Oja v. Howmedica, Inc. ( 1997 )


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  •                               UNITED STATES COURT OF APPEALS
    Tenth Circuit
    Byron White United States Courthouse
    1823 Stout Street
    Denver, Colorado 80294
    (303) 844-3157
    Patrick J. Fisher, Jr.                                                                  Elisabeth A. Shumaker
    Clerk                                                                                   Chief Deputy Clerk
    June 10, 1997
    TO:      All recipients of the captioned opinion
    RE:      95-1085, 95-1104, 95-1123, Oja v. Howmedica, Inc.
    April 16, 1997
    Please be advised of the following correction to the captioned decision:
    Due to a formatting error, the section headings are incorrectly labeled. The Arabic
    numbers should be Roman numerals.
    A corrected version of the opinion is attached for your convenience.
    Very truly yours,
    Patrick Fisher, Clerk
    Susie Tidwell
    Deputy Clerk
    encl.
    F I L E D
    United States Court of Appeals
    Tenth Circuit
    PUBLISH
    APR 16 1997
    UNITED STATES COURT OF APPEALS
    PATRICK FISHER
    Clerk
    TENTH CIRCUIT
    MAUREEN G. OJA,
    Plaintiff - Appellee/
    Cross - Appellant,            No. 95-1085, 95-1104, 95-1123
    v.
    HOWMEDICA, INC., a Delaware
    corporation,
    Defendant - Appellant/
    Cross - Appellee.
    --------------------------
    PRODUCT LIABILITY ADVISORY
    COUNCIL, INC.; HEALTH
    INDUSTRY MANUFACTURERS
    ASSOCIATION; ASSOCIATION OF
    TRIAL LAWYERS OF AMERICA,
    Amici Curiae.
    APPEAL FROM THE UNITED STATES DISTRICT COURT
    FOR THE DISTRICT OF COLORADO
    (D. Ct. No. 93-C-858)
    Malcolm E. Wheeler, Parcel, Mauro, Hultin & Spaanstra, Denver, Colorado,
    appearing for Defendant-Appellant/Cross-Appellee.
    Elizabeth C. Moran, Pryor, Johnson, Montoya, Carney & Karr, Englewood,
    Colorado (Peter W. Pryor, Pryor, Johnson, Montoya, Carney & Karr, Englewood,
    Colorado, and Thomas L. Roberts, Roberts & Zboyan, Denver, Colorado, with her
    on the briefs), appearing for Plaintiff-Appelle/Cross-Appellant.
    Robert N. Weiner and Steve J. Boom, Arnold & Porter, Washington, DC, and
    Hugh Young, Jr., Product Liability Advisory Council, Inc., Reston, Virginia, for
    amicus curiae Product Liability Advisory Council, Inc.
    Bruce N. Kuhlik and Jennifer A. Johnson, Covington & Burling, Washington, DC,
    and Donnellda Rice, Health Industry Manufacturers Association, Washington,
    DC, for amicus curiae Health Industry Manufacturers Association.
    Pamela A. Liapakis, President, Association of Trial Lawyers of America,
    Washington, DC and Jeffrey Robert White, Washington, DC, for amicus curiae
    Association of Trial Lawyers of America.
    Before TACHA, BRISCOE, and MURPHY, Circuit Judges.
    TACHA, Circuit Judge.
    Maureen Oja brought a products liability action against Howmedica, Inc.,
    the manufacturer of a prothestic hip replacement system, asserting three claims
    relevant to this appeal: (1) negligence, (2) negligent failure to warn, and (3) strict
    liability. At the close of the plaintiff’s case, the district court granted
    Howmedica’s motion for a directed verdict on Oja’s strict liability manufacturing
    defect claim. The court, however, permitted Oja to proceed with her strict
    liability claims based on design and warning defects.
    -2-
    The jury returned a general verdict for Howmedica on the negligence and
    remaining strict liability claims. The jury, however, found for Oja on her
    negligent failure to warn claim. The jury awarded Oja $896,921 in compensatory
    and $896,921 in punitive damages. The district court reduced the damage award
    to $448,460.50 and $612,535.96, respectively, and awarded Oja prejudgment
    interest from the date the action accrued.
    On appeal, Howmedica argues that: (1) the Medical Device Amendments
    of 1976 (“MDA”) preempts Oja’s negligent failure to warn claim; (2) the jury’s
    finding of negligent failure to warn is inconsistent with its verdict for Howmedica
    on the strict liability and negligence claims; (3) the district court erred in
    submitting both a “negligence” and “negligent failure to warn” claim to the jury
    without properly instructing the jury about the elements and burdens of proof on
    each claim; and (4) punitive damages cannot be awarded as a matter of law
    because the evidence was insufficient to show that Howmedica acted wantonly or
    recklessly.
    In her cross-appeal, Oja raises two issues. Oja argues that the district court
    erred in (1) dismissing her strict liability claim based on a manufacturing defect
    and (2) awarding her prejudgment interest from the date that her action “accrued”
    as defined by the relevant statute of limitations rather than the date of her injury.
    -3-
    We exercise jurisdiction pursuant to 
    28 U.S.C. § 1291
    . For the reasons set
    forth below, we affirm the district court’s ruling that the MDA does not preempt
    Oja’s negligent failure to warn claim. We reverse and remand for a new trial,
    however, because we conclude that the jury’s finding of negligent failure to warn
    is irreconcilably inconsistent with its verdict for Howmedica on the strict liability
    claim. We also reverse the district court’s order granting a directed verdict for
    Howmedica on the strict liability manufacturing defect claim. Because we
    remand for a new trial, we do not address the remaining issues on appeal.
    BACKGROUND
    The Porous-Coated Anatomic One-Piece Acetabular Component hip (“PCA
    hip”) consists of three components: (1) a metal stem that is inserted into the
    central canal of the patient’s large upper leg bone, (2) a cup that is inserted into
    the patient’s hip socket, and (3) a rounded metal femoral head that is rigidly
    attached to the top of the metal stem and is fitted into the cup. The cup is
    composed of an outer metal shell and an inner polyethylene liner. The liner
    attaches to the metal shell by an integral staking peg projecting from the back of
    the liner through a hole in the metal shell. An “anti-rotation lug” prevents the
    liner from rotating in the metal shell. Unless the liner is prevented from rotating,
    -4-
    the liner will wear and shed microscopic debris. Such debris may cause a patient
    to suffer from severe bone dissolution or “osteolysis.”
    On July 2, 1984, Oja underwent surgery to replace her existing artificial hip
    with a PCA hip. Her orthopedic surgeon, Dr. McElhinney, implanted the PCA hip
    without using cement because he had concluded that Oja’s existing bone structure
    provided little area for cement fixation.
    By early 1992, Oja began experiencing severe pain in her hip in the area of
    her PCA hip implant. Dr. Richard Evans, an orthopedic surgeon, recommended
    immediate surgery. On July 29, 1992, he removed the PCA hip. The surgery
    revealed that the staking peg was missing, that the polyethylene liner had
    completely disengaged from the metal cup, and that debris had spread into Oja’s
    hip joint. Moreover, osteolysis had left large defects in Oja’s hip, especially in
    the area of the hole in the cup. On April 21, 1993, Oja filed this products liability
    suit against Howmedica.
    -5-
    DISCUSSION
    I.   P REEMPTION OF O JA ’ S N EGLIGENT F AILURE TO W ARN C LAIM
    a.   Overview of the Medical Device Amendments
    -6-
    Howmedica argues that the MDA preempts Oja’s negligent failure to warn
    claim. 1 Because Congress’s intent is the “ultimate touchstone” in every
    preemption case, see Retail Clerks Int’l Ass’n v. Schermerhorn, 
    375 U.S. 96
    , 103
    (1963), we begin our preemption analysis by outlining the purposes and statutory
    framework of the MDA.
    In 1976, Congress enacted the MDA “to provide for the safety and
    effectiveness of medical devices intended for human use.” Pub. L. No. 94-295,
    
    90 Stat. 539
    , 539 (1976) (preamble). The MDA classifies medical devices into
    three categories (classes I, II and III) based on the amount of risk they pose to the
    public. Class I devices are subject only to “general controls” because they pose
    little threat to public heath and safety. 21 U.S.C. § 360c(a)(1)(A). Class II
    devices are subject to special controls because “general controls by themselves
    are insufficient to provide reasonable assurance of the safety and effectiveness of
    1
    Prior to trial, Howmedica moved for summary judgment, claiming that all of Oja’s
    state law claims were preempted by the MDA. The district court denied Howmedica’s
    motion and its motion for reconsideration. At the close of the evidence, Howmedica
    moved for a directed verdict on all of Oja’s state law claims based on MDA preemption.
    The district court denied the motion.
    After the jury returned its verdict, Howmedica renewed its motion for judgment as
    a matter of law, arguing only that the MDA preempted Oja’s negligent failure to warn
    claim. The district court denied the motion. On appeal, Howmedica again argues only
    that the MDA preempts Oja’s negligent failure to warn claim. Thus, we do not address
    whether the MDA preempts any of Oja’s other state law claims. See State Farm Fire &
    Cas. Co. v. Mhoon, 
    31 F.3d 979
    , 984 n.7 (10th Cir. 1994) (holding that the failure to raise
    an issue in the opening brief waives the issue).
    -7-
    the device.” 21 U.S.C. § 360c(a)(1)(B). Class III devices are subject to the most
    stringent MDA controls because they present “a potential unreasonable risk of
    illness or injury.” 21 U.S.C. § 360c(a)(1)(C).
    The MDA automatically classifies a device as a class III device unless the
    device fits within one of three exceptions listed. First, a device placed in
    commercial distribution prior to May 28, 1976, avoids class III status through a
    grandfathering provision. 21 U.S.C. § 360c(f)(1)(A)(I)(I). Second, a post-1976
    device may escape classification as a class III device if the FDA has reclassified
    the device as a class I or II device. 21 U.S.C. § 360c(f)(1)(A)(I)(II); 21 U.S.C.
    § 360c(f)(1)(B). Finally, a device may avoid class III device status if it is
    “substantially equivalent” to a grandfathered device or a post-1976 device that the
    FDA has classified as a class I or II device. 21 U.S.C. § 360c(f)(1)(A)(ii).
    Manufacturers intending to market any new medical device must submit a
    premarket notification to the FDA. 
    21 U.S.C. § 360
    (k). In addition to the
    premarket notification (also known as the “§ 510(k) process”), Class III devices
    must undergo a comprehensive premarket approval (“PMA”) process before
    marketing. 21 U.S.C. § 360e. The purpose of the PMA is to provide the FDA
    with “reasonable assurance” that the device is safe and effective. 21 U.S.C. §
    360e(d)(2).
    -8-
    While the MDA contemplates that most Class III devices will reach the
    market only through the PMA process, a manufacturer may obtain market
    approval through any of three alternative processes. First, the MDA contains a
    grandfathering provision which allows pre-1976 devices to remain on the market
    without FDA approval until the FDA completes the PMA. 21 U.S.C.
    § 360e(b)(1)(A); 
    21 C.F.R. § 814.1
    (c)(1). Second, the MDA contains an
    investigational device exemption (“IDE”) for new devices under clinical
    investigation to determine their safety or effectiveness. See 21 U.S.C. § 360j(g).
    In order to foster the development of useful devices, IDE procedures allow
    manufacturers to begin limited marketing of new devices without undergoing the
    rigorous PMA process. 21 U.S.C. § 360j(g)(1). Finally, a Class III device may
    reach the market without undergoing the PMA procedures if the FDA determines,
    on the basis of the § 510 process, that the device is “substantially equivalent” to a
    device already on the market. 21 U.S.C. § 360e(b)(1)(B).
    b.     Regulation of the PCA Hip Under the MDA
    On April 25, 1983, Howmedica filed a premarket notification submission
    with the FDA, seeking permission to market the PCA hip under the § 510(k)
    process. The application included sample labels, a description of the intended
    use, a description of the product (dimensions, materials, processing, and
    sterilization procedures), photographs of the components, engineering drawings,
    -9-
    and a description of test results. During the next few months, the FDA requested
    that Howmedica submit additional testing information and certification that the
    PCA hip would be used only with cement. Howmedica complied with each of
    these requests.
    On August 10, 1983, the FDA granted Howmedica permission to market the
    PCA hip for use with bone cement pursuant to the § 510(k) process “subject to the
    general controls provision of the Federal Food, Drug & Cosmetic Act.” The FDA
    also imposed several specific limitations on Howmedica: (1) the PCA hip could
    not be labeled or promoted for non-cemented use, (2) the PCA hip could only be
    used with low-viscosity cement, and (3) fixation of the PCA hip without cement
    would be considered an investigational procedure requiring an IDE.
    On October 18, 1983, Howmedica submitted an IDE application in order to
    conduct a clinical study of the PCA hip when used without cement. 2 Over the
    course of the next year, Howmedica submitted animal studies, comparative
    control groups, and other information to the FDA. On December 12, 1984, the
    FDA authorized Howmedica to conduct the clinical investigation. After that date,
    2
    Oja underwent her PCA hip surgery on July 2, 1984, when Howmedica’s IDE
    application was pending. Thus, at the time of Oja’s surgery, Howmedica had not yet
    received an IDE for cementless use. This distinguishes our case from Martin v.
    Telectronics Pacing Sys., Inc., 
    105 F.3d 1090
     (6th Cir. 1997) and Becker v. Richards
    Med. Co., 
    937 F. Supp. 181
     (N.D.N.Y. 1996).
    - 10 -
    the PCA could be used without cement in an experimental context, with a
    patient’s full informed consent.
    On September 4, 1987, the FDA issued its final rule classifying the PCA
    hip as a class II medical device when used with cement. 
    52 Fed. Reg. 33686
    ,
    33707 (codified at 
    21 C.F.R. § 888.350
    ). At that time, the FDA had determined
    that classification as a class III device was “not necessary to provide reasonable
    assurance of the safety and effectiveness of the device.” 
    21 C.F.R. § 860.93
    .
    On October 26, 1989, following the clinical investigation of the PCA hip,
    Howmedica filed a request for a PMA to market the PCA hip when used without
    cement. The FDA issued a conditional approval letter on April 2, 1991. The
    FDA conditioned final approval upon: (1) deleting one word from the proposed
    labeling, (2) providing an update of the clinical database, and (3) complying with
    future requirements, such as the summation of long-term survivorship data.
    In 1991, the FDA inspected and cited Howmedica for several regulatory
    violations, including the failure to report information that the PCA hip had caused
    serious injury in patients. In response, Howmedica informed the FDA that it
    would “voluntarily” issue a “Dear Doctor” letter to surgeons using the device,
    instructing them on the proper surgical techniques to avoid damage to the
    polyethylene liner of the cup. The FDA indicated that it had “no adverse
    comments” about the content of the letter.
    - 11 -
    On February 21, 1992, the FDA reclassified the PCA hip when used
    without cement from a class III device to a class II device. See 
    58 Fed. Reg. 3227
    (Jan. 8, 1993). Howmedica therefore invoked the § 510(k) process (rather than
    the more rigorous PMA) to obtain authorization to market the PCA hip without
    cement. On June 10, 1992, the FDA granted Howmedica permission to market the
    PCA hip when used without cement under the premarket notification procedure.
    On January 8, 1993, the FDA published its final rule classifying the PCA hip as a
    class II medical device when used without cement. 
    58 Fed. Reg. 3227
    , 3228
    (codified at 
    21 C.F.R. § 888.358
    )
    c.       MDA Preemption Analysis in Medtronic, Inc. v. Lohr
    In Medtronic, Inc. v. Lohr, 
    116 S. Ct. 2240
     (1996), the Supreme Court
    addressed whether the MDA’s general labeling regulations preempted a state law
    negligent failure to warn claim for injuries suffered by the recipient of a
    pacemaker, a class III device. 3 
    Id. at 2256-58
    . The regulations require
    manufacturers of every medical device, with a few limited exceptions, to label the
    device with “information for use, . . . any relevant hazards, contraindications, side
    effects, and precautions.” 
    21 C.F.R. § 801.109
    (c).
    3
    In a five to four decision, the Court held that the MDA did not preempt any of the
    plaintiffs’ common law claims. Justice Stevens authored the plurality opinion, which
    Justices Kennedy, Souter, and Ginsburg joined in its entirety. Justice Breyer, who
    concurred in the judgment, joined in Parts I, II, III, V, and VII of the plurality opinion.
    Thus, only those five sections constitute the opinion of the Court.
    - 12 -
    The Court began its preemption analysis by looking to the text of the
    MDA’s preemption provision (21 U.S.C. § 360k) and the FDA’s regulation
    interpreting that provision (
    21 C.F.R. § 808.1
    (d)):
    § 360k State and local requirements respecting devices
    (a) General Rule
    Except as provided in subsection (b) of this section, no State or
    political subdivision of a State may establish or continue in effect
    with respect to a device intended for human use any requirement--
    (1) which is different from, or in addition to, any requirement
    applicable under this chapter to the device, and
    (2) which relates to the safety or effectiveness of the device or to any
    other matter included in a requirement applicable to the device under
    this chapter.
    § 808.1 Scope
    (d) State or local requirements are preempted only when the Food
    and Drug Administration has established specific counterpart
    regulations or there are other specific requirements applicable to a
    particular device under the Act, thereby making any existing
    divergent state or local requirements applicable to the device
    different from or in addition to, the specific Food and Drug
    Administration requirements.
    Medtronic, 
    116 S. Ct. at 2256-58
    . The Court concluded that the statute and
    regulation evinced “an overarching concern that pre-emption occurs only where a
    particular state requirement threatens to interfere with a particular federal
    interest.” 
    Id. at 2257
    .
    Based on the MDA’s statutory language and the FDA’s regulation, the
    Court developed a two-prong inquiry to determine the preemptive scope of the
    MDA. 
    Id.
     First, a federal requirement must be “applicable to the device” in
    - 13 -
    question. 
    Id. at 2257
     (quoting 21 U.S.C. § 360k). In other words, a federal
    requirement will preempt state law only if “specific” to a “particular device.” Id.
    (quoting 
    21 C.F.R. § 808.1
    (d)). Second, a state requirement must be “with
    respect to” a medical device and must be “different from, or in addition to” a
    federal requirement. 
    Id.
     (quoting 21 U.S.C. § 360k). Accordingly, “[s]tate
    regulations of ‘general applicability’ are not preempted except where they have
    ‘the effect of establishing a substantive requirement of a specific device.’” Id.
    (quoting 
    21 C.F.R. § 808.1
    (d)(1)).
    Applying the two-prong test, the Court concluded that the MDA’s labeling
    regulations did not preempt the plaintiffs’ negligent failure to warn claim. First,
    the Court found no preemption because the federal labeling regulations reflected
    “important but entirely generic concerns about device regulation generally.” 
    Id. at 2558
    . Second, the Court concluded that the negligent failure to warn claim
    also escaped preemption because its “generality leaves [it] outside the category of
    requirements that § 360k envisioned to be ‘with respect to’ specific devices.” Id.
    d.     Application of Medtronic
    In its supplemental brief, Howmedica argues that the FDA imposed two
    warning requirements sufficient to preempt Oja’s negligent failure to warn claim. 4
    4
    Prior to the Supreme Court’s decision in Medtronic, Howmedica argued that
    several FDA “requirements” would preempt Oja’s negligent failure to warn claim. The
    Supreme Court rejected most of these grounds in Medtronic. Accordingly, in
    - 14 -
    Howmedica points to the FDA’s regulation of the PCA hip in 1983 and in 1991.
    With respect to Howmedica’s dealings with the FDA in 1983, Howmedica alleges:
    In 1983, when first deciding whether to allow Howmedica to begin
    marketing the PCA hip, the FDA four times required Howmedica to
    submit more testing, information, and certifications . . . and then
    required Howmedica to add, to all labeling and promotional materials
    for that specific device, specific warning statements that the device
    be used only with bone cement, not cementless . . . . The warnings
    specifically required by the FDA did not include any of the warnings
    that Oja asked the jury to impose under Colorado tort law.
    Applt. Supp. Brief at 4 (citations omitted).
    Under the Medtronic two-pronged preemption test, we must first determine
    whether the FDA imposed any specific federal warning requirement applicable to
    the PCA hip in its 1983 dealings with Howmedica. The record indicates that the
    FDA imposed only one labeling requirement on Howmedica: the FDA stated that
    Howmedica could not label or promote the PCA hip for non-cemented use. This
    mandate constitutes a specific federal requirement applicable to the PCA hip, but
    that does not end our preemption inquiry. Like the failure to warn claim at issue
    in Medtronic, the general state common law requirements imposed by Oja’s
    negligent failure to warn claim were not specifically developed “with respect to”
    medical devices. Medtronic, 116. S. Ct. at 2258. Instead, Oja’s negligent failure
    Howmedica’s supplemental brief filed after Medtronic, Howmedica limited its
    preemption argument to the only viable grounds remaining, namely the FDA’s dealings
    with Howmedica in 1983 and 1991. Thus, we address only these grounds.
    - 15 -
    to warn claim is predicated upon a general duty applicable to every manufacturer
    “to inform users and purchasers of potentially dangerous items of the risks
    involved in their use.” Id. Moreover, Howmedica’s general duty to warn users of
    potential dangers in this case does not have “the effect of establishing a
    substantive requirement for a specific device.” Id. at 2257. Thus, the standard of
    care governing Oja’s negligent failure to warn claim is not the type of device-
    specific requirement that would threaten the MDA’s federal interests. See id. at
    2258. Accordingly, we find no preemption based on Howmedica’s dealings with
    the FDA in 1983.
    Similarly, we find no preemption based on the FDA’s regulation of the
    PCA hip in 1991. Howmedica alleges:
    In 1991 the FDA specifically scrutinized Howmedica’s internal
    documents regarding reported problems with the PCA hip,
    reexamined Howmedica’s medical device reports pertaining to the
    PCA hip (including reports relied on by Oja at trial as evidence of
    the need for additional warnings), reexamined Howmedica’s labeling
    and warning materials, and imposed device-specific requirements for
    specific additional labeling and warnings. The warnings required by
    the FDA did not include any of the warnings that Oja asked the jury
    to require under Colorado tort law. . . .
    Applt. Supp. Brief at 3-4 (citations omitted). First, we note that any FDA
    requirement imposed in 1991 would have no preemptive effect as to Howmedica’s
    pre-1991 post-sale duty to warn. Second, the record is not clear that the 1991
    “voluntary” Dear Doctor letter even constituted an MDA “requirement” at all.
    - 16 -
    We need not resolve this question, however, because assuming arguendo that the
    warnings contained in the letter were specific federal requirements, we find no
    preemption under the second prong of the analysis employed in Medtronic. As
    with the 1983 claims, the duties imposed by Oja’s negligent failure to warn claim
    do not constitute positive enactments of state law sufficient to constitute a state
    requirement developed “with respect to” a medical device. The Court in
    Medtronic made clear that the general duty to warn of foreseeable dangers is “not
    the kind[] of requirement[] that Congress and the FDA feared would impede the
    ability of federal regulators to implement and enforce specific federal
    requirements.” Medtronic, 
    116 S. Ct. at 2258
    . Accordingly, we affirm the
    district court’s ruling that the MDA does not preempt Oja’s negligent failure to
    warn claim.
    II.   I NCONSISTENT J URY V ERDICTS
    a.      Waiver
    Howmedica next contends that we should vacate the judgment entered on
    the jury verdict in favor of Oja on her negligent failure to warn claim because it is
    irreconcilably inconsistent with the jury verdict in favor of Howmedica on Oja’s
    strict liability claims. As a preliminary matter, we must determine whether we
    may review this issue. A party’s failure to object to a general jury verdict on the
    ground of inconsistency before the jury is discharged constitutes waiver, unless
    - 17 -
    the verdict is inconsistent on its face such that entry of judgment upon the verdict
    is plain error. Hinds v. General Motors Corp., 
    988 F.2d 1039
    , 1047 (10th Cir.
    1993) (citing Diamond Shamrock Corp. v. Zinke & Trumbo, Ltd., 
    791 F.2d 1416
    ,
    1424 (10th Cir. 1986)).
    In this case, the parties do not dispute that the verdict forms required the
    jury to return a general verdict. The jury reached a verdict at 5:00 pm on the
    night before Thanksgiving. The court then read the verdict, polled the jury,
    entered judgment, and excused the jurors. Howmedica relies on Jarvis v.
    Commercial Union Assurance Cos., 
    823 F.2d 392
    , 393 (10th Cir. 1987), to
    support its position that under these circumstances, Howmedica had no
    “meaningful opportunity” to object to the verdict and therefore its failure to
    object should not constitute waiver. In Jarvis, the jury returned a verdict and
    special interrogatory answers that the trial judge recognized as arguably
    inconsistent. 
    Id. at 394
    . In open court, the judge asked the jury to review its
    verdict and answers to determine if the jury marked the forms as intended. 
    Id.
    After further deliberations, the jury sent the judge a note stating that the forms
    were correctly marked and that “if there is a conflict with the Special
    Interrogatory form and the Verdict Forms, we will need a description of this
    conflict.” 
    Id. at 395
    . The court informed the parties of the jury’s note and
    explained:
    - 18 -
    I wanted to inquire if there was an inconsistency in the jury’s mind.
    They are saying that there is none, so I am going to bring them in and
    publish the verdict.
    
    Id. at 394
    . Accordingly, the judge read the verdict, polled the jury, entered
    judgment, and discharged the jury. 
    Id.
     We held that “it would be a perverse
    default of justice to say that under the circumstances present here, counsel had
    waived the right to correct an onerous inconsistency in the jury’s resolution of his
    client’s case only because he did not raise an objection.” 
    Id. at 396
    .
    We find Howmedica’s reliance on Jarvis misplaced. In Jarvis, “the court
    summarily declared the conflict resolved and proceeded with entry of the verdict.”
    
    Id.
     Under such circumstances, an objection to the verdict as inconsistent would
    have been frivolous in light of the trial court’s disposition of the issue. In
    contrast to Jarvis, the trial court in this case did not raise and decide the issue sua
    sponte before discharging the jury. Instead, the record indicates that Howmedica
    had the opportunity to object to any inconsistencies in the verdict prior to the
    jury’s discharge or immediately thereafter. In fact, Howmedica’s counsel
    objected to at least one aspect of the verdict before leaving the courtroom. The
    attorney stated: “I think there are some problems with the verdict in that there are
    -- seems to me the punitive damages are above the compensatory.” Howmedica
    could have made similar objection to the verdict being inconsistent or complained
    that the trial court discharged the jury before Howmedica could make such an
    - 19 -
    objection. Howmedica did not do this. Under such circumstances, we hold that
    Howmedica has waived its right to object to the verdict unless it is “inconsistent
    on its face such that entry of judgment upon the verdict is plain error.” Hinds,
    
    988 F.2d at 1047
    .
    b.     Facial Inconsistency
    “A verdict that resolves separate and distinct causes of action in favor of
    both parties is not inconsistent on its face.” Harris Mkt. Research v. Marshall
    Mktg. & Communications, Inc., 
    948 F.2d 1518
    , 1522 (10th Cir. 1991). In
    contrast, when “several causes of action are identical and defended on the same
    ground, a verdict for the plaintiff on one cause of action and for the defendant on
    another is inconsistent.” Diamond Shamrock Corp., 
    791 F.2d at 1425
    .
    To determine whether the verdicts in this case are irreconcilably
    inconsistent, we must examine the relationship between strict liability and
    negligence under Colorado law. In Fibreboard Corp. v. Fenton, 
    845 P.2d 1168
    ,
    1174 (Colo. 1993) (en banc), the Supreme Court of Colorado stated:
    Under a negligence theory a plaintiff is required to prove that a
    manufacturer’s failure to warn of a risk fell below an acceptable
    standard of care. Under a strict liability theory, however, the focus
    of the inquiry is whether the defendant failed to warn of particular
    risks that were known or knowable in light of the generally
    recognized and prevailing scientific and technical knowledge
    available at the time of manufacture and distribution.
    - 20 -
    Despite the theoretical differences noted in Fibreboard Corp., we have recognized
    that Colorado has not drawn a “rigid distinction between negligence and strict
    liability failure to warn concepts.” Romero v. International Harvester Co., 
    979 F.2d 1444
    , 1452 (10th Cir. 1992). For example, as with all tort claims, the
    plaintiff must prove the elements of causation and damages. More importantly,
    “[o]ne critical area of overlap is that, ‘[r]egardless of whether a product liability
    action is grounded in negligence or strict liability, a plaintiff must prove that the
    product was defective.’” Perlmutter v. United States Gypsum Co., 
    54 F.3d 659
    ,
    663 (10th Cir. 1995) (quoting Mile High Concrete, Inc. v. Matz, 
    842 P.2d 198
    ,
    205 (Colo. 1992)). Under either theory, the product must have been defective at
    the time of sale. See Perlmutter v. United States Gypsum Co., 
    4 F.3d 864
    , 869
    (10th Cir. 1993) (holding that in a negligence claim, there is “no post-sale duty to
    warn or remedy when the product was non-defective under standards existing at
    the time of manufacture”); Fibreboard Corp., 845 P.2d at 1175 (stating that “[i]n
    [strict liability] failure-to-warn cases, a product is not defective and unreasonably
    dangerous if a particular risk is not known or knowable in light of the generally
    recognized and prevailing scientific and technical knowledge available at the time
    of manufacture and distribution”).
    In this case, the elements of defectiveness and causation were common to
    all of Oja’s claims. The record on appeal reveals that these two elements were
    - 21 -
    essentially the only elements disputed at trial. To find for Oja on her negligent
    failure to warn claim, the jury had to find that the PCA hip was defective at the
    time of sale and caused her injuries. 5 To find for Howmedica on Oja’s strict
    liability claim, the jury had to find that the PCA hip was either not defective at
    5
    The jury instruction regarding Oja’s negligent failure to warn claim stated:
    If a product manufacturer knows, or in the exercise of reasonable
    care should know, that use of the product may be harmful or injurious to a
    user, and such risk of harm or injury is not obvious to a reasonable surgeon,
    then the manufacturer must use reasonable care to warn the surgeon of the
    risk of harm or injury if, and to the extent, and in the manner, a reasonably
    careful person would warn under the same or similar circumstances.
    The duty to warn may extend beyond the time of sale of a product
    where a danger concerning the product becomes known to the manufacturer
    subsequent to the sale and delivery of the product, even though it was not
    known at the time of the sale. A manufacturer has no duty to warn surgeons
    regarding its product after the product is sold unless you find that the
    product was defective and unreasonably dangerous as originally designed
    and sold. Where dangerous defects in design come to the manufacturer’s
    attention after the device has been sold, the manufacturer has a duty to
    either remedy such defects, or, if such a complete remedy is not feasible, to
    give physicians adequate warnings and instructions concerning methods for
    minimizing danger and injury. Failure to do so is negligence.
    A manufacturer has no duty to warn surgeons using a product about
    a newly developed safety device if the product was not defective under
    standards existing at the time the product was manufactured.
    Whether or not the PCA hip was defective as originally sold should
    be determined by the standard set forth in these instructions of the
    plaintiff’s claim for sale of a defective product.
    Here, too, if the defendant had a duty to warn, it would be a duty to
    warn members of the medical profession, including the plaintiff’s surgeons.
    - 22 -
    the time of sale or did not cause her injuries. 6 Given these parameters, we hold
    that the verdict for Oja on her negligent failure to warn claim and the verdict for
    Howmedica on Oja’s strict liability failure to warn claim were facially
    inconsistent. Accordingly, we vacate the judgment of the district court and order
    a new trial.
    III.   D IRECTED V ERDICT ON T HE M ANUFACTURING D EFECT C LAIM
    In her cross-appeal, Oja argues that the district court erred in directing a
    verdict for Howmedica on Oja’s manufacturing defect claim. The district court
    concluded that Oja had failed to present any evidence to support a jury finding
    that the PCA hip contained a manufacturing defect. Instead, the court found that
    Oja had presented evidence sufficient only to permit a jury to find that the PCA
    hip suffered from a design defect.
    6
    With respect to the strict liability for failure to warn claim, the jury instructions
    stated in relevant part:
    For the plaintiff, Ms. Oja, to recover from the defendant, Howmedica, on
    her claim for sale of a defective product, you must find that all of the
    following facts have been proved by a preponderance of the evidence:
    (1) The PCA hip was defective and, because of one or more defects, it was
    unreasonably dangerous to a person who might reasonably be expected to
    use it or be affected by it;
    (2) The PCA hip was defective at the time it was sold by the defendant or
    left its control;
    (3) Plaintiff incurred injuries, damages or losses; and
    (4) The defect in the PCA hip was a cause of the plaintiff’s injuries,
    damages or losses.
    - 23 -
    We review the district court’s grant of a directed verdict de novo, applying
    the same standard used by the district court. Knight v. Snap-on Tools Corp., 
    3 F.3d 1398
    , 1401 (10th Cir. 1993). “A directed verdict is appropriate only if the
    evidence, viewed in the light most favorable to the nonmoving party, ‘points but
    one way and is susceptible to no reasonable inferences supporting’ the nonmoving
    party.” 
    Id.
     (internal citations omitted). “However, a mere scintilla of evidence is
    insufficient to create a jury question.” Honce v. Vigil, 
    1 F.3d 1085
    , 1088 (10th
    Cir. 1993). Although federal law dictates whether a directed verdict is
    appropriate, in a diversity action we examine the evidence in terms of the
    underlying burden of proof as dictated by state law. Mason v. Texaco, Inc., 
    948 F.2d 1546
    , 1554 (10th Cir. 1991).
    In Hiigel v. General Motors Corp., 
    544 P.2d 983
    , 988 (Colo. 1975), the
    Supreme Court of Colorado expressly adopted the doctrine of strict liability in
    tort for selling a product in a “defective condition unreasonably dangerous to the
    user or consumer” as stated in section 402A of the Restatement (Second) of Torts.
    To avoid a directed verdict in a strict liability action brought under Colorado law,
    a plaintiff must offer proof of each element set forth in section 402A sufficient to
    create an issue of fact. Belle Bonfils Mem’l Blood Bank v. Hansen, 
    665 P.2d 118
    , 125 n.12 (Colo. 1983). In particular, a plaintiff must offer sufficient
    evidence that the product at issue was in a “defective condition unreasonably
    - 24 -
    dangerous” at the time the product was sold to the plaintiff. White v. Caterpillar,
    Inc., 
    867 P.2d 100
    , 104-05 (Colo. Ct. App. 1993). A claim of defect can be
    premised on a manufacturing, design, or warning defect. 
    Id. at 105
    . “The
    question in manufacturing defect cases is whether the product as produced
    conformed with the manufacturer’s specifications.” Camacho v. Honda Motor
    Co., 
    741 P.2d 1240
    ,1247 (Colo. 1987). A defect in manufacturing usually occurs
    because of insufficient quality control. See, e.g., L EWIS B ASS , P RODUCTS
    L IABILITY : D ESIGN AND M ANUFACTURING D EFECTS , § 4.07, at 57 (1986).
    Under Colorado law, a plaintiff may prove a manufacturing defect by direct
    or circumstantial evidence. See Union Ins. Co. v. RCA Corp., 
    724 P.2d 80
    , 82-83
    (Colo. Ct. App. 1986). In this case, the staking peg was completely missing when
    Dr. Evans removed Oja’s PCA hip. Under such conditions, direct proof of a
    defect in the staking peg was impossible. See 
    id. at 83
    . Accordingly, Oja relied
    exclusively on circumstantial evidence to support her manufacturing defect claim.
    Oja’s surgeon testified that he made only a visual check for improper
    staking before implanting the PCA hip. Her expert concluded that although the
    surgeon saw no noticeable defect in the device, the PCA hip could still have
    suffered from an internal manufacturing defect in the staking peg. To support her
    claim, Oja introduced evidence that Howmedica received at least two product
    experience reports (“PERs”) describing instances in which surgeons discovered a
    - 25 -
    staking problem only after implanting the PCA hip and performing a trial
    reduction.
    In addition to those two PERs, Oja submitted six other PERs describing
    inadequate staking in PCA hips manufactured near the time Howmedica
    manufactured Oja’s PCA hip. In particular, Howmedica received a PER on
    February 1, 1984, that stated:
    Nature of Complaint [By Surgeon]: Please replace to my stock--
    no charge--while dislocating the hip during a trial reduction in
    surgery the plastic core came out of metal backing.
    Results of Evaluation [By Howmedica Employee]: The assembly
    staking on above part was inadequate. We have established a push
    test & careful visual inspection (100%) on PCA acetabular cup
    assemblies which should preclude such failures.
    Similarly, Howmedica received a PER on August 27, 1984, that stated:
    Nature of Complaint [By Surgeon]: Customer complains that the
    HDP is not close enough in the metal part.
    Results of Evaluation [By Howmedica Employee]: As received the
    fit of the insert to the cup was excellent but the stake holding the
    components together was poor. This part was of very early
    production (Oct. 1983) and the staking process still required
    improvement. The process has been improved and we have also
    added a “push test” to the stake to assure adequate assembly.
    Finally, Oja submitted evidence indicating that Howmedica rejected one of
    the PCA hips from the same lot as Oja’s PCA hip because of a staking problem.
    The remaining devices in her lot underwent a “tightness of plastic insert to cup
    VISUAL” test. Howmedica did not, however, conduct any other performance
    - 26 -
    tests on the lot of PCA hips containing her hip. Oja claims the absence of
    adequate inspection and testing procedures increased the likelihood that her PCA
    hip suffered from a manufacturing defect.
    We have carefully reviewed the record and conclude that Oja presented
    sufficient evidence from which a jury could reasonably conclude that Oja’s PCA
    hip suffered from a manufacturing defect. The staking peg in Oja’s PCA hip was
    completely missing. Within a year of the device’s manufacture, Howmedica sent
    a number of other PCA hips to surgeons that did not “conform to [Howmedica’s]
    specifications” because of inadequate staking. See Camacho, 741 P.2d at 1247.
    The PERs strongly suggest that problems with inadequate staking were not
    infrequent during early production of the PCA hip. More importantly, the PERs
    indicate that the problems could have been caused by inadequate testing and
    inspection in the manufacturing process, in addition to inadequate design. Under
    such circumstances, we hold that a jury could reasonably conclude that Oja’s PCA
    hip suffered from a manufacturing defect.
    CONCLUSION
    We AFFIRM the district court’s order finding that the MDA does not
    preempt Oja’s negligent failure to warn claim. We VACATE the judgment
    entered on the jury’s verdict and REMAND for a new trial because we hold that
    - 27 -
    the jury’s verdict for Howmedica on the strict liability failure to warn claim but
    against Howmedica on the negligent failure to warn claim are irreconcilably
    inconsistent. We also REVERSE the directed verdict for Howmedica on Oja’s
    strict liability manufacturing defect claim. Because we remand for a new trial, we
    do not address the remaining issues presented on appeal.
    - 28 -