Opinion ID: 2084684
Heading Depth: 1
Heading Rank: 16

Heading: Refusal to Give Jury Instruction

Text: The plaintiffs contend that the trial justice improperly denied their request for a specific instruction that if interns and residents of Roger Williams observed the patient's priapism, then they had a duty under the circumstances to report the patient's condition, and if they failed to report the condition, and that failure prevented the patient from receiving proper treatment that would have prevented the injury, then the jury must find that Roger Williams was negligent. General Laws 1956 § 8-2-38 requires the trial justice to instruct the jury on the law to be applied to the issues raised by the parties. Malinowski v. United Parcel Service, Inc., 792 A.2d 50, 55 (R.I.2002) (quoting State v. Briggs, 787 A.2d 479, 486 (R.I.2001) and State v. Lynch, 770 A.2d 840, 846 (R.I. 2001)). However, [i]t is well settled that the charge given to the jury must be applicable to the facts that have been adduced in evidence and that a request for instructions is properly denied when there is no basis for such instruction in the evidence. Brodeur v. Desrosiers, 505 A.2d 418, 422 (R.I.1986) (citing Labrecque v. Branton Yachts Corp., 457 A.2d 617, 619 (R.I.1983)). In this case, plaintiffs maintain that they presented sufficient evidence to establish that interns and/or residents at Roger Williams were negligent, and therefore, the hospital, as their employer, was vicariously liable to plaintiffs. This argument requires us to determine whether the record contains sufficient evidence from which a reasonable jury could reach the conclusion set forth in the requested instruction, that the alleged interns and/or residents had a duty and were negligent by failing to report the patient's priapism. After a review of the record, we conclude that the record lacks evidentiary support to warrant plaintiffs' theory of negligence based on the acts or omissions of hospital interns or residents, and therefore, the trial justice did not err when she refused to give the jury the proposed instruction. [12] The plaintiffs failed to present any expert testimony that would support the requested instruction that the interns, in particular, had a duty to report the priapism under the circumstances present in this case. Indeed, plaintiffs did not present expert testimony on any standard of care that the interns failed to meet. [13] In a medical malpractice action, the plaintiff must establish a standard of care applicable to the defendant and the defendant's deviation from that standard through the use of expert testimony, unless the breach of a duty of care would be obvious to a lay person. Boccasile v. Cajun Music Ltd., 694 A.2d 686, 689-90 (R.I.1997); see also Riley v. Stone, 900 A.2d 1087, 1095 (R.I. 2006); Sheeley, 710 A.2d at 164. [14] Expert testimony is needed to explain    what proper procedures and alternatives are available to a physician    [and] to show why the procedures followed by the defendant physician were negligent, and not legitimate, alternatives. Sousa v. Chaset, 519 A.2d 1132, 1135 (R.I.1987). In our opinion, specific expert testimony was required to adequately present the issue to the jury because the alleged negligence of the interns was not the type of negligence that would be obvious to a layperson. Cf. Foley v. St. Joseph Health Services of Rhode Island, 899 A.2d 1271, 1278 (R.I. 2006) (holding expert testimony required in medical malpractice action against radiologist for five hour delay in reporting results of emergency room patient's CT scan); Boccasile, 694 A.2d at 690-91 (requiring expert testimony when alleged negligence of nurse in responding inadequately to a medical emergency involves professional skill and judgment of nurse). The plaintiffs' theory was based on negligent observation and reporting of a medical condition that involves an intern's professional skill and judgment. A layperson cannot be expected to know what is expected of an intern who checks on a nonteaching patient in a hospital. The plaintiffs argue, however, that the testimony of the nurses and nursing expert, together with the testimony of the doctors, including Dr. Warshaw, Dr. Rote, and plaintiffs' experts, Dr. Schneider and Dr. Goldstein, collectively provided sufficient evidence of an applicable standard of care. They maintain that a reasonable jury could have found that the alleged interns were negligent based on the assumption that they should have communicated something about the patient's condition in a timely manner. The plaintiffs argue that interns and residents are held to the same standard of care as doctors, see Baccari v. Donat, 741 A.2d 262, 264 (R.I.1999) (In this jurisdiction residents are held to the same duty of care as other physicians.); therefore, they maintain that the testimony of the other physicians presented relevant evidence on the standard of care for the interns and residents. For the following reasons, we decline plaintiffs' invitation to cobble together a standard of care from this testimony. Although in Baccari, 741 A.2d at 264, this Court said that residents are held to the same general standard of care as physicians and are not held to a lesser standard, that holding did not define or address an intern's or resident's duties under the circumstances present in a particular case. Cf. Cornfeldt v. Tongen, 262 N.W.2d 684, 694-95 (Minn.1977) (holding trial court properly excluded expert's testimony that the accepted medical practice required a resident to review preoperative test results because the expert lacked knowledge of the requirements of the resident in his first stage of residency). In general, we hold physicians to a duty of care that is expected of a reasonably competent practitioner acting under similar circumstances.  Oliveira v. Jacobson, 846 A.2d 822, 826 (R.I.2004) (citing Sheeley, 710 A.2d at 167) (emphasis added) (holding defendants could not rely on the standard of care of a non-defendant doctor to establish the standard of care applicable to the defendant doctor because they did not operate under similar circumstances). The testimony of Dr. Warshaw and Dr. Schneider focused on the standard of care for an on-call attending physician who is responsible for diagnosing and treating admitted patients and who learns that a patient has been experiencing a persistent erection. On the other hand, the testimony of Dr. Rote and Dr. Goldstein concerned only the standard of care for a urologist who is treating a patient who has been experiencing a persistent erection. Nothing from the testimony of these doctors established what the unidentified interns were expected to do when they saw Gianquitti, a nonteaching patient whom they were not authorized to treat. Because the interns (accepting the patient's testimony that interns visited him) were operating under different circumstances from the physicians and had duties different from those of the other physicians, it is our opinion that the testimony of the physicians did not support an instruction on the standard of care for the interns. There simply is nothing in the record that would establish what the alleged interns should have done in these circumstances. No evidence was presented about whom the interns should have notified, what steps they should have taken in the circumstances, or what they could have done despite any limitations that they may have had upon their authority. The plaintiffs also ask us to rely on the testimony relating to nurses to establish the standard of care for the interns. Catherine Graziano, a retired nurse who testified as an expert, said if a nurse had assumed the responsibility to monitor an admitted patient and the patient complained of a persistent erection, the nurse should ask the patient questions and investigate the condition. She explained that if a nurse found out that the erection persisted over two hours or more, it would be the nurse's obligation to notify the attending physician. In addition, Nurse Bousquet testified that if she had found out that the patient was experiencing a priapism, she would have considered it her responsibility, as a nurse, to call the attending physician. Similarly, Nurse Lemoi-Brown testified that even though she did not consider a priapism to be of an emergency nature, she understood that urgent medical care was required. In our opinion, plaintiffs cannot rely on the testimony about the standard of care for nurses to establish the standard of care for the interns. None of the nurses testified about the standard of care for the interns and residents at Roger Williams. Rather, the nurses testified about what the nurses should have done when presented with a patient for whom they are responsible who is experiencing a persistent erection, not what a physician who is an intern should do under those circumstances. Furthermore, none of the nurses testified that the standard of care for intern physicians under the circumstances was within their knowledge, skill, training, or experience. It is well settled that the expert witness must have knowledge, skill, training, or experience in the same field as the alleged malpractice so that the expert's testimony can be genuinely helpful to the jury. Debar v. Women and Infants Hospital, 762 A.2d 1182, 1188 (R.I. 2000) (quoting Marshall v. Medical Associates of Rhode Island, Inc., 677 A.2d 425, 427 (R.I.1996)). Therefore, the testimony of the nurses could not have provided the jury with evidence from which it could reasonably conclude that any interns or residents were negligent.