Opinion ID: 864522
Heading Depth: 2
Heading Rank: 1

Heading: whether the court of appeals erroneously found

Text: INSTRUCTION C-20 TO BE REVERSIBLE ERROR. 1 The Defendants also assert that the Court of Appeals' majority opinion misapprehends the facts concerning Bickham's alleged blood clotting disorder which was allegedly diagnosed when she was seven years of age. Since these statements of fact have no bearing on our decision to affirm the Court of Appeals decision, we need not consider the merits of this issue. Suffice it to say, the Court of Appeals did in fact make three misstatements of fact, those being (1) Bickham's diagnosis with a blood clotting disorder at the age of seven; (2) information regarding Bickham's blood clotting disorder was a part of her medical records; and (3) the information regarding Bickham's blood clotting disorder was relied upon by the physicians in providing treatment. 4 ¶9. The Court of Appeals, on rehearing, found Instruction C-20 to be subjective and in conflict with this Court's holding in Morrison, 657 So.2d 808. The Court of Appeals opined that just as this Court found the jury instruction involved in Morrison to be subjective and misleading, so too was Instruction C-20. The Defendants argue that the Court of Appeals erred in its reasoning. Specifically, they argue that Instruction C-20 merely instructed the jury on alternative treatments as evidenced by conflicting expert testimony and that the facts in Morrison are wholly distinguishable from the present circumstances. Bickham, of course, agrees with the Court of Appeals' rehearing holding. ¶10. In Morrison, the medical malpractice claim instituted by the plaintiff alleged negligence resulting from a penile prosthesis surgery and the defendant doctor's failure to diagnosis and treat the recurring problems which exhibited themselves as a result of the botched surgery. Id. at 809-11. The facts in Morrison are not distinguishable from the present facts as asserted by the Defendants. The holding in Morrison did not, as asserted by the Defendants, just center around the fact that there was only one method of treatment for the problems exhibited by the plaintiff, the penile prosthesis operation. The negligence claim in Morrison not only dealt with the treatment, meaning the surgery, but also with the care given the plaintiff after the surgery which was claimed to be deficient and amounting to a failure to diagnosis and treat. Id. at 811. Looking at the instructions in Morrison which were at issue, makes it clear that the doctor's treatment of the plaintiff not only encompassed the surgery itself, but also the seven months of followup treatment the plaintiff received. Id. Ultimately, we held that the trial court erred in allowing a jury instruction in a medical malpractice action which held the physician not liable for a mere error in judgment. Id. We rejected bona fide or good faith judgment jury instructions in medical malpractice actions. Id. Our reasoning was clear. Such instructions create confusion with the jury and subject physicians to a 5 subjective and not an objective standard of care. We also found that such subjective standards could sway a jury to conclude, incorrectly, that a physician is not liable for malpractice even if he or she is negligent in administering the treatment selected. Id. at 812 (quoting Riggins v. Mauriello, 603 A.2d 827, 831 (Del. 1992)). The central issue in the ordinary negligence case is whether the defendant has deviated from the required standard of care, not his mental state at the time of the conduct which constitutes the deviation. Id. at 813 (quoting Logan v. Greenwich Hosp. Ass'n, 191 Conn. 282, 299, 465 A.2d 294, 303 (1983)). Additionally, we stated that: If this Court were to settle for the mere error of judgment language as the controlling law in this state for medical malpractice cases, then most injured individuals could forget recovery. A physician or a professional can always claim he was exercising his own judgment even though he was mistaken or negligent. Id. at 814 (emphasis added). ¶11. Looking at the above language, there is no difference between the statement in Morrison regarding exercising his own judgment and in their best judgment. It is clear that our decision in Morrison addressed not only the confusion of physician error and actionable liability, but also the inappropriateness of subjective standard jury instructions in medical malpractice actions. ¶12. Today, we are faced with a similar instruction, Instruction C-20. Instruction C-20 provides that: You are instructed that you have heard from the expert witnesses who have testified in the case differing views as to what would be the proper procedures to be followed by Doctors Grant and Harris in their treatment of Tamara Bickham. If you find from these opinions that two or more alternative courses of action would be recognized by the profession as being proper and within the standard of care and that Doctors Grant and Harris, in the exercise of their best judgment, elected one of the proper alternatives you should find for Doctors Grant and Harris. (emphasis added). This instruction provides a subjective standard of care by the doctor regarding his own misdiagnosis. This is clearly what our holding in Morrison forbids. To charge juries with the responsibility 6 of assessing the mental state of treating physicians and to make a determination of liability is preposterous. Not to mention the negative effect such instructions will have on those injured. There is no conceivable way a jury weighing alternative treatments would possibly find physicians negligent for exercising their best judgment. ¶13. Instruction C-20's failure to include the word error does not lead to the conclusion that our holding inMorrison is not applicable. Instruction C-20 provides for an in the exercise of their best judgment standard of care. The word judgment is not in and of itself subjective. The word judgment used in connection with other words can certainly constitute a subjective jury instruction, as with the phrase in the exercise of their best judgment. These words together, not alone, are what amounts to a subjective jury instruction. ¶14. Furthermore, a subjective jury instruction in a medical malpractice case is a misstatement of law, and as stated earlier a defendant is generally entitled to an instruction that presents his side of the case, if such instruction is a correct statement of the law. Humphrey, 759 So.2d at 380 (citing Heidel, 587 So.2d at 842). The appropriate standard of care in a medical malpractice case is objective and centers around exercising the degree of care, diligence, and skill ordinarily possessed and exercised by a minimally competent and reasonably diligent, skillful, careful, and prudent physician in that field of practice. What the physician may have been thinking in his best judgment is irrelevant. What the physician did in treating the patient is the key factor. Patients expect their physician to always be exercising their best judgment. However, it is clear that there are times where the physician's best judgment regarding treatment falls below the applicable standard of care. This is why instructions such as C-20 are misstatements of law as they hold the physician to his own personal standard of care and not the standard of care applicable to physicians in his area of practice. 7