## Facts

- Jonna M. Lawrence (referred to at trial as “Shannon”) went to St. Mark’s Hospital’s emergency room for an allergic reaction after taking Tylenol 3 following dental work.
- The emergency-room physician ordered epinephrine to be administered subcutaneously and ordered two other medications to be administered intravenously.
- Contrary to the physician’s order, a nurse administered all three medications intravenously, including epinephrine.
- Immediately after the IV epinephrine, Shannon experienced acute symptoms; a witness described severe pain and vomiting, and the nurse described palpitations, pallor, nausea, anxiety, and rapid onset of effects.
- The nurse recognized the route-of-administration mistake based on the speed and nature of the reaction, notified a physician, and Shannon was transferred to the ICU for monitoring.
- Hospital personnel prepared internal incident/risk-management documentation and spoke with Shannon and her family, acknowledging that an error occurred.
- While still hospitalized, Shannon contacted her family attorney.
- Shannon was discharged but later alleged that the IV epinephrine caused long-term medical problems; she returned for additional care, and providers documented disputed findings relevant to causation.
- Shannon sued MountainStar Healthcare, Northern Utah Healthcare Corporation, and St. Mark’s Hospital (collectively, the Hospital) for medical malpractice and related theories.
- The case was tried to a jury in Utah district court; the jury returned a verdict for the Hospital, and Shannon appealed several trial-court rulings.

## Issues

1. Whether the trial court erred by limiting or excluding portions of Shannon’s expert testimony (including causation opinions) based on the scope of pretrial disclosures and evidentiary rulings.
2. Whether the trial court erred by preventing Shannon from proceeding on an ostensible-agency theory to hold the Hospital vicariously liable for the actions of certain physicians.
3. Whether the trial court erred by refusing to give a spoliation/adverse-inference jury instruction based on alleged destruction, alteration, or nonproduction of evidence, including risk-management materials.
4. Whether the trial court erred by refusing Shannon’s requested “lost chance” jury instruction and instead instructing on ordinary proximate-cause standards.

## Decision

- The Utah Court of Appeals affirmed the judgment entered on the jury’s defense verdict.
- The court held that the trial court acted within its discretion in enforcing expert-disclosure limits and in restricting testimony to opinions properly disclosed and supported under the applicable rules.
- The court held that Shannon did not establish a basis to submit ostensible agency to the jury because the required elements—hospital “holding out” and patient justifiable reliance—were not adequately supported on the record presented.
- The court held that the trial court properly denied a spoliation/adverse-inference instruction because Shannon did not show intentional destruction or bad-faith conduct sufficient to justify the sanction.
- The court held that the trial court correctly refused a “lost chance” instruction because the proposed instruction did not accurately state Utah law and ordinary causation principles governed the claims.

## Legal Principles

- Trial courts have broad discretion over evidentiary rulings, including limiting expert testimony to opinions fairly disclosed before trial; reversal requires a showing of both error and prejudice.
- Ostensible agency requires proof that the hospital represented the physician as its agent and that the patient reasonably relied on that representation when accepting treatment; without evidence supporting those elements, the theory need not go to the jury.
- A spoliation or adverse-inference instruction generally requires evidence of intentional destruction or bad faith tied to foreseeable litigation, along with materiality; mere gaps or internal-document disputes are not enough.
- Jury instructions are reviewed as a whole; a court may refuse a requested instruction that misstates state law, duplicates other instructions, or risks confusing the causation standard.
- Utah courts apply ordinary proximate-cause standards in medical-malpractice cases unless a legally recognized alternative doctrine applies; a “lost chance” instruction is not warranted when it does not match Utah law.

## Conclusion

The Court of Appeals left intact the jury’s verdict for the Hospital arising from a nurse’s mistaken IV administration of epinephrine, concluding that the trial court properly controlled the scope of expert testimony, correctly declined to submit ostensible agency to the jury, and acted within its discretion in refusing spoliation and lost-chance instructions while instructing the jury on standard negligence and causation principles.


Lawrence v. MountainStar Healthcare, 320 P.3d 1037 (2014)