gregory C. Weiss, New Orleans, Elaine W. Selle, for Applicant.
Michael R. Guidry, New Orleans, Dwight Doskey, H. Muldrow Etheredge, Covington, for Respondent.

Opinion:
KIMBALL, J.
h We granted certiorari to determine whether the court of appeal erred when it declared manifestly erroneous a jury's determination that defendants in a medical malpractice case did not breach the standard of care in their treatment of plaintiff. For the reasons that follow, we find that the evidence supports the jury's findings, and the court of appeal erred when it substituted its view of the evidence for that of the jury. Accordingly, we reverse the judgment of the court of appeal and reinstate the judgment of the trial court.
FACTS AND PROCEDURAL HISTORY
On March 26, 1990, plaintiff, Yata Jackson, was referred by her treating obstetrician, Dr. Max Pailet, to Tulane Medical Center Hospital for evaluation of her preeclampsia. Once she was admitted, Ms. Jackson was evaluated by defendant, Dr. Dabney Hamner, a second-year obstetrics and gynecology resident. Initially, Dr, |2Hamner performed an ultrasound as part of a physical examination to ascertain the fetus's gestational age, which was revealed to be approximately 37 weeks.
Dr. Hamner discussed his examination and findings with Dr. Pailet, who instruct ed him to perform an amniocentesis to determine the maturity of the fetus's lungs. Ms. Jackson signed a consent form, which stated that "Dr. Pailet and resident" would perform the amniocentesis and did not mention any risks to the fetus. Dr. Hamner performed the amniocentesis without Dr. Pailet.
On March 30, 1990, Ms. Jackson's son, Troy, was born via cesarean section. Ms. Jackson and Troy were discharged on April 4, 1990. Ms. Jackson testified that once she and Troy got home, she noticed a white dot in his left eye, which her mother had talked about while they were in the hospital. When Ms. Jackson took Troy to the well baby clinic about two weeks after she was discharged from the hospital, she asked the nurse about the white dot in Troy's eye and was told that it was probably just pigment that had not formed yet. Approximately two weeks after that appointment, Ms. Jackson took Troy to the emergency room of Tulane Medical Center Hospital because he had a skin rash. When she also inquired about the white dot in his eye, she was instructed to take Troy to Charity Hospital the next day to have his eye examined.
The next day, Ms. Jackson took Troy to Charity Hospital and was given an appointment to return to the ophthalmology department in a couple of weeks. On May 18, 1990, Troy was seen in the ophthalmology department and found to have a traumatic cataract, a peaked iris, and a corneal scar in his left eye. On May 22, 1990, Troy underwent cataract removal surgery, which revealed a penetrating-type injury to the eye. A second surgery to relieve pressure in the eye was performed on September 25, 1990. After the surgeries, it was determined that Troy has no vision |sm his left eye.
Subsequently, Ms. Jackson and Troy's father, individually and on behalf of Troy, filed a complaint with the Patient's Compensation Fund alleging that Tulane Medical Center Hospital and its employees were liable to Ms. Jackson, Troy's father, and Troy for damages sustained to Troy's left eye during the amniocentesis. The complaint alleged that defendants' negligence was a direct cause of the injuries and damages suffered by Ms. Jackson, Troy's father, and Troy. The Medical Review Panel -concluded "there is material issue of fact, not requiring expert opinion, bearing on liability for consideration by the Court.... Namely, insufficient information documenting the ultrasound and amniocentesis procedures versus the complaints of [plaintiff]." However, the Panel concluded there was no causal relationship between the amniocentesis and trauma to the baby because "[t]he nursing notes and the lack of statements by [plaintiff] during her hospitalization, as well as [plaintiffs] subsequent statement in the emergency room at Tulane, on April 29, 1990, evidence that there was no abnormality noted in the baby's left eye, until after hospital discharge."
On December 10, 1992, Ms. Jackson and Troy's father filed suit, individually and on behalf of Troy, for damages sustained during the amniocentesis performed prior to Troy's birth. After trial, the jury found that defendants, Dr. Hamner and Tulane Medical Center, did not breach the standard of care in their treatment of plaintiff, Yata Jackson. Consequently, the jury did not consider the questions of causation or damages. The trial court entered judg ment in accordance with the jury's | ¿verdict, denying and dismissing with prejudice plaintiffs' claims.
On appeal, a five-judge panel of the Fourth Circuit reversed the trial court's judgment. Jackson v. Tulane Med. Ctr. Hosp. & Clinic, 04-0462 (La.App. 4 Cir. 4/20/05), 900 So.2d 1154 (unpub'd opinion). The court of appeal began its analysis by noting the uncontested nature of plaintiffs' expert obstetrician's testimony that the amniocentesis, which plaintiffs alleged caused blindness in their son's left eye, was not warranted under the circumstances. The court of appeal also noted that this expert testified the performance of the amniocentesis itself fell below the standard of care. After additionally reviewing the nurses' notes of the procedure, Ms. Jackson's testimony, and Dr. Hamner's testimony, the court of appeal concluded the jury clearly erred in finding "no negligence on the part of Dr. Hamner and Tulane Medical Center Hospital and Clinic."
Reviewing the record de novo, the court of appeal examined the testimony and evidence and concluded that the amniocentesis was negligently performed and that the negligently performed amniocentesis caused the baby's eye injury.
The court of appeal went further and found that although plaintiffs failed to plead the issue of informed consent, the issue was actually tried during trial without objection by the defense. Thus, the court concluded, the trial court committed legal | ¡error when it denied plaintiffs the right to amend the pleadings to conform to the evidence regarding informed consent during the trial. Considering this issue de novo, the court of appeal concluded that plaintiffs proved that when Ms. Jackson gave her consent for the amniocentesis, she relied on improper and inadequate information regarding the material risks related to the procedure and that if fully informed, Ms. Jackson would not have consented to the procedure.
The court of appeal awarded the following damages to the child: (1) $250,000 for past and future pain and suffering; (2) $250,000 for permanent disability; and (3) $17,770 for past and future medical expenses. The court did not award damages to the child's parents.
We granted certiorari to review the correctness of the court of appeal's judgment. Jackson v. Tulane Med. Ctr. Hosp. & Clinic, 05-1594 (La.1/13/06), 920 So.2d 217.
DISCUSSION
Under the manifest error standard of review, a factual finding cannot be set aside unless the appellate court finds that it is manifestly erroneous or clearly wrong. Smith v. Louisiana Dept. of Corrections, 93-1305 (La.2/28/94), 633 So.2d 129, 132; Stobart v. State through Dept. of Transp. and Development, 617 So.2d 880, 882 (La.1993); Rosell v. ESCO, 549 So.2d 840, 844 (La.1989). In order to reverse a fact-finder's determination, an appellate court must review the record in its entire ty and (1) find that a reasonable factual basis does not exist for the finding, and (2) further determine that the record establishes that the factfinder is clearly wrong or manifestly erroneous. Salvant v. State, 05-2126 (La.7/6/06), 935 So.2d 646; Stobart, 617 So.2d at 882. The appellate court must not re-weigh the evidence or substitute its own factual findings because it would have decided the case differently. Pinsonneault v. Merchants & Farmers Bank & Trust Co., 01-2217, p. 11 (La.4/3/02), 816 So.2d 270, 279. Where there are two permissible views of the evidence, the factfinder's choice between them cannot be manifestly erroneous or clearly wrong. Rosell, 549 So.2d at 844. However, where documents or objective evidence so contradict the witness's testimony, or the testimony is so internally inconsistent or implausible on its face that a reasonable factfinder would not credit the testimony, the court of appeal may find manifest error or clear wrongness even where the finding is purportedly based on a credibility determination. Id. at 844-45. But where this situation does not exist, and a factfinder's determination is based on its decision to credit the testimony of one of two or more witnesses, that finding can virtually never be manifestly erroneous or clearly wrong. Id. at 845.
In a medical malpractice case, the plaintiff has the burden of proving:
(1)The degree of knowledge or skill possessed or the degree of care ordinarily exercised by physicians, dentists, optometrists, or chiropractic physicians licensed to practice in the state of Louisiana and actively practicing in a similar community or locale and under similar circumstances; and where the defendant practices in a particular specialty and where the alleged acts of medical negligence raise issues peculiar to the particular medical specialty involved, then the plaintiff has the burden of proving the degree of care ordinarily practiced by physicians, dentists, optometrists, or chiropractic physicians within the involved medical specialty.
(2) That the defendant either lacked this degree of knowledge or skill or failed to use reasonable care and diligence, along with his best judgment in the application of that skill.
(3) That as a proximate result of this lack of knowledge or skill or the failure to exercise this degree of care the plaintiff suffered injuries that would not otherwise have been incurred.
La. R.S. 9:2794(A); Salvant, 05-2126 at p. 6, 935 So.2d at 651; Pfiffner v. Correa, 94-0924, pp. 7-8 (La.10/17/94), 643 So.2d 1228, 1233.
[7In the instant case, the jury specifically found that neither Dr. Hamner nor the employees and/or staff of Tulane Medical Center Hospital breached the standards of care in their treatment of Ms. Jackson. A complete reading of the closing arguments presented by counsel gives us insight into the factual findings made by the jury when they answered the first two questions on the jury verdict form "no." When read in context, the closing arguments make it clear that the jury did not believe Troy's eye injury occurred during the amniocentesis procedure.
When explaining to the jury how to answer the jury verdict form, plaintiffs' attorney stated:
You are going to be asked, first of all, "Do you find by preponderance of the evidence that the defendant, Dr. Dabney J. Hamner, M.D., breached the standard of care in his treatment of Yata Jackson?" Yes or no.
Was it below the standard of care? He stuck the needle into the baby's eye. He shouldn't have stuck the needle into the baby's eye. That's a breach.
Is that as bad as the breach that Tulane had? Probably not. Tulane let this inexperienced resident do it.
Next, Number 2, "Do you find by a preponderance of the evidence that any of the employees and/or staff of defendant, Tulane Medical Center Hospital and Clinic, breached the standard of care in their treatment of Yata Jackson?"
Yes. They let an inexperienced doctor do this unsupervised. They did not train him in the safest way of doing it. They didn't train him how to do it supra-pubically. Even to this day, he doesn't know how to do a real time ultrasound amniocentesis by himself.
If your answer to Question 1 or 2 is yes, then you go forward to the next or third question. If you answer both of these no, that's it. Plaintiff loses. And we have said that more likely than not Yata Jackson or Dina Jackson, or someone else you never heard of, didn't stick the stick the needle in the baby's eye.
Similarly, the defense attorney explained:
IsDid you find by preponderance of the evidence that the defendant Dr. Dabney Hamner, M.D., breached the standard of care in treating Yata Jackson?
Ladies and gentlemen, I saw no evidence whatsoever that he breached the standard of care of Yata Jackson.
And the reason they are assuming this accident had to have happened in the hospital, when there is no evidence whatsoever that it, in fact, did happen in the hospital, but there is a period of time that Troy Jackson was out of that hospital, from April 4th to April 29th, when the earliest time that we find out about that dot is on April 29. And Miss Jackson told us that her mother and her noticed it a week after they got home.
Do you find by a preponderance of the evidence that any of the employees and staff of Tulane Medical Center and Hospital breached the standard of care in their treatment of Yata Jackson? Well, I think the answer to that question is absolutely not. I don't see it.
These arguments to the jury make it plain that the jury did not believe it was during the amniocentesis that Troy's eye was injured.
After considering the record as a whole, we find a reasonable factual basis to support the jury's determination that defendants did not breach the standard of care in their treatment of Ms. Jackson because Troy's eye injury did not occur during the amniocentesis procedure. Thus, we find no manifest error in the jury's determination.
Dr. Hamner testified that after he performed the initial physical examination and history, he discussed Ms. Jackson's situation with Dr. Pallet, who decided to do an amniocentesis to determine the maturity of the fetus. The amniocentesis was necessary because Dr. Pailet had only seen Ms. Jackson three or four times, so there was a possibility she was not actually 37 weeks along. Dr. Hamner testified that the ultrasound showed the amniotic fluid was not around the fetus's head, and that even if it was, he would never insert the needle in a pocket of fluid near the fetus's head. He stated that when he performed the amniocentesis, the fluid drawn was clear. Had [ 9any injury occurred, the fluid would have contained blood. Dr. Hamner also related that the results of the tests on the amniotic fluid were normal and did not indicate that any other tissues or contents were present in the fluid.
Although Ms. Jackson and Dina Jackson, Ms. Jackson's mother and Troy's grandmother, testified that Dina Jackson saw a white dot in Troy's eye before he was discharged from the hospital after his birth, Ms. Jackson stated in her deposition that her mother had noticed the white dot in the first week he was at home. Additionally, the Tulane medical records indicate that when Ms. Jackson took Troy to the emergency room 25 days after his discharge from the hospital, she reported the white dot had been in his eye for about two weeks.
Defendants' expert in the fields of obstetrics, gynecology, and reading ultrasounds, Dr. Lazarus, testified that it would have been impossible for Dr. Hamner to injure Troy's left eye during the amniocentesis as follows:
Q: Do you have any opinion, based upon . a reasonable degree of medical probability, based on your 30-plus years of experience as a Board-certified obstetrician and gynecologist, as to whether or not there is any truth to that allegation [that Dr. Hamner injured Troy's eye with the amniocentesis needle], sir?
A: I think that this is virtually impossible, given the evidence that I'm aware of, that . an injury to the left eye could have been sustained at the time of the amniocentesis.
And the reason I say that is that, first of all, during the procedure of an amniocentesis, knowing that the head is down here, you wouldn't put the needle down here toward the head. You would come up here to the small part where the fluid is. Unfortunately, we don't have pictures of that, but clearly, that's where it would be.
But, most importantly, is that since this is the right side of the head and this is the left side of the head and, so, again, the right side of the head is up. The left side is down. It would be impossible to hit the left eye. It would be away from the needle. It's on the opposite side of the head. It wouldn't be possible to get the needle in the left eye.
|1nDr. William Gill, a pediatrician with a subspecialty in neonatology, performed a physical examination of Troy following his delivery. Dr. Gill testified that he examined Troy's eyes by both a visual examination with his own naked eyes and with an ophthalmoscope and did not see anything that resembled a white dot in Troy's eye. Dr. Gill acknowledged, however, that if the scar was not in the center of Troy's eye and if the eye was asymptomatic, he could have missed seeing it during the examination.
Considering the above testimony, we conclude the jury could have reasonably determined that defendants did not breach the standard of care in their treatment of Ms. Jackson or that Troy's eye was not injured during the amniocentesis. The court of appeal's conclusion that "the jury was clearly wrong to find no negligence on the part of Dr. Hamner and Tulane Medical Center Hospital and Clinic" is erroneous and suggests that the court of appeal improperly substituted its factual findings for those of the jury. While the evidence detailed by the court of appeal could support a jury determination that Dr. Hamner and Tulane Medical Center were negligent, the jury heard that evidence, made credibility determinations, and decided to the contrary. We find no clear error in its determination.
The court of appeal also determined that the trial court erred when it refused to allow plaintiffs to expand their pleadings to include lack of informed consent as a cause of action. While the consent form omitted any reference to the risks faced by the fetus during amniocentesis, we find this issue, even if resolved in favor of plaintiffs, would be irrelevant in light of our determination that the jury was not manifestly erroneous in finding defendants were not negligent in their treatment of Ms. Jackson.
[^DECREE
For the reasons explained above, we find the court of appeal erred in its determination that the jury was clearly wrong to find no negligence on the part of Dr. Hamner and Tulane Medical Center. In light of the evidence presented in this case, the jury could have reasonably concluded that defendants did not breach the standard of care in their treatment of Ms. Jackson or that Troy's eye was not injured during the amniocentesis. Consequently, the judgment of the court of appeal is reversed and the judgment of the trial court is reinstated.
REVERSED.
CALOGERO, C.J., dissents for reasons assigned by WEIMER, J.
JOHNSON and WEIMER, JJ., dissent and assign reasons.
. Specifically, the jury answered the following:
1. Do you find, by a preponderance of the evidence, that the defendant, Dr. Dabney J. Hamner, Jr., M.D., breached the standard of care in his treatment of Yata Jackson?
Yes_
No X
2. Do you find, by a preponderance of the evidence, that any of the employees and/or staff of defendant, Tulane Medical Center Hospital and Clinic, breached the standards of care in their treatment of Yata Jackson?
Yes_
No x
The Jury Verdict Form instructed that if the answer to questions 1 and 2 was "No," the jury should not answer further questions, but the foreperson should sign and date the form and return it to the court.