Asher v. Ob-Gyn Specialists, P.C., 2014 Iowa Sup. LEXIS 49

Background

Larysa Asher delivered a baby at Covenant Medical Center; the child suffered a brachial plexus injury and fractured clavicle. Plaintiffs sued delivering physician Dr. Anthony Onuigbo for professional negligence.
Trial lasted two weeks; jury instructions listed six alternative negligence theories, including (A) failure to document fetal station during second stage and (B) use of a vacuum extractor. The jury returned a general verdict for Asher.
The district court’s causation instruction defined proximate cause using the Restatement (Second) substantial-factor formulation rather than the Restatement (Third) approach adopted in Thompson v. Kaczinski.
Onuigbo challenged (1) the propriety of the substantial-factor causation instruction under Thompson, and (2) sufficiency of evidence for the two specifications: vacuum-extractor use and failure to document.
Experts for Asher testified (a) labor was protracted and documentation was inadequate, (b) vacuum extraction increased the risk of shoulder dystocia, and (c) proper documentation or cesarean delivery would likely have reduced the injury risk.

Issues

Issue	Plaintiff's Argument (Asher)	Defendant's Argument (Onuigbo)	Held
Whether the jury instruction on causation was erroneous under Thompson (Restatement (Third))	Thompson controls; scope-of-liability often is decided as a matter of law; here scope was established so the error was harmless	Instruction misstated law by using the substantial-factor test (Restatement (Second)) and thus required a new trial	Court: Instruction was erroneous but harmless because brachial plexus injury fell within defendant’s scope of liability as a matter of law and the erroneous instruction raised plaintiff’s burden, not lowered it; verdict affirmed
Whether there was substantial evidence that vacuum-extractor use was a factual cause of injury	Vacuum extraction increased risk of shoulder dystocia and set in motion events leading to injury; need not be sole or direct instrumentality	The vacuum itself did not directly injure the infant; experts said the instrument did not cause injury	Court: Substantial evidence supported submission — vacuum use could be a factual cause under Restatement (Third) §26; instruction submission proper
Whether failure to document fetal station during second stage caused the injury	Lack of hourly station documentation concealed protracted labor; proper charting would have alerted physician to need for cesarean or other interventions; expert testimony supports causation	Writing (or not writing) in the chart cannot be the proximate cause; Onuigbo was sole attendant so documentation would not change care	Court: Substantial evidence (expert testimony) created a jury question on causation; failure-to-document specification properly submitted
Whether a general verdict on multiple theories requires reversal given possible invalid theories	If at least one submitted theory had support and erroneous instruction was harmless, the general verdict stands	Because general verdict could rest on invalid theories, reversal is required unless error harmless and at least one valid theory supported	Court: General verdict stands — causation-instruction error harmless and both challenged theories had sufficient evidentiary support

Key Cases Cited

Thompson v. Kaczinski, 774 N.W.2d 829 (Iowa 2009) (adopted Restatement (Third) separation of factual cause and scope of liability)
Pavone v. Kirke, 801 N.W.2d 477 (Iowa 2011) (standards for reviewing jury instructions)
Hoekstra v. Farm Bureau Mut. Ins. Co., 382 N.W.2d 100 (Iowa 1986) (view evidence in light most favorable to party supporting submission)
Nichols v. Westfield Indus., Ltd., 380 N.W.2d 392 (Iowa 1986) (general verdicts and unsupported specifications require reversal)
Vachon v. Broadlawns Med. Found., 490 N.W.2d 820 (Iowa 1992) (instructions unsupported by evidence are error)
Hagenow v. Schmidt, 842 N.W.2d 661 (Iowa 2014) (harmless-instruction analysis where erroneous wording made claim harder to prove)