This is an appeal by a hospital and a physician from a large judgment against them in a medical malpractice case. Ap-pellee Crystal “Wheeler suffered various medical complications as the result of a Rathke’s cleft cyst behind her left eye, which went undetected for nearly ten years despite its appearance on a 1996 MRI report. “Wheeler brought a medical-malpractice suit against the appellants, Marilyn McPherson-Corder, M.D., and the President and Directors of Georgetown College (“Georgetown”), claiming that their negligence caused the cyst to go undiscovered. Following a lengthy trial in Superior Court, a jury awarded Wheeler more than $2.5 million in damages. Dr. McPherson-Corder and Georgetown now appeal, making four arguments: (1) the jury’s verdict was irreconcilably inconsistent, in that it found that the appellants’ negligent failure to detect the cyst was a proximate cause of Wheeler’s injuries, but also found that Wheeler’s own failure to follow up on the 1996 MRI report, while negligent, was not a proximate cause; (2) the trial court erred by admitting Wheeler’s proffered expert testimony, as her experts’ conclusion that her cyst caused certain gastrointestinal problems has not been generally accepted in the medical scientific community; (3) Wheeler’s counsel made improper and prejudicial statements during her closing argument; and (4) the jury’s verdict was against the weight of the evidence.
We reject the appellants’ first argument because they waived their objection to any alleged inconsistency by failing to raise the issue before the jury’s dismissal. We find their second argument lacking, as it misstates our standard for the admission of expert testimony. We likewise find their third argument unpersuasive, as we see no impropriety in Wheeler’s counsel’s remarks. We do, however, find merit in one aspect of appellant’s argument on the weight of the evidence, i.e., insofar as it relates to the jury’s award of greater future medical costs than the evidence established. Because the jury awarded $19,450
I.
Wheeler has long suffered from a litany of health problems, including serious gastrointestinal difficulties. At several times in her youth, she was hospitalized due to extreme nausea and vomiting. These problems persisted throughout her adolescence, and have lasted well into her adult life.
In 1996, Wheeler began attending college in southern Virginia. When she returned home to Washington, D.C., the following summer, she complained of severe headaches to her then-pediatrician, Dr. Marilyn MePherson-Corder. Accordingly, Dr. MePherson-Corder referred her to a Georgetown University Hospital pediatric neurologist, Dr. Yuval Shafrir.
Dr. Shafrir saw Wheeler twice that summer, once on July 8, and again on August 5. During the first visit, Wheeler was also experiencing leg аnd ear pain. Because of these other maladies, Dr. Shafrir was unable to fully diagnose her headaches. He prescribed medication for her ear pain, which he concluded was the result of an ear infection, and asked her to come back in a few weeks when her symptoms cleared. When she returned, Dr. Shafrir diagnosed her headaches as migraines. Accordingly, he instructed her on migraine management, prescribed medication, and asked her to keep a headache diary. He also noticed “a new complete blurring of [Wheeler’s] right optic disk,” which prompted him to give her a prescription and tell her to arrange an EKG and an MRI through her primary-care physician.
The parties dispute exactly what Dr. Shafrir told Wheeler about these tests. At trial, Wheeler testified that Dr. Shafrir told her that both procedures were merely “precautionary,” and that he would contact her if there were “any concerns with the MRI.” Dr. Shafrir, however, testified that while he does not have any independent memory of Wheeler’s visits, he “always” told patients to contact him within three days of having an MRI if they did not hear from him. He also testified that whenever he ordered an MRI he would instruct the patient to come back for a follow-up visit. He said that this system, which placed the onus on the patient to follow up on test results, had “never” failed him. He testified that it would be “impossible” for him to track down every result independently, in light of the system he used for having patiеnts get an MRI.
After Wheeler’s second visit, Dr. Shafrir wrote to Dr. MePherson-Corder, informing her that he asked Wheeler to undergo an MRI and EKG. Although he indicated that he had already received the EKG results, which came back “normal,” he did not mention any MRI results. He also wrote that he would “like to see [Wheeler] again in my office during her next college vacation.”
Wheeler obtained a referral for the MRI from Dr. McPherson-Corder’s office. She then had the MRI performed at Georgetown Hospital on August 16. This MRI revealed a 8-5 mm supersellar cyst behind her left eye — likely a Rathke’s pouch cyst. At the time, the cyst was not pressuring her pituitary gland, hypothalamus, or her optic chiasm. Neither Dr. MePherson-Corder nor Dr. Shafrir ever saw the results of this MRI during the time relevant to this proceeding.
Wheeler’s gastrointestinal issues troubled her throughout college. She continued to struggle with nausea, vomiting, and low appetite. After her graduation in 2000,
Wheeler’s physical decline correlated with her deteriorating mental health. In 2002, she reported increasing depression and stress, which she attributed to her physical mаladies. In 2003, her depression worsened, and she began to suffer from panic attacks. She was diagnosed with depressive disorder in 2004 and major depression in 2005. She was also diagnosed with a mood disorder.
Her medical problems came to a head when, in December 2005, she checked into George Washington University Hospital (“GWU”) complaining of vertigo and double vision. At that time, GWU doctors ordered an MRI. Like the 1996 MRI, this new test showed a cyst-like mass behind Wheeler’s left eye. The cyst had visibly grown, now measuring approximately 11 x 8.5 x 10 mm, and was causing “mass effects” on 'Wheeler’s optic chiasm. Also at this time, GWU doctors diagnosed "Wheeler with thyroid and adrenal deficiencies, as well as abnormally low levels of human growth hormone.
After her discharge from GWU Hospital, Wheeler saw Dr. Walter Jean, a neurosurgeon at Georgetown University Hospital. Dr. Jean asked Wheeler to undergo another MRI. While examining the results of this MRI in March 2006, Dr. Jean discovered the 1996 MRI. Comparing the two MRIs, he noted that Wheeler’s cyst had “progress[ed]” during the intervening decade, becoming “bigger.” Dr. Jean then performed surgery to remove the cyst, without complication.
Wheeler brought suit against Georgetown
The jury ultimately returned a verdict in Wheeler’s favor. It found that the doctors breached their respective standards of care and that their breaches proximately caused Wheeler’s injuries. It also found that Wheeler was “contributorily negligent” for not “following Dr. Shafrir’s instructions to follow up with him after obtaining the MRI.” However, it concluded that her negligence was not a proximate cause of her injuries. It awarded her $505,450.37 in past medical expenses, $800,000 in future medical expenses, and $1,200,000 in noneconomic damages, for a
Following trial, Georgetown and Dr. McPherson-Corder moved jointly for judgment notwithstanding the verdict, or in the alternative for a new trial. In support of this motion, they presented four arguments. First, they claimed that the jury could not rationally have concluded that the negligence of each of the physicians was a proximate cause of Wheeler’s injuries, but that her own negligent failure to follow up with Dr. Shafrir was not. Therеfore, they argued, the jury’s verdict was irreconcilably inconsistent. Second, they asserted that there was no general acceptance in the medical scientific community of a causal connection between Rathke’s cleft cysts and gastroparesis. Accordingly, Wheeler’s expert testimony on that point had been inadmissible under Dyas v. United States,
The trial court denied their motion on April 27, 2012. This appeal followed.
II.
On appeal, Georgetown and Dr. McPherson-Corder reiterate the arguments they presented in their post-trial motiоn. We address these arguments in turn, beginning with their claim that the verdict was irreconcilably inconsistent.
(a)
Georgetown and Dr. McPherson-Cord-er’s first argument on appeal is essentially the same one they made to the trial court: that the jury could not rationally have concluded that their negligent conduct was a proximate cause of Wheeler’s injuries, but that the contributory negligence it found Wheeler had committed was not a proximate cause. The trial court rejected this argument, finding that the verdict was not irreconcilable. We now affirm, but on alternate grounds. We do not reach the question of whether the verdict was irre
In general, a civil jury will return one of three types of verdicts. In many cases, this will be a standard general verdict. A general verdict is “ ‘[a] verdict by which the jury finds in favor of one party or the other, as opposed to resolving specific fact questions.’ ” Wilbur v. Corr. Servs. Corp.,
In addition, Superior Court Civil Rule 49
Second, subsection (b) authorizes the court to “submit to the jury, together with appropriate forms for a general verdict, written interrogatories upon [one] or more issues of fact the decision of which is necessary to a verdict.” Verdicts submitted under this section are “hybrid[s]” between standard general verdicts and special verdicts. Mason, supra,
The distinction between these verdict types is crucial in this case, because a party waives its objection to any alleged inconsistency in a general verdict, with or without interrogatories, if it fails to object before the jury’s discharge. See District of Columbia Hous. Auth., v. Pinkney,
In this case, the verdict form itself did not specify the type of verdict to be rendered. That form, labeled simply “Verdict,” first directed the jurors to determine whether Dr. Shafrir or Dr. McPherson-Corder breached the applicable standards of care in his or her care of and treatment of Wheeler. If the jurors answered either question with a “yes,” the form instructed them to determine whether the breach by either or both doctors was a proximate cause of injuries and damages to Wheeler. If the jurors answered “yes” again, the form instructed them to then determine whether Wheeler was “contributorily negligent in not following Dr. Shafrir’s instructions to follow up with him аfter obtaining the MRI.” Then, if the jurors found that she was, the form required them to determine whether Wheeler’s “negligence [was] a proximate cause of her injuries and damages.”
The verdict form used in this case did not call for a general verdict of the most basic type. In the past, however, we have at times referred to similar verdicts as general. See Nimetz v. Cappadona,
But it is likewise unclear that the form called for a Rule 49(b) general verdict with interrogatories. True, one portion of the form suggests such a verdict, because, as noted above, the jury answered at least one question regarding a discrete factual issue (i.e., whether Wheeler failed to follow Dr. Shafrir’s instructions), while still deciding the ultimate issue of liability. See Portage II, supra,
The issues before us, however, do not require us to choose between labeling this verdict a general verdict or a Rule 49(b) general verdict with interrogatories, because we can clearly determine that it was not a special verdict — the only type of verdict to which a party might be permitted to raise an inconsistency objection after the jury’s discharge. Special verdicts do not require the jury to determine ultimate liability, or indeed reach any legal conclusions whatsoever. Mason, supra, 307 F.3d at 1274 (“[A] Rule 49(a) special verdict is a verdict by which the jury finds the facts particularly, and then submits to the court the questions of law arising on them.” (internal quotation marks omitted)). Indeed, when a trial court uses a special-verdict form, it generally will not instruct the jury on the law at all, because the jury will not be called upon to apply the law. See Bills v. Aseltine,
But here, the jury did much more. Not only did the jury determine ultimate liability, it explicitly resolved several mixed legal and factual issues along the way, including negligence, proximate cause, and assumption of the risk. Cf. Jarvis v. Ford Motor Co.,
Accordingly, because the verdict was not special, it was either a standard general verdict or a Rule 49(b) general verdict with interrogatories. To preserve an objection to an alleged inconsistency in either of these types, a party must raise the argument before the jury is discharged. Here, aрpellants failed to do so. Accordingly, they waived their objection to any inconsistency in the verdict. See, e.g., Underwood, supra,
III.
The appellants next argue that the trial court erred by permitting Wheeler’s expert witnesses to testify that there was a causal link between her Rathke’s cleft cyst and her gastroparesis. They assert that Wheeler failed to demonstrate that such a causal relationship is generally accepted in the medical scientific community.
In general, “[t]he trial court has broad discretion to admit or exclude expert testimony.” Russell v. United States,
(1) the subject matter must be so distinctively related tо some science, profession, business or occupation as to be beyond the ken of the average layman; (2) the witness must have sufficient skill, knowledge, or experience in that field or calling as to make it appear that his opinion or inference will probably aid the trier in his search for truth; and (3) expert testimony is inadmissible if the state of the pertinent art or scientific knowledge does not permit a reasonable opinion to be asserted even by an expert.
Id. at 586 (quoting Dyas v. United States,
This argument misstates our admissibility standard. The third Dyas requirement focuses not on “ ‘the acceptance of a particular ... conclusion derived from [the] methodology,’ ” but rather on “the acceptance of the methodology itself.” Minor v. United States,
Here, the appellants challenge Wheeler’s experts’ “eonclusion[s],” not their methodology. This challenge fails, because it “foeuse[s] on the wrong question.” Minor, supra,
IV.
Next, the appellants argue that the trial court should have ordered a new trial based on certain comments Wheeler’s counsel made during closing arguments. Specifically, they point to counsel’s statements regarding the applicable standard of care, which they characterize as an improper send-a-message argument:
You know, the jury system in our country exists to protect the community. And in this medicаl malpractice case, you will decide what standards doctors must meet in the community when they provide care and treatment to patients. You will decide what standards doctors must meet to protect patient health and safety.... Remember, the standards ... in the medical community exist for a reason. They have been developed by doctors for doctors. They exist to promote patient safety. They exist to protect patient health. They’re to provide a medical care system that above all prevents harm that’s avoidable. And what these standards are in this community is what you will be deciding when you go back to the jury room.
This court will reverse on the basis of improper comments by counsel only when it is likely that the comments left “ ‘the jurors with wrong or erroneous impressions, which were likely to mislead, improperly influence, or prejudice them to the disadvantage of the [defendant].’ ” Psychiatric Inst. of Wash. v. Allen,
Here, the trial court concluded that counsel’s statements “related to the determination the jury was being asked to make regarding the standard of care,” and found “no impropriety in the closing argument.”
y.
Finally, the appellants argue that the verdict was against the weight of the evidence. Although their argument is multi-faceted,
In general, we do not require plaintiffs to prove their damages “ ‘precisely1 ” or “ ‘with mathematical certainty.’ ” District of Columbia v. Howell,
Here, Wheeler’s damages expert, economist Dr. Richard Lurito, testified that a lump-sum payment of $780,550 would fully compensate Wheeler for her future medical costs. He reached this figure by looking at historical trends, projected treatment costs, and estimated inflation in the general economy. He testified that he used a 3.75% after-tax discount rate, which he described as “reasonable and conservative.” He adopted this rate based on current market conditions, accounting for current returns on short-and long-term government bonds, and adjusting for relatively low present interest rates. Then, during closing arguments, Wheeler’s counsel urged the jury to award Wheeler $780,550 — the full amount Dr. Lurito recommended. But the jury was ultimately more generous, rounding Dr. Lurito’s figure up and awarding Wheeler $800,000 for future medical expenses — a sum $19,450 in excess of the amount Dr. Lurito indicated was necessary.
Wheeler points us to no record evidence upon which the jury could have reasonably awarded this additional $19,450, nor can we discern any. Wheeler argues that the jury could have inferred that a larger sum would be necessary based on Dr. Lurito’s
The jury is not permitted to award damages based on such speculation. See Rom-er, supra,
So ordered.
Notes
. Wheeler’s claim against Georgetown was based on its respondeat superior liability for Dr. Shafrir’s alleged negligence.
. The verdict form’s first three questions, and the jury’s answers to them, read:
VERDICT FORM
1(a). Did Yuval Shafrir, M.D., as agent and employee of Georgetown University Hospital, breach the standard of care in his care and treatment of Crystal Wheeler? Yes x; No_
1(b). Did Marilyn McPherson-Corder, M.D. breach the standard of care in her care and treatment of Crystal Wheeler? Yes x; No_
If you answered "NO” to BOTH Questions # 1(a) and # 1(b), STOP ANSWERING QUESTIONS HERE. THE FOREPERSON SHOULD SIGN AND DATE THIS FORM, AND NOTIFY THE JUDGE.
If you answered “YES” to Question # 1(a), please answer Question # 2(a).
If you answered “YES” to Question # 1(b), please answer Question # 2(b).
2(a). Was the breach of the standard of care by Yuval Shafrir, M.D., as agent and employee of defendant Georgetown University Hоspital, a proximate cause of injuries and damages to Crystal Wheeler? Yes x; No_
2(b). Was the breach of the standard of care by Marilyn McPherson-Corder, M.D. a proximate cause of injuries and damages to Crystal Wheeler? Yes x; No_
If you answered "NO” to Questions # 2(a) and # 2(b), STOP ANSWERING QUESTIONS HERE. THE FOREPERSON SHOULD SIGN AND DATE THIS FORM, AND NOTIFY THE JUDGE.
If you answered "YES” to Question #2(a) or # 2(b), please proceed to Question # 3. 3(a). Was Crystal Wheeler contributorily negligent in not following Dr. Shafrir's instructions to follow up with him after obtaining the MRI? Yes x; No_ % sfc
3(b). Was Crystal Wheeler’s negligence a proximate cause of her injuries and damages? Yes_; Nox
. In full, the rule states:
(a) Special Verdicts. The Court may require a jury to return only a special verdict in the form of a special written finding upon each issue of fact. In that event the Court may submit to the jury written questions susceptible of categoricаl or other brief answer or may submit written forms of the several special findings which might properly be made under the pleadings and evidence; or it may use such other method of submitting the issues and requiring the written findings thereon as it deems most appropriate. The Court shall give to the jury such explanation and instruction concerning the matter thus submitted as may be necessary to enable the jury to make its findings upon each issue. If in so doing the Court omits any issue of fact raised by the pleadings or by the evidence, each party waives the right to a trial by jury of the issue so omitted unless before the jury retires the party demands its submission to the jury. As to an issue omitted without such demand the Court may make a finding; or, if it fails to do so, it shall be deemed to have made a finding in acсord with the judgment on the special verdict.
(b) General Verdict Accompanied by Answer to Interrogatories. The Court may submit to the juty, together with appropriate forms for a general verdict, written interrogatories upon 1 or more issues of fact the decision of which is necessary to a verdict. The Court shall give such explanation or instruction as may be necessary to enable the jury both to make answers to the interrogatories and to render a general verdict, and the court shall direct the jury both to make written answers and to render a general verdict. When the general verdict and the answers are harmonious, the appropriate judgment upon the verdict and answers shall be entered pursuant to Rule 58. When thе answers are consistent with each other but 1 or more is inconsistent with the general verdict, judgment may be entered pursuant to Rule 58 in accordance with the answers, notwithstanding the general verdict, or the Court may return the jury for further consideration of its answers and verdict or may order a new trial. When the answers are inconsistent with each other and 1 or more is likewise inconsistent with the general verdict, judgment shall not be entered, but the Court shall return the jury for further consideration of its answers and verdict or shall order a new trial.
Super. Ct. Civ, R. 49.
. Federal courts widely follow the same practice under Federal Rule 49. See, e.g., Heil Co. v. Evanston Ins. Co.,
. In Mason, the Eleventh Circuit noted an apparent "conflict” among the federal courts as to whether a party also waives its objection to inconsistent special verdicts by not raising the objection before the jury is discharged. Supra,
. The appellants do not argue that the verdict form was facially inconsistent because it allowed the jury to reach different conclusions as to Wheeler's "contributory negligence,” a concept which ordinarily encompasses negligence and proximate cause. Indeed, it is not clear they could do so, given that appellants’ counsel took primary responsibility for drafting the verdict form. See Preacher v. United States,
Appellants could have avoided any potential confusion on this point by simply phrasing the verdict form to ask only whether Wheeler had been negligent by failing to follow Dr. Shafrir's instructions (as opposed to contribu-torily negligent), and whether her negligence was a proximate cause of her injuries. Such phrasing would have tracked the language of the applicable Standardized Instructions. See Standardized Civil Jury Instructions for the District of Columbia, No. 5-15 (2013 rev. ed.) ("The defendant alleges that the plaintiff was negligent. The defendant is not liable for the plaintiff’s injuries if the plaintiff’s own negligence is a proximate cause of [his] [her] injuries.").
. Specifically, Dr. Stuart Finkel testified that, based on his knowledge, education, experience, and familiarity with the medical literature on gastroparesis, roughly 20 percent of cases like Wheeler’s are cause by endocrine disorders, such as hypothyroidism. Dr. Michael Cooperman testified that he based his own conclusions on two case studies, which he considered similar to Wheeler’s case.
. Even if it were appropriate for the appellants to challenge the genеral acceptance of Wheeler’s experts' conclusions, the appellants would have difficulty doing so, given that their own experts admitted that hypothyroidism is a known cause of gastroparesis.
. The appellants also make a broader weight-of-the-evidence argument, contending that the jury could not rationally have credited Wheeler's experts over their own. We do not think it necessary to restate the particulars of that argument here. We note only that it would not be proper for this court to usurp the jury’s factfinding role by reweighing the evidence in a manner more to the appellants’ liking. "When the case turns on disputed factual issues and credibility determinations, the case is for the jury to decide.” Durphy v. Kaiser Found. Health Plan of Mid-Atlantic States, Inc.,
