A man underwent open-heart, mitral valve replacement surgery. The surgical team included an echocardiologist. During the surgery, the surgeon was unable to see behind the mitral valve to determine whether he had placed an errant suture in sewing the replacement mitral valve. Because of this, the echocardiologist reviewed the echocardiogram that revealed how the patient’s heart was functioning and how the replacement valve was functioning. The echocardiologist and the surgeon disagreed as to whether the echocardiologist alerted the surgeon about a possible aortic insufficiency (A.I.) immediately after the mitral valve was replaced. None was documented in the medical record.
Following the surgery, the man’s cardiologist diagnosed him with severe A.I., caused by an errant suture stitched by the surgeon. Consequently, the man underwent a second open-heart surgery. While in recovery from that surgery, the man suffered cardiac arrest.
The man sued the echocardiologist for negligent conduct during his mitral valve replacement surgery. Prior to trial, the judge allowed the echocardiologist to amend his complaint to assert an affirmative defense of intervening and superseding cause, in which he alleged that the surgeon's negligence was the superseding cause of the man's injuries.
After both parties rested, the trial justice gave her closing instructions to the jury. The instructions included a warning not to consider insurance in their deliberations. She did not instruct the jury on intervening and superseding cause. The Providence County Superior Court entered a jury verdict in favor of the patient.
The Supreme Court of Rhode Island affirmed the judgment of the Superior Court. The court held that (1) the Rhode Island statute mandating prejudgment interest at a rate of 12 percent on pecuniary damages in medical malpractice actions is not unconstitutional, (2) the trial court did not err when it chose not to instruct the jury on intervening and superseding cause, (3) the trial court did not err when it allowed testimony regarding the man’s post-operative cardiac arrest, (4) the trial court did not err when it rejected the echocardiologist’s motion for remittitur or a new trial, and (5) the trial justice's insurance instruction was proper.
First, deciding an issue of first impression before it, the Supreme Court of Rhode Island held that the Rhode Island statute mandating prejudgment interest at a rate of 12 percent on pecuniary damages in medical malpractice actions is constitutional. Specifically, the court rejected the echocardiologist’s argument that the 12 percent prejudgment interest rate deprives litigants of both substantive and procedural due process. The court found that the right to a trial by jury in a civil case is not a fundamental right and therefore is not subject to strict scrutiny analysis. Instead, like other economic legislation, it is subject to a rational basis review. The court reasoned that prejudgment interest statutes are rationally related to the legitimate goals of encouraging prompt resolution of disputes, and ensuring prompt payment of compensation. Therefore, the Rhode Island statute mandating prejudgment interest at a rate of 12 percent on pecuniary damages in medical malpractice actions passes the rational basis test under the due process clause.
Second, the court held that the trial justice was correct in refusing to instruct on intervening and superseding cause. The court held that an instruction on intervening and superseding cause is not proper in every case where there is harm caused by two negligent tortfeasors. It is the duty of the trial justice to decide, as a matter of law, whether the alleged negligence of the second tortfeasor was independent of the first tortfeasor. Thus, a jury instruction on intervening and superseding cause should only be given where the trial justice makes such a finding. Only if the trial justice determines that the negligence of the second tortfeasor (in this case, the surgeon) was independent of that of the first (in this case, echocardiologist) must the jury be instructed to decide whether that independent negligence was foreseeable to the first tortfeasor. Based on the court’s review of the record, it found that the trial justice did not err in refusing to instruct on intervening and superseding cause.
Third, the court found no error with respect to the trial justice's allowance of testimony regarding the post-operative cardiac arrest. The plaintiff’s medical expert testified that there was a nexus between the cardiac arrest and the negligence of the echocardiologist in connection with the mitral valve surgery. The court concluded that there was enough evidence to suggest that a causal relationship existed between the cardiac arrest and the echocardiologist's negligence at the first surgery, such that the admission of testimony concerning the cardiac arrest was proper.
Fourth, the court found that the trial justice did not err in denying the echocardiologist's motions for remittitur or a new trial. A trial justice may disregard an award of damages and grant a new trial only if that award shocks the conscience or indicates that the jury was influenced by passion or prejudice or if the award demonstrates that the jury proceeded from a clearly erroneous basis in assessing the fair amount of compensation to which a party is entitled. The court reviewed the trial justice's decision to uphold the jury's damage award like their review of a trial justice's decision on a motion for a new trial—that is, unless the trial justice overlooked or misconceived material evidence or was otherwise clearly wrong, the appellate court will leave the decision undisturbed. The court found that in her decision denying these motions, the trial justice aptly performed her role in assessing the credibility of witnesses, weighing the evidence, and evaluating the propriety of the damage award. After first determining that the evidence was sufficient to establish the echocardiologist's negligence, she concluded that the damages award was satisfactory and that the verdict did not shock the conscience.
Fifth, the court found that the trial justice's insurance instruction was proper. In order to review the trial justice’s instructions, the court looked to the Rhode Island rule of evidence restricting disclosure of insurance information. Specifically, the rule states: “[e]vidence that a person was or was not insured against liability is not admissible upon the issue whether he acted negligently or otherwise wrongfully.” However, such evidence may be allowed “when offered for another purpose, such as proof of agency, ownership, or control, bias or prejudice of a witness, or when the court determines that in the interests of justice evidence of insurance or lack of insurance should be permitted.” The purpose of Rule 411 is to discourage inquiry into a defendant's indemnity in a manner calculated to influence the jury. It is applicable only where, in all the circumstances, it cannot be reasonably concluded that the jury could ignore or disregard such references to an insurer.
The court found that, although neither party introduced evidence regarding insurance, the trial justice, who had a front-row seat to the trial proceedings, was not oblivious to the fact that the overall concept of liability insurance may have pervaded the minds of the jurors in this case. The trial justice's instruction simply addressed the reality that jurors often wonder about liability coverage, especially in instances where there is typically an insured risk, such as medical malpractice. The trial justice's instruction did nothing more than prohibit the jury from speculating about insurance coverage in its deliberations on the merits of the case—a prohibition that directly squares with the spirit of Rule 411. While the trial justice might more appropriately have refrained from using the phrase “a physician's insurance premiums” in her instruction, the use of this phrase did not so pervade the minds of the jurors that they were rendered incapable of arriving at a fair and impartial verdict. The court reasoned that the instruction expressly told the jurors to completely ignore any assumptions or implications concerning insurance coverage and it is well settled that the members of the jury are presumed to follow the trial justice's instructions.
See: Oden v. Schwartz, 2013 WL 2109929 (R.I., May 16, 2013) (not designated for publication).