D conducted an examination of P, which included obtaining a Pap smear. D received a report dated June 4, which read: 'Cellular changes are present consistent with moderate dysplasia. Papanicolaou Class II. Repeat smears in two months. Estrogen effect; slight.' The term 'dysplasia' means abnormal growth. On or about October 10, 1986, P received a telephone call from a nurse in D's office, informing P that her Pap smear report showed an abnormal finding of class II and that she should make an appointment to return to the office. On October 27, 1986, D obtained another Pap smear and sent the sample to the examining laboratory. The laboratory's November 3, 1986, report read: 'Negative for malignant cells (Class I). Additional estrogen effect; slight.' On or about November 7, a nurse from D's office informed Stang-Starr of the reported results from this second Pap smear. The nurse instructed Stang-Starr to contact Byington in 6 months for another Pap smear. As she began experiencing a heavier menstrual flow, P scheduled an appointment for January 4, 1988. Byington's examination on this occasion revealed cervical irritation and vaginitis, for which he prescribed treatment and scheduled a return visit. On February 3, D obtained a third Pap smear and performed a colposcopy, a microscope-aided visual examination of the cervix and vagina. The colposcopy revealed an abnormality, and D performed a biopsy. On February 5, D learned that the biopsy revealed the presence of cancer and notified P by telephone. The examining laboratory's report with respect to the third Pap smear, bearing a date of February 12 read: 'Neoplastic cells are present consistent with squamous cell carcinoma, keratinizing type. Papanicolaou Class V. Follow up tissue studies. Additional findings: Endocervical cells, inflammation.' D called the lab to inquire about the November 3, 1986, report which had failed to report any malignant cells or abnormalities in the second Pap smear. According to the examining laboratory's Dr. Sharon Rosenthal, a mistake had been made. The report should have indicated that the sample sent was unsatisfactory because the cells were obscured by blood and could not be evaluated properly. D informed P and her husband of the examining laboratory's error and of the possibility that P's earlier class II dysplasia might have developed into a class V cancer during the interval. P was diagnosed as having a stage IV carcinoma. P called two physicians to testify on her behalf as expert witnesses: Dr. Manford Oliphant and Dr. William Woodard. Oliphant testified he reviewed technical bulletins in preparation for his testimony in this case, along with reviewing other journals, textbooks, and excerpts from textbooks. Oliphant also testified that obstetricians and gynecologists develop information for their daily practices from textbooks and technical bulletins. Based on his knowledge and information obtained from textbooks, medical literature, and personal experience, Oliphant formed an opinion, to a reasonable medical probability, as to the standard of care required of a board-certified obstetrician in May 1986 in Lincoln or similar communities. He then testified that he had read a particular technical bulletin issued by the college as a predicate to formulating some of the opinions on dysplasia to which he had testified. P offered that bulletin into evidence, and D Byington successfully interposed a hearsay objection. P made an offer of proof of the bulletin and material found in more than 12 textbooks concerning gynecology and colposcopy. Oliphant would identify the text as an authority in the field, identify the text as a basis of opinion, and identify and read specific passages of the material upon which Oliphant relied in testifying. The district court sustained D's objections. Woodard testified that in forming his opinion, he had reviewed 5 or 6 textbooks, other specifically named textbooks, 15 to 18 journal articles, and the college bulletin identified earlier. In making an offer of proof, P represented that were Woodard allowed to respond to questions about those medical authorities, he would describe the textbooks by title, author, and date of publication, but would not attempt to quote from the actual text. D's hearsay objection to the offer was sustained. D got the verdict and P appealed.

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