Opinion ID: 1276333
Heading Depth: 1
Heading Rank: 2

Heading: Instruction 14DPhysical Frailties.

Text: Defendants, citing Mogensen v. Hicks, 253 Iowa 139, 110 N.W.2d 563 (1961), ultimately persuaded trial court to give the following instruction: Defendants have alleged that they have no control over the physical frailties, allergies, reactions, anomalies, or idiosyncrasies of Plaintiff Erma A. Sammons. They further contend that the alleged condition of her right leg and foot after her treatment by them does not demonstrate a lack of due care. The plaintiff's physical frailties, allergies, reactions, anomalies, or idiosyncrasies which were unknown to these defendants, if any you find, is a circumstance for you to consider in determining whether or not Dr. Koert R. Smith or Dr. Wilfrido Calderon exercised due care in their treatment of plaintiff in the operating room at Burlington Medical Center on the date in question. Plaintiff, objecting, pointed out that the Mogensen court was citing [plaintiff's] frailties ... [for] the reason why ... the doctrine of res ipsa has been rejected .... Here we are past that threshold .... They are indicating in this case that the doctor is not in full control of the instrumentalities involved .... I don't think there is anything in the record to support it. The above instruction first appeared in the record as one of Dr. Smith's requested instructions, applicability of which was argued on two different trial days. When on the second day trial court indicated he had read the cases this defendant relied on and would give the instruction, he had been apprised fully of plaintiff's above objection and others, advanced the prior day on the record, when objections to instructions were made. In these circumstances we think plaintiff preserved the alleged error, despite her more cursory, general and additional objection later lodged, and we reject defendant's contrary contention. During the trial it became evident defendant doctors were relying on a defense that plaintiff had some physical anomaly that made her unusually susceptible to pressure nerve injury. Admissions were obtained from plaintiff's experts that persons could have such an anomaly, although expert witnesses on both sides agreed there was no objective or definitive indication plaintiff had such a condition. Plaintiff's lead expert opined the chances of plaintiff having some unusual localized vascular anomaly at considerably less than one percent. Other evidence indicated the maximum tourniquet time and pressure were designed to accommodate such cases. Nonetheless, defendant Dr. Smith expressed the opinion, without objection, that such an anomaly was exactly the situation in this case. Apparently the opinion was grounded on lack of evidence that some specific act of negligence or malfunction of equipment caused the injury. Despite the rarity of such occurrences and the realization of plaintiff's serious injury from the outset, the doctors testified they never critiqued the operation at the time when the procedures would have been fresh in their minds, and had little recall of the events at trial. Plaintiff made no specific objection at trial that the instruction was overbroad in including frailties, allergies or other physical conditions that no witness identified as having any relationship to her injury. She argued in district court, and reasserts here, the instruction had no support in the record. Plaintiff points out the diagnosis of allergic reaction discussed in Mogensen was supported by the evidence, and it was the basis for the court's rejection of the res ipsa doctrine in that case because such evidence disclosed defendants did not have exclusive control of the instrumentalities. Consequently, plaintiff argues, Mogensen does not support an instruction in this case because trial court did submit the case to the jury on a res ipsa loquitur theory. Although the issue is close, we conclude on this record that trial court did not commit error in giving the above instruction. Under the res ipsa instruction, the court properly left to the jury's determination the two key foundation facts for invoking the permissible inference of negligence under the doctrine: (1) plaintiff's injury by an instrument under the exclusive control of defendants, and (2) an occurrence such as in the ordinary course of things would not happen if reasonable care had been used. See Reilly v. Straub, 282 N.W.2d 688, 695 (Iowa 1979); Cronin v. Hagan, 221 N.W.2d 748, 751, 753 (Iowa 1974); Wiles v. Myerly, 210 N.W.2d at 624-25; Iowa Uniform Jury Instruction 5.12. Contrary to plaintiff's contentions, the court does not find these elements as a matter of law in the process of deciding whether to instruct on the res ipsa theory, but only concludes there is sufficient competent evidence of the existence of the foundational facts to generate a jury question. See Cronin, 221 N.W.2d at 748; Wiles, 210 N.W.2d at 627. From this it follows that defendants may introduce competent evidence tending to disprove either or both foundational elements. Although there is no duty to instruct upon an issue without substantial support in the evidence or with support resting only on speculation or conjecture, Nolte v. Case, 221 N.W.2d 741, 745 (Iowa 1974), we, unlike the court of appeals, believe there was enough evidence in this record to permit trial court to give an instruction incorporating defendants' theories relating to both foundational facts. In so holding, we do not intimate what evidence or opinions should be admitted under a different record, nor whether the above instruction should be given despite objections not made in this instance.