Saint Joseph Healthcare, Inc. v. Thomas

• Decision Date: 05 May 2016
• Docket Number: 2014–SC–000008–DG
• Citation: 487 S.W.3d 864
• Parties: Saint Joseph Healthcare, Inc. (d/b/a Saint Joseph Hospital), Appellant v. Larry O'Neil Thomas (as Administrator of the Estate of James ‘Milford‘ Gray, Deceased), et al, Appellees
• Court: United States State Supreme Court — District of Kentucky

487 S.W.3d 864

Saint Joseph Healthcare, Inc. (d/b/a Saint Joseph Hospital), Appellant

v.Larry O'Neil Thomas (as Administrator of the Estate of James ‘Milford‘ Gray, Deceased), et al, Appellees

2014–SC–000008–DG

Supreme Court of Kentucky.

RENDERED: MAY 5, 2016

COUNSEL FOR APPELLANT: Robert Franklin Duncan, Jay Edward Ingle, Patrick F. Estill, Jackson 85 Kelly, PLLC, 175 East Main St., Suite 500, Lexington KY 40507

COUNSEL FOR APPELLEES: William R. Garmer, Garmer And Prather, PLLC, Darryl Lamont Lewis, Searcy Denney Scarola Barnhart &Shipley, PA, Charles Albert Grundy, Grundy Law Group, Elizabeth R. Seif, Decamp Talbott Seif P.S.C.

OPINION OF THE COURT BY JUSTICE VENTERS

Appellant, Saint Joseph Healthcare, Inc. d/b/a Saint Joseph Hospital (the Hospital), appeals from an opinion of the Court of Appeals that affirmed a Fayette Circuit Court judgment awarding $1,450,000.00 in punitive damages to Larry O'Neil Thomas, Executor of the Estate of James Milford Gray and Gray's statutory survivors (collectively “the Estate”). The award was based upon a jury verdict finding that the Hospital had engaged in gross negligence in its treatment of Gray following two visits to the Hospital's emergency room.¹ As grounds for relief, the Hospital raises the following arguments: (1) the trial court erred in failing to grant a directed verdict on the Estate's claim for punitive damages; (2) the evidence failed to establish that the Hospital ratified its staffs misconduct so as to authorize an award of punitive damages against it pursuant to KRS 411.184(3) ; (3) the jury instructions provided for the Hospital's liability based upon tortious conduct of the independent contractor physicians engaged to provide emergency room services; (4) the punitive damage award was excessive and violated the Due Process provisions of the Fourteenth Amendment; and (5) the trial court's failure to dismiss a sleeping juror deprived the Hospital of a fair trial. For the reasons stated below, we affirm.

I. FACTUAL AND PROCEDURAL BACKGROUND

The sufficiency of the evidence and the inferences that may reasonably be drawn from it were vigorously contested in this action. Upon appellate review, we are constrained to view the sufficiency of the evidence in the light most favorable to the verdict. The prevailing party is entitled to all reasonable inferences which may be drawn from the evidence. Le wis v. Bledsoe Surface Mining Company, 798 S.W.2d 459, 461 (Ky.1990) (citing Kentucky & Indiana Terminal R. Co. v. Cantrell, 298 Ky. 743, 184 S.W.2d 111 (1944) and Cochran v. Downing, 247 S.W.2d 228 (Ky.1952) ). Viewed accordingly, the evidence at trial established the following facts.

At 8:08 p.m. on April 8, 1999, thirty-nine year old James Milford Gray, an uninsured and indigent paraplegic, arrived at the Hospital's emergency room complaining of extreme abdominal pain, nausea, vomiting, and severe constipation. He was examined by Dr. Barry Parsley and Physician's Assistant (PA) Julia Adkins. Gray was in extreme pain and great distress during this visit to the Hospital. A witness acquainted with Gray testified that he heard Gray crying, complaining of extreme stomach pain, and calling for help. An Xray technician at the Hospital testified that Gray's severe agony made it difficult to obtain a suitable x-ray image of him. During his initial visit to the Hospital, Gray was treated with pain medication, an enema, and manual disimpaction of his colon to alleviate his constipation.

At 12:40 a.m. on April 9, four-and-a-half hours after his arrival, Gray was discharged from the Hospital. Without designating a specific destination, the Hospital arranged for Rural Metro Ambulance Service to transport Gray away from the premises. The ambulance team took Gray to the homes of various family members, including the home of his niece, Chesity Roberts, where Gray had recently resided.

Roberts testified that when the ambulance brought Gray to her home, his face was ashen, his lips were white, and he was moaning in pain. Given his gravely ill appearance, Roberts declined to accept him because she was not able to provide the care he needed. Other family members responded in like manner. Unable to find a suitable caretaker for Gray, the ambulance service took him back to the Hospital.

Upon his return to the Hospital, rather than re-admitting him to the emergency room and despite evidence of his continuing pain and distress, the hospital staff transported paraplegic Gray in a wheelchair to a motel across the street. They paid for his room and left him there without the wheelchair. After seeing him vomit dried blood, the motel staff became concerned about Gray's manifest illness. They called 911 for emergency medical service and at 5:25 a.m. on April 9, Gray was taken back to the Hospital emergency room.

Back in the emergency room, Gray was attended by Adkins and Dr. Parsley, and later by Dr. Jack Geren. Dr. Geren discharged Gray at 12:15 p.m. According to the evidence, Gray was warned that if he returned to the Hospital again he would be arrested. He was taken first to the home of his sister and then to the home of Chesity Roberts. Family members urged him to return to the Hospital but he refused to do so, expressing fear of being arrested. A few hours later, Gray died at Roberts' home.

An autopsy revealed that Gray suffered from duodenal peptic ulcer disease and that his death resulted from purulent peritonitis caused by the rupture of a duodenal ulcer. The autopsy identified constrictive atherosclerotic coronary artery disease as a contributing factor in Gray's death. It also disclosed the presence of unprescribed controlled substances in his system.

As administrator of Gray's Estate, Larry Thomas brought suit in the Fayette Circuit Court alleging medical negligence by the Hospital, Dr. Parsley, Dr. Geren, Julia Adkins, Dr. Richardson,² and three of the Hospital's emergency room nurses. The Estate also asserted a claim under the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (EMTALA).³ EMTALA places two basic duties upon a hospital when a patient is presented for treatment at its emergency room: (1) the hospital must screen the patient for medical care needs; and (2) the hospital must stabilize the patient before discharging him or transferring him.

This case has endured a tortuous course through the courts. The verdict now under review is the second jury verdict awarding punitive damages against the Hospital in this matter. After the Estate's claims against Drs. Richardson, Parsley, and Geren were settled, the case went to trial on the claims against the Hospital and its employees. The jury returned a verdict in favor of the Estate, assessing compensatory damages in the sum of $25,000.00. The jury allocated fault for Gray's death as follows: 25% to Gray; 30% to Dr. Parsley; 30% to Dr. Geren; and 15% to the Hospital. The Hospital's 15% of the compensatory award was $3,750.00. The jury also assessed $1,500,000.00 in punitive damages entirely against the Hospital.

The verdict was appealed. The Court of Appeals affirmed the award of compensatory damages, but based upon BMW of North America, Inc. v. Gore, 517 U.S. 559, 116 S.Ct. 1589, 134 L.Ed.2d 809 (1996), it set aside the punitive damages as excessive and remanded the case for a new trial on punitive damages. The Court of Appeals reasoned that the great disparity between the Hospital's share of the compensatory damage award and the punitive damages assessed by the jury constituted a violation of the Fourteenth Amendment due process clause under Gore.

Thereafter, we granted review and remanded the case to the Court of Appeals for further consideration in light of the then recent EMTALA decision in Martin v. Ohio County Hospital Corporation, 295 S.W.3d 104, 112 (Ky.2009). After its reconsideration of the case, the Court of Appeals reaffirmed its original disposition, so the case went back to the circuit court to retry the punitive damages claim. On retrial, the jury again awarded punitive damages, this time in the amount $1,450,000.00. The Court of Appeals affirmed the award. We granted discretionary review and now affirm the decision of the Court of Appeals.

II. THE EVIDENCE WAS SUFFICIENT TO SUPPORT AN AWARD OF PUNITIVE DAMAGES

The Hospital first argues that a directed verdict should have been granted dismissing the punitive damage claim because any deficiencies in the care and services provided to Gray did not rise to the level of “gross negligence,” and that any award of punitive damages was flagrantly against the evidence. We disagree.

Damages recoverable for an EMTALA violation are determined by the application of state law. 42 U.S.C.A. § 1395dd provides:

Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate.

(Emphasis added.)

The availability of punitive damages for an EMTALA violation is, therefore, a matter of state tort law. Kentucky law provides two different avenues for the recovery of punitive damages: one statutory and one under common law. KRS 411.184(2) provides for the recovery of punitive damages “only upon proving, by clear and convincing evidence, that the defendant from whom such damages are sought acted toward the plaintiff with oppression, fraud or malice.” However, in Williams v. Wilson, 972 S.W.2d 260 (Ky.1998), we held that punitive damages may also be awarded under the common law standard of “gross negligence.” Gross negligence means a “wanton or reckless disregard for the lives, safety, or property of others.” Gibson v. Fuel Transport, Inc., 410 S.W.3d 56, 59 (Ky.2013). Thus, punitive damages may be awarded, when the evidence satisfies either the statutory standard of KRS 411.184(2), or the common law standard of...