The Hawaii Intermediate Court of Appeals recently affirmed a ruling in a medical negligence case involving Marian Tetsuko Gramley and The Queen's Medical Center. The court's decision, issued on October 29, 2026, addressed several key issues raised by Gramley, including the exclusion of expert testimony and the awarding of costs to the hospital. This ruling impacts Gramley and potentially sets a precedent for similar medical negligence cases in Hawaii.

In this case, Gramley underwent a robotic hysterectomy at The Queen's Medical Center on February 12, 2019. After the surgery, she was discharged without any reported complications. However, three days later, her condition worsened, leading to emergency surgery that revealed a bowel perforation. In January 2022, Gramley filed a lawsuit against The Queen's Medical Center and its associated entity, University Clinical, Education & Research Associates, alleging negligence and other claims.

The lawsuit progressed through the courts, and on March 7, 2024, The Queen's Medical Center made a settlement offer of $70,000, which Gramley declined. Subsequently, on March 12, 2024, Gramley settled her claims against the University Clinical, Education & Research Associates, narrowing the trial to focus solely on the negligence claim against The Queen's Medical Center. The trial began on March 18, 2024, and the jury ultimately found that the hospital did not breach the applicable nursing standard of care.

Following the trial, Gramley appealed the circuit court's July 22, 2024 Final Judgment, raising five points of error. These included challenges to the trial court's evidentiary rulings, the denial of a juror challenge, and the awarding of costs to The Queen's Medical Center. The court ruled that the trial court did not abuse its discretion in any of these areas.

The appeals court specifically addressed the exclusion of expert testimony from Dr. Steven McCarus, who was limited to the opinions in his expert report. The court noted that Gramley failed to disclose additional opinions in a timely manner, leading to their exclusion. The court stated, "Under these circumstances, the circuit court did not abuse its discretion by confining Dr. McCarus's testimony to the contents of his report."

Additionally, the court upheld the exclusion of testimony from Dr. John Hyde, an expert in hospital administration, as irrelevant to the case at hand. The court found that the issues raised by Dr. Hyde did not pertain to the medical negligence claim regarding Gramley’s discharge. The ruling emphasized that evidence must be relevant to be admissible, stating, "Gramley has not shown how Dr. Hyde's 'conditional discharge' testimony was relevant to the medical negligence claim."

Regarding the juror challenge, the court ruled that the trial judge acted within their discretion in allowing a current Queen's employee to remain on the jury. The court noted that the juror indicated she could be fair and impartial, and Gramley did not present sufficient grounds to remove her for cause. The court explained, "The decision of whether to excuse a prospective juror for cause must be left to the sound discretion of the trial judge who is in a better position than the appellate court to ascertain... whether the juror is able to be fair and impartial."

Finally, the court addressed the issue of costs awarded to The Queen's Medical Center. The court found that the hospital was entitled to recover costs incurred during the litigation, particularly since Gramley had rejected a settlement offer and did not achieve a more favorable outcome at trial. The court stated, "Thus, under HRCP Rule 68, Queen's is also entitled to costs incurred after making the offer."

The court's ruling affirms the circuit court's decisions and highlights the importance of timely disclosures and the relevance of evidence in medical negligence cases. This decision may influence how similar cases are handled in the future, particularly regarding expert testimony and the awarding of costs.

Looking ahead, it remains to be seen whether Gramley will pursue further legal action or if there are any related cases pending. The court's ruling in this case sets a significant precedent for future medical negligence claims in Hawaii.