Lawrence v. Mountainstar Healthcare, N. Utah Healthcare Corp.

• Citation: 754 Utah Adv. Rep. 12,320 P.3d 1037
• Decision Date: 21 February 2014
• Docket Number: No. 20120352–CA.,20120352–CA.
• Parties: Jonna M. (Shannon) LAWRENCE, Plaintiff and Appellant, v. MOUNTAINSTAR HEALTHCARE, Northern Utah Healthcare Corporation, and St. Mark's Hospital, Defendants and Appellees.
• Court: Court of Appeals of Utah

320 P.3d 1037
754 Utah Adv. Rep. 12

Jonna M. (Shannon) LAWRENCE, Plaintiff and Appellant,
v.
MOUNTAINSTAR HEALTHCARE, Northern Utah Healthcare Corporation, and St. Mark's Hospital, Defendants and Appellees.

No. 20120352–CA.

Court of Appeals of Utah.

Feb. 21, 2014.

[320 P.3d 1041]

Lynn C. Harris, D. David Lambert, Leslie W. Slaugh, and Richard A. Roberts, Provo, for Appellant.

Eric P. Schoonveld, Tawni J. Anderson, Salt Lake City, and Shelley M. Doi–Taketa, for Appellees.

Judge CAROLYN B. McHUGH authored this Opinion, in which Judges J. FREDERIC VOROS JR. and STEPHEN L. ROTH concurred.

Opinion
McHUGH, Judge:

¶ 1 Jonna M. (Shannon) Lawrence ¹ appeals from a jury verdict in favor of MountainStar Healthcare, Northern Utah Healthcare Corporation, and St. Mark's Hospital (collectively, Hospital). We affirm.

BACKGROUND ²

¶ 2 Shannon went to the emergency room at St. Mark's Hospital on January 22, 2007, seeking treatment for an allergic reaction to Tylenol 3, a common painkiller that she had taken following dental work earlier that day. Dr. Paradise treated Shannon in the emergency room and prescribed several medications.

[320 P.3d 1042]

The first, epinephrine, was to be administered subcutaneously, i.e., under the skin, and the two others were to be administered intravenously, i.e., through the vein. Contrary to Dr. Paradise's orders, a nurse (Nurse) administered all of the medications intravenously. Shannon's friend (Friend), who was present at the time, testified ³ that immediately after Nurse administered the epinephrine intravenously, Shannon cried out in pain and her back arched up off the bed.⁴ Friend also saw Shannon vomit once or twice. According to Nurse, Shannon sat up, put her hands on her chest, said that her heart was palpitating, and became pale, nauseous, and anxious. Nurse realized her mistake when she noticed the side effects of epinephrine happen faster than expected. After Nurse alerted a physician, Shannon was transferred to the intensive care unit (ICU) where she received further medical attention. Meanwhile, Nurse's shift ended as scheduled, and she completed risk management paperwork related to the incident before leaving the hospital.

¶ 3 Later that day, Dr. Paradise spoke with Shannon about the erroneous administration of the epinephrine and explained that she needed to stay in the hospital for observation. Hospital administrators and risk managers who met with Shannon and her family during her hospitalization also acknowledged that an error had been made. Shannon contacted her family attorney, who may have been present during some of the conversations. Shannon recuperated enough to be discharged within a week, but she complains of ongoing symptoms and serious medical conditions allegedly caused by the intravenous administration of epinephrine.

¶ 4 After her discharge, Shannon made multiple visits to Hospital's emergency room. On the first visit, the attending physician performed a full assessment but found no physical abnormalities except for mouth sores. During the second visit, Shannon underwent a variety of cardiac and neurologic tests, which all came back negative. After four additional visits, Shannon's physicians still could not discover any physical problems, other than an unrelated kidney infection.

¶ 5 On December 15, 2008, Shannon filed a complaint against Hospital seeking damages under a theory of negligence. In particular, Shannon claimed that the intravenous delivery of the epinephrine caused her to suffer anoxic brain damage,⁵ cardiac damage, and thoracic outlet syndrome,⁶ as well as headaches, depression, anxiety, cognitive defects, and neck, shoulder, and back pain. Subsequently, Shannon and Hospital reached a stipulation “that the administration of epinephrine to [Shannon] intravenously rather than subcutaneously by [Nurse] on January 22, 2007 was a breach of the applicable standard of care.” The parties clarified, however, that “[t]his stipulation does not constitute, and is neither intended, nor should it be construed as, an admission that this breach ... was the direct, proximate, or contributing cause of any damages allegedly sustained by [Shannon], which such causation and damages are denied by [Hospital], both generally and specifically, to exist.” The trial court took notice of the joint stipulation and ordered that only the issues of causation and damages would be submitted to the jury for decision.

[320 P.3d 1043]

¶ 6 Before trial, Hospital filed a motion to exclude references to any statements made by persons associated with Hospital regarding offers to pay medical expenses on the grounds that such information was irrelevant and unfairly prejudicial. Shannon, in turn, moved to admit those and other statements where Hospital allegedly admitted fault, arguing that the statements were admissions by a party opponent that should be permitted into evidence. According to Hospital, the statements Shannon identified were inadmissible as expressions of apology or compassion. The trial court granted Hospital's motion and denied Shannon's, ruling that the statements were irrelevant because “[n]one of [them] are helpful to resolve any of the issues that are remaining in this case,” namely “what harm was actually caused by this error.”

¶ 7 Shannon also filed a pretrial motion to exclude evidence. Specifically, she moved to exclude any references to her alleged substance abuse that predated the hospitalization, as well as evidence that she had been charged with misdemeanor offenses, which included charges resulting from a July 4, 2011 arrest for driving under the influence (DUI) and possession of drug paraphernalia. At a pretrial hearing, the trial court excluded most of the misdemeanor charges but ruled that the possession of paraphernalia charge “is relevant because it ties into whether or not there is substance abuse as an ongoing issue in [Shannon's] life and whether the substance abuse provides an alternative causation for her symptom[s].” Although the trial court ruled that the drug paraphernalia charge was “fair for the defense to go into,” it excluded evidence of Shannon's DUI charge, her failure to pass the field sobriety test, and the arresting officer's observations stemming from the arrest. The parties later stipulated that the jury could be informed of the paraphernalia charge by the following statement, which the trial court read to the jury: “[O]n July 4, 2011 [Shannon] was in possession of a plastic [pen] straw with opiate residue.”

¶ 8 During trial, Shannon argued that Nurse's negligence caused the epinephrine to reach her bloodstream too quickly, similar to the effects of a drug overdose, thereby resulting in permanent brain and heart tissue damage. Shannon sought $5.7 million in damages for her injuries. Hospital countered that the “wrong route” delivery of the epinephrine did not cause harm to Shannon and that her lingering medical complaints were due to preexisting conditions. Hospital's counsel read to the jury Shannon's admission that she had suffered from anxiety, hyperventilation, and chest pain since 1995; from neck and shoulder pain since 2002; and from headaches since 2006. Hospital's counsel also read to the jury Shannon's acknowledgment that in the year prior to the intravenous epinephrine injection, she had been treated for headaches, anxiety, and neck and shoulder pain. Hospital argued that Shannon's ongoing physical complaints stem from somatoform disorder, which is a term used when psychological issues are manifested as physical complaints that have no physiological explanation.⁷

¶ 9 Hospital also presented Shannon's medical records from Dr. Shockey, a pulmonary critical care specialist who treated Shannon in the ICU. Dr. Shockey's report stated that his physical examination of Shannon after her transfer to the ICU revealed normal neurological function and no abnormalities relating to her neck or shoulders. However, Dr. Shockey's records indicated that Shannon had pulmonary edema “secondary to intravenous epinephrine.” ⁸ Hospital also presented evidence that the results of two scans of Shannon's brain and a test to evaluate the blood vessels of Shannon's head and neck for evidence of vertebral artery dissection, brain cell death, or abnormal intracranial

[320 P.3d 1044]

flow were all normal. In addition, Hospital presented evidence that before Shannon was discharged, her chest CT scan and an MRI of her spine also came back normal aside from “minimal endplate degenerative changes.”

¶ 10 Both sides supported their theories of causation with expert testimony. Shannon called two specialists in physical medicine, rehabilitation, and pain medicine (physiatrists); a neurologist; and a neuropsychologist. Dr. Fish, one of the physiatrists, testified that the intravenous delivery of epinephrine caused Shannon's current symptoms. Dr. Krusz, the neurologist, opined that Shannon had received an epinephrine dose three times larger than normal that led to cardiac and pulmonary problems, which caused anoxic brain injury. On cross-examination, Dr. Krusz acknowledged that it is a “speculative question” how Shannon would have reacted had the epinephrine been administered as ordered and conceded that a person might also react adversely to a normal dose of epinephrine administered subcutaneously. Dr. Loong, the neuropsychologist, testified that all of Shannon's current symptoms are explained by known medical conditions, which he indicated rules out a diagnosis of somatoform disorder. In addition, Dr. Anden, the second physiatrist, who had treated Shannon for musculoskeletal problems, diagnosed Shannon with thoracic outlet syndrome and myofascial pain syndrome.⁹ Shannon also called Dr. Paradise, who testified that he was unable to determine whether Shannon's symptoms were complications resulting from the underlying allergic reaction that brought her into the emergency room, the epinephrine, or some combination of both. Dr. Paradise further indicated that...