Opinion ID: 1850445
Heading Depth: 1
Heading Rank: 4

Heading: Whether the District Court Erred in Its Instructions to the Jury.

Text: A. Eggshell plaintiff. The hospital asserts it was inappropriate for the district court to give an eggshell plaintiff instruction in a case involving a claim of medical malpractice. It urges that every patient can be considered to be an eggshell plaintiff. The instruction of which the hospital complains was as follows: If the decedent, Samuel Wolbers, had a condition which made him more susceptible to injury than a person in normal health, then the Defendant is responsible for all injuries and damages which are experienced by the decedent proximately caused by Defendant's actions, even though the injuries claimed produce a greater injury than those which might have been experienced by a normal person under the same circumstances. We believe that the objection lodged to this instruction in the trial court was inadequate to preserve the challenge now being made on appeal. The hospital's objection to this instruction was as follows: We object to the use of the word normal health. The Court hasn't defined normal health and the point is that the reason for this instruction as urged by the Plaintiff and accepted by the Court is that Mr. Wolbers had a condition which was a consequence of long-term smoking. There's been evidence in this case of that effect. You heard it  heard it as recently as yesterday, your honor, yet one reads these instructions and they're innocent of any suggestion that smoking is an issue in this case and the failure to instruct on that gives grievous harm to the Defendant and I think puts the court in equally grievous error. The objection appears to have been an attempt to reassert the issue concerning comparative fault, which was disposed of in Division I of this opinion. It was insufficient to preserve the challenges to the instruction that are being made for the first time on appeal. B. Presumptive evidentiary value of death certificate. 1. Arguments. The hospital asserts the cause of Mr. Wolbers' death was an important issue in this case, and it was error for the district court not to instruct the jury that the death certificate was presumptive evidence of the facts contained therein. Plaintiff argues the requested instruction would have been an improper comment on the evidence and a misstatement of the law. 2. Analysis. The hospital requested the following jury instruction: A certified copy of a death certificate by a physician is presumptive evidence of the facts contained in the death certificate. We conclude that the proffered instruction was properly rejected by the district court. One of the fighting issues in this case was the cause of death. The death certificate stated as cause of death: Sudden death due to left carotid endarterectomy 5/16/97, due to peripheral vascular disease due to tobacco use. We have recognized that, although Iowa Code section 144.45 makes death certificates presumptive evidence of facts recited, that is limited to such facts and data as are specific and known, but do not contemplate the perpetuating of hearsay testimony, which is merely conclusions or opinions of the person or persons making them. Beardsley v. Ostrander, 254 Iowa 356, 359, 118 N.W.2d 61, 62-63 (1962) (citing Morton v. Equitable Life Ins. Co., 218 Iowa 846, 853, 254 N.W. 325, 328 (1934)). A jury given only the instruction proffered by the hospital would not be apt to draw the distinction between facts and opinions and might apply the statutory presumption to the cause of death as expressed in the death certificate. For that reason, the instruction was properly refused. C. Hypothetical questions to an expert. The hospital argues that the court's instruction regarding hypothetical questions and expert-witness testimony was a misstatement of the law and that it was prejudiced by the instruction. The instruction that has been challenged provided: An expert witness was asked to assume certain facts were true and to give an opinion based on that assumption. This is called a hypothetical question. If any fact assumed in the question has not been proved by the evidence, you should decide if that omission affects the value of the opinion. The hospital contends that the instruction does not truly state the law as established in Cody v. Toller Drug Co., 232 Iowa 475, 480, 5 N.W.2d 824, 827 (1942). Cody states the rule as follows: [Answers] to hypothetical questions should be disregarded if the facts assumed have not been proven and juries are not permitted to pass on the materiality of such facts. 232 Iowa at 480, 5 N.W.2d at 827 (emphasis added). We need not decide whether the instruction given impermissibly deviates from the rule of law established in Cody. The hospital does not identify any hypothetical questions in the present case that assumed facts that were not proven. Consequently, we have no basis for concluding that the giving of the instruction was prejudicial even if it was improperly worded. D. Submission of past loss of function of mind and body as an element of damage. The hospital urges that loss of function of mind and body was not a proper item of damage because it lacked support in the evidence. We have recognized that this element of damage may be allowed even though the time between a negligent act impeding a patient's bodily functions and the time of death is brief. Mead v. Adrian, 670 N.W.2d 174, 179 (Iowa 2003). Plaintiff's evidence revealed that over the course of several hours her decedent's upper airway became obstructed. Dr. Raphael testified that plaintiff's decedent went into respiratory arrest and died because of an upper airway obstruction. Before he completely lost consciousness, he was gasping for air. We conclude that the jury could have found that, for some time prior to his death, plaintiff's decedent suffered loss of ability to breath and loss of mental function as he succumbed to the effect of oxygen deprivation. This element of damage was properly submitted to the jury.