Hansen v. Central Iowa Hosp. Corp.

• Decision Date: 01 September 2004
• Docket Number: No. 03-0626.,03-0626.
• Citation: 686 N.W.2d 476
• Parties: Marlys HANSEN and Tom Hansen, Appellants, v. CENTRAL IOWA HOSPITAL CORPORATION, d/b/a Iowa Methodist Medical Center, Appellee.
• Court: Iowa Supreme Court

686 N.W.2d 476

Marlys HANSEN and Tom Hansen, Appellants, v. CENTRAL IOWA HOSPITAL CORPORATION, d/b/a Iowa Methodist Medical Center, Appellee.

No. 03-0626.

Supreme Court of Iowa.

September 1, 2004.

Rehearing Denied September 21, 2004.

Jerry Crawford and Jim Quilty, Des Moines, for appellants.

Thomas A. Finley, Connie Diekema, and Tamara K. Hackmann of Finley, Alt, Smith, Scharnberg, Craig, Hilmes & Gaffney, P.C., Des Moines, for appellee.

LAVORATO, Chief Justice.

In this medical negligence case, Marlys Hansen sued Central Iowa Hospital Corporation, d/b/a Iowa Methodist Medical Center (IMMC), for injuries and damages she allegedly received in a fall while a patient at the hospital. Her husband, Tom Hansen, joined in the suit, claiming loss of consortium. The district court disallowed testimony from Marlys's treating physician because the Hansens did not designate him as an expert pursuant to Iowa Code section 668.11 (2003). A jury found IMMC negligent but denied any damages because it also found that such negligence was not a proximate cause of the fall and the Hansens' damages. The district court thereafter denied the Hansens' motion for new trial. The Hansens appealed, contending the district court abused its discretion in excluding the physician's testimony and in denying their motion for new trial.

We transferred the case to the court of appeals, and that court affirmed. We granted the Hansens' application for further review and now vacate the court of appeals decision and reverse the district court judgment. We remand the case for a new trial.

I. Background Facts and Proceedings.

On June 1, 1999, Marlys was hospitalized at IMMC because of back pain, a condition of long duration. Because Marlys was unstable on her feet and had a history of falls due to her back condition, IMMC placed her on "fall precautions." "Fall precautions" meant that while Marlys was in the hospital, she should not get up without assistance, her bed side rails should be up, and her call light should be within reach. However, during the night of June 5, hospital staff placed a commode next to Marlys's bed and told her to use it for her restroom needs throughout the night.

During the night, Marlys tried to go from her bed to the commode. While attempting to get to the commode, Marlys fell because the bed rolled. The wheels on the bed were not locked. When she tried to get up, she fell a second time.

On June 9 Marlys was discharged from the hospital. Once at home, she felt pain that was different from any pain she had previously experienced. The pain did not subside. She reported increased pain to her physical therapist. Her pain became so intolerable that she quit her job.

After the 1999 hospitalization, Marlys fell on other occasions. Some of those falls required her to seek medical treatment.

Dr. Kenneth Pollack, an anesthesiologist specializing in chronic pain problems, surgically implanted a morphine pump into Marlys's back. Even with the morphine pump, Marlys has continued to have pain.

On June 1, 2001, Marlys sued IMMC and Dr. Daniel McGuire, alleging medical negligence resulting in the falls from which Marlys sustained injuries. Marlys's husband, Tom, joined in the suit for loss of consortium. A scheduling order dated October 8 established December 24 as the deadline for plaintiffs to designate expert witnesses.

On December 21 the Hansens filed a designation of experts, naming Jane Fleming, R.N. as an expert who would "be called to testify regarding standard of care, breach and causation." They reserved the right to call additional witnesses. The Hansens also identified an accountant who would be called to testify regarding economic damages.

On December 26 the Hansens moved to extend the time to designate medical experts. On January 31, 2002, the Hansens dismissed Dr. McGuire from the suit without prejudice. On February 1 the Hansens withdrew their motion to extend the time to designate medical experts, citing the dismissal of Dr. McGuire from the case.

On April 19 IMMC filed its designation of expert witnesses. IMMC designated all of Marlys's treating health care providers as potential witnesses concerning causation and their diagnosis and treatment of her.

On November 26 the Hansens moved for leave to substitute Sandra R. Willems-Stewart, R.N., in lieu of Jane Fleming, R.N. The district court granted the motion.

On January 14, 2003, the Hansens filed what they termed a compliance with Iowa Rule of Civil Procedure 1.508 (discovery of experts). In this document they stated:

COMES NOW the Plaintiffs, Marlys Hansen and Tom Hansen, and for compliance with Iowa Rule of Civil Procedure 1.508 state[] to the Court as follows:

1. Dr. Kenneth Pollack has treated Plaintiff Marlys Hansen with regard to chronic pain management. Based on a review of the records, and his November 25, 2002 deposition, it is anticipated that Dr. Pollack may be called to testify regarding the plaintiff's medical condition, as well as causation and damage issues.

2. Based on a review of the records and her January 13, 2003 deposition, Sandra Willems-Stewart, R.N. may be called to testify regarding standards of nursing care.

On January 21 IMMC moved in limine to prevent the Hansens from using physicians as expert witnesses who were not properly designated as such. IMMC asserted that the Hansens were attempting to use a treating doctor to give opinions on causation. On the same day, IMMC moved to strike Dr. Pollack as an expert witness on the grounds that Dr. Pollack was not designated as an expert witness who would provide causation testimony as required by Iowa Code section 668.11. In support of its motion to strike, IMMC cited Cox v. Jones, 470 N.W.2d 23 (Iowa 1991).

On February 3 the Hansens filed a resistance to IMMC's motion in limine and reply in opposition to its motion to strike. They argued they were not required to designate Dr. Pollack as an expert pursuant to section 668.11 because he was a treating physician. They cited Carson v. Webb, 486 N.W.2d 278 (Iowa 1992), in support of their position.

On February 10, just before the jury trial was to start, the district court sustained IMMC's motion to strike Dr. Pollack's testimony on causation. It did so because the Hansens had failed to designate Dr. Pollack as an expert pursuant to section 668.11. Before the court's ruling, the Hansens argued that this court in Carson v. Webb had indicated that when a treating physician has formed an opinion in the course of the physician's treatment, the physician need not be designated as an expert as required by Iowa Code section 668.11. During the trial, the Hansens made an offer of proof of Dr. Pollack's testimony on causation, which the district court denied because the Hansens had failed to designate him as an expert pursuant to section 668.11.

Sandra Willems-Stewart, R.N., the Hansens' expert, testified that IMMC breached nursing standards of care. She testified that "[m]aking sure that the wheels on a bed are in the locked position would be one of an expected standard of care for a patient who is at risk for falls."

On February 14 the jury returned a verdict, finding IMMC negligent. However, the jury also found that IMMC's negligence was not a proximate cause of any damage to the Hansens.

The district court denied the Hansens' motion for new trial in which they contended that, among other things, the district court erred in excluding Dr. Pollack's testimony on causation. In denying the motion, the court reaffirmed its earlier decision to exclude Dr. Pollack's testimony, because the Hansens had failed to designate him as an expert pursuant to section 668.11. The court also noted that Dr. Pollack's testimony was insufficient on causation because he did not state his opinion in terms of "a medical degree of certainty."

The Hansens appealed; we transferred the case to the court of appeals, which affirmed.

II. Issues.

On further review, we consider two issues. First, did the district court abuse its discretion when it excluded the testimony of a treating physician on the question of causation? Second, if so, did such denial deprive the Hansens of a fair trial thereby entitling them to a new trial?

III. Scope of Review.

To the extent that we are required to interpret Iowa Code section 668.11, our review is for correction of errors at law. In re Det. of Cubbage, 671 N.W.2d 442, 444 (Iowa 2003) (review of a district court's construction and interpretation of a statute is for correction of errors at law). On the question of whether the district court properly exercised its discretion in excluding Dr. Pollack's testimony, our review is for abuse of discretion. Bell v. Cmty. Ambulance Serv. Agency, 579 N.W.2d 330, 338 (Iowa 1998) (review of exclusion of expert testimony is for abuse of discretion).

Our review of rulings on motions for new trial depends on the grounds for new trial asserted in the motion and ruled upon by the district court. Ladeburg v. Ray, 508 N.W.2d 694, 696 (Iowa 1993). If the motion and the ruling are based on a discretionary ground, we review the ruling for abuse of discretion. Id. If the motion and ruling are based on a legal issue, our review is for correction of errors at law. Id. at 696-97. Here, the motion and ruling were based on a discretionary ground. See Iowa R. Civ. P. 1.1004(1). Our review is therefore for abuse of discretion.

IV. Exclusion of the Expert Testimony.

As mentioned, the district court excluded Dr. Pollack's testimony on causation because the Hansens failed to designate him as an expert witness in accordance with Iowa Code section 668.11. In its ruling on the Hansens' motion for new trial, the court in addition found the doctor's opinion on causation to be "insufficient to be admissible" because the opinion was not "expressed to a medical degree of certainty."

A. Iowa Code section 668.11. This provision provides:

1. A party in a professional liability case brought against a licensed

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