Court Opinion

ID: 9612640
Source: CourtListenerOpinion
Date Created: 2023-08-22 04:10:20.688615+00
Date Added: 2024-06-11T09:42:47.226494
License: Public Domain

HUNTLEY, Justice,
dissenting.
A more detailed review of the facts and proceedings surrounding this case is beneficial, as the majority opinion does not fully explain the proceedings below. In April 1981, Grimes, who was approximately thirty-five weeks pregnant, began experiencing weakness, nausea and back pain. When hospitalized in Blaine County Hospital, she was feverish and reported that her membranes had ruptured. However, no evidence indicated rupture, and several tests to detect amniotic fluid were negative. Blood tests did, however, indicate a bacterial infection. Her condition deteriorated, and Grimes was transported to Magic Valley Hospital in Twin Palls. There she was placed under the care of defendant-appellant, Green, who is a board-certified Obstetrician-Gynecologist. Her original physician, Dr. Donald Levin, had noted on the transfer documents an indication of suspected amnionitis, which is a bacterial infection of the amniotic fluid surrounding the fetus. Upon examination of Grimes, Green could detect no evidence of membrane rupture, but observed that Grimes had a bacterial infection and suspected that Grimes might be suffering from amnionitis. Green did not perform amniocentesis, a process by which a sample of the amniotic fluid is extracted and analyzed. Instead, he placed Grimes on a treatment plan of antibiotics. The record indicates that, when Grimes arrived in Twin Falls, Green did not believe she would survive the day, and, in fact, failed to note any tests or results on her chart for the first three days she was in his care. The record further indicates that Dr. Green failed to conduct follow-up Gram Stains or cervical cultures, which, according to expert testimony, should have been given.
After some short-lived improvement, Grimes began experiencing Adult Respiratory Distress Syndrome (ARDS), which is a life-threatening condition that often is caused by septic shock, which, in turn, is caused by a bacterial infection. At this point, Green considered performing a caesarean section, but, upon consultation with Dr. Randall Skeem, an internist, concluded that surgery would be fatal to Grimes.
Grimes’ condition continued to deteriorate, and she was transferred to the shock trauma unit of LDS Hospital in Salt Lake City where there were superior intensive care and neo-natal facilities. There she was diagnosed as having septicemia caused by amnionitis. In an effort to save her life, a caesarean section was performed and the child was stillborn. The attending physician, Dr. Stuart Wise, testified that the caesarean was performed because of Grimes’ extreme condition of low blood oxygen, caused by the prolonged (two-and-a-half days) existence of Adult Respiratory Distress Syndrome and amnionitis with ruptured membranes. Additionally, fetal distress required a rapid caesarean section. *523During the procedure, it was discovered that the amniotic fluid around the baby was foul smelling which indicated bacterial infection in the form of amnionitis. A hysterectomy was later performed to stem a continuing bacterial infection in the area originally infected by amnionitis and to save Grimes’ life.
During trial, board-certified obstetrician-gynecologists testified as experts on behalf of Grimes and indicated that a national standard of care existed for board-certified obstetrician-gynecologists, and further testified that Green had violated that standard of care by failing to perform amniocentesis on Grimes. Defense experts testified that amniocentesis was not routinely used in the Twin Falls area. Hence, they testified that the actions of Green were in conformance with the standard of care then prevailing in the Twin Falls community.
Applying I.C. § 6-1012,1 the trial court instructed the jury that Green’s treatment of Grimes should be measured against the standard of care then prevailing in the Twin Falls community, stating:
An individual physician shall be judged in comparison with similarly trained and qualified physicians of the same class in the same community, taking into account his or her training, experience and fields of medical specialization, if any. The term community refers to that geographical area ordinarily served by the license general hospital or at nearest to which such care was or allegedly should have been provided.
During the time the jury was deliberating, we released our opinion in Buck v. St. Clair, 108 Idaho 743, 702 P.2d 781 (1985). In Buck, we held that, for board-certified specialists, the local or community standard of care is equivalent to the national standard of care.
We believe that for board-certified specialists, the local standard of care is equivalent to the national standard of care____ The board-certified specialists practicing within the state are the product of nationally designed education programs. The standard of care familiar to any board-certified physician in this state is the national standard of care. Id. at 745, 702 P.2d 781.
After ten hours of deliberation, the jury indicated confusion as to which standard to apply by sending the following question to the judge: “I think that it would help us if we could have an explanation of standard of care at Twin Falls.” At this time, counsel also requested supplemental jury instructions in light of Buck. The trial court, however, did not instruct that a national standard of care was applicable, but instead gave the following supplemental instruction to the jury:
You are further instructed that the standard of care in Twin Falls, Idaho, at the time in question is a fact question solely in the province of this jury to determine based upon the testimony given in open court and the instructions already given in the case.
After some more hours of deliberation, the jury returned a verdict finding no negli*524gence on the part of Green. Subsequent to this verdict, Grimes moved for a new trial, which motion was granted by the trial court on grounds that its jury instructions would have been modified had it had time to analyze the Buck decision in depth.
At the time this Court instructed the jury in the above-entitled matter, it did not have the benefit of the Buck opinion. Of considerable concern to the court at the time of instructing the jury in the above matter was the applicable standard of care required of the defendant. This concern was also paramount in the minds of the jury during its deliberations. This is obvious because of the length of the deliberations and the written communication to the court regarding instruction of the applicable standard of care. After analyzing the Buck decision, this court is convinced that had it had the benefit of the same at the time of instructing the jury, that the instructions given to the jury regarding the applicable standard of care would have been somewhat modified. (Emphasis added.)
I begin by noting our standard of review of trial court orders granting or denying new trial is limited to ascertaining whether there has been a manifest abuse of discretion by the trial court. In the absence of such manifest abuse, the order granting or denying new trial will not be overturned.
This court is firmly committed to the rule that a trial court possesses the discretion to be wisely exercised in granting or refusing to grant a new trial and that such discretion will not be disturbed on appeal unless it clearly appears to have been exercised unwisely and to have been manifestly abused. Dinneen v. Finch, 100 Idaho 620, 626, 603 P.2d 575, 581 (1979).
(See also Luther v. Howland, 101 Idaho 373, 613 P.2d 666 (1980); Tibbs v. City of Sandpoint, 100 Idaho 667, 603 P.2d 1001 (1979); Seppi v. Betty, 99 Idaho 186, 579 P.2d 683 (1978)). Here, we have a trial court which granted a motion for new trial after having expressly stated that, after analyzing the Buck decision, it would have instructed the jury differently regarding the applicable standard of care. I can see no better reason for the granting of a new trial than the trial court’s admission that it erroneously instructed the jury.
Green argues, and the majority opinion states, that our standard of review is inapplicable in the instant case, urging that we must review a question of law, that is, whether the trial court correctly perceived our holding in Buck as requiring a modified instruction on the applicable standard of care. However, Green appealed from the trial court’s grant of the motion for new trial, not from the Buck decision. Additionally, the trial court did correctly perceive our holding in Buck that, as to board-certified specialists, the national standard of care would apply. Buck clearly expressed its holding, while also addressing the impact of I.C. §§ 6-1012 and -1013, interpreting legislative intent regarding those sections.
We believe that for board-certified specialists, the local standard of care is equivalent to the national standard of care. Our reasons for this decision are simple: board-certified medical specialists are highly trained individuals who become certified after completing a rigorous training program. Medical schools are accredited by a national team of physicians and administrators. The residency training programs are approved by a single board of specialists, and a physician is certified as a specialist only after passing a nationally administered exam consisting of both oral and written components. The board-certified specialists practicing within the state are the product of nationally designed education programs. The standard of care familiar to any board-certified physician in this state is a national standard of care____ Our holding today is limited to those physicians who hold themselves out as board-certified specialists. In so doing, we are cognizant of the intent and purpose of the passage of I.C. § 6-1012 and 6-1013____ [W]e believe the legislature, in its wisdom, recognized that the standard of care for nationally board-certified specialists was the same throughout our na*525tion____ Buck, Id. 108 Idaho at 745, 702 P.2d 781.
Not only did the trial court correctly interpret Buck as requiring a different standard of care (i.e. national) than he had instructed upon, it was well within its discretion to grant a new trial on the basis of its failure to so instruct.
In Morrison v. MacNamara, 407 A.2d 555 (D.C.1979), the court addressed a similar situation, holding that where a national standard of care had been adopted, it was error requiring new trial to instruct that the jury look to the standard in the local community, as such an all-encompassing error effectively precluded the jury from considering the issue on the basis of the correct standard.
“Varying geographical standards of care are no longer valid in view of the uniform standards of proficiency established by national board certification.” 407 A.2d at 565.
It follows that an instruction which compares a nationally certified medical professional’s conduct exclusively with the standard of care [locally] or [in] a similar community is erroneous____ [T]he trial court instructed the jury that the appellee’s conduct is to be compared solely with the standard of care prevailing in Washington D.C. Thus, in effect, the jury was instructed to ignore the testimony of appellant’s expert witness on the standard of care. This instruction was error. 407 A.2d at 565. (Emphasis added).
As in Morrison, the trial court’s initial instruction that a local standard of care was controlling, and supplemental instruction that the standard of care “in Twin Falls, Idaho” was a question of fact for the jury, negated any prospect of the jury utilizing a national standard of care as mandated under Buck. As in Morrison, the jury was effectively instructed to ignore the testimony of Grimes’ witnesses who set forth the national standard of care and indicated that Green had violated such. (See also Robbins v. Footer, 553 F.2d 123 (D.C.Cir.1977), wherein it was held that a trial court’s instructions to the jury indicating that the defendant’s conduct be compared only to practice within his own geographic community or that of a similar locality mandated a new trial where the defendant was a board-certified specialist and subject to a national standard of care. The court further held that the particular circumstances of a community (i.e. local deviations) could be relevant in a suit, but could not be outlined without first giving a correct instruction on the national standard of care.)
As the jury had arguably been irrevocably tainted and prejudiced against Grimes’ experts by the erroneous instructions, I certainly cannot say that the trial court manifestly abused its discretion in granting a new trial. As in Robbins, the local community practice was given as the sole standard for the jury. I agree with the Robbins court that local deviations may be relevant in individual cases, but, as that court noted, it can never serve as the sole basis of an instruction, for to do so would not only ignore Buck, but would be a nonsequitur — there can be no “local deviations,” unless there is something to deviate from (i.e. a national standard).
For the majority to hold otherwise is nothing more than a convoluted, indirect and sub-rosa attempt at limiting our Buck holding, with the trial court designated as scapegoat. Here, the trial court could do little else under the circumstances presented it and, at the very least, did not manifestly abuse its discretion in granting a new trial.
BISTLINE, J., concurs.

. Idaho Code section 6-1012 reads in pertinent part:
6-1012. Proof of community standard of health care practice in malpractice case.— ... claimant or plaintiff must, as an essential part of his or her case in chief, affirmatively prove by direct expert testimony and by a preponderance of all the competent evidence, that such defendant then and there negligently failed to meet the applicable standard of health care practice of the community in which such care allegedly was or should have been provided, as such standard existed at the time and place of the alleged negligence of such physician and surgeon, hospital or other such health care provider and as such standard then and there existed with respect to the class of health care provide that such defendant then and there belonged to and in which capacity he, she or it was functioning. Such individual providers of health care shall be judged in such cases in comparison with similarly trained and qualified providers of the same class in the same community, taking into account his or her training, experience, and fields of medical specialization, if any. If there be no other like provider in the community and the standard of practice is therefore indeterminable, evidence of such standard in similar Idaho communities at said time may be considered. As used in this act, the term "community” refers to that geographical area ordinarily served by the licensed general hospital at or nearest to which such care was or allegedly should have been provided.