In its opinion dated January 3, 2025, the Massachusetts Supreme Judicial Court affirmed a $20 million medical malpractice verdict, which was increased to a total judgment in the amount of $28,870,400 after prejudgment interest was applied to the verdict, stating, “We discern no abuse of discretion or error of law in the trial judge’s decision not to allow cross-examination regarding a high-low agreement, his formulation of jury instructions regarding but-for causation, and his denial of Hanlon’s post verdict motion. We also find no error in the calculation of prejudgment interest on the damages awarded in this case. Accordingly, the judgment is affirmed.”
Background Facts
The plaintiff, Steven Luppold, then thirty-five years old, visited the emergency department (ED) of Lowell General Hospital (Lowell) on March 7, 2015. The plaintiff told the staff member at the registration desk that his foot was painful, cold, and turning blue. The plaintiff was then evaluated by a triage nurse, Carla Crocker, RN. As triage nurse, Crocker evaluated patients to determine whether they should be seen in the “primary” part of the ED — the side for more serious cases, which is staffed by physicians — or the “ambulatory” part of the ED, for less acute cases. The plaintiff told Crocker that he had back pain and numbness in his left leg and that his left foot was cool to the touch, painful, and turning blue. Crocker requested the plaintiff remove his shoe and sock, felt the plaintiff’s foot, and asked the plaintiff if he had stuck his foot in a snowbank, which the plaintiff denied doing. Crocker determined that the plaintiff would be seen by a provider from the “ambulatory” side of the ED. Several minutes later, the plaintiff was seen by Loucraft, who did not read the triage note written by Crocker before or during his evaluation. Loucraft reportedly did a physical examination of the plaintiff, including his foot. Loucraft described the plaintiff’s skin as warm. Loucraft diagnosed the plaintiff with sciatica, prescribed a number of pain medications and muscle relaxants, and told the plaintiff someone else would come in and discharge him.
Hanlon, a registered nurse, discharged the plaintiff shortly thereafter. Hanlon summarized the following for the plaintiff: he had come in with a blue foot, no testing had been done, and the plaintiff was being discharged. The plaintiff stated that his foot was still swollen and purple and asked Hanlon whether that made a difference. Hanlon responded that the plaintiff would be discharged anyway and provided him patient education materials. Both Hanlon and the plaintiff then signed the discharge paperwork.
Five days later, on March 12, the plaintiff called his primary care provider, Lahey Hospital & Medical Center (Lahey).
When a doctor from Lahey returned his call the next day, the plaintiff described his March 7 visit to Lowell and reported left foot discoloration and persistent numbness. The doctor encouraged the plaintiff to go to the nearest ED immediately to be evaluated.
On that day, March 13, the plaintiff again visited the Lowell ED. The plaintiff was brought into the ED in a wheelchair by a friend, and the plaintiff reported at registration that he had left foot pain. The plaintiff was then evaluated by Stefanie Busa, RN, a triage nurse. The plaintiff told Busa his back and upper leg pain had improved but that he had “severe” pain in his left ankle and that he had run out of muscle relaxants. Busa examined the plaintiff’s bare foot, which was discolored and swollen, and ultimately assigned him to the ambulatory side of the ED.
On the ambulatory side, Hanlon did an initial assessment of the plaintiff, and a few minutes later, the plaintiff was evaluated by Carlos Flores, NP. The plaintiff was in a great deal of pain and had difficulty concentrating, so his friend frequently spoke on his behalf during the evaluation. Flores did not read the triage note made by Busa, review the records from the plaintiff’s March 7 visit, or examine the plaintiff’s foot. Flores diagnosed the plaintiff with radiculopathy, peripheral edema, chronic low back pain, and hypertension. Shortly thereafter, Flores saw the patient a second time to discuss his high blood pressure and prescribed pain medication, muscle relaxants, and high blood pressure medication. Hanlon again discharged the plaintiff with patient education materials related to these conditions.
On March 17, the plaintiff called Lahey and reported that his left foot was intermittently painful, numb, discolored, and
cool to the touch. Lahey scheduled the plaintiff for an evaluation that same afternoon. Dr. Robert Brew examined the
plaintiff’s foot and ordered an ultrasound. Brew diagnosed the plaintiff with arterial thrombosis and deep vein thrombosis, and Brew himself walked the plaintiff to the ED in a wheelchair, where the plaintiff was admitted. On the next day, March 18, the plaintiff underwent an above-the-knee amputation of his left leg.
The plaintiff’s Massachusetts medical malpractice lawsuit alleged that Crocker, Busa, Loucraft, Flores, and Hanlon had failed to satisfy the applicable standards of care with respect to detecting and treating his blood clots and that his amputation was the result of their negligence.
Source Luppold v. Hanlon, SJC-13577.
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