Court Opinion

ID: 9845318
Source: CourtListenerOpinion
Date Created: 2023-09-24 03:18:58.505474+00
Date Added: 2024-06-11T09:16:01.185979
License: Public Domain

KAUGER, Justice,
dissenting:
I agree that strict liability should not be imposed upon physicians who hold themselves out as specialists. I cannot agree that failure to give instructions which make it clear that a specialist is to be held *606to a higher standard than that of a general practitioner is not error.
FACTS
The facts outlined in the majority opinion are accurate and succinct, but sparse. A more detailed description of the course of the incidents leading to Bobby Boyanton’s (Boyanton) death is appropriate. After falling from a ladder on March 30, 1983, Boyanton was brought to the emergency room at Mercy Hospital. Boyanton suffered from a lacerated liver and a detached gallbladder. The appellee, Michael E. Reif (Reif), performed emergency surgery removing 75% of Boyanton’s liver. There are no allegations that the surgery was negligently performed.
Boyanton was given no antibiotics from April 6 through April 20, 1983. During the period before his death, Boyanton displayed a number of classic signs of infection — oscillating fever, elevated white blood cell count,1 disorientation, and distention in the surgical area. On April 15, Reif noted a yellow or greenish drainage which he testified could have indicated infection. On April 20, the hospital records indicate that the drainage was “foul smelling.” Despite these warning signs, no culture to determine the presence or absence of infection was performed by Reif, and no antibiotics were prescribed.2 A culture was finally ordered on April 20, 1983, which showed pseudomonas, staphylococcus, and streptococcus bacteria. Reif ordered an antibiotic. Because of Boyanton’s worsening condition, a second surgery was performed on April 21, 1983. Boyanton died shortly after the second surgery. The autopsy indicated that Boyanton died due to a gangrenous bowel and acute peritonitis. Reif testified that the infection was probably present approximately three to five days before the second surgery was performed.
GIVING CONFLICTING INSTRUCTIONS ON THE STANDARD OF CARE TO WHICH A PHYSICIAN MAY BE HELD IS REVERSIBLE ERROR.
Although it is undisputed that Reif is a board certified surgeon and the head of surgery at Mercy Hospital and not a general practitioner, two instructions were given to the jury — one relevant to a non-specialist and one relevant to a specialist. Under instruction No. 6, extracted almost verbatim from the Oklahoma Uniform Jury Instructions — Civil (OUJI-CIV) 13.3,3 the *607jury was informed that a physician promises to use that degree of skill ordinarily possessed by others of his profession practicing in the same field, and to use ordinary care in the exercise of skill and knowledge. The heading of OUJI-CIV No. 13.3 clearly indicates that it is applicable to a “non-specialist.” Under instruction No. 7, which is identical to the OUJI-CIV 13.4,4 the jury was advised that a medical specialist is held to a higher degree of learning — he/she must exercise that degree of skill and knowledge possessed by other specialists in the same field. This OUJI-CIV instruction is headed “Duty of a Medical Specialist.” The jury was given conflicting instructions on the duty owed to the patient — the duty of a “non-specialist” and the duty of a “specialist.” The jury instructions did not include the headings to indicate to the jury which instruction was for a non-specialist or a specialist.
Considered as a whole, jury instructions must be consistent and harmonious. When the instructions given are conflicting on a material matter tending to confuse the jury, a new trial must be granted.5 The test for review of improper instructions is whether there is a probability that jurors were misled and reached a different result than they would have reached but for the error.6 Here, the central issue is the standard to which the surgeon is to be held. The jury was given conflicting instructions on the duty owed by Reif to Boyanton. Certainly, the differing instructions could have confused the jury on the issue of the standard to which Reif was to be held— that of a specialist.7 Apparently, the jurors were misled by the inconsistent instructions. Were Reif held to the proper standard under the facts presented, the jury may well have found for Boyanton on the malpractice charge. Therefore, the cause should be reversed for a new trial.
The majority’s reliance upon Karriman v. Orthopedic Clinic, 516 P.2d 534, 538 (Okla.1973) and Runyon v. Reid, 510 P.2d 943, 950, 58 A.L.R.3d 814, 824 (Okla.1973) for the proposition that this Court has approved instructions equivalent to those given here when the defendants are medical specialists is misplaced. Karriman is clearly distinguishable. No application of judicial gloss8 will justify reliance on Runyon.
Unlike the instructions given in the instant cause, the instruction given in Karri-man specifically provided that the specialist was to be held to the same standard as other specialists.9 Runyon does include *608some discussion of the standard to which a medical specialist will be held. However, jury instructions are not considered in the case. Runyon was disposed of by the trial court on a motion for sunimary judgment.
CONCLUSION
This Court adopted the OUJI-CIV on December 14, 1981. The purpose of the OUJI-CIV is twofold: 1) to provide juries with clear, concise, uniform, and unbiased instructions to guide their deliberations; and 2) to increase the efficiency of trial counsel and trial courts by eliminating the need to draft and select proposed instructions on commonly encountered subjects.10 The purposes for which the OUJI-CIV were adopted are not served when confusing and conflicting instructions are given. Because the jury could not have determined the standard to which Reif should have been held, the cause should be remanded for a new trial.

. Boyanton’s blood count ranged from 18,000 to 20,000 white blood cells per cubic millimeter (cu mm). A normal count should be 5,000 to 10,000 white blood cells cu mm. C. Pickney and E. Pickney, The Patient's Guide to Medical Tests, p. 379 (3rd Ed. Facts on File 1986).

. One medical expert testifying on behalf of Boyanton indicated that the combined signs of infection were analogous to smoke being evidence of a fire.

. Oklahoma Uniform Jury Instructions — OUJI-CIV 13.3 IMPLIED WARRANTY OR CAPACITY AND ABILITY — NON-SPECIALIST provides:
"Unless he states or agrees (contracts) otherwise, a physician employed to treat a person impliedly warrants that he possesses that degree of learning, skill and experience ordinarily possessed by others of his profession practicing in the same or a similar locality at the same time, and that he will use ordinary care in the exercise of his skill and the application of his knowledge and experience to accomplish the purpose for which he is employed, and that he will use his best judgment in the exercise of his skill in diagnosing the condition and in treating the patient. He does not warrant a cure and is not responsible for the lack of success unless that lack results from his failure to exercise ordinary care or from his lack of ordinary learning, skill and experience. If he possesses ordinary learning, skill and experience, and exercises ordinary care in applying same, he is not responsible for mistakes of judgment.”
Jury instruction No. 6 provides:
"Unless he states or agrees otherwise, a physician employed to treat a person impliedly warrants that he possesses that degree of learning, skill and experience ordinarily possessed by others of his profession practicing in the same field. The physician further impliedly warrants that he will use ordinary care in the exercise of his skill and the application of his knowledge and experience to accomplish the purpose for which he is employed, and that he will use his best judgment in the exercise of his skill in diagnosing the condition and in treating the patient.
The physician does not warrant a cure and is not responsible for the lack of success unless that lack results from his failure to exercise ordinary care or from his lack of ordinary learning, skill, and experience. If he possess*607es ordinary learning, skill, and experience and exercises ordinary care in applying same, he is not responsible for mistakes of judgment.
You are instructed that the standard of care required of those engaging in the practice of healing arts within the State of Oklahoma (sic) shall be measured by national standards.”

.Oklahoma Uniform Jury Instructions — OUJI-CIV 13.4 DUTY OF MEDICAL SPECIALIST provides:
“A physician who holds himself out to be a specialist in a particular field of medicine owes to his patient the duty of possessing and using that degree of learning and skill ordinarily possessed and used by other specialists of good standing in the same special field under similar circumstances. This is a higher degree of learning and skill than that of a general practitioner."
Instruction No. 7 provides:
"A physician who holds himself out to be a specialist in a particular field of medicine owes to his patient the duty of possessing and using that degree of learning and skill ordinarily possessed and used by other specialists of good standing in the same special field under similar circumstances. This is a higher degree of learning and skill than that of a general practitioner.”

. Hall v. Orthopedic Clinic, 444 P.2d 191, 193 (Okla.1968); City of Tulsa v. Pearson, 277 P.2d 135, 137 (Okla.1954).

. Woodall v. Chandler Material Co., 716 P.2d 652, 654 (Okla.1986); Reinhart & Donovan Co. v. Williamson, 191 Okl. 539, 131 P.2d 765, 766-67 (1942).

. Two of Reif's colleagues testified that Reif did not depart from an appropriate standard of care in treating Boyanton. This testimony does not negate the fact that the jury was not informed of the correct standard to which Reif should be held — that of a specialist.

. See, City of Oklahoma City v. Oklahoma Tax Comm’n, 789 P.2d 1287, 1297 (Okla.1990) (Opala, V.C.J., dissenting).

. The pertinent portion of the instruction provides:
"... An orthopedic specialist is required to exercise reasonable skill and care in treating a *608patient, which is that skill and care ordinarily used by careful and skillful orthopedic specialists.”

. Thomas v. Gilliam, 774 P.2d 462, 464 (Okla.1989).