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Supreme Court
No.   99-563-Appeal.
(PC 95-4029)
Cindy L. Patino, as Administratrix of the Estate                                                             :
of Eugene J. Janarelli et al.
v.                                                                                                           :
Frank Suchnik et al.                                                                                         :
Present:  Williams, C.J., Lederberg, Bourcier, Flanders, and Goldberg, JJ.
O P I N I O N
PER CURIAM.   This appeal challenges a trial justice’s jury instructions concerning the alleged
gross negligence of emergency rescue workers (EMTs) in deciding not to transport an injured party to a
hospital.  Following complications ensuing from a head wound, the injured party died approximately one
year after the incident in question.   The plaintiffs, Cindy L. Patino, as administratrix of the estate of
Eugene J. Janarelli (Janarelli), and Denise Laurens on behalf of her minor children, Crystal Laurens and
Kayla Laurens, appeal from a Superior Court judgment in favor of the defendants, Frank Suchnik in his
capacity as Treasurer for the City of Central Falls, Robert Noury, Steven Ouellette, K.L.C. Associates,
Inc. d/b/a Macondo and Augusto Garrces a/k/a Luis Garces.   After reviewing the parties’ prebriefing
statements, a single justice of this Court ordered the parties to show cause why the issues raised in this
appeal should not be summarily decided.   Because no such cause has been shown, we proceed to do
so.
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The key question for the jury in this case was whether the defendant EMTs were grossly
negligent in deciding that the injured Janarelli did not need to go to the hospital.1   Earlier in the evening
Janarelli had been struck on the head by a beer bottle at a nightclub.   He was nursing a small head
wound and reposing at his girlfriend’s apartment when he started to complain about his aching head.
The rescue personnel arrived to examine him in the early morning hours of January 2, 1993.   Earlier,
Janarelli’s girlfriend had called 9-1-1 at Janarelli’s request and asked for emergency assistance.  Shortly
thereafter, two EMTs arrived at the apartment and the girlfriend escorted them to the bedroom where
Janarelli was lying diagonally face down on a bed.
The EMTs testified that shortly after they arrived they asked Janarelli whether he wanted to go
to the hospital.   Initially, Janarelli indicated that he wanted to go to the hospital, and the EMTs ordered
an ambulance to be dispatched.   According to the EMTs, they began to take Janarelli’s vital signs, but
he increasingly resisted their ministrations.    Although the EMTs asked Janarelli some questions,
Janarelli’s girlfriend did not recall seeing them perform any diagnostic tests on him.  The EMTs asserted
that because Janarelli pulled away from them, they could not use the blood pressure cuff to take his
blood pressure; as a result, they were forced to take it by hand from his wrist.   After observing and
questioning Janarelli further and after checking other diagnostic indicators, the EMTs concluded that
Janarelli was not in need of medical attention.   Nevertheless, because Janarelli had indicated previously
that he wanted to go to the hospital, the EMTs were prepared to help him do so.  While waiting for the
ambulance to arrive, the EMTs suggested to Janarelli that he put some pants on for the trip out to the
ambulance.    Even with the assistance of his girlfriend, however, Janarelli apparently experienced
1
Pursuant to G.L. 1956 § 23-4.1-12(a), emergency rescue personnel enjoy a qualified immunity
from negligence claims, provided they are not guilty of gross negligence or willful misconduct in
performing their functions.
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problems in attempting to do so.   Finally, after becoming very impatient and frustrated, he eventually
refused to dress.  Janarelli then reportedly told the EMTs that he did not want to go to the hospital.  The
EMTs testified that they repeatedly asked if he was sure he did not want to go, but that he did not
change his mind.  Therefore, on the basis that they did not believe Janarelli was in need of hospital care
anyway, the EMTs called and canceled the ambulance.
As they were leaving the apartment, the EMTs testified that they told Janarelli’s girlfriend to call
them immediately if Janarelli started to exhibit any signs of further medical problems, such as vomiting.
Janarelli’s girlfriend denied that they gave her this advice.   In any event, although Janarelli began
vomiting only an hour or so after the EMTs left the apartment, his girlfriend insisted that she was
unaware that this development signaled a potential problem for Janarelli that called for further medical
attention.   By the next morning when he was finally taken to the hospital, Janarelli was unconscious.
After spending a year in the hospital, Janarelli died from the head injury he received on the night in
question.
The plaintiffs offered expert testimony from a neurologist who testified that Janarelli’s symptoms
indicated that “something [was] not right” and that further evaluation (that is, a CT scan) was necessary
to properly diagnose and treat his injury.   In addition, plaintiffs offered the expert testimony of an EMT
trainer.   Relying upon the Department of Health protocol in this state governing the conduct of EMTs,
he concluded that the EMTs had breached their duty of care.  In contrast, defendants offered the expert
testimony of an EMT trainer who opined                                                                        — based upon the same protocol and based upon the
materials used to train the EMTs — that the EMTs had acted in accordance with the standard of their
profession.
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Before jury deliberations began, plaintiffs requested jury instructions based in part on the
Department of Health protocol for EMTs.   The trial justice rejected these instructions and charged the
jury generally that Rhode Island law provides qualified immunity for EMTs and that they could be held
liable only if their alleged misconduct was a result of gross negligence or willful misconduct.   The trial
justice then gave the jury a broad definition of gross negligence without specifying in detail the specific
duty of care owed by the EMTs to Janarelli.   The plaintiffs objected generally to the instructions: “[t]he
definition of gross negligence, I would suggest that it ought to have been in accordance with my request
for charge, and would object as far as it is inconsistent.  With respect to my request [sic] 4 through 13,
with regard to duty and so forth owed by the defendants to plaintiffs, I respectfully object.  These have
not been given.”  The trial justice refused to amend or supplement his instructions and the jury found that
plaintiffs failed to prove by a fair preponderance of the evidence that the acts or omissions of either of
the EMTs individually or in their joint capacity constituted gross negligence or willful misconduct that
had proximately caused Janarelli’s death.
Analysis
The key issue in this case was whether the EMTs were grossly negligent in concluding that
Janarelli did not need further treatment at the hospital.   Both EMTs testified that, after observing
Janarelli and questioning him, they did not believe that he needed to go to the hospital.   The instructions
requested by plaintiffs, however, would have removed this issue from the jury’s consideration because
they required the EMTs to warn Janarelli of the potential adverse consequences of his refusing hospital
treatment — irrespective of whether the workers ever had offered him such treatment or had been
grossly negligent in concluding that Janarelli needed no such treatment.   Thus, the proffered instructions
improperly assumed that the rescue workers had been grossly negligent in failing to determine that
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Janarelli needed hospital treatment, in failing to proffer that treatment to him, and in failing to warn him
that  his  refusal  of  needed  and  proffered  hospital  treatment  might  still  result  in  serious  adverse
consequences to him.
The plaintiffs argue that the trial justice committed reversible error by refusing to charge the jury
consistent with their requests.   Allegedly, without these instructions, the jury was not properly informed
of the standard of care owed by the EMTs to Janarelli and therefore could not have correctly assessed
whether the EMTs were grossly negligent.   The plaintiffs’ proposed instructions were based upon the
Rhode Island Department of Health Ambulance/Rescue Report Form Instructions (protocol), which
define an EMT’s duty of care with respect to a patient who has refused proffered care or assistance.
According to the protocol:
“The EMT must inform the patient that if s/he does not permit the EMT
to provide the particular service or treatment recommended that the
patient  may  suffer  some  particular  harm.    If  the  patient  declines
assistance, the EMT must urge the patient to consent to care, in
recognition of the possibly harmful consequences of not being treated or
taken to a medical facility.  If a competent patient declines examination,
treatment, or transportation with the knowledge that harm may (or is
likely to) result, then the patient's refusal is an informed one, and legally
valid.”  Division of Emergency Medical Services, Department of Health,
State of Rhode Island and Providence Plantations, Ambulance/Rescue
Report Form Instructions, § 3.5 at 16 (June 1986).   (Emphasis added.)
This protocol, however, contains an implicit predicate that an EMT or some other health-care
provider already has determined that the patient needs further medical “assistance” and that some
“particular service or treatment [has been] recommended” to the patient.   Only after an EMT or some
other health-care provider has made such a determination and recommended it to the patient and only
after the patient has “decline[d] assistance” that has been recommended to him or her is the EMT then
required by the protocol to “urge the patient to consent to care” and “inform” the patient of “the
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possibly harmful consequences of not being treated or taken to a medical facility.”   The plaintiffs,
however, proposed to misstate this standard of care to the jury by omitting the predicate requirement
that EMTs (or some other health-care provider) must first determine that a patient needs hospital care
and recommend that treatment to the patient  — who then refuses it —   before the EMTs would be
bound  to                                                                                                      “urge”  and   “inform”  the  patient  to  consent  to   “the  particular  service  or  treatment
recommended.”  Specifically, plaintiffs proposed to instruct the jury that “[i]n this case the EMTs had a
duty to inform Mr. Janarelli that if he refused transportation to a hospital, he could suffer severe brain
injury and die.”   Such an instruction clearly would have confused the jury and led them to the incorrect
assumption that either there were no predicate requirements to EMTs giving such a warning, as
described above, or that the predicate requirements had been satisfied in this case, a conclusion that
was very much in dispute given the evidence before the court and jury.
Although a trial justice must “determine and instruct the jury concerning what legal duty is owed
to the plaintiff under the various alternative factual scenarios supported by the evidence,” Kuzniar v.
Keach, 709 A.2d 1050, 1055 (R.I. 1998), he or she may not interfere with the jurors’ exclusive role as
fact-finders by instructing them to make or to assume any particular finding of fact when that fact is
disputed by the evidence presented.   See id.; see also Morinville v. Old Colony Co-operative Newport
National Bank, 522 A.2d 1218, 1222 (R.I. 1987) (“A trial justice fulfills his or her obligation to charge
the jury properly by framing the issues in such a way that the instructions ‘reasonably set forth all of the
propositions of law that relate to material issues of fact which the evidence tends to support.’”).
Therefore, because the EMTs had no duty to “urge” and “inform” hospital treatment upon Janarelli
unless they (or some other health-care provider) first had concluded that Janarelli actually needed such
care, and then had recommended it to him, only to have him refuse it, and because the question of
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whether they were grossly negligent in concluding that he did not need such care was a question of fact
reserved for the jury, the trial justice properly refused plaintiffs’ incomplete and misleading instructions.
The plaintiffs also proposed that the trial justice instruct the jury that the EMTs “shall be
considered liable to plaintiffs,” if they failed to “urge” or “inform” Janarelli as required by the protocol.
But giving such an instruction would have been a clear misstatement of the law.   Even if the EMTs had
breached their duty under the protocol, they would not necessarily have been liable to the plaintiffs.
Under G.L. 1956 § 23-4.1-12(a), the EMTs could not be held liable “unless [their] act or omission was
the result of gross negligence or willful misconduct.”   Finally, because it was not the law that the EMTs
had an absolute duty to transport Janarelli to the hospital or that they had a duty to attend to Janarelli
“until they were relieved by an ambulance crew,” the instructions proposed by plaintiffs that so provided
were also properly rejected.
Having held that the trial justice properly rejected all the jury instructions requested by plaintiffs,
we next consider plaintiffs’ general objection to the charge given by the trial justice.  In their brief to this
Court, plaintiffs argue that “the trial justice’s refusal to charge the jury regarding the EMTs’ duties and
responsibilities as defined and required by the Department of Health protocols constitutes reversible
error.”  But when plaintiffs’ counsel was asked by the trial justice whether he had any objections to the
charge as given, counsel responded that “[t]he definition of gross negligence, I would suggest that it
ought to have been in accordance with my request for charge, and would object as far as it is
inconsistent.   With respect to my request [sic] 4 through 13, with regard to duty and so forth owed by
the defendants to plaintiffs, I respectfully object.  These have not been given.”
We review a trial justice’s charge to the jury in its entirety, “‘in light of the meaning and
interpretation that a jury composed of ordinary, intelligent lay persons would give [to the instructions].’”
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Neri v. Nationwide Mutual Fire Insurance Co., 719 A.2d 1150, 1153  (R.I. 1998).                                   “An erroneous
charge warrants reversal only if it can be shown that the jury ‘could have been misled’ to the resultant
prejudice of the complaining party.”   Brodeur v. Desrosiers, 505 A.2d 418, 422 (R.I. 1986) (quoting
Anter v. Ambeault, 104 R.I. 496, 501, 245 A.2d 137, 139 (1968)).   Even if we were to assume that
the trial justice’s charge to the jury was erroneous because he failed to define sufficiently the applicable
standard of care, as plaintiffs allege, we still would not reverse because plaintiffs’ objection to the jury
instructions was not “specific enough to alert the trial justice as to the nature of his alleged error.”2
Majewski v. Porter, 121 R.I. 757, 764-65, 403 A.2d 248, 252 (1979) (holding that Rule 51(b) of the
Superior Court Rules of Civil Procedure “bars a party from challenging an erroneous instruction unless
he lodges an objection to the charge which is specific enough to alert the trial justice as to the nature of
his alleged error”); see also Kelly v. Kalian, 442 A.2d 890, 892 (R.I. 1982); Seabra v. Puritan Life
Insurance Co., 117 R.I. 488, 503, 369 A.2d 652, 661 (1977).
Rule 51(b) of the Superior Court Rules of Civil Procedure provides that “[n]o party may assign
as error the giving or the failure to give an instruction unless the party objects thereto before the jury
retires to consider its verdict, stating distinctly the matter to which the party objects and the grounds of
the party’s objection.”  Here, by merely objecting generally to the court's gross-negligence instruction to
2
Nor can we rule in favor of plaintiffs based upon the “plain error rule,” because we do not
follow it in this jurisdiction.   See Rhode Island Depositors Economic Protection Corp. v. Rignanese,
714 A.2d 1190, 1196-97 (R.I. 1998) (“It is well settled that this Court will not consider on appeal an
issue that was not raised before the trial court.   * * *  An exception to the raise-or-waive rule is that this
Court will review allegations of violations of basic constitutional rights but even then only in very narrow
circumstances.”).  Compare State v. Rupert, 649 A.2d 1013, 1015 (R.I. 1994) (stating that “[i]t is well
established that Rhode Island does not recognize the plain-error rule”),  with     Provencher v. CVS
Pharmacy, 145 F.3d 5, 9 (1st Cir. 1998) (holding that the court will review for plain error even when a
party fails to object and that “[p]lain error applies only where the error results in a clear miscarriage of
justice or seriously affects the fairness, integrity or public reputation of the proceedings”).
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the extent that it was inconsistent with the plaintiffs’ proposed instructions (which either misstated the
law and/or assumed facts for the jury that were disputed), the plaintiffs failed to satisfy their burden
under Rule 51(b) to alert the trial justice to the specifics of how and why his instructions failed to inform
the jury on the proper standard of care for EMTs in this situation.   Moreover, the trial justice “hardly
[could have been] expected to divine the nature of [their] contention.”   Seabra, 117 R.I. at 503, 369
A.2d at 661.
Conclusion
Therefore, we conclude that because the plaintiffs did not object to the trial justice’s instructions
with sufficient specificity beyond pointing to their alleged inconsistency with their own flawed proposed
instructions, they failed to preserve for appeal any objection to the given standard-of-care instruction.
Accordingly, we deny the plaintiffs’ appeal and affirm the trial court’s judgment.
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COVER SHEET
TITLE OF CASE:                         Cindy L. Patino, as Administratrix of the Estate of
                                       Eugene J. Janarelli et al. v. Frank Suchnik et al.
DOCKET NO.:                            1999-563-Appeal.
COURT:                                 Supreme Court
DATE OPINION FILED:     May 11, 2001
Appeal from                                                                                  County:
SOURCE OF APPEAL:                      Superior                                              Providence
JUDGE FROM OTHER
COURT:                                 Cresto, J.
JUSTICES:                              Williams, CJ, Lederberg, Bourcier,
                                       Flanders, Goldberg, JJ.                               Concurring
                                                                                             Not Participating
WRITTEN BY:                            PER CURIAM
ATTORNEYS:                             Robert D. Parrillo
For Plaintiff
ATTORNEYS:                             Michael DeSisto
For Defendant

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Rhode Island Law