Opinion ID: 2570625
Heading Depth: 1
Heading Rank: 6

Heading: Prejudicial error established

Text: Notwithstanding the incorrect statement of law in the jury instruction in this case, reversal of the district court's judgment is not warranted unless the error was prejudicial. [25] To determine whether an error is prejudicial, this court has articulated at least two standards. Specifically, in Peterson v. Silver Peak, [26] we explained that reversible error occurs when the error substantially affects the rights of the complaining party. Subsequently, however, in Pfister v. Shelton, [27] we stated that a judgment's reversal based on an erroneous instruction is not warranted unless the `error has resulted in a miscarriage of justice.' [28] But, regardless of the language employedwhether miscarriage of justice or affecting substantial rightswhat is clear from our caselaw is that prejudice must be established in order to reverse a district court judgment; it is not presumed and is established by providing record evidence showing that, but for the error, a different result might have been reached. [29] Indeed, in Truckee-Carson Irrigation District v. Wyatt , we noted that prejudicial error was error that constituted a miscarriage of justice and that to determine whether a miscarriage of justice occurred the record must be considered as a whole to resolve whether absent the district court's error it is probable a different result may have been reached. [30] Similarly, in Boyd v. Pernicano, [31] when deciding whether the error complained ofan attorney's improper statement, the objection to which was overruledwas prejudicial error, we held that it was not prejudicial because upon consideration of the record the error did not affect a substantial right of the party because it was not probable that a different result might have been reached absent the error. In Driscoll v. Erreguible, [32] we did not use either articulation to describe prejudice when we were asked to resolve whether a district court's erroneous instruction in response to the jury's request for clarification of an instruction constituted prejudicial error. We continued to recognize, however, that whether an erroneous jury instruction is prejudicial is determined based on a review of the record, noting that generally the appellate record must contain evidence that a different result might have been reached absent the error at issue. [33] And, recently, in Carver, we considered whether the giving of a mere happening instruction along with a res ipsa loquitur instruction was so conflicting as to constitute prejudicial error. [34] In resolving the issue in Carver, we reiterated that prejudice is met when, based on a showing of sufficient-record evidence, a party establishes that a different result might have been reached were it not for the district court's error. [35] In that regard, we clarify Carver to the extent that it may be construed as changing the complaining party's burden of proof on appeal or to the extent that it could imply that a superficial presentation of record evidence is sufficient; such is not the case. Thus, to reverse a district court judgment based on an erroneous jury instruction, prejudicial error must be established. [36] This is accomplished when the complaining party demonstrates that the error substantially affected the party's rights. [37] That standard is met when the complaining party provides sufficient-record evidence showing that, but for the error, a different result might have been reached. [38] In this appeal, the Cooks cite specific expert testimony that they contend shows that they were prejudiced by the improper instruction. For example, they presented expert testimony that Sunrise was negligent because it failed to make available a fluoroscopy machine, also called a C-arm, with vascular imaging software. According to the Cooks, this failure to provide the requested imaging equipment increased the time Mrs. Cook's vessels were without oxygen. Additionally, Mrs. Cook's medical records indicate, and Dr. Ameriks testified, that he also encountered problems with obtaining images of Mrs. Cook's lower limb due to the C-arm's inability to navigate around the operating table's center post. Without these additional images, Dr. Ameriks testified that he could not visualize the necessary vessels to determine whether there were additional blood clots. According to Dr. Ameriks and the Cooks' expert, Dr. Bruce Hirschfeld, this failure to provide adequate equipment severely hampered Dr. Ameriks' ability to treat the loss of blood flow and delayed the treatment of Mrs. Cook's leg. Sunrise's experts, however, testified that a plain x-ray film was sufficient to obtain the additional images needed by Dr. Ameriks. Those experts also testified that there were other options available to Dr. Ameriks to get around the table's center post, if Dr. Ameriks was truly concerned with obtaining additional images. The Cooks also presented expert testimony that Dr. Ameriks' decision to close Mrs. Cook's wound sites and monitor her condition was reasonable. In particular, based on Mrs. Cook's small vessels and the fact that Dr. Ameriks had established blood flow to a portion of the body that he could visualize by x-ray, Dr. Ameriks' believed that it was possible that the vessels in her lower limb had merely constricted due to spasms. As a result, Dr. Ameriks made the decision to close the wound sites and monitor Mrs. Cook's condition. Sunrise's expert, Dr. Fred Littooy, a vascular surgeon, agreed that it was reasonable for Dr. Ameriks to close Mrs. Cook's wound sites based on the situation presented to Dr. Ameriks during his first attempt at revascularization. Yet, Dr. Robert Wagmeister, a vascular surgeon who also testified on behalf of Sunrise, concluded that Dr. Ameriks' decision to close the wound sites fell below the standard of care. Specifically, Dr. Wagmeister testified that Dr. Ameriks should have performed further exploration to determine why there were no pulses in Mrs. Cook's lower limb before he closed. Additionally, Dr. Wagmeister testified that the absence of Doppler signals [39] was an indication that the vessels were not in spasm. Additionally, the Cooks introduced testimony that despite a request and a subsequent assurance by a Sunrise nurse that an angiography suite would be made available, Sunrise's employees failed to make the suite available. Likewise, Dr. Ameriks testified and Mrs. Cook's medical records showed that despite a second request for the angiography suite, Sunrise's staff informed Mrs. Cook's surgeons that the angiography suite was unavailable. Vickie Gooss, Director of Imaging at Sunrise, testified, however, that there were no procedures being conducted in the angiography suite at the time that the surgeons had requested it. And she testified that if a nurse had been told that it was available, but then informed the surgeons that it was not, that was incorrect. According to the Cooks, this failure contributed to the loss of Mrs. Cook's limb because Dr. Ameriks testified that he would not have closed Mrs. Cook's wound sites if he had known that the angiography suite was not going to be available for further diagnostic imaging. Further, the Cooks presented evidence that had the angiography suite been available it would have taken the angiography team between a half hour to one hour to image Mrs. Cook's limb, thereby providing Dr. Ameriks with a specific diagnosis and location of the problem. Moreover, with respect to making the angiography suite available, Sunrise's experts conceded that if an order for the angiography suite had been made, then noncompliance with that order meant the hospital fell below the standard of care. Sunrise's experts, however, asserted that while in the recovery room, Mrs. Cook's condition presented an emergency situation that required immediate intervention, not an angiogram in the angiography suite. These experts testified that if Mrs. Cook had been taken to the angiography suite first, it would have merely increased the time that her vessels were without oxygen. Sunrise also countered with medical expert testimony that Dr. Ameriks knew what the problem was, and even after the imaging was completed in the angiography suite, it still would have been necessary to move Mrs. Cook to the operating room to revascularize her limb. Here, the Cooks provided evidence showing that the issue of liability was close. Specifically, the Cooks presented evidence suggesting that Sunrise was negligent or at least creating a close question of fact for the jury, the jury was improperly instructed, and the jury rendered a quotient verdict, six to two. [40] Thus, had the proper jury instruction been given, it is probable that a different result might have been reached by the jury. Accordingly, we conclude that the Cooks have met their burden of showing from the record that prejudice resulted from the misstatement of law in the jury instruction because absent that mistake it is probable that a different verdict might have resulted.