Can medical textbooks be admitted as exhibits in Utah malpractice trials? Butler v. Naylor Explained

In medical malpractice cases, attorneys often seek to introduce authoritative medical texts to support their arguments about proper procedures and standards of care. However, Utah courts impose strict limitations on how such materials may be presented to juries under the state’s evidence rules.

Background and Facts

Nina Butler sued Dr. Robert Naylor after developing incontinence following sphincterotomy surgery. During trial, Dr. Naylor testified that he performed the surgery according to procedures outlined in the Zollinger medical text. Over Butler’s objection, the trial court admitted a page from this text as an exhibit and allowed the jury to take it into deliberations. The court also gave a jury instruction regarding alternative treatment methods. The jury returned a verdict for Dr. Naylor, and Butler appealed both rulings.

Key Legal Issues

The case presented two primary issues: whether Utah Rule of Evidence 803(18) permits admission of learned treatises as exhibits, and whether sufficient evidence supported a jury instruction on alternative treatment methods in medical malpractice cases.

Court’s Analysis and Holding

The Utah Supreme Court found that the trial court erred by admitting the Zollinger text page as an exhibit. Rule 803(18) creates a hearsay exception for learned treatises but explicitly states that such materials “may be read into evidence but may not be received as exhibits.” The rule prevents treatises from being taken into jury rooms to ensure jurors are not unduly influenced and don’t use texts as starting points for conclusions untested by expert testimony.

However, the Court applied harmless error analysis and concluded the evidentiary error did not undermine confidence in the verdict. Multiple expert witnesses testified that Butler’s surgery was performed properly and that her incontinence was unrelated to the procedure. Regarding the jury instruction, the Court found it presented only one of several theories supporting the verdict.

Practice Implications

This decision reinforces that while medical treatises may be referenced during expert testimony under Rule 803(18), they cannot be admitted as physical exhibits for jury deliberation. Practitioners should ensure medical texts are only read aloud during testimony rather than submitted as demonstrative evidence. When challenging evidentiary rulings on appeal, consider whether substantial evidence supports the verdict on alternative grounds that might render any error harmless.