Court Opinion

ID: 9845059
Source: CourtListenerOpinion
Date Created: 2023-09-24 03:14:48.360575+00
Date Added: 2024-06-11T09:15:51.205106
License: Public Domain

BISTLINE, Justice,
specially concurring.
PART I
Having fully concurred in Justice McDevitt’s opinion, my purpose in writing additionally is based on the belief that the readers of the Court’s opinions often appreciate being informed more fully as to what the controversy was all about. Basically, as set out in Justice McDevitt’s opinion, the primary issue here involved the trial court’s giving the jury, against plaintiffs’ objection, Instruction No. 12. Justice McDevitt has correctly noted that plaintiffs’ counsel strenuously objected to the last two paragraphs thereof, and that plaintiffs’ counsel explained his reasons for objecting, i.e., that it supplied the defense with ammunition with which to riddle the plaintiffs’ case in defendants’ final summation address to the jury. Accordingly, it is only necessary to explain the full extent of given Instruction No. 12, and why it should not have been given, and illustrate fully the manner in which astute defense counsel in his final summation to the jury was able to capitalize on it, thereby insuring that the jury was misdirected to the disadvantage of the Leazers in their attempt at recovering monetary damages for an extremely serious personal injury. At the same time the reader is presented with a short critique of the dissenting opinion issued by Chief Justice Bakes.2
In the instant case it is beyond cavil that plaintiffs’ counsel realized on reflection that the particular submitted instruction possessed the capability of being used to the disadvantage of his clients. In defendants’ brief filed in this Court it is acknowledged that plaintiffs registered a strong objection to given No. 12, and in that brief the defendants displayed some of the plaintiffs’ reasons for objecting. However, rather than recite the content of the brief, it is better that all of the plaintiffs’ objection be lifted from the reporter’s transcript and spread before the readers of the various and sundry opinions which today emanate from the Court relative to the instructing of the jury:
[Mr. Schlender:] My objection isn’t to the entire instruction. In fact, I think that the portion of it that comes down to line 23 that says, ‘the failure to fulfill the foregoing duty is negligence,’ I think that is correct. It’s about half way through your stack, I think. That is not the exact language of 205, IDJI 205, but it’s very close. It paraphrases it, adds a few things, and I think capsulizes the law of medical negligence.
From line 23 on, however, I have grave consternation about the instruction because from that point on it begins to comment upon what judgment is and is not and is argumentative. That it begins to argue as to when a physician is negligent and when he is not.
*908It says he’s not necessarily negligent. Well, that isn’t accurate because he can be negligent. And whether he is necessarily or not necessarily or almost necessarily provides my argument, in that adjectives and adverbs are argumentative. They are expanders or contractors and are unnecessary.
I think it would be highly prejudicial because of the argument that can be made from the instruction by counsel. And that is, this is simply an error or he used his best judgment. And if he used his best judgment, he can’t be negligent because he’s not necessarily negligent if he errs in his judgment.
They can argue that from the above instruction. In other words, you’ve already said he has to use reasonable diligence in line 11 and his or her best judgment in the skill, exercise of skill and the application of learning. That’s accurate and that does provide the exact language from IDJI 205. It’s the same sentence as ‘it is further to use his duty to use reasonable care, skill and diligence and to use his best judgment in the exercise of his skill and the application of his learning.’ So you have already advised on it. Counsel can comment and fair comment will include comments to the effect of what comes from line 23 down.
Moreover, the remainder of the paragraph isn’t applicable to this case in that there has been no testimony that there is, quote ‘more than one recognized method of diagnosis and/or treatment.’ All the surgeons, all the experts have agreed as to diagnostic testing or what is available and what the treatment should be.
There might be a divergence of opinion as to when treatment and when diagnosis should be done, but there is no divergence of opinion as to what should be done. So in that respect, it is also simply surplusage.
That is really my only objection to the ones that the court is now going to give. Tr., pp. 1977-78.
Tr.Vol. 19, 1977-79 (emphasis added).
Plaintiffs’ counsel’s observation that prejudicial comment could be made on this instruction was borne out by opposing counsel’s closing argument, as is readily seen from the transcript and the briefs filed in this court. Extremely adept defense counsel did indeed capitalize on the instruction, closing his argument with the following:
[Mr. Quane:] Now, there is a jury instruction that I want to briefly mention, and its a page and a half. And it starts out by defining what the obligation of Dr. Kiefer was. And these instructions are just as much a law in a jury trial like this as the law that you can’t speed or you can’t run through stop signs. Has the same legal effect and we’re all bound by it, whether we like them or not. And we’re all duty bound, whether we’re jurors or not, to obey these laws. They’re called instructions, but they’re laws.
And this is a big, long job and I want to read just two paragraphs. ‘A physician is not necessarily negligent because he errs in judgment or because his efforts prove unsuccessful. The physician is negligent only if the error in judgment or lack of success is due to a failure to perform any of his duties defined in these instructions.
Where there is more than one recognized method of diagnosis or treatment and no one of them is used exclusively and uniformly by all practitioners in good standing in the particular field of that specialization, a physician is not negligent if, in exercising his best judgment, he selects one of the approved methods which later turns out to be a wrong selection or one not favored by certain other practitioners.’
This is, as far as a civil case of this case [sic, kind] is concerned, this is as sacred a law as the law against murder. It doesn’t matter whether we like it or not.
Now, Dr. Kiefer chose a method of treatment and/or diagnosis after the 16th that he, per the record, envisioned as that which was appropriate in not returning the man to surgery, thinking it was either the traction or this hysteria, *909or both. He chose that course as the record tells us.
Dr. Powell disagrees with that, said he should have not done that. He should have engaged in the treatment and diagnosis that I prefer, that I recommend. But this law says he does not have to do that.
‘Where there is more than one recognized method of diagnosis or treatment and no one of them is used exclusively — ’ and I’m talking about diagnosis following the 16th surgery and what he did and how this case, the hematoma was ultimately diagnosed. Not what you do after the diagnosis is made, not what you do afterwards, but how you go about arriving at the problem, reaching a diagnosis, and what you should do — ‘a physician is not negligent if, in exercising his best judgment, he selects one of the approved methods which later turns out to be a wrong selection or one not favored by certain other practitioners.’ And he is not necessarily negligent because he errs in judgment or because his efforts prove unsuccessful
Tr.Vol. 19, 2125-27 (emphasis added).
PART II
It is not understood why Justice McDevitt finds it necessary to vacate the final opinion of the Court of Appeals in this case. That opinion is structurally sound and in my view should have been left undisturbed, allowing the cause to have been returned to the district court for a new trial over a year and one-half ago. The full text of the Court of Appeals opinion is:
This is a medical malpractice case. The appellant, Richard Leazer, argues that the trial judge erred in denying Leazer’s motion for a new trial following a jury verdict in favor of the defendant, Doctor Edward Kiefer, a neurosurgeon. Leazer first contends that the judge erroneously instructed the jury regarding the standard of care owed by a physician to his patient. Second, Leazer argues that the jury’s verdict was against the weight of the evidence. Because we find Leazer’s argument regarding the jury instruction convincing, we reverse the judge’s denial of Leazer’s motion for a new trial and remand the case to the district court for a new trial.
The facts of this case are complex, but those essential to our opinion may be summarized as follows. Dr. Kiefer operated on Leazer to repair a ruptured disc. Following the operation, a blood clot formed next to Leazer’s spinal cord. Dr. Kiefer removed the clot two days after the disc operation. However, Leazer was rendered a paraplegic due to damage caused by the clot. Leazer sued Dr. Kiefer, alleging that his post-operative treatment failed to meet the applicable standard of health care practiced in the community. After evidence was presented at trial, the jury was given — over Leazer’s objection — an instruction commonly referred to as an ‘error in judgment’ instruction:
In performing professional services for a patient, a physician has the duty to have the degree of learning, skill, and qualifications ordinarily possessed by reputable physicians practicing in the same community, at the same time, and under similar circumstances.
A physician has a further duty to use the care and skill ordinarily exercised in like cases by reputable members of the profession practicing in the same community, at the same time, and under similar circumstances, and to use reasonable diligence and his or her best judgment in the exercise of skill and the application of learning and qualifications in an effort to accomplish the purpose for which the physician is employed.
If the physician holds himself out as a specialist in a particular field of medical, surgical, or other healing science, it also is his duty to have the knowledge, skill, and qualifications ordinarily possessed, and to use the care and skill ordinarily used, by reputable specialists practicing in the same field, in the same community, at the same time, and under similar circumstances.
*910A failure to fulfill the foregoing duty or standard of care is negligence.
A physician is not necessarily negligent because he errs in judgment or because his efforts prove unsuccessful. The physician is negligent only if the error in judgment or lack of success is due to a failure to perform any of his duties defined in these instructions.
Where there is more than one recognized method of diagnosis or treatment, and no one of them is used exclusively and uniformly by all practitioners in good standing in the particular field of specialization, a physician is not negligent if, in exercising his best judgment, he selects one of the approved methods which later turns out to be a wrong selection or one not favored by certain other practitioners.3 [Emphasis and bracketed numbers added.]
The jury returned a verdict in Kiefer’s favor. Leazer timely filed a motion for new trial, alleging error in giving the instruction quoted above. Leazer’s motion was denied and this appeal followed.
In reviewing jury instructions, our task is to determine whether the trial judge instructed the jury in all matters of law necessary for the jury’s information. I.C. § 19-2132(a). In doing so, we must ascertain whether the instructions, as a whole, properly state the law applicable to the issues, and if not, whether the complaining party was prejudiced thereby. See Blaine v. Byers, 91 Idaho 665, 672, 429 P.2d 397, 404 (1967); accord Packard v. Joint School District No. 171, 104 Idaho 604, 612, 661 P.2d 770, 778 (Ct.App.1983). In determining whether the trial judge has properly instructed the jury regarding the applicable law, we will exercise free review.
In the present case, Leazer contends that the error in judgment instruction improperly states the standard of care owed to Leazer under the circumstances. Leazer submits that the instruction is argumentative because it infers that Kiefer was not negligent if he used his best judgment in performance of his duties. Relying on the recent Oregon case of Rogers v. Meridian Park Hospital, [307 Or. 612], 772 P.2d 929 (Or.1989), Leazer maintains that he was prejudiced by the challenged instruction.
In contrast, Dr. Kiefer submits that the error in judgment instruction is an acceptable jury charge, and is recognized as such in other jurisdictions. See Fraijo v. Hartland Hospital, [99 Cal.App.3d 331], 160 Cal.Rptr. 246 (Cal.App.1979); Fall v. White, 449 N.E.2d 628 (Ind.App. 1983); Grassis v. Retik, [25 Mass.App.Ct.595], 521 N.E.2d 411 (Mass.App.1988); Husaker [Hunsaker ] v. Bozeman Deaconess Foundation, [179 Mont. 305], 588 P.2d 493 (Mont.1978). Dr. Kiefer also contends that the instruction is applicable where there is evidence the physician was exercising reasonable care in treatment of his patient, but was faced with the decision of having to make a choice between acceptable medical treatments.
We disagree with Dr. Kiefer’s contentions. In Rogers v. Meridian Park Hospital, supra, the Oregon Supreme Court discussed an error in judgment instruction similar to that given in the present case. That instruction read:
A physician is charged with applying without error those principles and learnings that are settled and agreed upon by all members of the medical profession. [2] In some cases, there may be reasonable differences of opinion among members of the medical profession as to the nature of the patient’s condition or the proper course of treatment. [3] When there is such a difference of opinion, the physician must exercise reasonable judgment. [4] A physician is liable for an error of judgment if the physician fails to act with reasonable care and skill in exercising that judgment. [5] A physician is not liable for an error in judgment if the physician acts with reasonable care *911and skill in exercising that judgment. [Bracketed numbers part of original quote.]
772 P.2d at 930. In evaluating this language, the Oregon Court recognized a growing trend among courts in other jurisdictions to disapprove of such instructions.4 The Court noted that inclusion of error in judgment language in the instruction obscured the fact that, to avoid liability, the defendant must exercise the degree of care, skill and diligence required by law. 772 P.2d at 933. The Court also stated that sentence [3] of the instruction made it appear that the exercise of reasonable judgment was the operative issue for the jury to decide; yet, as the Court noted, the reasonable judgment issue does not displace the ultimate question of reasonable care. Id. Furthermore, the Court stated that sentences [4] and [5] were confusing because they implied that a physician would not be liable for bad results which arise from an error in judgment and, as a result, some types of negligence are not culpable. Finally, the Court noted:
The instruction given by the trial court was based on language concerning the exercise of ‘judgment’ by doctors found in opinions of this court and the Court of Appeals. If the term ‘judgment’ refers to choices between acceptable courses of treatment, then the term ‘error in judgment’ is a contradiction in itself. [Footnote omitted.] Use of any acceptable alterative would not be an ‘error.’ Witnesses may continue to use terms such as ‘exercise of judgment.’ But the court should not instruct the jury in such terms; such instructions not only confuse, but they are also incorrect because they suggest that substandard conduct is permissible if it is garbed as an ‘exercise of judgment.’
Id. at 933.
Here, we reach a similar conclusion. Like the Rogers court, we conclude that the fifth and sixth paragraphs of the instruction challenged in this case obscure the fact that a physician must meet the standard of care, skill and diligence required by law in order to avoid liability. The statements contained therein imply that a physician may escape liability solely by exercise of best judgment, without regard for the applicable standard of care. This is in contradiction to the standard that a physician may evade liability for utilizing best judgment only when that judgment constitutes choosing between one of several medically acceptable courses of treatment, each of which represents reasonable care for the patient. Use of the term ‘best judgment’ in this instruction could easily be interpreted by the jury to mean that a physician would be free of negligence if he exercised either reasonable care or his or her best judgment. See Teh Len Chu, supra, n. 2, 290 S.E.2d at 822. This is not the standard which we find embodied in Idaho law regarding a physician’s standard of care. I.C. § 6-1012; see Conrad v. St. Clair, 100 Idaho 401, 405-06, 599 P.2d 292, 296-97 (1979).
As the Legislature has recognized in I.C. § 6-1012, a physician’s fundamental duty is to provide care ‘meeting] the applicable standard of health care practice of the community____’ This duty is more elaborately expressed in IDJI 205, which antedates the statute. IDJI 205 speaks of a physician’s duty to possess a requisite level of skill, his duty to exercise that skill with reasonable care, and his duty ‘to use his best judgment in the exercise of his skill and the application of his learning.’ Thus, IDJI 205 sets forth a three-pronged standard and makes it clear that the physician must satisfy each prong.
There may be a question as to whether IDJI 205 can, or should, elaborate upon *912the legislatively prescribed standard. But even if IDJI 205 is valid, the fact remains that an IDJI 205 instruction was not given in this case. Rather, the district court gave a long and tortuous instruction, focusing heavily upon the ‘best judgment’ test. The instruction gave elevated prominence to ‘best judgment’ in comparison to the other elements of a physician’s duty. The instruction reasonably could have been read to establish ‘best judgment’ as the standard critical to this case, obscuring or subsuming the other elements.
Based upon our review of the other instructions and of the testimony elicited at trial, we conclude that the instruction was prejudicial. We therefore reverse the district court’s order denying Leazer’s motion for a new trial, and remand this case for a new trial. Costs to appellants. No attorney fees on appeal.
This appeal should have ended with the foregoing unanimous opinion of the Court of Appeals. As the late Justice Shepard once wrote in stone, “Justice delayed is justice denied.” Deshazer v. Tompkins, 93 Idaho 267, 274, 460 P.2d 402, 409 (1969).
PART III, ADDENDUM
Some years ago in an opinion I suggested the lack of wisdom on the part of a majority of the then members of this Court who had earlier argued against expanding this Court to seven members. The inefficiency and waste of judicial resources of this present two-tiered appellate system is extremely well illustrated by today’s debacle. Were this Court comprised of seven justices (which of interest is the manner in which this building was designed and constructed), many of the appeals which five of us now sit to hear could be, and in my humble opinion would be, more expeditiously heard by panels of three justices. Where deemed appropriate, as would be immediately apparent, whenever a panel could not reach a unanimous conclusion, the cause could be immediately reheard by a five-member panel which could readily be accomplished by the Chief Justice making the assignments necessary. In extremely important civil and criminal cases, especially where issues of a constitutional dimension were involved, the Court could sit en banc, and four votes would constitute a majority. The entire legal profession hopefully will see the need for initiating appropriate action, the purpose of which should be to place seven justices behind the bench which was designed for seven, and in seven office spaces which were designed and constructed for seven justices and their three supporting personnel.
The readers of the opinions which emanate from the two Idaho appellate courts will readily see in counting raised hands, that there was for certain one additional vote to join Chief Judge Walters, Judge Swanstrom, and Judge Silak, thus constituting a majority of four, if our appellate system had been restructured as suggested. That one certain vote could have been any one of us who this day votes that the cause finally be returned to the district court for a new trial. Under this present two tiered system of appellate review there is unnecessary waste of judicial resources and, consequently, needless expenditure of public monies.

. The Chief Justice sets forth the plaintiffs’ requested instruction at 913, 821 P.2d at 968. That which he neither mentions nor considers is that the instruction, which plaintiffs submitted prior to trial (as is known to be the established procedure) was not binding on the plaintiffs, simply because it was not given. Justice McDevitt in his opinion for the Court states as much. He also discloses the highly singular fact that the district judge gave Instruction No. 12 on his own initiative. To which I add only that over a full month before the trial date the plaintiffs’ attorney submitted a full set of instructions one of which did include “best judgment" language. But that is not the end of all inquiry. As a trial progresses, there may be developments which bring counsel to a change of mind as to the applicability of the admitted evidence to certain instructions which were requested earlier. Any trial practitioner, even of limited experience, is aware of his entitlement to withdraw an instruction submitted prior to trial. During a long span of time in law school and then practicing, and then in this position, I have yet to hear of a trial judge advising an attorney that he is saddled forever with whatever instruction he has drafted and submitted prior to trial.

. See, e.g., Logan v. Greenwich Hospital Association, 191 Conn. 282, 465 A.2d 294 (1983); Veliz v. American Hospital, Inc., 414 So.2d 226 (Fla.App.1982); Wall v. Stout, 310 N.C. 184, 311 S.E.2d 571 (1984); Teh Len Chu v. Fairfax Emergency Medical Associates, Ltd., 223 Va. 383, 290 S.E.2d 820 (1982); see G. Douthwaite, Alexander's Jury Instructions on Medical Issues, § 3.37 comment at 130 (2d ed. 1980).