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IN THE SUPREME COURT OF THE STATE OF HAWAI#I --- o0o --NOBUO MIYAMOTO and ASAKO MIYAMOTO, Plaintiffs-Appellants, vs. KENNETH W. LUM, SR. and ALEJANDRO LAZO, D.C., Defendants/Cross-Claimants/Cross-Claim Defendants-Appellees, and PETRONILO GARCES and JOLENA GARCES, Defendants/CrossClaimants/Cross-Claim Defendants, and JOHN DOES 1-10, JANE DOES 1-10, DOE PARTNERSHIPS 1-10, DOE CORPORATIONS 1-10, DOE ENTITIES 1-10, AND DOE GOVERNMENTAL UNITS 1-10, Defendants. NO. 24288 APPEAL FROM THE SECOND CIRCUIT COURT (CIV. NO. 98-0647(3)) FEBRUARY 6, 2004 MOON, C.J., LEVINSON, NAKAYAMA, ACOBA, and DUFFY, JJ. OPINION OF THE COURT BY MOON, C.J. Following a jury trial, plaintiff-appellant Nobuo Miyamoto (Nobuo) appeals from the March 5, 2001 final judgment of the Circuit Court of the Second Circuit, the Honorable Joseph E. Cardoza presiding, in favor of defendants-appellees Kenneth W. Lum, Sr. and Alejandro Lazo, D.C. (Dr. Lazo) (collectively, the defendants) in this negligence action. Nobuo also appeals from

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notwithstanding the verdict or, in the alternative, motion for new trial [hereinafter, motion for new trial]. Briefly stated,

this case arises out of an automobile collision involving Nobuo, his wife, and Lum, as well as Dr. Lazo's subsequent chiropractic treatment of Nobuo. On appeal, Nobuo contends that the trial court erred in: (1) denying his motion for new trial; (2) refusing to

utilize one of his proposed jury instructions; (3) denying in part his motion for judgment as a matter of law; and (4) denying a motion in limine. We agree with Nobuo that the trial court

erred in denying his motion for new trial as against Lum and refusing to utilize a jury instruction that was applicable only to Lum, but we disagree with his remaining contentions. Therefore, we vacate in part both the order denying Nobuo's motion for new trial and the judgment with respect to all of Nobuo's claims against Lum and remand this case for a new trial as against Lum. aspects. I. A. Factual History1 This action arises out of two negligence claims. The BACKGROUND The order and judgment are affirmed in all other

first claim of negligence resulted from a motor vehicle collision on October 20, 1996 in Wailuku, Maui, in which Lum's vehicle

Facts pertaining to specific issues challenged in this appeal are discussed in more detail in the Discussion section, infra.

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struck Nobuo's vehicle. The second claim of negligence arises

out of Dr. Lazo's chiropractic treatments of Nobuo. Nobuo was seventy-nine years old at the time of the automobile accident. Prior to the accident, Nobuo had had

several medical conditions, including cardiovascular and gastroenterological problems for which he was being treated by several physicians. He also had a history of two heart bypass

surgeries, one in 1977 and one in 1985, and was taking multiple medications, including Coumadin, an anticoagulant or blood thinner. On October 2, 1996, a few weeks before the accident,

Nobuo had visited his family physician, Nolan Arruda, M.D. (Dr. Arruda), with complaints of pain in his left shoulder that had persisted for two months. "arthritic in nature." On October 20, 1996, Nobuo was driving his truck on Market Street, a one-way street, in the proper direction with his wife as a passenger. Lum, who has always lived on Kaua#i, was on Dr. Arruda diagnosed the pain as

Maui for his grandson's birthday and was unfamiliar with the area. Lum proceeded in the wrong direction on Market Street and Upon impact, Nobuo's

struck Nobuo's truck on the passenger side.

wife bumped Nobuo's right side, and Nobuo's left shoulder hit the left door panel of the truck. Lum later stipulated that his

actions that day were negligent.2

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The stipulation agreement provides: [All of the parties], by and through their respective

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Nobuo declined treatment at the scene, but later that day he had increasing pain in his left shoulder and right ribs and received medical treatment at the Maui Medical Group. Radiologist Bruce S. Lepolstat, M.D. noted that one of Nobuo's right ribs was fractured. Nobuo first sought treatment from Dr. Lazo two days later, on October 22, 1996, for pain in his left shoulder. Nobuo

indicated on forms he filled out at Dr. Lazo's office that he had not suffered from pain to his left shoulder before and indicated that he had no physical complaints prior to the accident. Dr.

Lazo testified that he did not inquire about any other medical conditions because Nobuo had indicated on the forms that he did not suffer from any other conditions. Dr. Lazo testified that he examined Nobuo and diagnosed him with cervicobrachial syndrome, cervical neuritis, thoracic sprain/strain, and shoulder sprain/strain. Dr. Lazo testified

and his reports showed that his treatment of Nobuo included the use of an activator, trigger-point therapy (thumb pressure),

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undersigned attorneys, hereby stipulate and agree as follows: 1. [Lum] admits that, on October 20, 1996, he was negligent in the operation of his motor vehicle which negligence caused the collision between his 1992 Plymouth Voyager and [Nobuo]'s 1993 Dodge Ram truck. [Lum] reserves the right to contest the nature and extent of [Nobuo's] injuries and damages, the causation thereof, and all claims against [Dr. Lazo].

2.

(Emphases added.)

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chiropractic adjustments, electrical stimulation, manual traction, mechanical traction, moist heat, and myofacial release. Dr. Lazo treated Nobuo nearly every three days until December 20, 1996. On Friday, December 20, 1996, while Dr. Lazo was massaging Nobuo's left shoulder area with his thumbs, Nobuo informed Dr. Lazo that the massage was painful, but Dr. Lazo did not stop. When Nobuo left Dr. Lazo's office, he felt "all

right," but Nobuo testified that he later felt nauseated and had a "funny feeling" -- he thought he was getting sick. He noticed

a "small little lump," the size of a "quarter or dime," on his left shoulder that was red and painful. Nobuo testified that it The

was "pound[ing]" and prevented him from sleeping that night.

next morning, the lump was the size of a half-dollar, and Nobuo "felt more sick." On Sunday, the lump was the size of a

baseball, and Nobuo testified that he could not move his neck. On Monday, December 23, 1996, at his regularly scheduled appointment with Dr. Lazo, Nobuo informed him of the lump. that time, Dr. Lazo inquired as to any medications Nobuo was taking, and Nobuo told him that he was taking Coumadin. Nobuo immediately visited Dr. Arruda, who referred him to Jeffrey H. Kaplan, M.D. A computed tomography scan (i.e., CT At

scan) was performed, which showed that Nobuo's lump was "a huge hematoma with a combination of [bloody] fluid and solid components." Later that day, Nobuo was admitted to Maui Memorial

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Hospital for treatment of his hematoma. Dr. Arruda's "working

diagnosis" was that the hematoma was "partially secondary to localized [chiropractic] therapy and manipulation coupled with [Coumadin] anti-coagulation." Thomas Nickles, M.D. (Dr.

Nickles), a neurologist, similarly noted in his "Consultation Record" that he believed the hematoma was caused by chiropractic treatment and Coumadin. The hematoma was eventually lanced and After the draining,

"dark bloody/serous fluid" was drained.

Nobuo's left hand became numb, and it was still numb at the time of trial in 2001. At trial, with respect to the cause of the hematoma, the defendants focused on the possibility of spontaneous bleeding, arguing that Nobuo's blood was so thin that internal bleeding resulted in the formation of a hematoma. Dr. Arruda

testified that Nobuo had had a "chronic-anticoagulation" problem with his heart, for which he was taking Coumadin to prevent further coagulation. Dr. Arruda explained that a patient's

dosage of Coumadin must be carefully monitored because, on the one hand, if blood clots too easily, a blood clot could form and enter the heart or lungs, but on the other hand, if blood does not clot at all, spontaneous bleeding can occur anywhere in the body. Dr. Arruda also explained that Coumadin dosage is

monitored through various blood tests, called "prothrombin time" (PT), which measures the length of time for blood to clot, and "international normalization ratio" (INR), which "indicates a

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level of thinness of the blood." Dr. Arruda further explained

that Coumadin causes the blood to thin and that, in turn, PT and INR values will increase, which can result in spontaneous bleeding. Dr. Arruda testified that Nobuo's PT and INR levels were monitored throughout August, September, and October 1996. Because Nobuo's levels had normalized and were stable in October 1996, Dr. Arruda advised Nobuo to return for his next blood test in three months, at the end of January 1997. However, blood

tests were taken on December 23, 1996, when Nobuo was hospitalized for his hematoma. levels were substantially high.3 On that day, Nobuo's PT and INR Dr. Arruda testified that such

elevated PT and INR values could result in spontaneous bleeding. On December 25, 1998, more than two years after the accident, Nobuo was admitted to the Maui Memorial Hospital for chest pain, which was later diagnosed as a "stress attack." Nobuo testified that he had experienced a similar stress attack prior to the accident, but he did not have another attack until December 1998. Nobuo testified that he believed that the stress

attack in 1998 resulted from the stress of taking care of his bedridden wife. However, one of Nobuo's medical experts, Charles

Salzberg, M.D. (Dr. Salzberg), testified that the chest pain

The "normal" desired range for one's PT level is 11.0 to 13.0 and the desired range for one's INR level is 2.0 to 3.0. On December 23, 1996, Nobuo's PT level was at 39.1 and his INR level was at 11.4.

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resulted from "stress and anxiety as a direct complication of [the October 20, 1996] motor vehicle accident." B. Procedural History Jury trial commenced on January 8, 2001.4 On January

12, 2001, Nobuo filed a motion in limine, requesting, inter alia, that the trial court preclude the defendants from submitting evidence that Nobuo's hematoma could have been caused by spontaneous bleeding. After a hearing on the matter, the trial

court denied the motion on this issue and ruled that "[t]he parties are allowed to explore with the medical witnesses whether a spontaneous bleed was the cause of [Nobuo's] hematoma." On February 2, 2001, at the close of evidence, Nobuo moved for judgment as a matter of law, arguing, inter alia, that Lum's actions were the legal cause of Nobuo's medical expenses. The trial court denied the motion as to this issue. That same day, the jury returned a special verdict, in which it determined that Lum's admitted negligence was not the legal cause of Nobuo's injuries, but it attributed $18,446.00 in general and special damages to Lum.5 Lazo was not negligent. The jury found that Dr.

On March 5, 2001, the trial court

entered judgment in favor of Lum and Dr. Lazo.

Nobuo's wife was initially a plaintiff in this case, but on August 11, 2000, the parties stipulated that all of her claims be dismissed with prejudice. As discussed more fully infra, the special verdict form instructed the jury to determine the amount of damages attributable to Lum irrespective of whether the jury found his actions to be the legal cause of Nobuo's injuries.
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On March 15, 2001, Nobuo filed a motion for new trial. Nobuo's motion for new trial was directed at both Lum and Dr. Lazo. As against Lum, Nobuo argued, inter alia, that the verdict

was irreconcilably inconsistent and that the verdict in favor of Lum was against the manifest weight of the evidence. As against

Dr. Lazo, Nobuo argued, inter alia, that the verdict in favor of Dr. Lazo was against the manifest weight of the evidence and that Nobuo was prejudiced when one of his own medical experts recanted his medical opinions during trial. Nobuo's motion on May 7, 2001. On May 18, 2001, Nobuo timely filed his notice of appeal. II. A. STANDARDS OF REVIEW The trial court denied

Motion for New Trial "Both the grant and the denial of a motion for new

trial is within the trial court's discretion, and we will not reverse that decision absent a clear abuse of discretion." Carr

v. Strode, 79 Hawai#i 475, 488, 904 P.2d 489, 502 (1995) (citing Richardson v. Sport Shinko (Waik

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