State v. Buman

• Decision Date: 19 February 2021
• Docket Number: No. 19-0981,19-0981
• Citation: 955 N.W.2d 215
• Parties: STATE of Iowa, Appellee, v. Michael BUMAN, Appellant.
• Court: Iowa Supreme Court

955 N.W.2d 215

STATE of Iowa, Appellee,

v.Michael BUMAN, Appellant.

No. 19-0981

Supreme Court of Iowa.

Submitted November 17, 2020

Filed February 19, 2021

Priscilla E. Forsyth (argued), Sioux City, for appellant.

Thomas J. Miller, Attorney General, Linda J. Hines (argued), Assistant Attorney General, and Darin J. Raymond, County Attorney, for appellee.

Appel, J., delivered the opinion of the court, in which all justices joined.

APPEL, Justice.

In this case, Michael Buman appeals his conviction following a jury trial of the offense of wanton neglect of a resident of a health care facility in violation of Iowa Code section 726.7(1) and subsection (3) (2016). The criminal charge arose out of the alleged failure of Buman to properly ensure that a facility resident received medications as ordered by the resident's physician. During the trial the State introduced evidence regarding the standard of care in the nursing profession, and the trial court provided the jury with instructions related to the use of the standard of care in the case.

Buman claims on appeal that the admission of the professional standards and the subsequent instruction were improper and served only to confuse the jury in its deliberations. A divided court of appeals agreed with Buman, reversed his conviction, and remanded for a new trial. We granted the State's application for further review.

For the reasons stated below, we reverse Buman's conviction and remand the matter to the district court for further proceedings.

I. Background Facts and Proceedings.

Defendant Michael Buman has been in the medical field for several decades. He became an emergency medical technician in 1977 but moved into nursing, becoming a registered nurse in 2004.

In November 2015, Buman began working at the Pride Group Residential Care Facility (Pride Group Facility) in Le Mars, Iowa. Buman worked the night shift at the Pride Group Facility. His duties included distributing medicine to residence and handling direct care with residents. Buman worked at the Pride Group Facility during the relevant dates at issue in this case in October 2016.

In October 2016, Joe Lenz was a resident of the Pride Group Facility who had been at the facility for more than twenty years. Lenz suffered from what was diagnosed as chronic paranoid schizophrenia with catatonic features, obsessive compulsive disorder, and mild intellectual disability.

At the Pride Group Facility, an off-site psychiatrist or medical doctor issued doctor's orders for medications. The prescriptions were filled by L & M Pharmacy. The pharmacy delivered a two-week supply of medication. The pharmacy placed the medications in a locked room where the medication was then separated and organized for distribution by placing the medication on trays that had individual drawers for each medication the resident was taking.

Lenz had been prescribed a number of medications, including Clozapine. Another nurse testified that the Clozapine was available to be administered to Lenz on October 12 and 13, but on October 15, the Clozapine was not there. The nurse reported to the day-shift nurse that the medication was missing so that the day-shift nurse could contact the pharmacy. She then marked "NA" on the medication administration record for Lenz on October 15 and also on October 16 when the medication was still not there. On October 17, the initials of "AW" appeared on the Lenz medical record. AW is another nurse who did not testify and there is no indication of whether AW's initials signified administration of Clozapine on October 17.

On October 18, Buman testified that he initialed Lenz's medical record, indicating that he administered the Clozapine, but he did so automatically and that, in fact, the Clozapine was not present to be administered. According to Buman, Lenz asked why he had not been receiving the drug, and Buman in response searched to see if the medication was misplaced. He could not find the drug.

After talking with Lenz and looking at the records, Buman testified that he concluded that the medication must have been discontinued and that no one had marked the chart indicating the discontinuation. According to Buman, he entered the notation "DC'd" on the chart. According to an administrator at the facility, by marking the record "DC," other medication passers would not administer the drug, but the marking of the medication record with a "DC" would not affect the pharmacy's continued delivery of the medication. The record contained no evidence for whether the Clozapine had been delivered to Lenz after Buman notated "DC" on the medical record.

On October 27, Lenz had a psychotic episode. He believed a bomb went off in the building and that the building was on fire—eventually running out into the night. With the assistance of law enforcement, he was taken to the hospital. Lenz's physician assistant testified at trial that he believed that Lenz was not receiving his Clozapine and that this led to the October 27 event.

During the trial, the State introduced, over Buman's objection, a portion of the Iowa Administrative Code related to the practice of nursing as Exhibit 15. Specifically, Exhibit 15 provided, in relevant part:

The registered nurse shall recognize and understand the legal implications of accountability. Accountability includes but need not be limited to the following:

....

e. Executing the regimen prescribed by a physician. In executing the medical regimen as prescribed by the physician, the registered nurse shall exercise professional judgment in accordance with minimum standards of nursing practice as defined in these rules. If the medical regimen prescribed by the physician is not carried out, based on the registered nurse's professional judgment, accountability shall include but need not be limited to the following:

(1) Timely notification of the physician who prescribed the medical regimen that the order(s) was not executed and reason(s) for same.

(2) Documentation on the medical record that the physician was notified and reason(s) for not executing the order(s).

The district court also gave the jury an instruction related to Exhibit 15. Specifically, Instruction No. 17 provided:

In accordance with the standards in the Iowa Administrative Code, a registered nurse is required to follow a medical regimen prescribed by a physician. If a medical regimen prescribed by a physician is not carried out by a registered nurse, the registered nurse is required to timely notify the physician who prescribed the medical regimen and also document on the medical record that the physician was notified and the reason for not executing the physician's order. A violation of this standard, in and of itself, is not a criminal act. You may consider this standard only in determining whether the State has proven beyond a reasonable doubt the elements of the charge set forth in Instruction 15.

The jury found Buman guilty of wanton neglect of a resident of a health care facility but found that Buman's actions or omissions did not cause serious injury to Lenz.

Buman appealed his conviction. On appeal, he claims that Exhibit 15, which related to professional nursing standards, was improperly admitted into evidence. Buman further claims that Instruction No. 17 was erroneous because it misled and confused the jury. Finally, Buman claims there was insufficient evidence to support the verdict.

We transferred the case to the court of appeals. In a divided opinion, the court of appeals reversed Buman's conviction and remanded the case to the district court. For the reasons expressed below, we affirm the court of appeals decision and remand the case for a new trial.

II. Standard of Review.

"We review evidentiary rulings for abuse of discretion." State v. Huston , 825 N.W.2d 531, 536 (Iowa 2013). "We reverse a ruling that the district court makes in the balancing process ... only if the district court has abused its discretion." Id. (quoting McClure v. Walgreen Co. , 613 N.W.2d 225, 235 (Iowa 2000) (en banc)).

"[W]e review challenges to jury instructions for correction of errors at law." Alcala v. Marriott Int'l, Inc. , 880 N.W.2d 699, 707 (Iowa 2016) (quoting Anderson v. State , 692 N.W.2d 360, 363 (Iowa 2005) ). We reverse erroneous jury instructions when prejudice results. State v. Coleman , 907 N.W.2d 124, 138 (Iowa 2018). But we presume errors in jury instructions are prejudicial "unless the record affirmatively establishes there was no prejudice." State v. Hanes , 790 N.W.2d 545, 551 (Iowa 2010).

"We review the sufficiency of the evidence for correction of errors at law." State v. Kelso-Christy , 911 N.W.2d 663, 666 (Iowa 2018). "We view the evidence in the light most favorable to the State, ‘including legitimate inferences and presumptions that may fairly and reasonably be deduced from the record evidence.’ " State v. Tipton , 897 N.W.2d 653, 692 (Iowa 2017) (quoting State v. Williams , 695 N.W.2d 23, 27 (Iowa 2005) ). We evaluate the sufficiency of the evidence by considering whether the record contains substantial evidence to support conviction. Kelso-Christy , 911 N.W.2d at 666. "Substantial evidence exists when the evidence ‘would convince a rational fact finder the defendant is guilty beyond a reasonable doubt.’ " Kelso-Christy , 911 N.W.2d at 666 (quoting State v. Meyers , 799 N.W.2d 132, 138 (Iowa 2011) ).

III. Discussion.

A. Positions of the Parties. On appeal, Buman maintains that the admission of Exhibit 15 was contrary to Iowa Rule of Evidence 5.403. In particular, he attacks the language of the exhibit which provides: "The registered nurse shall recognize and understand the legal implications of accountability. Accountability includes but need not be limited to the following ...." He maintains that the standard of accountability in the professional standard is not the same as the standard of "knowingly act[ing] in a manner likely to be injurious" to a resident under Iowa Code section 726.7 and thus could confuse the jury. A jury, according to Buman, could...