December 12, 2020

The Supreme Court of Mississippi in its opinion dated November 19, 2020 held: “Both Dr. Ilercil and Williams presented evidence that Nurse Howard was negligent by failing to contact Dr. Ilercil after she observed Williams’s rapidly declining condition, the signs of which Dr. Ilercil had specifically instructed the nursing staff to notify him. The jury must be instructed on all material issues presented in evidence. We therefore conclude that the trial court erred by refusing Dr. Ilercil’s intervening/superseding-cause instruction and, thus, denied Dr. Ilercil his right to have his theory of the case properly presented to the jury. We reverse the judgment of the circuit court and remand the case for a new trial.”

The Underlying Facts

On September 4, 2015, Dr. Orhan Ilercil (“Dr. Ilercil”) performed an anterior cervical discectomy and fusion and a posterior cervical discectomy and fusion on James Williams (“Williams”) at St. Dominic-Jackson Memorial Hospital (“St. Dominic”). There were no complications during the surgery.

In postoperative orders, Dr. Ilercil asked to be notified if Williams showed any signs of shortness of breath, difficulty swallowing, or excessive swelling. Some swelling was brought to Dr. Ilercil’s attention shortly after the surgery, but he did not note anything out of the ordinary.

Several nurses monitored and cared for Williams on a rotation. During the evening of September 5, 2015, the day after the procedure, Nurse Rhonda Howard (“Nurse Howard”) noticed that Williams’s speech was muffled. She documented this change in Williams’s condition but did not notify Dr. Ilercil. Williams also experienced trouble swallowing and difficulty breathing. Nurse Howard again documented the changes, but she did not did not notify Dr. Ilercil. Williams was later taken to the radiology department for a CT scan and then returned to his room. He coded shortly thereafter. It was later determined that Williams coded due to a large blood clot that had developed and had cut off his airway. His muffled speech and difficulty swallowing and breathing were caused by the hematoma as it developed. Medical personnel were able to resuscitate Williams, but he suffered a brain injury that rendered him completely disabled. Dr. Ilercil was notified of Williams’s condition after he coded.

Williams’s wife and estate sued St. Dominic and Dr. Ilercil for medical malpractice. St. Dominic settled for $2.5 million, plus another $500,000 contingent on the outcome of the litigation against Dr. Ilercil. Williams died three years after the surgery while the litigation was pending.

The Mississippi medical malpractice jury found Williams’s damages to be $1.63 million for past pain, suffering, and mental anguish (reduced to $500,000 under the cap on noneconomic damages); $535,000 for medical bills and expenses; $334,000 for care and services; and $3,000 for funeral costs. The jury apportioned 15 percent fault to Dr. Ilercil, and a $205,800 judgment was entered against him.

Dr. Ilercil appealed, arguing that the trial court committed reversible error by failing to instruct the jury as to intervening and/or superseding causes, as he requested. A superseding cause is an independent and unforeseen act by a third person which follows the defendant’s actions and which is the substantial fact in causing the plaintiff’s injuries.

Mississippi Supreme Court Opinion

The Mississippi Supreme Court stated: “In today’s case, Dr. Ilercil presented evidence to the jury that the acts or failures to act of the staff of St. Dominic caused Williams’s injuries and subsequent death. A plethora of evidence was presented to the jury that the registered nurse, charged with the responsibility to attend Williams, made an ill-advised, conscious decision not to follow the surgeon’s written orders. It is without dispute that Dr. Ilercil was not notified of Williams’s deteriorating condition until after Williams coded, depriving Dr. Ilercil of an opportunity to prevent this tragedy. An intervening/superseding-cause instruction was supported by the evidence. Because the trial court committed reversible error by denying Dr. Ilercil’s requested jury instruction, we reverse the judgment of the circuit court and remand this case for a new trial.”

A dissenting opinion stated: “Simplified, if a doctor’s order were insufficient to inform a nurse adequately at the beginning, then the nurse’s actions or inactions would not be a “new and independent cause” but rather an integral part of a continuous “succession of events” that led to improper medical care … Here, Nurse Howard’s negligence was not independent of Dr. Ilercil’s negligence because her negligence, at least in part, was the product of Dr. Ilercil’s negligent failure at the outset to provide a sufficient order that informed and instructed the nursing staff fully of the seriousness of Williams’s condition. Thus, Nurse Howard’s negligence was not a intervening and superseding cause.”

Source Ilercil v. Williams, No. 2019-CA-00527-SCT.

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