Sandretto v. Payson Healthcare Management, Inc.

IN THE

ARIZONA COURT OF APPEALS

DIVISION TWO

LORI SANDRETTO, A SINGLE WOMAN,

Plaintiff/Appellee,

v.

PAYSON HEALTHCARE MANAGEMENT, INC. an Arizona corporation,

dba PAYSON REGIONAL BONE & JOINT,

Defendant/Appellant.

No. 2 CA-CV 2013-0044

Filed March 11, 2014

Appeal from the Superior Court in Gila County

No. CV2010-00115

The Honorable Gary V. Scales, Judge

AFFIRMED

COUNSEL

Lloyd & Robinson, PLLC, Payson

By Arthur E. Lloyd and Doris Robinson Wait

and

McGovern Law Offices, Phoenix

By Thomas P. McGovern

SANDRETTO v. PAYSON HEALTHCARE MANAGEMENT, INC.

Opinion of the Court

and

Law Office of Scott E. Boehm, P.C., Phoenix

By Scott E. Boehm

Counsel for Plaintiff/Appellee

Law Offices of Don Stevens, P.C., Phoenix

By Don Stevens

Counsel for Defendant/Appellant

OPINION

Judge Miller authored the opinion of the Court, in which Presiding

Judge Vásquez and Chief Judge Howard concurred.

M I L L E R, Judge:

¶1 Payson Healthcare Management (PHM) appeals from

the trial court’s denial of its motion for new trial after a medical

malpractice case ended in judgment for the appellee, Lori Sandretto.

PHM contends the court erred in denying the motion, which

included claims the court made erroneous evidentiary rulings,

improperly denied a continuance request, and improperly approved

a co-defendant’s settlement agreement. PHM also argues the court

erred in finding the jury verdict was supported by substantial

evidence. Finding no error, we affirm.

Factual and Procedural Background

¶2 We view the evidence in the light most favorable to

upholding the jury’s verdict. Hutcherson v. City of Phoenix, 192 Ariz.

51, ¶ 13, 961 P.2d 449, 451 (1998). In April 2008, Sandretto slipped

on a wet floor and injured her right knee, which eventually required

outpatient surgery by a non-party physician to repair a torn

meniscus. Sandretto’s pain continued, which prompted her to see

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Dr. Charles Calkins, an orthopedic surgeon with thirty-five years of

experience. Calkins was employed by PHM. He found that the

meniscus was still torn and performed a second surgery on

September 5, 2008. Calkins removed fluid from the knee during

surgery for testing, which was subsequently negative for infection.

¶3 Sandretto’s condition initially improved, but within a

week her knee became swollen, red, and painful. She was examined

by James Morphis, a physician’s assistant (PA) for Calkins. Morphis

prescribed antibiotics for a skin infection. On September 14, 2008,

Sandretto went to the emergency room. Calkins came to the

hospital, diagnosed her with a common skin infection and

prescribed a different antibiotic. Five days later, Sandretto called

Calkins’s office to say her knee still hurt and was now draining

fluid. Morphis told a staff member to tell Sandretto to keep taking

antibiotics.

¶4 Sandretto saw Morphis again on September 24, 2008,

and still believed she had a skin infection. On October 10, 2008,

Morphis aspirated Sandretto’s knee and had the fluid tested. Three

days later, the results came back positive for methicillin-resistant

Staphylococcus aureus (MRSA).1 Calkins did not recall being told

about the results, but records showed he wrote a prescription for

intravenous antibiotics. Sandretto eventually saw Calkins on

October 22, 2008, and he performed a surgery on October 24, 2008, to

wash out the MRSA. Sandretto required two more “washout”

surgeries, and eventually needed a knee replacement. Her knee

pain continued despite the knee replacement, and her treating

physician diagnosed her with Complex Regional Pain Syndrome

(CRPS), a chronic pain condition caused by a nerve injury.

¶5 In 2010, Sandretto sued Calkins and PHM for medical

malpractice, alleging Calkins did not act quickly enough to diagnose

and treat the MRSA infection, thus necessitating aggressive medical

1MRSA is an infection that destroys tissue and, when found in

a joint, requires high doses of antibiotics as well as surgery to wash

it out.

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Opinion of the Court

treatments that resulted in permanent impairment. Calkins and

Sandretto settled days before trial. After an eleven-day trial, the jury

returned a verdict in favor of Sandretto for $7,275,160. Having filed

an offer of judgment before trial, Sandretto sought and was granted

sanctions pursuant to Rule 68, Ariz. R. Civ. P.

¶6 The trial court entered judgment on October 3, 2012,

and PHM subsequently moved for a new trial. After a hearing, the

court denied the motion. This timely appeal followed.

Discussion

Scope and standard of review on appeal

¶7 We first note that PHM’s notice of appeal only seeks

review “from the Order of the Gila County Superior Court, made

and entered on the 19th day of February, 2013, denying the Motion

for New Trial filed by [PHM].” Further, PHM properly invokes this

court’s jurisdiction pursuant to A.R.S. § 12-2101(A)(5)(a). The notice

does not appeal from the final judgment as permitted by A.R.S.

§ 12-2101(A)(1). In its briefs, however, PHM raises arguments not

made in its motion for a new trial. Because PHM did not appeal

separately the underlying judgment, we must limit our review to

issues raised in the Rule 59, Ariz. R. Civ. P., motion.2 See Wendling v.

Sw. Sav. and Loan Ass’n, 143 Ariz. 599, 601, 694 P.2d 1213, 1215 (App.

1984); Matcha v. Winn, 131 Ariz. 115, 116, 638 P.2d 1361, 1362 (App.

1981) (“[I]n reviewing the denial of a motion for new trial, this court

may not go beyond the matters assigned as error in the motion.”).

¶8 Generally, we review a trial court’s decision to deny a

motion for a new trial for an abuse of discretion, and the burden is

on the party seeking to overturn the trial court’s judgment to show

such an abuse. See Pullen v. Pullen, 223 Ariz. 293, ¶ 10, 222 P.3d 909,

912 (App. 2009). Similarly, we review rulings on admissibility of

testimony, motions to continue, and petitions to approve settlement

for an abuse of discretion, as discussed further below. See Pipher v.

2The issues excluded on appeal include the sanctions imposed

pursuant to Rule 68, Ariz. R. Civ. P.

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Loo, 221 Ariz. 399, ¶ 6, 212 P.3d 91, 93 (App. 2009) (testimony);

Alberta Sec. Comm’n v. Ryckman, 200 Ariz. 540, ¶ 11, 30 P.3d 121, 124

(App. 2001) (motions to continue); Barmat v. John & Jane Doe Partners

A-D, 165 Ariz. 205, 210, 797 P.2d 1223, 1228 (App. 1990) (settlement

agreements). A trial court abuses its discretion if it commits an error

of law reaching a discretionary conclusion; therefore, we review de

novo questions of law that were included in the motion for new

trial. See Twin City Fire Ins. Co. v. Burke, 204 Ariz. 251, ¶ 10, 63 P.3d

282, 284 (2003).

Admissibility of expert medical testimony

¶9 PHM argues the testimony of Dr. Michael Ferrante, one

of Sandretto’s expert witnesses, should have been precluded

pursuant to Rule 702, Ariz. R. Evid. Ferrante opined that Sandretto

suffered from CRPS caused by one or more of the surgical

procedures required to clean out the MRSA infection and to replace

Sandretto’s knee. His opinion complemented the testimony of

Sandretto’s MRSA expert, Dr. Talan, who testified to the deleterious

effects of MRSA and its treatment, unnecessary damage caused by

the late diagnosis, and his opinion about the date of infection. Taken

together, the testimony of Ferrante and Talan permitted the jury to

construct a cause-and-effect timeline regarding MRSA, multiple

surgeries, and CRPS.

¶10 PHM contends Ferrante’s diagnosis of CRPS and his

causation opinion lacked “reliable or scientific[]” grounds. 3 This

argument requires us to examine the gate-keeping function of

Rule 702 as it pertains to the opinions of an examining physician.

3PHM also appears to argue the trial court made a procedural

error when it did not make a record of its inquiry or specific findings

of fact to support its ruling under Rule 702, Ariz. R. Evid. PHM did

not contend in its motion for a new trial that the court erred

procedurally, noting only that “the Court recognized that it was

required to be the gatekeeper,” pursuant to Rule 702. We will not

address this new argument on appeal from the denial of the motion

for a new trial. See Matcha, 131 Ariz. at 116, 638 P.2d at 1362.

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Opinion of the Court

¶11 We review the trial court’s decision to admit or exclude

expert testimony for an abuse of discretion. See Pipher, 221 Ariz. 399,

¶ 6, 212 P.3d at 93. The admissibility of expert testimony is

governed by Rule 702, which was amended effective January 1, 2012

to adopt the language of Rule 702, Fed. R. Evid., and to reflect the

principles set forth in Daubert v. Merrill Dow Pharmaceuticals, Inc., 509

U.S. 579 (1993). See State v. Salazar-Mercado, 232 Ariz. 256, ¶ 5, 304

P.3d 543, 546 (App. 2013); see also Ariz. R. Evid. 702 cmt. We

construe the amended Arizona rule in accordance with its federal

counterpart. Ariz. State Hospital/Ariz. Cmty. Protection & Treatment

Ctr. v. Klein, 231 Ariz. 467, ¶ 26, 296 P.3d 1003, 1009 (App. 2013); see

also Ariz. R. Evid. Prefatory Cmt. to 2012 Amendments (“Where the

language of an Arizona rule parallels that of a federal rule, federal

court decisions interpreting the federal rule are persuasive but not

binding . . . .”).

¶12 Rule 702 as amended sets out four requirements that

must be met before an expert witness may testify in the form of an

opinion or otherwise, and states in its entirety:

A witness who is qualified as an expert by

knowledge, skill, experience, training, or

education may testify in the form of an

opinion or otherwise if:

(a) the expert’s scientific, technical, or other

specialized knowledge will help the trier of

fact to understand the evidence or to

determine a fact in issue;

(b) the testimony is based on sufficient facts

or data;

(c) the testimony is the product of reliable

principles and methods; and

(d) the expert has reliably applied the

principles and methods to the facts of the

case.

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Ariz. R. Evid. 702. Daubert offers additional “non-exclusive factors

for determining whether scientific evidence is admissible,”

including empirical testing, peer review, error rate, the existence of

standards and controls, and the degree to which the theory and

technique is generally accepted by a relevant scientific community.

Ariz. State Hosp., 231 Ariz. 467, ¶ 27, 296 P.3d at 1009; see also Daubert,

509 U.S. at 593-94.

¶13 Application of the Daubert factors, however, particularly

to medical testimony like that of Ferrante, requires flexibility. See

Sullivan v. U.S. Dept. of Navy, 365 F.3d 827, 834 (9th Cir. 2004) (when

medical testimony in malpractice case “based on specialized as

distinguished from scientific knowledge, the Daubert factors are not

intended to be exhaustive or unduly restrictive”); see also Huss v.

Gayden, 571 F.3d 442, 455 (5th Cir. 2009) (Daubert standards flexible).

Although grounded in science, medicine is a profession that requires

physicians to rely on their previous experiences and sound

judgment. Cf. Primiano v. Cook, 598 F.3d 558, 565 (9th Cir. 2010)

(finding experience-based physician testimony admissible in

products liability action). Moreover, federal appellate courts have

cautioned against the exclusion of medical testimony based on

factors more relevant in a product liability case. The Sixth Circuit

explained:

Daubert’s role of “ensur[ing] that the

courtroom door remains closed to junk

science” . . . is not served by excluding

[physician] testimony . . . that is supported

by extensive relevant experience. Such

exclusion is rarely justified in cases

involving medical experts as opposed to

supposed experts in the area of product

liability.

Dickenson v. Cardiac & Thoracic Surgery of E. Tenn., 388 F.3d 976, 982

(6th Cir. 2004), quoting Amorgianos v. Nat’l R.R. Passenger Corp., 303

F.3d 256, 267 (2d Cir. 2002).

¶14 Arizona’s adoption of the language of the federal rule

included a caution that the amendment “is not intended to . . .

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preclude the testimony of experience-based experts.” Ariz. R. Evid.

702 cmt.; see also McMurtry v. Weatherford Hotel, Inc., 231 Ariz. 244,

¶ 17, 293 P.3d 520, 527 (App. 2013). The advisory committee note to

Federal Rule 702—from which Arizona’s 2012 comment is derived—

similarly explains, “Nothing in this amendment is intended to

suggest that experience alone—or experience in conjunction with

other knowledge, skill, training or education—may not provide a

sufficient foundation for expert testimony.”

¶15 Although the application of new Rule 702 to expert

medical opinions requires flexibility, it has long been true that the

proponent has the burden of showing the expert’s qualifications are

relevant to particular issues in the case. See, e.g., Gaston v. Hunter,

121 Ariz. 33, 51, 588 P.2d 326, 344 (App. 1978) (witness must be

“competent to give an expert opinion on the precise issue about

which he is asked to testify”). The qualification requirement

continues under amended Rule 702. See, e.g., State v. Delgado, 232

Ariz. 182, ¶ 12, 303 P.3d 76, 80-81 (App. 2013) (medical doctor with

extensive experience in emergency medicine had expertise to opine

whether victim’s injuries were consistent with strangulation).

Ferrante testified in detail about his background, as well as how and

why he had diagnosed Sandretto with CRPS. He is the chief of pain

medicine at the University of California, Los Angeles Medical School

and a professor of internal medicine and anesthesiology. Ferrante

has extensive experience with CRPS, a condition recognized by the

American Medical Association and taught at medical schools.

¶16 While implicitly acknowledging Ferrante might be a

national expert on CRPS, PHM argues the trial court abused its

discretion by failing to evaluate the scientific basis for Ferrante’s

opinions regarding CRPS, as well as by admitting his causation

opinion. PHM also contends the court should have conducted a

Daubert hearing before trial and precluded the testimony.

¶17 As a procedural matter, we first observe a trial court has

great discretion whether to set a pretrial hearing to evaluate

proposed expert testimony. Ariz. State Hosp., 231 Ariz. 467, ¶ 31, 296

P.3d at 1010. The court may properly decide to hear the evidence

and objections during the trial. Id. Here, PHM filed a pretrial brief

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that broadly questioned whether opinions about CRPS could be

stated to a reasonable degree of medical probability. It requested

the court determine which CRPS testimony would be offered and

whether it would be admissible under Rule 702. PHM did not

appear to request a separate hearing. But assuming arguendo it had,

in the context of a general challenge under Rule 702, we have no

reason to conclude the court abused its discretion to defer hearing

the objection until trial.

¶18 PHM’s substantive challenge to the scientific basis and

reliability of Ferrante’s causation opinion was based on certain facts4

to demonstrate generally, and specific to Sandretto’s condition, that

the trial court should have precluded the causation opinion

pursuant to Rule 702. Whether the trial court abused its discretion

in admitting the causation opinion requires us to examine the

grounds for it.

¶19 To diagnose Sandretto, Ferrante had her fill out the

“McGill Pain Questionnaire,” from which he concluded she had

nerve-related pain. He also performed a neurological exam which

showed increased sensitivity and a bone scan which “li[t] up” in the

affected area. Ferrante concluded she suffered from CRPS Type I,

with “Type I” indicating that he could not identify which specific

nerve had been injured.5

¶20 In his CRPS causation opinion, Ferrante explained the

“unifying factor” was MRSA because the surgeries that followed the

diagnosis would not have been required without the MRSA

4 PHM’s proffered facts, disputed by Sandretto, can be

summarized as follows: CRPS is a not-well-understood pain

syndrome caused by traumatic damage to one or more nerves;

further, it is not caused by infection and can change over time.

5PHM also appears to argue that Ferrante had no basis for his

diagnosis because he could not identify which nerve was damaged.

It concedes, however, that CRPS Type I is a valid diagnosis when a

specific nerve cannot be identified.

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infection. Ferrante further testified that CRPS is caused by trauma;

surgery is a traumatic injury; therefore, “more likely than not,” it

was one of the surgeries after the MRSA diagnosis that caused the

CRPS. He further ruled out Calkins’s surgery to repair the meniscus

because Sandretto “got better for a few days then the bad spiral

began.” Ferrante did not link the CRPS to any negligence by PHM.

That connection was made through Talan’s testimony that the more

time a MRSA infection has to progress before the first wash-out

surgery, the more damage is done to the joint, and “probably the

more surgeries you’re going to need to get it cleaned out

completely.”6

¶21 PHM argues Ferrante’s causation opinion was “medical

mumbo-jumbo” and “rank speculation” that “Rule 702 was

designed to prevent.” It relies on Black v. Food Lion, Inc., 171 F.3d

308, 314 (5th Cir. 1999), for the proposition that a pain syndrome

without a clear genesis requires “critical scientific predicates” rather

than a “general methodology.” In Black, the plaintiff’s medical

expert rendered her causation opinion based on the absence of

symptoms in plaintiff’s pre-accident medical history and a lack of

6PHM notes it is undisputed the standard of care requires a

washout procedure once MRSA is detected and contends this and

other facts are “fatal to [Sandretto’s] causation theory,” because

Ferrante could not pinpoint exactly which surgery caused the CRPS.

To the extent PHM is arguing the trial court should have granted its

motion for new trial on this basis, the argument is waived because it

is not clearly raised and argued on appeal. See Lohmeier v. Hammer,

214 Ariz. 57, n.5, 148 P.3d 101, 108 n.5 (App. 2006). Further, on

review of the denial of a motion for new trial we will not reweigh

the evidence “‘merely because the jury could have drawn different

inferences or conclusions or because [we] feel that other results are

more reasonable.’” Hutcherson v. City of Phoenix, 192 Ariz. 51, ¶ 27,

961 P.2d 449, 454 (1998), quoting Tennant v. Peoria & Pekin Union Ry.

Co., 321 U.S. 29, 35 (1944). Finally, PHM does not challenge the

sufficiency of the evidence, only its admissibility.

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intervening events to account for her fibromyalgia.7 Id. at 313. The

Fifth Circuit found the trial court failed to apply Daubert criteria,

which would have shown no support by researchers or the medical

literature that trauma causes fibromyalgia. Id. at 312-14. The

appellate court quoted at length recent medical articles and a

“Consensus Report” evaluating experimental data on trauma and

fibromyalgia. Id. The scientific literature showed no causal

connection, which allowed the court to conclude the expert’s theory

of causation had not been “verified or generally accepted” and had

“no known potential rate of error.” Id. at 313. Even the plaintiff’s

expert conceded she could not identify a cause, but instead “found

an event that contributed to the development of the symptom.” Id.

¶22 PHM’s reliance on Black is misplaced for a number of

reasons. First, one disease, such as fibromyalgia, is not the

functional equivalent of another. More important, PHM did not

present to the trial court in its Rule 702 motion scientific literature

undermining the reliability or application of Ferrante’s causation

opinion. Instead, PHM relied on two medical information sheets

from the internet.8 Both documents included disclaimers that the

information could not be used for the diagnosis or treatment of any

medical condition. The information sheets were unsigned and

without endorsement by a recognized body; moreover, there was no

suggestion that the information represented a consensus in the pain

management field.

¶23 When examined about the information sheets, Ferrante

testified that the molecular mechanism of CRPS is not clearly

understood, but the medical cause, traumatic injury, was well

documented. When a properly qualified physician with expertise in

7 Although

PHM initially argued fibromyalgia was “another

name for CRPS,” it acknowledged the error in its Reply Brief, but

contended an analogy remains because fibromyalgia “is another

syndrome about which medical science knows very little.”

8 See,

e.g., www.ninds.nih.gov/disorders/reflex_sympathetic_

dystrophy/reflex_sympathetic_dystrophy.htm (last visited March 4,

2014).

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a recognized medical condition opines on the cause of the condition

in a particular patient based on his examination and testing, such

testimony is admissible unless the opponent proffers scientific

evidence challenging the reliability of the underlying principles and

application. See Ariz. R. Evid. 702 cmt.; Huss, 571 F.3d at 455.

Reliance on internet-based general medical information with

disclaimers against using the information for medical diagnosis and

treatment does not satisfy this requirement.

¶24 Finally, PHM’s challenge of Ferrante’s testimony based

on isolated portions of his testimony and the testimony of PHM’s

expert does not present a Rule 702 argument; rather, it is a jury

argument going to the weight and credibility of the testimony. See

Ariz. R. Evid. 702 cmt. (“Where there is contradictory, but reliable,

expert testimony, it is the province of the jury to determine the

weight and credibility of the testimony.”); see also Pipher, 221 Ariz.

399, ¶ 17, 212 P.3d at 96. “No rule is better established than that the

credibility of the witnesses and the weight and value to be given to

their testimony are questions exclusively for the jury.” State v.

Clemons, 110 Ariz. 555, 556-57, 521 P.2d 987, 988-89 (1974). As the

First Circuit observed in a medical malpractice action with

competing expert opinions, the trial court’s “gatekeeping function

ought not to be confused with the jury’s responsibility to separate

wheat from chaff.” Crowe v. Marchand, 506 F.3d 13, 18 (1st Cir. 2007).

Here, the jury properly was allowed to evaluate the differing

opinions of the experts based on reasons given for them. We

conclude the trial court did not abuse its discretion by admitting

Ferrante’s diagnosis of CRPS and his causation opinion.

Preclusion of evidence of prior medical conditions

¶25 PHM next argues the trial court erred when it

precluded evidence of Sandretto’s prior medical conditions on the

basis of Rule 403, Ariz. R. Evid., and when it failed to make specific

findings supporting its Rule 403 balancing. As explained below,

neither argument is sufficiently presented for our review.

¶26 Before and during trial, PHM requested that it be

allowed to question witnesses about Sandretto’s prior medical

history, including her history of pain and emotional issues.

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Sandretto filed four motions in limine to limit testimony regarding

those issues. PHM also filed an offer of proof listing sixty-one facts

it sought to have admitted. On appeal, PHM cites to the offer of

proof and items contained in the four motions in limine as evidence

it sought to have admitted, and contends the preclusions “unfairly

limited PHM’s cross examination of Plaintiff and her experts.” It is

apparent from the trial record, however, that much of that evidence

was actually admitted. PHM does not list specific items that should

have been admitted but were not, nor does PHM analyze why the

relevance of those individual items or categories of items was not

outweighed by the danger of unfair prejudice pursuant to Rule 403.

Thus, we find the argument insufficient for our consideration on

appeal. See Adams v. Valley Nat’l Bank of Ariz., 139 Ariz. 340, 343, 678

P.2d 525, 528 (App. 1984) (appellate court cannot assume duty of

advocate and search voluminous records to support argument on

appeal).

¶27 PHM’s second argument regarding Rule 403 is

procedural. It contends the trial court should have made “findings

about the factors [it] used in striking the proper [Rule 403] balance.”

Here, again, we cannot determine which evidentiary items were

precluded without specific citations to the record. PHM does not

direct us to the rulings, cite to transcripts, or even provide the

transcripts for every instance in which the court considered whether

or not to admit the evidence. Consequently, we will not consider

this issue on appeal. See Adams, 139 Ariz. at 343, 678 P.2d at 528.

Foundation for future care testimony

¶28 PHM argues Sandretto’s expert Loretta Lukens did not

provide proper foundation to testify about the cost of Sandretto’s

future medical care. More specifically, it contends Ferrante should

have testified at trial that each specific element of the life care plan

was medically necessary. We review the admission of evidence for

an abuse of discretion. See Pipher, 221 Ariz. 399, ¶ 6, 212 P.3d at 93.

¶29 Rule 703, Ariz. R. Evid., details the proper sources of

information for expert opinions. Experts may base their opinions on

“facts or data in the case that the expert has been made aware of or

personally observed,” and facts or data on which “experts in the

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particular field would reasonably rely.” Ariz. R. Evid. 703; Standard

Chartered PLC v. Price Waterhouse, 160 Ariz. 6, 44, 945 P.2d 317, 355

(App. 1996). There is no requirement that the facts or data be part of

the trial testimony. Ariz. R. Evid. 703; see also Pipher, 221 Ariz. 399,

¶ 8, 212 P.3d at 94 (facts or data need not be admissible in evidence).

¶30 Lukens testified that she relied on her own observations

and experience, as well as input from medical doctors, and readily-

available pricing information for procedures, medications, and other

line items. She explained she had twenty years experience

preparing life care plans. To prepare the plan here, she met with

Sandretto and spoke to Ferrante on two occasions. She also spoke to

Dr. Stewart Shanfield regarding orthopedic items on the plan. She

testified she typically relied on physicians to provide medical

justification for individual line items in the life care plan, and then

she would determine the cost to build the plan. Regarding the

reasonableness of costs, Lukens testified her expertise includes the

calculation of the costs of the plan, but the doctors determined

whether a particular line item was appropriate. She also testified

her methods and life care plan are accepted by those in her field

with her level of expertise.

¶31 PHM contends the basis for Lukens’s life care plan is

insufficient because Ferrante testified he did not recall looking at the

plan line by line, and in a deposition he said he had not. Lukens,

however, testified Ferrante had reviewed it all or she would not

have marked it as “reviewed.” Any inconsistency in testimony went

to its weight, not its admissibility. See Smith v. Uniroyal, Inc., 420

F.2d 438, 442 (7th Cir. 1970) (inconsistency in expert testimony to be

considered by jury); Ariz. R. Evid. 702 cmt. (“Where there is

contradictory, but reliable, expert testimony, it is the province of the

jury to determine the weight and credibility of the testimony.”).

PHM has failed to show Lukens’s testimony was not based on facts

or data on which those in her field would reasonably rely.

¶32 PHM makes a related challenge to Lukens’s testimony

based on its conclusion she was not candid in the preparation of her

life care plan. But we do not address the accuracy of PHM’s

characterization because credibility of a witness is a question for the

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trier of fact. See Belliard v. Becker, 216 Ariz. 356, ¶ 19, 166 P.3d 911,

914 (App. 2007); Ariz. R. Evid. 702 cmt. (recent amendment did not

disturb “traditional jury determinations of credibility and the weight

to be afforded” testimony). The trial court did not err in admitting

Lukens’s testimony and life care plan and, therefore, did not err in

denying the motion for a new trial on this basis.

Scope of standard of care opinion

¶33 PHM argues the trial court abused its discretion in

allowing the admission of opinions by Dustyn Severns that had not

been properly disclosed before trial. At trial, Severns testified about

the standard of care of a PA, stating it required proper

communication between a PA and a doctor, and further opining the

PA cannot stay quiet if he believes the doctor is letting too much

time pass between a MRSA diagnosis and treatment.

¶34 A trial court’s decisions regarding alleged disclosure

violations will not be disturbed absent an abuse of discretion.

Solimeno v. Yonan, 224 Ariz. 74, ¶ 9, 227 P.3d 481, 484 (App. 2010).

Rule 26.1(a)(6), Ariz. R. Civ. P., requires parties to disclose

information about the expert witnesses they expect to call at trial,

including a writing detailing “the substance of the facts and

opinions to which the expert is expected to testify,” and “a summary

of the grounds for each opinion.” The purpose of the pretrial

disclosure rules is “to provide the parties ‘a reasonable opportunity

to prepare for trial.’” Breitbart-Napp v. Napp, 216 Ariz. 74, ¶ 21, 163

P.3d 1024, 1030 (App. 2007), quoting Bryan v. Riddel, 178 Ariz. 472,

476 n.5, 875 P.2d 131, 135 n.5 (1994). Detailed scripting is not

required, Solimeno, 224 Ariz. 74, ¶ 14, 227 P.3d at 484, and deposition

testimony may be considered an amendment to prior disclosures,

Link v. Pima Cnty., 193 Ariz. 336, ¶ 9, 972 P.2d 669, 672 (App. 1998).

¶35 Severns’s pretrial disclosure affidavit did not include a

discussion of PA-physician communication protocol and a PA’s

duty to remind a doctor about a MRSA diagnosis. Rather, it focused

more generally on the delay in Sandretto’s treatment after the MRSA

diagnosis. However, Severns testified about the communication

failures during his deposition six months before trial and opined

Morphis’s failure to communicate with Calkins constituted a

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Opinion of the Court

violation of the standard of care. The affidavit and deposition

testimony together were detailed enough for PHM to prepare its

case. Cf. Solimeno, 224 Ariz. 74, ¶ 15, 227 P.3d at 484 (finding

insufficient disclosure where doctor would testify to “his care and

treatment of [patient] and any conversations he had with [her] . . .

[and] his care and treatment . . . complied with the applicable

standard of care”); Englert v. Carondelet Health Network, 199 Ariz. 21,

¶ 7, 13 P.3d 763, 767 (App. 2000) (affirming grant of new trial on

basis of failure to disclose affirmative defense). The trial court did

not abuse its discretion in admitting Severns’s testimony, nor in

refusing to grant a new trial on this basis.

Calkins’s settlement

Time allowed for “Good Faith Settlement” hearing

¶36 PHM argues the trial court abused its discretion in

denying its motion to continue trial to prepare for a “good faith”

settlement hearing regarding Calkins’s settlement with Sandretto.

¶37 Sandretto and Calkins settled on June 19, 2012, and

moved for a good faith settlement hearing the same day. On

June 22, PHM moved to continue the trial, in part to determine the

extent of liability and the effect of the settlement agreement on the

case. On June 25, the court held a hearing, denied the motion to

continue, and determined the settlement had been made in good

faith. The trial began the next day. PHM never filed a formal

objection to the settlement, but made substantive arguments against

approval of the settlement during the hearing.

¶38 We review the grant or denial of a motion to continue

for an abuse of discretion. Alberta Sec. Comm’n, 200 Ariz. 540, ¶ 11,

30 P.3d at 124. Rule 16.2(a), Ariz. R. Civ. P., permits a party to

petition the court for a “formal determination whether [a] settlement

is made in good faith.” Pursuant to Rule 16.2(b), any party may file

an objection within ten days, although that time period “may be

shortened or enlarged by the court.” Rule 16.2(c), requires the court

to set a hearing date upon the timely request of a party, but does not

provide any guidance as to when that hearing may be held.

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¶39 PHM argues it had ten days to object to the settlement

pursuant to Rule 16.2(b), and therefore should have had more time

to prepare for the hearing. The plain language of the rule, however,

provides that the trial court may shorten the time to object and sets

no boundaries for the hearing itself. Additionally, PHM provides no

authority, nor are we aware of any, for why it should have had more

time under Rule 16.2(b) or (c).

¶40 PHM admitted during the good faith settlement hearing

that its evidence of collusion likely would be limited to the terms of

the agreement stating, “[PHM] acknowledge[s] that it would be

difficult to interview the lawyers about what they were doing and so

[it is] left, then, with arguing on the four corners of the agreement.”

At the hearing, PHM had the opportunity to make its substantive

arguments that the agreement was collusive, and the trial court

stated it had read the pleadings and listened to the argument and

concluded the agreement was made in good faith.

¶41 PHM has not demonstrated that a continuance would

have permitted it to obtain the required evidence or present

arguments it had been unable to present. We cannot say the trial

court abused its discretion in refusing to continue trial to allow more

time to prepare objections and conduct discovery into the propriety

of the settlement. See Anderson Aviation Sales Co. v. Perez, 19 Ariz.

App. 422, 428, 508 P.2d 87, 93 (1973) (no abuse of discretion in

denying continuance where one of the defense attorneys was

disbarred on opening day of trial); see also Barmat, 165 Ariz. at 210,

797 P.2d at 1228 (no abuse of discretion in denying further discovery

into settlement agreement).

Vicarious liability claims for Calkins’s acts and omissions

¶42 PHM contends the vicarious liability claims based on

Calkins’s actions should have been dismissed after the trial court

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Opinion of the Court

approved the settlement agreement, when PHM moved for

judgment as a matter of law.9

¶43 Although we review the trial court’s denial of the

motion for a new trial for an abuse of discretion, a court abuses its

discretion when it commits an error of law. Twin City Fire Ins. Co.,

204 Ariz. 251, ¶ 10, 63 P.3d at 254. We review de novo the denial of

a motion for judgment as a matter of law. Acuna v. Kroack, 212 Ariz.

104, ¶ 23, 128 P.3d 221, 227 (App. 2006).

¶44 Under the terms of the agreement, Calkins’s own

insurance carrier,10 which had a $1 million policy limit, would pay

$950,000 to Sandretto in exchange for dismissing the claims against

Calkins without prejudice and agreeing to a covenant not to execute

in his favor. PHM argues the dismissal and covenant constituted a

release and compromise of the claims against PHM as well.

¶45 PHM relies primarily on Law v. Verde Valley Med. Ctr.,

217 Ariz. 92, 170 P.3d 701 (App. 2007), for the proposition that a

judgment in favor of an agent, such as Calkins, eliminates vicarious

liability for the principal, PHM. In Law, the claims against two

doctors sued for medical malpractice were dismissed with prejudice.

9PHM also contends “the trial court abused its discretion by

refusing to inform the jury of the fact that Calkins had settled with

[Sandretto].” PHM provides no authority for this argument, instead

making a substantive argument about whether the claims based on

vicarious liability should have been dismissed and whether the

agreement was collusive. Accordingly, we do not address this issue.

Ariz. R. Civ. App. P. 13(a)(6); Brown v. U.S. Fidelity & Guar. Co., 194

Ariz. 85, ¶ 50, 977 P.2d 807, 815 (App. 1998) (assertion without

authority not considered).

10The agreement also stated that Calkins was covered under

PHM’s liability insurance policy, which provided a policy limit of

$5 million and covered him whether the individual insurance policy

existed or not.

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Id. ¶¶ 4-6. The trial court also granted summary judgment in favor

of the hospital on claims based on the vicarious liability of those

doctors. Id. ¶ 8. This court concluded summary judgment was

proper, relying on DeGraff v. Smith, 62 Ariz. 261, 157 P.2d 342 (1945),

for the principle that “[w]hen a judgment on the merits—including a

dismissal with prejudice—is entered in favor of the ‘other

person’ . . . there is no fault to impute and the party potentially

vicariously liable . . . is not ‘responsible for the fault’ of the other

person.” Law, 217 Ariz. 92, ¶ 13, 170 P.3d at 705, quoting A.R.S. § 12-

2506(D)(2).

¶46 Here, unlike in Law, there was no “judgment on the

merits” regarding Calkins. A dismissal without prejudice—even

when the statute of limitations has run—is not a dismissal on the

merits. Hovatter v. Shell Oil Co., 111 Ariz. 325, 326, 529 P.2d 224, 225

(1974). Additionally, “a covenant not to execute is not a release from

liability.” A Tumbling-T Ranches v. Flood Control Dist. of Maricopa

Cnty., 220 Ariz. 202, ¶ 22, 204 P.3d 1051, 1058 (App. 2008). PHM

contends that this is a “legal fiction,” but does not provide contrary

authority for its position. Neither the dismissal without prejudice

nor the covenant not to execute constituted a release from liability.

The trial court did not err in denying the motion for judgment as a

matter of law and therefore did not abuse its discretion in denying

the motion for a new trial on that basis.

Collusion between Calkins and Sandretto

¶47 PHM also argues the trial court erred in determining

the settlement agreement was not collusive because it allowed

Calkins to admit fault and “avoid the consequences of his

admission,” while leaving PHM to defend the case on the eve of

trial.

¶48 We review a trial court’s decision to approve a

settlement agreement for an abuse of discretion. See Barmat, 165

Ariz. at 210, 797 P.2d at 1228. PHM relies on In re Alcorn, 202 Ariz.

62, ¶¶ 20-21, 41 P.3d 600, 606 (2002), for the principle that an

agreement may be collusive if it deprives the non-settling party of a

fair trial by changing the motive or trial tactics in defending the case.

In that attorney disciplinary proceeding, our supreme court

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Opinion of the Court

determined a secret agreement to dismiss the single remaining

defendant at the close of the case, during which the defendant’s

attorney would not object to the scope of inquiry, was collusive. Id.

¶¶ 11, 30. It resulted in a “sham” trial in which the parties were not

adverse, and the only purpose was to educate the trial judge before

he decided a pending motion to reconsider an earlier summary

judgment in favor of the other defendant. Id. ¶¶ 12, 30. The court

concluded any newly-discovered evidence the plaintiffs wanted to

present in reconsideration of the motion for summary judgment

should have been presented in the motion proceedings, so the other

defendant could participate. Id. ¶ 32.

¶49 Here, PHM may not have expected Calkins to settle, but

its motive and tactics in defending the case did not change in the

manner considered in Alcorn. PHM’s liability was based on the acts

of Calkins and his PA, whether Calkins was a party to the case or

not. Further, Calkins did not suddenly cease defending his actions

as PHM contends. PHM and Sandretto both contend Calkins

changed his testimony between the deposition and the trial,

originally stating he was not aware of the MRSA diagnosis until

nine days after the results, although neither party indicates where or

if the deposition testimony can be found in the record. Even

assuming this to be true, Calkins did not reverse course at trial and

testify that he remembered the MRSA diagnosis; rather, he said he

had no personal recollection of the diagnosis, but the existence of an

antibiotic prescription in the chart indicated that he knew earlier

than he originally stated in his deposition.11

11 At trial, Calkins also admitted that he could not in

truthfulness say he met the standard of care given the documented

delay in treatment. This admission, however, occurred during

PHM’s cross examination and PHM did not then challenge this

statement as inconsistent with earlier deposition testimony. There is

no indication in the briefs or the record that this admission was

inconsistent with Calkins’s deposition testimony.

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Opinion of the Court

¶50 The settlement agreement was disclosed to the trial

court, did not result in a “sham” trial lacking adverse parties, and

did not require that PHM change its tactics or motives in defending

the case, as in Alcorn. The court did not err in approving the

settlement agreement, or in denying the motion for a new trial on

that ground.

Sufficiency of the Evidence

¶51 PHM argues the trial court erred in denying its motion

for a new trial because the verdict shocked the conscience and was

not supported by evidence, and because Sandretto’s counsel made

improper statements during closing argument.

¶52 In ruling on a motion for a new trial, the trial judge sits

as the ninth juror. Hutcherson, 192 Ariz. 51, ¶ 23, 961 P.2d at 453.

“The basic question he or she must ask is whether the jury verdict is

so ‘manifestly unfair, unreasonable and outrageous as to shock the

conscience.’” Id., quoting Young Candy & Tobacco Co. v. Montoya, 91

Ariz. 363, 370, 372 P.2d 703, 707 (1962). The amount of a damages

award is “‘a question peculiarly within the province of the jury, and

such award will not be overturned or tampered with unless the

verdict was the result of passion or prejudice.’” In re Estate of

Hanscome, 227 Ariz. 158, ¶ 12, 254 P.3d 397, 401 (App. 2011), quoting

Larriva v. Widmer, 101 Ariz. 1, 7, 415 P.2d 424, 430 (1966). We do not

reweigh the facts in considering whether there was sufficient proof

to support the jury’s verdict. Hutcherson, 192 Ariz. 51, ¶ 27, 961 P.2d

at 454. “[V]erdict size alone does not signal passion or prejudice.”

Id. ¶ 36. Further, if the size of the verdict is exaggerated “in an area

in which reasonable persons may differ, the trial court should not

lightly conclude that it is tainted.” Estate of Hanscome, 227 Ariz. 158,

¶ 13, 254 P.3d at 401.

¶53 PHM’s argument on appeal relies in large part on its

arguments that much of Sandretto’s expert testimony was

inadmissible, which we have addressed above. PHM admits, “The

verdict may have been supported by the evidence that the trial court

admitted, but the errors by the court deprived PHM of a fair

opportunity to challenge the testimony.”

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¶54 We first must consider whether Sandretto proffered

sufficient evidence of her past and future medical expenses. Her

past medical expenses totaled approximately $330,000. Her

economic expert, Stan Smith, determined her future medical

expenses totaled almost $2 million, based on the life care plan

created by Lukens. Smith also calculated her lost earning capacity

until retirement somewhere between approximately $400,000 and

$740,000, depending on pay. Loss of household services was totaled

at approximately $485,000. In total, Sandretto provided evidence of

economic losses of up to $3.5 million.

¶55 The jury was instructed to compensate Sandretto not

only for her existing and future medical bills or lost earnings, but

also for damages including pain, disfigurement, anxiety, and loss of

enjoyment. Sandretto demonstrated for the jury that her knee is

locked in position, requiring her to walk on her toes. Her boyfriend

testified that riding in the car causes her pain, and she cannot travel

long distances. PHM’s own expert agreed Sandretto’s pain was real.

Because reasonable people may differ as to how much Sandretto

should be compensated for her pain, we do not find the trial court

erred denying the motion for a new trial. See Estate of Hanscome, 227

Ariz. 158, ¶ 13, 254 P.3d at 401.

¶56 PHM’s assertion of improper closing arguments is

waived on appeal because it failed to object at trial. See Copeland v.

City of Yuma, 160 Ariz. 307, 309-10, 772 P.2d 1160, 1162-63 (App.

1989). Waiver will not apply, however, if serious misconduct

actually influences the verdict. See Monaco v. HealthPartners of

S. Ariz., 196 Ariz. 299, ¶ 18, 995 P.2d 735, 741 (App. 1999). PHM

contends Sandretto made two improper arguments: (1) that

Sandretto was “in jail” because “[h]er body is her prison” and that

“she can hear [PHM] laughing,” and (2) that the jury should award

$9 million because that figure would essentially double the

economic damages and past and future medical expenses. The trial

court found no misconduct in Sandretto’s closing arguments, and

we will not reverse that discretionary finding “‘unless the record

clearly establishes that the trial court was incorrect.’” See id., quoting

Grant v. Ariz. Pub. Serv. Co., 133 Ariz. 434, 455, 652 P.2d 507, 528

(1982); see also Ritchie v. Krasner, 221 Ariz. 288, ¶ 52, 211 P.3d 1272,

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Opinion of the Court

1287 (App. 2009) (trial court in “best position” to determine whether

misconduct materially affected rights of other party).

¶57 PHM relies on the size of the verdict to support its

contention, stating that “on the basis of the evidence introduced at

trial . . . [the verdict] clearly demonstrate[s] that the damages were

not only excessive and unsupported by the evidence, but were

undoubtedly the result of passion and prejudice.” Because we have

reviewed the record and determined the verdict was based on

substantial evidence, we cannot say that the record clearly

demonstrates reversible error. See Monaco, 196 Ariz. 299, ¶ 18, 995

P.2d at 741.

Disposition

¶58 For the foregoing reasons, we affirm the trial court’s

denial of PHM’s motion for a new trial.

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