Watson v. Hockett
| Decision Date | 06 November 1986 |
| Docket Number | No. 52454-8,52454-8 |
| Citation | 727 P.2d 669,107 Wn.2d 158 |
| Parties | Ronald Noel WATSON and Virginia Joy Watson, husband and wife, Respondents, v. Clyde HOCKETT, M.D. and Jane Doe Hockett, and the marital community thereof; and Family Medicine Yakima Valley, Petitioners. |
| Court | Washington Supreme Court |
Williams, Kastner & Gibbs, William Mays, Eileen Lawrence, Tacoma, for petitioners.
Richards & Kinerk, P.S., Dwayne Richards, Laurie Kinerk, Seattle, for respondents.
Dr. Clyde Hockett, his marital community and Family Medicine Yakima Valley (the Clinic) where Dr. Hockett practiced are the defendants in this medical malpractice action. Ronald N. Watson (the patient) and his wife are the plaintiffs. At issue is whether the trial court erred in not giving certain of the defendant doctor's proposed instructions to the jury. It is conceded that if the verdict stands against the doctor, it stands as against all of the defendants. 1
Dr. Hockett was a medical doctor at the Clinic at all times relevant to this action. He is a specialist in family practice. He treated the patient for chronic headaches in October 1979, then did not see him again for somewhat over 6 months.
On April 25, 1980, the patient experienced severe stomach cramps and rectal pain. He made an appointment at the Clinic and there saw Dr. Hockett on April 29.
Dr. Hockett's examination of the patient revealed a small area of inflammation and discharge about the patient's rectum and a small hemorrhoid with no evidence of fissure, mass or internal hemorrhoid. He concluded that the patient was suffering from constipation caused by taking excessive amounts of headache medication containing codeine. Dr. Hockett prescribed treatment which he believed would correct the problem and testified that he told the patient to return to the Clinic for follow-up in a week, and to call if the problem worsened.
In the week between this April 29 examination and the following May 6, when the patient went to the hospital, the patient and his wife phoned Dr. Hockett several times concerning the patient's continuing problems and rectal pain.
At trial, there was flatly conflicting testimony as to the content of these phone conversations. According to the patient, Dr. Hockett ignored his complaints and refused to either see him or refer him to the hospital emergency room. According to Dr. Hockett, the patient refused to come in and see him and did not follow his instructions to this effect
On May 6, 1980, the patient was admitted to the emergency room at Yakima Valley Memorial Hospital and was diagnosed by the doctors there as having a very large rectal abscess. He underwent surgery to have the abscess drained, but the abscess had already caused extensive damage. The patient testified that as a result he now suffers urinary and rectal incontinence, as well as sexual dysfunctioning.
The case was tried to a jury which found that Dr. Hockett and the patient were both negligent (73 percent and 27 percent respectively) and assessed damages totaling $99,000. Judgment for $72,270 (the total damages less a $26,730 offset for the patient's contributory negligence) was thereupon entered in favor of the plaintiffs against the defendants. Defendants' motion for a new trial was denied.
Dr. Hockett and the Clinic appealed. The Court of Appeals affirmed the trial court's judgment. 2 The case comes before this court on a petition for review brought by the doctor and the Clinic asking this court to reverse the Court of Appeals on the basis of three of the defendant doctor's proposed jury instructions which were not given.
We are presented with two issues.
ISSUE ONE. Were the defendant's proposed jury instructions on the following legal principles proper?
(a) A doctor does not guarantee a good medical result.
(b) A poor medical result is not, in itself, evidence of any wrongdoing by the doctor.
(c) A doctor who otherwise follows the appropriate professional
standards should not be found negligent because he or she makes an error of judgment.
ISSUE TWO. Did the trial court commit reversible error by not giving these proposed instructions to the jury?
ISSUE ONE.
CONCLUSION. The proposed instructions on the three principles of law in question were all approved in a unanimous opinion of this court and properly state the law. In the light of modern jury instruction practice, however, which is aimed at avoiding slanted or argumentative instructions, these instructions should be phrased differently anytime they are used in the future.
It is helpful to put this matter into perspective at the outset.
First, then, some general observations.
The law of medical malpractice is for the most part based on theories of fault based liability. Absent a contract promising the patient a particular result, 3 a doctor will not normally be held liable under a fault based system simply because the patient suffered a bad result. 4 It must, rather, be shown that the doctor's conduct fell below a level that society considers acceptable. 5 Even under the negligence doctrine of res ipsa loquitur, there must be evidence from which negligence can at least be inferred. 6 In the absence of proof that the doctor failed to exercise the required level of skill and care, the patient suing the doctor should not prevail; 7 the mere fact that an injury was therapy produced or that there was an unfavorable or "bad" result from the therapy, however, does not necessarily mean that there was negligence or other wrongful conduct. 8
The most critical element of most medical malpractice claims based on negligence, and that which has stirred the most debate in our judicial forums and legislative halls, is the standard of care owed by the doctor to his or her patient.
For many years in this state, the standard of care was "the standard and degree of care and skill expected of the average medical ... practitioner, in the class to which defendant belongs, acting in the same or similar circumstances." 9 In a case tried under that standard of care, Miller v. Kennedy, both the Court of Appeals 10 and this court 11 unanimously held that the trial court did not err when it gave instructions to the effect of those proposed by the doctor in the present case. The last appeal in the series of appeals in that case was Miller v. Kennedy, 91 Wash.2d 155, 588 P.2d 734 (1978), and that being the final word on the case, it is to that decision which we particularly direct our attention and quote, and it is that decision which we hereinafter refer to as "Miller ".
The "no guarantee" and "bad result" instructions were contained in separate sentences of the following single jury instruction given in Miller:
91 Wash.2d at 159 n. 3, 588 P.2d 734.
In Miller, the giving of these instructions was unanimously held by this court not to have been error. Dr. Hockett proposed identical instructions in this case but they were not given by the trial court.
The above "no guarantee" and "bad result" instructions state well-nigh universally recognized principles of medical malpractice law. 12 While the above instruction, if given, would not have been error, 13 its language does not comport with modern practice in instructing juries. Current practice is
to avoid slanted or argumentative instructions. A jury instruction should be a statement of the law only. It is the function of argument by the lawyers to persuade the jury that the legal principle fits their version of the evidence or their theory of the case. 14
This instruction, when given in the future, should simply state the principles as follows:
A doctor does not guarantee a good medical result.
A poor medical result is not, in itself, evidence of any wrongdoing by the doctor. 15
Published uniform jury instructions commonly contain instructions to this same general effect. 16 The instruction language set forth just above is based on the published New Mexico uniform instruction. 17 As the instructions for use of that instruction state, "in most cases, this instruction will be given." 18 Such an instruction is particularly appropriate where the jury has heard evidence or argument from which it might reach an improper conclusion that doctors guarantee good results or can be found negligent merely because of a bad result. 19 It would, of course, not be appropriate in a case tried on a theory that the doctor had promised a particular result. 20
The "error of judgment" instruction unanimously upheld by this court in Miller, and also proposed by Dr. Hockett in this case, is also proper:
A physician or surgeon is not liable for an honest error of judgment if, in arriving at that judgment, the physician or surgeon exercised reasonable care and skill, within the standard of care he was obliged to follow.
(Italics ours.) Miller, 91 Wash.2d at 160 n. 4, 588 P.2d 734. Henceforth, however, the italicized word "honest" should not be used in those cases where it is appropriate to give this instruction. This is because the use of the word "honest" imparts an argumentative aspect into the instruction which, as discussed above, does not coincide with current jury instruction practice. As the Virginia Supreme Court explained in Teh Len Chu v....
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