Court Opinion

ID: 2826079
Source: CourtListenerOpinion
Date Created: 2015-08-11 08:43:38.188582+00
Date Added: 2024-06-11T12:24:51.946375
License: Public Domain

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

ANNETTE BAUGHMAN, individually
and as guardian of E.S. and M.S.,             No. 71835-5-1
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minors;                                                                               C~'1j
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                                              DIVISION ONE                                         - —1 ^4
                                                                                      155 Wash. App. 560, 570-71, 228 P.3d 828, review denied, 169 Wash. 2d

1024 (2010). Jury instructions must properly inform the jury of the applicable law

and permit each party to argue his or her theory of the case. Keller v. City of

Spokane, 146 Wash. 2d 237, 249, 44 P.3d 845 (2002).

       In granting the motion for a new trial, the trial court concluded that

instruction 7 was erroneous for the reasons stated in Richards v. Overtake

Hospital Medical Center, 59 Wash. App. 266, 796 P.2d 737 (1990), review denied,
No. 71835-5-1/8

116 Wash. 2d 1014 (1991), and Dinner v. Thorp. 54 Wash. 2d 90, 338 P.2d 137

(1959).

       In Richards, a family medicine practitioner was providing pediatric care at

the time of an alleged malpractice. Over the plaintiff's objection, the trial court

gave the following instruction:

             "A physician who is a family practitioner has a duty to
       exercise the degree of skill, care and learning of a reasonably
       prudent family practitioner in the State of Washington acting in the
       same or similar circumstances at the time of the care or treatment
       in question. Failure to exercise such skill, care and learning is
       negligence.
              If a family practitioner holds himself out as qualified to
       provide pediatric care, or assumes the care or treatment of a
       condition which is ordinarily treated by a pediatrician, he has a duty
       to possess and exercise the degree of skill, care and learning of a
       reasonably prudent family practitioner in the State of Washington
       acting in the same or similar circumstances at the time of the care
       and treatment in question. Failure to exercise such skill, care and
       learning is negligence."

Richards, 59 Wash. App. at 276. The Richards court held the second paragraph

was erroneous because it prevented the jury from choosing to apply the standard

of care of a pediatric specialist:

       Instruction 7 given by the court deprived the jury of the
       determination of whether Dr. Haeg should be held to the standard
       of care of a reasonably prudent family physician or to the standard
       of a reasonably prudent pediatrician, because the instruction as
       given assumed that regardless of the conclusion of the jury, Dr.
       Haeg was to be judged by the standard of care of a family
       practitioner.

Richards, 59 Wash. App. at 276. An analogous problem occurred in Dinner. In that

case, a standard of care instruction misleadingly suggested that a specialist

could be held to the standard of care of an "average physician" when practicing

within his board certified specialty. Dinner, 54 Wash. 2d at 97.

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No. 71835-5-1/9

       Here, instruction 7 was similarly misleading. The instruction expressed

the standard of care in a confusing composite phrase—"the degree of skill, care

and learning expected of a reasonably prudent pediatrician in an urgent

care/emergency room setting." The trial court recognized the problem when

orally ruling on the motion for a new trial:

              Next issue is whether there's any factual evidence
       supporting plaintiffs' proposed alternative to the Court's No.7. This
       indeed was a contested factual issue at trial and the plaintiff did
       produce—introduce evidence that, if believed by a jury, supports
       the proposition that the doctor held himself out to be a specialist ER
       doctor and that the urgent care center was the equivalent of an
       emergency room. This was a contested issue.

The trial court correctly concluded instruction 7 misstated the law.

       A court will find an instructional error harmless if it had no effect on the

verdict or did not deprive a party of her theory of the case. Estate of Dormaier ex

rel. Dormaier v. Columbia Basin Anesthesia, PLLC, 177 Wash. App. 828, 861, 313

P.3d 431 (2013). Group Health argues instruction 7 was harmless because the

plaintiffs' expert witnesses testified that all physicians, whatever their specialty,

should be trained to recognize indicators of sexual abuse. On its face, this

argument has some weight, but it ignores the discretion a trial court has in

deciding whether to grant a motion for a new trial. The trial judge who has seen

and heard the witnesses is in a better position to evaluate whether a new trial is

warranted than an appellate court reviewing a cold transcript. State v. Hawkins,

181 Wash. 2d 170, 179, 332 P.3d 408 (2014).
No. 71835-5-1/10

       Here, the trial judge heard competing testimony about the applicable

standard of care. The plaintiff's expert witnesses were emergency room

physicians. They testified that the differential diagnosis methodology—"assume

the worst"—is the standard of care to be employed in the practice of emergency

medicine. The defendant's expert witnesses were pediatricians. They testified

that pediatricians satisfy their standard of care by using the unifying diagnosis

methodology that zeroes in on the most likely explanation for a patient's

symptoms.

       The trial court also listened to the closing argument, in which Group

Health repeatedly emphasized, using PowerPoint slides, that the plaintiff's

witnesses were not pediatricians.

       The experts that we have called and had testify and tell you their
       opinions in this case, three out of four are pediatricians, three out of
       four are child abuse experts. Plaintiffs' experts: No pediatricians,
       no child abuse specialists.

Group Health used this point to exploit the advantage created by instruction 7.

Calling the jury's attention to instruction 7, counsel argued that only the defense

experts were discussing the appropriate standard of care:

               Pediatricians are to be judged based on the way reasonably
       prudent pediatricians care for patients in this kind of urgent care
       setting. The only people we have had who have told you what
       pediatricians do are—I mean, the actual people who were
       pediatricians, every single one of them have been defense experts
       and they have all told you that what was done was reasonable and
       appropriate under the circumstances, and in fact, what they would
      do in their facilities.

      The closing argument demonstrates how instruction 7 allowed Group

Health to marginalize the testimony of the emergency room physicians. The

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No. 71835-5-1/11

effect of the instruction was to endorse the standard of care presented by the

pediatrician witnesses. As the trial court saw it, Group Health "attacked the

reliability of the plaintiffs' experts, because they were not pediatricians like the

defense experts." The instruction not only misstated the law but prejudicially

undermined the plaintiff's ability to present her theory of the case. The trial court

was within its discretion to find the instructional error warranted a new trial.

       Group Health also claims that Baughman did not adequately preserve the

instructional error raised in her motion for a new trial. We disagree. The key

factual issue involved in Baughman's objection to the final version of instruction 7

was whether Dr. Milligan should be held to the standard of care of an emergency

room physician. Baughman did not explicitly cite Richards, but she did employ

its reasoning:

                 I think the word "pediatrician" there should be "physician."
       That's from the WPI instruction, and the reason that instruction is
       given, Your Honor, is that when someone from a different specialty
       fills a role other than they would typically fill, that's when this
       instruction is given.
                So to use a really extreme example, if they decide to staff
       their emergency department with an allergist, that allergist isn't held
       to the standard of care of an allergist in the emergency department.
       He's held to the standard of care of a reasonably prudent
       emergency room physician.
                And so I think this is the defendant's modified language, but
       it guts the instruction of its intended meaning by saying that a
       pediatrician has to perform to the standard of care of a pediatrician.
       The point of the instruction is to tell the jury that the pediathcian, if
       he's going to be practicing in an emergency room, he has to
       practice to the same standard as an emergency room physician,
       and not the same standard as a pediatrician. That doesn't make
       any sense.

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No. 71835-5-1/12

(Emphasis added.) This was sufficient to preserve the instructional error raised

in Baughman's motion for a new trial. Washburn v. City of Federal Way, 178

Wash. 2d 732, 746-49, 310 P.3d 1275 (2013).

      Affirmed.

WE CONCUR:

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