Jones v. St. Francis Cabrini Hosp.
| Decision Date | 10 April 1995 |
| Citation | 652 So.2d 1331 |
| Parties | 94-2217 La |
| Court | Louisiana Supreme Court |
Harry Alston Johnson, III, Phelps Dunbar, Baton Rouge, Charles H. Munsterman, Alexandria, for applicant.
Milo Addison Nickel, Jr., Woodley, Williams, Fenet, Boudreau, Norman & Brown, Lake Charles, for respondent.
Troy E. Bain, Shreveport, for Troy E. Bain and Louisiana Trial Lawyers Ass'n amicus curiae.
Lawrence S. Kullman, New Orleans, for Louisiana Trial Lawyers Ass'n amicus curiae.
[94-2217 La. 1] MARCUS, Justice *.
On February 5, 1989, Mrs. Ruby Lee Jones, age 75, was admitted to St. Frances Cabrini Hospital (Cabrini) with a broken hip. Dr. John Weiss, an orthopedist, diagnosed her condition as a fracture of the left hip and performed surgery to place a screw nail in the bone to compress the fracture.
Prior to surgery, blood tests were performed and suggested that Mrs. Jones had anemia. Dr. Harishwar Agarwal, a specialist in internal medicine and gastroenterology, testified that anemia in someone of Mrs. Jones' age usually indicates bleeding in the stomach or colon and may indicate colon cancer. Therefore, Dr. Agarwal ordered three tests focusing on that area. First, Dr. Agarwal conducted a gastroscopic examination, which revealed no bleeding. Second, Dr. Agarwal used a flexible sigmoidoscope to examine Mrs. Jones' rectum and the lower part of her colon. No bleeding was found, and her rectum appeared normal. Finally, on February 16, 1989, Dr. William Baber, a radiologist who was not an employee of Cabrini, performed a barium enema examination. Cabrini employees inserted the rectal tube and began the [94-2217 La. 2] flow of barium. Dr. Baber found that the barium flow was not progressing as expected. Several attempts were made to correct the problem and x-rays were taken. Upon examination of the x-rays, Dr. Baber concluded that the barium was collecting outside of Mrs. Jones' rectum and that a pararectal tear had occurred.
Dr. Baber immediately ordered the flow of barium stopped and called Dr. Agarwal and Dr. Weiss. Dr. Agarwal called in Dr. Donald Edgerton, a general surgeon, as a consultant. Dr. Edgerton concluded that the presence of fecal material outside of the normal confines of the intestinal tract, together with the barium, created a chance of serious infection that required surgery. That afternoon, Dr. Edgerton performed a colostomy on Mrs. Jones, whereby the bowel was cut in two, the fecal stream directed to a bag outside of the body, and the lower half of the colon stapled or sutured closed.
Following the surgery, Mrs. Jones remained at Cabrini for convalescence from both her hip injury and the colostomy surgery. Dr. Weiss' orders indicated that no weight was to be put on Mrs. Jones' hip. However, while transferring her to a wheelchair, a Cabrini nurse apparently caused her to put weight on her leg contrary to the doctor's orders, resulting in pain. Dr. Weiss ordered x-rays, which revealed some compression or separation of the bone in her hip. As a result of this incident, Mrs. Jones requested a transfer from Cabrini and was transferred to Rapides General Hospital (Rapides) in early March, 1989. After convalescing at Rapides for approximately one month, she was discharged on April 6, 1989, and returned to the nursing home where she resided prior to her hospitalization. While at the nursing home, Mrs. Jones was unable to change her colostomy bag herself due to the arthritis in her hands, and required assistance from nurses or her family to change the bag.
At the time Dr. Edgerton performed the colostomy, he had informed Mrs. Jones that if everything went well, he would be able to reverse it in six to eight weeks. Thereafter, Mrs. Jones and Dr. Edgerton had several discussions about the reversal. Dr. [94-2217 La. 3] Edgerton testified that he tried to dissuade Mrs. Jones from going through with the reversal because of the risks involved, although he admitted that he believed she had a reasonable chance of surviving the procedure and knew she felt strongly about wanting the reversal.
On May 3, 1989, Dr. Edgerton readmitted Mrs. Jones to Rapides and reversed the colostomy the next day. Shortly after the reversal, she developed severe complications, including leakage of fecal material. In an attempt to correct the leakage, Dr. Edgerton performed an ileostomy (an operation similar to a colostomy) on May 14, 1989. Three days later, Mrs. Jones developed bleeding. A second ileostomy was performed in an attempt to stop the bleeding. However, Mrs. Jones continued to show evidence of bleeding even after this operation. As Mrs. Jones was extremely ill at this time, it was felt that she could not survive another operation. Therefore, procedures were attempted to cause the blood vessels to clot, but were unsuccessful. On June 8, 1989, approximately one month after being admitted to Rapides for the reversal, Mrs. Jones died.
After proceeding through the medical review panel, Billie Jo Jones and Willie V. Jones, Jr., 2 individually and as provisional administrator of the estate of Ruby Lee Jones, filed a "petition in suit for damages for wrongful death, survival action and medical expenses," naming as defendants Cabrini, Dr. Baber and his insurer. Of the eleven allegations of negligence against Cabrini in the petition, ten related to the rectal perforation and one related to the hip separation. Plaintiffs named the Louisiana Patient's Compensation Fund (PCF) as an additional defendant. Subsequently, Cabrini, as a self-insured health care provider, agreed to settle its liability for $100,000 in accordance with La. R.S. 40:1299.44(C). Upon joint motions by plaintiffs and Cabrini, the trial judge approved the settlement and dismissed Cabrini with prejudice, reserving plaintiffs' rights against the PCF, Dr. Baber [94-2217 La. 4] and his insurer. 3
The case was tried before a jury. At the conclusion of the trial, the jury returned the following verdict:
The trial judge signed a judgment in accordance with this verdict and allowed the PCF a credit of $125,000 as a result of the prior settlements.
Plaintiffs appealed. A five judge panel of the court of appeal, with two dissents, affirmed in part and reversed in part. 4 On appeal, plaintiffs argued the trial judge's jury instructions were incorrect on the issue of Cabrini's liability. The court found no error in the jury instructions. However, it found that [94-2217 La. 5] the jury's verdict sheet contained "internal inconsistencies," 5 and therefore performed a de novo review of the record. The court held that Cabrini's settlement for $100,000 constituted an admission of liability for both the separated hip and perforated rectum. It awarded damages for the hip separation, rectal perforation and resulting colostomy. However, the court refused to award damages for the reversal of the colostomy and subsequent death. Accordingly, it made an award of general damages in the amount of $82,000, plus an award of special damages in the amount of $40,998.62. These amounts were made subject to the credit granted to the PCF as a result of the prior settlements ($125,000). No award was made on the wrongful death claim.
Upon plaintiffs' application, we granted certiorari to review the correctness of that decision. 6 Plaintiffs claim the court of appeal erred: (1) in concluding the jury instructions concerning the effect of a full settlement by Cabrini were correct; (2) in finding Cabrini was not liable for the reversal of the colostomy and resulting death, and (3) in its calculation of damages in the survival and wrongful death actions.
La. R.S. 40:1299.44(C)(5) provides in pertinent part:
In approving a settlement or determining the amount, if any, to be paid from the patient's compensation fund, the court shall consider the liability of the health care provider as admitted and established where the insurer has paid its policy limits of one hundred thousand dollars, or where the self-insured health care provider has paid one hundred thousand dollars.
Plaintiffs argue that since Cabrini paid $100,000, its liability was established. As a result, they argue the trial judge incorrectly instructed the jury in such a way as to lead it to believe [94-2217 La. 6] it could decide liability. The relevant portion of the jury charges are as follows:
Liability admitted. Liability is stipulated or admitted in this case and the jury will not have to make a finding on legal liability.
* * * * * *
Damages. We next come to the issue of damages. In this case while the fault or liability of St. Frances Cabrini to the plaintiff is established, the plaintiff at trial must nonetheless demonstrate what damages by kind and by seriousness were caused by St. Frances Cabrini's fault.
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You are not to award damages for any injury the plaintiffs may have suffered unless it has been established by a...
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