Evans v. Scanson and Peters , 388 Mont. 69 ( 2017 )


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  •                                                                                                06/27/2017
    DA 16-0363
    Case Number: DA 16-0363
    IN THE SUPREME COURT OF THE STATE OF MONTANA
    
    2017 MT 157
    KERRIE EVANS,
    Plaintiff and Appellant,
    v.
    PEGGY SCANSON, CNP and WILLIAM PETERS, M.D.,
    Defendants and Appellees.
    APPEAL FROM:            District Court of the Eighteenth Judicial District,
    In and For the County of Gallatin, Cause No. DV 11-990B
    Honorable Mike Salvagni, Presiding Judge
    COUNSEL OF RECORD:
    For Appellant:
    E. Casey Magan, Russell S. Waddell, Waddell & Magan, Bozeman,
    Montana
    For Appellees:
    Julie Lichte, Danielle A.R. Coffman, Jill Laslovich, Crowley Fleck PLLP,
    Bozeman, Montana
    John A. Scully, Cooper & Scully, Dallas, Texas
    (Attorneys for Peggy Scanson, CNP)
    Lisa A. Speare, William J. Speare, George T. Kimmet, Speare Law Firm,
    Billings, Montana
    (Attorneys for William Peters, M.D.)
    Submitted on Briefs: April 19, 2017
    Decided: June 27, 2017
    Filed:
    __________________________________________
    Clerk
    Justice Laurie McKinnon delivered the Opinion of the Court.
    ¶1     Kerrie Evans (Evans) appeals from a jury verdict after a nine-day trial in the
    Eighteenth Judicial District Court that found Peggy Scanson (Scanson) and William Peters,
    M.D. (Dr. Peters) did not deviate from the standard of care when providing Evans with
    prenatal care. Evans seeks a new trial or amended judgment based on our disposition of
    the following issues:
    1. Whether the District Court erred by admitting collateral source testimony under
    the rule of curative admissibility.
    2. Whether the District Court abused its discretion by ruling expert testimony was
    within the scope of its corresponding disclosure and otherwise admissible.
    3. Whether the District Court erred by refusing to grant a new trial or alter the
    judgment after hearing defense counsel’s closing argument.
    ¶2     We affirm.1
    FACTUAL AND PROCEDURAL BACKGROUND
    ¶3     Kerrie Evans’ child was born in 2010 with Cystic Fibrosis (CF), a chronic condition
    that will require medical care for the rest of her life. Faced with the prospect of paying for
    years of medical expenses, Evans filed suit to recover against the medical professionals
    who provided her with prenatal care and counseling because, she alleged, she would have
    opted to abort her pregnancy had she been timely provided with the child’s CF diagnosis
    in utero. Evans saw Scanson, a nurse practitioner at Livingston HealthCare, for a prenatal
    1
    Evans asked that we consider her fourth issue, whether the District Court erred by refusing to
    grant partial summary judgment on the issue of causation, if we “reversed and remanded under
    Issues 1-3[.]” Accordingly, since we affirm the District Court on issues 1-3, we do not consider
    Evans’ fourth issue.
    2
    care appointment in October of 2009. Evans was 38 years old. Scanson’s notes from this
    visit indicate the fetus was at risk for Down syndrome due to Evans’ advanced age, that
    Evans wanted the fetus tested, and that Evans would abort for an abnormality. During that
    initial visit, Scanson provided Evans with pamphlets containing information on pregnancy,
    childbirth, and prenatal screening and diagnosis for genetic disorders, including CF.
    ¶4     One of the pamphlets focused on CF screening and diagnosis. CF is a genetic
    disease, but the age of the mother does not increase its probability of occurrence, as is the
    case with Down syndrome. The pamphlet explained that testing for CF begins with an
    analysis of test samples from both parents to determine whether they carry the CF gene.
    The brochure stated that, if both parents are carriers, there is a one-in-four chance their
    child will have CF and “further prenatal testing can be done to see whether [the] baby has
    CF.” If both parents carry the CF gene, the additional prenatal tests to determine whether
    the baby will have CF are chorionic villus sampling (CVS), and amniocentesis.
    ¶5     Accordingly, one of the pamphlets Scanson gave Evans also provided information
    on amniocentesis and CVS, explaining that pregnant women who are 35 or older on their
    due date should opt for one of these tests because “the risk of having an infant with a
    chromosomal problem such as Down syndrome increases with the age of the woman.” The
    brochure discussed the differences between the two tests, particularly that CVS can be
    performed earlier in the pregnancy. Scanson recalled, and her notes confirmed that Evans
    was concerned during the visit that her child would have Down syndrome and that she
    would opt to abort if that were so. Evans alleged, however, that she asked for CF testing
    as well as testing for Down syndrome.
    3
    ¶6     According to Scanson, she gave Evans the pamphlet on prenatal testing and
    informed her that Dr. Peters could perform the CVS. Scanson stated that Evans preferred
    CVS over amniocentesis because it could be performed sooner than amniocentesis and
    would test for Down syndrome. At that time, Scanson also informed Evans that Dr. Peters
    would need an ultrasound of the fetus prior to performing the test. After scheduling the
    ultrasound, Scanson returned to the exam room and began discussing CF with Evans.
    Scanson showed Evans the CF pamphlet and discussed the information it provided,
    stressing that it was important. Scanson instructed Evans to read the pamphlet and review
    it with her husband. Evans agreed at trial that the pamphlet’s information was “fairly
    clear,” but in the end, she and her husband did not read through the information Scanson
    provided, including the pamphlet on CF, until after her daughter was born.
    ¶7     Scanson also instructed Evans to schedule mandatory genetic counseling prior to
    the CVS test. In conjunction with Scanson’s instruction, Dr. Peters sent Evans a letter
    explaining that she needed to call the genetic counselor for an appointment prior to the
    CVS test. The record reflects that Evans declined the genetic counseling because she was
    concerned about its expense. Dr. Peters nonetheless performed the CVS test. Dr. Peters
    testified at trial that, during Evans’ visit for CVS, he explained to her that CVS could
    identify chromosomal abnormalities like Down syndrome. He again instructed her to
    schedule genetic counseling and informed her that if she wanted, he could draw her blood
    for CF carrier screening, and that additional testing was available if she returned a positive
    result. She did not ask for the initial CF carrier screening.
    4
    ¶8     Evans filed a complaint on October 21, 2011, alleging that Scanson, Dr. Peters, and
    other defendants did not sufficiently inform her that the CVS she received would only test
    for Down syndrome and certain other abnormalities, but not CF. She asserted claims in
    equity, negligence, negligent misrepresentation, and negligent infliction of emotional
    distress. By the time of trial, only Scanson and Dr. Peters remained as defendants to the
    suit, and Evans’ theories of recovery had been winnowed to negligent infliction of
    emotional distress and negligence, as a medical malpractice action. The jury found that
    Scanson and Dr. Peters did not breach the standard of care in treating Evans and so did not
    consider the remaining elements of negligence—causation and damages.                Whether
    Scanson’s and Dr. Peters’ treatment fell below the standard of care turned on whether they
    had adequately informed Evans of her genetic screening options, and the credibility of her
    own testimony that she would have aborted her pregnancy had she known of an
    abnormality. Although Evans testified to her concerns of genetic disorders and to her
    willingness to terminate her pregnancy, Scanson and Dr. Peters testified that Evans had
    been adequately informed of her screening options and the nature of the tests she would
    undergo when Peters wrote and advised her and when Scanson provided her with brochures
    on CF and genetic counseling resources.
    ¶9     At trial, Evans introduced testimony relating to her insurance coverage and medical
    expenses to counter defense assertions that she would have declined medical services like
    genetic counseling because of cost, and also to establish the extent of her damages and
    cause of her mental anxiety relating to her negligent infliction of emotional distress claim.
    She objected and sought a mistrial, however, when the District Court permitted the jury to
    5
    hear similar evidence when it was elicited by defense counsel. Evans argued at trial, as she
    does on appeal, that the defense’s line of questioning and testimony violated Montana’s
    statutory prohibition against a jury hearing collateral source evidence, § 27-1-308(3),
    MCA. Evans made similar arguments regarding expert testimony that centered on the
    affordability of care and treatment options available for individuals with CF. At the
    conclusion of the trial, she premised her motion for a new trial in part on the injection of
    such collateral source testimony throughout trial, and in part on certain of defense counsel’s
    closing statements, which she alleged were inflammatory. She seeks reversal of the District
    Court’s denial of her motion for mistrial and her post-trial motion for new trial. We affirm
    the District Court’s rulings denying her motions.
    STANDARDS OF REVIEW
    ¶10    We review a district court’s evidentiary rulings for an abuse of discretion, which
    occurs if the court acts arbitrarily without employment of conscientious judgment, or if it
    exceeds the bounds of reason and substantial injustice results. Byrum v. Andren, 
    2007 MT 107
    , ¶ 15, 
    337 Mont. 167
    , 
    159 P.3d 1062
    . We review a district court’s denial of a motion
    for a mistrial or an M. R. Civ. P. 59 motion for a new trial for a manifest abuse of discretion.
    A manifest abuse of discretion is obvious, evident, or unmistakable, and significant enough
    to materially affect the substantial rights of the complaining party. A district court’s denial
    of a mistrial must be based on whether the moving party was denied a fair and impartial
    trial. We will not lightly disturb the district court’s determination to deny a mistrial, as the
    district court is in the best position to determine the prejudicial effect of attorney
    6
    misconduct on the jury. O’Connor v. George, 
    2015 MT 274
    , ¶ 17, 
    381 Mont. 127
    , 
    357 P.3d 323
    .
    DISCUSSION
    ¶11 Issue 1: Whether the District Court erred by admitting collateral source testimony
    under the rule of curative admissibility.
    ¶12    Evans’ concerns of cost were central to the District Court’s evidentiary rulings that
    comprise the primary basis of this appeal. Indeed, in her complaint, Evans stated that
    “[g]enetic counseling should also have been covered in full as a maternity benefit under
    [Evans’] BCBS insurance, and would have cost her nothing.”              At trial, Evans first
    introduced her concerns of cost during voir dire, stating that she could not afford the child’s
    medical expenses and so had to sue to recover from her healthcare providers. In her
    opening statement too, her counsel informed the jury that, “[Evans and her husband] can’t
    afford that type of extraordinary care that a child would need.” Although Evans had filed
    for and been granted two motions to exclude collateral source evidence, including evidence
    of Evans’ health insurance, Evans nevertheless introduced evidence of her health
    insurance. On direct examination, Evans’ counsel elicited testimony from Evans that
    indicated she would not have refused genetic counseling on the basis of cost because she
    had excellent health insurance as a federal employee. She answered additional questions
    on direct examination about her out-of-pocket expenses, co-pays, the identity of her carrier,
    and the existence and scope of her insurance coverage. Evans also testified to her fear of
    being unable to afford her daughter’s medical care. During closing statements, Evans’
    7
    counsel proffered that it would be illogical to conclude that Evans would “decline anything
    due to costs when she had health insurance, which she testified to covered everything.”
    ¶13     On cross-examination, Scanson’s counsel moved outside of the jury’s presence to
    be allowed to ask Evans questions regarding her insurance coverage, arguing that Evans
    had opened the door to examine the topic of health insurance by giving the jury the
    impression she is financially unable to care for her child. Evans’ counsel countered that
    only Evans should be allowed to introduce evidence of her health insurance, to which
    Scanson’s counsel replied, “my client [should] not be prejudiced by the Plaintiff’s decision
    to inject health insurance into the trial without me being able to explain and address the
    health insurance situation.” The District Court granted Scanson’s motion and permitted
    defense counsel to question Evans on whether she had health insurance, and what the policy
    provisions were. Yet, to narrow the breadth of questioning under the collateral source rule,
    the court did not permit defense counsel to question Evans on the amounts the policy paid
    for her medical expenses, or what the limits of her coverage were. Additionally, the court
    limited the nature of defense counsel’s inquiry to Evans’ claim for emotional distress, since
    Evans had premised that claim on anxiety arising from her baby’s unaffordable medical
    care.   To comply with the court’s instructions, Scanson’s counsel asked Evans five
    questions regarding insurance: (1) whether Evans had insurance through her employer; (2)
    how long she had that insurance; (3) whether her insurance covered her child; (4) whether
    her insurance covered the child from birth; and (5) whether the child was currently covered
    by insurance.
    8
    ¶14    On appeal, Evans argues that she was forced to introduce evidence of insurance
    coverage to refute the defense claim that she refused genetic counseling because of its
    expense. Scanson and Dr. Peters argue that Evans in fact exceeded that threshold by
    introducing evidence of insurance not only during her pregnancy, when the genetic
    counseling was at issue, but also post-partum, introducing evidence of her out-of-pocket
    expenses for the child’s medication and the general cost of her daughter’s medical care.
    Scanson claims in response that Evans should not be permitted to open the door to these
    topics without an opportunity for Scanson to respond.
    ¶15    “Under the rule of curative admissibility, or the ‘opening the door’ doctrine, the
    introduction of inadmissible evidence by one party allows an opponent, in the court’s
    discretion, to introduce evidence on the same issue to rebut any false impression that might
    have resulted from the earlier admission.” Stevenson v. Felco Indus., 
    2009 MT 299
    , ¶ 40,
    
    352 Mont. 303
    , 
    216 P.3d 763
    (quoting U.S. v. Whitworth, 
    856 F.2d 1268
    , 1285 (9th Cir.
    1988)). Despite the potential prejudice to a plaintiff, collateral source information may be
    introduced where there has been a persuasive showing that the evidence has substantial
    probative value. Mickelson v. Mont. Rail Link, Inc., 
    2000 MT 111
    , ¶ 38, 
    299 Mont. 348
    ,
    
    999 P.2d 985
    .     Here, the proffered testimony complies with the rule of curative
    admissibility and our rule in Mickelson. Scanson’s counsel elicited collateral source
    testimony only after Evans had herself injected collateral source matters into the
    proceedings—in her complaint, in voir dire, and on direct examination. The District Court
    was therefore entitled to exercise its discretion in admitting rebuttal evidence on the same
    issue under the rule of curative admissibility articulated in Stevenson. In light of Evans’
    9
    repeated references to collateral source information, the fact that she made affordability the
    cornerstone of her negligent infliction of emotional distress claim, and her assertion she
    would not have refused genetic counseling because of her adequate insurance coverage,
    the District Court did not arbitrarily admit the rebuttal evidence without conscientious
    judgment.    Neither can we conclude that Evans suffered substantial injustice by its
    admission, since she first determined herself that such evidence was at issue and ought to
    be brought into the proceedings. Thus, despite the potential for such evidence to prejudice
    the jury, it bore substantial probative value to the plaintiff as a tenet of her claims, and to
    the defendant as a means of impeachment. We note here too, that the District Court took
    steps to dispel the potential prejudicial effect of defense counsel’s efforts by limiting the
    scope of the permitted inquiry to whether Evans had insurance and the nature of its
    provisions. That limitation, coupled with the precision of defense counsel’s questioning,
    constrained the potentially prejudicial effects the evidence may have had on the jury and
    enhanced its probative value such that its admission sufficiently complied with our rule in
    Mickelson.
    ¶16 Issue 2: Whether the District Court abused its discretion by ruling expert testimony
    was within the scope of its corresponding disclosure and otherwise admissible.
    ¶17    Evans argues also that the District Court erred by refusing her motion for a mistrial
    following the testimony of her expert witness, Dr. Lysinger, who testified regarding the
    expense of Orkambi, a drug used to treat CF. At trial, Dr. Lysinger testified on direct
    examination that he had been told by a pharmacist that Orkambi costs $294,000 per year.
    On cross-examination, Scanson’s counsel asked him whether he was aware that Orkambi’s
    10
    manufacturer had “a program that is designed to help cystic fibrosis families and physicians
    understand how to obtain Orkambi.” Evans objected to this question and others like it on
    collateral source grounds. The District Court sustained the objections and the witness did
    not answer. The court had already instructed the jury that, “when I strike an answer that
    means that you’re . . . to disregard the answer[.] I’m not allowing the answer and you’re
    not to consider the answer.” Evans moved for a mistrial, arguing that Scanson had raised
    the issue of insurance or other collateral sources. The District Court denied the motion
    after an in-chambers discussion, agreeing with defense counsel that the line of questioning
    had not violated the court’s order against introducing evidence of collateral sources or
    insurance, but was instead meant to impeach the witness’s credibility and show the witness
    did not “research whatsoever into the cost of the drug.” The court took the additional
    curative step of providing a final jury instruction that cautioned the jury against guessing
    the answer to any stricken question or drawing inferences from the question itself.
    ¶18    Evans also argues the District Court abused its discretion by overruling her
    objections concerning the testimony of Dr. Merlo, a pulmonary and critical care specialist
    from Johns Hopkins specializing in CF, who was called as a defense expert to rebut the
    opinions of Evans’ experts. Evans objected to Dr. Merlo’s testimony as outside the scope
    of his expert disclosure and because, she alleged, he testified to collateral source
    information. Scanson disclosed Dr. Merlo as an expert who would not only testify to “rebut
    the opinions of Plaintiff’s experts[,]” but also regarding the medical treatment of adult
    patients with cystic fibrosis; the long-term management of CF; and that CF is a chronic,
    manageable disease. Evans objected initially on disclosure grounds when Scanson’s
    11
    counsel asked Dr. Merlo whether he “ever had the situation where a cystic fibrosis patient
    in need of a cystic fibrosis drug was unable to obtain it[.]” After examining the expert
    disclosure, the District Court overruled Evans’ objection and permitted Dr. Merlo to
    answer. When the question was repeated for the record, Evans objected again, this time on
    collateral source grounds, which the District Court overruled. Evans soon objected to
    another question, also on collateral source grounds, which the court sustained:
    [By Scanson’s counsel] Q: Have you ever had a patient who was
    unable to get Orkambi [the $294,000 per year drug] due to cost?
    A: No
    [By Evans’ counsel]: Objection Your Honor, Collateral Source.
    Outside the scope of disclosure as well.
    THE COURT: Sustained. The answer is stricken.
    ¶19    When counsel objects to the admission of evidence, the district court is presumed
    to have cured any error committed by sustaining counsel’s objection, striking the evidence
    from the record, and instructing the jury to disregard the evidence. State v. West, 
    252 Mont. 83
    , 91, 
    826 P.2d 940
    , 945 (1992). Evans made multiple objections to the testimony given
    by Dr. Lysinger. The court sustained the objections, and had instructed the jury that it was
    to disregard the testimony. The error alleged by Evans because of that stricken testimony
    is therefore presumed cured. In examining the record, and in light of the great deference
    we afford a district court’s determination to deny a mistrial, we cannot conclude that the
    District Court here committed a manifest abuse of discretion by striking the testimony,
    conducting an in-chambers hearing and instructing the jury, but refusing to grant a mistrial.
    12
    The District Court overruled Evans’ collateral source objection, however, when Dr. Merlo
    was questioned. We conclude that this question, probing the accessibility of Orkambi,
    served as rebuttal to Dr. Lysinger’s testimony that Orkambi costs $294,000 per year. As
    such, it fell within the rule of curative admissibility and bore sufficient probative value to
    overcome any prejudice to the jury.
    ¶20    We further conclude that the District Court did not abuse its discretion by ruling Dr.
    Merlo’s testimony fell within the scope of his expert disclosure. The rule of evidence
    governing expert disclosures, M. R. Civ. P. 26, is meant to eliminate surprise and promote
    the effective cross-examination of witnesses. Hawkins v. Harney, 
    2003 MT 58
    , ¶ 26, 
    314 Mont. 384
    , 
    66 P.3d 305
    . Refusing the testimony of an expert is an extreme sanction when
    the offense arises from incomplete discovery, but one which we have upheld when
    opposing counsel’s ability to effectively cross-examine the witness has been severely
    limited. Hawkins, ¶¶ 22-23. But even a brief expert disclosure, so long as it identifies the
    facts and opinions to which the expert is expected to testify, can be sufficient to eliminate
    the possibility that opposing counsel will be surprised by the testimony or unable to
    adequately prepare for cross-examination. Hawkins, ¶¶ 25-26. Here, the District Court did
    not exceed the bounds of reason or act arbitrarily by admitting Dr. Merlo’s testimony.
    Defense counsel laid out the basis of his testimony as rebuttal evidence to the plaintiff’s
    expert, who testified to the exorbitant costs of caring for patients with CF. The disclosure
    additionally revealed that he would testify to the manageability and medical treatment of
    the disease. It was reasonable therefore, for the District Court to conclude that, based on
    this disclosure, plaintiff’s counsel could adequately prepare to cross-examine him when
    13
    and if his testimony addressed his own experience of dealing with patients who might have
    had difficulty procuring the costly medications required to treat the disease. The disclosure
    at issue here in fact exceeds what we previously upheld in Hawkins, where the grounds for
    the expert’s opinions were addressed with the phrase, “standard veterinary teaching and
    practice.” Hawkins, ¶ 25. We conclude therefore that the District Court did not abuse its
    discretion by admitting Dr. Merlo’s testimony over Evans’ objection.
    ¶21 Issue 3: Whether the District Court erred by refusing to grant a new trial or alter
    the judgment after hearing defense counsel’s closing argument.
    ¶22    Evans lastly argues that Scanson’s and Dr. Peters’ counsel made inflammatory
    statements during closing arguments that were sufficiently prejudicial to constitute
    reversible error. She argues that the statements, which exhorted the jury to ponder the
    immensity of the award sought, violated a Motion in Limine previously filed by counsel,
    but never adopted by the District Court. Evans did not, however, contemporaneously
    object to these statements at trial. Evans did object though, when, during closing, Dr.
    Peters’ counsel admonished the jury that Evans’ child was not the plaintiff in the case, and
    that although under Montana law a parent is entitled to bring an action on behalf of a child,
    Evans had not done so, opting instead to recover for her own damages and not those of the
    child. To that, the District Court issued an instruction that there had “been no determination
    under Montana law as to whether a parent can bring a cause of action on behalf of the
    parent’s child relating to the issues involved in this case.” Evans argues here that the
    instruction was insufficient, prejudicial, and warranted granting her motion for a new trial,
    or to alter or amend the judgment. The District Court did not rule on her motion for a new
    14
    trial and so the motion was deemed denied pursuant to M. R. Civ. P. 59. See Challinor v.
    Glacier Nat’l Bank, 
    283 Mont. 342
    , 344, 
    943 P.2d 83
    , 84 (1997).
    ¶23    A party who fails to contemporaneously object to purportedly impermissible
    comments during closing argument forfeits the right to appeal that error. To preserve an
    issue for appeal, a party must object when the grounds for the objection become apparent.
    McDermott v. Carie, 
    2005 MT 293
    , ¶ 14, 
    329 Mont. 295
    , 
    124 P.3d 168
    . If defense counsel
    made the allegedly inflammatory comments during closing argument, the grounds for
    objection became apparent during the closing argument. Evans argues the comments
    violated a proposed Order in Limine that addressed inflammatory statements and so
    obviated the need to object. We disagree. Ultimately, the District Court did not adopt the
    proposed order and so reliance upon it does not bolster Evans’ arguments on appeal.
    Regardless of the order, however, if Evans believed the comments were inflammatory,
    Evans should have objected and stated so when the comments were made, allowing the
    court to rule on the issue. A party may not preserve an issue for appeal, even if based on
    an opponent’s violation of an order in limine, without the party first obtaining a definitive
    ruling from the district court on the issue. State v. Favel, 
    2015 MT 336
    , ¶ 19, 
    381 Mont. 472
    , 
    362 P.3d 1126
    . We decline to create such precedent here.
    ¶24    Evans did timely object, however, to Dr. Peters’ statement that parents in Montana
    are legally entitled to bring an action on behalf of their minor children, but chose not to do
    so in this action. On appeal, she argues this was an inflammatory statement that prejudiced
    the jury to believe she was acting out of avarice for herself instead of her child’s well-
    being. If the statement was inflammatory, Evans’ argument that the District Court’s jury
    15
    instruction did not adequately address Dr. Peters’ statement of the law has shortcomings.
    Although the District Court has an obligation to ensure a fair trial, a fair trial is not
    necessarily an error-free trial. To support her argument, Evans calls our attention to Lopez
    v. Josephson, 
    2001 MT 133
    , ¶ 35, 
    305 Mont. 446
    , 
    30 P.3d 326
    . There, we stated that,
    “[t]he repeated asking of questions clearly intended to keep the assumption of damaging
    facts which cannot be proven before the jury, in order to impress upon their minds the
    probability of the existence of the assumed facts upon which the questions are based,
    constitutes gross misconduct.” Lopez, ¶ 35. And indeed, in Lopez, we found error where
    the District Court allowed counsel to repeatedly inject evidence into the proceedings after
    he had been cautioned against it—to the extent we found it “difficult to grasp just how
    ubiquitous and egregious the conduct of plaintiffs’ counsel was[,]” and that “[o]nly a
    complete transcript review [could] establish the actual extent of counsel’s misconduct.”
    Lopez, ¶ 36. We do not find the alleged misconduct here nearly so pervasive or pernicious.
    Here, counsel made a single statement during closing that arguably reflected an accurate
    statement of Montana law. Evans objected to the statement and, after an in-chambers
    hearing, the District Court issued a curative instruction to the jury that explained counsel’s
    statement might not be entirely accurate given the facts of the case. This does not rise to
    the level of egregious conduct and inadequate cure by the District Court that we identified
    in Lopez.
    ¶25    Moreover, since Evans objected to the comment contemporaneously, the District
    Court was able to take effective corrective action by issuing a curative instruction. Our
    review of the record reveals a thorough discussion of the comment at issue and the current
    16
    state of Montana law, in addition to ways in which the District Court could adequately
    address Evans’ concerns over the comment. To that end, the District Court formulated the
    curative instruction in discussion with all counsel present, revised it more than once to
    address Evans’ counsel’s concerns, sought his definitive approval of the final wording, and
    then wrote it down to preserve the exact wording for presentation to the jury. Evans’
    counsel did not object to the instruction or state during the hearing that it would
    inadequately remedy defense counsel’s remark. We conclude upon our review of the
    proceedings that this instruction, which Evans’ counsel sought and argued, did not
    prejudice Evans’ right to a fair trial, especially given that Evans’ counsel participated in
    and did not object to its formulation.
    ¶26    A district court is in the best position to observe jurors and the potentially prejudicial
    effects of evidence presented to them. We, accordingly, afford district courts broad
    discretionary latitude when ruling on prejudicial evidence. O’Connor, ¶ 17. When a
    district court withdraws or strikes improper testimony from the record and provides the
    jury an accompanying cautionary instruction, the error committed is presumed cured.
    Reciprocally, we do not presume that the jury will ignore the district court’s instructions.
    State v. Long, 
    2005 MT 130
    , ¶¶ 25-27, 
    327 Mont. 238
    , 
    113 P.3d 290
    . Here, the District
    Court was in the best position to gauge the effect of the statement on the jury and its ability
    to deliver a fair verdict. The court’s instruction is presumed to have cured the error alleged,
    particularly given Evans’ counsel’s approval of it as a remedy and his participation in its
    formulation. We do not find in our review of the record here any evidence of misconduct
    comparable to the behaviors we discovered in Lopez, which would be sufficient to
    17
    overcome the presumption that the instruction cured the error. The District Court did not
    therefore exhibit an obvious abuse of discretion significant enough to materially affect
    Evans’ substantial rights when it issued the curative jury instruction in response to the
    comment.
    CONCLUSION
    ¶27   The judgment and rulings of the District Court are affirmed.
    /S/ LAURIE McKINNON
    We Concur:
    /S/ MIKE McGRATH
    /S/ JAMES JEREMIAH SHEA
    /S/ BETH BAKER
    /S/ DIRK M. SANDEFUR
    18