Was amount of punitive damages awarded v. hospital fair?(Legal Focus on Hospital Law Issues)

CASE ON POINT: Thomas v. St. Josepoh Healthcare, Inc, 2008-KY-1210.096 (12/2/2008)--KY

CASE FACTS: The parties vigorously disagreed about the facts in this case. However, they did agree that James Gray, age 39, arrived at St. Joseph Hospital's ER on April 8,1999, at 8:08 p.m. He was complaining of abdominal pain, constipation for four days, nausea and vomiting. He was seen by physician's assistant Julia Adkins and Dr. Barry Parsley. He received medication for pain and later received an enema and manual disimpaction of his colon. Although lab tests were ordered, either Gray refused to cooperate, or upon reorder, they were never taken. Likewise, no x-rays were conducted. Gray was discharged at 12:40 a.m., on April 9. He was taken by ambulance to the homes of several relatives. However, none of his relatives were willing to allow him into their homes. Accordingly, he was returned to the hospital. Upon his return to the ER, the hospital made arrangements for Gray to stay at the nearby Kentucky Inn. Gray returned to the hospital at 5:25 a.m., after the staff at the Kentucky Inn contacted 911 on his behalf. He had been vomiting dried blood for several hours. He was again seen and evaluated by physician's assistant Adkins and Dr. Parsley. Lab tests and x-rays were conducted during this visit. Subsequently, he was discharged by Dr. Jack Green at 12:15 p.m. However, Gray died later that same day at a family member's home. The autopsy report listed the cause of death as purulent peritonitis caused by a rupture of a duodenal ulcer due to duodenal peptic ulcer disease. The autopsy report also listed constrictive atherosclerotic coronary disease as a contributory cause of death. Gray's estate brought suit against the hospital and all those involved in Gray's treatment, alleging medical negligence against the hospital. Further, the estate alleged that the hospital violated the Emergency Medical Treatment and Active Labor Act (EMTALA). After a lengthy period of discovery, the case proceeded to trial. Prior to trial, the Estate settled with Drs. Richardson, Parsley, and Geren. The case proceeded ti a jury trial on the claim against the hospital. The jury returned verdicts for the estate on both the medical negligence and the EMTALA claims. The jury apportioned fault as follows: 15% to the hospital; 0% to Dr. Richardson; 30% to Dr. Parsley and physician's assistant Adkins; 30% to Dr. Geren; and 25 % comparative fault to the decedent. The jury awarded compensatory damages of $25,000 of which the hospital's share was $3,750. The jury also assessed punitive damages against the hospital for $1,5000,000. The trial court granted the hospital's motion for a new trial on the grounds that the punitive damage award against the hospital was excessive. The hospital appealed. The estate cross-appealed.

COURT'S OPINION: The Court of Appeals of Kentucky held that a plaintiff can bring a suit under the EMTALA provisions of the law, and at the same time sue a hospital for negligence in its care and treatment of the same patient involved in the under the EMTALA claim. However, the court agreed with the trial court, which had granted the hospital's motion for a new trial, that the hospital was entitled to a new trial because the punitive damages awarded against the hospital were excessive.

LEGAL COMMENTARY: Both parties raised issues with respect tot he estate's claim for punitive damages. The trial court set aside the jury's verdict for punitive damages, finding that it was clearly excessive. The hospital argued that the issue of punitive damages should not have been submitted to the jury, or in the alternative, that the jury instructions regarding punitive damages were inadequate. The estate responded that the issue was properly submitted to the jury, and the estate further contended that the award of punitive damages was not excessive and therefor the hospital was not entitled to a new trial on the issue. The hospital argued that the punitive damages could not be assessed against it without a showing that it ratified the grossly negligent conduct of its employees. Editor's Note: Since when does a hospital have to ratify the negligence of its own employee? The doctrine of Respondeat Superior makes all employers, whether they be hospitals or not, liable for the negligence of their employees as long as the employees are acting in their capacities as employees of their employers. Obviously, if during the course of the work day an employee decides to rob the bank next door, the employer is not responsible for the employee's conduct since it is outside the scope of the employer's business. There was no evidence that any of the hospital employees was acting outside the scope of his duties as a hospital employee. There was no basis upon which the hospital should not have been held liable. The refusal of the hospital to admit this patient, as well as the extraordinary efforts of hospital employees to send the patient out by ambulance to find a relative who would take the patient in, is appalling. However, no relative would take, him in. He returned to the hospital's ER by the same ambulance. However the hospital sent him to a nearby inn. The patient was in dire need of care, as evidenced by the fact that in only a matter of hours, he was sent back to the hospital vomiting blood, only to die in a matter of hours. The hospital's conduct was so egregious as to make the jury's award for punitive damages a just award! The failure to comply with EMTALA was deplorable!

A. David Tammelleo JD Editor & Publisher

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars oil medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition ill Martindale-Hubbell's Bar Register of Preeminent Lawyers. Marquis Who's Who in American Law. Who's Who in America and Who's Who in the World.

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