Opinion ID: 1294625
Heading Depth: 1
Heading Rank: 3

Heading: Locality Instruction.

Text: The trial court gave the following instruction to the jury: A physician must use the degree of skill, care, and learning ordinarily possessed and exercised by other physicians in similar circumstances. The locality of practice in question is one circumstance to take into consideration but is not an absolute limit upon the skill required. The plaintiffs object to the last sentence of this instruction for two reasons: (1) [t]he `locality' rule is not the law of Iowa; and (2) the evidence did not support inclusion of a locality factor. We review the court's decision to give the challenged instruction for correction of errors of law. See Anderson v. Webster City Cmty. Sch. Dist., 620 N.W.2d 263, 265 (Iowa 2000). Error in giving an instruction will not warrant reversal unless the objecting party has been prejudiced by the instruction. See Kurth v. Iowa Dep't of Transp., 628 N.W.2d 1, 5 (Iowa 2001). The locality rule in its original form provided that a physician is bound to use that degree of knowledge, skill, care and attention ordinarily exercised by physicians under like circumstances and in like localities.  McGulpin v. Bessmer, 241 Iowa 1119, 1129, 43 N.W.2d 121, 126 (1950) (emphasis added); accord Whitesell v. Hill, 101 Iowa 629, 636-37, 70 N.W. 750, 751 (1897). It was formulated over 100 years ago to protect rural practitioners presumed to be less adequately informed than their colleagues in the city. Amy Jurevic Sokol and Christopher J. Molzen, The Changing Standard of Care in Medicine, 23 J. Legal Med. 449, 476 (2002) [hereinafter Sokol Article]; accord Bartimus v. Paxton Cmty. Hosp., 120 Ill.App.3d 1060, 76 Ill.Dec. 418, 458 N.E.2d 1072, 1077 (1983); Hall v. Hilbun, 466 So.2d 856, 868 (Miss.1985), superseded by statute on other grounds as noted in Narkeeta Timber Co. v. Jenkins, 777 So.2d 39, 42 (Miss.2000). In Iowa, the rule was also intended to equitably account for differences in physicians' ability to develop skill in their profession due to the greater or lesser opportunities afforded by the locality, for observation and practice. Smothers v. Hanks, 34 Iowa 286, 289-90 (1872). Finally, the rule allowed the fact finder to take into account differences in physicians' access to the latest technology. Sokol Article, 23 J. Legal Med. at 474. Over time, courts began to abandon the rule as a strict limitation on the skill and care required of a physician. See Speed v. State, 240 N.W.2d 901, 907 (Iowa 1976). This court followed suit and held in McGulpin that the locality in which the physician practices was but one circumstance to be considered in determining whether he or she exercised reasonable care; this circumstance was not, however, an absolute limit upon the skill required. 241 Iowa at 1131, 43 N.W.2d at 128; accord Vergara v. Doan, 593 N.E.2d 185, 187 (Ind.1992) (stating locality of practice is but one of the factors to be considered in determining whether the doctor acted reasonably); cf. Dickinson v. Mailliard, 175 N.W.2d 588, 596-97 (Iowa 1970) (modifying locality rule as it applies to hospitals, stating hospitals are held to standard of care of hospitals operating under similar circumstances; standards and practices of hospitals in the particular community and similar communities are only one consideration, and are not conclusive). Our adherence to this qualification of the locality rule was reaffirmed in Speed. 240 N.W.2d at 908. Although the availability of medical knowledge has become more universal across the United States, the locality rule has retained validity in its other aspects. See, e.g., Gambill v. Stroud, 258 Ark. 766, 531 S.W.2d 945, 948 (1976) (stating similarity depends not on size or location of community, but on medical facilities, practices and advantages available in community); Hall, 466 So.2d at 872 (noting there remains a core of validity to the locality rule with respect to the medical facilities, services, equipment and options ... reasonably available to a physician); Birchfield v. Texarkana Mem'l Hosp., 747 S.W.2d 361, 366 (Tex.1987) (The purpose of the locality rule is to prevent unrealistic comparisons between the standards of practice in communities where resources and facilities might vastly differ.). Thus, pertinent to the case before us, the facilities, personnel, services, and equipment reasonably available to a physician continue to be circumstances relevant to the appropriateness of the care rendered by the physician to the patient. See Hall, 466 So.2d at 873 (stating physician's duty of care must take into consideration the quality and kind of facilities, services, equipment and other resources available). Therefore, we reject the plaintiffs' contention that the locality rule is not the law in Iowa. The plaintiffs also assert as error the trial court's failure to define locality of practice, arguing this omission invited misapplication of the law by the jury. They contend that once the court chose to instruct on the locality rule, it should have informed the jury that the location of the defendant's practice was pertinent in this case only to the extent it affected the resources reasonably available to him. Even if an explanation of the locality-of-practice factor would have assisted the jury, we do not think the plaintiffs were prejudiced by the court's failure to define this phrase under the facts of this case. The primary dispute in this case centered on whether Dr. Peterson should have called a surgical team to the hospital as soon as it became apparent that Dawn Hagedorn might have a placental abruption. The plaintiffs' experts testified the surgical personnel should have been summoned sooner so they would be immediately available in case it became necessary to perform a cesarean section. The defendant and his experts claimed, however, that assembling a standby surgical team was not a reasonable option due to the limited medical personnel available in the community. Thus, as the plaintiffs acknowledge in their brief, the only way in which the locality of Dr. Peterson's practice was relevant in this case was in a resource-based sense. Given the clear focus of the experts' disagreement, we do not see how the jury could have been misled by the court's instruction. See Vergara, 593 N.E.2d at 188; see also Kiesau v. Bantz, 686 N.W.2d 164, 175 (Iowa 2004) (stating if the instructions do not mislead the jury, there is no reversible error). As a final matter, the plaintiffs assert the evidence did not implicate the locality rule. See generally Peters v. Vander Kooi, 494 N.W.2d 708, 713 (Iowa 1993) (The submission of instructions upon issues that have no support in the evidence is error.). They contend the personnel needed to perform an immediate cesarean section were available to Dr. Peterson, and therefore, there was no resource-based limitation on his ability to comply with the standard of care requiring immediate delivery upon a complete abruption. In essence, they argue that because a surgical team could have been called to the hospital on a standby basis, reasonable care required that the surgical personnel be summoned even before surgery was determined to be necessary. But that was precisely the dispute between the experts: whether, given the limited medical personnel available in the community, a physician of ordinary skill and learning would have assembled a surgical team on a standby basis. This dispute implicated the resource component of the locality rule, and therefore there was record support for the court's instruction.