Johnson v. Egtedar

• Decision Date: 30 April 1996
• Docket Number: No. 26031,26031
• Citation: 915 P.2d 271,112 Nev. 428
• Parties: Joan JOHNSON, Appellant, v. Ascar EGTEDAR, M.D. and Ascar Egtedar, M.D., Inc., Respondents.
• Court: Nevada Supreme Court

Page 271

915 P.2d 271

112 Nev. 428

Joan JOHNSON, Appellant, v. Ascar EGTEDAR, M.D. and Ascar Egtedar, M.D., Inc., Respondents.

No. 26031.

Supreme Court of Nevada.

April 30, 1996.

Review Denied July 11, 1996.

Appeal from final judgment in an action for medical malpractice. Eighth Judicial District Court, Clark County; Joseph S. Pavlikowski, Judge.

James Oran Porter, Chtd. and Robert D. Walker, Las Vegas, for Appellant.

Dawson & Associates and Booker T. Evans, Las Vegas; Schuering, Zimmerman, Scully & Nolen and Thomas J. Doyle, Sacramento, California, for Respondents.

OPINION

PER CURIAM:

Appellant Joan Johnson underwent surgery to the lumbar region of her spine. Following the surgery, Johnson exhibited various adverse symptoms. Johnson thereafter filed suit against respondents Ascar Egtedar, M.D. and Egtedar, M.D., Inc. (referred to collectively as "Dr. Egtedar") for battery and medical malpractice. After a trial, the jury returned a six-to-two verdict in favor of the respondent physician. Because the district court abused its discretion by refusing Johnson's proposed jury instructions and by limiting the testimony of one of her expert witnesses, we are constrained to vacate the judgment entered below and remand this case for a new trial.

FACTS

The present litigation arises out of plaintiff/appellant Joan Johnson's December 1986 lower back surgery (lumbar laminectomy), which was performed by defendant/respondent Ascar Egtedar, M.D., an orthopedic surgeon. At trial, Johnson presented expert testimony that Dr. Egtedar operated at the wrong level of Johnson's spine and plunged an instrument out of the operative field penetrating her spinal dura, psoas major muscle, colon and left ureter. Following the surgery, Johnson developed peritonitis and began to accumulate fluid, presumably urine, in the tissue surrounding her left ureter. Soon thereafter, Johnson also developed an e. coli spinal meningitis which resulted in serious disability. According to Johnson's experts, the meningitis resulted from the transfer of e. coli bacteria by a contaminated instrument during the operation and from the continuing migration of bacteria from the colon to the spinal column along the abnormal pathway cut by Dr. Egtedar.

In rebuttal, Dr. Egtedar presented expert medical testimony contradicting the opinions given by Johnson's experts. According to Dr. Egtedar's experts, Johnson's injuries and illnesses were attributable to an unrelated disease process (namely, diverticulitis of the colon), her post-operative positioning, and the conduct of Johnson's subsequent treating physicians. Dr. Egtedar's experts also testified that the operation had been conducted at the proper level of the spine.

On appeal Johnson contends that the district court erred (1) by refusing to instruct the jury according to Nevada's statutory res ipsa loquitur rule in medical malpractice cases; (2) by instructing the jury, using an improper definition of proximate cause; (3) by limiting the testimony of one of her expert witnesses; and (4) by admitting pathology slides without proper authentication. Johnson also contends that she was denied a fair trial because of certain misstatements allegedly made by the bailiff in response to a question from the jury foreman.

DISCUSSION

Res ipsa loquitur instruction.

It is well established that a party is entitled to jury instructions on every theory of her case that is supported by the evidence. See Allan v. Levy, 109 Nev. 46, 846 P.2d 274 (1993); Beattie v. Thomas, 99 Nev. 579, 668 P.2d 268 (1983). Johnson contends that the trial court erred in refusing her proposed jury instructions patterned on NRS 41A.100, Nevada's statutory res ipsa loquitur rule for medical malpractice cases. ¹

Johnson's Proposed Jury Instruction A (Plaintiff's A) follows Nev.J.I. 6.17, as modified to reflect the alleged existence of only two of the five possible factual predicates enumerated in NRS 41A.100, namely: 41A.100(1)(d) ("injury" suffered "during the course of treatment to a part of the body not directly involved in the treatment or proximate thereto") and 41A.100(1)(e), (surgical procedure performed "on the wrong patient or the wrong organ, limb or part of a patient's body"). ² Dr. Egtedar objected to Plaintiff's A on the ground that it is an inadequate res ipsa loquitur instruction. We believe the legislature intended NRS 41A.100 to replace, rather than supplement, the classic res ipsa loquitur formulation in medical malpractice cases where it is factually applicable. Thus, Dr. Egtedar's objection is without merit.

Under the traditional res ipsa loquitur doctrine, the presumption of negligence only arises after the plaintiff has established that the event in question is one that ordinarily does not occur in the absence of negligence. Restatement (Second) of Torts § 328D cmt. c (1965). In a medical malpractice case, under the traditional doctrine, whether the event in question is one that ordinarily does not occur in the absence of negligence may be within the common knowledge of a lay person. If not, the testimony of an expert witness is required. Id. at cmt. d.

Under NRS 41A.100, however, the presumption automatically applies where any of the enumerated factual circumstances are present. In regard to these factual predicates, the legislature has, in effect, already determined that they ordinarily do not occur in the absence of negligence. Thus, we conclude, all a plaintiff need do to warrant an instruction under the statutory medical malpractice res ipsa loquitur rule is present some evidence of the existence of one or more of the factual predicates enumerated in the statute. If the trier of fact then finds that one or more of the factual predicates exist, then the presumption must be applied. This is the approach taken in Nev. J.I. 6.17 and Plaintiff's A. Accordingly, the district court should have given the proposed instruction if it was supported by evidence adduced at trial.

In the present case, Johnson presented evidence that Dr. Egtedar injured her colon and ureter during a spinal laminectomy and that Dr. Egtedar operated at the wrong level of her spine. These circumstances fit the factual predicates enumerated in NRS 41A.100(1)(d) and (e); therefore, Johnson's proposed jury instruction was supported by the evidence. Consequently, we hold that the district court erred in refusing Johnson's proposed jury instruction.

Dr. Egtedar nevertheless contends that Johnson has not properly preserved this issue for appeal. If a party requests an instruction and it is refused by the trial court, in order to preserve the issue for review, the party must object and distinctly state the grounds for the objection. NRCP 51; Village Development Co. v. Filice, 90 Nev. 305, 526 P.2d 83 (1974). A general objection such as "the instruction is proper" is generally inadequate to preserve the issue for appeal unless there is "plain error." Otterbeck v. Lamb, 85 Nev. 456, 456 P.2d 855 (1969); Downing v. Marlia, 82 Nev. 294, 417 P.2d 150 (1966). However, where counsel timely calls to the district court's attention the issues of law involved, a slight omission in compliance with NRCP 51 will not preclude appellate review. Tidwell v. Clarke, 84 Nev. 655, 447 P.2d 493 (1968); see also Barnes v. Delta Lines, Inc., 99 Nev. 688, 690 n. 1, 669 P.2d 709, 710 (1983) ("by providing the trial judge with a citation to relevant legal authority in support of giving the instruction, the requirements of NRCP 51 were met, despite the fact that extensive legal arguments did not take place concerning the propriety of giving this instruction"). In view of the need for precision in establishing compliance with NRCP 51, objections made during conferences in chambers should be on the record. Carson Ready Mix, Inc. v. First Nat'l Bank, 97 Nev. 474, 477, 635 P.2d 276, 278 (1981).

In the present case, instructions were settled in chambers off the record. The parties then made a record of their objections. Johnson's objection, as it appears in the record, was, at most, only slightly more than a "general objection." ³ Nevertheless, upon review of the record in this case, including Dr. Egtedar's original objection to the proposed instruction, we conclude that the district court was adequately apprised of the issue of law involved and was given an opportunity to correct the error. ⁴ The requirements of NRCP 51 have, therefore, been met. See Barnes, 99 Nev. 688, 669 P.2d 709; Tidwell, 84 Nev. 655, 447 P.2d 493. Accordingly, we reject Dr. Egtedar's contention that the issue has not been preserved for appeal. ⁵

Proximate causation instruction.

Johnson contends that the district court erred in using a jury instruction for causation that included a "but for" test rather than Johnson's proposed instruction, which employed a "substantial factor" test for causation. ⁶ The actual and proposed instructions are based on Nev.J.I. 4.04 and Nev. J.I. 4.04A, respectively. The use note to Nev.J.I. 4.04 correctly points out that the "but for" instruction should be abandoned in favor of the "substantial factor" instruction in cases in which an injury may have had two causes, either of which, operating alone, would have been sufficient to cause the injury.

In the present case, each side argued its own theory of causation for each of Johnson's injuries and disputed the theory of causation of the other side. The two theories were presented as being mutually exclusive. For example, at trial it was argued that the damage to the colon was caused by diverticulitis or a surgical instrument wielded by Dr. Egtedar--but not both. Under the circumstances, it was proper for the district court to choose an instruction including a "but for" test of causation.

Dr. George Schanz's opinion.

Johnson next contends that the district court erred by not allowing Dr. Schanz, one of Johnson's treating physicians, to give his expert opinion during testimony at trial as to whether Dr. Egtedar caused...