Opinion ID: 2587444
Heading Depth: 1
Heading Rank: 5

Heading: The district judge reached his decision by an exercise of reason.

Text: Our final inquiry under the threepart Sun Valley, test is whether the district judge reached his decision by an exercise of reason. 119 Idaho at 94, 803 P.2d at 1000. Our role again is to review the process of the district judge in rendering his decision. Quick, 111 Idaho at 772, 727 P.2d at 1200. In order for this Court to perform this function properly, we require the district judge to disclose his reasoning for granting or denying the motion for a new trial unless those reasons are obvious from the record itself. Id. St. Luke's argues the district judge failed to give careful consideration to the relevant factual circumstances by basing his decision to set aside the jury's verdict on facts that were mischaracterized in the Memorandum Decision as undisputed. This argument centers on the section in the Memorandum Decision entitled Undisputed Facts, which included both undisputed facts and testimony that was arguably disputed by other information. Despite the imprecision in naming the facts section, a review of the entire decision shows the district judge carefully considered the relevant factual circumstances, clearly indicated the facts he believed were truly uncontroverted, and understood the facts in dispute. For example, St. Luke's incorrectly asserts the district judge improperly eliminated the defense expert evidence and characterized the diagnosis of kernicterus as undisputed. However, the Memorandum Decision demonstrates the district judge recognized and considered the defense testimony disputing the diagnosis of kernicterus and carefully considered the issue of proximate cause. The district judge specifically addressed the conflicting interpretations of the MRI studies performed on Cal, and the testimony of Dr. Moltini, who thought it was a virus, and of Drs. Glass and Vleck, who was only 49% sure it was kernicterus. Clearly he understood the diagnosis of kernicterus was not undisputed. After considering the conflicting expert testimony, the district judge found the evidence was compelling that Cal was indeed suffering from kernicterus. The district judge's determination to discount the testimony of the defendant's expert witnesses was not an inappropriate mischaracterization of the evidence, or a misunderstanding of the disputed diagnosis, but was a proper exercise of his discretion in weighing the demeanor, credibility and persuasiveness of the evidence. St. Luke's also argues the district judge abused its discretion in granting a new trial to the Sheridans because a causal link was not established between the alleged negligence of St. Luke's and Cal's injuries. This argument parallels St. Luke's argument in support of their motion for a directed verdict for failure to show proximate cause. As discussed below in Part III, B, the element of proximate cause can be established through a chain of circumstances from which the ultimate fact required to be established is reasonably and naturally inferable. Formont v. Kircher, 91 Idaho 290, 296, 420 P.2d 661, 667 (1965)(quoting Reinhold v. Spencer, 53 Idaho 688, 690, 26 P.2d 796, 798 (1933) (citation omitted)). The Memorandum Decision outlines the process and reasoning of the district judge in concluding the causal link had been established. The hospital did not have in place any protocols or policies on jaundice. The general policies and protocols required the newborn nursery nurses to notify the pediatrician when any general abnormal symptoms or conditions were noted. None of the nurses notified the pediatrician in this case. The nurses instructed mom only on the progress of normal jaundice but did not warn mom that the jaundice in this case might not be normal, and that serious brain damage could occur if it worsened and was not treated. Finally, the nurses knew that no bilirubin tests had been conducted, although such tests were routine and readily available. They did not suggest such to the pediatrician, although such suggestions are often offered to physicians and usually acted upon. If not accepted or acted upon, there is a procedure within the hospital for a nurse to act as the patient's advocate, and insist that the physician's decision on treatment be reviewed. This did not occur. Finally ... there was a failure to establish any policy with regard to the handling of core blood retrieved on birthparticularly whether it was or should have been tested to reveal the possible blood incompatibility between Cal and his mom. The confusion in the chart led the doctors to assume that the blood types were the same when they were not. Dr. Jambura testified that if he had realized that Cal's blood was different than his mom's, he would have treated the hyperbilirubinemia more aggressively. The two nurses who cared for Cal during the first 24 hours both noted the existence of jaundiceone at 17 hours of life and the other at 23 hours of life. Although both testified that they would be concerned if the jaundice progressed rapidlythat it was the progress of the jaundice rather than the mere presence of it that would be of concern to themneither noted on chart any indicia from which the progress could be ascertained. The later nurses made no inquiry of earlier nurses to ascertain the progress of jaundice. The third nurse to care for Cal on the morning of his discharge noted that the jaundice was present over his entire bodymoderate on head and mild on trunk and extremitiesbut did not consider this as alarming .... While I think the pediatrician in this case must bear the brunt of responsibility for the mismanagement of Cal's care, in my mind at least some degree of fault is attributed to the failure of the newborn nurses to be the physician's eyes and ears at the outset of Cal's life. I am satisfied that if the nurses had sounded the alarm upon the first observation of jaundice, and had pressed for appropriate bilirubin monitoring before he was discharged from the hospital the first time, the catastrophe that befell a few days later would have been completely averted. Based on the conduct of the nurses, and the district judge's determination that the evidence offered by the plaintiff on the issue of the diagnosis of kernicterus overwhelmed the defense witnesses and evidence, the district judge concluded, any errors in the identification and treatment of the predicate hyperbilirubinemia were a proximate cause of this condition. Defense experts disputed some of evidence in the chain of circumstances described by the district judge. However, it is within the district judge's broad discretion to set aside the verdict, even when there is substantial evidence to support it. Quick, 111 Idaho at 766, 727 P.2d at 1194. The district judge's conclusion that the causal link had been established was based on expert testimony regarding the standard of care, medical research and knowledge of the impact of high bilirubin levels in a newborn and expert testimony regarding the long term damage that can be caused by those high bilirubin levels. Therefore, we find this conclusion was reached by an exercise of reason. St. Luke's next argues the district judge failed to address their argument that intervening, superceding forces cut off any causal link between the hospital's involvement and the occurrence of brain damage. However, the district judge specifically acknowledged: There is no allegation or evidence of any negligence or breach on the part of the hospital or staff after Cal's discharge from the hospital on March 26. There is an argument that the subsequent acts of the pediatrician superseded any negligence of the hospital. However, I am persuaded in this case that the overwhelming evidence indicates a finding of some degree of fault on the part of the hospital, notwithstanding the later omissions of the pediatrician. Finally, St. Luke's argues the district judge abused his discretion by concluding because he granted a new trial as to defendant Jambura, it was necessary to grant a new trial as to St. Luke's. Idaho Rules of Civil Procedure, Rule 59(a) allows a trial court to grant a new trial to all or any of the parties. Watson v. Navistar Intern. Transp. Corp., 121 Idaho 643, 669, 827 P.2d 656, 682 (1992). The law is well established that the trial court's determination whether to include some or all of the parties is discretionary. Id. (citing Smallwood v. Dick, 114 Idaho 860, 761 P.2d 1212 (1988)). The test for determining whether a party can be excluded from an order for a new trial is whether there is a clear showing that the issues in the case are so distinct and separable that a party may be excluded without prejudice. Id. (citation omitted). Applying this standard, the district judge properly recognized his discretionary authority to grant a new trial as to one or both of the parties. In his Memorandum Decision, he specifically noted the close relationship between the nurses and physicians, and the interrelationship expected of them in the first hours of an infant's life and concluded, I think it necessary for a new jury to reconsider the conduct of both in this case. The district judge exercised reason in concluding the actions of the hospital and doctors were so intertwined as to necessitate a new trial for both. The Memorandum Decision shows a careful analysis of St. Luke's arguments, the facts in dispute, and the applicable principles of law. The district judge specifically articulated the reasons for granting a new trial against St. Luke's. He has clearly given due consideration to the facts and circumstances of the case, and correctly applied the law thereto; therefore, we find his decision to grant a new trial was based on an exercise of reason.