Timothy J. SANDER and Rebecca Lee Holloway, Co-Executors of the Estate of Kimberlee J. Sander, Deceased, Plaintiffs and Appellants, v. The GEIB, ELSTON, FROST PROFESSIONAL ASSOCIATION d/b/a Clinical Laboratory of the Black Hills; J.A. Rud, M.D., Defendants and Appellants.
Nos. 17763, 17769, 17803, 17804, 17811, 17818
Supreme Court of South Dakota
Decided Sept. 15, 1993
Argued Jan. 12, 1993
506 N.W.2d 107
The real blunder in this case is that Martin drafted Meyers’ will while he stood to gain as executor of the will and as manager of a major portion of the Meyers estate assets for twenty years. Having placed himself in a position to receive these benefits, Martin still neglected to advise Meyers to seek independent counsel in regards to the will.
The management provision gave Martin sole discretion to invest these estate assets as he saw fit. Martin would have performed these duties while he was substantially indebted to the estate on the real estate contract. A possible scenario in this situation would be negotiating with himself on amending the contract for reduced annual payments, reduced interest, or whatever had not been agreed to by Meyers prior to his demise. A review of the contract and its proposed amendments almost leads one to the conclusion that the legal documents could have been appropriately captioned “adoption papers.”
In reviewing disciplinary proceedings, this court determines what is an appropriate discipline from “the whole evidence as submitted[.]” In re Discipline of Walker, 254 N.W.2d 452, 455 (S.D.1977). Further, attorneys should be disciplined when they have conducted their practice of law in a manner which fails to comply with the standards of the Code of Professional Responsibility. In re Discipline of Strange, 366 N.W.2d 495 (S.D.1985).
This court also attempts to maintain some semblance of consistency in meting out discipline so that the practicing bar is aware of what the consequences will be in the event an attorney violates the standards of the profession. In Matter of Discipline of Bleeker, 466 N.W.2d 858 (S.D.1991), the attorney was suspended from the practice of law for six months along with other terms and conditions for: Violating Disciplinary Rule 6-101 of the Code of Professional Responsibility (failing to act competently); Rule 1.1 of the South Dakota Rules of Professional Conduct (
After reviewing all of the evidence in this case, I cannot find the conduct of Martin more egregious or more exemplary than the conduct in Bleeker. Therefore, I conclude that the appropriate discipline in this case is a six-month suspension from the practice of law. This certainly would seem to be a sufficient time for reflection on his past practices and ample time to renew an acquaintance with the rules of professional ethics. As to the other conditions imposed by the majority, I concur.
HECK, Circuit Judge (dissenting).
I dissent. I would follow the findings, conclusions, and recommendation of the referee, Circuit Judge Grosshans.
Timothy J. SANDER and Rebecca Lee Holloway, Co-Executors of the Estate of Kimberlee J. Sander, Deceased, Plaintiffs and Appellants, v. The GEIB, ELSTON, FROST PROFESSIONAL ASSOCIATION d/b/a Clinical Laboratory of the Black Hills; J.A. Rud, M.D., Defendants and Appellants.
Nos. 17763, 17769, 17803, 17804, 17811, 17818.
Supreme Court of South Dakota.
Argued Jan. 12, 1993.
Decided Sept. 15, 1993.
William G. Porter and Lonnie Braun of Costello, Porter, Hill, Heisterkamp & Bushnell, Rapid City, SD, for defendants and appellants.
Mark Barnett, Atty. Gen., Sherri Sundem Wald, Asst. Atty. Gen., Pierre, SD, for amicus curiae State of S.D.
Gary D. Jensen of Lynn, Jackson, Shultz & Lebrun, Rapid City, SD, for amicus curiae South Dakota Trial Lawyers Ass‘n.
MILLER, Chief Justice.
This case arises out of a medical malpractice action initiated by Kimberlee Sander (Kim) against a clinical laboratory and certain of its employees. A jury found against the defendants and awarded damages of $3.7 million, which the parties had stipulated should be entered only against the laboratory, a professional association under South Dakota law. The trial court applied
FACTS
Kim was just three days past her thirty-fourth birthday when she died of cancer of the cervix on September 5, 1988. She had lived near Custer, South Dakota, with her husband and children ages 15, 12 and 8. During the thirteen years prior to Kim‘s death, her medical needs had been attended to primarily by Dr. Dennis Wicks, a Custer area general practitioner. Part of her care included routine gynecology examinations which included pap smears. Kim had pap smears taken in Dr. Wicks’ office in 1977, 1978, twice in 1980, and again in 1984, 1986 and 1987. All of these pap smears were submitted for evaluation to The Geib, Elston, Frost Professional Association, d/b/a Clinical Laboratory of the Black Hills (Clinical Lab).
Clinical Lab processes approximately 18,000 pap smear slides per year. Its usual procedure during the time relevant to this appeal was to have a clerk assign each smear a number upon its receipt. A stain was then
Clinical Lab‘s cytology reports3 classified the cells discovered and its pathologists made a recommendation to the patient‘s physician depending upon the classifications made. The recommendation ranged from a low of “no recommendation” for a Class I screen to (by agreement among Clinical Lab‘s pathologists) placing a telephone call to the patient‘s physician in order to quickly obtain additional information. In the event its highest classification was screened (a Class IV), Clinical Lab‘s pathologists would also recommend a biopsy. Class IV meant malignant cells were present. Occasionally, lower classifications would result in a telephone call to the patient‘s physician. Clinical Lab frequently received biopsies back on patients following all screenings other than Class I screenings.
Each analysis by Clinical Lab of Kim‘s pap smears, except its last one in 1987, resulted in a report of “Class I Negative.” This classification meant no abnormal/atypical cells were found in the examined pap smear. Clinical Lab‘s 1987 pap smear reported a “Class IIB,” which was suggestive of mild to moderate dysplasia. In other words, pre-malignant cellular changes were present.
In 1986, Clinical Lab included an additional notation on its “Class I Negative” cytology report to Dr. Wicks, Kim‘s physician, that there was “moderate inflammation” present. Ordinarily, this “Class I Negative” pap smear would not have been viewed by a pathologist unless by chance it happened to be randomly viewed for purposes of quality control. However, it was the personal practice of Dr. James Rud, Clinical Lab‘s assigned pathologist at the time, to review all slides where “inflammation” was noted by a cytotechnologist, regardless of whether abnormal cells were also marked for review. Dr. Rud looked at the slide only to determine the extent of “inflammation“; he did not look at the entire slide nor did he look for abnormal cells. Dr. Wicks was at that time treating Kim with antibiotics for an inflammation resulting from a puncture wound to her foot and felt those antibiotics would probably take care of the noted “inflammation” as well.
In September, 1987, Kim returned to Dr. Wicks with complaints of pelvic pain, erratic periods and tiredness. Dr. Wicks conducted a pelvic exam and was disturbed by the results. He could neither feel nor see Kim‘s cervix, could not feel her ovaries, and could not evaluate her uterus; the entire area was firm, irregular and nodular. He took a pap smear, which he sent to Clinical Lab, and immediately referred her to Dr. Ralph Heirigs, a Rapid City, South Dakota, gynecologist.
On September 17, 1987, Dr. Frost, rather than a cytotechnologist, screened and interpreted Kim‘s pap smear. In his report to Dr. Wicks, he recommended a biopsy as a result of what he determined was a “Class IIB” smear. At about the time Dr. Frost made his report, Dr. Heirigs examined Kim and took biopsies. These revealed squamous cell carcinoma. He then “staged” her cancer as “IIIB invasive,” which meant her cancer had spread to her pelvic bones or lower one-
Dr. Drummond asked Clinical Lab to review Kim‘s 1986 pap smear. Upon re-examination, a pathologist and cytotechnologist from Clinical Lab reported, contrary to the original “Class I Negative” report to Dr. Wicks, that the 1986 smear showed “Class III” cells were present. This classification means cancer is either present or has not invaded, or that cellular changes are present which indicate that malignancy is highly likely.
At Dr. Drummond‘s request, Dr. Rud also re-examined Kim‘s 1986 pap smear. His new determination was that the smear contained “Class IIB” cells. This indicated there were mild to moderate dysplastic cells present. This was different, both from his own initial determination of “Class I Negative” and from the recent determination of the other pathologist from Clinical Lab.
When Kim‘s cancer was finally diagnosed in the fall of 1987, she initially underwent radiation therapy. She was then referred to the University of Minnesota to determine whether she was a viable candidate for radical treatment procedures. However, the cancer had spread and the procedures were not undertaken; Kim had no chance of surviving her cancer.
Clinical Lab was asked by the pathologists at the University of Minnesota to let them examine Kim‘s prior pap smears. Smears prior to 1984 were not available as Clinical Lab destroys “Negative” slides after three years. However, the smears from 1984, 1986 and 1987 were available and were sent. The interpretations of those slides by the University‘s pathologists differed significantly from those of Clinical Lab‘s pathologists. Regarding the 1984 pap smear, the University‘s pathologists diagnosed cellular changes which, under Clinical Lab‘s classification system, would be classified “Class IIB,” not “Class I Negative” as Clinical Lab reported to Dr. Wicks. The University pathologists also upgraded the 1986 and 1987 pap smears and stated unequivocally that the 1987 pap smear contained malignant cells.
Kim started this lawsuit in July, 1988, ten months after she had been diagnosed with an advanced stage of cancer. Her claims alleged the failure of Clinical Lab and its pathologists to detect and report the presence of cellular changes in routine pap smears in sufficient time to prevent the spread of her cancer. Two months after filing this action, Kim died. After her death, the co-executors of her estate (her husband and sister) were substituted as plaintiffs (Sander). The complaint was amended to include a wrongful death claim in addition to a claim for Kim‘s pain, suffering and medical expenses.
Trial began October 15, 1991. At the close of the evidence, the trial court dismissed one of the defendants5 and the remaining parties stipulated that any judgment against any other individual defendant would be entered only against Clinical Lab. The case then went to the jury, which found against Clinical Lab. Sander was awarded damages of $3.7 million.
Prior to the entry of judgment, Clinical Lab‘s counsel wrote the trial judge requesting to be heard on the applicability of
The trial court held
Sander filed several notices of appeal and defendants filed several notices of review, all of which have been consolidated. To simplify our discussions, and in view of the parties’ stipulation that any judgment awarded by the jury would be entered only against Clinical Lab, references to Clinical Lab are deemed to refer to any, or all, of the other defendants as well. Sander brings several constitutional and non-constitutional attacks against
PART I
EVIDENTIARY ISSUES
“The rulings of the trial court are presumptively correct; we have no duty to seek reasons to reverse. The party alleging error must show prejudicial error affirmatively from the record.... [On appeal,] we must determine whether the trial court abused its discretion.” Shamburger v. Behrens, 380 N.W.2d 659, 661 (S.D.1986); State v. Holland, 346 N.W.2d 302, 307 (S.D.1984); Drier v. Perfection, Inc., 259 N.W.2d 496, 503 (S.D.1977); Shaffer v. Honeywell, 249 N.W.2d 251, 258 (S.D.1976). “To show such prejudicial error an appellant must establish affirmatively from the record that under the evidence the jury might and probably would have returned a different verdict if the alleged error had not occurred.” Alberts v. Mutual Serv. Cas. Ins. Co., 80 S.D. 303, 314, 123 N.W.2d 96, 103 (S.D.1963); K & E Land and Cattle Co. v. Mayer, 330 N.W.2d 529, 533 (S.D.1983). “The term ‘abuse of discretion’ refers to a discretion exercised to an end or purpose not justified by, and clearly against, reason and evidence.” Herndon v. Herndon, 305 N.W.2d 917, 918 (S.D.1981) (citations omitted).
A. THE 1984 PAP SMEAR SLIDE.
One of the issues raised in the complaint was that Clinical Lab was negligent in “inaccurately interpreting [Kim‘s] pap smear from 1984.” Substantial evidence regarding this smear was admitted at trial. Clinical Lab asserts that because this action was commenced July 7, 1988, more than two years after the “inaccurate” 1984 interpretation, it was error for the trial court to submit to the jury the negligence claims based upon the 1984 slide.
Sander argues several grounds to support admission of negligence claims based upon the 1984 slide. We address only the assertion that the statute of limitations is tolled because Kim‘s visits to Dr. Wicks to have her pap smears taken and submitted to Clinical Lab constituted a continuing treatment relationship with Clinical Lab.
Clinical Lab responds, citing a lower court of New York, that the statute of limitations cannot be tolled because Kim‘s routine visits to Dr. Wicks to have the pap smears taken and submitted to Clinical Lab for evaluation were “return visits merely to have her condition checked.” Massie v. Crawford, 78 N.Y.2d 516, 522, 577 N.Y.S.2d 223, 583 N.E.2d 935, 937 (1991) (citation omitted). We have been cited to numerous additional authorities which stand for this proposition. They offer limited guidance as our research discloses most of the cases, which come from New York, were decided in the face of a statute
Clinical Lab‘s authorities do, however, help clarify the question to be resolved: Whether the 1984 screening and report by Clinical Lab was also the last treatment by Clinical Lab with respect to matters arising out of the 1984 report, or whether the 1984 screening and report was part of a continuing treatment relationship with Clinical Lab.
The medical malpractice statute of limitations in this state requires an action to be brought against a physician within two years of the alleged malpractice.
We have previously recognized the continuing treatment doctrine in Wells v. Billars, 391 N.W.2d 668 (S.D.1986). The principles behind that doctrine were found to be applicable in legal malpractice cases in Schoenrock, 419 N.W.2d 197. We elaborated there that a continuing legal representation relationship must be based upon an “on-going, continuous, developing and dependent relationship.” Id. at 201. Our statement in regard to legal malpractice actions applies equally to the doctrine of continuing treatment in medical malpractice actions.
Clinical Lab asserts that “information regarding deficiencies in [its testing program] had nothing to do with [Kim‘s] level of trust.” We cannot take this assertion seriously. The service provided by Clinical Lab is “critically important to the patient [who] is completely dependent upon the professional to screen for [an insidious disease].” Morgan v. Taylor, 434 Mich. 180, 193, 451 N.W.2d 852, 858 (1990).7 Morgan did not find it significant that a patient may be “served” rather than “treated” by a health professional and neither do we. As noted by another court:
The nature of a pathologist‘s work is such that he rarely, if ever, has a direct physician-patient relationship with an individual—in other words, he never treats patients in a conventional sense—but his work is often the basis upon which the nature of subsequent treatments to be given by the attending physician is determined.... [W]here the pathologist should have reasonably expected that his work would be relied on by other practitioners in determining the mode of treatment we feel it appropriate to impute to that pathologist or diagnostician constructive participation in that treatment so long as it continued.
Fonda v. Paulsen, 46 A.D.2d 540, 545, 363 N.Y.S.2d 841, 846 (1975).
The record shows Kim had been going to Dr. Wicks for her gynecology examinations since at least 1977. Using instruments and equipment furnished by Clinical Lab, Dr.
Although not necessarily determinative of a course of treatment, we note Clinical Lab had an informal program to compare previous pap smears with a current abnormal smear and tried to correlate its pap smear observations with its biopsy observations. We find it particularly relevant that the relationship between Kim and Clinical Lab was not sporadic. Rather, it was routine. Further, during the time relevant to this action, Kim had no contact with another party for her gynecology exams, pap smears or screenings until 1987 when, for the first time, she was referred to a Rapid City gynecologist after she developed severe physical problems.
This situation is in marked contrast to Schoenrock where we found the relationship was “sporadic at best.” Schoenrock, 419 N.W.2d at 201. There, three years and seven months had passed with no contact between the parties. There was “a total absence of any claimed continuing representation within the period of limitations.” Id. (emphasis in original). Further, that plaintiff sought advice and counsel on the same matter from another individual. Under these facts, Kim and Clinical Lab did have an “on-going, continuous, developing and dependent relationship ... which [was] not sporadic, but developing and involve[d] a continuity of the professional services from which the alleged malpractice stem[med].” Id. The trial court did not err in concluding that the 1984 slide was admissible “on the basis that there was a continuing treatment or some variation of that rule.”
B. THE 1987 PAP SMEAR SLIDE.
The parties agree that even if Clinical Lab negligently misread the 1987 pap smear slide, Kim‘s ultimate course was not affected by any such negligence as she was already terminally ill. Clinical Lab, therefore, asserts the 1987 slide should not have been admitted as it is “entitled to be tried only for acts of alleged negligence that could actually be found to have harmed Sander.” When evidence relating to that pap smear was objected to at trial, the trial court allowed the evidence
for the purpose of allowing the jury to determine whether or not the person who read that slide had the appropriate skill level for a person who‘s usually performing that type of screening and also for the purpose of the jury determining whether or not there was a pattern of misreading Pap smears. In [contrast to other plaintiffs in cases cited to the court who] attempted to offer, evidence of other cases where physicians allegedly performed acts of malpractice with other patients, ... [t]his is the same patient process, and I think it‘s for the jury to decide whether or not this has a probative value, only on the issue of negligence.
Clinical Lab declined to accept the trial judge‘s offer to give an immediate limiting instruction regarding this evidence, preferring to wait until the final jury instructions were given.
After both sides had rested, and outside the presence of the jury, Clinical Lab moved to strike all evidence concerning that slide. In denying the motion, the trial judge found the prejudicial impact of the misreading was outweighed by its probative value. The jury was allowed to consider the evidence “not for the purpose of deciding that there was proximate cause of [Kim‘s harm from] the alleged reading, but only to determine whether or not there was a violation of the standard of care in 1984 and 1986.” This was embodied in jury instruction 14 which reads:
The alleged failure to properly classify the 1987 Pap smear cannot be the basis of any award of damages, but you may consider this evidence for the following purpose and no other: Whether the alleged failure to properly classify the 1987 Pap smear tends to show that Defendants lack the required
standard of professional learning, skill and care to properly read and classify either the 1984 or 1986 Pap smear or both.
This instruction was not objected to by Clinical Lab when proposed by the trial court. Clinical Lab asserts the trial court‘s ruling admitting the evidence was “unquestionably” erroneous and, on appeal, further objects because the court “essentially” told the jury “the only purpose of the admission of the 1987 slide ... was to allow the jury to find negligence upon the occasions under inquiry through proof that at another time the laboratory committed a similar act.” Clinical Lab argues that the trial court‘s “errors” are of such a magnitude as to warrant a new trial. We are not persuaded.
The party alleging a ruling of the trial court is erroneous “must prove not only error in the instructions, but prejudicial error to the effect that under the evidence, the jury might and probably would have returned a different verdict.” Darrow v. Schumacher, 495 N.W.2d 511, 518 (S.D.1993); Stormo v. Strong, 469 N.W.2d 816, 825 (S.D.1991) (internal quotations omitted). Further, the party alleging error “must show prejudicial error affirmatively from the record.” Shamburger, 380 N.W.2d at 661.
Clinical Lab notes that in making its ruling the trial court referred to Federal Rule of Evidence 404. Rule 404 addresses the use of character and other acts evidence. The South Dakota counterpart to this Rule is found at
Here, however, the situation is reversed. The trial court‘s jury instruction showed that the evidence of the most recent occasion, 1987, was being used to prove a defendant acted in conformity therewith on past (1984 & 1986) occasions. We agree with the trial court that it is significant that the “similar acts” Clinical Lab complains of were the misread 1984, 1986 and 1987 pap smears of the same patient—Kim—by, in each instance, Clinical Lab. The misreadings did not concern unrelated instances of other patients’ misreadings. That would be an entirely different question than we are herein presented. See, e.g., Kentucky-West Virginia Gas Co. v. Slone, 238 S.W.2d 476 (Ky.1951) (evidence of a well operator‘s actions on other occasions is not admissible); Rayburn v. Day, 126 Or. 135, 268 P. 1002 (1928) (evidence that on a prior occasion a doctor had left a sponge inside another patient‘s body after surgery was inadmissible to show negligence by the same doctor who had left a sponge inside another patient). Accord, Lefcourt v. Jenkinson, 258 A.D. 1080, 18 N.Y.S.2d 160 (1940).
We determine the trial court did not err in its post-trial ruling or its jury instruction. However, even if the trial court had erred, Clinical Lab, despite its assertions to the contrary, has not shown unfair prejudice as a result of the trial court‘s decisions. At most, the disputed evidence was harmless as it was merely cumulative to other testimony. State v. Younger, 453 N.W.2d 834, 839 (S.D.1990); State v. Fender, 358 N.W.2d 248, 254 (S.D.1984). The trial court found, and we agree, that there was “testimony saying that a defendant missed what was obvious on a slide. That‘s direct testimony and opinion
Clinical Lab‘s own expert agreed with Dr. Rud. Although he testified that Clinical Lab‘s “underclassifications” were reasonable if the slides were viewed prospectively, rather than with the assistance of hindsight by one who expects to find cancer in the slides, he nevertheless did find malignant cells in Kim‘s 1984 pap smear. Clinical Lab‘s expert also acknowledged that none of Kim‘s 1984, 1986 or 1987 pap smears were accurately reported by Clinical Lab. There is sufficient evidence from which the jury could conclude, even without the aid of evidence relating to the 1987 slide, that Clinical Lab was negligent in reading Kim‘s 1984 and 1986 slides.
We note Sander has urged several additional purposes for admitting the evidence relating to the 1987 pap smear slide. These include proof of Clinical Lab‘s failure to follow appropriate standards of care, proof of a pattern of conduct in misscreening and misreading Kim‘s pap smears, illustrating with the slide itself previous oral and handwritten descriptions of what invasive cancer actually looks like, proof on the claim that Clinical Lab‘s lack of skill and care allowed Kim‘s cervical cancer to go undetected and undiagnosed by Clinical Lab until after the 1987 pap smear was taken, proof on the claim that Clinical Lab was negligent in failing to adequately monitor, supervise, screen and employ safeguards and procedures to insure accuracy in detecting, interpreting and reporting abnormalities in Kim‘s pap smears, and as proof on the claim of negligence on the part of Clinical Lab‘s selection and review of competent medical staff.
The trial court did not articulate that it was allowing the admission of evidence relating to the 1987 slide based on this latter argument, although jury Instruction 16 stated: “It is also the duty of such a laboratory to use reasonable care in selecting a competent medical staff and periodically reviewing the competency of its medical staff.” This is clearly a proper purpose for the admission of evidence relating to the 1987 pap smear. In light of the record before us, we hold the trial court did not abuse its discretion in admitting this evidence.
C. THE ADMISSION OF CHARACTER EVIDENCE.
The trial court allowed a portion of the personnel records of Clinical Lab to be submitted to the jury. This evidence came in by way of deposition testimony of Karen Baer, a cytotechnologist who had been a co-worker of Norma Hellman, the cytotechnologist who had examined Kim‘s 1984 and 1986 pap smear slides. The evidence tended to show Hellman was “sloppy” in her work habits in that she hurried through the screening process. It also reflected that Baer had conveyed her concerns and observations about those work habits to a supervisor at Clinical Lab. Other evidence from that personnel file was withheld from the jury by the trial court.
Sander asserts this evidence was properly before the jury on its claim of negligence by Clinical Lab in failing to adequately monitor, supervise, screen and employ safeguards and procedures to insure accuracy in the interpretation of cytologies. Clinical Lab asserts the trial court erroneously admitted this evidence over its objections. “When reviewing evidence presented by deposition, we do not apply the clearly erroneous rule but review that testimony as though presented here for the first time.” Day v. John Morrell & Co., 490 N.W.2d 720, 723 (S.D.1992).
Clinical Lab relies on Rocky Mt. Helicopters v. Bell Helicopters Textron, 805 F.2d 907 (10th Cir.1986), as support for its position that the disputed evidence is inadmissible. In that case, the evidence sought to have been admitted would have shown the employer may have known that the employee in question was not properly trained and was “potentially unsafe.” Id. at 916. On appeal, it was found the proffered evidence was relevant and “arguably admissible” on that issue. Therefore, “the district court erred in exclud[ing] evidence that Rocky Mountain may have known that [its employee] was an unsafe pilot.” Id. at 916-17.
That court went on to note the trial court had other reasons for excluding the evidence regarding the employee‘s work habits and noted that under Federal Rule of Evidence 404, an individual‘s alleged substandard work habits generally are “not admissible for the purpose of proving that a person acted in conformity therewith on a particular occasion [as such] evidence is generally regarded as being of slight probative value and potentially very prejudicial.” Id. at 917. Thus, Federal Rule of Evidence 403 also came into play:
Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence.
We have adopted this Rule in its entirety at
The notes of the Advisory Committee on Federal Rules of Evidence for Rule 404 indicate that where character evidence is offered for a purpose other than showing actions consistent therewith, there is no “mechanical solution” for admitting or excluding the evidence. According to the Committee, the determination must be made “whether the danger of undue prejudice outweighs the probative value of the evidence,” a determination which lies squarely with the discretion of the trial court.
Id. at 917 (emphasis added). The Rocky Mt. court found the trial court did not abuse its discretion when it determined that under the circumstances of that case the evidence, which was otherwise “arguably admissible,” was unduly prejudicial.
Clinical Lab asserts the disputed evidence should have been excluded as it was used improperly in Sander‘s closing argument as direct evidence of Clinical Lab‘s negligence in screening the slides at issue. We have said that
[The defense‘s expert] has indicated in his testimony that [the pap smear] isn‘t a very good test, if you will recall that, but that it makes up for itself over time. In other words, that time takes care and justifies missing pap smears, misreading them. That may be—maybe that‘s true, generally, that time would take care of that, unless, because of that assumption the test is taken for granted. And if you start out with the assumption that time is going to cure your mistakes so that you then are less careful and somebody is going to pick it up the next time, or if not the next time, then the next time after that, what happens is you start getting careless. And that‘s what happened in this case. People started getting careless.
The court‘s instructed you that it is the duty of one who undertakes to perform the service of a pathologist or a cytotechnologist to have the knowledge or skill ordinarily possessed and to exercise the care and skill ordinarily used in like cases. Failure to do that is negligence. The key word is care. You have to be careful to not rush through screening to look at the entire slide when you are doing this. So that until you are able to rule out cancers, you better check them out. Its care we are talking about. (Emphasis added).
Clinical Lab asserts the emphasized language was so prejudicial as to require a new trial. A review of the extensive record before us reflects that, with the exception of the phrase “not rush through screening,” the emphasized language is as likely to be in reference to, and attributable to, the testimony of witnesses other than that obtained from the personnel records.
Regarding the phrase “not rush through screening,” and a subsequent reference a short time later by Sander to Baer‘s
We now turn to issues raised regarding the verdict and a subsequent tender by Clinical Lab to deposit the judgment amount with the court.9
D. THE JURY AWARD.
The jury returned a verdict against Clinical Lab and awarded lump-sum damages of $3.7 million. Clinical Lab then moved for a remittitur to not more than $438,000, which motion was denied. Clinical Lab asserts it is entitled to a new trial or, in the alternative, a new trial as to damages alone or an order or remittitur to a reasonable sum10 as the jury‘s verdict was the result of passion, partiality and prejudice.
“[T]he amount of damages to be awarded is a factual issue to be determined by the trier of fact, [and] we review the issue on appeal under the clearly erroneous standard.” Flagtwet v. Smith, 393 N.W.2d 452, 455 (S.D.1986) (Flagtwet II). We will not let stand a verdict if it “is so excessive as to strike mankind, at first blush, as being beyond all measure, unreasonable, and outrageous and such as manifestly shows the jury to have been actuated by passion, partiality, prejudice or corruption. The fact that a verdict is extremely liberal is not grounds for a new trial.” Small v. McKennan Hosp., 437 N.W.2d 194, 203-04 (S.D.1989); Weidner v. Lineback, 82 S.D. 8, 20, 140 N.W.2d 597, 603 (1966).
Kim initiated this action to recover damages for personal injuries. When she died, the complaint was amended by the co-executors of her estate to include a wrongful death cause of action. It is, therefore, appropriate to recall that “[i]n every action for wrongful death the jury may give such damages as they may think proportionate to the pecuniary injury resulting from such death to the persons respectively for whose benefit such action shall be brought.”
Kim was thirty-four years old at the time of her death. At trial, there was testimony that the monetary value of Kim‘s loss to the family was $388,000. Funeral, medical and other expenses of $51,000 were also proved. In closing argument to the jury, the
The jury was informed, in Instruction 23, of numerous other elements of damage which it could bear in mind in this combined personal injury and wrongful death action. These included
the instruction, moral training and superintendence of education [Kim] might reasonably have given her children had she lived; [the] counsel, guidance and aid [Kim] would reasonably have given [her husband] had she lived; [and] the loss of advice, assistance, companionship, society and protection [Kim] would presumably have given [her husband] and children had she lived.
Sander‘s counsel argued to the jury in closing that the monetary value of Kim‘s advice, companionship, moral training, education and aid as mother to her children, who were 15, 12 and 8 years old at the time of her death, amounted to $480,000 per child and the monetary value of those losses to her husband was $890,000. The total damages awarded by the jury were approximately $69,000 less than argued by counsel.
Clinical Lab did not argue damages in closing arguments to the jury. Even so, Clinical Lab asserts the jury‘s award cannot stand as “the jury‘s passion is so evident.” It argues that Bethel v. Janis, 597 F.Supp. 56 (D.S.D.1984), clearly demonstrates these damages were excessive. We have examined Bethel, keeping in mind that only applications of South Dakota law by this Court are binding on us.
We are struck that any similarity between the instant case and Bethel ends with the observation that both are wrongful death and personal injury actions. Though both parents there died, and injuries were sustained by two of their children, the deaths were quick, if not instantaneous, and the injuries sustained were comparatively minor and short-lived. Further, evidence submitted in that trial to the court on the majority of the damages alleged, was often “perfunctory at best” or nonexistent.
Clinical Lab also argues this case is “indistinguishable” from Zaninovich v. American Airlines, 26 A.D.2d 155, 271 N.Y.S.2d 866 (1966). Zaninovich was a wrongful death action brought on behalf of minor children whose parents had both died instantly in an airplane crash. Zaninovich did not include a cause of action for personal injuries, pain or suffering sustained by the deceased parents. That court found the damages awarded were excessive and explained: “The gross excessiveness of the principal awards is easily demonstrated [because it puts the surviving children] far above the standard of living to which they were accustomed[.]” Id. at 872. Further, that court concluded, as Clinical Lab argues we should conclude, that this change in the standard of living was alone sufficient to show the jury award was unreasonable. Id.
We are not persuaded by that lower New York court‘s focus on placing survivors in a standard of living equal to that to which they were accustomed prior to the death of the father, the only wage-earning parent. We have not been cited to, nor has our research uncovered, any instance where any court, including the courts of New York, have adopted this philosophy. We decline to adopt what the Zaninovich court itself called a “crude analysis.”
Significantly, we note the trial court specifically found the jury did not act out of an “excess of emotion” and that their reactions to the testimony “wasn‘t an unmeasured or inappropriate response[.]” Just as we defer to “[t]he trier of fact [as] the exclusive judge of the credibility of the witnesses,” unless clearly erroneous, Wolff v. Royal Ins. Co. of America, 472 N.W.2d 233, 236 (S.D.1991), so too do we defer to the determina-
Finally, we bear in mind that we have not found any prejudicial errors by the trial judge in the course of the trial which would lend support to a finding of excessive damages. E.g., Edwards v. Sears, Roebuck & Co., 512 F.2d 276, 283 (5th Cir.1975). A review of the record does not leave us with the opinion that, under all the facts of this case, this award was “beyond all measure, unreasonable, and outrageous and such as manifestly shows the jury to have been actuated by passion, partiality, prejudice or corruption.” Small, 437 N.W.2d at 203-04; Weidner, 82 S.D. at 20.
E. THE TENDERED $1,000,000 POST-JUDGMENT IN-COURT DEPOSIT.
The trial court reduced the jury‘s damages award of $3.7 million to $1 million, over Sander‘s objections, and entered judgment against Clinical Lab for that amount. See Part II, infra. Shortly thereafter, Sander refused Clinical Lab‘s offer to pay the judgment for satisfaction. Sander then filed this appeal and Clinical Lab moved, pursuant to
Clinical Lab asserts the trial court was “mistaken” in its view of the law. Sander, though agreeing with the trial court‘s rejection of the tendered deposit, argues that
We begin our determination by recalling that “construction of a statute is a question of law and thus, the decision below is fully reviewable without deference to the decision of the trial court.” Reid v. Huron Bd. of Educ., 449 N.W.2d 240, 242 (S.D.1989). “Moreover, when the question is which of two enactments the legislature intended to apply to a particular situation, ‘terms of a statute relating to a particular subject will prevail over general terms of another statute.‘” Nelson v. School Bd. of Hill City, 459 N.W.2d 451, 454 (S.D.1990) (quoting Meyerink v. Northwestern Pub. Serv. Co., 391 N.W.2d 180, 184 (S.D.1986)). The rules of procedure in the circuit courts, and the rules of appellate procedure relevant to this appeal, are rules promulgated by this Court and, although codified, are not legislative enactments. We are, therefore, uniquely situated to determine the intent and application of our own rules.
It is provided that the procedure to be followed by a party who seeks a stay of execution on a judgment “upon appeal shall be as provided in chapter 15-26A.”
An appeal from a judgment or order shall not stay enforcement of proceedings in the circuit court [other than for certain exceptions not here relevant] unless the appellant executes a supersedeas bond in the amount and form approved by the circuit court or otherwise complies with the provisions of this rule.
The other relevant section of our Rules of Appellate Procedure sets the terms of the supersedeas bond referred to above:
If the appeal is from a judgment directing the payment of money, the conditions of the bond required by § 15-26A-25 shall be the payment of the judgment or that part of the judgment which is affirmed together with interest thereon from the date of the judgment.
We conclude the procedure outlined in the statutes is complete in its outline concerning the handling of funds which are the subject of a judgment. This includes a legislative determination that the interest to be paid on judgments is that rate as set out in the statutes. Thus, statutory enactments appear to preclude an in-court deposit of judgment funds which are subject to fluctuating market rates of interest. However, it is necessary to examine the procedural rule found at
In an action in which any part of the relief sought is a judgment for a sum of money or the disposition of a sum of money or the disposition of any other thing capable of delivery, a party, upon notice to every other party, and by leave of court, may deposit with the court all or any part of such sum or thing. Money paid into court under § 15-6-67 shall be deposited and withdrawn as ordered by the court.
Nevertheless, we address Clinical Lab‘s assertion that
South Dakota has generally adopted the Federal Rules of Civil Procedure, including Rule 67, upon which
We are of the opinion that Clinical Lab‘s federal authorities do not support its argument that Federal Rule 67, standing alone, authorizes even a federal court to accept a post-judgment in-court deposit of funds which are subject to a judgment. Therefore, Clinical Lab‘s authorities do not support its argument that the South Dakota counterpart to Rule 67, standing alone, authorizes a South Dakota court to accept a post-judgment in-court deposit of funds which are subject to a judgment.
Moreover, Schmidt v. Iowa Beef Processors, 347 N.W.2d 897 (S.D.1984), which represents our limited opportunity to comment on the application of
In sum, we affirm the trial court in its conduct of the trial.11 We turn now to a discussion of the issues raised by the trial court‘s application of
PART II
LIMITATION ON DAMAGES AWARDED FOR MEDICAL MALPRACTICE: SDCL 21-3-11
The South Dakota Legislature has limited the medical malpractice damages which may be awarded a plaintiff in this state:
In any action for damages for personal injury or death alleging malpractice against any physician, chiropractor, dentist, hospital, registered nurse, certified registered nurse anesthetist, licensed practical nurse or other practitioner of the healing arts under the laws of this state, whether taken through the court system or by binding arbitration, the total damages which may be awarded may not exceed the sum of one million dollars.
Sander raises numerous issues regarding
A. WHETHER SDCL 21-3-11 BENEFITS CLINICAL LAB.
Medical corporations can only be formed by individuals who are licensed to practice medicine and when the corporations are established “for the study, diagnosis and treatment of human ailments and injuries, whether physical or mental.”
As originally enacted in 1976,
In Cunningham v. Yankton Clinic, P.A., 262 N.W.2d 508 (S.D.1978), we had occasion to examine a statutory listing of individuals and entities to determine whether a non-listed entity received the statutory benefits. In that case, the plaintiffs had brought a medical malpractice action against the Yankton Clinic. That medical corporation asserted a two-year statute of limitations defense. The language of the two-year statute of limitations enumerated individuals and entities who were benefitted by the two-year time period, but did not include medical corporations. We said there that we would not “enlarge a statute beyond its face where the statutory terms are clear and unambiguous in meaning and do not lead to an absurd or unreasonable conclusion.” Id. at 510. We refused to extend the unambiguous list to include medical corporations and held the action had been timely brought within the applicable three-year limitations period.
Following that 1978 decision, the legislature enacted
Although the plain list of individuals and entities which are benefitted by
We are aided in our conclusion, that a “practitioner” of the healing arts cannot be an entity, by our discussion in South Dakota Physician‘s Health Group v. State, 447 N.W.2d 511 (S.D.1989). We said there that a “practitioner of such an art is one who engages in, or offers to engage in, or holds himself or herself out as qualified to engage in such an art, and holds a legal and unrevoked license or certificate, issued by the State of South Dakota, under which he or she practices.” Id. at 514. Although our decision in that case was not necessarily dependent upon the recited definition, we now hold that Physician‘s Health Group defines a “practitioner” in the context of the healing arts.
Clinical Lab asserts it can be a “practitioner” because “person” is statutorily defined to include “natural persons, partnerships, associations, and corporations[.]”
We have, on occasion, found individuals to be “practitioner[s] of the healing arts” even though they were not licensed under the Medical Practice Act. However, unlike a corporation, those individuals were capable of becoming licensed under the Medical Practice Act. Fjerstad v. Knutson, 271 N.W.2d 8 (S.D.1978), (an unlicensed intern was engaged in the practice of medicine); Nelson v. Palmquist, 363 N.W.2d 570 (S.D.1985) (an unlicensed chiropractor was practicing a healing art). Our case law leads but to one conclusion: A “practitioner” is a natural person.
We also find statutory support for the conclusion that a practitioner must be a natural person from the language of
Terms used in this chapter [36-2], unless the context otherwise requires, mean:
...
(3) “Healing art,” “healing,” “art of healing,” “practicing healing,” “practicing of healing,” [-] any system, treatment, operation, diagnosis, prescription, or practice for the ascertainment, cure, relief, palliation, adjustment, or practice for the ascertainment, cure, relief, palliation, adjustment, or correction of any human disease, ailment, deformity, injury, unhealthy or abnormal physical or mental condition[.]
We conclude the language of statutory and case law plainly requires a “practitioner” to be a natural person. We therefore hold the term “other practitioner of the healing arts” does not include entities such as Clinical Lab, a medical corporation. Thus, the trial court erred in applying
Our determination, that
B. WHETHER SDCL 21-3-11 IS AN AFFIRMATIVE DEFENSE.
The day after the jury returned its verdict, Clinical Lab‘s counsel wrote the trial judge requesting to be heard on the applicability of
We again look to federal court decisions for assistance in interpreting this phrase. Brasel, 89 S.D. at 116; Wilson, 83 S.D. at 211. One purpose behind the federal counterpart to our affirmative defense statutes is to give the opposing party notice. Blonder-Tongue Lab. v. University of Ill. Found., 402 U.S. 313, 350, 91 S.Ct. 1434, 1453, 28 L.Ed.2d 788, 812 (1971). The notice purpose of pleading an affirmative defense has here been served as it is beyond dispute that Sander was made aware several months before trial, and again at trial, that Clinical Lab intended to seek the benefits of
Another purpose of pleading an affirmative defense is to give the plaintiff a chance to rebut the asserted defense. Id. However, here the question is not whether Sander has had a chance to rebut an application of
While the enumerated defenses in
For the foregoing reasons, the trial court did not err when it determined
C. WHETHER SDCL 21-3-11 APPLIES TO MULTIPLE CAUSES OF ACTION.
The parties raise the question of whether
The second cause of action which may arise from medical malpractice is a legislatively created wrongful death action.
The possible plaintiffs in these two causes of action are distinct as are the remedies, the recipients of any damages awarded and the distributions of damage awards from each damages action. Pexa v. Clark, 85 S.D. 37, 42, 176 N.W.2d 497, 500 (1970). The legislature used the disjunctive “or” when it enacted
In the normal course of events it is likely the trial court would order these multiple actions consolidated, where possible, because of the nature of the overlapping, or identical, proofs required in these actions. However, a consolidation of these actions and parties, whether voluntary or court ordered, does not alter the separate damages cap applicable to each action and each party.
We conclude that
D. CONSTITUTIONAL CHALLENGES TO SDCL 21-3-11 .
We have previously determined
We are not unmindful of the importance of the constitutional questions to the parties. Nor are we unmindful of their great interest and concern to the people and public policy of this State. It is foreseeable that we shall be faced with these same questions again in the future. The parties’ briefing to this Court on the many constitutional issues is excellent, as has been their presentation to this Court on all the issues. Under some circumstances, these considerations may form a sufficient reason to address the constitutional issues. See Physician‘s Health Group, 447 N.W.2d at 515; Rapid City Journal, 283 N.W.2d at 565. But we have a factual uncertainty: The jury awarded damages as a lump sum. Consequently, we do not know how the jury actually apportioned the damages, either between the common law cause of action and the statutorily created cause of action, or between the several plaintiffs themselves.15
We will not assume as fact that one of these plaintiffs has been adversely affected by
In sum, we conclude the trial court made no reversible errors in its conduct of the trial. The trial court‘s determination that
WUEST, HENDERSON and AMUNDSON, JJ., concur.
SABERS, J., concurs in result.
SABERS, Justice (concurring in result).
I write specially to assert a better basis for affirming this jury verdict.
Under
South Dakota has codified the law of negligence in
Every person is responsible for injury to the person, property, or rights of another caused by his willful acts or caused by his want of ordinary care or skill, subject in the latter cases to the defense of contributory negligence.
”
The task of determining damages belongs to the courts, not the legislature. See generally, id. (“[T]he task of determining proximate cause (and civil liability for wrongdoing) belongs to the courts, not the legislature.“). “The judicial power is the power to hear and determine those matters which affect the life, liberty, or property of the citizens of the State.” Cooley, Constitutional Limitations 184 n. 3 (citation omitted).
