389 P.3d 76
Ariz. Ct. App.2017Background
- Jesse Stafford presented to St. Joseph’s Hospital ED after ingesting unknown methadone; he was observed, tested, and treated for ~12 hours and discharged; he died the next day.
- Plaintiffs Dalton and Kristine Stafford sued Dr. Anne Burns for medical malpractice and wrongful death, alleging premature discharge; defendants contended Jesse re-ingested methadone post-discharge.
- After a 12-day jury trial, the jury returned a defense verdict; the trial court denied the Staffords’ motions for new trial and for relief from judgment.
- Central statutory issue: A.R.S. § 12-572(A) (heightened clear-and-convincing burden for claims against health professionals providing services “in compliance with EMTALA”).
- Additional contested issues at trial/appeal: alleged juror misconduct, scope of Dr. Burns’ testimony (standard-of-care vs. causation), admissibility of expert testimony about postmortem gastric methadone timing, admission of cocaine-metabolite evidence, denial of JML on cause-of-death issues, and Rule 68(g) sanctions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether A.R.S. § 12-572(A) clear-and-convincing burden applies | Stafford: §12-572(A) does not apply because Dr. Burns was not "in compliance with EMTALA"—initial screening already performed and no emergency condition was diagnosed | Burns: §12-572(A) applies to services provided in ED in compliance with EMTALA; ED evaluation/treatment here implicated EMTALA | Held: §12-572(A) applies where the challenged acts/omissions occurred in the course of ED screening/treatment; clear-and-convincing standard applies |
| Juror misconduct (Juror 10’s elevator comment) | Stafford: juror violated admonition, indicating inability to follow instructions and probable bias — entitles them to new trial | Burns: comment was isolated, noncommittal, and cured by voir dire/interview; no prejudice shown | Held: trial court did not abuse discretion; no presumption of prejudice and record showed comment was innocuous |
| Whether Dr. Burns improperly gave undisclosed causation expert testimony | Stafford: Burns opined about possibility of a second methadone dose causing death, acting as undisclosed causation expert in violation of Rule 26 | Burns: she was disclosed as a standard-of-care expert; her testimony about re-ingestion risk was within that scope and not a causation opinion | Held: testimony was proper to explain her standard-of-care view; she did not offer causation opinions that required extra disclosure |
| Validity of Rule 68(g) sanctions and alleged good-faith requirement | Stafford: offer of judgment was not in good faith and thus invalid for sanctions purposes | Burns: Rule 68(g) contains no good-faith requirement; sanctions are mandatory when offeree rejects and obtains less favorable judgment | Held: court refuses to graft a reasonableness/good-faith requirement onto Rule 68(g); sanctions under the rule were properly imposed |
Key Cases Cited
- Harvest v. Craig, 195 Ariz. 521 (App. 1999) (malpractice burden-of-proof general rule)
- Bryant v. Adventist Health Sys./W., 289 F.3d 1162 (9th Cir. 2002) (EMTALA duty discussion in ED context)
- Delbridge v. Salt River Project Agric. Improvement & Power Dist., 182 Ariz. 46 (App. 1994) (standard of review for jury instructions)
- Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993) (gatekeeping standard for expert admissibility)
- Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999) (trial court discretion re: expert reliability and hearings)