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Hirahara v. Tanaka6/9/1998
Opinion OF THE COURT BY NAKAYAMA, J.
Plaintiffs-appellants Gayle Hirahara, et al. [collectively Hiraharas], appeal from an adverse judgment after jury trial in their medical malpractice action. The sole issue raised by the Hiraharas is whether the trial court erred by instructing the jury that a treating physician is not necessarily negligent for "errors in judgment." The Hawai'i appellate courts have not previously addressed this issue. We perceive a clear modern trend disfavoring this language as confusing and misleading. Because cogent reasons support disallowing this language, we hold that the trial court erred when it gave such an instruction in the instant case. Therefore, we vacate the judgment in favor of defendant-appellee Kazushi Tanaka, M.D. and remand for further proceedings.
I. BACKGROUND
On August 8, 1994, Harvey Hirahara was referred to Kazushi Tanaka, M.D., for treatment of a rectal abscess. Dr. Tanaka determined that immediate surgery was necessary to drain the abscess. The proposed surgical procedure is normally routine and uncomplicated. Dr. Tanaka expected to complete the surgery within ten to fifteen minutes.
Dr. Tanaka was assisted in the surgery by John W. Pearson, M.D., an anesthesiologist. Harvey was positioned in a jackknife position, with his head and feet below his raised buttocks. Dr. Pearson injected Harvey with the anesthetic at 1:15 p.m. Dr. Pearson mistakenly prepared a hyperbaric anesthetic, with a specific gravity heavier than the spinal fluid. Because of Dr. Pearson's error, and the fact that Harvey's head was below the level of the injection site, the anesthetic flowed downwards to Harvey's brain.
Dr. Pearson was situated close to Harvey's head while Dr. Tanaka performed the surgery. A device known as a pulse oximeter, which measures the amount of oxygen in a patient's blood, was attached to Harvey. This device has an audible alarm that sounds if the oxygen level drops to 85% saturation. The pulse oximeter alarm first rang at approximately 1:26 p.m. Harvey was conscious at this point and, when Dr. Pearson addressed him, was able to take a breath which improved his blood oxygenation. It is unclear whether the surgery had started or not at this point. However, after Dr. Tanaka began the surgery, the pulse oximeter alarm sounded again. Harvey was unresponsive. Dr. Pearson began mask-ventilating Harvey in an attempt to improve his blood oxygenation. Dr. Tanaka asked Dr. Pearson if there was something wrong and if he should stop the operation. Dr. Pearson asked Dr. Tanaka how much longer the operation would take. Dr. Tanaka replied that it would only be a couple of minutes. It is unclear from the record if there was a further response from Dr. Pearson. Dr. Tanaka then completed the operation.
Immediately after Dr. Tanaka finished the operation, Harvey was turned over onto his back and found to be in cardiac arrest. Attempts to resuscitate Harvey were unsuccessful and Harvey remained in a coma until August 12, 1994, when life support was terminated due to a lack of brain activity.
The Hiraharas filed a complaint in the Circuit Court of the First Circuit on March 15, 1995. The complaint alleged that defendants Dr. Tanaka, Dr. Pearson, Island Anesthesia, Inc., and Castle Medical Center were liable for medical malpractice in their treatment of Harvey. All defendants except Dr. Tanaka were dismissed with prejudice by stipulation on July 11, 1996. Jury trial proceeded against Dr. Tanaka. The plaintiff's theory of liability at trial was that Dr. Tanaka negligently failed to perceive the seriousness of Harvey's condition and terminate surgery in time to get Harvey out of the ja
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