74 Cal.App.5th 610
Cal. Ct. App.2022Background:
- Ronald Zannini underwent uneventful cervical spine surgery on March 25, 2015 and was discharged; he developed severe pain and weakness and returned to the ER on April 5 with sudden paralysis.
- ER physicians called neurosurgeons; Dr. Mark Liker (the treating surgeon) consulted but left the hospital at ~7:17 p.m. for a scheduled flight after notifying the family that the on-call neurosurgeon (Dr. Mortazavi) would perform any emergency surgery.
- CTs were negative; an MRI (ordered ~6:11 p.m.) required an MRI‑compatible pressor pump and did not begin until ~7:40 p.m.; preliminary MRI images appeared ~8:10 p.m. and the complete series (showing a cervical epidural hematoma) was read by neuroradiology at ~9:38 p.m.
- Dr. Mortazavi agreed to operate on notification, but OR availability and transfers delayed surgery; evacuation began at ~11:35 p.m. (about six hours after ER arrival). Outcome: partial quadriplegia.
- Plaintiffs sued multiple providers for delayed diagnosis/treatment; all defendants except Dr. Liker were dismissed. At trial plaintiffs argued Liker negligently left before ensuring timely surgical care; the jury found no negligence and judgment for Liker was entered and appealed on instructional grounds.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the court should have given CACI 509 (abandonment) | Liker abandoned the patient by leaving before another neurosurgeon physically arrived, so CACI 509 applied | Liker notified ER and family, arranged coverage, remained available by phone; no evidence he assumed control and then withdrew | Court refused CACI 509; no abandonment as matter of law because Liker did not accept primary responsibility and there was a plan for coverage |
| Whether CACI 411 (reliance on others) prejudiced plaintiffs | Instruction could excuse Liker by shifting blame to others | Instruction reflects general law that one may rely on others' reasonable care when appropriate | No prejudicial error; instruction harmless because plaintiffs’ theory blamed only Liker and no evidence of other negligence existed |
| Whether trial court erred by declining CACI 430/431 (causation) and giving defense special causation instruction | Plaintiffs wanted standard causation instructions | Defense instruction tracked substantial-factor concept and tied to expert testimony | Moot: jury found no negligence, so causation instructions would not affect verdict |
| Whether CACI 506 (alternative methods) and BAJI 6.15 (emergency definition) were improper | Plaintiffs claimed no alternative methods existed and BAJI 6.15 unnecessary | Court argued instructions were standard/neutral and no prejudice shown | Claims waived or nonprejudicial; court did not err in giving/declining as charged |
Key Cases Cited
- Soule v. General Motors Corp., 8 Cal.4th 548 (1994) (right to instructions on every theory supported by substantial evidence; prejudice standard for instructional error)
- Arato v. Avedon, 5 Cal.4th 1172 (1993) (court may refuse an instruction when legal point is adequately covered by others)
- Solgaard v. Guy F. Atkinson Co., 6 Cal.3d 361 (1971) (trial court need not give instructions that are irrelevant, confusing, or misleading)
- Hongsathavij v. Queen of Angels Med. Ctr., 62 Cal.App.4th 1123 (1998) (abandonment: physician can’t withdraw treatment without due notice and opportunity to secure other care)
- Payton v. Weaver, 131 Cal.App.3d 38 (1982) (same general principle regarding physician abandonment)
- Wilkinson v. Southern Pac. Co., 224 Cal.App.2d 478 (1964) (reversal for instructional error requires showing the error was a factor in the verdict reached)