Nebraska Methodist Hospital

Nebraska Methodist Hospital


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Nebraska Methodist Hospital, an affiliate of Methodist Health System, is located in Omaha, Nebraska. Founded in 1891, this 430-bed acute care medical facility was the first Magnet Hospital in the state, with excellent nursing care.The hospital initially opened at a location just north of 20th and Harney streets by the members of the Methodist Episcopal Church and then moved to the present location in 1968. Today, the century-old hospital has grown to a prominent medical facility in the region.Accredited by Joint Commission on Accreditation of Health Care Organizations (JCAHO), the hospital offers surgical/medical health care needs to the community. Women and senior services, oncology, cardiology, orthopedics, neuroscience and urology are some of the areas of specialization.Nebraska Methodist is identified as the first hospital in the Omaha region for lithotripsy treatment for kidney stones. It is the best hospital in the region for obstetrics care, delivering nearly 4,000 babies annually.Methodist Cancer Center cares for its patients by providing the most advanced therapies and support services, including behavioral health, social work, resource library, resource room, education, screenings and support groups.The library at the center is a valuable resource with cancer and health-related items. In addition, the hospital features the Diabetes Institute, Renaissance Health Clinic, trauma center, sleep center, and an outpatient surgery center.Pastoral and interpreter services are available. Methodist also operates a highly automated pharmacy, cafeteria, and a gift shop.


Nebraska Methodist Health System

The Nebraska Methodist Health System, also known as Bestcare, is a nonprofit Nebraskan healthcare organization that was founded in 1982. Its headquarters are located at 825 S. 169th Street in Omaha, Nebraska. The three major facilities in the system, Methodist Jennie Edmundson Hospital (Council Bluffs, Iowa), Methodist Women's Hospital (Elkhorn, Nebraska), and Methodist Hospital (Omaha, Nebraska), have served the Omaha-Council Bluffs metropolitan area for more than 120 years. Two dozen additional facilities in rural Nebraska and Iowa provide family practice services and specialties including pediatrics, behavioral health, radiology, and allergy care.

Created in 1982 by Methodist Hospital leaders, the system operates as a not-for-profit. [1] There are 685 beds within the system, with facilities offering programs in obstetrics, neurology, cancer care, cardiology, rehabilitation, and geriatric care. [2]

The Methodist Health System is affiliated with the Nebraska Methodist College. [3]


Methodist Memories: 1st in Nebraska to Offer Lithotripsy

In 1985, Methodist Hospital became the first hospital in Nebraska to purchase a lithotripter, a medical device used to treat kidney stones. Lithotripsy comes from the Greek words for breaking or pulverizing stones.

The lithotripter was developed as a spinoff of the shock wave technology used to test supersonic aircraft parts.

Representatives of the Dornier Aircraft Company in West Germany happened to mention their research into the destructive power of raindrops hitting aircraft surfaces in supersonic flight to a physician. Would it be possible, the physician wondered, to use focused shock waves to smash kidney stones?

As a result of that conversation, the first human kidney stone lithotripsy was performed in Munich, West Germany, in 1980, using a prototype machine built by Dornier.

Surgery to remove kidney stones used to be a major operation requiring a 10-day hospital stay and 6-week recuperation. At Methodist Hospital, this type of kidney stone surgery ended in 1983 with the introduction of a less-invasive method called percutaneous removal. A half-inch incision was required to insert an endoscopic tube called a nephroscope into the kidney. Ultrasound through the nephroscope broke apart the stones, and stone materials were suctioned out of the body.

Lithotripsy, also called extracorporeal-generated shock wave therapy, offered a new and noninvasive way to disintegrate kidney stones. It had a high success rate in breaking stones into particles small enough to pass through the body without requiring percutaneous removal.

In early 1985, at the urging of Methodist Hospital urologist Hal Mardis, MD, Methodist applied to the state for a certificate of need to remodel two operating rooms and purchase a Dornier lithotripter at a cost of $1.72 million. Methodist Hospital received approval because of the unique equipment-sharing program developed by Dr. Mardis, who took several weeks of training in West Germany before returning to operate the device here.

Dozens of urologists from Nebraska, Iowa and South Dakota were trained at one of 14 centers in the U.S. or West Germany in how to use the lithotripter to treat their patients at Methodist Hospital. Methodist Hospital also arranged research projects with Mayo Clinic, Kansas University and Washington University of St. Louis, as well as arranging to train University of Nebraska Medical Center urology residents.

The original lithotripters pulverized stones with shock waves delivered through water. The patient undergoing treatment was dressed in a paper bathing suit and lowered into a water-filled tub. At the bottom of the tub was a 6-inch spark plug that fired off shock waves. At the time, the spark plug cost $225.

At either side of the tub were low-dose X-rays, called computerized image intensifiers, to view the kidney stones from two different perspectives. The resulting images appeared on two monitors, each marked at the center with crosshairs.

Shock waves were concentrated on an area 1/2 inch in diameter. At any single point, the shock wave had the impact of a raindrop. Collectively, the force was like a heavy rainstorm. The average patient received 500 to 1,600 shock waves during a treatment that lasted from 60 to 90 minutes.

Shortly after Methodist's lithotripter was in operation, Children's Hospital admitted a 7-month-old girl with a kidney stone. The decision was made to use the lithotripter on the girl, believed to be the youngest patient every scheduled for lithotripsy.

Because the girl was too small for the water tank support system, Dr. Mardis modified an infant car seat for her. A hole was cut in the back of the car seat for the shock waves to pass through, and styrofoam padding was attached to the upper part of the seat to protect the girl's lungs.

It took 1,800 shock waves to break up the child's kidney stone. The procedure was a success.

By the end of the lithotripter's first year of operation, 600 procedures had been performed, and 31 physicians from Omaha and the surrounding area were certified to use Methodist's lithotripter &mdash the highest number of physicians working on any of the 250 Dornier machines in the world at that time. Dr. Mardis delivered papers on the procedures at international medical meetings in England and Egypt.


Methodist Memories: Nursing Uniforms

Evelyn Bartee gets help with the buttons on the 1891 (original) NMHS student uniform from Marie Snyder (1920s), Walt Hemlstrand (men's uniform), Katie Steen (1930s), Deanna Clay (1940s & 1950s) and Kareen Johnson (1960s).

Student uniforms from the past were modeled at the 1961 alumni banquest held in celebration of the 70-year anniversary of the Methodist Hospital School of Nursing.

Do you have a great vintage photo of a Methodist uniform? Send your images or favorite memories to [email protected]

Source: Nebraska Methodist Hospital Pulse Beat Newsletter, August 1961

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(402) 354-4800

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Nebraska Methodist Hospital - History

Since 1881, the University of Nebraska Medical Center (UNMC) has been providing Nebraskans with excellent and advanced healthcare, and our department has been an integral part of it year by year. Herein, we give a summarized version of the department however, for a more detailed history of pathology and microbiology at UNMC and the formation of the department, please see a wonderfully written account by Dr. James Newland, emeritus professor for the department, and Brian Lenz, entitled, "Pathology and Microbiology at UNMC: A historical view of the department from 1882-2001."

The Early Years
When classes opened at the Omaha Medical College, between 12th and Pacific streets (upper left photo), in 1882, Dr. A. S. von Mansfelde (photo right) was named as professor of pathology. The entire medical curriculum was two years in length with instruction lasting 20 weeks each year and pathology was taught as one lecture per week. Throughout the early years of the college, the pathology curriculum increased in offered courses such as bacteriology, as well as teaching time. Many notable faculty members joined the ranks of the pathology faculty, including Harold Gifford, MD, W. K. Yeakel, MD, and W. F. Milroy, MD, who identified the condition of lymphedema of the lower extremities, hence the eponym, "Milroy's Disease".

In 1902, the Omaha Medical College was merged into the University of Nebraska and renamed the University of Nebraska College of Medicine (UNCM). After the construction of a new building in Omaha to house all medical instruction in 1912, the second year pathology course was significantly expanded to 306 hours and clinical pathology was added as a third year course. This expansion led to new pathology faculty members joining UNCM, including Oscar T. Schulz, MD, and A. A. Johnson, MD In 1917, the department had been renamed the department of pathology and bacteriology. Bridging the World War I and II years, Harold Eggers, MD was designated as professor of pathology in 1917 and remained as chairman for 31 years until his retirement in 1948. Joining the department in 1923, Miss Helen Wyant was the first trained medical technologist on the faculty and in the state of Nebraska. James Perry Tollman, MD, joined the department in the academic year 1931-32 and later became its chairman in 1948 and subsequently Dean of the College of Medicine.

Post-War Years
 In 1954, John Rudolf Schenken, MD, head of pathology at Nebraska Methodist Hospital was named chairman of the department of pathology at UNMC. Dr. Harry W. McFadden, a product of the UNCM College of Medicine and trained in the department of pathology and bacteriology, was named chairman of the new department of microbiology in 1955. Francis Smith, MD, a superb clinical pathologist, was brought into the department in 1956. The department purchased the first transmission electron microscope on the campus in 1957 and was expertly utilized by Richard B. Wilson, MD, another College of Medicine graduate and pathologist trained by the department.

 In 1965, C. A. McWhorter, MD, became chairman of the department. At this time, there were approximately 335 hours of instruction in general and clinical pathology. In 1968, the medical technology teaching program took part in a successful consortium of three hospitals. The department continued to expand in faculty through these years. In the 1968, the clinical pathology course was changed to one of significant amount so small group, case-based teaching. Over the 1970s, pathology instruction hours were decreased. The clinical laboratories continued to expand.

One Hundred Years Later
In 1981, David Theodore Purtilo, MD, became the chair very quickly expanded the research capabilities of the department, bringing to it world-wide recognition. Research and clinical faculty were added in greater numbers than previously. In 1984 the department of microbiology joined with the department of pathology, being renamed Pathology and Microbiology. With this, the department's graduate program expanded. Upon his arrival in 1983, Dennis Weisenburger, MD took directorship of the highly successful Lymphoma Study Group and was instrumental in the later stem cell transplant program. Talented hematopathologists were attracted to the department. Through Dr. Rodney Markin, the department skillfully supported the role of UNMC's liver transplant program.

In 1992 on Dr. Purtilo's untimely death, Dr. Samuel Monroe Cohen, MD, PhD, who was recruited as vice chairperson for research and education by Dr. Purtilo, became department chair. Research efforts continued to expand with significant amounts of NIH-supported activities. In 1997, University Hospital merged with Clarkson Hospital and eventually did the service pathology for the latter hospital.

Steven Hinrichs, MD, became Chair of the department in 2008. Earlier, in 1997, he had been named the director of the Nebraska Public Health Laboratories, and the laboratories moved to the Omaha campus. Dr. Hinrichs had continued the excellence in leadership of the Department of Pathology and Microbiology. Now, over 100 years since the inception of the Omaha Medical College in 1882, the changes to the university and the department are profound and delightful. 

Department Chairs

John R. Schenken, MD
Chair, Department of Pathology
1954-1965 

C.A. McWhorter, MD
Chair, Department of Pathology
1965-1981 

David T. Purtilo, MD
Chair, Department of Pathology
1981-1984
Chair, Department of Pathology and Microbiology
1985-1992


Nebraska Methodist Hospital - History

by John Schleicher, McGoogan Library of Medicine | July 02, 2013

A vintage postcard shows Omaha-area hospitals which survived. Clockwise from top left, University of Nebraska Hospital (now The Nebraska Medical Center), Immanuel Deaconess Institute (now Immanuel Medical Center), St. Joseph's Hospital (now Creighton University Medical Center) and Nebraska Methodist Hospital (now Methodist Hospital). (Postcard image courtesy of Mary Slowik, General Internal Medicine, UNMC).
"Omaha possesses unrivaled facilities for the treatment of any kind and every kind of human ailment. Omaha physicians and surgeons are among the very best."

These words might have been written last week or last month. In actuality, they come from an April 1928 article, "Omaha: A Great Medical Center," in Omaha's Own Magazine & Trade Review, which billed itself as "a journal of constructive optimism."

Omaha has been home to a number of hospitals over the decades some lasted, others did not. Bergan Mercy, Children's, Immanuel, Methodist -- all familiar names to Omahans.

Booth, Presbyterian, Radium, St. Catherine's -- these are perhaps less familiar.

Historical information from the 1920s shows 16 to 22 different hospitals in Omaha at that time, depending on the source consulted. In the 60 to 70 years of Omaha's history prior to 1920, other hospitals came and went, as well.

Most Christian denominations had a hospital at one time or another, Danish Lutheran, Swedish Mission, Evangelical Covenant and St. Joseph's, among others. Other former Omaha hospitals were founded and run by physicians, either individually or as a group. Among these were Frederick, Lord Lister (named for the pioneer of antiseptic surgery), South Side and Nicholas Senn.

Nicholas Senn Hospital (later called Doctor's Hospital). The building is currently being demolished. The institutional structure of this hospital evolved into today's Midlands Hospital.
Others were specialty hospitals, such as the Omaha Maternity Hospital. For a brief time, the city of Omaha ran the City Detention and Emergency Hospital and, of course, Douglas County Hospital has existed for many years.

As with other physician-run private hospitals, Nicholas Senn Hospital, located at 501 Park Ave., at the corner of Dewey Avenue, was built as an investment and expansion of private practice. It was opened in 1912 by Albert P. Condon, M.D., who named his hospital for a late-19th century Chicago surgeon who'd also been his professor of surgery at Rush Medical College.

Because of limited finances, most of these private hospitals did not stay in business for long.

Nicholas Senn Hospital was re-organized as Doctor's Hospital in 1916, apparently taking in more physician partners, though it seems to have been known as Nicholas Senn Hospital until about 1942.

Parts of the current building date to about 1953, with additions and improvements going through 1965 or 1966. The hospital moved in 1974 to Papillion, forming the origins of Midlands (Community) Hospital.

The original building, later a health club and eventually apartments, is currently being demolished to make way for another apartment development.


UNMC News

These words might have been written last week or last month. In actuality, they come from an April 1928 article, "Omaha: A Great Medical Center," in Omaha's Own Magazine & Trade Review, which billed itself as "a journal of constructive optimism."

Omaha has been home to a number of hospitals over the decades some lasted, others did not. Bergan Mercy, Children's, Immanuel, Methodist -- all familiar names to Omahans.

Booth, Presbyterian, Radium, St. Catherine's -- these are perhaps less familiar.

Historical information from the 1920s shows 16 to 22 different hospitals in Omaha at that time, depending on the source consulted. In the 60 to 70 years of Omaha's history prior to 1920, other hospitals came and went, as well.

Most Christian denominations had a hospital at one time or another, Danish Lutheran, Swedish Mission, Evangelical Covenant and St. Joseph's, among others. Other former Omaha hospitals were founded and run by physicians, either individually or as a group. Among these were Frederick, Lord Lister (named for the pioneer of antiseptic surgery), South Side and Nicholas Senn.

Nicholas Senn Hospital (later called Doctor's Hospital). The building is currently being demolished. The institutional structure of this hospital evolved into today's Midlands Hospital.
Others were specialty hospitals, such as the Omaha Maternity Hospital. For a brief time, the city of Omaha ran the City Detention and Emergency Hospital and, of course, Douglas County Hospital has existed for many years.

As with other physician-run private hospitals, Nicholas Senn Hospital, located at 501 Park Ave., at the corner of Dewey Avenue, was built as an investment and expansion of private practice. It was opened in 1912 by Albert P. Condon, M.D., who named his hospital for a late-19th century Chicago surgeon who'd also been his professor of surgery at Rush Medical College.

Because of limited finances, most of these private hospitals did not stay in business for long.

Nicholas Senn Hospital was re-organized as Doctor's Hospital in 1916, apparently taking in more physician partners, though it seems to have been known as Nicholas Senn Hospital until about 1942.

Parts of the current building date to about 1953, with additions and improvements going through 1965 or 1966. The hospital moved in 1974 to Papillion, forming the origins of Midlands (Community) Hospital.

The original building, later a health club and eventually apartments, is currently being demolished to make way for another apartment development.


Emil Kopac [RG1143.AM]

The collection contains miscellaneous papers of Emil Kopac of Scottsbluff, Nebraska. Included are items concerning fundraising efforts fo the West Nebraska Methodist Hospital in Scottsbluff in 1925 book lists and subscription forms for the anti-papal publisher "The Rail-Splitter," of Milan, Illinois Kopac's real estate tax statements (ca. 1950s) for Garden County, Nebraska property envelopes and telegrams relating to the Kopac Brothers business in Omaha, Nebraska a program for the 1969 rodeo held in Hardin, Montana misc. items relating to the Oregon Trail including hand-drawn maps showing portions of the Trail near Julesburg, Colorado and Scotts Bluff County, Nebraska, and a notebook containing Oregon Trail mileage. Also included in the collection is a letter dated November 2, 1917 from H.B. Chronister at Camp Cody, Deming, New Mexico, to Kopac in which he tells of camp life and the health conditions of the soldiers serving along the Mexico border.

Note: See also the photo component [RG1143.PH]. The Nebraska History Index and the Newspaper Index card catalog contain references to Emil Kopac.


Last Chance for Methodist Employees To Complete COVID-19 Survey

Over the past year, COVID-19 has affected us all in some way. Now a Methodist Health System research team is conducting a study to learn more about the physical and emotional impact of COVID-19 on Methodist employees. All employees &ndash whether they have had COVID-19 or not &ndash are invited to take the online survey, which has been approved by the Methodist Hospital Institutional Review Board (IRB).

The survey, titled &ldquoNatural History of Post-COVID-19 Convalescence Among Healthcare Personnel at the Nebraska Methodist Health System,&rdquo can be taken anonymously in less than 10 minutes and will close on April 30.

As is true for all studies, there is a small risk for breach of confidentiality. You do not have to complete the survey. All survey answers will be reported as a whole. Data will be kept on a password-protected computer.

Your agreement to take the survey is implied by clicking on the survey link.


Mahoney v. Nebraska Methodist Hosp., Inc.

Mary MAHONEY, Appellee, v. NEBRASKA METHODIST HOSPITAL, INC., a Nebraska corporation, Appellant.

Supreme Court of Nebraska.

*453 Joseph S. Daly, of Sodoro, Daly & Sodoro, P.C., Omaha, for appellant.

Gregory M. Schatz, Omaha, for appellee.

WHITE, C.J., CAPORALE, WRIGHT, CONNOLLY, and GERRARD, JJ., and LUTHER, D.J.

Nebraska Methodist Hospital, Inc., having admitted liability, appeals a jury verdict in favor of appellee, Mary Mahoney, in the amount of $400,000. Methodist Hospital asks this court to reverse the verdict and remand the cause because the trial court erred in excluding Methodist Hospital's expert testimony, in not admitting evidence of Mahoney's early retirement pension, and in instructing the jury on cosmetic deformity. We affirm the jury's verdict.

On July 13, 1990, police officer Mary Mahoney was attempting to provide crowd control in a riot disturbance in Omaha, Nebraska. While performing these duties, Mahoney was struck by a car. As a result, she suffered an injury to her right knee and was transported to a hospital for treatment. Mahoney ultimately had arthroscopic surgery on her right knee on September 11, 1990. Subsequent to this surgery, she returned to her duties as a police officer.

Despite the surgery, Mahoney continued to experience pain and mobility problems with her right knee. In February 1991, she sought the services of Dr. William M. Walsh, an orthopedic surgeon. Walsh first attempted to treat the injured knee with noninvasive procedures, such as physical therapy and taping to hold the kneecap in place. When these techniques failed to produce effective results, Walsh performed arthroscopic surgery on Mahoney's knee on April 8, 1991, during which the kneecap was realigned. Because of complications, Mahoney's knee filled up with blood, requiring a third surgical operation on the knee to drain the excess blood. Following Mahoney's recovery from the surgeries, she returned to her job as a police officer on August 1, 1991, with no restrictions. In releasing Mahoney back to work, Walsh was aware of the physical requirements of being a police officer.

Mahoney returned to Walsh for a 6-week followup on August 27, 1991, complaining of pain in her right knee. Walsh determined she was suffering from a condition known as reflex sympathetic dystrophy. This condition involves an imbalance of sympathetic nerve flow into an extremity, often resulting in pain, tingling, and numbness. In order to treat this condition, Walsh ordered a series of sympathetic nerve blocks to control Mahoney's pain. Mahoney was told these injections would offer relief to her leg in that they would dilate the blood vessels.

The injections were given by an anesthesiologist on an outpatient basis at Methodist Hospital. Prior to the actual injection, the contents of the nerve-block shot would be prepared by dissolving a guanethidine pill in a saline solution. The solution would then be put into a syringe. After draining the blood from Mahoney's leg with the use of a tourniquet, the anesthesiologist would inject the solution into her leg.

Mahoney was to receive a series of 16 shots, with the first commencing on August 29, 1991. Mahoney continued to work as a police officer with no restrictions during her first 12 nerve-block treatments. On October *454 31, she received her 13th nerve-block injection at Methodist Hospital. During the administration of this injection, Mahoney experienced severe cramping and burning in her leg. Tests were ordered to help determine the cause of Mahoney's pain. It was later determined that Mahoney had suffered a hypertonic saline injection injury because a pharmacist employed by the hospital had prepared the injection incorrectly. The hospital admitted its liability in this respect.

Mahoney was required to stay in the hospital for a period of 15 days following the damaging injection. Throughout her stay, she experienced extreme pain and swelling and required daily injections of morphine and other narcotic drugs. In the spring of 1992, Walsh concluded that Mahoney would be unable to return to her job because of the injuries she suffered to her knee in the car and hospital incidents. Mahoney subsequently retired from the Omaha Police Division in May 1992 and now receives a pension.

At trial, Mahoney offered evidence to establish the extent of her knee damage due to the hypertonic saline injection injury. Walsh testified that Mahoney's knee had a 30-percent permanent impairment, with 25 percent being attributable to the car accident and 5 percent attributable to the hypertonic saline injection injury at Methodist Hospital. In Walsh's opinion, the permanent impairment to Mahoney's knee because of the injection injury includes numbness in her calf throbbing discomfort during long periods of standing the possibility of edema, or swelling, of the right calf and muscle spasms. At one point, Walsh testified that Mahoney might not have been able to return to work as a police officer even if the incident had not occurred at Methodist Hospital. However, Walsh stated that he informed the Omaha Police Division that Mahoney would be unable to return to the police force because of both the car accident and the injury sustained while receiving the nerve-block injection.

Methodist Hospital attempted to offer the deposition testimony of its own expert, Dr. Donald Gammel. In his deposition, Gammel testified that Mahoney's knee was 35 percent permanently impaired, with 25 percent attributable to the car accident and the remaining 10 percent attributable to the hypertonic saline injection injury. When Gammel was asked his opinion on whether Mahoney could have returned to work had the vascular injury at Methodist Hospital not occurred, counsel for Mahoney objected on the basis of foundation. During cross-examination at the deposition, Gammel stated that he was not aware of Mahoney's tasks as a police officer and that his opinion as to her not being able to return despite the saline injection injury was based on "lack of information" regarding her day-to-day activities as a police officer. The court sustained the foundation objection to Gammel's testimony.

The district court also sustained Mahoney's motion in limine preventing Methodist Hospital from introducing evidence that she was currently receiving an early retirement pension from the Omaha Police Division. The court made its ruling on the basis that any income Mahoney may be receiving from the police department was inadmissible under the collateral source doctrine.

The jury returned a verdict in favor of Mahoney and awarded her $400,000 in damages. Methodist Hospital appeals, challenging the damage award.

Methodist Hospital contends the district court erred in (1) not allowing Gammel to give his expert opinion as to whether Mahoney could have returned to work absent the Methodist Hospital incident, (2) not allowing Methodist Hospital to introduce evidence of Mahoney's pension, (3) giving an improper jury instruction, and (4) not granting a new trial because the jury award was excessive and given under the influence of passion or prejudice.

A trial court's ruling in receiving or excluding an expert's testimony which is otherwise relevant will be reversed only when there has been an abuse of discretion. McArthur v. Papio-Missouri River NRD, 250 Neb. 96, 547 N.W.2d 716 (1996) McIntosh v. *455 Omaha Public Schools, 249 Neb. 529, 544 N.W.2d 502 (1996).

When reviewing a question of law, an appellate court reaches a conclusion independent of the lower court's ruling. Grand Island Latin Club v. Nebraska Liq. Cont. Comm., 251 Neb. 61, 554 N.W.2d 778 (1996).

A jury verdict will not be disturbed on appeal as excessive unless it is so clearly against the weight and reasonableness of the evidence and so disproportionate as to indicate that it was the result of passion, prejudice, mistake, or some means not apparent in the record, or that the jury disregarded the evidence or rules of law. Barks v. Cosgriff Co., 247 Neb. 660, 529 N.W.2d 749 (1995) McDonald v. Miller, 246 Neb. 144, 518 N.W.2d 80 (1994).

Methodist Hospital's first assigned error concerns the district court's sustaining the foundation objection to Gammel's testimony regarding Mahoney's ability to work as a police officer despite the injury she sustained as a result of the injection. Methodist Hospital asserts this was error because the record establishes that Gammel was fully aware of Mahoney's condition and medical history and that he possesses the requisite skill, training, and experience necessary to give an expert opinion.

To clarify, Mahoney's objection to Gammel's testimony did not concern his capacity as an expert in the evaluation of disabling injuries. Indeed, the objection to Gammel's testimony concerns only his knowledge of pertinent facts on which his opinion was offered. A firm understanding of the pertinent, underlying facts is critical when an expert offers his or her opinion.

Expert testimony should not be received into evidence if it is evident that the witness does not possess such facts that enable him to express a reasonable, accurate conclusion as distinguished from a mere guess. Without an adequate basis of facts, the witness should not be allowed to give an opinion.

Menkens v. Finley, 93, 251 Neb. 84, 555 N.W.2d 47, 53 (1996). See, also, Ketteler v. Daniel, 251 Neb. 287, 556 N.W.2d 623 (1996) Paulsen v. State, 249 Neb. 112, 541 N.W.2d 636 (1996).

After a proper foundation objection was made during Gammel's deposition testimony, Gammel admitted during his cross-examination that he was unaware of the tasks Mahoney was required to perform while working as a police officer. In addition, Gammel admitted that his opinion that Mahoney could not return to work as an officer despite the hypertonic saline injection injury was based on a "lack of information" as to her day-to-day activities as a police officer. On redirect examination, Gammel testified that he was somewhat familiar with the duties of a police officer on account of what he has seen on television and of his "general sense" of what "beat cops" do. This testimony of Gammel makes it apparent that he possessed no knowledge of the physical demands actually placed upon Mahoney as a police officer. As such, Gammel lacked knowledge of facts necessary to support his opinion concerning Mahoney's ability to perform as a police officer in Omaha. Recognizing that a trial court's ruling in receiving or excluding an expert's testimony which is otherwise relevant will be reversed only when there has been an abuse of discretion, McArthur v. Papio-Missouri River NRD, supra McIntosh v. Omaha Public Schools, supra, we conclude that the district court did not abuse its discretion in excluding Gammel's testimony concerning Mahoney's ability to return to work as a police officer.

In its next assigned error, Methodist Hospital asserts the district court incorrectly precluded it from offering any evidence of the pension Mahoney is receiving as a result of her early retirement from the Omaha Police Division. Methodist Hospital argues that the pension is paid to Mahoney because of the car accident injury to her knee and is therefore not a collateral source regarding the injury she suffered to her knee as a result of the injection. Mahoney contends the lower court's ruling is correct because the collateral source rule prohibits the mitigation of personal injury damages with evidence establishing that the injured party is *456 being compensated by another party during her disability.

Under the collateral source rule, the fact that the party seeking recovery has been wholly or partially indemnified for a loss by insurance or otherwise generally cannot be set up by the wrongdoer in mitigation of damages. Chadron Energy Corp. v. First Nat. Bank, 236 Neb. 173, 459 N.W.2d 718 (1990). We have stated:

This rule provides that benefits received by the plaintiff from a source wholly independent of and collateral to the wrongdoer will not diminish the damages otherwise recoverable from the wrongdoer. The theory underlying the adoption of this rule by a majority of jurisdictions is to prevent a tort-feasor from escaping liability because of the act of a third party, even if a possibility exists that the plaintiff may be compensated twice.

Hiway 20 Terminal, Inc. v. Tri-County Agri-Supply, Inc., 232 Neb. 763, 767, 443 N.W.2d 872, 875 (1989).

Ordinarily, compensation recognized as coming from a collateral source occurs in situations involving only one damaging incident. The instant case is unusual in that there exist two separate, and seemingly unrelated, injuries to Mahoney's knee: one injury attributed to the car accident and one injury attributed to the injection injury. Due to this division, Methodist Hospital asks us to declare the pension Mahoney receives from the Omaha Police Division to be related only to that portion of her permanent knee injury sustained because of the car accident. As such, Methodist Hospital asserts that the pension was not "collateral" to any injury Mahoney suffered because of the injection injury and that evidence of it should therefore have been admitted for the purpose of mitigating damages.

This court has not had occasion to address the application of the collateral source rule in a situation in which there are two separate injuries. As a general matter, however, we have held that presenting evidence of a pension or disability benefits is inappropriate for purposes of determining damages. In Harper v. Young, 139 Neb. 624, 298 N.W. 342 (1941), the plaintiff sought recovery for damages he sustained in a car accident. Throughout the trial, evidence was adduced that the plaintiff would be eligible for a pension in the future and that he could have obtained compensation from the government for his injuries had he applied for them. This court remanded the cause, holding that the introduction of this evidence without limiting instructions was "not admissible upon any theory" and therefore prejudicial to the plaintiff. Id. at 630, 298 N.W. at 345. See, also, Singles v. Union P. R.R. Co., 174 Neb. 816, 119 N.W.2d 680 (1963) (holding error committed in admission of testimony regarding size of pension, because financial conditions of parties are immaterial) Annot., Collateral Source Rule: Receipt of Public or Private Pension as Affecting Recovery Against a Tortfeasor, 75 A.L.R.2d 885 (1961) (stating general rule that payments from a collateral source may not be taken into consideration in assessing damages).

Other jurisdictions that have examined the precise issue put before us have concluded that benefits received for an initial injury are inadmissible to mitigate the damages of a subsequent tort-feasor responsible for further injury. In Holman v. Grandview Hosp. & Med. Ctr., 37 Ohio App.3d 151, 524 N.E.2d 903 (1987), the plaintiff was hospitalized for a permanently disabling back injury. Prior to surgery, he was to receive periodic injections of pain medication. A nurse improperly gave a shot, resulting in further injuries to the plaintiff. At trial, the defendant hospital attempted to introduce evidence that the plaintiff was receiving payments for workers' compensation. The court, after determining that the statutory malpractice statute did not apply, held that evidence of such collateral source payments was inadmissible.

Likewise, in Jones v. Laird Foundation, Inc., 156 W.Va. 479, 195 S.E.2d 821 (1973), the plaintiff suffered an initial injury to his back while at work. While hospitalized, he received inadequate care from a physician that caused further injury to his back. Due to the extent of both injuries, the plaintiff was awarded workers' compensation benefits. In reviewing the appeal of the plaintiff's claim against the physician, the West Virginia *457 Supreme Court held that the plaintiff's compensation benefits were a collateral source and therefore could not be considered in mitigation of damages in the action against the physician for the additional injury to the plaintiff's back.

In the instant case, Mahoney testified that she continued to work as a police officer during the timeframe in which she was receiving the injections at Methodist Hospital. It was only after the October 31, 1991, injection that Mahoney was unable to return to work. At trial, Walsh testified that he informed the Omaha Police Division that Mahoney would be unable to perform her tasks as a police officer because of permanent injuries to her knee due to both the car accident and the injection injury. Faced with this diagnosis, she retired and began receiving her pension. Thus, the pension benefits Mahoney is now receiving are essentially for both injuries she sustained to her knee. Therefore, in accordance with both this court's repeated statements that presenting evidence of a pension is inappropriate for determining damages and the reasoning of those courts that have examined the operation of the collateral source rule in the context of two separate injuries, we conclude that Mahoney's pension is, in fact, a "collateral" and "independent" source of income for Mahoney's injuries suffered because of Methodist Hospital's negligence. That being the case, the second assigned error is without merit.

As its third assignment of error, Methodist Hospital contends the district court erred in instructing the jury regarding damages. In particular, Methodist Hospital argues that portion of jury instruction No. 13 which provided that "[f]uture disability is not limited to functional disability, but includes cosmetic deformity as well" was incorrectly given because it was taken from the comments to and not the text of NJI2d Civ. 4.01, the pertinent instruction concerning general damages.

We have previously noted that "the instructions contained in the second edition of the Nebraska Jury Instructions are designed to be used when they reflect the law and the pleadings and evidence call for such an instruction." Anderson v. Nashua Corp., 246 Neb. 420, 426, 519 N.W.2d 275, 281 (1994). Obviously, any instruction derived from the comments to the Nebraska Jury Instructions must also meet the same criteria. Simply because instruction No. 13 in the instant case used language from the comments to NJI2d Civ. 4.01 does not require us to determine the instruction erroneous per se. To so hold would essentially deny a court the opportunity to properly formulate instructions that are tailored to the case at hand. Such a result would be at odds with our repeated statement:

"`"The purpose of an instruction is to furnish guidance to the jury in their deliberations, and to aid them in arriving at a proper verdict and, with this end in view, it should state clearly and concisely the issues of fact and the principles of law which are necessary to enable them to accomplish the purpose desired.". . .'"

First Nat. Bank v. Bolzer, 221 Neb. 415, 420, 377 N.W.2d 533, 536-37 (1985), quoting Bodtke v. Bratten, 166 Neb. 36, 88 N.W.2d 159 (1958).

Thus, for purposes of this appeal, we must determine whether the instruction given on cosmetic deformity is supported by the law and the evidence of the case. See Anderson v. Nashua Corp., supra. In this regard, we note that an instruction on cosmetic deformities for purposes of future disability was upheld by this court in Stapleton v. Norvell, 193 Neb. 71, 225 N.W.2d 409 (1975), where the evidence adduced at trial established that the plaintiff suffered permanent scarring due to lacerations she received during a car accident. We conclude that the evidence in the instant case also supports an instruction on cosmetic deformity. Walsh testified that the difference in size between Mahoney's left and right calves, as a result of the accident, was permanent in nature. Likewise, Mahoney testified that her calves were notably different in size as a result of the accident and that she has a scar on her forearm due to an infection from the IV's in her arm. In light of this evidence, the court did not err in instructing the jury on cosmetic deformity.

*458 The last assigned error concerns the amount of the jury verdict. According to Methodist Hospital, the $400,000 verdict is so excessive in nature that it demonstrates the jury acted with extreme passion and prejudice. We disagree.

A jury verdict will not be disturbed on appeal as excessive unless it is so clearly against the weight and reasonableness of the evidence and so disproportionate as to indicate that it was the result of passion, prejudice, mistake, or some means not apparent in the record, or that the jury disregarded the evidence or rules of law. Barks v. Cosgriff Co., 247 Neb. 660, 529 N.W.2d 749 (1995) McDonald v. Miller, 246 Neb. 144, 518 N.W.2d 80 (1994). An examination of the record in this case leads us to conclude that the jury verdict in favor of Mahoney was not excessive. At the time Mahoney received her injury at Methodist Hospital, she was a young police officer with substantial earning capacity. In 1989, her gross income was $41,399.28, and for 1990, it was $35,061. Mahoney testified at trial that she had planned on working as a police officer until the mandatory retirement age of 62. According to the dictates of Walsh, Mahoney's injuries to her knee make it impossible for her to fulfill that goal. The economic ramifications are substantial considering that James Rogers, a vocational rehabilitation counselor, testified that Mahoney's job qualifications allow her to make only $4.50 to $9 per hour.

In addition to the loss of her employment and earning capacity, Mahoney also testified that she experienced considerable pain and suffering as a result of Methodist Hospital's negligence. As noted above, Mahoney was constantly on high doses of pain medication for the 2 weeks following the nerve-block injection. In light of this evidence, we cannot conclude that the $400,000 jury verdict in this case is excessive. Accordingly, the fourth assignment of error is without merit.

In accordance with the above analysis, we conclude that no error was made and that the jury verdict in favor of Mahoney should be affirmed.


MAHONEY v. NEBRASKA METHODIST HOSPITAL INC

Mary MAHONEY, Appellee, v. NEBRASKA METHODIST HOSPITAL, INC., a Nebraska corporation, Appellant.

No. S-95-330.

Decided: February 28, 1997

Nebraska Methodist Hospital, Inc., having admitted liability, appeals a jury verdict in favor of appellee, Mary Mahoney, in the amount of $400,000. Methodist Hospital asks this court to reverse the verdict and remand the cause because the trial court erred in excluding Methodist Hospital's expert testimony, in not admitting evidence of Mahoney's early retirement pension, and in instructing the jury on cosmetic deformity. We affirm the jury's verdict.

On July 13, 1990, police officer Mary Mahoney was attempting to provide crowd control in a riot disturbance in Omaha, Nebraska. While performing these duties, Mahoney was struck by a car. As a result, she suffered an injury to her right knee and was transported to a hospital for treatment. Mahoney ultimately had arthroscopic surgery on her right knee on September 11, 1990. Subsequent to this surgery, she returned to her duties as a police officer.

Despite the surgery, Mahoney continued to experience pain and mobility problems with her right knee. In February 1991, she sought the services of Dr. William M. Walsh, an orthopedic surgeon. Walsh first attempted to treat the injured knee with noninvasive procedures, such as physical therapy and taping to hold the kneecap in place. When these techniques failed to produce effective results, Walsh performed arthroscopic surgery on Mahoney's knee on April 8, 1991, during which the kneecap was realigned. Because of complications, Mahoney's knee filled up with blood, requiring a third surgical operation on the knee to drain the excess blood. Following Mahoney's recovery from the surgeries, she returned to her job as a police officer on August 1, 1991, with no restrictions. In releasing Mahoney back to work, Walsh was aware of the physical requirements of being a police officer.

Mahoney returned to Walsh for a 6-week followup on August 27, 1991, complaining of pain in her right knee. Walsh determined she was suffering from a condition known as reflex sympathetic dystrophy. This condition involves an imbalance of sympathetic nerve flow into an extremity, often resulting in pain, tingling, and numbness. In order to treat this condition, Walsh ordered a series of sympathetic nerve blocks to control Mahoney's pain. Mahoney was told these injections would offer relief to her leg in that they would dilate the blood vessels.

The injections were given by an anesthesiologist on an outpatient basis at Methodist Hospital. Prior to the actual injection, the contents of the nerve-block shot would be prepared by dissolving a guanethidine pill in a saline solution. The solution would then be put into a syringe. After draining the blood from Mahoney's leg with the use of a tourniquet, the anesthesiologist would inject the solution into her leg.

Mahoney was to receive a series of 16 shots, with the first commencing on August 29, 1991. Mahoney continued to work as a police officer with no restrictions during her first 12 nerve-block treatments. On October 31, she received her 13th nerve-block injection at Methodist Hospital. During the administration of this injection, Mahoney experienced severe cramping and burning in her leg. Tests were ordered to help determine the cause of Mahoney's pain. It was later determined that Mahoney had suffered a hypertonic saline injection injury because a pharmacist employed by the hospital had prepared the injection incorrectly. The hospital admitted its liability in this respect.

Mahoney was required to stay in the hospital for a period of 15 days following the damaging injection. Throughout her stay, she experienced extreme pain and swelling and required daily injections of morphine and other narcotic drugs. In the spring of 1992, Walsh concluded that Mahoney would be unable to return to her job because of the injuries she suffered to her knee in the car and hospital incidents. Mahoney subsequently retired from the Omaha Police Division in May 1992 and now receives a pension.

At trial, Mahoney offered evidence to establish the extent of her knee damage due to the hypertonic saline injection injury. Walsh testified that Mahoney's knee had a 30-percent permanent impairment, with 25 percent being attributable to the car accident and 5 percent attributable to the hypertonic saline injection injury at Methodist Hospital. In Walsh's opinion, the permanent impairment to Mahoney's knee because of the injection injury includes numbness in her calf throbbing discomfort during long periods of standing the possibility of edema, or swelling, of the right calf and muscle spasms. At one point, Walsh testified that Mahoney might not have been able to return to work as a police officer even if the incident had not occurred at Methodist Hospital. However, Walsh stated that he informed the Omaha Police Division that Mahoney would be unable to return to the police force because of both the car accident and the injury sustained while receiving the nerve-block injection.

Methodist Hospital attempted to offer the deposition testimony of its own expert, Dr. Donald Gammel. In his deposition, Gammel testified that Mahoney's knee was 35 percent permanently impaired, with 25 percent attributable to the car accident and the remaining 10 percent attributable to the hypertonic saline injection injury. When Gammel was asked his opinion on whether Mahoney could have returned to work had the vascular injury at Methodist Hospital not occurred, counsel for Mahoney objected on the basis of foundation. During cross-examination at the deposition, Gammel stated that he was not aware of Mahoney's tasks as a police officer and that his opinion as to her not being able to return despite the saline injection injury was based on “lack of information” regarding her day-to-day activities as a police officer. The court sustained the foundation objection to Gammel's testimony.

The district court also sustained Mahoney's motion in limine preventing Methodist Hospital from introducing evidence that she was currently receiving an early retirement pension from the Omaha Police Division. The court made its ruling on the basis that any income Mahoney may be receiving from the police department was inadmissible under the collateral source doctrine.

The jury returned a verdict in favor of Mahoney and awarded her $400,000 in damages. Methodist Hospital appeals, challenging the damage award.

Methodist Hospital contends the district court erred in (1) not allowing Gammel to give his expert opinion as to whether Mahoney could have returned to work absent the Methodist Hospital incident, (2) not allowing Methodist Hospital to introduce evidence of Mahoney's pension, (3) giving an improper jury instruction, and (4) not granting a new trial because the jury award was excessive and given under the influence of passion or prejudice.

A trial court's ruling in receiving or excluding an expert's testimony which is otherwise relevant will be reversed only when there has been an abuse of discretion. McArthur v. Papio-Missouri River NRD, 250 Neb. 96, 547 N.W.2d 716 (1996) McIntosh v. Omaha Public Schools, 249 Neb. 529, 544 N.W.2d 502 (1996).

When reviewing a question of law, an appellate court reaches a conclusion independent of the lower court's ruling. Grand Island Latin Club v. Nebraska Liq. Cont. Comm., 251 Neb. 61, 554 N.W.2d 778 (1996).

A jury verdict will not be disturbed on appeal as excessive unless it is so clearly against the weight and reasonableness of the evidence and so disproportionate as to indicate that it was the result of passion, prejudice, mistake, or some means not apparent in the record, or that the jury disregarded the evidence or rules of law. Barks v. Cosgriff Co., 247 Neb. 660, 529 N.W.2d 749 (1995) McDonald v. Miller, 246 Neb. 144, 518 N.W.2d 80 (1994).

Methodist Hospital's first assigned error concerns the district court's sustaining the foundation objection to Gammel's testimony regarding Mahoney's ability to work as a police officer despite the injury she sustained as a result of the injection. Methodist Hospital asserts this was error because the record establishes that Gammel was fully aware of Mahoney's condition and medical history and that he possesses the requisite skill, training, and experience necessary to give an expert opinion.

To clarify, Mahoney's objection to Gammel's testimony did not concern his capacity as an expert in the evaluation of disabling injuries. Indeed, the objection to Gammel's testimony concerns only his knowledge of pertinent facts on which his opinion was offered. A firm understanding of the pertinent, underlying facts is critical when an expert offers his or her opinion.

Expert testimony should not be received into evidence if it is evident that the witness does not possess such facts that enable him to express a reasonable, accurate conclusion as distinguished from a mere guess. Without an adequate basis of facts, the witness should not be allowed to give an opinion.

Menkens v. Finley, 93, 251 Neb. 84, 555 N.W.2d 47, 53 (1996). See, also, Ketteler v. Daniel, 251 Neb. 287, 556 N.W.2d 623 (1996) Paulsen v. State, 249 Neb. 112, 541 N.W.2d 636 (1996).

After a proper foundation objection was made during Gammel's deposition testimony, Gammel admitted during his cross-examination that he was unaware of the tasks Mahoney was required to perform while working as a police officer. In addition, Gammel admitted that his opinion that Mahoney could not return to work as an officer despite the hypertonic saline injection injury was based on a “lack of information” as to her day-to-day activities as a police officer. On redirect examination, Gammel testified that he was somewhat familiar with the duties of a police officer on account of what he has seen on television and of his “general sense” of what “beat cops” do. This testimony of Gammel makes it apparent that he possessed no knowledge of the physical demands actually placed upon Mahoney as a police officer. As such, Gammel lacked knowledge of facts necessary to support his opinion concerning Mahoney's ability to perform as a police officer in Omaha. Recognizing that a trial court's ruling in receiving or excluding an expert's testimony which is otherwise relevant will be reversed only when there has been an abuse of discretion, McArthur v. Papio-Missouri River NRD, supra McIntosh v. Omaha Public Schools, supra, we conclude that the district court did not abuse its discretion in excluding Gammel's testimony concerning Mahoney's ability to return to work as a police officer.

In its next assigned error, Methodist Hospital asserts the district court incorrectly precluded it from offering any evidence of the pension Mahoney is receiving as a result of her early retirement from the Omaha Police Division. Methodist Hospital argues that the pension is paid to Mahoney because of the car accident injury to her knee and is therefore not a collateral source regarding the injury she suffered to her knee as a result of the injection. Mahoney contends the lower court's ruling is correct because the collateral source rule prohibits the mitigation of personal injury damages with evidence establishing that the injured party is being compensated by another party during her disability.

Under the collateral source rule, the fact that the party seeking recovery has been wholly or partially indemnified for a loss by insurance or otherwise generally cannot be set up by the wrongdoer in mitigation of damages. Chadron Energy Corp. v. First Nat. Bank, 236 Neb. 173, 459 N.W.2d 718 (1990). We have stated:

This rule provides that benefits received by the plaintiff from a source wholly independent of and collateral to the wrongdoer will not diminish the damages otherwise recoverable from the wrongdoer. The theory underlying the adoption of this rule by a majority of jurisdictions is to prevent a tort-feasor from escaping liability because of the act of a third party, even if a possibility exists that the plaintiff may be compensated twice.

Hiway 20 Terminal, Inc. v. Tri-County Agri-Supply, Inc., 232 Neb. 763, 767, 443 N.W.2d 872, 875 (1989).

Ordinarily, compensation recognized as coming from a collateral source occurs in situations involving only one damaging incident. The instant case is unusual in that there exist two separate, and seemingly unrelated, injuries to Mahoney's knee: one injury attributed to the car accident and one injury attributed to the injection injury. Due to this division, Methodist Hospital asks us to declare the pension Mahoney receives from the Omaha Police Division to be related only to that portion of her permanent knee injury sustained because of the car accident. As such, Methodist Hospital asserts that the pension was not “collateral” to any injury Mahoney suffered because of the injection injury and that evidence of it should therefore have been admitted for the purpose of mitigating damages.

This court has not had occasion to address the application of the collateral source rule in a situation in which there are two separate injuries. As a general matter, however, we have held that presenting evidence of a pension or disability benefits is inappropriate for purposes of determining damages. In Harper v. Young, 139 Neb. 624, 298 N.W. 342 (1941), the plaintiff sought recovery for damages he sustained in a car accident. Throughout the trial, evidence was adduced that the plaintiff would be eligible for a pension in the future and that he could have obtained compensation from the government for his injuries had he applied for them. This court remanded the cause, holding that the introduction of this evidence without limiting instructions was “not admissible upon any theory” and therefore prejudicial to the plaintiff. Id. at 630, 298 N.W. at 345. See, also, Singles v. Union P. R.R. Co., 174 Neb. 816, 119 N.W.2d 680 (1963) (holding error committed in admission of testimony regarding size of pension, because financial conditions of parties are immaterial) Annot., Collateral Source Rule: Receipt of Public or Private Pension as Affecting Recovery Against a Tortfeasor, 75 A.L.R.2d 885 (1961) (stating general rule that payments from a collateral source may not be taken into consideration in assessing damages).

Other jurisdictions that have examined the precise issue put before us have concluded that benefits received for an initial injury are inadmissible to mitigate the damages of a subsequent tort-feasor responsible for further injury. In Holman v. Grandview Hosp. & Med. Ctr., 37 Ohio App.3d 151, 524 N.E.2d 903 (1987), the plaintiff was hospitalized for a permanently disabling back injury. Prior to surgery, he was to receive periodic injections of pain medication. A nurse improperly gave a shot, resulting in further injuries to the plaintiff. At trial, the defendant hospital attempted to introduce evidence that the plaintiff was receiving payments for workers' compensation. The court, after determining that the statutory malpractice statute did not apply, held that evidence of such collateral source payments was inadmissible.

Likewise, in Jones v. Laird Foundation, Inc., 156 W.Va. 479, 195 S.E.2d 821 (1973), the plaintiff suffered an initial injury to his back while at work. While hospitalized, he received inadequate care from a physician that caused further injury to his back. Due to the extent of both injuries, the plaintiff was awarded workers' compensation benefits. In reviewing the appeal of the plaintiff's claim against the physician, the West Virginia Supreme Court held that the plaintiff's compensation benefits were a collateral source and therefore could not be considered in mitigation of damages in the action against the physician for the additional injury to the plaintiff's back.

In the instant case, Mahoney testified that she continued to work as a police officer during the timeframe in which she was receiving the injections at Methodist Hospital. It was only after the October 31, 1991, injection that Mahoney was unable to return to work. At trial, Walsh testified that he informed the Omaha Police Division that Mahoney would be unable to perform her tasks as a police officer because of permanent injuries to her knee due to both the car accident and the injection injury. Faced with this diagnosis, she retired and began receiving her pension. Thus, the pension benefits Mahoney is now receiving are essentially for both injuries she sustained to her knee. Therefore, in accordance with both this court's repeated statements that presenting evidence of a pension is inappropriate for determining damages and the reasoning of those courts that have examined the operation of the collateral source rule in the context of two separate injuries, we conclude that Mahoney's pension is, in fact, a “collateral” and “independent” source of income for Mahoney's injuries suffered because of Methodist Hospital's negligence. That being the case, the second assigned error is without merit.

As its third assignment of error, Methodist Hospital contends the district court erred in instructing the jury regarding damages. In particular, Methodist Hospital argues that portion of jury instruction No. 13 which provided that “[f]uture disability is not limited to functional disability, but includes cosmetic deformity as well” was incorrectly given because it was taken from the comments to and not the text of NJI2d Civ. 4.01, the pertinent instruction concerning general damages.

We have previously noted that “the instructions contained in the second edition of the Nebraska Jury Instructions are designed to be used when they reflect the law and the pleadings and evidence call for such an instruction.” Anderson v. Nashua Corp., 246 Neb. 420, 426, 519 N.W.2d 275, 281 (1994). Obviously, any instruction derived from the comments to the Nebraska Jury Instructions must also meet the same criteria. Simply because instruction No. 13 in the instant case used language from the comments to NJI2d Civ. 4.01 does not require us to determine the instruction erroneous per se. To so hold would essentially deny a court the opportunity to properly formulate instructions that are tailored to the case at hand. Such a result would be at odds with our repeated statement:

“ ‘ “The purpose of an instruction is to furnish guidance to the jury in their deliberations, and to aid them in arriving at a proper verdict and, with this end in view, it should state clearly and concisely the issues of fact and the principles of law which are necessary to enable them to accomplish the purpose desired.”․’ ”

First Nat. Bank v. Bolzer, 221 Neb. 415, 420, 377 N.W.2d 533, 536-37 (1985), quoting Bodtke v. Bratten, 166 Neb. 36, 88 N.W.2d 159 (1958).

Thus, for purposes of this appeal, we must determine whether the instruction given on cosmetic deformity is supported by the law and the evidence of the case. See Anderson v. Nashua Corp., supra. In this regard, we note that an instruction on cosmetic deformities for purposes of future disability was upheld by this court in Stapleton v. Norvell, 193 Neb. 71, 225 N.W.2d 409 (1975), where the evidence adduced at trial established that the plaintiff suffered permanent scarring due to lacerations she received during a car accident. We conclude that the evidence in the instant case also supports an instruction on cosmetic deformity. Walsh testified that the difference in size between Mahoney's left and right calves, as a result of the accident, was permanent in nature. Likewise, Mahoney testified that her calves were notably different in size as a result of the accident and that she has a scar on her forearm due to an infection from the IV's in her arm. In light of this evidence, the court did not err in instructing the jury on cosmetic deformity.

The last assigned error concerns the amount of the jury verdict. According to Methodist Hospital, the $400,000 verdict is so excessive in nature that it demonstrates the jury acted with extreme passion and prejudice. We disagree.

A jury verdict will not be disturbed on appeal as excessive unless it is so clearly against the weight and reasonableness of the evidence and so disproportionate as to indicate that it was the result of passion, prejudice, mistake, or some means not apparent in the record, or that the jury disregarded the evidence or rules of law. Barks v. Cosgriff Co., 247 Neb. 660, 529 N.W.2d 749 (1995) McDonald v. Miller, 246 Neb. 144, 518 N.W.2d 80 (1994). An examination of the record in this case leads us to conclude that the jury verdict in favor of Mahoney was not excessive. At the time Mahoney received her injury at Methodist Hospital, she was a young police officer with substantial earning capacity. In 1989, her gross income was $41,399.28, and for 1990, it was $35,061. Mahoney testified at trial that she had planned on working as a police officer until the mandatory retirement age of 62. According to the dictates of Walsh, Mahoney's injuries to her knee make it impossible for her to fulfill that goal. The economic ramifications are substantial considering that James Rogers, a vocational rehabilitation counselor, testified that Mahoney's job qualifications allow her to make only $4.50 to $9 per hour.

In addition to the loss of her employment and earning capacity, Mahoney also testified that she experienced considerable pain and suffering as a result of Methodist Hospital's negligence. As noted above, Mahoney was constantly on high doses of pain medication for the 2 weeks following the nerve-block injection. In light of this evidence, we cannot conclude that the $400,000 jury verdict in this case is excessive. Accordingly, the fourth assignment of error is without merit.

In accordance with the above analysis, we conclude that no error was made and that the jury verdict in favor of Mahoney should be affirmed.


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