Opinion
No. 2-255 / 01-1482
Filed September 25, 2002
Appeal from the Iowa District Court for Story County,Ronald Schechtman, Judge.
Plaintiffs' appeal in this medical malpractice action challenges the district court's rulings refusing to submit an issue of informed consent to the jury, excluding evidence of defendant Grabenstetter's withdrawn counterclaim, and permitting the testimony of an expert witness for the defendants. AFFIRMED.
David L. Leitner of Leitner Law Office, Johnston, for appellants.
Susanna Albaugh Brown of Rouwenhorst Brown, P.C., West Des Moines, for appellees.
Considered by Mahan, P.J., and Miller and Hecht, JJ.
Rina and Giora Slutzki (collectively the Slutzkis) appeal from the final judgment in their medical malpractice action against the defendants Dr. Joan Grabenstetter and McFarland Clinic, P.C. The Slutzkis contend the trial court erred in (1) "directing a verdict" on the issue of informed consent as it related to the nondisclosure of Dr. Grabenstetter's medical condition, (2) excluding evidence of Dr. Grabenstetter's withdrawn counterclaim, and (3) allowing the testimony of defense expert witness Dr. Taylor. We affirm.
I. BACKGROUND FACTS.
Dr. Joan Grabenstetter is an obstetrician and gynecologist at McFarland Clinic, P.C., in Ames. She first saw Rina Slutzki professionally in 1986, and this relationship continued. Dr. Grabenstetter diagnosed Rina with fibroids, which gradually increased in size. Dr. Grabenstetter recommended Rina have a hysterectomy, but Rina declined until the fibroids were more of a problem. Rina eventually scheduled surgery after an April 1997 visit to Dr. Grabenstetter. Although the hysterectomy was originally scheduled for May 1997, Rina cancelled the surgery, and she ultimately underwent the hysterectomy operation in August 1997.
At the time of the surgery, Dr. Grabenstetter had for some time been experiencing symptoms from a herniated disc in her neck region. She testified at trial that the symptoms caused by the disc did not affect her work or her ability to perform surgery. According to Dr. Grabenstetter, her herniated disc affected muscles involved in the use of her arms above the level of the shoulder so that her muscles were affected by driving and holding up her arms, but that surgery did not affect her muscles because the operating table was always adjusted to the surgeon's level of comfort, and when in a position to operate her arms are always down.
Rina's surgery resulted in both of her ureters becoming obstructed. Such injuries are a recognized complication of a hysterectomy. The injuries were recognized post-operatively and the damage was repaired within about twenty-four hours of the hysterectomy. She alleges she has some sexual dysfunction and difficulties with urinary control.
Rina and her husband, Giora, filed a petition alleging Dr. Grabenstetter was negligent in various particulars, causing injury to Rina and loss of consortium to Giora. Dr. Grabenstetter filed a counterclaim against Rina Slutzki for slander. She later dismissed the counterclaim. The Slutzkis claimed, among other things, lack of informed consent based on Dr. Grabenstetter's not advising Rina of Dr. Grabenstetter's medical condition. The district court granted the defendants' "motion for directed verdict" concerning the lack of informed consent issue. The jury returned a verdict in favor of the defendants, finding Dr. Grabenstetter was not at fault. The Slutzkis appeal.
II. INFORMED CONSENT.
The Slutzkis contend that the trial court erred in refusing to submit to the jury their informed consent claim involving the nondisclosure of Dr. Grabenstetter's medical condition. They argue that a reasonable patient would want to know about her medical condition, and a reasonable person would elect to either defer the surgery or obtain a different surgeon. They argue Rina was denied the opportunity to make these choices due to Dr. Grabenstetter's nondisclosure.
A. Scope of review. We review appeals from the grant of a motion for directed verdict for correction of errors at law. Dettmann v. Kruckenberg, 613 N.W.2d 238, 250 (Iowa 2000). We review the evidence presented in the light most favorable to the nonmoving party to determine whether a fact question was generated. Id. at 250-51. The court may sustain the motion if substantial evidence does not support each element of a plaintiff's claim. Id. at 251. "Evidence is substantial if reasonable minds could accept it as adequate to reach the same findings." Id. B. Merits. The doctrine of informed consent is based on the patient's right to exercise control over his or her body, absent extenuating circumstances, by making an informed decision concerning whether to submit to a particular medical procedure. Pauscher v. Iowa Methodist Med. Ctr., 408 N.W.2d 355, 358 (Iowa 1987). Thus, a doctor recommending a particular procedure generally has, among other obligations, the duty to disclose all material risks involved in the procedure. Id. In Iowa, we follow the patient rule in all informed consent cases, in both elective and nonelective medical procedures. Id. at 359. That rule generally requires that the physician's communications to the patient be measured by the patient's needs, and that need is the information material to the decision. Cowman v. Hornaday, 329 N.W.2d 422, 425 (Iowa 1983). To prevail on an informed consent claim, the patient has the burden to establish the following: (1) the existence of a material risk unknown to the patient; (2) a failure to disclose that risk on the part of the physician; (3) disclosure of the risk would have led a reasonable patient in plaintiff's position to reject the medical procedure or choose a different course of treatment; and (4) injury. Pauscher, 408 N.W.2d at 360. The patient is ordinarily required to present expert testimony relating to the nature of the risk and the likelihood of its occurrence, in order for the jury to determine, from the standpoint of the reasonable patient, whether the risk is in fact a material one. Id.
Materiality may be said to be the significance a reasonable person, in what the physician knows or should know is his [or her] patient's position, would attach to the disclosed risk or risks in deciding whether to submit . . . to surgery or treatment.
Id. at 361-62.
We conclude the trial court properly refused to submit to the jury the plaintiffs' claim of lack of informed consent regarding Dr. Grabenstetter's medical condition. There was no substantial evidence that her condition affected her ability to perform surgery, and therefore there was no evidence of a risk to Rina based on Dr. Grabenstetter's condition. There was simply no evidence that Dr. Grabenstetter's condition constituted any risk in the performance of a hysterectomy. We affirm the trial court on this issue.
III. COUNTERCLAIM.
The trial court excluded evidence regarding Dr. Grabenstetter's withdrawn counterclaim on grounds that it was irrelevant to the malpractice issues and also even if relevant, it would be inadmissible pursuant to Iowa Rule of Evidence 5.403. On appeal, the Slutzkis contend the trial court erred by excluding this evidence because the allegations in the counterclaim go to Dr. Grabenstetter's credibility. They argue her motive in filing the counterclaim is illuminative of her credibility and motive in this case.
A. Scope of review. We review a district court's decision concerning the admission of relevant evidence for an abuse of discretion. See McClure v. Walgreen Co., 613 N.W.2d 225, 235 (Iowa 2000). An abuse of discretion occurs when "the court exercised [its] discretion on grounds or for reasons clearly untenable or to an extent clearly unreasonable." Waits v. United Fire Cas. Co., 572 N.W.2d 565, 569 (Iowa 1997) (quoting State v. Maghee, 573 N.W.2d 1, 5 (Iowa 1997)).
B. Merits. The inquiry whether evidence is admissible under our Iowa Rules of Evidence 5.402 and 5.403 involves a two-step inquiry: (1) is the evidence relevant? and (2) if so, is its probative value substantially outweighed by the danger of prejudice or confusion? Mercer v. Pittway Corp., 616 N.W.2d 602, 612 (Iowa 2000). Evidence is relevant if it has a tendency to make the existence of a consequential fact more or less probable than it would be without the evidence. Iowa R. Evid. 5.401; McClure, 613 N.W.2d at 235. Even relevant evidence, however, may not be admissible "if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence." Iowa R. Evid. 5.403. "Unfair prejudice arises when the evidence prompts the jury to make a decision on an improper basis. . . ." Waits, 572 N.W.2d at 569.
We conclude that the trial court did not abuse its considerable discretion in ruling that evidence of the counterclaim was inadmissible. The evidence had no relevance or extremely little relevance to Dr. Grabenstetter's credibility. Nor does it show any motive of hers relative to the issues involved in the plaintiffs' claims, as any events giving rise to the counterclaim occurred well after the events that led to the plaintiffs' claims. Furthermore, we conclude that injecting evidence of the counterclaim into the trial of this case would result in the danger of unfair prejudice and confusion of the issues. It would also result in undue delay or waste of time. We affirm the trial court's ruling on this issue.
IV. EXPERT TESTIMONY.
The Slutzkis contend that the trial court erred in permitting the testimony of an expert witness for the defense, Dr. Michael Taylor. They argue that the defendants failed to comply with the requirements of Iowa Code section 668.11 (1999) concerning disclosure of expert witnesses and failed to timely supplement their answers to interrogatories as to the opinions of Dr. Taylor, as required under Iowa Rule of Civil Procedure 1.508(3). The Slutzkis maintain Dr. Taylor should have been prohibited from testifying.
A. Scope of review. We review a trial court's decision concerning compliance with section 668.11 for an abuse of discretion, Hantsbarger v. Coffin, 501 N.W.2d 501, 505 (Iowa 1993), as we do a trial court's decision on whether to extend the time allowed to designate expert witnesses, Donovan v. State, 445 N.W.2d 763, 766 (Iowa 1989); Hill v. McCartney, 590 N.W.2d 52, 54 (Iowa Ct. App. 1998). We will not disturb a district court's decision under rule 1.508(3) unless the court abused its discretion. Preferred Mktg. Assocs. Co. v. Hawkeye Nat. Life Ins. Co., 452 N.W.2d 389, 393 (Iowa 1990).
B. Merits. Rina claims she suffered severe emotional trauma as a result of her hysterectomy and the ensuing complications. Dr. Taylor's testimony did not address questions of the standard of care to which Dr. Grabenstetter should be held or whether Dr. Grabenstetter breached that standard of care. His testimony therefore did not address the question of whether Dr. Grabenstetter was at fault. Rather, his testimony went to questions of whether Rina suffered from depression and, if so, whether the depression was caused by her hysterectomy and resulting complications. Otherwise stated, his testimony was limited to questions of causation, whether fault if any of Dr. Grabenstetter caused emotional injury to Rina.
The case was submitted to the jury on special verdicts. The jury was first asked whether Dr. Grabenstetter was at fault, and was instructed that if its answer was "no" it was not to answer any further questions. It answered the first question "no" and did not reach the second question, whether fault of Dr. Grabenstetter was a proximate cause of the damages to Rina.
A trial court error is not reversible unless the error was prejudicial. See Mercer, 616 N.W.2d at 612 (admission of evidence); McClure, 613 N.W.2d at 235 (same); Iowa-Illinois Gas and Elec. Co. v. Black Veatch, 497 N.W.2d 821, 828 (Iowa 1993) (jury instruction). Reversal is not required if the record shows a lack of prejudice. Mercer, 616 N.W.2d at 612; McClure, 613 N.W.2d at 235; Shawhan v. Polk Co., 420 N.W.2d 808, 810 (Iowa 1988). We assume the jury heeded and complied with the instructions given by the trial court. Iowa-Illinois, 497 N.W.2d at 828.
We need not decide whether the trial court abused its discretion in allowing Dr. Taylor's testimony because any error in allowing the testimony was not prejudicial to the Slutzkis. An improper ruling on evidence offered to prove damages is not reversible error when the jury finds in favor of the defendant on liability (and thus does not reach the question of damages). See Shawhan, 420 N.W.2d at 810-11 (and cases cited therein). Similarly, error if any in allowing Dr. Taylor's testimony concerning whether Rina suffered from depression, and, if so, whether the depression was proximately caused by her hysterectomy and ensuing complications was not prejudicial because the jury found in favor of Dr. Grabenstetter on fault and did not reach the questions addressed by Dr. Taylor's testimony, existence and proximate causation of depression. Because the record shows that no prejudice could have resulted from the alleged error in admission of Dr. Taylor's testimony, no reversible error appears.
V. CONCLUSION.
We conclude the trial court did not err in refusing to submit to the jury the Slutzkis' claim of lack of informed consent, and did not abuse its discretion in refusing to allow evidence of Dr. Grabenstetter's counterclaim. Without deciding whether the trial court abused its discretion in allowing Dr. Taylor's testimony, we conclude the asserted error was not prejudicial to the plaintiffs and does not warrant reversal.