Hamilton v. Reg'l Med. Ctr.
| Docket Number | 6008,Appellate Case 2019-001921 |
| Decision Date | 02 August 2023 |
| Parties | Tekayah Hamilton, individually and as parent and guardian ad litem for Robert Lee M. Jr., a minor child under the age of 18, Respondent, v. Regional Medical Center, Appellant. |
| Court | South Carolina Court of Appeals |
Heard December 8, 2022
Appeal From Orangeburg County Edgar W. Dickson, Circuit Court Judge
Michael C. Tanner, of Michael C. Tanner, LLC, of Bamberg, and Morgan Rebekkah Long, of Michael Tanner, LLC, of Trenton North Carolina, both for Appellant.
Jonathan F. Krell, of Uricchio Howe Krell Jacobson Toporek Theos & Keith, PA, of Charleston; David Reynolds Williams and Virginia Watson Williams, both of Williams & Williams, of Orangeburg; and Kathleen Chewning Barnes, of Barnes Law Firm, LLC, of Hampton, all for Respondent.
In this medical negligence action, Regional Medical Center (Regional) appeals the trial court's (1) determinations of issues concerning expert witnesses, (2) admission of photographs, (3) publishing requests to admit to the jury, and (4) denial of its motions for a directed verdict and for a new trial absolute or new trial nisi remittitur. We affirm.
On October 25, 2014, a five-week old child, Robert Lee M., Jr (Minor), was admitted to Regional for a high fever. Jamie Downing worked at Regional as a nurse and treated Minor during his hospital stay. Medical personnel at Regional did not initially know the cause of Minor's fever but on the day of his admission, they started him on IV antibiotic therapy in case he had an infection. In the early morning of October 28, 2014, Downing administered an antibiotic, ampicillin, into Minor's IV. Shortly thereafter, Minor's hand became swollen with a dark spot and his mother, Tekayah Hamilton, called the nurses' station because Minor was "really crying." The antibiotic Downing gave Minor through the IV caused a third-degree burn to his hand because it infiltrated outside of his vein. On October 30, 2014, Minor was discharged from Regional.
On October 7, 2015, Hamilton, individually and as parent and guardian ad litem for Minor, filed an action against Regional[1] for medical negligence. Regional answered, denying liability and any wrongdoing and asserting numerous affirmative defenses.
Prior to trial, Regional moved to exclude Hamilton's expert, Monica Stobbs, a nurse, from being qualified as an expert witness "in administering/managing pediatric IV therapy." Regional argued Stobbs was not qualified to testify about IV therapy for pediatric patients because she had not administered IV therapy to a pediatric patient and did not review literature specifically about IV therapy for pediatric patients. Hamilton argued the administration and monitoring of an IV is the same for a pediatric or an adult patient and Regional's argument went to Stobbs's credibility rather than her qualifications. The trial court determined it would qualify Stobbs as a nursing care expert and Regional could "make all the hay you want to" about her pediatric experience.
Regional also moved to exclude photographs of Minor's hand on the ground that the danger of unfair prejudice substantially outweighed the probative value of the photographs. The trial court denied that motion as well.
At trial, Hamilton's expert witness, Stobbs, testified the standard of care for IV management is the same for pediatric and adult patients. She indicated that before administering medication through an IV, a nurse must flush the IV with saline to ensure the IV is actually going into the vein and not instead into the skin. She explained saline would not harm the area and cause a burn type of injury if it went into the surrounding tissue of the vein, unlike like an antibiotic which could if it did not go directly into the vein. Stobbs testified that Regional's policies and procedures for IV therapy state a saline flush should be given. Stobbs provided that Minor's medical chart indicated his IV was flushed on several occasions before the medication was administered but that on the occasion when the injury occurred, the chart did not indicate the IV was flushed. Stobbs noted Regional's policies and procedures state that the flush should be documented on the medication record. Stobbs stated: "If it's not documented, it wasn't done." Stobbs testified that Regional breached the standard of care by not documenting the saline flush and by not staying with Minor for at least five minutes after starting medication.
Downing testified that at the time she treated Minor, she had worked as a nurse at Regional for less than three months and had been allowed to work on her own for about two weeks. Downing stated Regional's policies and procedures "are direct instructions" and there is "not room for interpretation" of them. Downing testified that Regional's policies require a saline flush before putting medication into an IV. She believed the policies require flushing be documented on the electronic medical record only when not associated with giving a medication. Downing testified she could not specifically remember administering a saline flush prior to ampicillin that morning but testified her practice is to flush prior to giving medication. Downing stated Minor's medical records indicated a saline flush was given every four hours but Regional's system provided no way to document giving a saline flush before an antibiotic.
Hamilton testified that early in the morning on October 28, Minor's hand swelled and turned black with a "bubble," which burst the following day. She introduced photographs and testified they accurately showed Minor's hand at the time the injury occurred. Hamilton provided she does "a lot of hand motion things with [Minor] because his hand . . . cramp[s] up." She testified he sometimes has itching and irritation under the skin and tells her it hurts. Hamilton explained she was hesitant to have Minor get injections into the injury site because he had already gone through so much. She was afraid that if he received injections, he would need to have his hand and arm wrapped and would not be able to do anything. She testified that after the initial injury, he could not crawl because of his hand and she had to constantly watch him to make sure he did not hurt himself. During Hamilton's testimony, Minor was brought into the court room for the jury to observe his hand. Hamilton testified she lives in Santee but she takes Minor to MUSC in Charleston to see two doctors.
Minor visited a wound care center fifteen times due to his injury. Dr. Peter DeVito, an expert in plastic surgery, examined Minor in February 2015, when he was four months old. Dr. DeVito testified the injury was "too contaminated for a skin graft" and took "a lot of wound care" and time to heal. Dr. Devito believed the burn resulted in a keloid. He explained a keloid is "a tumor of scar tissue" that "invades" the normal skin surrounding it and causes burning and itching. He testified that some areas of the injury were painful while other parts were not due to the nerve damage but that "[t]he whole nature of the wound [wa]s painful." During Dr. Devito's testimony, Hamilton entered medical bills into evidence. Hamilton also questioned Dr. DeVito as to the cost of surgery to repair Minor's hand. He provided it could cost $6,500 to $14,500 or even more if a hospital stay needed to be extended.
During trial, Hamilton moved to publish certain requests to admit from Regional as a stipulation.[2] Those requests to admit stated:
Hamilton denied the first request to admit and admitted the second and third.
Regional objected, arguing the purpose of the requests was to obtain an independent medical examination (IME) under Rule 35, SCRCP,[3] and it was not a stipulation or admission. Regional asserted the prejudicial effect of publishing the requests outweighed the probative value under Rule 403, SCRE, because it would "reemphasiz[e] for the jury" Hamilton's position that "the case is worth more than a [$100,000]." Hamilton asked to "explain to the jury what a request to admit is." The trial court allowed Hamilton to read the exact language of the requests and answers to the jury with no explanation.
After Hamilton rested, Regional made a directed verdict motion, arguing Hamilton failed to present any evidence of gross negligence, particularly because Stobbs did not testify Regional was grossly negligent. The trial court denied the motion. Thereafter, Hamilton moved to exclude Regional from asking its expert, Cindy Hurley, a nurse, whether Regional committed gross negligence. The trial court granted the motion because Hurley was not qualified to testify about the legal concepts of negligence and gross negligence and Regional could elicit testimony about those topics without using the exact legal terminology.[4]
Following Regional's presentation of its case, it renewed its motion for a directed verdict, which the trial court again denied. After the parties made their closing arguments and the trial court gave the jury instructions, the jury deliberated and found Regional was grossly negligent; the gross negligence proximately caused Minor's and Hamilton's injuries; Minor sustained actual damages of $1,127,280; and Hamilton sustained actual damages of $135,477.
Regional filed a posttrial motion for judgment notwithstanding the verdict (JNOV), for a new trial absolute, or alternatively for a new trial nisi remittitur. Regional also filed a motion to reduce Minor's damages to the...
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