Howe v. Hull
| Decision Date | 21 November 1994 |
| Docket Number | No. 3:92CV7658.,3:92CV7658. |
| Citation | 873 F. Supp. 72 |
| Court | U.S. District Court — Northern District of West Virginia |
| Parties | Bruce HOWE, Representative of the Estate of Fred L. Charon, Plaintiff, v. Charles HULL, M.D., et al., Defendants. |
COPYRIGHT MATERIAL OMITTED
Marc E. Elovitz, Ruth E. Harlow, and William B. Rubenstein, American Civil Liberties Union Foundation, New York City, Ellen Simon Sacks, Spangenberg, Shibley, Traci, Lancione & Liber, Cleveland, OH, Doris K. Wohl, Wohl & Associates, Toledo, OH, for Bruce Howe.
Doris K. Wohl, Wohl & Associates, Toledo, OH, for Fred L. Charon.
Rolf M. Scheidel, Shumaker, Loop & Kendrick, Toledo, OH, for Charles E. Hull, M.D.
James M.L. Ferber, Schottenstein, Zox & Dunn, Columbus, OH, Timothy D. Krugh, Robison, Curphey & O'Connell, Toledo, OH, for Memorial Hosp.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
This cause was brought by the plaintiff as representative of the Estate of Fred Charon under the Americans with Disabilities Act (ADA), 42 U.S.C. § 12101 et seq., the Federal Rehabilitation Act of 1973 (FRA), and the Emergency Medical Treatment and Active Labor Act (EMTALA). Plaintiff also brought supplemental state law claims of intentional and negligent infliction of emotional distress. This Court, by a Memorandum and Order dated May 26, 1994, granted defendant Hull's motion for summary judgment on plaintiff's EMTALA and negligent infliction of emotional distress claims, and denied the motion as to the ADA, FRA and intentional infliction of emotional distress claims. In that same order, the Court granted defendant Memorial Hospital's motion for summary judgment on plaintiff's negligent infliction of emotional distress claim, and denied the motion as to plaintiff's ADA, FRA, EMTALA, and intentional infliction of emotional distress claims.
A trial was held between May 31, 1994 and June 14, 1994. Plaintiff's remaining FRA, EMTALA, and intentional infliction of emotional distress claims were tried to a jury, and plaintiff's ADA claims were tried to the bench by stipulation of the parties and pursuant to the applicable provisions of the ADA. On June 14, the jury returned a special verdict in favor of the defendants on the EMTALA and intentional infliction of emotional distress claims and against both defendants on the FRA claim, awarding plaintiff $62,000.00 compensatory damages. The jury also awarded punitive damages in the amount of $150,000.00 against defendant Hull and $300,000.00 against defendant Memorial Hospital.
Plaintiff brought suit in this action alleging that, on April 17, 1992, the defendants refused to provide him medical treatment because he was infected with HIV. The original plaintiff in this case, Fred L. Charon, is deceased, and plaintiff Howe was substituted as the representative of Mr. Charon's estate on June 10, 1993. Defendant Memorial Hospital is the facility where plaintiff sought treatment, and defendant Hull was the on-call admitting physician at Memorial Hospital when plaintiff sought treatment.
On April 17, 1992, Charon and Howe were travelling through Ohio, on their way to vacation in Wisconsin. Mr. Charon, a resident of Portland, Maine, was HIV-positive and had AIDS at the time. At approximately 9:00 on the morning of the April 17, Charon took a prescription medication called floxin which he had not taken before.
Charon had a severe reaction to the floxin. Charon vomited, began feeling light headed, had difficulty grasping objects, and suffered from a high fever, a rash, and extreme redness of the skin. Howe and Charon exited the highway due to Charon's condition. After consulting via the telephone with Charon's treating physician in Maine, they sought the nearest hospital. Howe conversed with Memorial Hospital personnel on the telephone and then drove Charon to Memorial Hospital and sought treatment in the emergency room.
Dr. Mark Reardon examined Charon in the emergency room. Dr. Reardon found that Charon was suffering from fever, severe erythema (redness of the skin) over virtually his entire body; erythematous conjunctivae; hot, painful and tender skin; arthralgia (painful joints); testicular pain; and headache. Dr. Reardon determined that Charon was suffering from a very serious allergic drug reaction and that he should be admitted to Memorial Hospital.
Dr. Reardon worried that this very severe drug reaction may ultimately develop into toxic epidermal necrolysis (TEN).1 Despite the fact that Dr. Reardon at the time only considered TEN to be a possibility, he ultimately entered "probable toxic epidermal necrolysis" into Charon's medical record. Although Memorial Hospital had the capability to effectively treat a severe allergic drug reaction and, in fact, did treat patients suffering from allergic drug reactions on a fairly routine basis, Memorial Hospital had neither the necessary equipment nor medical specialists necessary to effectively treat TEN.
After determining that Charon needed to be admitted to Memorial Hospital, Dr. Reardon telephoned Dr. Hull to obtain the necessary approval for Charon's admission. Dr. Hull, a physician with staff privileges at Memorial, was the hospital's on-call admitting physician. As the on-call admitting physician, Dr. Hull was in a position of authority at Memorial Hospital and was responsible for determining whether patients could be admitted from the emergency room into the hospital. Dr. Hull had the authority and discretion to admit Mr. Charon to Memorial Hospital for treatment.
Dr. Reardon told Dr. Hull that Charon was HIV-positive and was suffering from a severe allergic drug reaction. Dr. Reardon also told Dr. Hull that this condition was not related to Charon's HIV or AIDS status. An argument ensued between the two physicians over whether Charon's condition had progressed from HIV-positive to full-blown AIDS. Dr. Hull was concerned that Charon had progressed to AIDS, because he felt that patients with AIDS should be treated in special AIDS programs.
Dr. Reardon told Dr. Hull that Charon's condition was "not related to AIDS or HIV infection in any way." Despite this, Dr. Hull remained primarily concerned about Charon's AIDS/HIV status. Dr. Hull never asked Dr. Reardon why he was concerned about the possibility of TEN. During the course of their discussion, Dr. Hull told Dr. Reardon that "if you get an AIDS patient in the hospital, you will never get him out." Dr. Reardon subsequently recorded this statement in Charon's medical records.
Dr. Hull ultimately refused to admit Charon to Memorial Hospital. Dr. Reardon could have attempted to contact other physicians with staff privileges at Memorial Hospital in order to get Charon admitted; however, since it was a Friday evening, Reardon doubted whether he could promptly locate an admitting physician who was not "on-call." Due to the severity of Charon's drug reaction, Reardon felt he had to get the patient admitted to a hospital for care quickly. Consequently, acting on the suggestion of Dr. Hull, Dr. Reardon contacted the Medical College of Ohio (MCO) and arranged to have Charon transferred and admitted to that facility.
Dr. Reardon called Dr. Chris Lynn at MCO and asked if Lynn would accept admission of a patient with a severe drug reaction. Dr. Reardon never mentioned to Dr. Lynn that Charon possibly had the very rare TEN or that TEN was the reason for the transfer. Dr. Reardon also did not ask Dr. Lynn whether MCO had the capability to treat TEN. Dr. Reardon did tell Dr. Lynn that he had to transfer Charon because he "could not find a physician who was able to do it, to admit the patient and the concern was raised because he was HIV positive, that was the reason he could not be admitted to Memorial Hospital."
When Dr. Reardon returned from his conversations with Dr. Hull and Dr. Lynn, he explained to Charon and Howe that Charon would have to be transferred to MCO. Dr. Reardon never mentioned the possibility that Charon might have TEN, nor told Charon that TEN was the reason for the transfer. Dr. Reardon did state to Charon and Howe that "this is a small community and the admitting doctor does not feel comfortable admitting him."
At the end of his shift in the emergency room, Dr. Reardon recorded Dr. Hull's statement about AIDS patients in the official emergency room records. Dr. Reardon also recorded that Mr. Charon's allergic drug reaction was "not related to AIDS or HIV infection in any way."
Dr. Hull did not come to the Memorial Hospital emergency room, a four mile trip from his home, until after Dr. Reardon's shift had ended and arrangements for Charon's transfer had been made. When Dr. Hull did eventually come to the emergency room, he neither examined Charon, looked at him nor reviewed his chart, despite the fact that he knew that Charon was waiting in the emergency room and had not yet been transferred to MCO.
While at MCO, Charon was examined by Dr. Roger MacArthur, an infectious disease specialist. Dr. MacArthur testified that Charon suffered from "a very simple drug reaction." Dr. MacArthur was "surprised" that he was even consulted on the case because Charon's condition was very "straightforward." Dr. MacArthur further stated that "simply because Charon was HIV-positive doesn't mandate a consult from an infectious disease specialist."
Dr. Hull testified that the appropriate treatment for someone with TEN was at a hospital with a specialized burn unit, and that a TEN patient should be under the care of a dermatologist. Memorial Hospital had neither a burn unit nor a staff dermatologist. However, MCO, the hospital Dr. Hull recommended transferring Charon to, also did not have a burn unit. Charon was also never examined by a dermatologist during the course of his treatment at MCO.
When treated at MCO, Charon was treated for a simple, albeit severe, allergic drug reaction. Mr. Charon did not have TEN. He had a simple allergic drug reaction that was unrelated to and uncomplicated by his HIV/ AIDS...
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