$60 Million Medical Malpractice Pain and Suffering Verdict Reduced on Appeal to $600,000

Allison Hugh was 380 pounds in 2002 when she underwent successful gastric bypass surgery. Reduced to 185 pounds, the then 38 year old  Ms. Hugh was left with massive amounts of excess skin on her arms, abdomen and thighs.

To remove the unsightly and uncomfortable excess skin on her thighs,  medial thigh lift surgery was performed on March 2, 2005.

Claiming that the thigh lift procedure left her with significant deformities of her vagina's labium, Ms. Hugh sued her plastic surgeon  Ferdinand Ofodile, M.D. and in July 2009 a Bronx County jury awarded her a $60,000,000 pain and suffering jury verdict ($10,000,000 past - 4 1/2 years; $50,000,000 future - 37 years).

The trial judge ordered a reduction of the damages to $4,000,000 ($1,000,000 past, $3,000,000 future).

This week, in Hugh v. Ofodile (1st Dept. 2011), the appellate court orderd a further reduction - to $600,000 ($300,000 past, $300,000 future).

Ms. Hugh claimed that Dr. Ofodile:

  • removed too much tissue and
  • failed to inform her that he'd perform a medial, as opposed to a lateral, thigh lift and therfore there was a lack of informed consent

The jury found for plaintiff on both theories and the appellate court affirmed the liability decisions.

The appeal also addressed the enormous pain and suffering verdict:

  • Plaintiff's counsel conceded that $60 Million was not sustainable. He suggested a reduction to $12,000,000.
  • Defense counsel contended that the magnitude of the verdict suggested it could only have been the result of passion and prejudice against Dr. Ofodile and that the evidence of plaintiff's pain and suffering was minimal and, therefore, the damages should be reduced to a sum substantially less than $1,000,000.

Plaintiff's injuries included:

  • abnormal appearance of her labia (graphic photos were shown to the jurors)
  • discomfort during sexual relations
  • emotional pain

The appellate court relied upon four prior cases in which "plaintiffs sustained injuries much more severe than those sustained by [Ms. Hugh]:

  1. L.S.  v. Harouche (1st Dept. 1999) - $1,750,000 reduced from $4,000,000  for 18 year old who suffered from hypertrophy (enlargement) of her right labia majora resulting in unbearable pain when attempting sexual intercourse.
  2. Rabinowitz v. Elimian (2d Dept. 2008) - $750,000 affirmed for 32 year old with vaginal deformity following episiotomy to facilitate delivery of baby.
  3. Sutch v. Yarinsky (3d Dept. 2002) - $800,000 for 26 year old who underwent breast reduction surgery and was left with the loss of her entire left nipple areoa complex, a large scar and significant depression. Also, she underwent various debriding procedures.
  4. Beverly H. v. Jewish Hospital and Medical Center of Brooklyn (2d Dept. 1987) - $700,000 reduced from $1,500,000 for woman who underwent episiotomy to shorten the time of her labor and was left with a rectovaginal fistula requiring four operations including a colostomy.

 Inside Information:

  • Before undergoing surgery with Dr. Ofodile, Ms. Hugh consulted three other surgeons, one of whom recommended a full body lift, two of whom recommended a medial thigh lift. She said she underwent surgery with Dr. Ofodile because he specifically told her he'd perform a thigh lift that did not expose her to the well known risks of vaginal deformity and labial distortion that were described to her by other surgeons who'd recommended a medial thigh lift.
  • Plaintiff did not assert a lost earnings claim. She was unemployed at the time of trial having discontinued two jobs she had after her bypass surgery - an event planner and a "plus size" model.
  • Plaintiff's counsel will most likely reject the conditional reduction order and proceed to a new trial, encouraged by the 3-2 split decision with the minority opining that a reduction to $600,000 was too much and that $1,600,000 was an appropriate award.

 

Sciatic Nerve Injury Results in $1,690,000 Pain and Suffering Verdict Affirmed on Appeal

On October 12, 2007, Tina Holstein delivered her third child, without complications, at Community General Hospital in Syracuse. Within a couple of hours, she was nauseous and vomited so the nurse on duty administered an intramuscular injection of Phenergan (an anti-emetic).

Generally, an injection into the buttocks is delivered using the upper outer quadrant, so as to avoid the sciatic nerve:

In Mrs. Holstein's case, the injection was delivered in the wrong location - hitting the sciatic nerve - and she ended up with unremitting pain in her back and down her leg.

The sciatic nerve is the largest and longest single nerve in the body, about as big around as a man's thumb at its largest point. It originates in the lower spine as nerve roots exit the spinal cord and extends all the way down the back of the leg to the toes.

In an ensuing lawsuit against the hospital (and the nurse who gave the shot), on May 28, 2010, an Onondaga County jury found medical negligence against the defendants and awarded the then 34 year old Holstein pain and suffering damages in the sum of $1,690,000 ($140,000 past - 2 1/2 years, $1,550,000 future - 50 years).

The defense claimed in a post-trial motion that (a) there was insufficient evidence to warrant the jury's finding that the nurse was negligent and (b) the verdict was excessive. The trial judge denied the motion in all respects.

Last week, the verdict was affirmed on appeal in Holstein v. Community General Hospital (4th Dept. 2011).

The appellate court neglected to mention any of the injuries and disabilities sustained by the plaintiff:

  • pain, especially in her back and leg, so bad and constant that at times she wished she could get her leg amputated
  • altered sensation, excruciating sensitivity and burning
  • difficulty sleeping, waking up several times a night
  • unable to sit or stand for any extended period of time
  • inability to bend
  • inability to play with her kids

While plaintiff required narcotic medication for her pain and her medical expert testified that her conditions are permanent and will get progressively worse, the most significant treatment she'd undergone was a series of nerve blocks, she'd undergone no surgery (though a surgically implanted spinal cord stimulator was recommended) and there was no claim that she'd need any in the future.

The defense argued that plaintiff's injuries were not serious - that she was hardly limited in her daily activities (she'd returned to work as a nurse, albeit in a limited capacity), was not debilitated in any manner and her complaints of pain were subjective only.

A nerve conduction study, performed just before trial, though, showed positive findings of S1 radiculopathy (a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling or weakness along the course of the nerve). In view of a prior negative finding, this, plaintiff's counsel argued, was objective evidence indicating that Mrs. Holstein's condition was worsening.

Inside Information:

  • The defense argued on appeal that the trial judge failed to poll the jury, thus requiring a new trial. Three of the appellate court judges rejected that argument and voted to affirm, while two dissenters agreed with the defense and would have sent this case back for a new trial on the issue of polling (where the trial judge asks each individual juror if the verdict set out on the verdict sheet - already signed by each - is indeed his or her verdict).This 3-2 split means that the Court of Appeals (New York's top level appellate court) will be asked to resolve the polling issue (about which we wrote in 2009, here, when the Court of Appeals ruled in Duffy v. Vogel).
  • The jury verdict was reached at about 4:30 p.m. on the Friday of Memorial Day weekend, four hours after beginning deliberations and within only 40 minutes or so of having been given a read back of medical testimony. This, defense counsel argued (unsuccessfully), was evidence of juror confusion and a rush to judgment.
  • The $1,690,000 verdict is significant in view of the paucity of objective proof of plaintiff's injuries and the fact that plaintiff conceded there will be no surgery required. This is an outstanding result for plaintiff's counsel, Jeff D. DeFrancisco, a leading medical malpractice lawyer from Syracuse.

Medical Malpractice Verdict Reduced by Appellate Court from $4,500,000 to $2,000,000 in Hysterectomy Case

On March 22, 2006 Alice Silverberg was admitted to Maimonides Hospital Center in Brooklyn. Up to that point, she was an active 78 year old woman in generally good health but with a prolapsed uterus which brought her to the hospital for an elective vaginal hysterectomy.

Anamaria Guzman, M.D., attempted to anesthetize Ms. Silverberg so the operation could commence but the doctor was unable to place the endotracheal tube (ETT) in the trachea. Another anesthesiologist was called in to assist but he too was unable to intubate the patient. Three attempts were made but each time the instrument was placed into the esophagus (instead of the trachea).

Finally, Dr. Guzman was able to successfully intubate her patient. The hysterectomy then proceeded uneventfully; however, the unsuccessful attempts to intubate had already perforated the esophagus.

Post-operatively, Ms. Silverberg suffered from several unanticipated complications including:

Here is the anatomy involved in this case:

Ms. Silverberg remained hospitalized for almost a month until she was transferred to nursing homes where she remained for over a year until she was sent home.

In her ensuing lawsuit, Silverberg v. Guzman (Supreme Court, Kings County; Index # 24076/06), Ms. Silverberg claimed that the doctors were negligent in perforating her esophagus and that they thus caused her to undergo additional surgeries and a year of confined medical treatment unable to walk or feed herself as well as permanent dementia (the infection caused her to suffer hypoxic brain damage).

On April 1, 2009, the jury found that Dr. Guzman departed from accepted medial practice (i.e., she was negligent) in failing to read notes in her patient's chart and in failing, post-operatively, to communicate to plaintiff's other doctors that medical instruments had been placed in the esophagus, thereby causing a delayed diagnosis of the esophogeal perforation for several days.

The jurors then awarded plaintiff pain and suffering damages in the sum of $4,500,000 (allocated entirely to past pain and suffering with nothing at all awarded for any future period).

The defendant appealed arguing:

  1. there was no proof connecting the delayed diagnosis to plaintiff's damages and
  2. alternatively, that the pain and suffering award was excessive.

In Semel v. Guzman (2d Dept. 2011), the appellate court has now upheld the liability finding while ordering a reduction in damages from $4,500,000 to $2,000,000 (all for past pain and suffering).

Here are additional injury details:

  • Three surgeries after the hysterectomy: to repair the esophogeal perforation, to place an esophogeal stent and to remove the stent.
  • During most of the year in nursing homes, plaintiff was tube-fed, wheelchair-bound and unable to walk or dress herself.
  • As of the trial date, plaintiff was fully ambulatory and competent to testify but contended she could no longer manage her financial affairs, recognize family members or travel independently.

Inside Information:

  • The appellate judges did not discuss the main damages contention advanced by the defendant - that plaintiff failed to prove precisely which harms were caused by the delayed diagnosis as opposed to the perforated esophagus.
  • Plaintiff's attorney asked the jury to award $5,000,000 for past pain and suffering and $2,000,000 for the future.
  • In view of her near complete recovery (plaintiff had resumed many of her activities of daily living, including caring for herself, food shopping and cleaning her home), plaintiff was denied any recovery at all for future pain and suffering damages.
  • Ms. Silverberg died of unrelated causes in February 2011 and the case name was changed to reflect the substitution of her executors as plaintiffs.

 

 

 

Emotional Distress Verdict of $1,000,000 Upheld for Mother in Medical Malpractice Stillborn Case

On July 1, 1997, a 24 year old woman, pregnant at seven months with her first baby, went into precipitous labor at home. Lucia Ferreira and her husband had been excited about the birth of their first child (a girl) but tragedy was about to unfold - the baby was in a footling breech position and her head became stuck in the birth canal.

With no oxygen or blood able to get through the umbilical cord, the baby asphyxiated and was pronounced dead on arrival at the hospital.

A lawsuit followed - Ferreira v. Wyckoff Heights Medical Center (Civil Court, Kings County, Index # 1449/02) - in which it was claimed that plaintiff had been improperly evaluated and treated at the Brooklyn hospital when she'd presented there several times complaining of abdominal pain (due to premature labor) the week before the stillbirth (including three times the day before without being admitted).

Wyckoff Heights Medical Center:

After a 10 day trial in November 2006, the jury found that the hospital had committed malpractice in sending Ms. Ferreira home just 24 hours before her baby's death. Plaintiff argued that the breech position should have been detected and she should have been admitted and treated for premature labor and/or a Cesarean section could have been performed to deliver a healthy baby. The jury agreed and she was awarded $1,000,000 for her emotional distress injuries (past - 8 years, future - zero).

The defendant appealed claiming that the pain and suffering award was excessive. Now, in Ferreira v. Wyckoff Heights Medical Center (2d Dept. 2011), the appellate judges upheld the liability verdict against the defendant and sustained the propriety of $1,000,000 for pain and suffering. As to the verdict amount, they merely stated that the award "does not deviate from what would be reasonable compensation."

We have uncovered the details as to plaintiff's pain and suffering claim:

  • pathological bereavement
  • post-traumatic stress disorder
  • significant depression

The defense argued that the award was improperly fueled by compassion and sympathy and was excessive because plaintiff:

  • never sought any mental health treatment after only a single counseling session a month after the incident, and
  • recovered, as evidenced by her successful return to full-time work in a collection agency in 2000 and the birth of a healthy child in that year

Plaintiff countered, though, with the fact that she treated only once because she could not afford counseling fees and because she found it too painful to talk about and thereby relive the horrible event.

She also presented expert testimony from a psychiatrist who stated that his diagnosis of pathological bereavement was based on his examination of Ms. Ferreira, his review of all of the medical records and on Ms. Ferreira's eight years of carrying around and displaying two photographs of her deceased daughter taken after resuscitation efforts failed. He recommended ongoing psychiatric treatment.

There was no case law cited in the appellate court decision as to prior similar injuries and that's because, in stillborn cases, until 2004, damages for a mother's emotional distress  were not recoverable without an independent physical injury to the mother. The Court of Appeals, in Broadnax v. Gonzalez (2004), changed the law to allow emotional distress damages without physical injury to the mother.

The $1,000,000 emotional distress damages award that was sustained in Ferreira v. Wyckoff Heights Medical Center is significant for two reasons:

  1. it's the first time this New York appeals court was asked to review a pain and suffering award made to a plaintiff for emotional injuries sustained as a result of a stillbirth; and,
  2. the court declined to reduce a substantial verdict in a case in which there was a paucity of objective proof of the injuries

Inside Information:

  • Since Ms. Ferreira's case was brought before the law changed, her initial claim was for wrongful death damages (e.g., the baby's short-lived physical pain) on the theory that her baby was born alive. When she changed her theory - arguing instead that her baby was stillborn - the defense objected but to no avail.
  • In 2005, one of defendant's in-house lawyers penned a provocative article entitled, "The Medical Malpractice Crisis, Again." And one of defendant's arguments on appeal was that to permit the $1,000,000 pain and suffering award for this newly allowed emotional distress damages claim would have a materially detrimental impact on New York's health care crisis. The appellate court judges did not discuss these issues.
  • The jurors found that Ms. Ferreira was negligent because she failed to seek further medical treatment after her return home from the hospital about 24 hours before the stillbirth but that they then found that her negligence was not a substantial factor in bringing about the premature delivery and death of her baby. The defense argued (unsuccessfully) that these two findings are inconsistent and require reversal of the verdict. The appellate judges rejected this argument because had plaintiff been admitted to the hospital the day before (and not sent home) the premature breech birth of the baby without medical intervention could have been prevented.
  • Both sides were represented by appellate attorneys widely regarded as among the best in New York - Arnold E. DiJoseph for the plaintiff and Mauro Lilling Naparty LLP (formerly known as Mauro, Goldberg & Lilling) for the defendant.

$3,000,000 for 11 Months of Pre-Death Pain and Suffering Affirmed in Medical Malpractice Case

Theresa Capwell was 33 years old and in good health when she started experiencing abdominal pain. She was diagnosed with pancreatitis (an inflammation of the pancreas) and admitted to Westchester Medical Center on September 18, 2000.

Within five days of her hospital admission, Theresa suffered acute respiratory distress and she was placed on a ventilator. On October 4th, she suffered a heart attack and brain damage from lack of oxygen (anoxic brain damage).

As a result of the anoxia, she was in a persistent vegetative state from which she never recovered and Theresa Capwell died 11 months later on September 10, 2001.

A medical malpractice lawsuit followed - Capwell v. Guneratne (Supreme Court, Westchester County, Index #14832/02) - in which plaintiffs (Theresa's husband and their three young daughters) claimed that her brain damage and death were caused by mistreatment of her pancreatitis and mismanagement of her respiratory condition.

Essentially, plaintiffs argued that the doctors at Westchester Medical Center failed to recognize that Theresa's problems stemmed from pancreatitis. Instead, they erroneously suspected and treated her for ovarian cancer. That misdiagnosis led to a cascade of ever worsening medical problems: Theresa got sicker and sicker and ultimately suffered from life threatening respiratory distress that led to a ventilator placement, a tension pneumothorax, a heart attack and anoxic brain damage. Then, death.

The jury returned a verdict in plaintiff's favor on December 12, 2008 finding that the hospital's malpractice had caused Theresa's injuries and they awarded $7,000,000 in damages as follows:

  • pre-death pain and suffering - $3,000,000 (11 months)
  • loss of consortium - $4,000,000 (11 months)

The defense made a post-trial motion challenging the verdict amounts as excessive. The plaintiffs countered that they were reasonable and asserted their own challenge for the jury's failure to award any wrongful death damages (i.e., economic losses sustained by the family members due to Theresa's death, such as the value of her household services and parental guidance). In a post-trial decision, the judge rejected the defense claim that the pain and suffering award was excessive but agreed that the loss of consortium award was excessive and should be reduced - to $1,000,000.

Also, the trial judge agreed with plaintiffs that there should be a new trial on the issue of wrongful death damages - that is, whether, in addition to causing Ms. Capwell's pre-death injuries, the malpractice also caused her death. If so, her family may be entitled to substantial additional economic damages, most significantly loss of parental guidance for the 7, 9 and 11 year old girls.

The defendant appealed. This week, in Capwell v. Muslim (the name of the case after some defendants were dismissed) (2d Dept. 2011), the appellate court affirmed the trial judge's decision.

Plaintiffs argued, successfully, that $3,000,000 is a reasonable sum for pain and suffering in this case because, as a result of the brain damage until her death 11 months later, Theresa Capwell was:

  • confined to her bed
  • lived out her days cared for by others in every aspect of her existence
  • could not communicate with the outside world beyond facial expressions, hand squeezing, eye movements and following simple commands (like moving her feet)

The affirmance of a $3,000,000 pre-death pain and suffering for a period of 11 months is quite significant. Generally, pain and suffering awards in brain damage cases that are sustained in excess of $1,000,000 involve much longer periods of time, such as:

  • Reed v. City of New York (1st Dept. 2003) - $5,000,000 ($2,500,000 past - 6 years, $2,500,000 future - 30 years); 43 year old; brain damage with progressive tissue loss in lobes
  • Paek v. City of New York (1st Dept. 2006) - $4,300,000 ($1,300,000 past - 6 years, $3,000,000 future - 40 years); 36 year old; traumatic brain injury with severe cognitive dysfunction
  • Weldon v. Beal (2d Dept. 2000) - $5,000,000 ($2,000,000 past - 12 years, $3,000,000 future - 15 years); 26 year old; anoxic brain damage
  • Evans v. St. Mary's Hospital (2d Dept. 2003) - $1,800,000 ($800,000 past - 13 years, $1,000,000 future - 31 years); 28 year old; anoxic brain damage

Plaintiffs argued that while Theresa's period of suffering was much less than those in most cases involving multi-million dollar pain and suffering awards for brain damage, the distinctive factor in this case is that the 11 month period represented the remainder of plaintiff's life. Thus, they cited Cepeda v. New York City Health and Hospitals Corp. (1st Dept. 2003) in which $750,000 was held reasonable for an infant who died 12 days after suffering severe brain damage at birth due to medical malpractice. In that case, the court found that the fact that decedent experienced pain and suffering for most of her life was a factor in assessing the pain and suffering award.

Interestingly, neither party discussed the relevance of a recent case - Schaffer v. Batheja (2d Dept. 2010), about which we wrote in detail, here. In that case, the court approved a pre-death pain and suffering award of $2,500,000 for a woman in a coma who was only sporadically aware of her condition (she'd lapsed into a coma due to medical malpractice) for the 4 1/2 years until she died.The distinction between these two cases appears to be that the court determined that Ms. Capwell's level of awareness was much more significant than Mrs. Schaffer's.

The $1,000,000 loss of consortium award was based upon the fact that Scott and Theresa Capwell had enjoyed an idyllic 11 year marriage described by him as "the perfect life." They raised three young girls (Theresa was the homemaker, Scott the bread winner), enjoyed a very intimate relationship and were in "bliss." After the malpractice, for 11 months, their entire relationship consisted of his visiting her in the hospital, touching her face and kissing her in an effort to relax her, playing her favorite television shows and watching her deteriorate and die. The testimony in this regard was quite poignant and the appellate judges declined to disturb the trial judge's reduction of the jury award for loss of consortium from $4,000,000 to $1,000,000.

Inside Information:

  • As to pain and suffering, the defense argued not only that $3,000,000 is excessive but also that Theresa was already suffering from numerous underlying health problems when she entered the hospital and that plaintiffs failed to prove she sustained new, different or exacerbated pain and suffering.
  • Plaintiffs' law firm, Kramer, Dillof, Livingston & Moore, is widely recognized as one of the top medical malpractice firms in the state.
  • The loss of parental guidance claims belonging to Theresa Capwell's three young daughters could add several million dollars more to the plaintiffs' recovery in this case. As much as $1,500,000 has been held reasonable by an appellate court for loss of a young child's parental guidance (Paccione v. Greenberg - 2d Dept. 1998). If the new jury in Capwell v. Muslim finds a causal connection between the malpractice and the death and determines to award parental guidance damages, the size of the awards in this case may break new ground.

 

 

 

Pre-Death Pain and Suffering Verdict of $3,500,000 Upheld on Appeal in Death of Ten Year Old Girl

 

Anna Gloria Rivera was born in 1988 and within three months she was diagnosed with asthma (a chronic inflammatory disease of the airways). Growing up, she used a nebulizer with Albuterol to alleviate her symptoms but from time to time suffered from asthma attacks that would sometimes end up with emergency room treatment before she'd be released back to her home, school and an otherwise normal life of a young kid.

In the early morning hours of December 21, 1998, though, Anna suffered a severe asthmatic episode and was rushed by ambulance to a city hospital, Woodhull Medical and Mental Health Center.

After four hours and forty-five minutes of frantic treatment, during which she was restrained to a hospital bed, Anna's lung collapsed and she died due to  tension pneumothorax.

In the ensuing lawsuit , Rivera v. City of New York (Supreme Court, Kings County; Index # 6288/00), the hospital and its doctors and technicians were found to have committed malpractice because they:

  • administered oxygen at an excessive rate
  • failed to manage intubation properly resulting in extubation and re-intubation
  • failed to administer sedatives and paralytics

The jury awarded pre-death pain and suffering damages in the sum of $3,500,000 based on evidence that during the 4 3/4 hours that Anna was being worked on at the hospital she endured excruciating pain and panic, especially as she fought, her arms and legs restrained in bed, against the treatment and her breathing difficulties. 

Here is an endotracheal tube, like the one doctors inserted into Anna's airway to try to save her:

The $3,500,000 verdict has now been upheld on appeal in Rivera v. City of New York (2d Dept. 2011).

The appellate court decision failed to mention any of the underlying facts as to Anna's pain and suffering. Nor did the court compare this award with similar cases.

During the terrible final few hours of Anna Rivera's life, she suffered enormous physical pain and terror from:

  • unrelenting pain while gasping for air and struggling to survive;
  • extreme fright, anxiety and confusion at not being allowed the presence of and comfort from her parents
  • panic and fear from being physically restrained to the bed without the paralytic and sedatives
  • choking and gagging from the endotracheal tube while having to endure the invasive intubation procedures three times without anesthetics, sedatives and muscle relaxants
  • severe agitation from fighting and bucking against the endotracheal tube 

 
Here are the cases relied upon by the plaintiff in arguing, successfully, that the $3,500,000 pain and suffering verdict is reasonable and should not be modified downward:

  • Lubecki v. City of New York (1st Dept. 2003) - $3,000,000 for pre-impact terror and other injuries in shooting of a hostage who died one hour later
  • Twersky v. Busch (2d Dept. 2007) - $1,000,000 for pain during 2 1/2 hours of consciousness after car accident
  • McAndrews v. City of New York (2d Dept. 2002) - $1,000,000 for 40 minutes of conscious pain from multiple fractures and internal injuries in car accident before death on the operating table 35 minutes later

Inside Information:

  •  The appellate court also ruled that plaintiff's claim for pecuniary damages should not have been dismissed by the trial judge. Even though Anna died at the age of 10 years, her mother should have been permitted to present to the jury her claim for lost future potential economic support. The court cited Parilis v. Feinstein (Court of Appeals 1980) in which $50,000 in pecuniary damages was affirmed in the case of a 12 year old boy's death. In Rivera v. City of New York, there was evidence that Anna was quite accomplished academically and helped out around the house with chores and the like.  While an appellate court would not likely sustain much more than a low six figure verdict in this instance, plaintiff may proceed to a new trial for additional damages on this claim alone if the parties do not now settle the pecuniary damage claim.  

 

Dental Malpractice Pain and Suffering Verdict for $450,000 Upheld on Appeal

On August 9, 2006, an electrical fire broke out destroying oral surgeon Gideon Kay's offices in a house on Utopia Parkway in Flushing, Queens.

Here is the actual home of the dental practice as it appeared shortly after the fire:

Within days, Dr. Kay sent letters to his patients advising them of the fire and that for medical reasons he had to retire immediately from the practice of dentistry.

Linda Rizzo, a 58 year old retiree, had been undergoing four years of dental treatment with Dr. Kay for which she had paid $36,000. She, like many others, though, was literally left out in the cold because Kay claimed that the fire destroyed patient records and he could not make arrangements with another dentist for continued care.

Claiming that Dr. Kay had inserted both upper and lower bridges that did not fit and that she'd been abandoned, Ms. Rizzo sued Dr. Kay. In the suit, Rizzo v. Kay (Supreme Court, Queens County, Index # 24608/06), plaintiff sought pain and suffering damages for permanent residual injuries of her jaw and gums.

Kay was sued by many more patients on similar grounds and the state Office of Professional Misconduct and Discipline charged him with practicing dentistry while his ability was impaired by physical disability. Kay did not contest the charge and his application to surrender his license was granted on October 23, 2007.

Meanwhile, Rizzo's suit proceeded and a jury verdict was rendered in May 2009. Kay was found to have departed from the accepted standards of care (in other words, he was adjudged negligent) and  Rizzo was awarded pain and suffering damages in the sum of $450,000 ($300,000 past - 3 years, $150,000 future).

The defendant appealed claiming that the jury verdict was excessive. This week, the verdict was affirmed in Rizzo v. Kay (2d Dept. 2010).

The appellate court did not describe the injuries sustained. Here are the details:

  • 10 implant procedures and the insertion of ill-fitting bridges
  • need for 1-2 years restorative work
  • severe shooting ear pain
  • headaches
  • difficulty eating
  • TMJ disorder (pain and clicking in the temporomandibular joint)

An award of $450,000 for pain and suffering damages in a dental malpractice case is significant. Here are other recent significant dental malpractice cases in which pain and suffering damages have been ruled upon by the appellate courts in New York:

  • Garber v. Lynn (1st Dept. 2010) - $150,000 for 71 year old with improper bridge that caused pain, gum swelling and need for 20 implants and 14 crowns [case discussed here]
  • Clarke v. Limone (2d Dept. 2007) - $125,000 for improperly performed root canal causing cellulitis, infection and TMJ
  • Resnick v. Linkow (1st Dept. 2006) -$400,000 for 41 year old; nerve penetrated during dental implant surgery leaving him with permanent facial numbness, a drooling sensation and itchiness. 
  • Dansby v. Trumpatori (1st Dept. 2005) - $550,000 for 48 year old; misplaced bridge caused abscesses and eye swelling, need for intravenous treatment and surgery
  • Green v. Blanket (1st Dept. 2005) - $225,000 for 60 year old; improperly performed root canal fractured linguinal root causing  pain on bite, swelling and inability to chew on one side
  • Becker v. Woods (2d Dept. 2005) - $750,000 for 41 year old with nerve damage from injection causing permanent parasthesia to side of face and scalp with tingling, twitching, numbness and low voltage electrical currents coursing through face
  • Krechmer v. Mintzer (1st Dept. 2004) - $275,000 for negligently made nightstand (a dental appliance) resulting in open bite, lisp and difficulty chewing
  • Cicalese v. Carter (2d Dept. 2004) - $105,000  for TMJ caused by dentist placing a bridge too forcefully
  • Rafaniello v. Gronowitz (App. Term 2004) - $348,000 for unneeded extraction of several teeth requiring periodontal, restorative and orthodontic treatment

Inside Information:

  • Defendant argued that the controversial trial judge, Duane Hart (about whom we've written before, here) improperly and unfairly inserted himself into the trial by asking too many questions of witnesses and demonstrating partiality toward the plaintiff. While the appellate court rejected this argument, in light of the fact that similar conduct by Judge Hart has resulted in several reversals and the need for new trials they admonished him and basically told him to stop acting improperly.
  • Defendant claimed he had an unspecified heart problem that led to his retirement; however, no medical evidence was introduced at trial to substantiate that claim.

 

Pre-Death Pain and Suffering Verdict of $3,000,000; Case Dismissed on Appeal

Tragedy struck on January 28, 2004 when four year old Nico Rivera died. He'd fallen ill on December 22nd with what appeared to be flu-like symptoms and over the next 4 1/2 weeks, his parents took him several times both to and from his pediatrician's office and the hospital. After his second seizure, Nico stopped breathing, his father resuscitated him and an ambulance returned him to the hospital but he died that day.

Autopsies indicated that the cause of death was acute myocarditis (an inflammation of the muscular wall of the heart).

Nico's parents sued (Rivera v. Greenstein, Supreme Court, Bronx County, Index # 26799/04) claiming that the pediatrician was negligent in her failure to have ordered heart-related tests that would have discovered the cardiac involvement and that had these tests been done Nico would have received the medical care he needed to survive.

On December 9, 2008, the Bronx County jury found that:

  • the pediatrician was negligent in failing to order a cardiac evaluation and  certain tests (a CK-MB test, an EKG and a serum troponin test) and that these failures were substantial factors in causing Nico's death
  • $3,000,000 was fair and just compensation for Nico's  4 1/2 weeks of pain and suffering

Here is a copy of the actual verdict sheet completed by the jurors.

The defense asked the judge to dismiss the complaint notwithstanding the verdict or, alternatively, to reduce the damages award because it was excessive. In his post-trial decision, the judge determined that the liability verdict was proper; however, he opined that the $3,000,000 pain and suffering award was "a classic case of a runaway jury" and that it should be reduced to $300,000. The judge cited no cases in support of the reduction.

On appeal this week in Rivera v. Greenstein (1st Dept. 2010), the entire case against the pediatrician has been dismissed on liability grounds. The appellate judges, in an unusually detailed opinion discussing complicated medical facts, ruled that there was no evidence that the doctor departed from accepted medical standards in failing to order the cardiac tests because:

  1. the tests she did perform and Nico's symptoms could also indicate problems with other areas of his body and
  2. all of the tests she did perform indicated a normal heart

Additionally, as a separate basis for dismissing the case, the appellate judges found that plaintiff had failed to establish proximate cause. In medial malpractice cases, this is often referred to as the "so what" defense - meaning that even if there was mistreatment the plaintiff must link up that negligence with the claimed injury in order to win at trial.

Here, plaintiff did not present evidence as to what care Nico should have received for his presumed heart condition that would have made a difference. The failure to show what the doctor could have done to save Nico had she discovered myocarditis meant that proximate cause was lacking and the verdict could not stand.

Here is PJI 2:70, the pattern jury instruction language New York judges use regarding the meaning of proximate cause.

Had the liability verdict been upheld, there is little doubt but that the $3,000,000 pain and suffering verdict would have been reduced and some figure closer to the $300,000 ordered by the trial judge would have been assessed by the appellate judges. 

Without in any way suggesting that the death of this young boy was not tragic or that he did not suffer a great deal, prior case law indicates clearly that $3,000,000 was excessive under the facts in this case in which during all or some of 4 1/2 weeks before his death, Nico's pain and suffering included:

  • unable to sit, walk or stand on his own
  • had to be fed by his parents
  • did not talk
  • cried often
  • sustained two seizures

There is little case law as to pain and suffering damages analogous to this case; however, there have been a few cases (most of which we discussed here, here, here and here) that would give some guidance as to a sustainable figure for Nico Rivera's pre-death pain and suffering:

  • Frenchman v. Westchester Medical Center (2d Dept. 2010) - $1,000,000 in medical malpractice case; 7 1/2 months of constant pain, morphine use and fear of death
  • Dowd v. New York City Transit Authority (2d Dept. 2010) - $1,200,000 in a bus-pedestrian accident case; 18 minutes from impact to death; legs partially amputated, crush injuries, fear of impact and death
  • Perez v. St. Vincents Hospital (2d Dept. 2009) - $800,000 in medical malpractice case; 30 minutes of choking on food
  • Ramos v. Shah (2d Dept. 2002) - $450,000 in medical malpractice case; 10 days of pain from dehydration
  • Johnson v. Queens Long Island Med. Grp. (2d Dept. 2000) - $1,200,000 in medical malpractice case; 12 weeks of stomach pain and vomiting, need for colostomy and seizures
  • Hoehmann v. Siebkin (2d Dept. 2007) - $525,000 in medical malpractice case; 10 days of pain from massive inflammation of colon and multiple organ failure

In Nico Rivera's case, there was no evidence that he was aware of or feared his impending death, significant factors present in each of the foregoing cases.

Inside Information:

  • Plaintiffs settled before trial for $150,000 their claims against a neurologist who'd treated Nico years earlier for a suspected neurogenic disorder and who examined Nico and ordered a brain MRI a few days before Nico died.
  • There were two autopsy reports, both of which stated that on gross inspection the heart appeared normal.  One report (from the hospital) found microscopic evidence of focal myocyte necrosis (muscle cell death) on 2 of 34 slides and stated therefore that myocarditis was the cause of death. The other report (from the city's medical examiner) did not find myocyte damage but stated the cause of death was myocarditis based on the hospital slides.
  • There was only one mention in any medical records as to pain Nico suffered from before he died - the day after the pediatrician first saw him, she noted that he appeared "uncomfortable when legs touched."
  • Plaintiffs' attorney was Elsa Rodriguez Preston; the pediatrician was represented by Schiavetti, Corgan, DiEdwards, Weinberg & Nicholson (Carl Weinberg at trial and Samantha E. Quinn on appeal).

Dental Malpractice Pain and Suffering Award Increased on Appeal from $25,000 to $150,000 Plus $100,000 in Punitive Damages

On July 29, 2005, Helen Garber began extensive treatment in a dental office on 57th Street in Manhattan known as Toothsavers, a practice established by Jerry Lynn, with 50 employees including numerous dentists. 

Over the next few months, the 71 year old Ms. Garber was treated at Toothsavers under a comprehensive plan that included implants, caps and permanent bridgework. By November a permanent bridge was made but it didn't fit. It had to be revised three times. Finally, in February 2006, Garber left Toothsavers and never returned.

She sued for malpractice in April 2006 (Garber v. Lynn, Supreme Court, New York County, Index # 105673/06) and two years later a Manhattan jury found that there had indeed been malpractice (in the fit and placement of the temporary bridge) and plaintiff was awarded pain and suffering damages in the sum of $25,000 ($10,000 past - 3 years, $15,000 future). She was also awarded $75,000 in past and future dental expenses and $260,000 in punitive damages.

Now, on appeal, in Garber v. Lynn (1st Dept. 2010), the liability verdict has been affirmed while the pain and suffering award has been increased to $150,000 ($90,000 past, $60,000 future), the punitive damages award upheld but reduced to $100,000 and the dental expenses award affirmed.

Here are the details of plaintiff's injuries:

  • severe pain
  • swelling of gums which bleed easily, pull away from the bone and trap bacteria
  • impairment of ability to chew
  • inability to clean the area around the bridge

Plaintiff established that to restore the damage she needs more than 20 additional implants and 14 crowns.

The defense argued  on appeal (unsuccessfully) that the pain and suffering award should not be increased, in part, because Ms. Garber had failed to mitigate her own damages in that she wore an ill-fitting, painful temporary bridge for three years without seeking new treatment. Thus, they claimed, the jury was justified in concluding plaintiff acted unreasonably and, accordingly, discounting her claims of pain and suffering. This argument was rejected by the appellate court.

The affirmance of the punitive damages award is significant because, as New York's highest court held in McDougald v. Garber (1989), they are prohibited unless the harmful conduct is intentional, malicious, outrageous or otherwise aggravated beyond mere negligence. And, as was held in Bothmer v. Schooler, Weinstein, Minsky & Lester, P.C. (1st Dept. 1999), even where there is gross negligence, punitive damages are awarded only in singularly rare cases such as those involving an improper state of mind or cases involving wrongdoing to the public.

Defense counsel argued that the conduct of Toothsavers was, at worst, mere negligence, and nowhere near the severe standards required for the imposition of punitive damages. The key to the punitive damages award in this case, though, was the fact that it was a Toothsavers technician - not a licensed dentist - who always fit, placed, adjusted and re-cemented plaintiff's temporary bridge.

The appellate court noted that the unlicensed practice of dentistry is a crime and the jury was therefore free to conclude that Toothsavers was "callous in its indifference to such illegality" by having a mere technician repeatedly conduct complicated procedures such as fabricating, placing and adjusting the bridge. This, the court concluded, is precisely the sort of willful or wanton negligence or recklessness that warrants deterrence and an award of punitive damages.

Inside Information:

  • Ms.Garber had gone to Toothsavers only to ask about repairing two chipped front teeth. After an examination, she was told she needed a whole lot more dental work including implants, caps and permanent bridgework. A $25,000 fee was quoted. When she said she couldn't afford $25,000, the fee was adjusted down to $5,000 - and treatment began that day.
  • Jerry Lynn and Toothsavers were notorious long before Helen Garber walked in the door. They were the subject of an expose in the New York Daily News on March 10, 2000.
  • In March 2002, Lynn did not contest the charge of rendering substandard dental treatment and surrendered his dental license to the New York State Board of Regents. No longer allowed to practice, Lynn then entered into what the trial judge stated was a sham transaction - the purported $6,000,000 sale of his shares in Toothsavers to Sol Stolzenberg, then a 69 year old dentist employed by Toothsavers who had recently declared bankruptcy.
  • The judge also stated that the evidence was overwhelming that Lynn controlled the day to day operations of the dental practice and that Dr. Stolzenberg was a "strawman."
  • The technician - defendant Raimondo Perez - appears to have been a licensed dentist in the Domincan Republic for 11 years but when he applied here to a program for foreign dentists he was rejected.
  • New York City attorney Joel M. Kotick represented Ms. Garber and says he's represented patients in 50 cases against Lynn over the years. And has been successful in every one of them.

$562,000 Appeals Court Award for Pain and Suffering from Thoracic Nerve Injury Causing Scapular Winging and Disabled Arm

He was a tough 47 year old steel cutter employed for many years at the Goodyear-Dunlop plant in Tonawanda, New York (the Buffalo-Niagara Falls metropolitan area) when in 2004 he noticed his right arm was swelling. After visits to a local ER and his primary care doctor, Richard Winiarski ended up seeing a vascular surgeon who told him he had a blood clot and thoracic outlet syndrome, pain in the arm and shoulder areas caused by a rib compressing upon a subclavian blood vessel.

Here is the involved anatomy:

The doctor successfully treated the clot over the next six months with blood thinning medication and an injection (known as a lytic procedure). All seemed fine but she recommended a rib resection operation to prevent a recurrence of the blood clot. The surgery involved removing the first rib so as to allow more space for the blood vessel.

During surgery, though, the doctor did not identify the thoracic nerve (which runs through the belly of the middle scalene muscle) and the nerve was damaged  when she cut through the muscle using an electrocautery device - a surgical tool which is heated with electric current to cauterize, or burn, vessel tissue.

 

Immediately after the surgery, Mr. Winiarski had tremendous pain in the area of his scapula (or "shoulder blade") and within two weeks at physical therapy he was seen to have scapular winging (in which the scapula protrudes at rest or with arm and shoulder movement).

In the medical malpractice lawsuit that followed (Winiarski v. Harris - Supreme Court, Erie County, Index #3375/07), the jury found that the thoracic nerve had been injured by the surgeon  whose failure to identify the nerve was malpractice. The jurors then awarded plaintiff damages for his pain and suffering in the sum of $52,000 ($12,000 past - 4 years, $40,000 future - 24 years).

On appeal, in Winiarski v. Harris (4th Dept. 2010), plaintiff's pain and suffering award has been increased to $562,000 ($162,000 past, $400,000 future).

The appellate decision states that plaintiff suffers from scapular winging and a permanent limitation of his right shoulder and arm; however, there's more. Here are the details as to the injuries, which are permanent because the nerve cannot heal, grow back or be replaced:

  • 80% loss of use of his arm
  • can only lift his arm to 45 or 90 degrees (with decreasing range of motion)
  • pain requiring lifelong use of the narcotic medication Lortab
  • sleep deprivation and depression

Inside Information:

  • Mr. Winiarski was unable to resume heavy labor and was therefore fired from his job at Goodyear-Dunlop. He then took a job as a shoe salesman in a department store but had to stop after several months because it required him to climb ladders holding shoe boxes. The jury awarded him (and the appellate court affirmed) loss of earnings damages (including health insurance and pension) in the sum of approximately $1,300,000 ($200,000 past, $1,100,000 future). 
  • The court also upheld Mrs. Winiarski's claim for loss of consortium in the sum of $120,000 ($20,000 past, $100,000 future).
  • Defense counsel claimed (unsuccessfully) that the trial judge committed reversible error when he granted plaintiff an adjournment of several days to start his proof. The doctor was scheduled to be out of town at a medical conference and objected to the adjournment because it would mean she'd be unable to attend the end of the trial proceedings (the defendant did in fact miss summations and the judge's jury instructions).
  • The trial judge had increased the future pain and suffering award to $540,000 - an amount deemed $140,000 too much by the appellate judges. It appears that they wanted to bring the award in this case somewhat more in line with the $500,000 pain and suffering award affirmed recently in Garrow v. Rosettie Assoc. (3d Dept. 2009), one of the few cases dealing with injuries very similar to those sustained by Mr. Winiarski.

 

 

$6,500,000 Pain and Suffering Verdict Reduced to $1,000,000 for 32 Year Old Woman who underwent Unneeded Mastectomy

She moved to New York City from Jamaica as a 29 year old and within the year she felt a lump on her left breast. Over the next year and a half, Lydia Williams had mammograms, an excisional biopsy (that revealed cancer), a CT scan and chemotherapy before her doctor told her she needed a mastectomy (surgical removal of her breast) in order to tell if any cancerous cells remained.

On November 22, 2000, Ms. Williams had the surgery (a modified radical mastectomy with axillary dissection - the removal of 26 lymph nodes). Immediately following, she also had abdominal trans-flap breast reconstruction surgery which involved transferring tissue from her abdomen to try to recreate her left breast.

When the post-op pathological study was reviewed a few weeks later, it turned out that there was no cancer.

Williams then sued her surgeon and the hospital claiming that the surgery was unnecessary and that she was entitled to damages for her pain and suffering (both physical and psychological) related to the loss of her breast.

On October 3, 2008, the jury in Williams v. New York City Health & Hospitals Corp. (Supreme Court, Bronx County; Index # 14520/01) returned a verdict finding that the surgeon had committed malpractice in unnecessarily performing a mastectomy and that he did so without properly informing his patient of other options.

The jury found that Ms. Williams was not given the option of a lumpectomy (in which a small incision is made and the rest of the breast remains intact):

Williams was awarded pain and suffering damages in the sum of $6,500,000 ($3,000,000 past - 8 years, $3,500,000 future - 42 years). In a post-trial decision, Justice Cynthia S. Kern agreed with the defense that the damages award was excessive and ordered a reduction to $1,000,000.

This week, in Williams v. New York City Health & Hospitals Corp. (1st Dept. 2010), the appellate court has affirmed both the liability finding and the trial judge's reduction of the damages award to $1,000,000.

Here are some details as to the plaintiff's injuries:

  • complete surgical removal of her left breast
  • permanent scarring and disfigurement across abdomen and breast
  • significant post-op pain requiring a morphine pump and constant pain to the date of trial
  • chronic pain and swelling in her left arm, symptomatic of lymphedema
  • restricted social and athletic activities

The appellate judges split 3-2 in their decision. The majority justified the $5,500,000 reduction of the jury award simply by referring to (but not discussing the relevance of) three prior cases that bear factual similarities and by stating that there was no trial testimony establishing that plaintiff had suffered extreme emotional distress.

Here are the three cases cited by the majority:

  1. Motichka v. Cody (1st Dept. 2001) -$850,000 reduced from $2,250,000 for unnecessary modified radical mastectomy
  2. King v. Jordan (3d Dept. 1999) - $800,000 upheld for unnecessary mastectomy
  3. Lopez v. Bautista (2d Dept 2001) - $1,000,000 for failure to diagnose cancer, later requiring a mastectomy

The foregoing cases are all about 10 years old and in certain respects they are factually distinguishable from the Williams case. Lydia Williams was 32 years old at the time of her trial and unmarried; whereas, Ms. Motichka was 45 years old when she underwent her mastectomy, Ms. Lopez was 42 and married and Ms. King was 52 and married. Furthermore, Ms. Williams was cancer free free after her chemotherapy and need not have suffered any disfigurement while the injuries suffered by the plaintiffs in the other cases were of degree (they would have suffered less disfigurement and less pain). The appellate judges discussed none of these facts.

The two dissenting judges found that the graphic, unsettling photos of plaintiff's body taken a few months after the surgery (that were shown to the jury) obviated the need for any extensive testimony by plaintiff or a psychologist regarding her extreme emotional distress. They stated that extensive testimony regarding plaintiff's emotional damages might have been overkill and that it was obvious (a "universal truth") that plaintiff's physical injuries and disfigurement resulted in tremendous lifelong psychological damages. The dissenting judges would have approved a pain and suffering award of $4,000,000.

Inside Information:

  • Plaintiff's attorney asked the jury for $4,000,000 in pain and suffering damages for his client (and I hear that plaintiff would have accepted $1,200,000 before trial).
  • Defense counsel stated in his closing that not only was there no malpractice but also "the doctors in this case absolutely, absolutely saved the life of Lydia Williams."
  • The defense argued (unsuccessfully) that there was an improper attempt to inject race into this case - plaintiff's attorney, in his closing argument, had stated that Ms. Williams was a poor Jamaican without insurance and that poverty and race have an impact on whether patients get the option of breast conserving treatment.

 

 

$1,000,000 Affirmed for 7 1/2 Months of Pre-Death Pain and Suffering; 68 Year Old Underwent Successful Heart Surgery but Post-Op Feeding Tube Caused Stomach Perforation and Leakage Leading to Fatal Cardiac Arrest

On June 11, 2001, Gerald Frenchman, who’d been asymptomatic and in generally good health, underwent routine cardiac testing which revealed coronary artery blockage and valve disease. A triple coronary bypass surgery was successfully done right away but a few months later, he was diagnosed with right sided heart failure. On October 4th, Mr. Frenchman underwent a tricuspid valve replacement. Again, the heart surgery was successful.

Here is what the heart looks like before and after a typical bypass surgery:

Three weeks after the second heart surgery, Mr. Frenchman required a feeding tube because he was having difficulty breathing and swallowing and needed adequate nutrition.

A percutaneous endoscopic gastrotomy/jejunostomy (PEG/PEJ ) tube, like this, was inserted:

The doctors expected that Mr. Frenchman would recover from his heart surgery, regain nutritional health and live a long and natural life. Unfortunately, he did not and Mr. Frenchman died on July 6, 2002 after 7 ½ months at another hospital.

Mr. Frenchman’s widow, Cynthia, sued the hospital where he underwent his heart surgeries, Westchester Medical Center ("WMC"), as well as her husband’s heart doctors. She claimed that they caused his death by using a type of feeding tube that was contraindicated in view of the fact that Mr. Frenchman was suffering from ascites - excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).

Plaintiff alleged that the tube failed resulting in a stomach perforation, leakage and a whole host of ever-growing difficulties (such as the placement of a colostomy bag) and diseases (such as peritonitis and pneumoperitoneum) from which her husband suffered greatly and never recovered.

Mrs. Frenchman also claimed that after the feeding tube caused problems her husband’s care was further mismanaged in that several maladies over the ensuing weeks went undiagnosed and he was prematurely discharged from WMC.

Defendants claimed that Mr. Frenchman’s deterioration was due to chronic heart and respiratory problems not attributable to the feeding tube and that he somehow sustained the stomach perforation after he left their care.

On January 3, 2008 the case of Frenchman v. Westchester Medical Center (Supreme Court, Westchester County, Index # 02300/03) came to trial and the jury found that WMC and two of its cardiac surgeons had been negligent in their treatment of Mr. Frenchman from October 3 through November 20, 2001 (when they discharged him from WMC to a rehabilitation center where he was found to be in critical respiratory distress and immediately sent to White Plains Hospital).

The jurors awarded pre-death pain and suffering damages in the sum of $1,000,000 (7 ½ months).

Now, the jury’s findings as to liability and damages have been upheld in Frenchman v. Westchester Medical Center (2nd Dept. 2010).

Unfortunately, the appellate court decision did not discuss any of the pain and suffering details in this case. As to the $1,000,000 pain and suffering award, the decision merely states that it does not deviate materially from what would be reasonable compensation and no prior cases are mentioned.

Here are the details as to Mr. Frenchman's pain and suffering during his 7 1/2 months at White Plains Hospital:

  • constant pain requiring morphine drip
  • need for colostomy bag
  • long term placement of nasogastric tube
  • multiple surgical procedures including ulcer debridements
  • emergency surgery the day after discharge from WMC to repair stomach perforation
  • multiple respiratory issues requiring intubation
  • fear of impeding death

The decision in Frenchman v. Westchester Medical Center also failed to discuss any of the prior decisions that dealt with pre-death pain and suffering damages in similar situations. We have previously discussed in some detail the important appellate cases that have ruled on such damages when the decedent was comatose or when very short periods of time transpired before death.

Mr. Frenchman, though, was neither in a coma nor did his death come very shortly after the malpractice; instead, his pain and suffering lasted 7 1/2 months. Here are two of the cases that the attorneys cited which the judges could and should have discussed in explaining why they sustained the jury's $1,000,000 verdict for pre-death pain and suffering:

  • Alston v. Sunharbor Manor, LLC (2nd Dept. 2008) [cited by plaintiff] - $1,000,000 trial judge's reduction from $3,000,000 sustained; 62 year old wheelchair bound man in nursing home left unattended for hours outside in 95 degree heat and intense sunlight burned over 10% of his body, rushed to hospital and died 30 days later after great pain, multiple skin debridements and overall deterioration
  • Hoehman v. Siebkin (2nd Dept. 2007) [cited by defendant] - $525,000 (reduced from $750,000 jury verdict); 69 year old man admitted to hospital with pneumonia, developed inflammation of his colon which led to systemic toxicity, multiple organ failure and death nine days later

Inside Information:

  • Plaintiff initially sued not only the hospital and the cardiac doctors but also three other doctors - two of whom she dropped from the suit and the third of whom, the attending gastroenterologist (who inserted the feeding tube), was exonerated at trial. The jury apparently upheld his claim that his role was limited and did not involve monitoring. Even if the tube was contraindicated, he asserted he should have been (but was not) called back by the attending doctors if her were needed.
  • As set forth on the verdict sheet, the jurors also awarded damages for Mrs. Frenchman’s loss of services ($150,000), medical expenses ($335,000), economic losses ($220,000) and funeral expenses ($15,000). All of these damage awards were upheld by the appellate court.
     

 

Brain Damage from Medical Malpractice at Birth - $56 Million Verdict, including $22 Million for Pain and Suffering, to be Resolved on Appeal

On October 10, 2003, Mary Swanson, then 41 years old, delivered her fourth child, Michael, at a hospital in Mount Kisco, New York. During delivery, shoulder dystocia was encountered (a condition at delivery in which the baby’s shoulder gets hung up on the mother’s pubic bone after delivery of the baby’s head).

Here is what the delivery looks like in many shoulder dystocia cases:

Due to the application of force to relieve the dystocia, Michael sustained a brachial plexus injury (known as Erb’s palsy, a usually transient condition in which nerve roots of the spinal cord are damaged and, typically, a child’s arm becomes pulled in towards his body and internally rotated).

Here  are the nerves whose damage can cause Erb's palsy:

 

Michael’s parents sued the hospital and Mary’s obstetrician claiming that the shoulder dystocia problem was mismanaged, its resolution wrongly delayed and excessive force applied to the baby’s head during nine minutes from delivery of the head until full delivery. As a result, plaintiffs claimed that Michael sustained not only a brachial plexus injury but also asphyxia (loss of consciousness due to too little oxygen) and a brainstem injury leaving him with developmental delays, including speech, language and cognitive function deficits as well as difficulty swallowing and recurrent aspiration syndrome.

Michael did not testify during the trial, however plaintiffs played for the jury a videotape taken at various times during the year before trial showing Michael and depicting his injuries and symptoms.

After a 14 day trial in Swanson v. Northern Westchester Hospital Center (Supreme Court, Westchester County, Index # 16743/07), on December 11, 2009, a Westchester County jury determined that the defendants had indeed been negligent and liability was apportioned 75% to the doctor (and her practice group) and 25% to the hospital.

Damages were assessed in the sum of almost $56,000,000 – including $22,000,000 for Michael’s pain and suffering ($2,000,000 past - 6 years, $20,000,000 future – 69 years), $29,000,000 for a lifetime of medical, rehabilitation and custodial care costs and $4,600,000 for future lost earnings).

After trial, the hospital asked the trial judge to set aside the liability verdict as irrational and without basis in fact. As to the hospital, plaintiffs argued that a delivery room nurse (an employee of the hospital) was negligent when she improperly initiated the delivery process without supervision or notification to the attending physician. The trial judge discussed the conflicts in evidence as to what happened in the delivery room, when and who was present, and in his post-trial decision on June 24, 2010, he rejected the hospital’s motion to set aside the jury verdict on liability.

The hospital’s post-trial motion also argued that the damages award was grossly excessive and required a substantial reduction; however, the judge gave short shrift to this claim and, as to the $22,000,000 pain and suffering award, merely stated that it “did not deviate materially from what would be reasonable compensation in the circumstances at bar.”

The judge cited no cases and gave no explanation for upholding this enormous pain and suffering verdict despite the substantial briefing of this issue by the parties that was presented to him and the many appellate court decisions that have dealt with and discussed multi-million dollar pain and suffering awards.

Should liability against the hospital be upheld, it’s quite likely that the appellate court will hold that the $22,000,000 pain and suffering award is grossly excessive and slash substantially in view of recent relevant appellate court cases dealing with injuries and conditions that appear to be much worse than those dealt with by Michael Swanson, such as cerebral palsy, and which determined that pain and suffering damages should be reduced to the $3,000,000 to $4,250,000 range.

Here are some of the cases that should have been discussed by the trial judge in considering the propriety of the jury’s pain and suffering award and that will likely be considered by the appeals court:

  • Maing v. Fong (2nd Dept 2010), a case we discussed recently, here, in which the appeals court increased to $4,150,000 from $2,650,000 a pain and suffering award for a boy whose brain damage from medical malpractice at birth left him with left side hemiparesis and attention deficit disorder
  • Flaherty v. Fromberg (2nd Dept. 2007) - infant suffered anoxia and acidosis in utero for 21 minutes before delivery via C-section ultimately diagnosed with severe cerebral palsy and spastic quadriparesis; jury awarded him pain and suffering damages in the sum of $20,250,000 reduced on appeal to $4,250,000
  • Lovett v. Interfaith Medcial Center (2nd Dept. 2008) - post-natal brain hemorrhage and hydrocephalus led to infant’s cerebral palsy; $4,575,000 pain and suffering award reduced on appeal to $3,000,000
  • Avila v. City of New York (1st Dept. 2010) - $8,000,000 verdict for birth related brain damage leading to mild cerebral palsy and global developmental delays set aside on appeal due to trial errors; new trial ordered; discussed in detail here

Shortly after trial, the Swansons accepted a settlement offer from the doctor and her group representing their full malpractice insurance policy limits of about $3,300,000. Under CPLR 1207, a settlement for an infant such as Michael must be approved by the trial judge and papers seeking such approval have been presented to the judge.

The hospital has determined to appeal, arguing that there was no basis for any liability at all against it and, alternatively, that the damage awards (not only the pain and suffering but also the costs and need for medical, rehabilitation and custodial care, and the future lost earnings) were grossly excessive and must be substantially reduced.

Inside Information:

  • Michael’s developmental delays did not begin for two years during which time he had no special treatment or abnormal diseases and the defense argued that no error during the birthing process could possibly have caused the delays.
  • In their bill of particulars dated December 26, 2006, Michael’s lawyers made injury claims only for shoulder dystocia, brachial plexus, asymmetric hand/arm movements, cervical hematoma and facial and arm bruising. Thereafter, with new attorneys, on November 8, 2007, claims were added for perinatal distress, acidosis, asphyxia and global developmental delays.
  • Plaintiff’s expert pediatric neurologist testified that Michael’s brain damage resulted from an injury to his vertebral artery and he has lateral medullary syndrome (also known as Wallenberg's Syndrome), however, he admitted that this is caused by a stroke and he'd never in 20 years of practice diagnosed a child with this syndrome.
  • The defense expert opined that traction as applied to the shoulder causing Erb’s palsy in no way can injure the vertebral artery and that there was no injury at all to Michael’s brain as a result of the labor or delivery.
  • There was evidence that the hospital’s records as to this incident may have been changed or altered after the fact. Its original chart was missing and a microfiche of the records was produced that had been prepared almost three years after the delivery. During deliberations, the jury sent out a note asking if they found the hospital not liable for physical injuries to Michael, but should pay restitution for sloppy recordkeeping and/or falsification of documents, could they still award damages. The judge told them “no” but thereafter they returned their verdict for the plaintiffs. The defense claims that this note shows the jury’s stated intention to impose restitution and penalize the hospital for improper reasons.
  • During trial, plaintiff had offered to settle with the obstetrician for $1,850,000 and her practice group for $850,000 – $600,000 less than their post-verdict full policy limits settlements.
  • In closing arguments Michael’s attorney suggested an award of $1-3 million for past pain and suffering and as to the future 69 years asked: “Is $10,000,000 over 70 years too much? Or too little?” Clearly, the jury found it was too little.

We will follow this case for its appellate court resolution.
 

Pre-Death Pain and Suffering Verdict Slashed by Appellate Court from $5,000,000 to $2,500,000 because Woman in Coma for 4 ½ Years was only "Sporadically Aware" of her Condition

On October 3, 1996, Edith Schaffer, then 67 years old, voluntarily admitted herself to a small psychiatric hospital in Ossining, New York, for an episode of depression and anxiety. The next day, she suffered the first of a series of seizures and was sent to a nearby community hospital for a neurological consult and tests.

Mrs. Schaffer's tragic odyssey began here:

Two days later, due to an undiagnosed critically low serum sodium level (hyponatremia), Mrs. Schaffer lapsed into a coma where she remained until her death on June 6, 2001.

Her husband sued the hospitals and various doctors and on November 6, 2008 a Westchester County jury found that a by-then deceased doctor at the community hospital was fully liable for Mrs. Schaffer’s injuries and death in that he failed to appreciate the significance of her condition which was easily reversible.

We discussed this case, Schaffer v. Stony Lodge Hospital, here, back in January 2009. The trial judge denied the defendant’s motion to set aside the verdict. Now, a decision has been issued on the appeal and the judges drastically reduced the pain and suffering award from $5,000,000 to $2,500,000.

The appellate court decision in Schaffer v. Batheja (the name of case after some defendants were dismissed) does not mention any of the facts upon which the judges relied in reducing the pain and suffering award except for stating that “Mrs. Schaffer was only sporadically aware of her condition” during the 4 ½ years she lay in a coma.

In cases where a plaintiff is comatose or in a vegetative state, her level of consciousness, if any, will be the key to whether and the extent to which a pain and suffering award will be upheld.

Under the leading case of McDougald v. Garber (Court of Appeals,1989), to support a pain and suffering award plaintiff had to prove that Mrs. Schaffer had “some level of awareness.”

We have dug up the underlying facts and arguments as to consciousness that were brought out at trial. Each side relied upon different aspects of the following evidence:

  • the testimony of doctors and nurses who treated Mrs. Schaffer over the years
  • the testimony of family members who came to visit
  • the opinions of medical experts
  • notations in the voluminous medical records

Plaintiff argued that Mrs. Schaffer was well aware of her condition and experienced pain in view of evidence that she:

  • abducted her shoulder and flexed her upper extremities in response to nail bed pressure
  • opened her eyes on occasion and followed people moving in her room with her eyes
  • cried and tears came to her eyes often when her family came to visit
  • sometimes moved her head on command

The defense argued that there was insufficient proof that Mrs. Schaffer had any level of awareness from the time she lapsed into a coma until her death, based on evidence that she:

  • was comatose at all times
  • had no ability to communicate or consciously sense any pain
  • reacted to painful stimuli only reflexively
  • was in a persistent vegetative state in which eye openings can occur when one is not at all awake

As to the amount of the pain and suffering verdict, the defense argued, successfully, that $5,000,000 was unreasonably excessive and that there should be a drastic reduction. Both sides cited numerous cases to support either a reduction of the award or its affirmance; however, the appellate judges cited none.

Here are the main relevant cases, all except one involving pre-death pain and suffering:

  • Ramos v. Shah (2nd Dept. 2002) - $450,000 for several days in coma before death from cardiac arrest due to medical malpractice
  • Maracle v. Curcio (4th Dept. 2005) - $125,000 affirmed for 40 months of pain and suffering after fall left woman in vegetative state (she never communicated any indication of pain before death)
  • Weldon v. Beal (2nd Dept. 2000) - $5,000,000 for 26 year old woman with severe brain damage from medical malpractice in semi-comatose state for 12 years [not a death case - $2,000,000 past - 12 years, $3,000,000 future - 15 years]
  • Jump v. Facelle (2nd Dept. 2002) - $1,300,000 upheld for eight months of pre-death pain and suffering, including persistent abdominal infection, several surgeries and permanent colostomy and bed sores.
  • Walsh v. Staten Island Obstetrics & Gynecology Associates, P.C. (2nd Dept. 1993) - $650,000 affirmed for infant in vegetative state for eight years before death due to medical malpractice

Mrs. Schaffer’s husband, Paul Schaffer, was awarded $3,000,000 by the jury for his loss of services claim meant to compensate him for his economic loss (i.e., the monetary value of his wife's services as a homemaker) and his loss of companionship or consortium.

The roles of women in the home and the workforce have changed in many ways over the years.

The law recognizes that physically uninjured spouses may suffer losses when their injured husbands or wives) can no longer assist with tasks in the home or provide the love and comfort previously enjoyed. When these factors are present, judges instruct jurors (PJI 2-315 and PJI 2-316) that they should render monetary verdicts in favor of the uninjured spouse.

The appellate court reduced Mr. Schaffer's $3,000,000 jury award to $500,000 simply stating that there was “limited proof as to the value of the services rendered" by Mrs. Schaffer to her husband.

Our review of the underlying facts indicates that the appellate judges were influenced by the fact that plaintiff offered no evidence as to the value of his late wife’s homemaker services loss and simply argued that his $3,000,000 award should be upheld in full in light of a 40 year marriage and his dutiful daily visits until his wife’s death. The defense argued persuasively that Mr. Schaffer’s award should be reduced significantly in view of evidence that the marriage had long been strained with no sexual relations for the 10 year period before the coma.

Inside Information:

  • Nurain Batheja, M.D. the internist at Phelps Hospital against whom the jury assessed all of the liability, died in 1997, less than a year after Mrs. Schaffer lapsed into a coma. He was never deposed in the ensuing lawsuit.
  • Before trial, a $1,750,000 settlement was reached with defendants Phelps Hospital and one of its doctors and plaintiff dropped his claims against Stony Lodge and all other defendants except Dr. Batheja. Under New York’s General Obligations Law Section 15-108, therefore, the $3,000,000 appellate award will be reduced by the $1,750,000 pre-trial settlement to $1,250,000.
  • The appeals court also upheld $557,485 in medical expenses but there are Medicare and Medicaid liens related thereto


 

Improper Conduct of Trial Judge in Medical Malpractice Case Leads to Appellate Court Reversal of Defense Verdict for Orthopedic Surgeon; New Trial Ordered

Joan Sutton, a 68 year old retiree, suffered from chronic left hip pain, was diagnosed with degenerative arthritis and underwent total hip replacement surgery on June 12, 2003 with orthopedic surgeon Elias Kassapides, M.D. at St. Luke’s - Roosevelt Hospital in New York City. The doctor removed and exchanged the femoral head (the ball) and the acetabulum (the cup) which together comprise the hip joint and replaced them with artificial components.

Here is what a degenerative hip joint looks like:


Unfortunately, Ms. Sutton’s hip pain continued after surgery and she eventually treated with new surgeons, one of whom, on August 18, 2004, performed revision surgery on her left hip. He took out the prosthetic devices and put in new ones.

And here is what the hip replacement components look like after the surgery:

Contending that surgical mal-positioning of the hardware implants caused the need for new surgery, Sutton sued Dr. Kassapides but on May 2, 2008, a jury in Queens County rendered a defense verdict finding that there was no malpractice.

Now, though, in Sutton v. Kassapides, an appellate court has upheld plaintiff’s appeal and reversed that finding, set it aside and ordered that a new trial be held. The appellate court ruled that plaintiff was deprived of a fair trial as a result of the cumulative effect of the improper conduct of the trial judge, both during his cross-examination of witnesses and in his charge to the jury.

No details about the judge’s inappropriateness were set forth in the appellate court’s decision so we’ve dug up the information and here it is. The judge, Duane A. Hart, was charged by plaintiff’s counsel with stepping beyond his role as a disinterested umpire, evincing a clear bias in favor of the defendant and excessively intervening into the trial proceedings by:

  • Pre-judging the case before trial began and concluding that plaintiff’s claims required dismissal
  • Taking over the cross-examination of witnesses by his tone and the nature of his questions demonstrating partiality to the defense
  • Falling asleep while on the bench during court proceedings

For examples of some of the judge’s improprieties during the trial, here is the plaintiff’s brief on appeal which includes portions of the trial transcript, at pages 11-18, demonstrating several instances of the judge’s unusual and improper actions in this case.

On retrial, the issue to be determined will be whether the defendant’s positioning of the hardware components "deviated from medically accepted practices." That’s precisely the phrase judges routinely use in their instructions to jurors at the end of medical malpractice cases in New York and it’s set out in full at Pattern Jury Instructions 2:150.

Plaintiff claimed that Dr. Kassapides was negligent (and caused the need for revision surgery) because he left about 25% of the hip socket uncovered due to his placement of the acetabular cup at corresponding angle of 30 degrees instead of 45 degrees. Defendant’s expert testified, though, that the cup was properly placed and that, as plaintiff’s expert conceded, an acetabular cup may be safely placed between 30 and 50 degrees.

As to damages (not reached at trial due to the defense verdict on liability), plaintiff will have to convince the new jury that she would not have been required to undergo left hip revision surgery but for the defendant’s negligence. The defendant will point out that plaintiff had, before her initial left hip surgery, undergone an unrelated right hip replacement that needed to be revised because the cup was placed too vertically. That may well undercut her claim that it was only the defendant’s negligence (assuming she can prove negligence) that caused the need for her left hip revision surgery.

In any event, whatever a new jury might award, it's unlikely damages would be sustained above $500,000 in view of last month's appeals court decision in Dublis v. Bosco (2010). There, a 74 year old woman underwent surgical revision of an artificial hip in which the femoral head and the acetabular cup were replaced. Unfortunately, plaintiff was left with a foot drop caused by intra-operative nerve damage. While her attorneys requested $800,000 for plaintiff’s pain and suffering, the jury awarded pain and suffering damages in the sum of $500,000 ($200,000 past, $300,000 future) and that amount was, over defendant’s objections, upheld as reasonable. While not perfectly analogous to the facts in Sutton v. Kassapides, it’s likely that this decision, as a practical matter, has set the ceiling for damages in Ms. Sutton’s retrial.

Inside Information:

  • Plaintiff’s attorneys made the unusual request, granted on appeal, that the retrial should be held before a different judge. That request has been made and granted several times regarding this particular trial judge, for example, in Williams v. Naylor (2009), Pickering v. Lehrer (2006) and Allstate Insurance Co. v. Albino (2005).
  • Judge Hart has been censured by the state Commission on Judicial Conduct for his improper conduct in other cases and matters.
  • It is often very difficult for plaintiffs in medical malpractice cases to find top notch local experts to testify for then (and against their colleagues) so resort is made to out of state experts. Here, though, plaintiff’s expert, Ronald Krasnick, M.D., a Burlington, New Jersey orthopedist, appears to have been overmatched by defendant’s expert, William Macaulay, M.D., a world-renowned orthopedic surgeon. Jurors are often greatly influenced by such matters, especially considering that these types of cases are often battles of experts and are decided in large part based on which competing expert’s opinion is more credible.
  • One of the mistakes by Judge Hart was his charge to the jury that if they concluded that defendant merely made an error in judgment (i.e., he chose among several accepted methods of treatment) as opposed to a deviation from accepted medical practices in how he perfumed the surgery, then they could find for the defense. The plaintiff argued successfully on appeal that this charge should not have been given because her claim was not whether the initial left hip surgery should have been performed or not; rather, she claimed that it was how the doctor performed the surgery (the ball and cup placement mal-positioning) that constituted negligence. In charging the error in judgment rule, Judge Hart ignored clear and binding precedent from New York’s highest court in the case of Nestorowich v. Ricotta (2002).

 

$8,000,000 Brain Damage Verdict Vacated by Appeals Court; New Trial Ordered Because Trial Judge Erroneously Discharged a Deliberating Juror

Destiny Avila was born at Harlem Hospital on January 5, 2001. It was a difficult delivery - Destiny was 10 pounds and her clavicle had to be forcibly fractured to get her out. Then, she was intubated and sent to the neonatal ICU for two days. Apparently all was well and baby and mother were discharged on January 9, 2001 (four days after birth).

Here is where Destiny Avila's saga began:

By the time she was three years old, Destiny's mother noticed she had developmental delays. An evaluation indicated that she had a developmental age of only 10 months. Her mother promptly started a lawsuit in 2004 against the hospital and its doctors claiming medical errors during delivery had caused brain damage to her baby.

After a three week trial in Manhattan Supreme Court, on October 18, 2007 the jury rendered an $8,000,000 verdict in plaintiff’s favor.

In Avila v. City of New York, an appeals court has now set aside the verdict and ordered a new trial because the trial judge erroneously dismissed a juror and seated an alternate after deliberations had begun.

Plaintiff’s medical experts had testified that the doctors should have performed a caesarean section because of the baby’s large size and indications that she was not receiving enough oxygen. They felt that Destiny had sustained hypoxic ischemic encephalopathy (permanent brain injury due to a lack of oxygen or adequate blood flow to the brain) and they concluded she has mild cerebral palsy as a result.

The defendants’ medical experts could not have disagreed more. The said a vaginal delivery was appropriate and that Destiny suffered no significant injuries other than the clavicle fracture and that injury was no one’s fault. Most importantly, they were adamant that Destiny was not suffering from cerebral palsy. Instead, they strongly urged that any medical or developmental problems plaintiff may have had were minimal and/or within the spectrum of a previously diagnosed autism disorder.

The defense urged that the only injury Destiny sustained at birth was a fractured clavicle:

In awarding plaintiff $8,000,000 ($500,000 past – 6 ½ years, $7,500,000 future – 74 years), the jury clearly rejected the defense claims that there was no medical negligence and that the injuries were minimal. While the defense argued that there was no negligence, they did concede that Destiny was 50% globally delayed with speech and language deficits.

On appeal, the defense claimed that:

  1. plaintiff should not have been allowed to present expert testimony that she had cerebral palsy since this was a brand new never before disclosed theory,
  2. the trial judge committed an error requiring reversal when, without meaningful inquiry, she seated an alternate juror without defense counsel’s consent after discharging a deliberating juror who claimed there was intimidation inside the jury room, and
  3. if the verdict on liability should be upheld the amount of damages was grossly excessive and should be reduced

The appeals judges agreed with the defense that the verdict must be reversed because of the juror dismissal and seating of an alternate without consent and they vacated the verdict (thus rendering the other two issues moot).

Here are the details as to the drama inside the jury room. After deliberations began, the lone female juror, “Juror Number 3,” ran out of the jury room and said:

“I’m not going in there again. I am not going to – I’m starting to physically fight and I’m not going to be in the room.”

Things were pretty crazy inside the jury room:

After speaking with the entire panel, the judge sent them back to deliberate further. The day ended with the jury having reached a partial (undisclosed) verdict. The next morning, Juror Number 3 delivered a note to the judge complaining that another juror had been intimidating and threatening and that he physically threatened another juror and yet other jurors had to intervene. Juror Number 3 wrote that she was not comfortable she could make a rational decision in the case.

The judge then dismissed Juror Number 3, seated an alternate juror and a full verdict was reached after four more hours of deliberation.

Alternate jurors are chosen during jury selection so that if, before jury deliberations begin, a regular juror dies or becomes ill or for any other reason is unable to perform his duty, an alternate will be available and seated. There is no provision in the statute, CPLR 4106, that contemplates seating an alternate after jury deliberations begin. That's because citizens in civil actions have a constitutionally protected right to a jury of six. Only if the attorneys all consent may an alternate be allowed to deliberate after deliberations begin.

Defendants in this case, though, did not consent. Had the judge conducted an inquiry into Juror Number 3’s concerns before discharging her then defense counsel may have consented but the judge’s dismissal of Juror Number 3 without meaningful inquiry was held to be improper and therefore seating of the alternate was also improper.

The question of whether $8,000,000 in damages was excessive was briefed fully by the parties on appeal but not resolved because it became moot. Should plaintiff again prevail on liability, it’s unlikely that such a sum would be sustained.

Here are some of the recent appellate decisions that sustained pain and suffering awards for brain damage in the multi-million dollar range (and plaintiff’s injuries in Avila v. City of New York do not appear to be nearly as severe as those in any of these cases):

  • Lopez v. NYCHHC (1st Dept. 2000)- $3,100,000 for 30 years of future pain and suffering where infant suffered cerebral palsy, spastic quadriplegia and inability to speak, sit or walk
  • Reed v. City of New York (1st Dept. 2003) - $2,500,000 for 30 years of future pain and suffering for multiple skull fractures and very substantial brain damage leading to memory loss, a permanent inability to lie down, total loss of smell, severe orthopedic disabilities and pain, depression and suicidal ideation 
  • Paek v. City of New York (1st Dept. 2006) - $3,000,000 for 40 years of future pain and suffering for a 35 year old woman with permanent significant cognitive deficits affecting her memory, attention span and concentration as well as severe depression and constant pain from persistent headaches

Inside Information:

  • Plaintiff did not seek an award of future damages for medical care. While not dispositive of whether there will be future pain and suffering, where there are no likely future medical costs the claim for future pain and suffering is often discounted by jurors. Not so in this case so far but with another jury that could be a problem for the plaintiff’s future pain and suffering claim.
  • Plaintiff, age 6 at trial, had no physical disabilities, a normal gait and was described by her mother as a happy child who likes to dance and play.
  • Plaintiff claimed that Destiny will never have functional communication, be able to live independently or hold a job.
  • With a new trial, Destiny will have aged a few more years and the new jury will be better able to estimate her future damages, should plaintiff again prevail on liability.
     

Failure to Monitor for Lupus Medical Malpractice Verdict Reversed by New York's High Court - $2,500,000 Award Vacated and New Trial Ordered

Just six months ago an appellate court upheld a $2,500,000 jury verdict in favor of Susan Midler, a woman in her 60’s, against her rheumatologist, Richard Crane, M.D., to whom she’d been referred for joint pain. She was later diagnosed with lupus and won her lawsuit against the doctor based on a jury's finding that he had not properly monitored her over the years.

This week, though, in Midler v. Crane, the decision of the intermediate appellate court was reversed by New York’s Court of Appeals (the state’s highest court) and the case sent back for a new trial because of impermissible inconsistencies in the jury's findings.

Court of Appeals Hall, originally known as State Hall, was completed in 1842. It's on Eagle Street in Albany, New York:

We discussed the intermediate appeals court finding, here. Readers will recall that the defendant had diagnosed the plaintiff with degenerative arthritis, ruling out kidney disease based, among other factors, on a normal urinalysis (one of the important tests for lupus).

Ms. Midler thereafter treated with an endocrinologist Joel Curtis, M.D. who conducted a urinalysis with an abnormal result. Dr. Curtis claimed he sent the results to Dr. Crane but he denied receipt.

Two and a half or so years after Dr. Crane first treated Ms. Midler, she was hospitalized for kidney failure, underwent dialysis and six months later a kidney transplant. She had lupus.

Dialysis machines filter blood and rid the body of harmful wastes, extra salt and water. Patients often need to sit for three hours or more 3-4 times a week.

The jury made several specific findings, the inconsistencies of which resulted in this week's reversal of the verdict and the mandate for a new trial:

  • Dr. Crane was negligent in the manner in which he monitored the plaintiff, including not performing further urinalysis tests after her initial visit with him when that test was normal - and his negligence was a substantial factor in causing her injuries.
  • Dr. Crane was not negligent for failing to diagnose the lupus.
  • Dr. Curtis was negligent in not ensuring that the results of the urinalysis test he performed reached Dr. Crane - but his negligence was not a substantial factor in causing plaintiff's injuries.

In the new ruling, all seven of the judges on the Court of Appeals agreed with Dr. Crane – the verdict was impermissibly inconsistent in finding that his failure to monitor Ms. Midler was a substantial factor in causing her injury while at the same time also finding that the negligence of Dr. Curtis in failing to transmit his urinalysis results was not. Therefore, a new trial was ordered.

 

Appeals Court Affirms Medical Malpractice Finding but Reduces $900,000 Pain and Suffering Award to $200,000

As regular readers know, we rail against appeals court judges who issue decisions that fail to explain why they decrease (or increase) pain and suffering awards. Under CPLR 5501 and 5522, they are required to explain their reasoning when they rule on requests to decrease or increase awards.

In a new medical malpractice lawsuit decision, Walsh v. Brown (2nd Dept., 2010), the plaintiff has been left with $700,000 less than the $900,000 she was awarded after trial and without any adequate explanation why.

After being diagnosed with endometrial cancer, 66 year old retired schoolteacher Margaret Walsh consulted with Carol Brown, M.D., a gynecologic oncologist at Manhattan’s Memorial Sloan-Kettering Cancer Center. The doctor recommended and on February 14, 2005 performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection – open surgery to remove the uterus, cervix and ovaries.

Here’s what the hysterectomy surgery looks like while it’s underway:


To perform the surgery, doctors used retractors, like the ones illustrated above, in order to obtain and maintain adequate exposure of the surgical site. That’s standard operating procedure. In this case, though, a retractor was improperly placed on and compressed the right sided femoral nerve injuring it and leaving Mrs. Walsh with femoral neuropathy.

The femoral nerve is located in the leg and supplies the muscles that help straighten the leg. It provides sensation to the front of the thigh and part of the lower leg.

The jury in Walsh v. Brown determined that:

  1. the doctor was negligent in her placement of a retractor against the femoral nerve,
  2. doing so injured the nerve (femoral neuropathy), and
  3. plaintiff was entitled to a past pain and suffering award in the sum of $750,000 (4 years).

The jury declined to make any award at all for future pain and suffering.

On competing post-trial motions (plaintiff sought an increase in future damages while the defendant sought a decrease in past damages), the trial judge issued an order that $150,000 be added to the verdict – new total $900,000 ($750,000 past, $150,000 future). She did so because the jurors improperly ignored evidence (including the defense doctor’s testimony that plaintiff has permanent residual weakness in her leg).

Defendant appealed claiming that $750,000 was unreasonably excessive for past pain and suffering and that the trial judge should not have awarded any future damages at all. In addition, the defense claimed all along and on appeal that there was insufficient proof of any negligence; however that argument was rejected by the jury and all of the judges. As to the amount of damages, though, the plaintiff fared quite poorly with the appellate panel. Without any explanation at all, the judges reduced the past pain and suffering award from $750,000 to $200,000 and they reinstated the award of zero for future damages.

As to past pain and suffering, here’s what Mrs. Walsh endured for four years:

  • an extra two weeks or so as an inpatient after hysterectomy surgery, 10 weeks in a nursing home, home therapy for 12 weeks and a year of outpatient physical therapy
  • continued weakness of her quadriceps and hip flexor muscles necessitating use of a quad cane to walk
  • sensory loss and absent knee jerk reflexes
  • neuropathic pain syndrome – burning pain in her thigh and cramping

Here are the quad cane and other types of canes that are prescribed to help injured or disabled people walk:

Mrs. Walsh was a previously active woman who exercised regularly on a treadmill but now she'll never able to do so again. The jury saw fit to award $750,000 for her pain and suffering to the time of trial, the trial judge approved and then the appellate judges simply and without explanation concluded that $500,000 should be lopped off and Mrs. Walsh should get only $200,000 for her past pain and suffering.

As to future pain and suffering, there was testimony from doctors for both sides that the injury was permanent and that plaintiff still has right leg weakness which affects her ability to go up and down stairs, kneel and bend her knees. Mrs. Walsh admitted that she is much improved but claimed she still needs a quad cane to walk.

In overturning the trial judge’s decision to award future damages, the appellate court cited DeVito v. Ho (2nd Dept. 2006), however that case dealt with a simple wrist fracture (no surgery) that required no treatment after six months. Although DeVito claimed some residual weakness, there was other testimony that by the time of trial four years later, all of his accident injuries had healed. DeVito received $60,000 for past pain and suffering and nothing for future damages. Clearly, that case is distinguishable from Walsh v. Brown in that here the defense expert acknowledged permanence and continuing disabilities.

Inside Information:

  • Mrs. Walsh had orthopedic problems that pre-existed her hysterectomy:  left hip osteoarthritis that needed surgery and many years before she had right knee pain from arthritis that was asymptomatic for the five years or so before surgery. The defense argued at trial and on appeal that because of these prior issues, her right leg at trial was no worse than it had been before the surgery so no future damages should be awarded.
  • There was one case, Lalanne v. Nyack Hospital (2nd Dept., 2007), that both parties referred to in their appellate briefs as conclusive on the issue of past damages. It also involved medical malpractice in a hysterectomy that caused a femoral neuropathy. The 49 year old plaintiff there was awarded $750,000 for her pain and suffering ($150,000 past – 4 years, $600,000 future). The case was appealed but not on the issue of damages. Mrs. Walsh's lawyer, John Bonina, Jr., argued that Lalanne v. Nyack Hospital established that $750,000 for total pain and suffering for a middle aged woman with femoral neuropathy was within the range permitted to stand by the appellate court; while defendant argued that the case established $150,000 as the upper limit for Mrs. Walsh's four years of past pain and suffering.


 

Medical Malpractice in Childbirth Results in Large Pain and Suffering Verdicts Approved by Appellate Court - $5,000,000 for Mother and $4,150,000 for Infant

On October 15, 1998, Eung Maing, then 37 years old and 41 weeks pregnant with her first child, was admitted to St. Vincent’s Hospital in Queens, New York. The doctors determined that she had insufficient amniotic fluid and labor should be induced.


After a difficult 24 hours or so, a low forceps delivery was performed and baby Daniel was born.


His Apgar score was one out of 10 because of a faint heartbeat so Daniel was intubated and taken to the intensive care unit where he remained for six days. Upon discharge, he appeared to be in good shape. Two years later, though, Daniel’s parents noticed that he had an abnormal gait and he was diagnosed with mild cerebral palsy.


Mrs. Maing had her own medical problems. During the course of delivery she sustained a fourth degree laceration of her vagina that extended to her rectum. It was repaired in the hospital but she later developed a rectovaginal fistula and other extensive and long lasting gastrointestinal problems.


In an ensuing lawsuit against the hospital and the doctors, plaintiffs claimed that:

  1. the doctors were negligent in their repair of Mrs. Maing's vaginal laceration and
  2. Daniel should have been delivered via Cesarean section, like this:

As a result of the malpractice, plaintiffs claimed and in 2008 the jury agreed:

  1. Daniel had sustained brain damage in his forceps delivery that left him with left side hemiparesis causing his walking problems as well as attention deficit disorder, and
  2. Mrs. Maing had sustained permanent incontinence resulting in nine surgeries, including a diverting colostomy and the ultimate need of a permanent colostomy.


Daniel was awarded $7,150,000 for his pain and suffering ($150,000 past – 10 years, $7,000,000 future – 65 years) and Mrs. Maing was awarded $11,000,000 ($4,500,000 past, $6,500,000 future – 34 years).

On a post-trial motion, the trial judge issued a decision reducing the awards in Maing v. Fong as follows: to $2,650,000 for Daniel ($150,000 past, $2,500,000 future) and to $5,000,000 for Mrs. Maing ($2,000,000 past, $3,000,000 future).


In an appellate court decision released on March 30, 2010 in Maing v. Fong (2nd Dept. 2010), Mrs. Maing’s $5,000,000 pain and suffering award was affirmed while Daniel’s $2,650,000 award was deemed inadequate and increased to $4,150,000 ($150,000 past, $4,000,000 future).


Once again, New York judges have rendered decisions involving very serious injuries in which, without any adequate explanation, they ordered millions of dollars of modifications to jury verdicts for pain and suffering. The trial judge’s decision fails to state the reasons for reducing Mrs. Maing’s $11,000,000 jury award for her pain and suffering to $5,000,000; nor does the appellate court decision that affirmed that $6,000,000 reduction. And neither decision set forth any reason for disturbing Daniel’s future pain and suffering award (the trial judge reduced it from $7,000,000 to $2,500,000 while the appellate judges then increased it to $4,000,000).


Our research team at New York Injury Cases Blog has dug up the facts that the judges refused to divulge ( the foregoing details as to the injuries were not disclosed in either opinion) and we have uncovered the legal arguments made by the parties and the case precedents that applied.


The defense argued that Daniel’s future pain and suffering award was excessive, his injuries were more akin to an orthopedic problem than to brain damage and any characterization of Daniel’s case to the plethora of “brain damaged infant” cases (that often result in multimillion dollar verdicts) would be woefully misplaced. While Daniel was in poor condition at birth, he responded well to treatment and was discharged from the hospital after one week.

Daniel appeared to be developing normally until he was 2 ½ years old when a left foot inversion and weak left lower extremity dorsiflexion were noted. He underwent physical therapy, wore a foot brace and by the age of five he was rollerblading.

At trial, there was evidence that Daniel was an outstanding student with an IQ in the 97th percentile and he could run and had a normal gait except for inversion of his toes that was diagnosed as tibial torsion - a usually temporary early childhood condition in which the tibia is twisted inwards and looks like this:


Daniel’s lawyers argued that he has mild cerebral palsy but with profound consequences that will get worse as he gets older. They exhibited Daniel’s walk to the jury and, while not dramatic, they argued that it is awkward, he has a slight limp and he can’t play sports. His parents said he avoids using his left hand.


As to Daniel’s mental condition, a neuropsychologist testified that he has major attention and behavioral problems, is hyperactive and very impaired in his ability to handle daily living tasks. The expert acknowledged that Daniel is smart but concluded that he has moderate to severe attention deficit disorder which is permanent and will get worse.


The law (CPLR 5522) requires appellate courts to identify the reasons for their decisions in cases where they modify a pain and suffering damages verdict under their powers in CPLR 5501. They should look to comparable prior cases when adding to or reducing from a jury verdict. If any of them did so in Maing v. Fong, we have no indication.


Here are some recent cases in which significant awards were sustained on appeal for injuries similar to Daniel’s that the judges in his case failed to cite or discuss in their opinions:

 

  • Lovett v. Interfaith Medical Center (2nd Dept. 2008) - $4,575,000 for a six year old who suffered brain damage at birth causing cerebral palsy, spastic diplegia, mental retardation, sleep apnea and motor skill deficits. He cannot communicate and is wheelchair bound.
  • Flaherty v. Fromberg (2nd Dept. 2007) – $4,250,000 for a seven year old who suffered brain damage at birth causing cerebral palsy and spastic quadriplegia. He is fed by a tube and is totally dependent on his family and caretakers.


As to Mrs. Faing, the defense had little to rebut the gruesome nature of her injuries and treatment. It had been 10 years during she’d been undergoing surgery after surgery (nine in all) to try to remedy her incontinence (the details of which are very unsettling) and there was credible testimony that she’s going to need a permanent colostomy. The issue, therefore, was not so much the severity of Mrs. Faing’s pain and suffering but what figure represents reasonable compensation. Was it $11,000,000 as the jury said? Or $5,000,000 as the judges said? Or something more or less?


Here are some recent cases in which significant awards were sustained on appeal for injuries similar to Mrs. Faing’s that the judges in her case failed to cite or discuss in their opinions:

  • Salmeri v. Beth Israel Medical Center (2nd Dept. 2007) – $1,820,000 for a 49 year old man who underwent four surgeries due to malpractice in treating his acute perforated diverticulum, suffered daily stomach pain, had to wear an abdominal binder and suffered from a fistula in his stomach.
  • Herrera v. St. Martin (2nd Dept. 2006) – $3,000,000 for a 55 year old woman with total paralysis of her lower extremities and incontinence.
  • Beverly H. v. Jewish Hosp. and Med. Center of Brooklyn (2nd Dept. 1987) - $700,000 for a woman who underwent an episiotomy during delivery of her child and over the next 18 months required four surgeries including a colostomy.


Inside Information:

  • Mr. Faing presented a claim for loss of consortium. The jury rejected it and awarded him nothing at all. The trial judge found that $1,000,000 should have been awarded to Mr. Faing and the appellate court agreed.
  • In Capone v. Ciancolo (Supreme Court, Kings County, Index # 37310/06; 2/27/10), a $5,000,000 jury verdict was rendered for pain and suffering in favor of a 48 year old man in a car accident who sustained a laceration of his colon requiring a colostomy (removed after eight weeks) and a hernia that required surgery. No doubt, the parties in that case will now look to the decision in Maing v. Fong in arguing for a reduction or affirmance of the verdict amounts.

 

 

 

 

 

Delayed Diagnosis of Spinal Tumor Results in $47,950,000 Medical Malpractice Jury Verdict - Defendant Appeals Claiming Lack of Causation and Excessive Damages


Shania-Gay Ffrench was 21 years old on February 3, 2000 when she went to the emergency room at Mount Vernon Hospital complaining of back pain. Doctors there suspected uterine fibroids and she was told to follow up with her primary care physician and her gynecologist. She did so.  She saw her internist Keith Edwards, M.D. who referred her to an orthopedist and she saw her gynecologist who performed a lysis of adhesions. Ms. Ffrench’s  pain persisted, though, and the cause was never diagnosed until a year later when an MRI revealed that her back pain was a product of a spinal tumor – an intramedullary astrocytoma (the white spot on the MRI).


The tumor took three surgeries and six years until it was finally and fully removed in 2007. Ms. Ffrench was left substantially unable to use her legs and she blamed her doctors for failing to diagnose and remove the tumor early enough so that her injuries could have been avoided.


A medical malpractice lawsuit was started (Ffrench v. Agnant - Supreme Court, Westchester County; Index # 14401/02) against nearly everyone involved in Ms. Ffrench’s care since 2000

After several years of litigation, on July 23, 2007, the judge issued an order absolving the neurosurgeon who removed the tumor and his hospital from any fault.

Four defendants settled after opening statements for a total of $875,000, as follows:

  • $600,000 by the gynecologist and his practice,
  • $100,000 by the initial hospital and
  • $175,000 by a primary care doctor.

Dr. Edwards refused to settle and the trial proceeded against him alone.


Dr. Edwards based his defense on the fact that he had seen Ms. Ffrench only three times – on February 7, 2000 (for back pain), February 26, 2000 (to clear her for gynecological surgery) and July 6, 2000 (for a headache) and he never treated her again. Furthermore, he claimed, plaintiff herself bore responsibility because, in January 2001, her new primary care physician told her to see a neurologist and she didn't do so until July 2001 when the MRI confirmed the tumor.

On August 31, 2001 Ffrench underwent surgery with a neurosurgeon who planned to do a biopsy and “debulk” or remove as much of the tumor as possible. During surgery, though, a somatosensory evoked potential (SSEP) test was abnormal, indicating that the spinal cord had become dysfunctional. The surgery had to be stopped.


French remained hospitalized for six months and then underwent four months of rehabilitation. As of trial in July 2009, she was able to walk only short distances and only with forearm crutches and leg braces. She frequently required the assistance of a wheelchair.


The jury returned a verdict finding Dr. Edwards 30% at fault, the original hospital 25%, the gynecologist and his practice 25%, a primary care doctor 10% and the orthopedist 10%.


Then, the jury assessed damages in the total sum of $49,750,000 as follows:

  • $29,500,000 pain and suffering ($4,500,000 past – 8 years, $25,000,000 future – 50 years),
  • $18,450,000  medical expenses and rehabilitation services ($450,000 past, $18,000,000 future)


Defendant made a post–trial motion under New York’s CPLR 4404 seeking a judgment of dismissal notwithstanding the verdict arguing that:

  • the plaintiff had failed to establish proximate cause -  i.e., that his alleged negligence (failing to refer plaintiff for neurological testing) actually caused plaintiff’s injuries,
  • the verdict was against the weight of evidence because there were no medical records substantiating plaintiff’s claim that she complained of neurological symptoms (such as numbness in her legs) that would have led him to refer her for neurological testing, and,
  • the amount of damages was grossly excessive


The trial judge denied the post-trial motion in a brief opinion that was devoid of any meaningful discussion of his reasoning. It’s not unusual for trial judges to give such short shrift to post-trial motions. Indeed, it’s well known and oft-stated that instead of delving into the issues, discussing the parties’ respective points and comparing the verdict amounts with other relevant prior cases, trial judges routinely leave it to the parties to appeal to the appellate division post-trial issues such as whether the jury’s verdict was against the weight of credible evidence or its damages awards were unreasonably excessive or minimal.


A notice of appeal has been filed and if this case doesn’t settle then the appellate court  will rule upon liability issues as well as damages and the appellate judges will most likely conclude that the $29,500,000 pain and suffering verdict is unreasonably excessive. Our analysis of appellate court decisions in which pain and suffering verdicts in the several millions of dollars range have been upheld indicates that the Ffrench verdict would be drastically reduced.

Generally, the largest sustained pain and suffering verdict cases involve paraplegia or quadriplegia. Here are some recent examples:

  • Miraglia v. H&L Holding Corp. (1st Dept. 2007) - $10,000,000 for construction worker rendered a paraplegic after being impaled on a rebar
  • Ruby v. Budget Rent A Car Corp. (1st Dept. 2005) - $10,000,000 for 25 year old rendered a paraplegic
  • Desiderio v. Ochs (1st Dept. 2002) - $4,500,000 for infant with devastating neurological injuries including loss of gag reflex, inability to eat without feeding tube, inability to walk without assistance and brain damage


In contrast to the plaintiffs in Miraglia, Ruby and Desiderio, Ms. Ffrench, while undoubtedly in great pain and suffering tremendously, can walk with assistance, attend to her job (at a desk for a health insurance plan), cook and is able to participate - albeit with much difficulty -  in many other activities of daily living. It's extremely unlikely that an appellate court would sustain even one-half of the future pain and suffering award in the Ffrench case. And my guess is that the $29,500,000 would be cut by a lot more than one-half.

A so-called collateral source hearing is set in this case for next month. That’s where the judge will hear evidence about whether any part of the verdict for medical expenses and rehabilitation services will be replaced or indemnified by collateral sources such as insurance. If so, the verdict will be reduced to that extent.


Inside Information:

  • Dr. Edwards asserts that plaintiff never proved what actually caused the loss of function in her legs; he also claims that damages against him should be limited to any worsening of plaintiff's condition from February 2000 to August 2001 rather than the sequelae of the surgery. Resolution of these issues on appeal may drastically affect the ultimate outcome in this case.
  • After trial, plaintiff’s attorney requested that the judge allow him an increased legal fee (i.e., one-third of the recovery instead of the lesser statutorily prescribed sliding scale fee) due to the complexity of the case and the unusual amount of effort required to bring it to trial. Joined by his client and without opposition, the trial judge approved the request. It seems that plaintiff had a change of heart (and attorneys) because thereafter she filed a motion to reargue (denied) and a notice of appeal (pending) seeking a reversal of the fee increase decision.
  • Before trial, plaintiff sought $950,000 to settle with Dr. Edwards. During trial, that settlement demand dropped to $600,000. Now, Dr. Edwards is exposed to a judgment of almost $15,000,000 (his 30% portion of the verdict).
  • Dr. Edwards has $2,000,000 of malpractice insurance. Given the size of the verdict and the several years spanning the claimed negligence, though, plaintiff’s counsel may try to implicate two or more years of malpractice coverage so that there wold be more coverage, perhaps a total of $4,000,000. Such claims are not unusual in cases like this but here it would likely fail because of the very short period in which Dr. Edwards actually treated the plaintiff.
  • Plaintiff’s attorney, Christopher Meagher, obtained another huge malpractice verdict in Westchester County in December 2009 - $56,000,000 (including $22,000,000 for pain and suffering) in Swanson v. Northern Westchester Hospital Center (Index # 16743/07) for a six year old boy with brain damage.

 

Appeal of Verdict in excess of $105,000,000 for Brain Damages from Medical Malpractice Results in Recovery of Only $5,377,000

On March 12, 2002, Thomas Dockery, a 34 year old cable splicer for Verizon, suffered a grand mal seizure in his sleep of unknown origin. He'd never before had a seizure so he was rushed by ambulance to Peninsula Hospital in Far Rockaway, New York.

At the hospital, a CT scan was interpreted as normal. An MRI two days later, though, was interpreted as showing a lesion that seemed to be a glioma (a central nervous system tumor) and Dockery was immediately referred to M. Chris Overby, M.D., a neurosurgeon, who concurred. A second opinion from Philip Gutin, M.D. of Memorial Sloan Kettering Cancer Center in Manhattan corroborated Dr. Overby’s diagnosis and surgery was set for March 25th.

At first, doctors thought Dockery had a brain tumor and here are several types:

A pre-surgical MRI on March 24th, though, indicated an inconsistent massive edema of the brain and Dockery underwent a craniotomy the next day during which pus in the lesion area was removed and found to be a non-tumorous abscess that had grown rapidly during the prior several days and caused an edema that produced herniation of the brain.

In a craniotomy, surgeons cut into the skull to access the brain, like this:


After several more brain surgeries, five weeks in the hospital and three and a half years of extensive rehabilitation, Mr. Dockery was left with severe aphasia – a loss of the ability to produce and/or comprehend language and a severe loss of memory.


Dockery (and his wife) sued claiming malpractice in the doctors’ failure to have properly and timely diagnosed his condition and removed the abscess by March 18th when his injuries could have been avoided.


During the trial, the judge dismissed claims against Peninsula Hospital and the doctors there but, in July 2007, after six weeks of testimony, a Queens County jury returned a verdict finding that there was malpractice by Dr. Overby (45%) and Dr. Gutin and his hospital (55%) and they awarded non-economic damages in the sum of $104,450,000.

                
Here’s how the $104,450,000 non-economic damages verdict broke down:

  • Pain and suffering - $37,750,000 ($10,000,000 past – 5 years; $27,750,000 future – 36 years)
  • Loss of consortium (wife's claim) - $66,700,000  ($18,000,000 past; $48,700,000 future).


Just before trial, Dr. Gutin and Memorial Sloan Kettering had settled for $4,400,000.

And just after the verdict, the trial judge dismissed the claims against Dr. Overby finding that the verdict against him was against the weight of the credible evidence (because he saw Dockery only once before Dr. Gutin took over and made a new diagnosis that was relied upon by Dockery and proved to be negligent).

The Dockerys thus gained no new money as a result of the trial because Dr. Gutin and Memorial Sloan Kettering had already settled and Dr. Overby's post-trial motion to dismiss the claims against him, notwithstanding the verdict, was granted.

In the ensuing appeal, plaintiffs claimed that the judge should not have dismissed the claims against Peninsula Hospital and its doctors, nor the claims against Dr. Overby. Conversely, the defendants argued that the dismissals were properly granted and, alternatively, that the damages verdict was grossly excessive.


On December 22, 2009, in Dockery v. Sprecher (2nd Dept., 2009), the appellate court upheld the dismissal as to Peninsula Hospital and its doctors, reinstated some liability against Dr. Overby (10%), found that Dr. Gutin and Memorial Sloan Kettering were 90% at fault and ruled that the non-economic damages should be reduced to $9,300,000.


Here are the non-economic damages reductions:

  • past pain and suffering – from $10,000,000 to $1,200,000
  • future pain and suffering – from $27,750,000 to $6,750,000
  • loss of consortium – from $48,700,000 to $1,350,000

The jury had awarded $470,000 in economic damages (mostly for lost earnings) which the appellate court did not disturb so the resulting new total damages award is $9,770,000.


The net result is that plaintiffs' total recovery is now $5,377,000, as follows:

  • $4,400,000 (the pre-trial settlement with Dr. Gutin and his hospital) plus
  • $977,000 (Dr. Overby's 10% share of the new $9,770,000 verdict)

Inside Information:

  • The appellate court decision was difficult to unravel as to what really happened and its practical effects. My colleague, Eric Turkewitz over at New York Personal Injury Law Blog has taken the court to task for its “tortured language” and the “open questions” its decision left for readers.
  • If there were a retrial in this case, the looks on the faces of plaintiffs’ counsel and the trial judge (Hon. Duane A. Hart) when in court together again would be something to behold. Counsel claimed that the judge handled the lawyers and witnesses rather roughly and therefore made the unusual request that any retrial be held before a different judge. The appeals judges ignored that request (and the fact that this judge has been censured twice by the Commission on Judicial Conduct for his actions towards lawyers during trials).
  • Counsel for Dr. Overby has indictated that he will make a motion to reargue this decision and/or for leave to appeal to the Court of Appeals based upon well settled law that provides one is not liable when one's negligence, if any, is superseded by an intervening act that caused the injuries complained of. Dr. Overby has long maintained that whatever he did or didn't do regarding Mr. Dockery could not as a matter of law result in a finding of liability against him because it was Dr. Gutin who took over treatment after only one day and Dr. Gutin's actions or inactions were the key to any malpractice. We will follow this case and report on any significant new developments.

 

Malpractice Lawsuit against New York Podiatrist Results in $3,000,000 Pain and Suffering Verdict for College Student; Trial Judge Orders Reduction to $1,000,000

On July 29, 2002, then 16 year old Jennifer Gillette underwent a procedure by podiatrist Greg Atlas in which a wart was removed from the side of her left heel.

Complications developed, she was forced to undergo five new surgeries and Jennifer ended up suing Dr. Atlas claiming that he negligently performed the procedure and that he never properly informed her of the substantial risks involved in the way he did it.


Seven years later, on August 18, 2009, an Orange County, New York jury awarded her $3,000,000 for her pain and suffering ($1,500,000 past, $1,500,000 future – 55 years).

The jury based liability only on the so-called informed consent claim. That’s a long-standing legal principle under which a doctor may be held liable to his patient when:

  1. he fails to disclose alternatives to the treatment given and fails to inform his patient of the reasonably foreseeable risks associated with the planned procedure,
  2. a reasonably prudent patient would not have undergone the treatment had she been fully informed, and
  3. the lack of informed consent is a proximate cause of the injury.


A plantar wart caused by the human papilloma virus (HPV) that appears as a small lesion on the foot and typically presents as a cauliflower. It looks like this:


Plantar warts tend to be painful and can be spread in showers and swimming pools. Treatment usually involves peeling away of the dead surface skin cells with chemicals, acid or liquid nitrogen. Lasers are often used too. Surgery is a last resort.


In Jennifer Gillette’s case,  the doctor excised the wart with a scalpel, a procedure she said at trial she was unaware of until the moment it happened. She had expected laser treatment only.

Dr. Atlas told the jury that he told Jennifer (and her mother) that the risks of the procedure involved skin infection, scaring and repetition of the procedure. Critically, though, he did not tell her that the excision procedure could result in the rupture of her Achilles tendon and he did not tell her about alternate, conservative, methods he could have used to remove the wart.


Here’s what happened after the office procedure:

  • development of hypertrophic and keloid scar
  • three rounds of steroid injections into the back of her heel overlying the Achilles tendon
  • development of soft tissue deficiency, tendinosis and Achilles tendon degeneration

Jennifer underwent five surgeries before trial including a Haglund’s type excision (removal of a bony protuberance of her calcaneus - the heelbone) and an Achilles tendon debridement, repair, transfer and release.

For the seven years from the date of the wart excision procedure until trial, Jennifer was substantially restricted to a wheelchair, crutch and/or cane assisted ambulation. When standing and walking could be accomplished, it was only for short periods of time.


As to Jennifer’s claim for future pain and suffering, the jury heard credible testimony from experts that she’d forever suffer:

  • permanent loss of function of her left big toe (due to the tendon transfer surgery),
  • less functional and likely failure or degeneration of her Achilles tendon (now a transposed, smaller tendon),
  • chronic pain in the Achilles insertion, and
  • inability to return to any of the many recreational endeavors previously enjoyed without restrictions.


While the jury returned a verdict for every dime of the $3,000,000 requested in summation by plaintiff’s attorney, the trial judge found the award excessive and reduced it to $1,000,000 ($500,000 past, $500,000 future) [Gillette v. Atlas - Supreme Court, Orange County, 1/22/10; Index # 3844/06.]


Under New York’s CPLR 4404, the trial judge’s decision is conditional. That means that either the plaintiff agrees to the reduction or there will be a new trial (limited to determining anew the amount of damages).


Inside Information:

  • the jury found that the defendant had not committed malpractice either by determining to remove the wart by scalpel and laser or by injecting steroids afterwards but they did find that appropriate information had not been given to Jennifer and that had she been given the information she would not have consented to the scalpel excision procedure
  • the defendant had offered plaintiff a high-low agreement under which, no matter what the verdict, the defense would pay at least $500,000 but no more than $1,500,000 – meaning that if there were a defense verdict Jennifer would nonetheless receive $500,000 and if, as it turned out, the jury awarded more than $1,500,000 then she’d get $1,500,000
  • My sources tell me this case will now settle for $1,000,000. If so, Jennifer should have taken the high-low deal under which she'd have received $1,500,000

 

Medical Malpractice Lawsuit Saga in NY: After 13 Years, Doctors Lose Two Trials, Fail to Enforce a Favorable Settlement Agreement and Must Pay $1,405,000

 It’s not an uncommon situation in the ever-uncertain world of jury deliberations in personal injury and medical malpractice cases in New York and nationwide. After years of litigation, months of trial preparation and weeks of trial testimony, the jury is deliberating and each side again assesses its strengths and weaknesses. A settlement is finally discussed and appears to have been reached. The end? Usually, but not in one medical malpractice case that started in 1996 with surgery in Brooklyn and ended this week with an amazing appellate court decision.

On June 5, 1996, a 32 year old college math professor underwent a lengthy surgery to repair chronic instability in his left knee. Immediately following surgery, he felt severe pain in his right legwhich was swollen and deformed. Turns out, he had deep venous thrombosis (DVT) in three veins in his right calf and was ultimately diagnosed with tibial and peroneal nerve damage and RSDresulting in permanent intense, burning pain in his right leg requiring lifelong narcotic pain medication.

The left leg (the one operated on) healed well; however, as to his right leg (the one not operated on and with respect to which he never before had any problems) Mahmoud Diarassouba sued his orthopedic surgeon and his two anesthesiologists claiming that their failure to reposition his right leg during the lengthy surgery was a departure from good and accepted medical practice that caused his right leg injuries.

These are the types of support stirrups used in knee surgeries:

Prof. Diarassouba won his case in 2003 when the jury found the doctors liable for $1,500,000 in pain and suffering damages ($500,000 past – 7 years, $1,000,000 future – 37 years). Here is a copy of the verdict sheet with the jury’s findings.

The defendants appealed the verdict against them on several grounds but mainly because certain evidence was improperly heard by the jury and other evidence was improperly held from them. The appellate court agreed, issuing a decision setting aside the verdict and directing a new trial.

The new trial was held in 2007. When the jury was deliberating a verdict, the parties appeared to have reached a settlement. Plaintiff’s attorney told the defendants’ attorney that plaintiff would accept defendants’ $150,000 offer and plaintiff’s attorney then told the court clerk who found and told the judge. At that time, though, the judge just received a note from the jury advising that they had reached a verdict!

Plaintiff’s attorney asked the judge to memorialize the settlement by putting it on the record – i.e., by stating the details in open court, having them transcribed by the court reporter and having defense counsel and the plaintiff himself state that they are in accord with and agree to the terms. The judge refused and told the plaintiff’s attorney that he would first bring in the jury and have its verdict read after which, the judge said, the parties would be free to do what they agreed to.

The jury was "out" - still in the jury room - when plaintiff's attorney advised the judge of a settlement:

The jury came in. The verdict was announced: the doctors were again found liable for pain and suffering damages, this time in the sum of $1,450,000 ($800,000 past – 11 ½ years, $650,000 future – 30 years).

This was a stunning development. Clearly, plaintiff had anticipated a defense verdict and had been eager to settle for a mere $150,000. Just as clearly, the jury found the defendants at fault and they assessed damages at 10 times the purported settlement figure. So: had the case already been settled for $150,000 or would the $1,450,000 verdict stand? Those were the questions in thesecond appeal in this case, a decision on which was issued this week holding that there was no legally enforceable settlement and the verdict stands.

At first glance, it looks like plaintiff was seeking to wiggle out of a binding agreement that he wished he hadn’t made since the verdict was so much more favorable. On close examination, though, the court’s decision makes sense and is fair. Before the verdict was announced, defense counsel had not acknowledged that a settlement had been reached. My reading is that the defendants were trying to have it both ways – hoping the verdict would exonerate them but if it didn’t and the verdict was more than $150,000 then defense counsel could claim (as he ultimately did) that a settlement had been reached for only $150,000.

Settlements during trial are common but to make them binding in the absence of a signed written agreement the law (CPLR 2104requires the attorneys to place the settlement agreement on the record – typically meaning that they announce the details of the settlement in open court, before the judge, with the court reporter transcribing the statements and the settling parties themselves stating that they understand the terms of the settlement and agree to them. None of that was done in this case, in part because the judge wanted the verdict announced first and in part because defense counsel did not state that he or his clients acknowledged and agreed to the $150,000 proposal (that is, until after the verdict was read).

Inside Information:

  • In the first trial, liability was apportioned 60% to the orthopedic surgeon and 20% each to the anesthesiologists but in the second trial the surgeon’s share was 30% and the shares of the other two were 35% each.
  • Before the second trial, the surgeon settled with the plaintiff for $390,000.
  • Since the surgeon was 30% at fault in the second trial, plaintiff’s total verdict of $1,450,000 was reduced by 30% as against the other two defendants and the plaintiff is entitled to only $1,015,000 from them. Since plaintiff already has $390,000 from the surgeon, his total recovery here is $1,405,000.

Doctor's Failure to Monitor for Lupus Leads to Kidney Failure and $2,500,000 Pain and Suffering Verdict Upheld on Appeal

In October, 2000, Susan Midler was referred by her gynecologist to Richard Crane, M.D., a rheumatologist. She had complaints of joint pain and he diagnosed her with arthritis after administering several diagnostic tests (including a urinalysis), two of which were positive for lupuserythematosis (an autoimmune disease that can affect vital organs).

Dr. Crane’s letter to the referring physician stated that continued monitoring was required to make a more definitive diagnosis as to lupus. He treated Ms. Midler for arthritis over the next two years but never again followed up with another urinalysis until January 2003 when he definitively diagnosed lupus nephritis (lupus affecting the kidneys). Ms. Midler’s kidneys rapidly failed, she underwent five months of three times a week dialysis (the process of cleansing the blood by passing it through a special machine) and then in December 2003 she underwent a kidney transplant.

A medical malpractice case followed and after a seven day trial in November 2006, a Manhattan jury concluded that the doctor had departed from good and accepted medical practice in the manner in which he monitored the plaintiff, including not performing urinalysis tests between October 2000 and January 2003. The jury then proceeded to evaluate pain and suffering and determined that this woman in her 60's sustained damages in the sum of $2,500,000 ($500,000 past, $2,000,000 future – 21 years). Both the liability and damages verdicts were upheld on appeal this week in Midler v. Crane.

As often occurs, the jury’s pain and suffering verdict was ruled upon by the appellate court without any significant reference to the facts supporting the pain and suffering figures. After extensive discussion of the treatment constituting the malpractice and the legal standards applicable thereto and after analyzing the testimony of the competing medical experts, the appellate judges addressed the substantial $2,500,000 damages award merely by stating: “ … the awards for pain and suffering do not deviate materially from what would be reasonable compensation ….”

Once again, we get from the appellate court canned language drawn directly from the controlling statute, CPLR 5501, without any guidance as to why the award was upheld.

What follows then are the missing details as to Ms. Midler’s pain and suffering:

  • terrifying fear and pain during the eight months leading up to the definitive diagnosis of lupus nephritis in January 2003
  • emergency hospitalization in May 2003 with life-threateningly low blood count
  • dialysis three times a week for five months with pain, nausea, sickness and suicidal psychological effects
  • kidney transplant surgery in December 2003
  • constant fear of transplant rejection
  • likelihood of additional dialysis (transplanted kidneys likely have a life span of 5-10 years)
  • need to take immunosuppressant drugs to avoid transplant rejection

Inside Information:

  • The jury found the doctor only 60% at fault and assigned 40% of the fault to Ms. Midlerbecause she hadn’t returned to Dr. Crane before January 2003 after being directed to do so by another physician and also because she didn’t treat with a kidney specialist for a month after Dr. Crane told her she had lupus nephritis. So: the $2,500,000 verdict gets reduced by 40% and Ms. Midler’s take is not $2,500,000 but is $1,500,000 (before attorney’s fees and disbursements)
  • Two of the five appellate court judges dissented from the liability finding of the majority and would have ordered a new trial because, they said, the liability verdict was inconsistent in finding that the doctor committed malpractice in failing to monitor his patient for the development of lupus while also finding that he was not negligent in failing to diagnose and treat her for lupus

UPDATE: On May 11, 2010, the decision of the court in this case was reversed by the Court of Appeals, New York's highest court and the new decision is discussed in a new post, here.

Medical Malpractice Pain and Suffering Verdict Reduced from $1,750,000 to $425,000; Appeals Court Gives No Explanation

In yet another significant New York personal injury lawsuit, an appeals court has modified downward a jury’s pain and suffering verdict with no explanation why, leaving the public clueless, judges and attorneys without guidance as to how to evaluate future cases and the plaintiff with $1,325,000 less than the jury awarded him. And the decision has forced me to dig out, gather and present here the missing information.

In Dehaarte v. Ramenovsky, the judges of the Appellate Division, Second Department last week issued a decision on the plaintiff’s appeal of an August 3, 2007 jury verdict in his case against doctors accusing them of medical malpractice. After a Kings County jury found in his favor , Kern Dehaarte, then 22 years old, was awarded pain and suffering damages in the sum of $1,750,000 ($250,000 past, $1,500,000 future) but the appellate court has now held that the award was unreasonably excessive.

Instead, the appeals court held the proper award should have been only $425,000 ($225,000 past, $250,000 future). And that’s all the court said. No mention at all of what the case was about – either how the plaintiff was injured or what the doctors did wrong. And no discussion at all as to why $1,325,000 should be lopped off the award. As we’ve repeatedly discussed (for example, here andhere), New York law requires the appellate courts to state their reasons when they find a jury award should be decreased (or increased).

So once again it has fallen to our research team here at New York Injury Cases Blog to dig into the court files and the attorneys' records to discover and report the missing information. We learned that in February 1997 Kern Dehaarte was a 12 year old boy suffering with gynecomastia, a condition in which male breasts are enlarged and resemble female breasts.

Kern's mother took him to a pediatric surgeon who recommended and performed a subcutaneous mastectomy that ended up leaving the boy without a nipple on his breast.

The jury must have loved him or else hated the doctor because the jury award of $1,500,000 for 54 years of future pain and suffering was clearly excessive, in view of these facts:

  • the main injury was a scar on the breast
  • there was no evidence of any continuing physical pain from the scar;
  • plaintiff claimed anxiety and depression but underwent no psychological treatment
  • an analysis of similar injury prior cases (almost all of which involved women as that’s to whom nearly all breast injuries occur) showed that none could justify the large verdict because there was no evidence that plaintiff’s sexual identity or interpersonal relationships with women was impacted by his injuries

Appellate counsel for the parties submitted briefs on appeal that cited and discussed in detailseveral prior appellate cases in each one of which awards were made in mastectomy injury cases (e.g., Sutch v. YarniskyMotichka v. Cody and Ditingo v. Dreyfus). The judges in Dehaarte v. Ramenovsky, however, mentioned none of them.

Even more startling, the only case the judges did cite in discussing damages was Evans v. St. Mary’s Hospital of Brooklyn and that case was cited merely for the proposition that Kern Dehaarte’s $250,000 past pain and suffering jury award (10 years) should be reduced to $225,000.Evans v. St. Mary’s Hospital of Brooklyn, though, dealt with a $100,000,000 jury award($30,000,000 past – 13 years, $70,000,000 future – 31 years) in a tragic medical malpractice case that was reduced to $1,800,000 ($800,000 past, $1,000,000 future).

In Evans, a 28 year old woman presented to a hospital emergency room with breathing difficulties and when doctors there improperly removed her breathing tube she suffered extensive and permanent brain damage.  Upon learning the facts in the Evans case (they were not reported in the decision), one wonders why the judges in Dehaarte (a mastectomy case) cited Evans (a brain damage case) as support for their findings as to damages.

 Final Note: Some have said I’m on a mission to make the appellate judges explain more in their decisions. Perhaps that’s true to some extent; however, I want to make it clear that I have great respect for these judges. Most have deservedly risen through the ranks, are exceedingly intelligent and are extremely hard working public servants. They read through records on appeal and attorneys’ briefs that are, together, often more than 1,000 pages for a single case. And they  typically issue several hundred decisions each month.

So I don’t at all question the integrity, acumen, or commitment of our appellate court judges. What I do question, though, is why they can’t make it part of their procedure in personal injury lawsuit appeals to explain their reasons for an increase or decrease of a jury award and to cite prior cases with meaningful and helpful explanations of why they are relevant or controlling. In that way, practicing lawyers will be better able to evaluate and settle cases with the result that fewer cases will clog our court system and more realistic positions will be taken by plaintiff and defense lawyers on the cases that remain.

In the end, this extra effort I’m urging upon our appellate judges will result in less work for them because there will be fewer cases brought and fewer still appealed. That’s a win-win situation for all of us.

New Brain Injury Cases at Nationwide Verdict Tracker

We've added several newly released cases to the Nationwide Verdict Tracker at our sister site, Brain Injury FAQ. For details on these TBI and medical malpractice brain injury cases, click on the links below or just head over to the site.

Smith v. All Children's Hospital (FL)

Russnak v. Nigalan (NJ)

Hutchinson v. Colindres (FL)

Bianchi v. Demma (CA)

Ziadie v. Duong (FL)

Stanislav v. Papp (NY)

 

We will continue to follow all significant TBI and other brain injury cases as the information becomes available about verdicts or settlements. We will report results here and at Nationwide Verdict Tracker.

 

Malpractice Suit Settles after Judge Refuses to Dismiss Punitive Damages Claim in Tragic Case Alleging Multiple Hospital Errors

New York firefighter Kevin Deane was skiing in lovely Vail, Colorado on April 1, 2007 when he fell and suffered a spinal cord injury requiring cervical discectomy and fusion surgery that was performed there without complication. When he flew back to New York City to undergo rehabilitation at Mount Sinai Hospital on April 6th, tragedy ensued. Kevin was admitted to the hospital that afternoon (a Friday) and he died about 60 hours later at 2:30 a.m. on April 9th (a Monday). He was 39 years old.

The cause of death was hemorrhage and aspiration of blood caused by the erosion of the surgically implanted hardware into the esophagus.

Here is what the hardware in the neck looks like after fusion surgery:

Claiming that this was a preventable death, a wrongful death lawsuit was filed against the hospital seeking not only damages for negligence but also punitive damages. It's extremely rare that a punitive damages claim (in which plaintiffs must prove reckless indifference) is even allowed to be considered by a jury in a medical malpractice case. And that's what the hospital argued here in making a motion to dismiss that part of the suit; however, the judge disagreed - strongly - and issued a decision released this week in Deane v. Mount Sinai Hospital. The punitive damages claim was allowed to proceed and be considered by the jury.

The judge stated that the hospital appeared to have made the following tragic mistakes:

  • after his admission, no attending physician ever saw Mr. Deane during the 2 1/2 days at the hospital
  • the weekend on call attending physician never showed up because he didn't get a hospital email advising him he was on call and no one followed up to tell him
  • the other on call attending was unaware that her colleague had failed to show up for work and unaware that half of the 100 rehab patients (including Kevin Deane) were not under the care of an attending

It angered the judge that Mr. Deane was, as she described it, effectively abandoned for over two days prior to his death and that no one ever even tried to tell hospital administration that the on call attending was missing. This appeared to constitute gross negligence, recklessness and gross indifference to patient care as did the hospital's lack of a system in place that would alert an administrator when an on call attending failed to arrive. Although this was merely a pre-trial decision on a motion to have the punitive damage claim dismissed, the judge's strong language all but held as a matter of law that the hospital was reckless.

The decision was rendered two weeks before the trial date. Not surprisingly, the case settled (for an undisclosed amount) before the jury was picked.

Inside Information:

  • Mr. Deane was unmarried and without children and therefore the damages that could have been awarded in this case were pretty much limited to those for his pre-death conscious pain and suffering during his 2 1/2 days at the hospital [the length of time a decedent suffers before death will greatly affect this element of damages, as we discussed, here and here]
  • punitive damages against an employer (here, the hospital) for acts of its employees (here, the medical staff) are imposed only where management has authorized or participated in the reckless conduct - in this case plaintiff would have claimed that management's inaction regarding the faulty email notification system warranted a punitive sanction

Even though the judge felt there was recklessness in this case, it would have been up to the jury to make that finding, or not. And because punitive damages are so rarely awarded in New York medical malpractice cases, and the standard of proof is so high and strict, there may have been a successful defense appeal of such an award had it been made.

One thing is perfectly clear, though: this was a tragic death and no amount of money can ever rectify the loss to the family of this young man.

 

 

 

No Pain and Suffering Damages in Wrongful Death Case Despite Appellate Court Ruling that Defendants Liable for Medical Malpractice

Dolores Johnson was 70 years old when she suffered a stroke and had to undergo surgery for a clot on a pre-existing mitral valve. There was a danger that the clot would break off and block a blood vessel. After the surgery, Ms. Johnson never woke up and five days later she died. Cause of death: severe anoxic injury to her brain.

In her husband's ensuing medical malpractice lawsuit, the jury found that the cardiothoracic surgeon deviated from accepted medical practice in performing the surgery and in utilizing a relatively new technology called "heartport" (sometimes used as an alternative for the traditional aortic clamp).

Here is the traditional aortic clamp:

So, defendant's malpractice was established in Johnson v. Jacobowitz and plaintiff won the case but then came the issue of damages. To recover pain and suffering damages in a wrongful death case, as we've noted before, here and here, plaintiff must show that the decedent experienced conscious pain and suffering before her death. That's where the case fell apart for Johnson.

This week, the appeals court in Johnson v. Jacobowitz upheld the trial judge's finding that there was insufficient evidence of awareness on the part of Ms. Johnson to make out a case with respect to conscious pain and suffering. Therefore, the the trial judge was correct in refusing to allow the jury even to consider the pain and suffering issue.

Proving conscious pain and suffering is difficult in cases involving comas or so-called vegetative states. It can be done, though, through medical testimony such as a neurologist testifying about the testing he did and the observations he made. Family members and nurses can show that the decedent cried out in pain, winced and so forth.

Walsh v. Staten Island Obstetrics & Gynecology Associates, P.C. is an oft-cited case in this area. There, an appeals court upheld a verdict of $650,000 in the case of an infant in a vegetative state for his entire eight year life. The court found that his level of awareness was established by testimony that he cried when he received painful stimuli and smiled and laughed at pleasurable stimuli.

Colombini v. Westchester County Health Care Corp. is a tragic case involving the death of a six year old boy. Michael Colombini was at the hospital undergoing magnetic resonance imaging when he was struck by an oxygen tank as he lay inside the MRI machine. He died from his injuries 53 hours later.

This is an MRI machine similar to the one in the Colombini case:

A medical malpractice case was brought by Michael's parents against the hospital and several others including the machine manufacturer, nurses, technicians and doctors. Damages were sought for Michael's pain and suffering. Additionally, plaintiffs claimed punitive damages (recoverable when a defendant engages in willful or wanton conduct evidencing an utter indifference for the safety of others). Much of the still pending litigation from this 2001 accident relates to the punitive damages claim (trial judge's July 2009 decision here) and the claims against defendants other than the hospital (which acknowledged its responsibility early on and offered $1,000,000 to settle).

The issue of pain and suffering in the Colombini case made its way to the appellate court. Both sides submitted medial affidavits.

  • Defendants' neurologist claimed that because Michael had been sedated before the MRI procedure, he was already unconscious at impact and that after impact the brain damage from the impact made him unable to feel pain.
  • Plaintiffs, however, submitted an affidavit from an anesthesiologist who stated that the sedatives merely put Michael into a tranquil state and that he was awake and experienced significant pain and suffering.

The appellate court in the Colombini case found that the competing medical affidavits resulted in issues of fact to be determined by a jury as to whether Michael did indeed experience conscious pain and suffering.

Whether plaintiffs prevail in the Colombini case as to pain and suffering or not, they will still face the fact that it was only two days after the accident that death occurred. Courts have necessarily addressed the issue of the amount of time a decedent suffered before death and have adjusted pain and suffering awards accordingly, as we discussed here.

 

No Future Pain and Suffering for Stroke Victim in Medical Malpractice Lawsuit? New York's Highest Court Affirms but Allows $300,000 for Past Pain and Suffering

It's rare that the Court of Appeals, New York's highest court, rules on the proper amounts for pain and suffering in accident or medical malpractice cases. Usually, jury verdicts are challenged by the aggrieved party at the trial court level (a post-trial motion addressed to the trial judge) and/or at the intermediate appeals court level (one of the four statewide Appellate Division courts). Last week, though, the Court of Appeals weighed in on the pain and suffering verdict in a medical malpractice case.

Lang v. Newman (link is to Court of Appeals decision; Appellate Division decision is here) involved the claims of a 26 year old woman who woke up on January 14, 2003 with weakness on her left side, lightheadedness and tunnel vision. After an ambulance took her to the hospital, she also complained of nausea and a severe headache. Ms. Lang was given a CT scan (it was negative), medicated, observed, offered a lumbar puncture (she declined) and after a couple of hours she was feeling much better, had no pain and the difficulties on her left side seemed to have abated. She was discharged to home with a diagnosis of migraine headaches (from which Ms. Lang suffered in the past).

Within hours she was back in the hospital and ultimately diagnosed with an ischemic stroke (a cerebral infarction caused by an inadequate supply of blood and oxygen due to a blocked artery).

 

She then sued the doctors.

Liability against one of her doctors was found by the Cortland County jury which concluded that the doctor prematurely discharged her from the hospital without further observation and treatment. While it was ultimately determined that Ms. Lang had already been suffering from a stroke when she first came to the hospital, the doctor was found to be liable for $300,000 in past pain and suffering damages (four years from the incident to the trial date) because of expert testimony that timely admission and treatment would have made the effects of the stroke less severe.

Plaintiff sought in addition substantial future pain and suffering damages claiming that sensory changes on her left side, a seizure disorder and worsening anxiety were all caused by the malpractice and are permanent. The jury's refusal to award her anything at all for the future was upheld by the appeals court.

The defense presented evidence that the plaintiff's seizure disorder had fully resolved by the time of trial and that whatever other symptoms she complained of were mild, subjective and could not be quantified. The trial judge concluded (and the appeals courts agreed) that it was not irrational for the jury to conclude that the majority of plaintiff's symptoms resolved prior to trial and that those that remained were either so minimal as to warrant no compensation or not satisfactorily proven by objective, credible medical evidence.

This was a hard fought case both on liability and damages grounds. The defense doctors claimed no liability because plaintiff's stroke had already occurred before she came to them and it seems there's merit to that position. Unfortunately, the jury, the judge and two banks of appeals courts judges (except for a lone dissent at the Appellate Division) disagreed. The plaintiff claimed she should be awarded millions in future damages because of the lifelong effects of the stroke (she was only 26 at the time); however, the jury clearly agreed with the defense that either she had already fully recovered or that whatever deficits she was left with could not - because she already had the stroke before being treated by the defendants - clearly be assigned to the malpractice.

Both sides walked away from this case feeling the sting of a loss.

 

 

 

Finger Amputation Cases - Pain and Suffering Awards Range from $85,000 to $2,000,000

The first thing many new mothers ask, even before seeing their newborns, is: "Are there 10 fingers (and toes)?" Of course, the answer is almost always "yes." Fingers can, though, be lost - amputated - later in life and when that happens it's usually due to an accident with a lawnmower or a power saw. And then the lawsuits follow.

As usual, we focus here on how pain and suffering is evaluated by juries and judges in New York injury cases. And as you might have guessed already, this post will discuss recent finger amputation cases. While that seems like a narrow topic, and one that might result in a small range of monetary recoveries, the opposite is the fact. That's because some cases involve amputations of just one (or just part of one) finger; while others involve two, three or more fingers. Then, there's the issue of which finger - we all know that thumbs, for example, are much more important to function than pinky fingers.

For a review of  hand and finger anatomy, see our post on hand injury pain and suffering verdicts here which includes diagrams of the phalanges (the finger bones).

The most recent case, Nisanov v. Black & Decker (U.S.), Inc. involved a 31 year old man who was using an old electric corded lawn mower. After mowing the lawn one day, Mr. Nisanov turned the mower upside down and began to remove grass clippings that had accumulated. Despite a warning on the machine of which he was aware, he did not unplug the mower and its blades restarted while he was removing the clippings. He suffered total amputations of his left hand's index, middle and right fingers, his left pinky was partially severed and his left thumb was lacerated. The jury found that Mr. Nisanov's pain and suffering damages totaled $2,000,000 ($600,000 past, $1,400,000 future) but it also found that Black & Decker was negligent in its design of the mower but it also found that Mr. Nisanov was 90% at fault for his own injury. Therefore, his net recovery was $200,000 (10% of the pain and suffering sum).

Do not stick your hand into a lawnmower or you may come out missing fingers:

Nisanov  made a post-trial motion challenging the 90% comparative negligence finding against him as well as the jury's $600,000 past pain and suffering verdict. He contended that $600,000 was too low for his pain and suffering for the five year period from the date of the accident to the date of the verdict. He did challenge the future pain and suffering figure.

On April 9, 2009, the trial judge issued a decision on the motion in the Nisanov case finding that the $600,000 past pain and suffering award was within the range of reasonableness and would not be modified. Also, the judge declined to disturb the jury's finding that plaintiff was 90% at fault. There will be no appeal.

In McKeon v. Sears, Roebuck & Co., a carpenter had four fingers of his dominant hand fully amputated and reattached. There, the jury verdict of $1,350,000 ($810,000 past, $540,000 future) was upheld by the appellate court. That decision was relied upon by the plaintiff in the Nisanov post-trial motion for the proposition that $600,000 was unreasonable for five years of pain and suffering. While the injuries appear to have been similar, the $210,000 difference between the two past pain and suffering awards was not significant enough for a trial judge or an appellate court to step in and modify upward. The courts will modify upward or downward only when the jury verdict is not in a range of figures that is reasonable. 

Here are the other important finger amputation cases insofar as pain and suffering damages is concerned:

  •  Hudson v. Lansingburgh Central School District - $240,000 Rensselear County jury verdict for pain and suffering ($90,000 past, $150,000 future) affirmed for a 14 year old boy who cut off a portion of the middle finger of his nondominant hand while operating a jointer-planer in technology class. He underwent surgery to amputate the finger at the proximal interphalangeal joint, which separates the lower and upper halves of the finger. Plaintiff was found to be 35% at fault so the his actual recovery was reduced to $156,000.
  • Bradshaw v. 845 U.N. Limited Partnership - $85,000 ($50,000 past, $35,000 future) upward modification by appellate court for pain and suffering involving the amputation of the distal portion of plaintiff's ring finger following a workplace accident in which a rebar caught on and partially severed the finger. The Manhattan jury had returned a verdict of $50,000 for past pain and suffering but nothing at all for for the future. The appeals court fond $35,000 should be added because the plaintiff would experience hypersensitivity in the remaining portion of the finger for the balance of her life.
  • Leon v. J&M Peppe Realty Corp. - $850,000 pain and suffering verdict ($100,000 past, $750,000 future) affirmed by appeals court for a 26 year old carpenter who suffered a partial amputation of his three middle fingers while working on a circular saw like this:   
    The Bronx County jury had awarded plaintiff $100,000 for his four years of past pain and suffering plus $1,500,000 for 40 years in the future. The trial judge, though, reduced the future award to $750,000 and it's the trial judge's $850,000 total that was affirmed by the higher court.
  • Huang v. Cherry Avenue Corp. (Index # 12201/05; Supreme Court, Queens County; 12/5/08) - $467,700 pain and suffering verdict ($200,000 past, $267,700 future) for a 42 year old mason in a construction site accident in which the tip of his left, nondominant hand's index finger was detached after it became caught between a hoist's hook and the hoisted material. Doctors were not able to reattach the detached portion of plaintiff's finger and they shaved a portion of the exposed bone and sewed skin into the open wound.

Inside Info: Plaintiff was willing to settle before trial for $325,000 but defendants' offer was only $75,000.

  • James v. Queens Long Island Medical Group (Index # 17741/03; Supreme Court, Queens County; 3/8/07) - $950,000 pain and suffering verdict ($350,000 past, $600,000 future - 19 years) for a 7 year old girl who fell at school and sustained a chip fracture of the proximal phalanx of the ring finger of her left, nondominant hand. Doctors splinted and wrapped her hand but when she returned for follow-up medical treatment two weeks later her finger was necrotic and she had to undergo a surgical amputation of the distal phalanx followed by several months of physical therapy. The jury found that the doctors had committed medical malpractice. The defense contended that the $950,000 verdict was excessive and made a post-trial motion to it set aside . During the pendency of that motion, the parties settled the case for $700,000.
  • Silverman v. State of New York  - $650,000 judge's decision for pain and suffering ($250,000 past, $400,000 future) for a 44 year old prison inmate injured in a carpentry class while working with a table saw that did not have a safety guard. Plaintiff sustained amputations of the digits of his thumb, index, middle and ring fingers of his left, nondominant hand. The award was reduced by one-half due to plaintiff's contributory negligence.

Finger amputation accidents are typically quite gruesome and can result in very significant pain and suffering verdicts that are sustainable. On the other hand (pun not intended), these cases often involve accidents in which there is a very significant amount of culpability on the plaintiff's part and then the award will be reduced accordingly. We will continue to follow new finger amputation cases as they arise.

 

Jury Finds Doctors Did Not Commit Malpractice But New York's Highest Appeals Court Orders New Trial Because Trial Judge Did Not Poll the Jury

Nine years after the fact and 2 1/2 years after the jury verdict, all of the parties in a medical malpractice case have been ordered back to court for a retrial because of the trial judge's error in refusing to ask the jurors individually whether in fact their unanimous, individually signed written jury verdict exonerating the defendant doctors of any fault was in fact their verdict.

This case has drawn the attention of the press (for example, here) and bloggers such as New York medical malpractice lawyer Eric Turkewitz.

In a decision last week by New York's highest court, the Court of Appeals held in Duffy v. Vogel that parties in a civil lawsuit have an absolute right to have the judge poll the jury (i.e., ask each juror, after the foreman reads aloud their verdict, whether he consents to the verdict) and that whenever that requirement is not met a new trial must be held - no matter how harmless it may appear to have been. The high court overturned an intermediate appellate court's 3-2 decision reinstating the jury verdict.

This decision breaks new ground in New York. There is an existing statute in the Criminal Procedure Law (Section 310.80) that requires polling in criminal cases; however, the requirement to poll juries in civil cases has no statutory basis and courts have applied the rule over the years but did not mandate a new trial for failing to poll a jury when the failure was found to be harmless error. The Court of Appeals has now effectively usurped the legislature and written new law. That argument was persuasively made by Daniel S. Ratner, the highly esteemed appellate counsel for Dr. Jacobs, but to no avail.

Who will be the new jurors and will they make the same findings?

Eleanor Duffy is a 52 year old woman with permanent fecal incontinence and permanent nerve damage in her vagina which she believes were caused by the malpractice of two physicians - her internist James Vogel, M.D. and her gynecologic oncologist Allan Jacobs, M.D. She sued them both in 2002 claiming that her injuries stemmed from their failures two years earlier when they treated her for complaints of pain in her pelvic area. She said that the doctors should have diagnosed a subsequently discovered tumor in her pelvis that would have been apparent had they ordered imaging studies such as an MRI, performed a biopsy and more thoroughly examined her.

 

 

An MRI study may have avoided the litany of litigation and, more importantly, Ms. Duffy's tragic injuries

After four years of litigation and a three week trial, on November 17, 2006, a jury in Manhattan answered "no" to each of many questions put to them regarding whether Drs. Vogel and Jacobs committed malpractice. Drs. Vogel and Jacobs were thus exonerated.

That should have been the end of it. Case closed. But in its 11 page verdict sheet (on which the trial judge told the jury to insert yes/no type answers to 21 listed questions), the jury stated that two other doctors (Arie Liebskind, M.D. and Martin Feuer, M.D.), who had also treated Ms. Vogel over the years, committed malpractice that caused Ms. Duffy's injuries and the jury then calculated plaintiff's pain and suffering damages as $1,500,000.

The problem is that neither Dr. Liebskind (a radiologist from 1996) nor Dr. Feuer (an internist) were sued by Ms. Vogel and they  were not defendants in this lawsuit. And, the jury was specifically told by the judge in advance to disregard the damages question should they (as they ultimately did) find that the defendants (Drs. Vogel and Jacobs) had not committed malpractice.

  • The jury did find that there was malpractice:  but only by non-parties Drs. Liebskind and Feuer

Insider's Information:

  • The fault of the non-party doctors was discussed at trial because it would be relevant if, but only if, there was fault on the part of the defendant doctors (the percentage of responsibility for payment of damages by defendants found liable is adjusted downward when there are non-party persons who are found to be at fault as well)
  • Dr. Liebskind was not sued because the 2 1/2 years statute of limitations had run as against him
  • It's not clear why Dr. Feuer was never sued - given the jury's finding that he committed malpractice in April 2000 by failing to order imaging tests such as an MRI. Perhaps he should have been sued and perhaps plaintiff's attorney was negligent in not adding him to the lawsuit - irony indeed.
  • The jury's confusion became apparent when during deliberations they sent out a note to the judge asking: "If we find named non-parties liable for her damages, are they responsible for any, if any of the compensation?"
  • Instead of answering directly, the judge then told the jury: "The percentage that is attributed to whoever you do attribute to ... then becomes a factor that is used as to that person's responsibility towards the total amount of whatever the damages are."
  • The judge was Donna M. Mills who was a year earlier censured by the New York State Commission on Judicial Conduct for acting inappropriately following her arrest for DWI (for which she was acquitted) and for conduct that undermined public confidence in the judiciary.
  • The judge could easily have avoided all of the post-verdict appeals and the upcoming retrial had she simply polled the jury as plaintiff's attorney had requested. All she had to do was ask each juror: "Was the verdict just announced by the foreman in all respects your verdict?" No doubt, each juror would have said "yes" since each had already signed the verdict sheet.

Clearly, plaintiff and her attorney are elated with the current appeals court decision. They believe that the jury intended to award her money damages and they will now get a second chance to try to convince a  jury that Drs. Vogel and Jacobs committed malpractice (though there's still no way to sue Dr. Liebskind because the statute of limitations ran against him and now the same is true as to Dr. Feuer).

The defendants and their attorneys are upset and rightfully so. They prevailed in a 16 day trial with 11 expert witnesses and it was clear that the jury exonerated them completely. Now, they must prepare again for trial, this time with a new jury (and we know how different jurors can come to stunningly different verdicts even though the facts and the parties are the same).

As the dissenting judge in the Court of Appeals said: requiring a new trial is a "gross injustice" and a "nightmarish result." Defense counsel went further, calling the order for a new trial so that jurors can be polled "a travesty of justice."

We will follow this case and report on developments.

  • Prediction: The case will not settle and will be retried. The defendants will prevail. Again.