Estate of Reinen v. Northern Arizona Orthopedics, Ltd.

Citations: 9 P.3d 314; 198 Ariz. 283; 2000 Ariz. LEXIS 79Docket: CV-98-0411-PR

Court: Arizona Supreme Court; August 31, 2000; Arizona; State Supreme Court

SummaryOriginalCytator Case TreatmentAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

Jared Reinen, a 19-year-old Jehovah's Witness, suffered a broken femur from a rollerblading accident on June 23, 1993, and was treated at Flagstaff Medical Center (FMC) by Dr. Michael Abeshaus. After discussing treatment options, Reinen opted for surgery, which was performed by Dr. John Durham on June 24. Following the surgery, Reinen's care was managed by nursing staff and on-call physicians, including Dr. Roman Lewicky and Dr. Thomas Henry, due to Dr. Durham's unavailability. 

On June 28, Reinen's condition deteriorated, prompting Nurse Christa Fowler to contact Dr. Lewicky for orders, who directed her to inform Dr. Henry if test results were abnormal. The testimony varies on whether Dr. Henry was to conduct a formal consultation or assist in management. He provided verbal instructions based on the test results but did not examine Reinen personally.

Reinen's condition worsened over the following days, leading to his transfer to St. Joseph's Hospital in Phoenix, where he was hospitalized multiple times until his death in 1998. Before his passing, he filed a lawsuit against several healthcare providers and their associates, claiming Dr. Lewicky failed to call for a critical care consultation, Dr. Henry breached medical standards by not examining him, and Nurse Fowler neglected her duty by not securing a physician's evaluation or informing her supervisor of the situation.

At trial, Dr. William O'Riordan served as the expert witness for the plaintiff regarding post-operative care without any objections to his qualifications during his testimony. However, after the plaintiff's case concluded and Dr. O'Riordan returned to California, Dr. Henry moved for dismissal, asserting that the witness was incompetent to testify about the standard of care, a motion joined by defendants Lewicky and FMC.

Defense counsel sought directed verdicts based on insufficient causation evidence. Dr. Henry testified that he would not have changed his treatment approach even if consulted, leading the trial court to rule that no proximate cause could be established, resulting in the dismissal of Dr. Lewicky and a finding that FMC was not vicariously liable for the nurse's actions. The court also challenged Dr. O'Riordan's qualifications, dismissing the case against Dr. Henry due to a lack of admissible expert testimony on the standard of care and proximate causation, which the plaintiff needed to prove. Remaining defendants were found not liable by the jury. The court of appeals upheld the trial court's decisions, and a petition for review was subsequently filed. 

At the trial's conclusion, the court deemed Dr. O'Riordan incompetent to testify on the internal medicine standard of care, but noted that the defense failed to object to his testimony in a timely manner, waiving their right to challenge it. This failure to object before or during O'Riordan's testimony was seen as a strategic choice by the defense, undermining their position. O'Riordan's testimony suggested a breach of care by Dr. Henry and a causal link to Reinen's injuries, indicating that the dismissal of Dr. Henry was incorrect. He testified that if Dr. Henry had acted appropriately by a specific time, Reinen would have had a 70% chance of avoiding permanent injury, warranting a denial of Henry's dismissal.

The trial judge dismissed the motions of Dr. Lewicky and FMC, concluding that there was insufficient evidence linking their actions to Reinen's injuries, primarily relying on Dr. Henry's testimony that he would not have altered the treatment. However, per the precedent in Orme School v. Reeves, a directed verdict is only appropriate when there is no factual dispute requiring witness credibility assessment. The jury has discretion in weighing witness credibility and is not obligated to accept the uncontradicted testimony of an interested party. 

Dr. O'Riordan's testimony raised questions regarding Dr. Lewicky and Nurse Fowler's conduct, indicating that Dr. Lewicky should have sought a critical care consult on June 28 and personally communicated with Dr. Henry, which he failed to do. Additionally, Nurse Fowler did not take necessary actions to secure immediate medical assistance. Dr. O'Riordan asserted that had a qualified doctor been present that morning, Reinen had a 70% chance of avoiding permanent injury. The evidence presented was sufficient for the jury to consider the standard of care and proximate cause of injuries, indicating that the directed verdicts for Dr. Lewicky and FMC were inappropriate.

The appeal also raised concerns regarding the jury instructions on assumption of risk. Following a motion for reconsideration, the court deemed it necessary to reevaluate these instructions in light of the jury's verdicts favoring the other defendants.

Three jury instructions regarding assumption of risk were provided, with the latter two given over strong objections. Jury Instruction 20 allowed the defendants to argue that the plaintiff assumed the risk of injury by knowingly and voluntarily exposing himself to it, requiring the jury to determine if the defendant proved the plaintiff's fault and if that fault should reduce the plaintiff's damages. Jury Instruction 21 clarified that while the plaintiff did not assume the risk of the defendants’ negligence, he did voluntarily assume risks related to refusing blood transfusions. Jury Instruction 22 stated that if a physician's negligence led to life-threatening injuries and the patient refused a reasonable life-saving treatment, the patient could bear liability for injuries caused by that refusal. 

The trial judge drafted instructions 21 and 22 after reviewing similar cases, but the plaintiff contended that they violated Article XVIII, Section 5 of the Arizona Constitution, which mandates that issues of contributory negligence and assumption of risk are questions of fact exclusively for the jury. The court agreed, emphasizing that the jury has the discretion to find in favor of the plaintiff even if the court would typically rule that the plaintiff assumed the risk.

Defendants argued that the cases reviewed by the trial judge were persuasive; however, those jurisdictions lack provisions like Arizona's Article 18, Section 5. Although Instruction 20 allowed the jury to determine the plaintiff's assumption of risk, Instruction 21 improperly restricted the jury by stating which risks had been assumed, compromising their role. This constituted reversible error under Arizona law regarding contributory negligence and assumption of risk.

Plaintiff contends that the term "should" in Instruction 22 violates Article XVIII, Section 5, while the defense argues that its use has been approved by the court as non-mandatory for jury findings. The plaintiff asserts that when considered with the erroneous Instruction 21, it suggests the jury was not free to determine the plaintiff's responsibility regarding his refusal of blood, leading to confusion. The court of appeals noted that the case did not actually involve an assumption of risk issue during the liability phase, and thus the jury's instructions on this matter pertained only to damages if negligence was established. The defense claims any instructional error was harmless due to the defense verdict. However, it is argued that jury instructions violating Article XVIII, Section 5 necessitate reversal, referencing several precedential cases. The historical context of these cases predates Arizona's comparative fault law, which the defense fails to acknowledge. Accepting the defense's view would undermine the constitutional provision, rendering it ineffective in light of comparative fault legislation. The jury was purportedly free to address the assumption of risk issue, complicating the assessment of how their decision was influenced by the flawed instructions, akin to the pre-comparative fault era.

In Perkins v. Komarnyckyj, the court established that certain errors are "inherently prejudicial," necessitating reversal and retrial without further demonstration of harm. The trial judge's improper response to a jury question regarding liability and damages, given without attorney consultation, violated the prohibition against ex parte communications and misstated the law. While the appellate court initially affirmed the liability verdict, it remanded the damage issues due to the judge's error. Upon review, the higher court determined that the error was inherently prejudicial to the entire case, stating that jurors are free to reconsider their decisions throughout deliberations, making it impossible to ascertain whether their conclusions remained constant regarding liability.

The court noted that the circumstances in this case were comparable to Perkins, as it was unclear how the erroneous instructions on assumption of risk influenced the jury's deliberations. The plaintiff's right to have the jury determine the presence and application of assumption of risk was compromised. Although the plaintiff raised additional constitutional arguments regarding judicial comments and religious toleration, the court did not address these issues. Ultimately, the appellate court's decision was vacated, the trial court's orders reversed, and the case remanded for a new trial involving all defendants.

The instruction in Rimondi v. Briggs, which focused on contributory negligence, shares analytical principles with assumption of risk, as both are covered under the same constitutional provision, according to Chavez v. Pima County. The court clarified that even when assumption of risk is relevant, it does not equate to the general assumption of risk as defined in the Arizona Constitution, although no specific authority supports this view. The court's reasoning draws from Hildebrand v. Minyard, which separates express and implied assumptions of risk from contributory negligence, and Valley Nat. Bank v. National Ass'n. For Stock Car Auto Racing, which addresses the validity of written liability releases. Importantly, neither case discusses the Arizona Constitution. The jury instructions indicate that the case was evaluated based on an assumption of risk theory, which aligns with the arguments presented on appeal.