King v. Ahrens
| Decision Date | 10 March 1994 |
| Docket Number | No. 92-2997,92-2997 |
| Citation | 16 F.3d 265 |
| Parties | , 43 Soc.Sec.Rep.Ser. 602 Eula Faye KING, Eddie Dwayne King, and Nancy Marie King, as the heirs at law of Franklin J. King, Jr., Deceased, Appellants, v. Robert AHRENS, M.D., Individually and d/b/a The Ahrens Clinic, and Richard Ahrens, M.D., Individually and d/b/a The Ahrens Clinic, A Partnership, Appellees. |
| Court | U.S. Court of Appeals — Eighth Circuit |
Counsel who presented argument on behalf of the appellant was Charles Phillip Boyd, Jr. of Little Rock, Arkansas.
Counsel who presented argument on behalf of the appellee was Walter B. Cox of Fayetteville, Arkansas. Constance G. Clark of Fayetteville, Arkansas, appeared on the brief.
Before MAGILL and HANSEN, Circuit Judges, and HAMILTON, * District Judge.
Eula Faye King and her children (the Kings) brought this diversity malpractice action after Franklin J. King, Jr., their husband and father died of a heart attack. The district court 1 entered judgment upon a jury verdict in favor of the defendant doctors on the malpractice claim and a directed verdict dismissing the Kings' claimed cause of action under 42 U.S.C. section 1395dd. For reversal, the Kings argue that the district court erred by excluding two categories of impeachment evidence they offered at trial and by dismissing their cause of action under section 1395dd, 798 F.Supp. 1371. We affirm.
On April 27, 1989, Eula Faye King brought her husband, Franklin J. King, Jr., to the Ahrens Clinic, fearing he might be having a heart attack. Dr. Robert Ahrens examined Mr. King, who was complaining of a "dull, gripping" chest pain radiating into his arms and neck. (Appellants' App. at 20.) During the examination, Dr. Ahrens ordered two EKGs, administered some medication to Mr King, including nitroglycerin and a narcotic pain medication, and obtained some medical history from Mr. and Mrs. King. Throughout the morning, Mr. King remained at the clinic where he was examined, observed, and given various tests.
In Dr. Ahrens' opinion, Mr. King's pain was an esophogeal spasm secondary to his hiatal hernia and reflux esophogitis, although he could not rule out the possibility of a heart attack. Dr. Ahrens instructed Mr. King to return the following Monday to undergo a treadmill test, and Mrs. King understood that she was to bring him back anytime if his condition got worse again before Monday. Dr. Ahrens prescribed percodan, a narcotic pain medication, for Mr. King and according to the medical chart he allowed Mr. King to go "home--to bed." (Id. at 20-21.) Mr. and Mrs. King went home where Mr. King died two days later of a myocardial rupture secondary to a heart attack.
Mrs. King and her children sued Dr. Robert Ahrens and Dr. Richard Ahrens, partners in the Ahrens Clinic, in a two-count complaint. In count I, they alleged that Dr. Robert Ahrens was negligent in failing to properly diagnose Mr. King's condition and that this negligence resulted in Mr. King's untimely death. In count II, they claimed that the doctors violated 42 U.S.C. section 1395dd, the Emergency Medical Treatment and Active Labor Act (Act), also known as the "patient-dumping" Act, by failing to recognize Mr. King's emergency condition and by releasing Mr. King before his condition had stabilized.
At trial, there was some expert testimony to the effect that Mr. King might not have died had he been hospitalized at the time of his examination by Dr. Robert Ahrens. (See Trial Tr., Vol. II at 33-34.) The testimony of Dr. Ahrens and Mrs. King was at variance concerning what advice Dr. Ahrens offered with regard to hospitalization. Dr. Ahrens testified that he informed the Kings that he did not think the episode was a heart attack but that he could not rule out the possibility that the pain was of cardiac origin. He testified that he gave the Kings three options: they could stay at the clinic awhile longer, go to a hospital, or go home. Dr. Ahrens stated that he advised the Kings that he preferred to send Mr. King to the hospital; however, he also testified that he did not feel hospitalization was completely necessary. He testified that Mr. King refused hospitalization because of the prohibitive cost and that he therefore allowed Mr. King to go home, knowing he could not force hospitalization upon him.
To the contrary, Mrs. King testified that during the examination Dr. Ahrens said that he was 100 percent certain that the pain was not a heart attack. She admitted that Dr. Ahrens gave them three options, one of which was going to a hospital. Nevertheless, she maintained that Dr. Ahrens did not tell them that hospitalization was necessary but rather that it was safe for Mr. King to go home. Mrs. King insisted that their decision to go home instead of to the hospital was based upon Dr. Ahrens' assurance that the symptoms were not of cardiac origin. Further, Mrs. King testified that she and her husband would have opted for and would have been able to pay for hospitalization had Dr. Ahrens advised them that it was necessary.
At trial, the Kings attempted to impeach Dr. Ahrens' credibility. They pointed out that Dr. Ahrens' trial testimony was inconsistent with what he recorded in the medical chart and also with his prior deposition testimony. For instance, at trial Dr. Ahrens testified that he never prescribed percodan for Mr. King. The Kings then confronted him with a written prescription which forced Dr. Ahrens to admit that he had in fact written a percodan prescription for Mr. King on April 27, 1989. The Kings also demonstrated that Dr. Ahrens failed to record the prescription on Mr. King's medical chart. Then the Kings confronted Dr. Ahrens with his own deposition testimony wherein he stated that prescribing percodan would be inappropriate in a situation like Mr. King's. They further noted that although Dr. Ahrens testified that he recommended hospitalization and Mr. King refused it due to the cost, the medical chart is devoid of any indication that Mr. King refused hospitalization or went home against Dr. Ahrens' medical advice. Dr. Ahrens attributed these omissions and inconsistencies to oversight on his part.
At the close of the Kings' evidence, the district court granted a directed verdict dismissing the Kings' claim under 42 U.S.C. section 1395dd. Following trial, the jury returned a verdict in favor of the doctors on the medical malpractice claim. The Kings appeal.
The Kings appeal two evidentiary rulings of the district court which they contend limited their ability to impeach Dr. Ahrens' credibility. First, the Kings unsuccessfully sought to admit evidence that Dr. Ahrens' medical license had been suspended for a period of 30 days approximately eight years earlier. Second, the Kings were unsuccessful in seeking to admit evidence that Dr. Ahrens had once been a member of the American Society for Clinical Hypnosis and had used hypnosis in his practice.
The district court has broad discretion in determining whether to admit or exclude evidence at trial. Cummings v. Malone, 995 F.2d 817, 823 (8th Cir.1993). We will reverse a district court's evidentiary decision "only for a 'clear and prejudicial' abuse of that discretion." Id. (citations omitted). Abuse of discretion occurs "[w]here the district court excludes evidence of a critical nature, so that there is no reasonable assurance that the jury would have reached the same conclusion had the evidence been admitted." Adams v. Fuqua Indus., Inc., 820 F.2d 271, 273 (8th Cir.1987).
Credibility was a key issue in this case because Dr. Ahrens and Mrs. King gave differing accounts of what advice and diagnosis Dr. Ahrens provided during his examination of Mr. King. The Kings attacked Dr. Ahrens' credibility from the very beginning of the trial by pointing out inaccuracies in his medical chart and demonstrating flaws in his memory. Dr. Ahrens attempted to explain away these inconsistencies by attributing them to mere oversight on his part.
The Kings then sought to introduce evidence of Dr. Ahrens' past medical license suspension for overprescribing percodan. They wanted to show that Dr. Ahrens did not innocently overlook the omission of percodan from the medical chart but rather that he intentionally tried to hide the prescription of percodan because of his past license suspension for overprescribing the drug. The district court ruled that the license suspension was collateral to any relevant issue in the case and found that the license suspension was "far more prejudicial than probative." (Trial Tr., Vol. I at 5, Vol. V at 4.) On appeal, the Kings contend that the district court abused its discretion in excluding the license suspension, arguing that it was admissible under Federal Rules of Evidence 403, 404(b), and 608(b).
Under Rule 404(b), 2 evidence of prior bad acts, though not admissible to show that a person acted in conformity with the prior act, is admissible if probative of some other purpose such as absence of mistake or accident. Fed.R.Evid. 404(b). Evidence is admissible under Rule 404(b) if it is relevant to a material issue, proved by a preponderance of the evidence, its probative value is not outweighed by its potential for prejudice, and it is similar in kind and close in time to the event at issue. See United States v. Aranda, 963 F.2d 211, 215 (8th Cir.1992). The trial court has broad discretion under this rule and will be reversed if it admits the evidence only if the evidence has no bearing on any issue involved and tends to prove only disposition. United States v. DeLuna, 763 F.2d 897, 912-13 (8th Cir.), cert. denied, 474 U.S. 980, 106 S.Ct. 382, 88 L.Ed.2d 336 (1985). In this circuit, Rule 404(b) is a rule of inclusion. United States v. Jones, 990 F.2d 1047, 1050 (8th Cir.1993), cert. denied, --- U.S. ----, 114 S.Ct. 699, 126 L.Ed.2d 666 (1994) (No. 93-5904); United States v. Sykes, 977 F.2d 1242, 1246 (...
To continue reading
Request your trial
-
Harry v. Marchant
... ... Hosp. San Francisco, 69 F.3d 1184 (1st Cir.1995); Eberhardt v. City of Los Angeles, 62 F.3d 1253 (9th Cir.1995); Urban ex rel. Urban v. King, 43 F.3d 523 (10th Cir.1994); Repp v. Anadarko Mun. Hosp., 43 F.3d 519 (10th Cir.1994); Holcomb v. Monahan, 30 F.3d 116 (11th Cir.1994); In re Baby "K", 16 F.3d 590 (4th Cir.1994); King v. Ahrens, 16 F.3d 265 (8th Cir.1994); Green v. Touro Infirmary, 992 F.2d 537 (5th Cir.1993); Johnson v. Univ. of Chicago Hosps., 982 F.2d 230 (7th ... ...
-
Millan v. Hosp. San Pablo
... ... See Eberhardt v. City of Los Angeles, 62 F.3d 1253 (9th Cir.1995); King v. Ahrens, 16 F.3d 265 (8th Cir.1994); Delaney v. Cade, 986 F.2d 387 (10th Cir.1993); Baber v. Hospital Corp. of America, 977 F.2d 872, 879 (4th ... ...
-
Heimlicher v. Steele
... ... He argues the EMTALA does not provide a cause of action for damages against an individual physician, citing King v. Ahrens, 16 F.3d 265, 270-71 (8th Cir. 1994) ... In King v. Ahrens, Mr. King was brought to a clinic with symptoms of a heart ... ...
-
Reynolds v. Mercy Hosp.
... ... § 1395dd creates no private cause of action against a private physician and a medical professional corporation. See, e.g., King v. Ahrens, 16 F.3d 265, 271 (8th Cir.1994); Delaney v. Cade, 986 F.2d 387, 393-94 (10th Cir.1993); Baber, supra, at 876-78; Gatewood v ... ...