Opinion ID: 895405
Heading Depth: 2
Heading Rank: 4

Heading: Application of Harm Analysis Law

Text: Young alleges, and the court of appeals agreed, that the trial court erred by submitting a jury question on Dr. Thota's theory of the case  Ronnie's contributory negligence. Even if Young is correct, Casteel 's presumed harm analysis does not apply because the separate answer blanks allow us to determine whether the jury found Dr. Thota negligent. Unlike Casteel, which involved thirteen independent grounds for liability with one answer blank for the defendant's liability, here, the charge provided two separate blanks for the jury to answer the single-theory-of-liability question. See Casteel, 22 S.W.3d at 387. The charge mirrors the Texas Pattern Jury Charges's longstanding use of separate blanks when multiple parties' negligence are in issue. See Comm. On Pattern Jury Charges, State Bar of Tex., Texas Pattern Jury Charges: General Negligence & Intentional Personal Torts PJC 4.1 (2010). The only theory of liability asserted against Dr. Thota was negligence, and the jury's findings on that theory are clear: Dr. Thota was not negligent. We hold that this charge question simply does not raise a Casteel issue, and the court of appeals erred in applying Casteel 's presumed harm analysis. Additionally, we hold that the new and independent cause instruction fails to present a Casteel situation. See Urista, 211 S.W.3d at 756-57. In concluding that the new and independent cause instruction constituted harmful error, the appellate court reasoned: Here, however, the jury was not only given an erroneous defensive instruction on new and independent cause that benefitted only Dr. Thota but also an erroneous jury question on liability  Ronnie's contributory negligence  a theory not supported by the evidence. So, we should not be limited to Urista 's traditional harm analysis when trying to determine the impact of the improperly submitted instruction on new and independent cause when combined with the improperly submitted question of Ronnie's contributory negligence. We simply cannot determine, on this evidence, whether the jury properly found Dr. Thota not negligent, properly found that his negligence was excused based upon the unavoidable accident instruction, or improperly found that his negligence was excused based upon the new and independent cause instruction alone or combined with its improper finding of Ronnie's negligence. 271 S.W.3d at 839. And in response to the dissent, the majority added: It is the combination of these two incorrect theories that prevents us from being able to determine whether the jury's finding of no liability as to Dr. Thota was a finding of no negligence on his part, an erroneous finding of contributory negligence on Ronnie's part, or an erroneous finding of new and independent cause. Importantly, we are not trying to extend Casteel 's presumed harm analysis to defensive theories; we are applying it to a single broad-form question that erroneously includes two different theories of liability. This error is only exacerbated by the erroneous defensive instruction of new and independent cause. Id. at 841. We disagree with the court of appeals' interpretation of our holding in Urista and hold that, even assuming the new and independent cause instruction in this charge constituted error, it does not raise a Casteel issue. Like Urista, this case involves a single liability theory  negligence  so Casteel 's multiple-liability-theory analysis does not apply. See 211 S.W.3d at 756-57. Moreover, as we noted in Urista, when a defensive theory is submitted through an inferential rebuttal instruction, Casteel 's solution of departing from broad-form submission and instead employing granulated submission cannot apply. Id. at 757. Inferential rebuttal issues are distinct from theories of liability and damage elements because they cannot be submitted in the jury charge as separate questions and instead must be presented through jury instructions. Id. Like the inferential rebuttal instruction on unavoidable accident in Urista, the new and independent cause instruction was given in reference to the causation element of the plaintiff's negligence claim. Id. at 756-57. While appellate courts may presume harm when meaningful appellate review is precluded because the submitted charge mixes valid and invalid theories of liability or commingles improper damage elements, the courts do not presume harm because of improper inferential rebuttal instructions on defensive theories. See id. at 757. Therefore, assuming without deciding that the submission of the new and independent cause instruction was an abuse of discretion, we hold that this charge error does not present a Casteel problem. Even if the inclusion of a jury question regarding a party's contributory negligence and an inferential rebuttal instruction were erroneous in a single-theory-of-liability case, the combination of these errors would not automatically trigger a situation where the appellate court must presume the error was harmful. If presumed harm analysis were required, then our fundamental commitment to submitting broad-form questions, whenever feasible, would routinely be discarded for separate, granulated submissions to the jury. See TEX.R. CIV. P. 277; Harris Cnty., 96 S.W.3d at 235-36. Moreover, even in multiple-theory-of-liability cases like Casteel, the presumed harm analysis is not automatic. See Casteel, 22 S.W.3d at 389-90; Romero, 166 S.W.3d at 227-28. As we stated in Casteel, when questions are submitted in a manner that allows the appellate court to determine that the jury's verdict was actually based on a valid liability theory, the error may be harmless. 22 S.W.3d at 389 (citing City of Brownsville v. Alvarado, 897 S.W.2d 750, 752 (Tex.1995)). And regardless of whether a granulated or broad-form charge is submitted, the trial court's duty is to submit only those questions, instructions, and definitions raised by the pleadings and the evidence. Harris Cnty., 96 S.W.3d at 236; see TEX.R. CIV. P. 278; Elbaor, 845 S.W.2d at 243. While Casteel 's presumed harm analysis is necessary in instances where the appellate court cannot determine whether the improperly submitted theories formed the sole basis for the jury's finding because the broad-form question mixed valid and invalid theories of liability, Casteel, 22 S.W.3d at 389, or when the broad-form question commingled damage elements that are unsupported by legally sufficient evidence, Harris Cnty., 96 S.W.3d at 235, an improper inferential rebuttal instruction and improper defensive theory of contributory negligence presented in a broad-form question with separate answer blanks in a single-theory-of-liability case does not prevent the harmed party from obtaining meaningful appellate review. When a trial court abuses its discretion by including erroneous charge questions or instructions in a single-theory-of-liability case, our traditional harmless error analysis applies and the appellate courts should review the entire record to determine whether the charge errors probably caused the rendition of an improper judgment. See TEX.R.APP. P. 44.1, 61.1; Urista, 211 S.W.3d at 757. Because we hold that Casteel 's presumed harm analysis does not apply, we next consider whether, applying traditional harmless error analysis, the alleged charge errors constitute reversible error. See TEX.R.APP. P. 61.1(a); Urista, 211 S.W.3d at 757. We address Young's objections to the inclusion of Ronnie's contributory negligence and the instruction of new and independent cause in turn.
When charge questions are submitted in a manner that allows the appellate court to determine whether the verdict was actually based on a valid theory of liability, the error may be harmless. Casteel, 22 S.W.3d at 389; see also Alvarado, 897 S.W.2d at 752 (Submission of an improper jury question can be harmless error if the jury's answers to other questions render the improper question immaterial.); Boatland of Hous., Inc. v. Bailey, 609 S.W.2d 743, 750 (Tex.1980) (holding that the potentially erroneous submission of defensive theories was harmless error because the jury found for the defendant on independent grounds and the complaining party failed to show how it probably resulted in an improper verdict). Young's argument that the inclusion of Ronnie's contributory negligence was harmful error fails for several reasons. First, Dr. Thota could only have been negligent in causing the tear in Ronnie's artery, and the jury failed to find that he was. The jury's finding as to Dr. Thota's non-negligence is entirely separate from its finding as to Ronnie's negligence. Perhaps the jury was confused about whether to find Ronnie negligent and, despite the unavoidable accident instruction, believed that they had to find someone negligent. Either way, any error associated with the inclusion of a jury question regarding Ronnie's negligence was harmless. Moreover, when determining whether harm occurred, we consider the entire charge. See, e.g., Tex. Emp'rs Ins. Assoc. v. McKay, 146 Tex. 569, 210 S.W.2d 147, 149 (1948). Here, the clarifying instructions at the end of Question 1 made it clear that the jury could answer in any of the following combinations: (1) Yes to both Dr. Thota and Ronnie; (2) No to both; or (3) Yes to one and No to the other  the choice the jury ultimately made. The charge's definition of proximate cause also clearly informed the jury that [t]here may be more than one proximate cause of an event. In light of the entire charge and the separate answer blanks for Dr. Thota and Ronnie, it is evident that the jury was well aware that its findings as to Dr. Thota's and Ronnie's negligence were separate and that there could be more than one proximate cause of an event. When the answer to a jury question cannot alter the effect of the verdict, the reviewing court considers that question immaterial. See Alvarado, 897 S.W.2d at 752. In Alvarado, we held that even if it were error for the trial court to submit a question as to the deceased plaintiff's negligence, that question was immaterial because of the jury's finding of No as to the defendant's liability for negligence. Id. Like Alvarado, any error in submitting the question of Ronnie's contributory negligence to the jury was harmless and rendered immaterial in light of the jury's finding of no negligence as to Dr. Thota. Once the jury answered No to whether any negligence of Dr. Thota proximately caused Ronnie's injury, Dr. Thota was exonerated, and neither a Yes nor a No answer as to Ronnie's contributory negligence could alter the verdict. See id.
Assuming without deciding that the new and independent cause instruction was improper, a review of the record does not indicate that it probably caused the rendition of an improper judgment. See TEX. R.APP. P. 61.1(a); Urista, 211 S.W.3d at 757; Reinhart, 906 S.W.2d at 473. At trial, Dr. Thota testified on his own behalf, and Neill Doherty III, M.D. testified as Young's expert witness. The evidence from the medical records and Dr. Thota's testimony indicated that good hemostasis was most likely obtained, which would mean that Ronnie was in a stable condition by the time he was released from the hospital. Even Young's own medical expert, Dr. Doherty, admitted on cross-examination that there was a 99% chance that Ronnie was not bleeding when he was released after the catheterization procedure and that, based on the totality of the medical records, there was no objective evidence that Ronnie was bleeding or experiencing any complications at the time he was discharged from the hospital. Both Dr. Thota and Dr. Doherty testified that if there had been an improper puncture in the iliac artery preventing hemostasis, Ronnie would likely have developed signs of bleeding before his discharge. Dr. Doherty also testified that the cardiac catheterization was a reasonable procedure, given Ronnie's condition, and that the medical records did not indicate Dr. Thota had incorrectly performed the procedure. Both parties' experts based their opinions, in part, on their interpretations of the doctors' reports from the emergency surgery the night of Ronnie's catheterization procedure. The report by Dr. Thota's partner, Dr. Sudharshan, noted that Ronnie had a puncture site just about the inguinal ligament and that a CT scan apparently revealed bleeding from [the] external iliac artery puncture site. Based on Dr. Sudharshan's assessment, Dr. Walker performed the emergency surgery, and Dr. Walker's report noted that he repaired a high tear in Ronnie's right external iliac artery. Neither Dr. Sudharshan nor Dr. Walker testified at trial. At trial, Dr. Thota's and Dr. Doherty's testimony about Ronnie's medical reports conflicted. Dr. Doherty testified that the standard of care for cardiac catheterization was to insert a needle and catheter into the right femoral artery below the inguinal ligament. In Dr. Doherty's opinion, Dr. Thota punctured Ronnie's artery at the wrong location, above the inguinal ligament and into the right external iliac artery. Dr. Doherty's opinion was based on Dr. Walker's report, the CT scan mentioned on Dr. Sudharshan's report, and the bleed in Ronnie's retroperitoneal cavity, which could occur when the puncture is too high, rather than the more visible femoral bleed that would occur if the puncture is in the femoral artery. In contrast, Dr. Thota claimed at trial that he did not breach the standard of care during Ronnie's catheterization procedure. He testified that he had no problems inserting the catheter and that he believed he entered the artery at the appropriate location. Dr. Thota stated that Dr. Sudharshan's finding that the puncture site was at about the inguinal ligament, would indicate that the puncture site was correct. He further testified that Dr. Walker's report was ambiguous as to what he repaired and how far above or below the inguinal ligament the bleed originated. Also, Dr. Thota testified that a retroperitoneal bleed can occur with a femoral artery stick as well as an iliac artery stick and that, based on his review of the medical records and his own knowledge of the procedure, he met the standard of care. Like many medical malpractice cases, this record contains conflicting expert opinions. The fact that Dr. Thota testified on his own behalf does not negate the weight that the jury could give to his testimony. See City of Keller v. Wilson, 168 S.W.3d 802, 827 (Tex.2005) (holding that the proper test for legal-sufficiency review must credit favorable evidence if reasonable jurors could, and disregard contrary evidence unless reasonable jurors could not); see also Wilson v. Scott, 412 S.W.2d 299, 303 (Tex.1967) (noting that the defendant physician's own testimony can establish the standard of care). Jurors are the sole judges of the credibility of the witnesses and the weight to give their testimony. City of Keller, 168 S.W.3d at 819. Because of the conflicting testimony of Dr. Doherty and Dr. Thota, and because both testifying experts agreed that Ronnie was likely not bleeding upon his discharge from the hospital, the jury could have reasonably believed Dr. Thota's opinions and discounted Dr. Doherty's opinions. In circumstances where a reasonable jury could resolve conflicting evidence either way, we presume the jury did so in favor of the prevailing party. See id. at 821. Based on the conflicting evidence, the jury could have reasonably concluded that Dr. Thota did not breach the standard of care without reaching the issue of proximate cause. In that case, the jury would not have relied on the new and independent cause instruction because it pertains only to the proximate cause element. See Hawley, 284 S.W.3d at 856 (New and independent cause is a component of the proximate cause issue.). Thus, the record supports the jury's finding of no negligence as to Dr. Thota. Accordingly, our review of the entire record provides no clear indication that the new and independent cause instruction, if erroneous, probably caused the rendition of an improper verdict. We therefore conclude that any error in the trial court's submission of the new and independent cause instruction was harmless. See Urista, 211 S.W.3d at 759.