Mather v. Griffin Hosp., 13154

• Citation: 540 A.2d 666,207 Conn. 125
• Decision Date: 19 April 1988
• Docket Number: No. 13154,13154
• Court: Supreme Court of Connecticut
• Parties: Victor R. MATHER, et al. v. The GRIFFIN HOSPITAL, et al.

Page 666

540 A.2d 666

207 Conn. 125

Victor R. MATHER, et al. v. The GRIFFIN HOSPITAL, et al.

No. 13154.

Supreme Court of Connecticut.

Argued Dec. 11, 1987.

Decided April 19, 1988.

Cushing O. Condon II, pro hac vice, with whom were Victor G. Gleser, New York City, pro hac vice, and, on the brief, D. Jeffrey Burnham, New York City, for appellants (named defendants)

Bruce D. Jacobs, New Haven, with whom were Wesley W. Horton, Hartford, and, on the brief, Stanley A. Jacobs, Carol Wolven Hopkins, New Haven, and Alexandra Davis, Hartford, for appellees (plaintiffs).

Before ARTHUR H. HEALEY, SHEA, CALLAHAN, GLASS and HULL, JJ. HULL, Associate Justice.

The defendant Griffin Hospital appeals from a judgment rendered on a jury verdict in this medical malpractice case. The minor plaintiff, Victor R. Mather, ¹ brought this action through his mother and next friend, Mohana Mather, against the hospital and Radoslav Maric, a physician, alleging that their negligence in his delivery and immediate postdelivery treatment resulted in cerebral palsy. The jury returned a verdict in the favor of Maric but found the hospital liable and assessed damages against it in the amount of $9 million. We find no error.

The jury could reasonably have found the following facts. Victor, who was just over three years old at the time of trial, was born at 3:41 a.m., on February 25, 1983. He was delivered by Maric at Griffin Hospital (hospital). At birth, Victor took a breath, cried, moved his extremities and opened his eyes. Maric suctioned some fluid from Victor's mouth and nose, cut the umbilical cord and turned him over to Dorothy Thompson, the delivery room nurse, while Maric turned his attention to the child's mother. Within approximately two or three minutes after delivery, Victor's condition began to deteriorate and he had trouble breathing. Thompson suctioned some slightly bloody fluid from Victor's stomach and forced oxygen into his lungs using positive pressure equipment. Victor did not respond and stopped breathing altogether. Maric suctioned more fluid from Victor's stomach and then inserted an endotracheal tube into his windpipe. Before administering oxygen through the tube, he attempted to suction fluid from the baby's lungs by inserting a suction tube within the endotracheal tube. The suction tube given to Maric by Thompson, however, was too large to insert through the endotracheal tube. Thompson did not respond to Maric's request for a smaller suction tube, and when he asked for a larger endotracheal tube, she gave him the same sized tube as before. As a result, Maric had to remove the endotracheal tube to suction Victor's lungs and reinsert it to administer oxygen. Victor's condition continued to worsen. Maric then asked Thompson for an "Ambu bag," a type of oxygen delivery device, which he intended to attach to the endotracheal tube to create a "closed system" to maximize the flow of oxygen to Victor's lungs. An Ambu bag has a mask attached to it; when it is removed, the bag can be connected to an endotracheal tube to deliver oxygen directly to the lungs. He attempted, without success, to remove the mask. He then told Thompson to do so. She was unable to remove the mask and, consequently, it could not be connected to the endotracheal tube. The mask was then placed over the child's nose and mouth and the oxygen administered. By this time, Victor was severely cyanotic, his color having turned dark blue to almost black from oxygen deprivation. Finally, Maric administered oxygen by blowing air from his mouth into Victor's lungs through the endotracheal tube. At twelve minutes of life, the baby was breathing on his own. Shortly thereafter, he was transferred to the neonatal nursery. During the next several hours, Victor suffered several tremors or seizures.

After two days, Victor manifested difficulty sucking, had trouble breast feeding and had to be bottle-fed. He also became jaundiced due to elevation of his bilirubin level. This condition persisted throughout his hospital stay. On March 1, 1983, Victor and his mother were discharged with instructions to see Laura Ment, a pediatric neurologist recommended by Victor's pediatrician.

The following day, Victor was seen by Ment. She admitted Victor to the Yale-New Haven Hospital newborn special care unit for treatment of hyperbilirubemia and dehydration. He was discharged from Yale-New Haven Hospital on March 8, 1983, with a diagnosis of birth asphyxia. Over the next several months, Victor displayed marked developmental delay, abnormal neurological findings and subnormal head growth. Gerald Germano, Victor's Following a trial lasting more than one month, the jury returned its verdict. The hospital moved to set aside the verdict and for judgment in accordance with its motion for a directed verdict. Both motions were denied. The hospital appeals on the following grounds: (1) the medical testimony failed to establish that the hospital's acts caused Victor's injuries; (2) the verdict was excessive as a matter of law and not supported by the evidence; and (3) the standard for measurement of damages used by the trial court was conceptually incorrect. ² We hold that the evidence adequately supports the jury's verdict as to both liability and damages and that the amount of the verdict was not excessive as a matter of law. We further hold that the standard for measurement of damages used by the trial court was not conceptually incorrect.

                pediatrician, diagnosed Victor's condition as "severe developmental delay and choreoathetoid cerebral palsy secondary to neonatal asphyxia" occurring between birth and Germano's first examination of Victor at twenty to twenty-five minutes of life.   At one year of age, Victor was referred to S. Nallainathan, a neurologist, for an examination.   Nallainathan detected atrophy of Victor's brain and attributed both this condition and his seizures to a lack of oxygen some time around birth
                

PROXIMATE CAUSE

Following the trial, the hospital moved for judgment in accordance with its motion for a directed verdict which was made but not resolved at trial. The hospital asserted before the trial court that there was no evidence as to the standard of care required of the hospital or any opinion evidence as to whether there had been a breach of the standard of care required. On appeal, the hospital contends that there was no competent expert testimony to establish the causal link between Victor's injuries and the hospital's acts or omissions. It also argues that there was evidence of many potential causes for Victor's condition and that the jury could not reasonably have ascribed his condition to actions by the hospital. It claims, therefore, that it was error for the trial court to have denied its motion for judgment in accordance with its motion for a directed verdict. We disagree.

Our review of the trial court's refusal to direct a verdict requires us to consider the evidence in the light most favorable to the prevailing party, according particular weight to the congruence of the judgment of the trial judge and the jury, who saw the witnesses and heard their testimony. Bound Brook Assn. v. Norwalk, 198 Conn. 660, 667, 504 A.2d 1047, cert. denied, --- U.S. ----, 107 S.Ct. 81, 93 L.Ed.2d 36 (1986); Bleich v. Ortiz, 196 Conn. 498, 500-501, 493 A.2d 236 (1985). "The verdict will be set aside and judgment directed only if we find that the jury could not reasonably and legally have reached their conclusion." Bound Brook Assn. v. Norwalk, supra.

Proximate cause is ordinarily a question of fact. Coburn v. Lenox Homes, Inc., 186 Conn. 370, 384, 441 A.2d 620 (1982). Establishment of the causal relationship between a defendant's actions or failure to act and a plaintiff's injuries requires a showing that the action or omission must have been a substantial factor in producing those injuries. Sanders v. Officers Club of Connecticut, 196 Conn. 341, 349, 493 A.2d 184 (1985); Mahoney v. Beatman, 110 Conn. 184, 195, 147 A. 762 (1929). " 'The meaning of the term "substantial factor" is so clear as to need no expository definition.... Indeed, it is doubtful if the expression is susceptible of definition more understandable than the simple and familiar words it employs.' Pilon v. Alderman, [112 Conn. 300, 301, 152 A. 157 (1930) ]."

                Connellan v. Coffey, 122 Conn. 136, 141, 187 A. 901 (1936).   In a medical[207 Conn. 131]  malpractice action, expert testimony is required to establish the standard of professional care to which the defendant is held;   Shelnitz v. Greenberg, 200 Conn. 58, 66, 509 A.2d 1023 (1986);  and that the defendant failed to conform to that standard of care.   Pisel v. Stamford Hospital, 180 Conn. 314, 334, 430 A.2d 1 (1980)
                

The hospital embarks upon a recitation of the facts pertaining to Maric's conduct during the labor and delivery and asserts that it cannot be held liable for the treatment provided by Maric. The jury, however, returned a general verdict for Maric. Thus, we presume that every issue was resolved in his favor. Stone v. Bastarache, 188 Conn. 201, 204, 449 A.2d 142 (1982). This result is not challenged here. Accordingly, we shall not address the hospital's claim with respect to Maric's conduct. The hospital also suggests, but never actually states, that Victor's condition could have been attributed to an alleged family history of brain problems or to the treatment he received for jaundice, dehydration and malnutrition. The hospital points to no evidence suggesting a causal relationship between the other alleged causes and Victor's condition. On the other hand, our review of the record discloses that there was sufficient evidence from which the jury could reasonably have concluded that the cause of Victor's cerebral palsy was oxygen deprivation immediately following his birth which the jury could have ascribed to a breach of the standard of care to which the hospital was held. Further, we find that there was expert evidence...