Lead Opinion
This аction was brought by the parents of an infant who died shortly after his premature birth. The plaintiffs claim the jury’s verdict in favor of the physician who rendered prenatal care to the child’s mother was contrary to the evidence and failed to render substantial justice. They also claim error in the trial court’s decision to instruct the jury that the locality of the defendant’s practice may bе considered in determining the applicable standard of care and that the defendant’s conduct was not to be judged with the benefit of hindsight. After reviewing the record and considering the arguments of the parties, we affirm.
I. Background Facts and Proceedings.
The plaintiff, Dawn Hagedorn, was in her thirty-third week of pregnancy when she experienced significant bleeding on Saturday afternoon, March 6, 1999. Hage-dorn went to the Spencer Municipal Hospital where she was treated by the physician on call, defendant Jeffry Peterson, a family practitioner. Dr. Peterson suspected the plaintiff had a placental abruption, a maternal hemorrhage that posed serious risks to the fetus and the mother if it progressed. The defendant decided to monitor Hagedorn’s condition while making arrangements for her transfеr to a tertiary care center offering specialized services for high-risk deliveries. Dr. Peterson was aware that if the abruption progressed to the point the baby was not receiving adequate oxygen, he would have roughly fifteen minutes to deliver the baby by cesarean section to avoid permanent injury to the child. Because Dr. Peterson did not perform cesarean sections, he began making phone calls to line up personnel who could deliver the baby and assist in the infant’s resuscitation if that became necessary.
After various diagnostic procedures and monitoring functions were performed, Dr. Peterson was reassured that the patient’s condition was stable, and he was hоpeful that she could be safely transported to a hospital in Sioux Falls, South Dakota. But while he was on the phone talking with a specialist at the Sioux Falls hospital, the baby’s heart rate dropped precipitously. Dr. Peterson called for an emergency cesarean section, and the surgical team was assembled. The baby was delivered thirty minutes later and was then transferred to Sioux Falls by a neonatal transport team that had been dispatched when the emergency arose. The child, Bryson Hagedorn, died the next evening.
This case was tried to a jury in April and May 2003. The trial, a classic battle of the experts, centered on the conflicting testimony of the plaintiffs’ experts and the defendant’s experts. The plaintiffs’ experts were critical of several aspects of Dr. Peterson’s care, but most significantly of his failure to assemble a surgical team to stand by at the hospital for an emergency cesarean section should the baby’s oxygenation become compromised. They believed that had a surgical team been ready, the baby could have been delivered within ten to fifteen minutes instead of over thirty minutes, and the baby’s chances of survival would have been good.
Dr. Peterson testified that at a community hospital, such as the one in Spencer, physicians do not call in a surgical team until surgery is actually needed. He said human resources are limited in rural Iowa, and in some eases a physician is on call fifty percent of the time. Consequently, on-call personnel are summoned only when it is certain that their services will be required. The defense experts echoed Dr. Peterson’s testimony and conclusions. They confirmed that in rural Iowa surgical teams are not assembled on a standby basis; when personnel are limited, having them on standby may disrupt the on-call providers’ attention to' other matters. As one physician simply summarized, “We don’t have that many personnel.”
The jury returned a verdict in favor of the defendant, specifically finding that the defendant was not negligent. The plaintiffs subsequently filed a motiоn for new trial on four grounds: (1) the verdict was contrary to the evidence under Iowa Rule of Civil Procedure 1.1004(6); (2) the verdict failed to effect substantial justice; (3) the court erroneously instructed the jury on the locality rule; and (4) the court erroneously included a “hindsight” standard in the instructions. The trial court denied the plaintiffs’ posttrial motion, and the plaintiffs then filed this appeal.
II. Was the Jury’s Verdict Sustained by Sufficiеnt Evidence and Did It Effect Substantial Justice?
Although the insufficiency of the evidence and a failure to effect substantial justice are independent grounds for challenging a jury verdict, we discuss them together because the plaintiffs’ argument in support of both claims is identical. Iowa Rule of Civil Procedure 1.1004(6) authorizes the trial court to grant a new trial when the verdict “is not sustained by sufficient evidencе” and the movanfe substantial rights have been materially affected. Because the sufficiency of the evidence presents a legal question, we review the trial court’s ruling on this ground for the correction of errors of law. See Estate of Long ex rel. Smith v. Broadlawns Med. Ctr.,
In addition to the grounds for granting a new trial set out in rule 1.1004(6), the trial court has inherent power to set aside a verdict when the court concludes “the verdict fails to administer substantial justice.” Lehigh Clay Prods., Ltd. v. Iowa Dep’t of Transp.,
The plaintiffs contend the jury’s verdict was not sustained by the evidence and did not render substantial justice because Dr. Peterson admittedly knew an emergency cesarеan section might be necessary, yet did not call in the required personnel to stand by for an immediate delivery even though he could have done so. Asserting “[n]o society is free to choose to ignore the life of a child,” they in essence argue the court should conclude the defendant’s choice was unreasonable as a matter of law. The trial court was unpersuaded by this аrgument, noting there was “a significant disagreement between the experts who testified in this case” on whether “Dr. Peterson’s failure to immediately assemble the surgical team” breached the applicable standard of care. The court concluded it was the jury’s duty to resolve this conflict, and so the court denied the plaintiffs’ motion for new trial.
We agree with the trial court that there is sufficient evidence to support the jury’s decision that Dr. Peterson was not negligent. Although the plaintiffs contend the defendant’s experts were not credible, the credibility of witnesses is peculiarly the responsibility of the fact finder to assess. See Top of Iowa Coop. v. Sime Farms, Inc.,
III. Locality Instruction.
The trial court gave the following instruction to the jury:
A physician must use the degree of skill, care, and learning ordinarily possessed and exercised by other physicians in similar circumstances. The locality of practice in question is one circumstance tо take into consideration but is not an absolute limit upon the skill required.
The plaintiffs object to the last sentence of this instruction for two reasons: (1) “[t]he ‘locality’ rule is not the law of Iowa”; and (2) “the evidence did not support inclusion of a locality factor.”
We review the court’s decision to give the challenged instruction for correction of .errors of law. See Anderson v. Webster City Cmty. Sch. Dist.,
The locality rule in its original form provided that “a physician is bound to use
Over time, courts began to abandon the rule as a strict limitation on the skill and care required of a physician. See Speed v. State,
Although the availability of medical knowledge has becomе more universal across the United States, the locality rule has retained validity in its other aspects. See, e.g., Gambill v. Stroud,
Even if an explanation of the locality-of-practice factor would have assisted the jury, we do not think the plaintiffs were prejudiced by the court’s failure to define this phrase under the facts of this case. The primary dispute in this case centered on whether Dr. Peterson should have called a surgical team to the hospital as soon as it became apparent that Dawn Hagedorn might have a placental abruption. The plaintiffs’ experts testified the surgical personnel should have been summoned sooner so they would be immediately available in case it became necessary to perform a cesarean section. The defendant and his experts claimed, however, that assembling a standby surgical team was not a reasonable option due to the limited medical personnel available in the community. Thus, as the plaintiffs acknowledge in their brief, the only way in which the locality of Dr. Peterson’s practice was relevant in this case was in a resource-based sense. Given the clear focus of the experts’ disagreement, we do not see how the jury could havе been misled by the court’s instruction. See Vergara,
As a final matter, the plaintiffs assert the evidence did not implicate the locality rule. See generally Peters v. Vander Kooi,
IV. Hindsight Instruction.
The trial court gave the following instruction over the plaintiffs’ objection:
A physician’s conduct must be viewed in light of the circumstances existing at the time of diagnosis and treatment and not retrospectively. If a physician exercised a reasonable degree of care and skill under the circumstances as they existed, though not as seen in perfect hindsight, then the physician is not negligent.
The plaintiffs claimed at trial that this instruction, particularly the reference to hindsight, was “not proper,” was “projec-tional,” and was “not a uniform instruction in Iowa.”
This court has held that similar objections made to a comparable instruction given in a legal malpractice case were not sufficient to preserve еrror. See Grefe & Sidney v. Watters,
Finding no reversible error in the submission of this case or the trial court’s rulings, we affirm.
AFFIRMED.
Notes
. The record shows a cesarean section required a nurse anesthetist, a scrub nurse, a circulating nurse, a labor and delivery nurse, a surgeon, a physician to assist the surgeon, and a pediatrician for the baby.
Concurrence Opinion
(special concurrence).
I agree with the majority that the locality rule is still a part of medical-malpractice jurisprudence in Iowa. In today’s society, a physician in rural Iоwa should possess the same skill, care, and ordinary learning as a physician from any metropolitan area in this country. Physicians have the benefit of continuing medical education and access to medical journals allowing physicians to stay up to date on the latest methods of diagnosis and treatment. The availability of facilities, equipment, and resources of a loсality are circumstances a jury can consider to determine whether a physician used the degree of skill, care, and learning ordinarily possessed and exercised by other physicians in similar circumstances.
I also think a court should not give an instruction that incorporates the locality rule, because the uniform jury instruction adequately covers the rule.
We have adopted the following guidelines in drafting instructions:
1. Instructions should not marshal the evidence or give undue prominence to any particular aspect of a case;
2. Courts, when instructing the jury, should not attempt to warn against every mistake or misapprehension a jury may make;
3. Jurors must be left to their intelligent apprehension and application of the rules put forth in the instructions.
. Uniform Jury instruction 1600.2 states, "[a] physician must use the degree of skill, care and learning ordinarily possessed and exercised by other physicians in similar circumstances.” See II Iowa Civ. Jury Instructions 1600.2 (1997).