Birchfield v. Texarkana Memorial Hosp.

• Decision Date: 28 October 1987
• Docket Number: No. C-5895,C-5895
• Parties: Phillip J. BIRCHFIELD et al., Petitioners, v. TEXARKANA MEMORIAL HOSPITAL d/b/a Wadley Hospital et al., Respondents.
• Court: Texas Supreme Court

Page 361

747 S.W.2d 361

Phillip J. BIRCHFIELD et al., Petitioners, v. TEXARKANA MEMORIAL HOSPITAL d/b/a Wadley Hospital et al., Respondents.

No. C-5895.

Supreme Court of Texas.

Oct. 28, 1987.

Rehearing Denied April 20, 1988.

Frank L. Branson and Paul N. Gold, Law offices of Frank L. Branson, P.C., Dallas, Prof. J. Hadley Edgar, Texas Tech University, Lubbock, for petitioners.

Victor Hlavinka, Atchley, Russell, Waldrop & Hlavinka, John C. Hawkins, Jr., Texarkana, William A. Eldredge, Jr., Friday, Eldredge and Clark, Little Rock, Ark., for respondents.

WALLACE, Justice.

Kellie Birchfield was born prematurely with a congenitally functionless right eye. Shortly after her release from the hospital, she was diagnosed as having retrolental fibroplasia (RLF) in her left eye and is now totally blind. Her parents, Phillip and Mary Jo Birchfield, individually and as next friends of Kellie, sued Texarkana Memorial Hospital (Wadley) and her three treating physicians, Dr. Jon Hall, Dr. Noel Cowan, and Dr. Betty Lowe. The petition alleged negligence on the part of all four defendants plus a D.T.P.A. action against Wadley under the 1973 version of the Act. Deceptive Trade Practices Act, ch. 143, 1973 TEX. GEN. LAWS at 322-43. The jury answered all issues favorably to the Birchfields. The trial court rendered judgment for actual damages against all defendants and exemplary damages against Wadley, but refused to render judgment on the D.T.P.A. action. The court of appeals initially affirmed the judgment, 718 S.W.2d 313, but on rehearing, reversed and remanded for trial. 718 S.W.2d at 345. We reverse the judgment of the court of appeals and render judgment for the Birchfields.

As a premature infant, Kellie was administered approximately 400 hours of supplemental oxygen without adequate monitoring of arterial blood gases. This occurred even though a 1971 report published by the American Academy of Pediatrics cautioned the medical community about the danger of RLF in premature infants receiving supplemental oxygen, and advised practitioners to closely monitor arterial blood gases of such infants. In the wake of the report Dr. Lowe predicted at a pediatrics section meeting, attended by a Wadley administrator, that the hospital was "going to have blind babies" unless it acquired the facilities to adequately monitor blood gases. However, during the period from 1971 through 1973 Wadley expended approximately $200 per year for nursery improvements. Kellie was born in August of 1974.

The jury found the individual doctors negligent and Wadley both negligent and grossly negligent in failing to properly treat Kellie. It also found that Wadley had violated the D.T.P.A. by holding out to the Birchfields that the hospital was adequately equipped to handle premature babies when it was not. The damage award was The issues before us fall within five groups: evidentiary, cumulative error, trial court bias, errors in the jury charge, and failure to award both exemplary and D.T.P.A. treble damages. We will discuss them in that order.

$2,111,500 actual damages against all defendants, jointly and severally, plus $1,200,000 exemplary damages against Wadley.

EVIDENTIARY ISSUES

Reference to Other "Blind Babies" and Other RLF Cases.

The court below held that evidence of other RLF cases was inadmissable, and that repeated references to "other blind babies" constituted harmful error. 718 S.W.2d at 341-45. We disagree. Evidence of a defendant's subjective knowledge of the peril created by his conduct is admissible to prove gross negligence. Williams v. Steves Industries, Inc., 699 S.W.2d 570, 573 (Tex.1985). Dr. Lowe's prediction of "blind babies," the lack of remedial action by Wadley and the occurrence of other RLF cases were admissible to show Wadley's conscious indifference to the peril its conduct created. Wadley did not request an instruction limiting the evidence to that purpose, therefore it waived any complaint to general admission of the evidence. TEX.R.EVID. 105(a). This is some evidence of gross negligence and defeats Wadley's no evidence contention.

Reference to Settlement of Another RLF Case.

Reference to settlement of another case is generally not admissible. TEX.R.EVID. 408. The Birchfields' expert witness made three passing remarks to the settlement. No timely objections to these remarks were made by the defendant and no timely request was made for instruction to the jury to disregard these references. The Birchfields' counsel referred to the settlement during voir dire and upon objection by defendant's counsel the court instructed the jury to disregard the reference. Counsel again referred to the settlement during closing argument and no objection was made nor instruction requested. During voir dire the jury was closely questioned by defendant's counsel about any bias arising from publicity about settlement of another RLF case. In view of the careful voir dire, the volume of testimony, and the full development of the case, we hold that the error was not reasonably calculated to cause and probably did not cause the rendition of an improper judgment. TEX.R.APP.P. 184(b); Standard Fire Insurance Co. v. Reese, 584 S.W.2d 835, 839-40 (Tex.1979).

Admissibility of an Expert's Opinion on a Mixed Question of Law and Fact.

The Birchfields' expert witness testified on direct examination that Wadley's conduct constituted "negligence," "gross negligence," and "heedless and reckless conduct," and that certain acts were "proximate causes" of Kellie's blindness. Contrary to the holding of the court of appeals, such testimony is admissible. TEX.R.EVID. 704. Fairness and efficiency dictate that an expert may state an opinion on a mixed question of law and fact as long as the opinion is confined to the relevant issues and is based on proper legal concepts.

Testimony of Expert Based on Conversation with Another Expert.

Ordinarily an expert witness should not be permitted to recount a hearsay conversation with a third person, even if that conversation forms part of the basis of his opinion. TEX.R.EVID. 801, 802. However, in this instance Dr. Eichenwald was invited to err by defendant's counsel telling him to "go right ahead" and explain an apparent inconsistency in his testimony. His explanation was based upon a conversation with another doctor. Also, Dr. Ehrenkranz was permitted to testify as to a telephone conversation with another doctor concerning transfer facilities at Wadley. This testimony was inadmissible but it was cumulative of other similar evidence and therefore harmless.

Reference to Minutes of Hospital Section Meeting.

In questioning Wadley's administrator, the Birchfields' counsel asked if Evidence of Financial Condition of the Hospital.

the administrator had reviewed the minutes of the pediatrics section in preparation for his testimony. Such records are privileged from discovery. TEX.REV.CIV.STAT.ANN. art. 4447d(3) (Vernon 1976). In this single reference to the minutes, no mention was made of their contents. We hold that a mere reference to the existence of the minutes was at most harmless error.

The Birchfields contended that Wadley was grossly negligent in refusing to provide proper facilities to monitor blood gases of premature infants even though they had the financial ability to do so. Evidence of the hospital's financial condition was admissible to show financial ability to provide proper facilities.

Transcript of a Meeting Between Doctors and an Attorney.

The trial court admitted into evidence portions of the transcript of a meeting attended by Dr. Hall, Dr. Lowe and other doctors with an attorney who had represented some of them in a prior lawsuit. The transcript indicated that both doctors were aware of the inadequate facilities at Wadley and it contradicted statements made by the doctors at the trial. The transcript was admissible as admissions by the doctors and its probative value outweighed the danger of undue prejudice and confusion. TEX.R.EVID. 801(e)(2)(A), (B) and 403. Also, no limiting instructions were requested by Wadley, so it waived any objection that the testimony was inadmissible to prove its liability.

CUMULATIVE ERROR AND TRIAL COURT BIAS

The issues in this case were clearly defined, and all theories of all the parties were ably presented to the jury. The record consisted of approximately 4,500 pages. The few minor errors were insignificant when considered in the context of the entire case. We hold that any error did not individually or in the aggregate constitute reversible error.

The court of appeals did not rule on several of the defendants' points of error which assert failure of the trial court to conduct the trial in a fair and impartial manner. Those points are within our jurisdiction so we will rule on them rather than remand them to the court of appeals. McKelvy v. Barber, 381 S.W.2d 59, 64 (Tex.1964). Our review of the record reveals no discernible bias or any suggestion to the jury that the trial court desired a particular result or that it favored the plaintiff.

ALLEGED ERRORS IN THE COURT'S CHARGE

The Locality Rule

The charge defined negligence of the hospital as "the doing of that which an ordinary prudent hospital ... in the exercise of ordinary care would not have done under the same or similar circumstances...." (Emphasis added.) Ordinary care was defined as "that degree of care that a hospital of ordinary prudence ... would have exercised under the same or similar circumstances." (Emphasis added.) Negligence and ordinary care of the physicians were similarly defined. These definitions closely parallel those contained in the Texas Pattern Jury Charges. See, 3 STATE BAR OF TEXAS, TEXAS PATTERN JURY CHARGES, PJC 40.01, 40.02. The defendants attacked these definitions because they failed to refer to hospitals and physicians in "this or similar communities," and thus do not reflect the "locality rule." The purpose of the locality rule is to prevent unrealistic comparisons...