Opinion ID: 1381810
Heading Depth: 3
Heading Rank: 2

Heading: Jury Instruction on Aggravation of Preexisting Condition and Promotion

Text: Wyeth and Upjohn argue that the district court erred in modifying the Arkansas Model Instruction on proximate cause to reflect Scroggin's theory that estrogen plus progestin use promotes preexisting abnormal cells into malignancies. We review a district court's decision on jury instructions for abuse of discretion, looking to the instructions as a whole to determine whether they fairly submitted the issues to the jury. Boerner v. Brown & Williamson Tobacco Co., 394 F.3d 594, 603 (8th Cir.2005). We afford the district court broad discretion in choosing the form and language of the instructions and will reverse a jury verdict only if the erroneous instruction affected a party's substantial rights. In re Prempro Prods. Liab. Litig., 514 F.3d 825, 829 (8th Cir.2008) (internal quotations omitted) (quoting Slidell v. Millennium Inorganic Chems., Inc., 460 F.3d 1047, 1054 (8th Cir.2006)). Model jury instructions are just that, models. They are not mandatory. United States v. Wilson, 565 F.3d 1059, 1067 (8th Cir.2009). The district court was not required to precisely follow Arkansas's Model Instruction, but only to fully and properly instruct upon all the elements of the case in light of controlling Arkansas law. Wright v. Farmers Co-Op of Ark. & Okla., 620 F.2d 694, 698 (8th Cir.1980) (internal quotations omitted) (citing Stafford v. S. Farm Bureau Cas. Ins. Co., 457 F.2d 366, 367 (8th Cir.1972) (per curiam)). Under Arkansas law, proximate cause is that cause which, in a natural and continuous sequence, produces damage. Sluder v. Steak & Ale of Little Rock, Inc., 361 Ark. 267, 206 S.W.3d 213, 218 (2005) (internal quotations omitted) (citing AMI Civ.3d 501; Bull v. Manning, 245 Ark. 552, 433 S.W.2d 145 (1968); Ben M. Hogan & Co. v. Krug, 234 Ark. 280, 351 S.W.2d 451 (1961)). The district court's instruction included this precise language, as well as the following definitions: A `producing' cause is one that in natural and continuous sequence causes or initiates injury and without which the injury would not have occurred. A `promoting' cause is one that in natural and continuous sequence aggravates a pre-existing condition or disease and without which the full extent of the injury would not have occurred. The court then clarified that the jury was to view the evidence in light of these definitions rather than how they may have been used during the trial. Wyeth's argument [14] acknowledges only two possible theories of Scroggin's case: either Scroggin already had breast cancer and the hormone replacement therapy aggravated it, or the therapy initiated the transformation of normal cells into cancerous cells. Given these alternatives, Wyeth asserts that including promoting in the instruction unfairly elevated Scroggin's presentation of the evidence and that the instruction was not supported by the evidence. Wyeth has refused to recognize Scroggin's theory of causation. Scroggin presented evidence that she had abnormal or susceptible cells, which were a pre-existing condition. In other words, she had these cells prior to her regimen of estrogen plus progestin. She also presented evidence that estrogen and progestin caused these cells to become cancerous. Dr. Colditz has described estrogen plus progestin's effect on these abnormal cells as acting like a fertilizer to get them to grow rapidly and progress on to cancer. Dr. Naftalis testified that combination hormone therapy has a promotion effect on the susceptible cell and turns it into cancer. Dr. Colditz stated that the epidemiologic field accepts promotion as the mechanism by which hormone replacement therapy causes breast cancer. Thus, the instruction was appropriately tailored to the facts. See Pershern v. Fiatallis N. Am., Inc., 834 F.2d 136, 139 (8th Cir.1987). The court showed no bias in its instruction. The producing-cause definition reflects Wyeth's theory of the case  that hormone replacement therapy does not initiate the first abnormal cells or turn normal cells into cancerous cells  and is appropriately supported by the evidence Wyeth presented. Scroggin argued promotion, Wyeth argued initiation, and the court instructed the jury on both theories. The court also instructed the jury that it could not award damages for any injury that did not occur as a result of Scroggin's taking Prempro or Premarin and Provera. The instruction contains the substantive requirements of proximate cause; what remains is form and language, which we leave to the court's broad discretion. In re Prempro Prods. Liab. Litig., 514 F.3d at 829.