Lewis C. Colley, Et Ux. v. Peacehealth ( 2013 )


Menu:
  •       IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
    LEWIS C. COLLEY and TALENA
    COLLEY, husband and wife, and the          No. 68267-9-I
    marital community thereof,
    DIVISION ONE
    Appellants,                                       CO
    v.
    ro
    PEACEHEALTH, a not for profit                                         CD
    Washington State corporation d/b/a
    ST. JOSEPH HOSPITAL and
    ST. JOSEPH MEDICAL GROUP,
    Respondent,            UNPUBLISHED OPINION
    JIAN Y. SUN, M.D. and JOHN DOE             FILED: September 3, 2013
    SUN, husband and wife and the marital
    community thereof; JANICE LUND and
    JOHN DOE LUND, husband and wife
    and the marital community therefor;
    K. HANBURYand JOHN DOE
    HANBURY, husband and wife and the
    marital community therefor; MELISSA
    DYKSTRA and JOHN DOE DYKSTRA,
    husband and wife, and the marital
    community thereof; NORTHWEST
    EMERGENCY PHYSICIANS, INC., a
    Washington State for profit corporation;
    RALPH WEICHE and JANE DOE
    WEICHE, husband and wife, and the
    marital community thereof; and JANE
    and JOHN DOES 1-10,
    Defendants.
    No. 68267-9-1/2
    Becker, J. — This appeal arises from a jury's defense verdict in a medical
    negligence action against PeaceHealth St. Joseph Hospital in Bellingham. The
    hospital patient and his wife contend the trial court admitted evidence that was
    speculative, irrelevant, and unfairly prejudicial. Finding no basis for granting a
    new trial, we affirm.
    FACTS
    The hospital patient is appellant Lewis Colley. In the spring of 2006, when
    he was around 45 years old, Colley began complaining of recurrent abdominal
    pain. On May 4, 2006, Colley's pain was severe. At around 7:45 p.m., he and
    his wife, Talena, went to the emergency room at the hospital. The emergency
    room physician suspected pancreatitis and prescribed morphine for pain relief.
    Colley's pain did not abate despite repeated doses of morphine and one
    dose of dilaudid. Around 2:00 a.m. on May 5, he was admitted to the observation
    unit.
    Several months earlier, in January 2006, Colley had been diagnosed with
    severe sleep apnea. Sleep apnea is a condition in which a patient stops
    breathing for periods of time while asleep. It was uncontested at trial that
    morphine tends to suppress respiration and that when patients with sleep apnea
    are given morphine, they need to be carefully monitored to ensure they are
    getting enough oxygen.
    While Colley was at the hospital on May 4 and 5, Talena observed that he
    was having difficulty breathing. She testified that she told several different
    No. 68267-9-1/3
    hospital employees that Colley suffered from sleep apnea. The sleep apnea
    condition was noted in Colley's chart by attending nurse Dawn Hooker at 3:35
    a.m. At some point thereafter, Talena made a quick trip home to pick up the
    breathing device Colley used while sleeping, called a CPAP (continuous positive
    airway pressure) machine.
    Talena testified that she returned to the hospital around 5:40 a.m., found
    Colley not breathing, and alerted the nursing staff. A respiratory therapist and a
    physician, Dr. Jian Sun, were called. A breathing tube was fed into Colley's
    throat, and he was taken to the intensive care unit and hooked up to an oxygen
    supply.
    One of Colley's witnesses testified at trial that blood oxygen saturation
    becomes "critical" when the percentage falls below 60 percent, while at 80
    percent, it generally causes only shortness of breath. A defense expert testified
    that 80 percent could be "right on the precipice of a severe deprivation of
    oxygen, depending on how frequently the apnea episodes were occurring.
    Colley's oxygen saturation level was documented in his medical chart as 97
    percent at intake at 2:13 a.m. and 92 percent at 4:11 a.m. There was no further
    record of it until 5:45 a.m., soon after he was hooked up to an oxygen supply. At
    that point his blood oxygen saturation was noted to be "in the 80s." At 6:04 a.m.,
    his oxygen level was 89.5 percent. At 7:10, his oxygen level had risen to 98.5
    percent. There was no way to know what his saturation level had been between
    4:11 a.m. and 5:45 a.m.
    No. 68267-9-1/4
    Five days later, Colley was discharged from the hospital. His abdominal
    pain had abated, but Talena observed changes in his personality and mental
    state that she attributed to the episode of respiratory failure. Talena testified that
    while Colley had been a jolly, happy, sociable, and capable man before the
    hospitalization, afterwards he became reclusive, fearful, and angry, he suffered
    from severe memory deficits, and he was generally unable to function normally
    without close supervision. She testified, "It's like I took my husband to the
    hospital and they sent me home with a stranger."
    The Colleys sued the hospital in July 2008, alleging that Colley suffered
    permanent brain injury due to the hospital's negligence in dealing with the
    episode of respiratory failure. The case came to trial before a jury in November
    2011. Trial lasted nine court days, spanned four weeks, and included testimony
    by 30 witnesses, most of whom were medical professionals.
    In the plaintiffs case, Dr. Ted Judd, a neuropsychologist, testified that
    Colley had a severe short-term memory deficit of a kind routinely associated with
    deprivation of oxygen. Dr. Arthur Ginsberg, a neurologist, testified that Colley's
    short-term memory deficit was caused, more probably than not, by brain damage
    resulting from the loss of oxygen associated with his respiratory failure. He
    explained that an injury to the brain that causes a memory deficit is not visible by
    imaging such as a computed tomography (CT) scan or a magnetic resonance
    imaging (MRI). Dr. Steven Pantilat testified that the standard of care required
    continuous pulse oximetry for a patient such as Colley, where a sensor that clips
    No. 68267-9-1/5
    onto the finger sets off an alarm if the patient's oxygen level falls below a certain
    point. Dr. Ralph Weiche, the emergency room physician who discharged Colley
    to the observation unit and wrote the morphine order, testified that Nurse Hooker,
    Colley's attendant in the observation unit, misinterpreted the order and as a
    result gave Colley more morphine than he had intended.
    The hospital responded with testimony that the doses of morphine Colley
    received were not excessive, that continuous pulse oximetry was not required to
    meet the standard of care, that nurses had monitored Colley adequately by
    making regular visits to his room throughout the night, and that the evidence did
    not show Colley's blood oxygen levels ever fell to dangerous levels capable of
    causing brain damage. The hospital brought out evidence that he had memory
    problems predating the incident in the hospital. The January 2006 report
    completed by Dr. Francisco Vega in connection with the diagnosis of sleep
    apnea stated that Colley "feels that his daytime fatigue has resulted in memory
    difficulties."
    Colley suffered from several pre-existing conditions, including not only
    obstructive sleep apnea, but also shortness of breath, diabetes, high cholesterol,
    hyperglycemia, recurrent toe infections, chronic headaches, post traumatic stress
    disorder, obsessive compulsive disorder, anxiety, and depression. Expert
    witnesses for the hospital testified that memory loss was consistent with some of
    these other conditions. Colley took a number of prescription medications. Earlier
    in his life, he had been a heavy drinker. Ten years earlier, he had suffered a
    No. 68267-9-1/6
    traumatic brain injury in a motor vehicle accident. Two years earlier, he had
    stopped working and applied for disability benefits.
    Colley asked the jury to award him some $7,000,000 in damages. The
    hospital suggested in argument that if the jury reached the issue of damages, an
    appropriate award would be in the range of $100,000. The jury found the
    hospital not negligent and did not reach causation or damages.
    This appeal followed.
    CITATION TO UNPUBLISHED OPINIONS
    As a preliminary matter, we address Colley's objection to the hospital's
    citation to two unpublished opinions of this court. The hospital attached the
    opinions and discussed them in the brief of respondent. Colley's criticism of this
    practice is well-founded. Citing an unpublished opinion is a violation of
    Washington court rules. "A party may not cite as an authority an unpublished
    opinion of the Court of Appeals." GR 14.1(a).
    There are cogent arguments for permitting citation to unpublished opinions
    and many courts do. See Jessie Allen, The Right to Cite: Why Fair and
    Accountable Courts Should Abandon No-Citation Rules (Brennan Ctr. for Justice
    at N.Y. Univ. Sch. of Law, Judicial Independence Ser., 2005), available at
    http://www.brennancenter.Org/sites/default/files/legacv/d/download file 35429.pdf
    But so long as Washington court rules forbid citation of this court's
    unpublished opinions, we will not look kindly upon the hospital's facile
    explanation that the opinions were cited as "illustrative" and "persuasive," not as
    6
    No. 68267-9-1/7
    "authority." See Johnson v. Allstate Ins. Co.. 
    126 Wn. App. 510
    , 519, 
    108 P.3d 1273
     (2005). That rationale swallows the rule. If one party cites an unpublished
    opinion, then in fairness the other party must be allowed to explain why the
    opinion is neither illustrative nor persuasive, creating a controversy that the
    appellate court will find difficult to resolve without citing the unpublished opinion.
    We recently explained, "If a party finds a helpful analysis in an
    unpublished opinion, the proper way to present it is to cite the authorities relied
    on in the unpublished opinion and show how they apply." State v. Nvsta, 
    168 Wn. App. 30
    , 44, 
    275 P.3d 1162
     (2012), review denied. 
    177 Wn.2d 1008
     (2013).
    This suggestion, while admittedly a workaround, enables a party to confront the
    Court of Appeals with its previous decisions without violating GR 14.1(a).
    CERTIFICATE OF MERIT
    On the merits, Colley contends that the trial court committed reversible
    error by denying three of his motions in limine. This court reviews a thai court's
    rulings on motions in limine for abuse of discretion. Gammon v. Clark Eguip.
    Co.. 
    38 Wn. App. 274
    , 286, 
    686 P.2d 1102
     (1984), afTd, 
    104 Wn.2d 613
    , 
    707 P.2d 685
     (1985). If the trial court abuses its discretion, the error will not be
    reversible unless the appellant demonstrates prejudice. Portch v. Sommerville.
    113Wn. App. 807, 810, 
    55 P.3d 661
     (2002). review denied. 149Wn.2d 1018
    (2003).
    When Colley filed suit in 2008, medical negligence actions were subject to
    a statutory procedural requirement set forth in RCW 7.70.150. The statute was
    No. 68267-9-1/8
    intended as an obstacle to meritless actions. At the time of commencing a
    medical negligence action, the plaintiff had to file a "certificate of merit" as to
    each defendant. The certificate had to be signed by a "health care provider who
    meets the qualifications of an expert in the action." RCW 7.70.150(2). Each
    certificate was required to contain
    a statement that the person executing the certificate of merit
    believes, based on the information known at the time of executing
    the certificate of merit, that there is a reasonable probability that the
    defendant's conduct did not follow the accepted standard of care
    required to be exercised by the defendant.
    RCW 7.70.150(3). Colley filed certificates of merit signed by Nurse Sarah
    Covington, a witness on the standard of care for nurses, and Dr. Pantilat. Nurse
    Covington's certificate tracked the language of the statute. She stated that she
    had "reviewed the information available to me at this time" and believed that
    several hospital employees she identified by name and "Jane and John Does 1-
    10" had committed malpractice, proximately causing injury to Colley.
    When Colley's case went to trial in November 2011, the requirement to file
    a certificate of merit was no longer in effect. The Supreme Court struck it down
    in 2009 as an unconstitutional deprivation of due process and access to the
    courts. Putman v. Wenatchee Valley Med. Ctr.. P.S.. 
    166 Wn.2d 974
    , 979, 
    216 P.3d 374
     (2009).
    Through the discovery process, plaintiffs uncover the evidence
    necessary to pursue their claims. Obtaining the evidence
    necessary to obtain a certificate of merit may not be possible prior
    to discovery, when health care workers can be interviewed and
    procedural manuals reviewed.
    8
    No. 68267-9-1/9
    Putman. 166 Wn.2d at 979.
    By the time of trial, after discovery had been conducted, Nurse Covington
    was expected to testify only that Nurse Hooker violated the standard of care.
    Nurse Hooker was not among the individuals named in Nurse Covington's
    certificate of merit.
    Colley moved in limine to prevent the hospital from using the certificates of
    merit to show that Dr. Pantilat and Nurse Covington had changed their opinions.
    He argued that such use would be unfair in view of Putman. "Having been forced
    to file certificates by an unconstitutional statute, Plaintiffs should not further be
    punished by having their witnesses questioned about opinions given at a time
    when the evidence provided by discovery was not available." The trial court
    denied the motion, accepting the hospital's argument that a certificate of merit
    was relevant and admissible under Evidence Rule 613 as the "prior statement" of
    a witness. ER 613(a).
    We agree with Colley that the motion in limine should have been granted.
    Putman demonstrates that the certificates of merit were unfairly and coercively
    extracted from Colley as the unconstitutional price of admission to the court. ER
    403 is applicable. The minimal relevance to the credibility of the witnesses was
    substantially outweighed by the danger of unfair prejudice, confusion of the
    issues, or misleading the jury. To put the evidence in its proper context for the
    jury would require explaining the statute, the Putman decision, and the rules of
    discovery. Such explanations would inevitably be lengthy and distracting.
    No. 68267-9-1/10
    Whether the error is reversible, however, is another matter. Portch, 113
    Wn. App. at 810. The only certificate the jury heard about was Nurse
    Covington's. On direct examination, Nurse Covington criticized Nurse Hookerfor
    failing to ask for clarification of an ambiguous morphine order, administering
    more morphine than had been prescribed, checking Colley's oxygen saturation
    too infrequently, and failing to tell the attending physician about Colley's sleep
    apnea, which was significant information about a patient who was receiving
    morphine.
    On cross-examination, defense counsel confronted Nurse Covington with
    her failure to identify Nurse Hooker in the certificate of merit.
    Q.   Okay. Now, when you first, when you first were asked to
    review records in this case, you were given kind of a binder of
    records?
    A.    Yes, sir.
    Q.    And it was your understanding that that was the complete
    hospital record?
    A.   Yes, sir.
    Q.    And you reviewed all of those documents, correct?
    A.   Yes, sir.
    Q.    And then you, you signed a, a legal document that said your
    opinion; is that correct?
    A.   Yes, sir.
    Q.    In your review of the records, you certainly saw the name of
    Dawn Hooker, correct?
    A.   Yes.
    Q.    It wasn't some scribble that you couldn't read or anything like
    that, correct?
    A.   Correct.
    Q.    So when you signed this document that these individuals were
    acting below the standard of care, you did not include Dawn
    Hooker, correct?
    A.   Correct.
    Q.    And you did not edit this to say, wait a minute, Mr. Leemon,
    10
    No. 68267-9-1/11
    let me include Dawn Hooker, correct?
    A.   Correct.
    This was the scope of the questions to Nurse Covington about the certificate of
    merit.
    Defense counsel also cross-examined Nurse Covington to elicit her
    agreement that in an observation unit, failing to use a continuous pulse oximetry
    device did not violate the standard of care; and that Colley's chart indicated that
    Nurse Hooker did not learn about his sleep apnea condition until 3:35 a.m.,
    whereas the last dose of morphine had been given at 3:20 a.m. Counsel brought
    out that Nurse Covington had not worked in a critical care unit in a hospital
    setting since 1988 and had no experience working in a hospital observation unit
    or emergency room. In closing, the hospital made no mention of Nurse
    Covington, other than to argue in passing that her credentials and hospital
    experience were less impressive than those of the nurse who testified as an
    expert witness for the hospital.
    Nurse Covington was a relatively peripheral witness. It was undisputed
    that Nurse Hooker misread the orders for morphine and gave Colley more than
    the prescribing physician intended. And the plaintiffs case did not depend on
    Nurse Covington's opinion to show that Colley's oxygen saturation level should
    have been monitored more continuously. This opinion was more authoritatively
    rendered by the physicians who testified on the standard of care. In the context
    of a nine-day trial, forcing Nurse Covington to admit that Nurse Hooker's name
    was not mentioned in the certificate of merit was a point too obscure to create
    11
    No. 68267-9-1/12
    more than a pinprick of prejudice.
    We conclude that the trial court erred by allowing the hospital to impeach
    Nurse Covington with the certificate of merit, but the error does not require reversal
    DEFENSE WITNESSES ON CAUSATION
    Colley moved in limine to exclude three experts who had been identified
    as defense witnesses on causation but who, according to Colley, had no opinions
    on causation. The court denied the motion. All three experts testified at trial.
    On appeal, Colley argues that the three experts presented an
    "overwhelming cacophony" of irrelevant and speculative evidence, insinuating
    that he was brain damaged before he arrived at the hospital.
    The hospital points out that each expert was offered as a witness on
    causation and the jury did not reach the issue of causation. This does not,
    however, necessarily mean that their testimony could not have been prejudicial.
    In a personal injury trial, it is not always possible to keep the issues of breach
    and causation compartmentalized. Even if the witnesses were examined only
    about causation, their opinions could have tainted the jury's consideration of the
    negligence question if they were irrelevant and unfairly put Colley in a bad light.
    Colley is entitled to consideration of his arguments about these witnesses.
    12
    No. 68267-9-1/13
    Dr. Pascualv
    Dr. Ralph Pascualy, M.D., a psychiatrist and expert in sleep apnea and
    sleep medicine, identified several factors besides oxygen deprivation that could
    have caused Colley to experience memory loss, including his severe sleep
    apnea, irregular use of the CPAP machine, diabetes, and past history of heavy
    drinking. He testified that because there was no evidence of Colley's oxygen
    saturation levels between 4:11 a.m. and 5:45 a.m., it was not possible to say
    whether the hospital event was severe enough to cause memory problems.
    Colley argues that Dr. Pascualy's testimony should not have been
    admitted unless he was prepared to say either that respiratory failure was not the
    cause of Colley's injury or that something else was the cause.
    It is the plaintiff's burden in a medical negligence action to prove the
    statutory elements, including breach and causation. RCW 7.70.040; Berger v.
    Sonneland. 
    144 Wn.2d 91
    , 111, 
    26 P.3d 257
     (2001). Witnesses who offer an
    opinion to prove medical causation must speak in terms of probability, not mere
    possibility. Miller v. Staton. 
    58 Wn.2d 879
    , 885-86, 
    365 P.2d 333
     (1961). The
    defendant does not have the burden to prove causation or lack of causation. Nor
    is the defendant obligated to agree or assume that the plaintiff is injured.
    Beginning with the premise that there was no other explanation for
    Colley's sudden loss of short-term memory, expert witnesses in the plaintiff's
    case deduced that the oxygen in his blood must have fallen to a critically low
    level during the hour and 30-minute period when it was not recorded. Dr.
    13
    No. 68267-9-1/14
    Pascualy's testimony attacked the premise. He said there could be other
    explanations for memory loss and it was not possible to infer with certainty that
    Colley experienced serious oxygen deprivation while at the hospital. Dr.
    Pascualy's experience was adequate foundation for his opinion.
    Colley cites Washington Irrigation & Development Company v. Sherman.
    
    106 Wn.2d 685
    , 
    724 P.2d 997
     (1986). The case involved a claim of lower back
    pain caused by industrial injury. The court held it was error for the opposing
    party to insinuate that two later auto collisions were a superseding cause of the
    lower back pain without proof that the collisions actually did aggravate the injury.
    This is not a similar case. Dr. Pascualy was not trying to establish a superseding
    cause. His testimony was offered to show that Colley lacked proof of causation.
    His testimony was properly admitted.
    Dr. Stimac
    In March 2006 Colley complained to his primary care provider of
    increasingly severe headaches. His provider referred him for a CT scan of his
    brain. In June 2006, the hospital performed an MRI test of Colley's brain when
    he complained of continued headaches as well as memory and sensory
    problems. These two examinations provided images of Colley's brain just before
    and just after the incident at the hospital. The results of the two examinations
    were discussed during the plaintiff's case by Dr. Ginsberg, who testified that one
    can have an injury to the brain that causes short-term memory loss, yet is not
    visible by imaging.
    14
    No. 68267-9-1/15
    The hospital presented Dr. Gary Stimac, a neuroradiologist, to interpret
    and compare the images. Dr. Stimac testified that as of March 2006, Colley's
    brain already showed signs of damage—a generally "shrunken" appearance and
    "a diffuse loss of brain substance"—and it did not show any visible differences by
    June 2006. Dr. Stimac agreed it was entirely possible that Colley had suffered a
    mental impairment such as memory loss in May 2006 which would not show up
    on an MRI.
    Colley contends Dr. Stimac's testimony was irrelevant because he had no
    opinion about what was causing the memory loss. Again, to be relevant, it was
    not necessary for Dr. Stimac to render an affirmative opinion as to the cause of
    Colley's alleged impairment. It was relevant for the jury to hear that the visible
    condition of Colley's brain was consistent with his previous medical issues and
    there was no image consistent with an acute insult to the brain such as extended
    oxygen deprivation.
    Dr. Ellsworth
    Just before Colley was admitted to the observation unit at 2:00 a.m., he
    was given 8 milligrams of morphine to relieve his abdominal pain. Dr. Weiche,
    the emergency room physician, left orders that Colley could receive up to 8 more
    milligrams in the next four hours depending on his level of pain. Over the next
    hour and a half, Nurse Hooker, who misunderstood the order, administered 10
    milligrams. Colley claimed that the misreading of the orders was one of the
    negligent acts that ultimately led to his respiratory failure.
    15
    No. 68267-9-1/16
    Dr. Allan Ellsworth, a pharmacology expert called by the hospital, testified
    that 10 milligrams of morphine was within the range of reasonable therapeutic
    doses under the circumstances. He explained the rate at which morphine
    typically cycles through the body and compared this information to when Colley
    received his morphine doses and when he began to suffer breathing troubles.
    Defense counsel referred to Dr. Ellsworth's testimony in closing, arguing that the
    administration often milligrams was not negligent because "we had plenty of
    evidence that ten milligrams is not outside the normal range."
    Colley contends he was not specifically claiming he had suffered an
    overdose of morphine and therefore the discussion about the range of
    acceptable morphine dosage was irrelevant. His argument is unconvincing.
    There would be no point to his allegation that Nurse Hooker misread the dosage
    instructions unless her carelessness resulted in an overdose.
    Colley suggests that Dr. Ellsworth's opinions were flawed because he
    based them on content gleaned from a web site, he used data derived from
    patients who had received morphine in a different manner than Colley, and he
    used data derived from adults who were not obese, even though narcotics tend
    to cycle more slowly through a heavier body such as Colley's. Expert testimony
    need not be flawless to be admissible. These objections go to the weight of Dr.
    Ellsworth's testimony, not its admissibility.
    Contrary to Colley's argument, allowing the three experts to testify was not
    contrary to Stedman v. Cooper. 
    172 Wn. App. 9
    , 
    292 P.3d 764
     (2012). In
    16
    No. 68267-9-1/17
    Stedman. the plaintiff alleged that she had sustained injuries in a car crash. A
    biomechanical engineer offered the opinion that the car crash could not have
    caused the injuries, even while disclaiming any intention of offering an opinion
    about whether the plaintiffs injuries were caused by the crash. Stedman. 172
    Wn. App. at 20. We reasoned that a trial court could find that such testimony
    was "more likely to be misleading than helpful" and held the trial court did not
    abuse its discretion by excluding it. Stedman. 172 Wn. App. at 20-21. Here, the
    experts stayed within their expertise and did not speculate. The trial court did not
    abuse its discretion by allowing them to testify.
    Colley presented expert testimony tending to prove that the hospital's
    negligence caused him grave harm. The expert witnesses for the hospital
    offered competing opinions tending to deprive Colley's proof of the persuasive
    power necessary to cross the 50 percent threshold. Colley cross-examined each
    defense expert to show the jury how poorly formed and unreliable he believed
    their opinions were. The record does not sustain Colley's argument that the
    testimony the witnesses were allowed to give was improper.
    PREVIOUS ALCOHOL ABUSE
    Colley's medical records included examinations in 2004 and 2005, during
    which he admitted that until about 2002, he "had been drinking beer like a fish."
    Colley's wife, who first met him in 2002, testified on direct examination that
    Colley admitted drinking heavily in his past, but she had never known him to
    have a drinking problem, and he took his last drink on the night of their wedding.
    17
    No. 68267-9-1/18
    Colley moved in limine under Evidence Rules 403 and 404(b) to exclude
    reference to his history of alcohol consumption. The court denied the motion.
    At trial, witnesses for the hospital referred to Colley's past history of
    alcohol abuse in connection with memory loss and tolerance to morphine. Dr.
    Stimac said it helped to explain why Colley's brain showed a "shrunken"
    appearance both before and after the incident. Dr. Kristoffer Rhoads testified
    that alcohol can affect the frontal lobes of the brain and affect memory, attention,
    and concentration, but that after six months of sobriety, any further damage
    would be "negligible." Dr. Pascualy referred to Colley's admission during
    examinations that he used to "drink like a fish." The hospital inquired about
    Colley's former alcoholism on cross-examination of Colley's witness Dr. Ted
    Judd, who testified that former alcohol abuse can cause a mild impairment to
    attention and concentration. In closing argument, Colley's counsel attempted to
    minimize the effect of the hospital's multiple references to Colley's former alcohol
    use. He said they were an attempt to suggest "that these people weren't worth
    very much to begin with and how much harm could we really cause them."
    Evidence of past alcohol abuse is potentially quite prejudicial, as this court
    recognized in Kramer v. Jl Case Manufacturing Company. 
    62 Wn. App. 544
    , 
    815 P.2d 798
     (1991). In Kramer, the plaintiff brought a product liability action against
    the manufacturer of a backhoe that slid into him on a jobsite. The trial court
    permitted the defendant to elicit evidence of alcohol abuse to support an
    argument that substance abuse reduces life expectancy and diminishes
    18
    No. 68267-9-1/19
    employment prospects. Several witnesses testified that the plaintiff had a
    serious, current addiction to alcohol and that he regularly used marijuana.
    Kramer. 
    62 Wn. App. at 557
    . This court held such evidence should have been
    excluded because there was no proof that substance abuse had actually affected
    the plaintiffs life expectancy or his employment prospects.
    Colley contends that similarly here, it was error to admit the evidence
    without proof of its relevance to some larger point. But here, the record does
    demonstrate the relevance of Colley's history of alcohol use. And unlike in
    Kramer, the hospital did not depict Colley as having a current alcohol problem.
    The undisputed testimony was that he was currently a regular church goer and
    fully abstinent. While prejudice always clings to alcohol abuse to some degree,
    the trial court could reasonably conclude that the evidence of Colley's heavy
    consumption of alcohol in the past had probative value that outweighed the
    prejudice.
    In summary, Colley has failed to show that the trial court's denial of his
    motions in limine deprived him of a fair trial.
    Affirmed.
    19
    No. 68267-9-1/20
    ckeg
    WE CONCUR:
    yt"-,/r.CT     Ctf^dste*.,
    20