Vachon v. Broadlawns Medical Foundation

• Decision Date: 23 September 1992
• Docket Number: No. 91-333,91-333
• Citation: 490 N.W.2d 820
• Parties: Maurice VACHON and Kathie Vachon, Appellants, v. BROADLAWNS MEDICAL FOUNDATION d/b/a Broadlawns Medical Center; Julie Wood; Thomas D. McClain; and State of Iowa, Appellees.
• Court: Iowa Supreme Court

Page 820

490 N.W.2d 820

Maurice VACHON and Kathie Vachon, Appellants, v. BROADLAWNS MEDICAL FOUNDATION d/b/a Broadlawns Medical Center; Julie Wood; Thomas D. McClain; and State of Iowa, Appellees.

No. 91-333.

Supreme Court of Iowa.

Sept. 23, 1992.

Rehearing Denied Oct. 23, 1992.

Randall J. Shanks of Gallner & Gallner, P.C., Council Bluffs, and David D. Nisley, Omaha, Neb., for appellants.

David L. Brown of Hansen, McClintock & Riley, Des Moines, for appellees Broadlawns and Wood.

Bonnie J. Campbell, Atty. Gen., and Robert D. Wilson, Asst. Atty. Gen., for appellees McClain and State.

Considered by McGIVERIN, C.J., and LARSON, SCHULTZ, NEUMAN and ANDREASEN, JJ.

ANDREASEN, Justice.

The jury returned a verdict for the defendants in a medical malpractice case. On appeal, the plaintiffs urge the court's judgment should be reversed because the court submitted improper jury instructions, allowed improper expert opinion testimony, and the defendant's attorney made improper closing arguments. After careful review of the record, we affirm the district court judgment.

I. Background.

Maurice Vachon was walking on a gravel road near Des Moines in the early morning hours of October 9, 1987. Around 6:30 a.m. he was struck from behind by a 1977 Ford LTD traveling approximately forty miles per hour. Vachon was severely injured; he suffered head lacerations, an open fracture of his left leg, and a bruised right leg. He was transported to Broadlawns Medical Center in Des Moines by ambulance, arriving at approximately 7:18 a.m. Upon admission to Broadlawns, Vachon's injuries were evaluated by Dr. Julie Wood, a third-year family practice resident who was doing emergency room coverage at the time. Wood observed Vachon had very serious multiple trauma injuries. She ordered a full x-ray series, including neck, chest, spine, pelvis, and left leg. She called in Dr. Thomas McClain, an orthopedic resident on rotation from University of Iowa hospitals and clinics, for specific orthopedic consultation and evaluation. Broadlawns does not have a trauma center. Wood concurred with McClain's suggestion that Vachon be transferred to the University hospital in Iowa City as soon as possible.

All the medical helicopters were unavailable to transport Vachon to Iowa City, so he was transported via ground ambulance, arriving approximately two hours later at 11:05 a.m. Upon arrival, Vachon was evaluated by the University hospital and clinics' trauma team. Surgery was then scheduled to repair the open tibia-fibula fracture of his left leg.

During the surgery on Vachon's left leg, Dr. James Nepola, one of the attending surgeons, diagnosed compartment syndrome in Vachon's right leg. Compartment syndrome is a condition in which pressure inside the muscular compartment increases to the point at which circulation is cut off. A fasciotomy was performed upon his right leg. A fasciotomy is a procedure to release pressure by surgical incision. The surgical procedures were completed at approximately 5:00 p.m.

While the left leg eventually healed, the right leg did not. Numerous surgeries were performed in an attempt to save the right leg; however, they were unsuccessful. The leg was amputated below the knee on October 16, 1987.

In August 1989, Maurice Vachon and his wife Kathie filed this medical malpractice action alleging negligence in failing to diagnose, care and properly treat the compartment syndrome in Maurice's right leg. Maurice's claim is a negligence claim for personal injury and damages; Kathie's claim is for loss of spousal support. The defendants are Broadlawns, Wood, McClain, and the State of Iowa as the employer of McClain. The jury returned a special verdict that found none of the defendants were negligent. The court entered judgment upon the jury verdict. Vachons' posttrial motions for a new trial and bill of exceptions were overruled. Vachons then filed this appeal.

Because this is an action at law, our review is confined to the correction of assigned errors. Iowa R.App. P. 4. We address Vachons' contention of errors in the order presented.

II. Jury Instructions.

The court is required to instruct the jury as to the law applicable to all material issues in the case. Iowa R.Civ. P. 196. The court must grant requested instructions that state correct rules of law unless the concept is embodied in other instructions. Stover v. Lakeland Square Owners Ass'n, 434 N.W.2d 866, 868 (Iowa 1989). The instructions should not marshal the evidence or give undue prominence to any particular aspect of a case. Id. Requested instructions that are not related to the factual issues to be decided by the jury should not be submitted even though they may set out a correct statement of the law. Wadle v. Jones, 312 N.W.2d 510, 516 (Iowa 1981). The submission of instructions upon issues that have no support in the evidence is error. Meck v. Iowa Power, 469 N.W.2d 274, 276 (Iowa App.1991). Error in giving or refusing to give an instruction does not warrant reversal unless the error is prejudicial. Smith v. Smithway Motor Xpress, Inc., 464 N.W.2d 682, 685 (Iowa 1990).

Here, the court submitted instructions to the jury upon: essentials for recovery (Iowa Civil Instruction 1600.1), duty of physicians (Iowa Civil Instruction 1600.2), duty of specialists (Iowa Civil Instruction 1600.3), duty of hospital (Iowa Civil Instruction 1600.4) and result of the treatment (Iowa Civil Instruction 1600.16). No objection was made to the submission of these instructions. However, Vachons assert the giving of instructions relating to alternative methods of treatment and as to mistake in diagnosis and treatment constitutes reversible error.

A. The court submitted Instruction No. 19 relating to alternative methods of treatment, which provided:

Physicians may disagree in good faith upon what would be the proper treatment or diagnosis of a medical condition in a given situation. It is for the physician to use his or her professional judgment to select which recognized method of treatment to use in a given situation. If you determine that there were two or more recognized alternative courses of action which have been recognized by the medical profession as proper methods of treatment and the Defendant employees in the exercise of their best judgment elected one of these proper alternatives, then Defendants were not negligent.

Vachons argue there is no dispute as to the proper treatment of compartment syndrome. It is undisputed in the evidence that the only treatment for compartment syndrome was performance of a fasciotomy. The plaintiffs urge the decision to transfer Maurice to the University hospital in Iowa City had nothing to do with the treatment of the compartment syndrome condition.

While we agree fasciotomy is the only proper treatment of compartment syndrome, we disagree with Vachons' limited characterization of the treatment issue as encompassing only the required surgical procedure. We find, as did the district court, there was an alternative treatment issue.

The issue is whether it was proper to transfer Vachon to the University hospital in Iowa City rather than transferring him to either Mercy or Methodist hospital in Des Moines. Vachons' supplemental answers to interrogatories suggest Vachon should not have been transported by ground to the University hospital. In opening statements to the jury, plaintiffs' counsel stated their expert medical testimony would show the defendants failed to diagnose and treat the compartment syndrome. Counsel stated the evidence would show the defendants should have transported Vachon to Des Moines Mercy or Methodist rather than the two hour trip to Iowa City. Vachons' expert medical witnesses testified Vachon should have been transferred to one of the closest trauma hospitals, Mercy or Methodist hospital in Des Moines; that if the compartment syndrome had been diagnosed and treated properly, the leg would have been saved; and the transfer and treatment decisions made by the defendants were the cause of Vachon having his right leg amputated. Vachons' counsel commented in chambers "Your honor, we have alleged all throughout this case that transfer is an issue." In Vachons' requested instruction they asked that the court instruct the jury that the defendants were negligent in failing to promptly transfer Vachon to a local hospital in Des Moines. This specification of negligence was submitted to the jury by the court.

In response, the defendants offered evidence that the transfer to the University hospital provided reasonable care. Evidence offered by the defendants indicates the transfer of Vachon to University hospital was appropriate because Vachon had suffered severe multiple trauma injuries and the University hospital had the only Level I full tertiary care center for the treatment of orthopedic trauma in Iowa. Defendants' expert witnesses testified there were no clinical signs of compartment syndrome at the time of transfer.

We recognize the definition of treatment is a broad term covering all the steps taken to effect a cure of an injury or disease, including examination and diagnosis. Marquis v. Nuss, 451 N.W.2d 833, 836 (Iowa 1990). The decision as to where Vachon should be transferred for care was a part of his treatment. Substantial evidence was presented to support a finding that transfer to the University hospital in Iowa City or to either Mercy or Methodist hospital in Des Moines would constitute reasonable care. We find the issue of alternative methods of treatment was an issue in the case and supported by the evidence. It was not reversible error for the court to submit an...