Court Opinion

ID: 9751869
Source: CourtListenerOpinion
Date Created: 2023-08-28 17:11:41.389138+00
Date Added: 2024-06-11T07:27:00.919967
License: Public Domain

*177DISSENTING OPINION BY
ORIE MELVIN, J.:
¶ 1 I respectfully dissent from the majority’s decision to reverse the judgment in favor of Appellees. I further disagree with the majority’s assessment that prior decisions addressing the use of the “error of judgment” instruction are “irreconcilable.” Rather, I find that this Court conducted the inquiry required of it under the applicable standard of review in determining whether or not the trial court committed reversible error in formulating its jury charge based upon the facts developed in each of those cases. Specifically, we must keep in mind that our review is limited as follows:
In reviewing a trial judge’s charge, the proper test is not whether certain portions taken out of context appear erroneous. We look to the charge in its entirety, against the background of the evidence in the particular case, to determine whether or not error was committed and whether that error was prejudicial to the complaining party.
Schmidt v. Boardmcm Co., 958 A.2d 498, 515 (Pa.Super.2008), appeal granted, — Pa. -, 973 A.2d 411 (2009) (quoting Reilly v. Septa, 507 Pa. 204, 231, 489 A.2d 1291, 1305 (1985)).
We will grant a new trial based on error in the court’s charge if, upon considering all the evidence of record we determine that the jury was “probably misled” by the court’s instructions or that an omission from the charge amounted to “fundamental error.” Price v. Guy, 558 Pa. 42, 735 A.2d 668, 671 (1999); see also Carpinet v. Mitchell, 853 A.2d 366, 371 (Pa.Super.2004). Conversely, “[a] jury instruction will be upheld if it accurately reflects the law and is sufficient to guide the jury in its deliberations.” Cruz v. Northeastern Hosp., 801 A.2d 602, 611 (Pa.Super.2002).
In accordance with this prescription, “all issues which are relevant to pleadings and proof may become the subject of jury instructions.” Carpinet, 853 A.2d at 371. Although the court’s instructions “should not exclude any theory or defense that has support in the evidence,” McClintock v. Works, 716 A.2d 1262, 1266 (Pa.Super.1998), the court may charge “only on the law applicable to the factual parameters of a particular case and it may not instruct the jury on inapplicable legal issues.” Cruz, 801 A.2d at 611.
Betz v. Erie Ins. Exch., 957 A.2d 1244, 1260-1261 (Pa.Super.2008) (quoting Angelo v. Diamontoni, 871 A.2d 1276, 1279 (Pa.Super.2005)).
¶2 I acknowledge that since at least 1981, the Pennsylvania Suggested Standard Civil Jury Instructions have not included any reference to the error in judgment exception, presumably because the committee believed that the principles contained in the exception “are adequately covered by the charge on the professional standard of care.” Pa.S.S.J.I. (Civ). 11.01, Note. However, these are “suggested” instructions and that same note also acknowledges that such an instruction may be appropriate in the context of the two schools of thought doctrine. Id. Nonetheless, this Court has repeatedly addressed the propriety of giving the error of judgment charge and found its application is dependent on the facts of each case as developed at trial. See King v. Stefenelli, supra, Maj. Op. n. 5.
¶ 3 In King, we found that “instructions given to a jury must be confined to the issues raised in the pleadings and the facts developed by the evidence in support of such issues.” Id. 862 A.2d at 671. We determined the charge on error of judg*178ment was warranted where the testimony could support a finding that the defendant doctor made a “judgment call” in the method used to explore the abdomen to locate the source of bleeding and his decision to conclude the procedure after observing no blood flow during his 45 minutes of observation and exploration.
¶ 4 Similarly, in Havasy v. Resnick, 415 Pa.Super. 480, 609 A.2d 1326, 1336 (Pa.Super.1992), appeal dismissed as improvidently granted, 537 Pa. 114, 641 A.2d 580 (1994), we found that the “mistake of judgment” instruction was properly given when expert testimony revealed that the plaintiffs condition of compartment syndrome was difficult to diagnose early and that the signs and symptoms apparent were most likely obscured by symptoms associated with his original injury which involved serious injury to his left foot and ankle after a 600 pound metal cabinet fell from a forklift onto his leg. However, we did note that a physician is “clearly liable if his mistake reflects a failure to follow proper practice” in violation of “the standard of care required of physicians.” Id. See Blicha v. Jacks, supra (finding jury charge on medical judgment was proper because defendant-physician exercised a medical judgment to conduct a lab test on the plaintiff rather than hospitalize him and exercised a medical judgment in his method of contacting the plaintiff about the test results); see also Fragale v. Brigham, supra.
¶ 5 In contrast, if the testimony presented is such that the breach of the applicable standard of care is uncontroverted, then an instruction on error of judgment would clearly be improper. For instance, in Val-lone v. Creech, supra, this Court concluded the “mere error of judgment” charge was erroneously given. There, we found the charge had no application because it was not supported by the evidence. Rather, the record reflected that defendant-physician knew there was a 20% chance that the plaintiffs breast cancer had reoccurred, and he failed to order any diagnostic testing including a biopsy until approximately 15 months later. We concluded this was not a “mere error of judgment” and determined that the trial court did not abuse its discretion when it concluded the confusing jury instructions warranted the grant of a new trial. Id. 820 A.2d at 766.
¶ 6 In the present case, we do not have a case where the breach of the standard of care is uncontroverted. The evidence at trial clearly established that Dr. Rapaport determined that this was a shoulder dysto-cia delivery.1 Dr. Rapaport employed the requisite maneuvers in an attempt to dislodge the baby’s shoulder from behind his mother’s pubic bone. Here, Dr. Rapaport applied the McRoberts maneuver using steady firm traction without success. He then applied suprapubic pressure on the mother’s abdomen but was unable to dislodge the shoulder. He then extended the episiotomy but was still unsuccessful. Finally, Dr. Rapaport was able to dislodge the impacted shoulder using the Woods or corkscrew maneuver. The delivery took between three and five minutes.
¶ 7 There was no dispute at trial that excessive traction should not be used when there is a shoulder dystocia. Appellants’ expert, Dr. Finkelstein, testified that use of excessive traction is below the standard of care and can substantially increase the risk of causing an injury which can be permanent to the brachial plexus. N.T. Trial, 1/26/06, at 117. Dr. Finkelstein testified that Dr. Rapaport applied excessive *179force or traction in his attempt to dislodge the shoulder causing the rupture of the child’s C-5, C-6, C-7, and C8 nerves out of the spinal cord. Id. at 131, 132, 150. He also testified that this type of severe injury does not occur in the absence of negligence. Id. at 132. Further, Dr. Rapaport as well as his experts testified that they agreed that excessive force should not be used in a shoulder dystocia. N.T. Trial, 6/28/06, at 151, 39, 47; N.T. Trial, 6/29/06, at 23. However, they disputed that excessive force was used here. Specifically, with respect to the McRoberts maneuver, Dr. Rappaport testified that he used one slow, steady motion downward and that he held the child’s head firmly so it would not slip. N.T. Trial, 6/28/06, at 134. He also testified that he applied the same traction here as in his other deliveries. Id. at 137. It should be noted that Dr. Finkelstein and Dr. Benedetti also agreed that a physician can do everything appropriately and still end up with a severe injury. N.T. Trial 6/26/06, at 150; N.T. Trial, 6/28/06, at 59.
¶ 8 Additionally, the expert testimony revealed that there was no way to determine when excessive force was being applied. Dr. Finkelstein testified that it is impossible to quantify how much force is being used because there is no way to measure that when a doctor is doing a delivery. N.T. Trial, 6/26/06, at 143. Further, Dr. Rapaport’s expert, Dr. Benedetti, agreed that there was no way one can tell when the traction has exceeded what the nerves can handle. N.T. Trial, 6/28/06, at 45.
¶ 9 Furthermore, testimony revealed that the method' of applying traction is learned in the residency program. Dr. Rapaport’s testimony revealed that there is nothing written in the books about the amount of traction to be used. Rather, the attending physicians place their hands over the resident’s hands. The attending physicians then apply the traction so that the residents feel how much pressure to apply. N.T. Trial, 6/28/06, at 70, 82. Dr. Benedetti agreed that every physician develops their own tactile sense of how much pressure or traction is normal. Id. at 37.
¶ 10 Instantly, the trial court found the mistake of judgment instruction was proper here. It determined that based upon the evidence presented, the jury could have easily concluded that Dr. Rapaport non-negligently misjudged the amount of traction he could use without injury to the child’s brachial plexus. Trial Court Opinion, 12/19/06, at 4.’ Based upon the facts of this case and the jury instruction as a whole, I would find no error in the trial court’s charge to jury. Clearly, this ease involved Dr. Rapaport’s judgment in the amount of traction required during the delivery of the child. Moreover, in accord with Havasy, the jury was also properly instructed that Dr. Rapaport could be liable for an error of judgment that was the result of negligence. See also Schaaf v. Kaufman, supra (finding the charge when read as a whole, accurately reflected that doctors are liable if they deviate from the standard of care, but if a judgment turns out to be wrong the doctor cannot automatically be found negligent), appeal denied, 582 Pa. 719, 872 A.2d 1200 (2005). Read as a whole, the charge accurately reflects that doctors are liable if they deviate from the standard of care, but if a judgment turns out to be wrong the doctor cannot automatically be found negligent. The charge required the jury to evaluate the evidence and consider whether the doctor was negligent or whether he used his best judgment at the time, exercised reasonable care, and had the requisite knowledge and skill in the care given to Mrs. Pringle even though complications arose. Accordingly, I would conclude that Appellants are not entitled to relief on this claim.
*180¶ 11 Furthermore, I do not believe it is this Court’s responsibility, nor within its authority, to preclude the use of this instruction. Trial judges are granted wide discretion in choosing the language of their jury charge provided it portrays an accurate statement of the law. While it is true, as the majority points out, that our Supreme Court has not sustained the use. of the error of judgment charge, it is also true that our Supreme Court has never repudiated its use despite multiple opportunities to do so.2 Quite the contrary, the Supreme Court in Yoke, supra, specifically lists this concept as one of the eight “well settled principles in this area of the law.”
¶ 12 Specifically, the Supreme Court noted:
In considering this contention certain well settled principles in this area of the law must be kept in mind: (a) in the absence of a special contract, a physician neither warrants a cure nor guarantees the result of his treatment (Donaldson v. Maffucci, 397 Pa. 548, 553, 156 A.2d 835, and cases cited therein); (b) “A physician who is not a specialist is required to possess and employ in the [diagnosis and] treatment of a patient the skill and knowledge usually possessed by physicians [of good standing] in the same or a similar locality, giving due regard to the advanced state of the profession at the time of the treatment; and in employing the required skill and knowledge he is also required to exercise the care and judgment of a reasonable man” (Donaldson v. Maffucci, supra, [at] 553, 554[156 A.2d 835]); (c) the burden of proof is upon the plaintiff to prove either (1) that the physician did not possess and employ the required skill or knowledge or (2) that he did not exercise the care and judgment of a reasonable man in like circumstances (Donaldson v. Maffucci supra, [at] 554[156 A.2d 835]); (d) the doctrines of res ipsa loquitur and exclusive control are not applicable in this area of the law (Demchuk v. Bralow, 404 Pa. 100, 104, 105, 170 A.2d 868; Robinson v. Wirts, 387 Pa. 291, 294, 295, 127 A.2d 706 and cases therein cited); (e) in malpractice cases which involve an appraisal of the care and skill of a physician a lay jury presumably lacks the necessary knowledge and experience to render an intelligent decision without expert testimony and must be guided by such expert testimony (Robinson v. Wirts, supra, lat] 292, 127 A.2d 706); (f) the only exception to the requirement that expert testimony must be produced is “where the matter under investigation is so simple, and the lack of skill or want of care so obvious, as to be within the range of the ordinary experience and comprehension of even nonprofessional persons ...” (Robinson v. Wirts, supra, [at] 297, 127 A.2d 706); (g) a physician is not liable for an error of judgment (Ward v. Garvin, 328 Pa. 395, 195 A. 885; Duckworth v. Bennett, 320 Pa. 47, 181 A. 558; Williams v. LeBar, 141 Pa. 149, 21 A. 525); (h) if a physician employs the required judgment and care in arriving at his diagnosis, the mere fact that he erred in his diagnosis will not render him liable, even though his treatment is not proper for the condition that actually exists (Richards v. Willard, 176 Pa. 181, 35 A. 114 (fracture as a sprain)); Duckworth v. Bennett, supra (fracture as arthritis); *181Ward v. Garvin, supra (wrong diagnosis of injury to foot).
Yohe, 412 Pa. at 98-100, 194 A.2d at 170. Rather, I believe such a preclusive ruling, even if this Court deems it desirable, must await our Supreme Court’s examination of the viability of its continued use. Given the fact that both this Court and our Supreme Court have viewed this instruction as a viable principle of law in medical malpractice cases, I believe it is incumbent upon our Supreme Court to settle any confusion as to its proper use. See Jones v. Chidester, supra, Maj. Op. n. 5, (wherein our Supreme Court reexamined the “two schools of thought” doctrine in the context of the appropriate instruction to be given to a jury due to the confusion between the appellate courts as to the proper test to determine whether a school of thought qualifies).
¶ 18 As to Appellants’ second issue, I would likewise find no abuse of discretion by the trial court in giving the “guarantor of a cure” instruction. It is well settled that the “guarantor of a cure” instruction is an accurate statement of the law. See Havasy, 609 A.2d at 1335-1336 (stating, “The trial court did not err when it instructed the jury that a physician does not guarantee a cure and that negligence should not be presumed from the occurrence of an unfortunate result. These are accurate statements of the law and do not contradict or confuse the instruction on increased risk of harm.”). Appellants have cited to no authority to support their claim that such a charge cannot be given when a plaintiff is proceeding under a theory of res ipsa loquitur.
¶ 14 In finding the charge was properly given, the trial court stated:
This case turned on whether the jury believed Dr. Finkelstein’s testimony that the tearing of the brachial plexus could only have occurred if Dr. Rapaport negligently applied excessive traction, or Dr. Benedetti’s testimony to the contrary. The charge correctly described the legal principles applicable to the dispute by explaining to the jury that they should find for the plaintiffs if they believed that the harm involved is of the kind that ordinarily does not occur in the absence of negligence, but that negligence should not be presumed just from the occurrence of an unfortunate result.
Trial Court Opinion, 12/19/06, at 5. Upon my review, I find no abuse of discretion and would, therefore, affirm the judgment. Accordingly, I must respectfully dissent.

. A shoulder dystocia is considered a medical emergency. N.T. Trial, 6/26/06, at 135; N.T. Trial, 6/28/06, at 90.

. I would point out that in each of the panel decisions of this Court cited by the majority (D'Orazio, Vallone, Gunn, Havasy, Schaaf, Fragale, and Soda) whether we affirmed the use of the instruction or affirmed the trial court’s refusal to give the instruction, our Supreme Court denied allowance of appeal or dismissed the appeal as improvidently granted.