Opinion ID: 173320
Heading Depth: 2
Heading Rank: 2

Heading: Medical MalpracticeCaptain of the Ship Instruction

Text: Willis complains the court erred in rejecting her proposed captain of the ship instruction which would have allowed the jury to hold Bender liable for Dr. Kirk's negligence. She claims Wyoming recognizes the captain of the ship doctrine; in fact, her proposed instruction is Instruction 14.09 of the Wyoming Civil Pattern Jury Instructions. Willis also asserts that during trial she proved the cause of her perforated bowel was the blind manipulation of the laparoscopic camera by Dr. Kirk who was working under Bender's direction. Therefore, by refusing the instruction, the court allowed the jury to find her injury was caused by the negligence of Dr. Kirk, for whom Bender was legally responsible, yet allow Bender to escape liability. Bender claims Wyoming has not adopted the captain of the ship doctrine and because the underlying basis for the doctrine has ceased to exist, it would likely not adopt it, as have a majority of the jurisdictions to recently address the issue. Even assuming the captain of the ship doctrine was viable in Wyoming, there was no evidence, specifically expert testimony, that Dr. Kirk was negligent and therefore no basis to hold Bender liable for Dr. Kirk's negligence.
In a diversity case, the substance of a jury instruction is a matter of state law, but the grant or denial of a tendered instruction is governed by federal law. Although we review the district court's refusal to give a particular instruction for abuse of discretion, the ultimate question of whether the jury was properly instructed is a question of law which we review de novo. Furthermore, we must examine the instructions as a whole to determine if they sufficiently cover the issues in the case and focus on the facts presented by the evidence. Blanke, 152 F.3d at 1232 (quotations and citations omitted).
Until the 1940's, hospitals enjoyed charitable immunity, entitling them to total immunity against their patients' medical malpractice suits. See KENNETH S. ABRAHAM & PAUL C. WEILDER, Enterprise Medical Liability and the Evolution of the American Health Care System, 108 Harv. L.Rev. 381, 385 (1994). As a result, patients injured by a hospital employee's negligence were often left without a form of redress for their injuries. Lewis v. Physicians Ins. Co. of Wis., 243 Wis.2d 648, 627 N.W.2d 484, 492 (2001). In an attempt to fill this gap, courts began using the borrowed servant doctrine to impose liability on the surgeon for negligence occurring in the operating room. Franklin v. Gupta, 81 Md.App. 345, 567 A.2d 524, 535 (1990). The notion was that the surgeon acted as a special employer who borrowed nurses and other attendants from their general employerthe hospitaland thus became liable for their negligence. Id. Liability, however, was conditioned on showing the surgeon actually controlled or had a right to control the details of the servant's conduct. Id. In McConnell v. Williams, the Pennsylvania Supreme Court applied the borrowed servant doctrine in a medical malpractice case in which the plaintiff sought to hold her obstetrician liable for a hospital intern's negligent administration of silver nitrate into the eyes of the plaintiff's newborn immediately after a caesarian section performed by the obstetrician. 361 Pa. 355, 65 A.2d 243 (1949). The court concluded there was a jury question as to whether there was a master-servant relationship between the obstetrician and the intern at the time of the intern's negligence; if so, the obstetrician was liable for that negligence. Id. at 248. Whether such relationship existed depended on whether the obstetrician had supervisory control over and the right to give orders to the intern at the time of the negligence. Id. at 246. In applying these principles, the court analogized a surgeon to a captain of a ship: [I]t can readily be understood that in the course of an operation in the operating room of a hospital, and until the surgeon leaves that room at the conclusion of the operation, ... he is in the same complete charge of those who are present and assisting him as is the captain of a ship over all on board, and that such supreme control is indeed essential in view of the high degree of protection to which an anaesthetized, unconscious patient is entitled.... Id. While it is clear from the McConnell decision that the court was not applying any new agency theory [13] and its reference to a captain of the ship was a mere analogy, some jurisdictions began using the phrase captain of the ship to impose strict or absolute liability on a surgeon for the negligence of every person associated with a patient's surgery regardless of whether the surgeon actually exercised any control over the actor. In other words, the surgeon's liability was presumed based on his mere status as surgeon and his presence in the operating room rather than any showing of actual control over the negligent actor. See Sparger v. Worley Hosp., Inc., 547 S.W.2d 582, 584-85 (Tex.1977); Thomas v. Raleigh Gen. Hosp., 178 W.Va. 138, 358 S.E.2d 222, 224 (1987). As hospitals have lost their charitable immunity and become large-scale providers of medical services with significant control over the manner in which their employees, including staff physicians, provide treatment, more recent courts have rejected the captain of the ship doctrine in favor of general agency principles. See, e.g., Franklin, 567 A.2d at 539 (rejecting captain of the ship doctrine in favor of borrowed servant doctrine; [g]iven the statutory curtailment of a hospital's eleemosynary and governmental immunity in Maryland ... there is no socio-economic need to extend the vicarious liability of a surgeon for the negligence of hospital employees simply to create a fund for victims of malpractice); Harris v. Miller, 335 N.C. 379, 438 S.E.2d 731, 738, 740 (1994) (holding surgeons should no longer be presumed to enjoy the authoritative control of a master over all who assist merely because they are `in charge' of the operation and instead looking to respondeat superior and borrowed servant principles); Anglin v. Kleeman, 140 N.H. 257, 665 A.2d 747, 751 (1995) (rejecting captain of the ship theory of liability; [i]n modern medicine, the surgeon is a member of a team of professionals, and we see no reason why the surgeon should be deemed responsible for the actions of other professionals neither employed nor controlled by him); Sparger, 547 S.W.2d at 585 (We disapprove the captain of the ship doctrine and hold that it is a false special rule of agency. Operating surgeons and hospitals are subject to the principles of agency law [(master-servant and borrowed servant doctrines)] which apply to others.); Lewis, 627 N.W.2d at 493-94 (`[C]aptain of the ship' has lost its vitality across the country as plaintiffs have been able to sustain actions [ ]against full-care modern hospitals for the negligence of their employees[;][a]ccordingly, we decline to resurrect the anachronistic `captain of the ship' doctrine....). There are few courts which still employ the captain of the ship doctrine. See, e.g., Fields v. Yusuf, 144 Cal.App.4th 1381, 51 Cal.Rptr.3d 277, 288 (2006); Ochoa v. Vered, 186 P.3d 107, 112 (Colo.Ct.App. 2008); Szabo v. Bryn Mawr Hosp., 432 Pa.Super. 409, 638 A.2d 1004, 1006 (1994). However, even these courts do not apply it in its purest form ( i.e., strict liability) but instead look to agency principles, in particular, requiring the surgeon to have controlled and supervised the negligent actor's work as well as the manner in which it was done at the time of the alleged negligence. See Fields, 51 Cal.Rptr.3d at 287 (The `captain of the ship' doctrine imposes liability on a surgeon under the doctrine of respondeat superior for the acts of those under the surgeon's special supervision and control during the operation.); Ochoa, 186 P.3d at 110-11 (same); Szabo, 638 A.2d at 1006 (The `Captain of the Ship' Doctrine has agency considerations at its base. The essential question... is whether one is subject to the control of another not only to the work to be done but also the manner of performing it.) (citation and quotations omitted). Even the instruction proposed by Willis does not impose liability on the surgeon for an assistant's negligence unless the negligence occurs while the assistant is under the surgeon's direction. We have uncovered no Wyoming case specifically addressing the captain of the ship doctrine. [14] While normally we would attempt to determine what the Wyoming Supreme Court would do if confronted with the issue, we need not do so here. Willis was not entitled to her proposed instruction because, as the district court decided, the evidence did not support its tender. See Woolard v. JLG Indus., Inc., 210 F.3d 1158, 1177 (10th Cir.2000) (stating a party is entitled to an instruction based on its theory of the case if it has produced appropriate evidence to support it); see also Short v. Spring Creek Ranch, Inc., 731 P.2d 1195, 1199 (Wyo.1987) ([A] party is entitled to have a jury instruction upon its theory of the case but only if such theory is supported by competent evidence and a proper request for the instruction is made.). The proposed instruction sought to hold Bender liable for the negligence of the surgical assistant acting under his direction (Dr. Kirk). The only alleged negligence supported by Willis with expert testimony was Bender's decision to continue with the laparoscopic approach after the first two attempts to enter Willis' abdomen were unsuccessful. While Willis' expert also testified he believed the perforated bowel was caused by manipulation of one of the laparoscopic instruments held outside the field of view (presumably held by Dr. Kirk), he did not testify such manipulation fell below the standard of care. Expert testimony was necessary. See Siebert v. Fowler, 637 P.2d 255, 257 (Wyo.1981) (stating expert testimony is necessary to prove the standard of care, whether the physician's conduct fell below the standard of care, and whether that conduct was the legal cause of the plaintiff's injuries). Absent expert testimony establishing Dr. Kirk was negligent, there was no basis for the proposed instruction. Even Bender's evidence did not support the giving of the instruction. Bender himself conceded the bowel perforation occurred sometime during the laparoscopic cholecystectomy and he took full responsibility for it. While he did not admit his conduct was negligent, neither did he claim it was caused by Dr. Kirk's negligence. Bender's expert, Dr. Barry Gardiner, also did not blame Dr. Kirk for Willis' injury. He believed Willis' injury occurred as Bender was taking down a dense adhesion connecting the bowel to the abdominal wall. (R. Appellee's Supp.App. at 330.) Again, absent evidence suggesting anyone involved in the surgery other than Bender was negligent, the court properly rejected Willis' proposed instruction. See Spoor v. Serota, 852 P.2d 1292, 1296 (Colo.Ct.App. 1992) (captain of the ship instruction not warranted absent evidence to support negligence claim against any party involved in the surgery other than the surgeon).