Watrous v. Porter Medical Center (2025 VT 47)
Hospital Policy Alone Cannot Establish the Standard of Care & Appellate Deference to Jury Findings on Rule 59 Motions

1. Introduction

The Vermont Supreme Court’s decision in Watrous v. Porter Medical Center, 2025 VT 47, addresses two recurring themes in medical-malpractice litigation: (i) the relationship between institutional policies and the legally operative “standard of care,” and (ii) the scope of a trial court’s discretion when ruling on a post-verdict motion for a new trial under Vermont Rule of Civil Procedure 59. The Estate of Arthur H. Watrous alleged that Porter Medical Center negligently administered a second dose of the antipsychotic drug Zyprexa to an elderly patient with Parkinson’s disease, COPD, and other complications, ultimately contributing to his death. After a five-day jury trial, the jury answered “No” to the threshold special-verdict question—“Did plaintiff prove the standard of care?”—and therefore never reached breach, causation, or damages. The trial judge denied plaintiff’s Rule 59 motion for a new trial, and the Supreme Court affirmed.

2. Summary of the Judgment

The Court (Cohen, J.) held that:

• The trial court did not abuse its discretion in denying a new trial because substantial evidence supported the jury’s finding that the plaintiff failed to establish the applicable standard of care.
• Conflicting expert testimony, combined with varying interpretations of the hospital’s chemical-restraint policy, created a factual question for the jury, not a legal question for the court.
• Hospital policies may inform—but do not, by themselves, determine—the legal standard of care in a malpractice case.
• Absent passion, prejudice, or a clear miscarriage of justice, Vermont appellate courts will defer to jury verdicts and to trial-court rulings on Rule 59 motions.

3. Detailed Analysis

3.1 Precedents Cited & Their Influence

• Shahi v. Madden, 2008 VT 25: Quoted for the proposition that “the law favors upholding jury verdicts.” Reinforces the presumption of correctness afforded to jury determinations.
• Epsom v. Crandall, 2019 VT 74: Provides the abuse-of-discretion standard governing appellate review of Rule 59 denials.
• Pirdair v. Medical Center Hospital of Vermont, 173 Vt. 411 (2002): Articulates when a verdict may be set aside—only if clearly wrong and unjust due to disregard of substantial evidence or because of passion/prejudice/misconception.
• Weeks v. Burnor, 132 Vt. 603 (1974): Classic statement that discretion is abused only when “clearly untenable or to an extent clearly unreasonable.”
• Taylor v. Fletcher Allen Health Care, 2012 VT 86: Restates the plaintiff’s burden in malpractice actions—prove standard of care, breach, and causation.
• 12 V.S.A. § 1908(1): Statutory definition of the “standard of care” for health-care providers practicing “under the same or similar circumstances.”

Each precedent underscores a deferential posture toward both jury verdicts and trial-court rulings. Together, they formed an analytical scaffold that made reversal nearly impossible absent a glaring error—which the Court did not find.

3.2 The Court’s Legal Reasoning

1. Framing the Issue Narrowly. The Supreme Court limited review to a single question: Did the trial court abuse its discretion by declining to grant a new trial? By doing so, the Court avoided re-weighing evidence or second-guessing credibility determinations.
2. Evaluating the Standard-of-Care Evidence.
   • Both sides offered experts on chemical restraints, but their testimony diverged on critical details—whether Zyprexa could be ordered “Q4H,” whether a face-to-face exam was required before or within one hour after administration, and whether “scheduled” versus “PRN” dosing mattered.
   • Because no single, undisputed articulation of the standard emerged, the jury was entitled to decide that plaintiff had not carried his burden of proof (preponderance of the evidence) on that foundational element.
3. Role of Hospital Policy. The Court emphasized that a hospital’s internal policy may be evidence of the standard of care but is not dispositive. The jury heard testimony that policies “do not dictate medical judgment calls,” allowing it to discount policy language when weighted against other professional standards.
4. Application of Rule 59(a). The trial court found no passion, prejudice, or manifest disregard of evidence. The Supreme Court, deferential under Pirdair and Weeks, refused to substitute its own judgment where the evidence supported multiple inferences.

3.3 Projected Impact on Vermont Law

Although the decision does not dramatically shift malpractice doctrine, it solidifies two practical rules:

1. Policy ≠ Standard of Care. Counsel cannot assume that proving a hospital’s internal guideline ipso facto proves the legal standard. Expert testimony tying policy provisions to prevailing professional norms remains indispensable.
2. High Bar for New Trials in Mixed-Evidence Cases. When expert testimony conflicts, the jury’s verdict will rarely be “clearly wrong.” Lawyers contemplating Rule 59 motions must marshal more than disagreement—they must show that evidence supporting the verdict was either nonexistent or irrationally ignored.

Future litigants will likely cite Watrous when resisting motions that invite courts to re-weigh balanced expert proof. Moreover, hospitals may take comfort that policy deviations do not automatically translate into liability, although they remain highly relevant evidence.

4. Complex Concepts Simplified

• Standard of Care. The yardstick against which a health-care professional’s conduct is measured: what a reasonably careful, skillful, and prudent provider would do in similar circumstances.
• Chemical Restraint. A drug used primarily to restrict a patient’s behavior or movement, not to treat a medical condition. Zyprexa (olanzapine) can act as such in acute agitation.
• PRN vs. Scheduled Order. “PRN” (pro re nata) means “as needed” based on patient status; a scheduled order calls for administration at fixed intervals regardless of current assessment.
• Rule 59 Motion. A request made within 14 days after judgment asking the trial court to set aside the verdict and grant a new trial—granted only in exceptional circumstances.
• Abuse of Discretion. A standard of appellate review that overturns a lower-court decision only if it was arbitrary, unreasonable, or based on an erroneous view of the law.

5. Conclusion

Watrous v. Porter Medical Center reinforces Vermont’s strong deference to jury verdicts and trial-court discretion in new-trial motions, especially where expert opinions conflict. The Supreme Court clarified that hospital policies, although probative, do not conclusively establish the legal standard of care; juries must still evaluate expert testimony and other evidence. The decision thus serves as a cautionary tale for plaintiffs: without a clear, uncontested articulation of the applicable professional standard, even compelling narratives of patient harm may founder at the threshold question. For defense counsel, it underscores the strategic value of presenting credible alternative standards through qualified experts, effectively creating a factual dispute that will insulate the verdict on appeal. In the broader legal landscape, Watrous solidifies the doctrinal guardrails around Rule 59 and the definition of “standard of care,” ensuring that fact-finders, not courts, remain the ultimate arbiters when evidence points in multiple directions.