By its decision issued on November 20, 2014, the District of Columbia Court of Appeals affirmed a jury’s $650,000 verdict in a medical malpractice case involving the alleged negligence of the nurses employed by the defendant hospital in failing to place sequential compression devices (SCDs) on the plaintiff’s legs as ordered by the surgeon following surgery, which allegedly led to the plaintiff requiring bilateral below-the-knee amputations that were performed at another hospital.
The defendant hospital had moved to set aside the verdict, arguing that the plaintiff had not proven a causal link between the alleged medical negligence and his injuries. The plaintiff had moved for a new trial on damages, arguing that the jury’s award was inadequate under the circumstances and was likely influenced by the trial court’s refusal to give an instruction on “special susceptibility” (i.e, if the plaintiff, because of a prior injury, disability or other condition, was more likely to suffer injury because of the defendant’s negligence than a normal person would, then the defendant is responsible for that injury. A defendant may not avoid responsibility for his or her negligent actions by showing that the injury would have been less serious if it had happened to someone else).
The plaintiff argued that the requested special susceptibility instruction was required because the plaintiff came to the defendant hospital with pre-existing risk factors that included diabetics, obesity, hypertension, and a history of smoking, and that without the special susceptibility instruction, the jury may have unfairly reduced or discounted the plaintiff’s damages to the extent it saw these risk factors, which were beyond the defendant hospital’s control, as combining with the defendant hospital’s negligence to cause the need for the amputations.
The issue at trial was whether deep venous thrombosis (DVT) became “well-established” in the plaintiff’s legs before or after a second surgery performed to ameliorate an abscess on the plaintiff’s right buttock. If it was after, the Court of Appeals stated that expert testimony supported the jury’s finding that negligence by nurses in not placing SCDs on the plaintiff’s legs after the second surgery, despite instructions from the surgeon to do so, contributed causally to the below-knee amputation of his legs ten days later.
The Court of Appeals disagreed with the defendant hospital that the plaintiff had to prove not only that the DVT more likely than not became well-established in the ten days after the negligence but that the plaintiff also had to disprove (rule out) that it did so in the five-day interval between the two surgeries — that is, that the plaintiff was required to negate the possibility that the DVT became established too early for the ordered prophylaxis to be effective and additionally show by a preponderance of the evidence that timely placement of the SCDs would have kept the DVT from becoming well-established, which the Court of Appeals stated would “amount to increasing his burden of proof to something akin to the standard in criminal cases.”
With regard to the plaintiff’s request for the special susceptibility instruction, the Court of Appeals stated that the instruction was not necessary because the defendant hospital argued that an independent cause (sepsis or a syndrome related to infection in his buttock abscess that developed only after his release from the defendant hospital), combined with the plaintiff’s prior conditions, led to a blockage of arteries, eventual gangrene, and the need for amputation, and the defendant hospital alleged that the progression that began with wound contamination was unrelated to the DVT and any attendant negligence (the defendant hospital did not imply in questioning of witnesses or in closing argument any mitigating link between the DVT and the plaintiff’s pre-existing conditions).
With regard to the plaintiff’s argument that the jury’s verdict was inadequate, the Court of Appeals stated that the jury, while finding that the defendant hospital’s negligence was a contributing cause, may have been unwilling to attribute more than a modest portion of the amputation-linked expenses to something it did not believe had predominantly necessitated the amputation.
Source Providence Hospital, Inc. v. John Willis, Nos. 13-CV-920 & 13-CV-921.
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