Opinion ID: 1452613
Heading Depth: 1
Heading Rank: 6

Heading: The textbook chapter and pamphlet written by Dr. Levine

Text: During trial, and over Dr. Prabhu's hearsay and relevance objections, the district court admitted a textbook chapter and a pamphlet written by Dr. Levine regarding eye care after acoustic neuroma surgery. Dr. Prabhu now complains that these materials were hearsay and also prejudicial, as they included distasteful photographs and drawings of disfigured eyes. At trial, only relevant evidence is admissible. NRS 48.025. Relevant evidence is defined as evidence having any tendency to make the existence of any fact that is of consequence to the determination of the action more or less probable than it would be without the evidence. NRS 48.015. Even if evidence is relevant, the district court must also determine whether its probative value is substantially outweighed by the danger of unfair prejudice, of confusion of the issues or of misleading the jury. NRS 48.035(1). The district court enjoys broad discretion in determining whether evidence should be admitted. See, e.g., Kazalyn v. State, 108 Nev. 67, 71-72, 825 P.2d 578, 581 (1992). Hearsay, which is generally inadmissible, is defined as a statement offered in evidence to prove the truth of the matter asserted. NRS 51.035. NRS 51.255 creates, under certain circumstances, an exception to the hearsay rule for medical writings: To the extent called to the attention of an expert witness upon cross-examination or relied upon by him in direct examination, a statement contained in a published treatise, periodical or pamphlet on a subject of history, medicine or other science or art, is not inadmissible under the hearsay rule if such book is established as a reliable authority by the testimony or admission of the witness or by other expert testimony or by judicial notice. In considering medical writings, as with other evidentiary issues, the district court has discretion to determine whether the proffered materials should be admitted. See, e.g., Foreman v. Ver Brugghen, 81 Nev. 86, 398 P.2d 993 (1965) (discussing NRS 51.040, which preceded NRS 51.255). During his deposition, Dr. Levine described the procedures he employed to repair Ms. Franco's post-operative eye problems. In particular, he discussed Ms. Franco's brow droop, inability to close her left eye, and problems with her cornea. Dr. Levine explained that he surgically opened her eyelids, which had been sewn together, revised the eyelid margins, and implanted a palpebral spring to allow the lids to close. In addition, Dr. Levine performed surgery on Ms. Franco's damaged cornea. Later in his testimony, Dr. Levine explained that post-operative complications and recovery are directly related to tumor size and that according to a statistical study that he performed, patients with small tumors rarely have post-operative facial paralysis, but patients with larger tumors frequently suffer such paralysis. In addition, Dr. Levine testified that patients with tumors smaller than two centimeters generally do not suffer from pre-operative vision problems. This testimony was directly related to Dr. Levine's textbook chapter, which discusses various problems related to post-operation neuroma patients, including brow droop, inability to close the eye, and cornea problems. The textbook chapter also discusses the techniques employed by Dr. Levine to improve Ms. Franco's problems, such as eyelid margin revisions and palpebral springs. In addition, the chapter includes a statistical study of ocular problems related to acoustic neuromas, including both pre-operative and post-operative signs and symptoms. This study describes in detail the percentages of patients with various symptoms and the correlating tumor sizes (small, medium or large). We conclude that with regard to those portions of the chapter that mirrored and explained Dr. Levine's testimony, the district court did not abuse its discretion in ruling that the textbook chapter was both relevant and a reliable authority. With regard to the portions of the textbook chapter that were not directly related to Dr. Levine's testimony, we conclude that they were not hearsay because they were not offered for the truth of the matter asserted. Specifically, they were not offered to prove that Dr. Prabhu's lack of diagnosis increased the harm to Ms. Franco or to show the damages suffered by Ms. Franco as a result of the tumor's size. As a consequence, the hearsay exception delineated in NRS 51.255 did not apply with regard to these portions of the chapter. Further, we conclude that the district court did not abuse its discretion in admitting these parts of the chapter as relevant evidence with a probative value not substantially outweighed by the danger of unfair prejudice. Although in his designation of the record on appeal, Dr. Prabhu designated all pleadings, papers and documents on file, the pamphlet about which he complains is not included in the record on appeal. It is the appellant's responsibility to ensure that the record on appeal contains the material to which exception is taken. If such material is not contained in the record on appeal, the missing portions of the record are presumed to support the district court's decision, notwithstanding an appellant's bare allegations to the contrary. Riggins v. State, 107 Nev. 178, 182, 808 P.2d 535, 538 (1991), rev'd on other grounds, 504 U.S. 127, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992). We therefore have no basis on which to review Dr. Prabhu's contention and must assume that the district court was correct in its ruling. See Schouweiler v. Yancey Co., 101 Nev. 827, 831, 712 P.2d 786, 791 (1985) (concluding that absence of trial transcript in record precluded review); Carson Ready Mix v. First Nat'l Bk., 97 Nev. 474, 476, 635 P.2d 276, 277 (1981) (recognizing that this court cannot consider matters not properly appearing in the record on appeal). Moreover, if, as Dr. Prabhu alleges, the pamphlet did not pertain to Dr. Levine's testimony, then it likely fell without the hearsay rule. As discussed above, the district court has broad discretion in determining whether evidence is relevant and whether or not its probative value is substantially outweighed by the danger of unfair prejudice.