Opinion ID: 2583948
Heading Depth: 1
Heading Rank: 7

Heading: Did the district court err in precluding the appellants' retained emergency medicine expert from offering opinions as to the standard of care for treatment?

Text: [¶ 12] As part of his burden of proof in a medical malpractice action, the plaintiff must establish the accepted standard of medical care or practice. Wyo. Stat. Ann. § 1-12-601 (LexisNexis 2003); Oakden v. Roland, 988 P.2d 1057, 1059 (Wyo. 1999) ( quoting Harris v. Grizzle, 625 P.2d 747, 751 (Wyo. 1981)). As with allegations of negligence in other professions, the standard of care in a medical malpractice case generally must be proven through expert testimony. Smyth v. Kaufman, 2003 WY 52, ¶ 27, 67 P.3d 1161, 1169 (Wyo. 2003); Sayer v. Williams, 962 P.2d 165, 167-68 (Wyo. 1998) ( quoting Mize v. North Big Horn Hosp. Dist., 931 P.2d 229, 233 (Wyo. 1997)); Siebert v. Fowler, 637 P.2d 255, 257 (Wyo. 1981). See also Rino v. Mead, 2002 WY 144, ¶ 17, 55 P.3d 13, 19 (Wyo. 2002). [¶ 13] The appellants called Dr. Tredal, an emergency medicine specialist, to testify as to the standard of care Dr. Hrabal was expected to meet when Armstrong appeared at the UMC emergency room. During the direct examination of Dr. Tredal, the following exchange occurred: Q. And, Doctor, did Tanya Hrabal meet the core standard of care in treating Ivan Armstrong on the 28th of February? A. No. Q. What should she have done? MR. RUTLEDGE: Your Honor, this has been asked and answered about five times. THE COURT: Sustained. [¶ 14] The appellants' trial counsel made no immediate response when the objection was sustained and made no offer of proof. In their appellate brief, the appellants contend that their counsel intended to question Dr. Tredal about the standard of care in several distinct areasevaluation, testing, consultation, treatment, appropriateness of discharge, and aftercare instructionsand that only evaluation, testing and consultation had been covered when the objection was sustained. They argue that it was clear error for the district court to preclude them from eliciting testimony on the critical issue of treatment. They identify prejudice in the fact that the jury submitted the following note to the district court during deliberations: We have a problem with what is standard of care[.] All dr's testified differently  We are [to] decide on evidence presented  If we come to an agreement  can we present a statement to the attys/plaintiff how we came to  [2] Furthermore, in finding against the appellants, the jury concluded that Dr. Hrabal did not deviate from the standard of care expected of her as an emergency room physician. [¶ 15] The appellees' counter-argument is that, pursuant to W.R.E. 403, the district court properly exercised its discretion in sustaining their objection in order to prevent the needless presentation of cumulative evidence. [3] They point to numerous prior questions where Dr. Tredal had been asked about the standard of care or about what Dr. Hrabal should have done: Q. And how do you treat bacterial sepsis generally? . . . Q. . . . Could you tell us what things Dr. Hrabal failed to do to meet the standard of care? . . . Q. And what were  what would the standard of care have required for [bacterial sepsis] on the differential to be ruled out? . . . Q. What testing was required by the standard of care? . . . Q. Were all of these tests required to evaluate  by the standard of care, were they required to evaluate Ivan Armstrong on February 28, 1999? . . . Q. Now, Doctor, in your opinion in this case did the standard of care require objective tests to rule out sepsis? . . . Q. If a doctor is thinking bacterial infection does the standard of care require them to do a septic work-up? [¶ 16] In the context of all these questions and their answers, sustaining the objection was certainly understandable. The appellants' counsel did not explain to the district court his plan to pursue the standard of care in six sub-categories nor did he make an offer of proof to alert the district court to how the proposed testimony would differ from earlier testimony. Further, the record does not suggest that such a plan of attack was apparent from the previous questions. In this situation, an offer of proof was required by W.R.E. 103(a)(2). See Contreras By and Through Contreras v. Carbon County School Dist. No. 1, 843 P.2d 589, 595-96 (Wyo. 1992); Rudolph v. State, 829 P.2d 269, 274-75 (Wyo. 1992); and Pack v. State, 571 P.2d 241, 245 (Wyo. 1977). The dual purpose of an offer of proof is to alert the trial court to the nature of the error in order to allow corrective action, and at the same time to create a sufficient record for appellate review. Padilla v. State, 601 P.2d 189, 194 (Wyo. 1979). Those purposes were not served in this case, and we affirm the district court's decision to sustain the appellees' objection.