Supak Beard was diagnosed with lupus in 1991. Lupus is an incurable, chronic autoimmune disease where a person’s immune system attacks their own tissues and organs. A person with lupus can have symptom-free periods and
symptomatic periods, referred to as flare-ups. The most common flare-up symptoms include joint, muscle, and chest pain; headaches; rashes; fever; hair loss; mouth sores; fatigue; shortness of breath; swollen glands; swelling in limbs and face; confusion; and blood clots. The occurrence of flare-ups is generally unpredictable but may be triggered by stress or infection. An untreated flare-up can cause debilitating fatigue and organ damage. Individuals with lupus are generally under the lifelong care of specialized physicians called rheumatologists.
Rheumatologists manage their patients’ medication needs, treat flare-ups, and address lupus-related symptoms or complications. Mrs. Beard established care with Dr. Shaila Gala, a rheumatologist, in 2007. Dr. Gala managed Mrs. Beard’s lupus by prescribing various medications, including prednisone, which is an anti-inflammation medication and immune suppressant. Over the years, Mrs. Beard’s flare-ups typically affected her joints, causing joint pain and swelling, as well as fatigue. Mrs. Beard occasionally developed rashes and mouth sores. Dr. Gala treated those flare-ups with temporary increases in prednisone before tapering Mrs. Beard back down to a maintenance dosage.
On March 22, 2015, Mrs. Beard had a follow-up appointment with Dr. Gala. She had a high fever and worsening symptoms. Later, after reviewing that day’s test results, including imaging showing intestinal inflammation, Dr. Gala called Mrs. Beard and recommended she go to the emergency room. Several hours after being admitted, Mrs. Beard underwent repeat abdominal imaging, which showed that Mrs. Beard’s small intestine had perforated and was leaking its contents into the surrounding area. Mrs. Beard immediately underwent surgery. On March 24, Mrs. Beard passed away while recovering from surgery. The pathology report later showed that Mrs. Beard had tuberculosis in her gastrointestinal tract.
Mrs. Beard’s spouse brought a medical malpractice suit on behalf of her estate against Dr. Gala and claimed the clinic where she practices was vicariously liable. Mr. Beard claimed that Dr. Gala failed to act within the standard of care in
treating Mrs. Beard by not urgently referring Mrs. Beard to an infectious disease specialist on March 1 and 2, by not ordering a repeat chest X-ray, and by not communicating to the gastroenterologist that she suspected Mrs. Beard had an infection.
When the parties were proposing jury instructions, Mr. Beard objected to the exercise of judgment instruction (“A physician is not liable for selecting one of two or alternative courses of treatment, if, in arriving at the judgment to follow the particular course of treatment, the physician exercised reasonable care and skill within the standard of care the health care provider was obliged to follow”) and an accompanying jury instruction. He claimed they were slanted toward the defense’s theory of the case and that they commented on the evidence. He also argued that insufficient evidence existed showing the exercise of judgment instruction was warranted. The trial court approved both challenged instructions. The jury determined that Dr. Gala did not breach the standard of care and returned a defense verdict. Mr. Beard appealed.
Exercise Of Judgment Jury Instruction
The exercise of judgment instruction is justified when (1) evidence shows the physician made a choice among alternative courses of treatment (or diagnoses) and (2) evidence exists showing the physician exercised reasonable care and skill consistent with the applicable standard of care in formulating their judgment when making that choice .
The Supreme Court of the State of Washington stated in its En Banc Opinion filed on March 12, 2026: “As required, Dr. Gala’s March chart notes show evidence that she exercised professional judgment in treating Mrs. Beard that month, especially because she created a treatment plan that addressed all of Mrs. Beard’s reported and observed health concerns on March 1 and 2.”
With regard to the second prong of the analysis: “Given that a physician will likely face a variety of choices along the way when reaching a diagnosis or treatment plan, the phrase “in arriving at a judgment” does not refer to the end choice but the steps the physician took along the way to get to that choice, which are evidence of the decision-making process … Here, the record contains evidence of Dr. Gala’s process in treating Mrs. Beard on March 1 and 2, which included clinical observations and the patient’s reported symptoms and history … the record contains ample evidence of Dr. Gala’s underlying basis supporting her treatment plan … given Dr. Gala’s actions, medical chart notes, experience treating Beard, and trial testimony, the record contains evidence of Dr. Gala’s process in selecting a course of treatment.”
“The trial court does not decide whether the health care provider’s care met the applicable standard. Instead, the court makes a threshold decision as to whether the evidence could support a jury finding that the provider’s
process and choices fell within the standard of care … Because the record contains substantial evidence that supports the jury finding Dr. Gala’s process met the standard of care, we hold that the second prong of the Fergen rule was met.”
The Washington State Supreme Court held: “In summary, we hold that to justify using the exercise of judgment jury
instruction, the record must contain evidence that the health care provider’s process in selecting a treatment course or diagnosis, and the choice itself, complied with the applicable standard of care. We hold that process evidence may include the health care provider’s actions, the health care provider’s experience, the patient’s medical record, and notes or testimony showing the health care provider’s thought process. We hold that the expert witnesses’ testimonies are necessary, though inconclusive, for the jury to determine the boundaries of the standard of care. Considering the jury instructions as a whole, the instructions properly informed the jury of the applicable law, both parties argued their theories of the case, and the trial evidence supported giving the exercise of judgment instruction. Thus, the trial court acted within its discretion in giving the exercise of judgment jury instruction. We affirm.”
Source Beard v. The Everett Clinic, PLLC, No. 103635-3.
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