LaQuinta Whitley-Murray passed away at Centennial Hills Hospital Medical Center during a sickle cell crisis. Respondent, on behalf of LaQuinta’s estate and heirs, filed a negligence action against appellant Valley Health Systems, which operates Centennial Hills. A Nevada medical malpractice wrongful death jury awarded respondent over $48 million in compensatory and punitive damages combined. Concluding respondent had prevailed under a theory of breach of fiduciary duty, the district court upheld the awards and declined to apply NRS Chapter 41A’s statutory caps on damages in professional negligence actions.
The Supreme Court of the State of Nevada (“Nevada Supreme Court”) held in its Opinion filed on March 14, 2024: “We clarify that hospitals do not owe a fiduciary duty to their patients in connection with medical treatment. Accordingly, we vacate the compensatory damages awards and remand to the district court to apply the damages cap to the award of noneconomic damages and to reduce both economic and noneconomic damages to the hospital’s 65-percent pro rata share. And because respondent’s breach of fiduciary duty claim against Centennial fails, we also reverse the award of punitive damages. We further vacate the award of prejudgment interest and remand for recalculation so that prejudgment interest is awarded solely on past damages. But we conclude that the district court did not abuse its discretion in awarding attorney fees and costs, and we accordingly affirm in that relevant part.”
Hospital Breach Of Fiduciary Duty Claim
Murray alleged that hospital staffs treatment of LaQuinta fell below the standard of care and, before trial, amended the complaint to allege that Centennial breached a fiduciary duty to LaQuinta by intentionally understaffing the hospital. Regarding breach of fiduciary duty, no witness testified that Centennial intentionally understaffed the hospital; to the contrary, testimony established that the hospital was not understaffed on the day LaQuinta died. During trial and
particularly closing arguments, Murray argued for the first time that Centennial’s medication administration policy was meant to increase the hospital’s profitability to the patients’ detriment. No discovery was conducted on the medication administration policy or on whether Centennial prioritized profits over patients, as Murray contended. The district court – over Centennial’s objection – nevertheless allowed Murray’s experts to criticize the policy.
The Nevada medical malpractice wrongful death jury was presented a verdict form that first asked whether Centennial had breached the standard of care, proximately causing LaQuinta’s death. The jury answered in the affirmative, awarding $16,210,000 in compensatory damages and apportioning 65-percent of the fault to Centennial. The verdict form then asked whether Centennial had intentionally breached its fiduciary duty to LaQuinta and instructed the jury to stop and sign the last page if it answered “NO.” The jury also answered this question in the affirmative, as well as the next question regarding whether that breach was a proximate cause of LaQuinta’s death, leading it to the final question: whether Centennial engaged in fraud, oppression. or malice toward LaQuinta. The jury also answered that question in the affirmative and thereafter awarded $32,420,000 in punitive damages.
The Nevada Supreme Court stated: “No authority supports a broad finding that hospitals owe patients a fiduciary duty. Further, recognizing a claim for breach of fiduciary duty against a hospital in relation to a patient’s medical care would be duplicative, and therefore improper, where the allegation boils down to one of medical malpractice by the hospital.”
“Here, Murray initially based the breach-of-fiduciary-duty claim on allegations of intentional understaffing, but at trial, Murray reversed course and argued what he failed to allege in his complaint: Centennial’s medication administration policy prioritized profits over patient safety and constituted an intentional breach of fiduciary duty because the policy
allowed staff to administer medication in violation of Toradol’s black box warning. Upon concluding Centennial owed a heightened duty of care to LaQuinta by virtue of her status as a patient who came to the hospital with an expectation of being cared for, the district court upheld the full damages award on grounds that NRS Chapter 41A did not apply to a claim of breach of fiduciary duty. This was error in light of the majority view and the absence of any compelling authority to the contrary. Centennial owed LaQuinta the same duties that hospitals owe patients in providing medical
services, that is, “to employ that degree of skill and care expected of a reasonably competent hospital in the same or similar circumstances.” Wickliffe v. Sunrise Hosp., Inc., 101 Nev. 542, 548, 706 P.2d 1383, 1388 (1985). It did not owe a heightened duty beyond that.”
Jury’s Noneconomic Award
The Nevada Supreme Court stated with regard to its reduction in the amount of noneconomic damages awarded by the jury: “The jury here found Centennial and its staff to be 65-percent liable. It awarded $5,000,000 for loss of companionship, comfort, and consortium; $7,000,000 for grief and sorrow; $1,700,000 for loss of probable support; $10,000 for funeral expenses; and $2,500,000 for LaQuinta’s pain and suffering. Of these, loss of companionship, comfort, and consortium; grief and sorrow; and pain and suffering are noneconomic damages and are accordingly capped at an aggregate amount of $350,000. Centennial’s liability is further limited severally to its share according to its 65-percent contribution to the negligence. Accordingly, we vacate the judgment’s damages award for loss of companionship, comfort, and consortium; grief and sorrow; and pain and suffering and remand for the district court to issue a judgment awarding $227,500 in aggregate for these damages and to determine what portion of the $227,500 is attributable to each of those loss categories. The damages for loss of support and funeral expenses are likewise subject to the pro rata cap, and we vacate that portion of the damages judgment and remand for the district court to issue a judgment against Centennial awarding $1,105,000 for loss of probable support and $6,500 for funeral expenses.”
Valley Health Systems, LLC v. Murray, 140 Nev., Advance Opinion 14.
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