Opinion ID: 2625045
Heading Depth: 1
Heading Rank: 4

Heading: Exclusion of Hazlett's Qualifications

Text: [¶ 11] In their first issue, the Beavises contend the district court erred in refusing evidence of Hazlett's alleged lack of competency, qualification, or certification to give the Kenalog injection. The Beavises argue it is unfair to apply what they consider a nurses' standard of care to Hazlett, yet not permit them to establish that Hazlett was not a nurse. The appellees respond, arguing the district court did not abuse its discretion in refusing the evidence because the only question for the jury was whether the injection had been properly administered and Hazlett's qualifications were thus irrelevant. [¶ 12] We first look at the standard of care, upon which the jury was instructed in part: Evidence has been received relating to the proper technique to be used in administering a Kenalog injection. Proper technique is the standard of care. It is the same for doctors, nurses and other health care professionals. That is the standard by which Deb Hazlett's actions are to be measured. The Beavises did not object to this instruction. Normally, when a party fails to object to instructions in the trial court, those instructions become the law of the case, and appellate review is precluded unless plain or fundamental error can be found. Goggins v. Harwood, 704 P.2d 1282, 1289 (Wyo.1985); Matter of Mora's Estate, 611 P.2d 842, 846 (Wyo.1980); Cox v. Vernieuw, 604 P.2d 1353, 1357 (Wyo.1980); Vinich v. Teton Constr. Co., 518 P.2d 137, 138 (Wyo.1974). [¶ 13] The standard of care in a medical malpractice action is well established. In Vassos v. Roussalis, 625 P.2d 768, 772-73 (Wyo.1981), this court wrote: A malpractice action is usually a form of a negligence action. It is in this instance. Accordingly, the elements necessary to sustain a negligence action must be here proven, i.e., a duty on the part of the defendant, failure to perform the duty proximately causing damage to plaintiff. The determination of the standard of care or duty is a matter of law and not the province of the jury. In this case, the existence of the physician-patient relationship established the duty. The standard is fixed as that which is required of a reasonable person in the light of all the circumstances. Some circumstances have acquired particular legal significance which make it possible for the court to fix a more specific standard.... A malpractice contention is also one of those circumstances. The more specific standard for malpractice actions is that a physician or surgeon must exercise the skill, diligence and knowledge, and must apply the means and methods, which would reasonably be exercised and applied under similar circumstances by members of his profession in good standing and in the same line of practice. ... When the circumstances in which the fictitious reasonable person acts are within the common knowledge of the jury, the jury does not need assistance in comprehending the standard fixed by the court. But when such circumstances are not of such common knowledge, the jury must depend upon testimony of experts to explain the standard and thus prevent a conclusion based on conjecture and speculation. In other words, an additional question of fact must be answered when the circumstances are such that the reasonable person standard is not within the common knowledge of the jury. (Citations omitted.) In this case, clearly a medical malpractice case, the Beavises present nothing to establish that the proper technique for performing an injection is within the common knowledge of the jury. Moreover, they present nothing to refute the instruction's premise that the standard of care to be applied to assess the propriety of an injection is the same regardless of whether the health care professional is a doctor, a nurse, or something else. This distinguishes the present case from Parker v. Haller, 751 P.2d 372, 376 (Wyo.1988), where the physician's assistant was to be held to the standard of care of a physician's assistant in determining whether his treatment and referral to a physician fell below the standard of care. Wyo. Stat. Ann. § 1-12-601 [1] also provides support for the standard of care instruction given in this case. Moreover, by failing to object to the standard of care instruction, the Beavises appeared content to hold Hazlett to the more exacting standard found in that instruction. They now argue it was the improper standard. The Beavises cannot have their cake and eat it too. We cannot conclude the instruction is an improper statement of the standard of care under these circumstances. [¶ 14] We also disagree with the Beavises' premise that the instruction created a false supposition that Hazlett was trained as a nurse, placing her in a non-achieved category of competency, or that it created a presumption of due care. The Beavises rely on Gilpatrick Constr. Co. v. Wind River Ready-Mix Concrete Co., 473 P.2d 586, 589 (Wyo.1970), a case where a road contractor argued that placement of barricades around a construction site satisfied its duty. The Gilpatrick court rejected that argument because the law of negligence is predicated upon that which is required of a reasonable person in light of all the circumstances present. Id. Therefore, whether the barricades were adequate was a question for the determination of the trial court. Id. However, the Beavises cannot stretch Gilpatrick to fit their case. First, nothing in the instruction indicates Hazlett was to be considered a nurse. Instead, the instruction is clear that Hazlett would be held to the same standard of care in performing the injection as a doctor, a nurse, or any other health care professional, regardless of her training or qualifications. Moreover, nothing in the instruction indicates that qualification as a nurse creates a presumption of due care, and, in accord with Gilpatrick, the jury in this case was permitted to make the determination of whether Hazlett's acts were negligent. See Wardell v. McMillan, 844 P.2d 1052, 1064 (Wyo.1992) (physicians not entitled to due-care instruction). [¶ 15] In light of the standard of care instruction, we turn to the question of whether the district court abused its discretion in precluding the testimony at issue. The Beavises contend Hazlett's training, qualification, and certification, or lack thereof, was clearly relevant to the question of whether the injection was properly administered, reasoning that if Hazlett was not trained or qualified to give the injection in question, it is more likely she did it improperly. However, this argument is premised on the Beavises' contention that the standard of care should be something other than that applied by the district court. As we have previously discussed, the standard of care instruction, which is the law of the case, indicates that all health care professionals would be held to the same standard in analyzing the propriety of an injection, arguably making Hazlett's qualifications and training irrelevant. [¶ 16] Nevertheless, even assuming the evidence of Hazlett's qualifications and training was relevant, it would still have to satisfy W.R.E. 403, which states: Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. The trial court's authority to exclude relevant evidence is discretionary in nature, as it is in a better position `both to detect and to assess the dangers and considerations enumerated in the rule, and to balance these against the probative value of proffered evidence.' Banks v. Crowner, 694 P.2d 101, 104 (Wyo.1985) (quoting 2 Louisell and Mueller, Federal Evidence, § 125, p. 10 (1978)). The district court's ruling indicates it was concerned that evidence of Hazlett's lack of qualification would implicate some of the matters listed in W.R.E. 403. Subsequently, during a lengthy discussion concerning admissibility of evidence that Hazlett had committed other errors at the Wright Clinic and her ensuing transfer, the district court offered the Beavises an opportunity for a hearing, after hours, on evidentiary matters. Although there is some question whether this opportunity for a hearing was specific to the present evidentiary issue, it is clear the opportunity existed. Later, prior to Hazlett's testimony, the district court again asked whether a hearing was needed on collateral matters. The Beavises' counsel indicated no hearing would be held. This court has written: Where a court gives a party seeking to admit evidence the opportunity to renew his attempt to have it admitted, the party cannot complain if he fails to take the opportunity which is offered. Contreras By and Through Contreras v. Carbon County School Dist. No. 1, 843 P.2d 589, 596 (Wyo. 1992). Although not directly on point, Contreras provides strong analogous support against the Beavises' position. We cannot find an abuse of discretion under these circumstances.