Meeks v. Peng
Docket Number | 20220815 |
Decision Date | 15 February 2024 |
Citation | 545 P.3d 226 |
Parties | Jenafer Birt MEEKS, individually and on behalf of the heirs and estate of Lillian Birt, deceased, Appellee, v. Wei PENG, M.D., PhD and Christina G. Richards, M.D., F.A.C.S., Appellants. |
Court | Utah Supreme Court |
Third District, Salt Lake County, The Honorable Matthew Bates, No. 180902456
Karra J. Porter, Anna P. Christiansen, Salt Lake City, for appellee Troy L. Booher, Caroline A. Olsen, Taylor P. Webb, Salt Lake City, for appellants
INTRODUCTION
¶1 This medical malpractice case stems from the withdrawal of life-sustaining treatment that resulted in the death of Lillian Birt. While Ms. Birt was in the intensive care unit (ICU), her children decided to discontinue life support based on their understanding of conversations they had with their mother’s treating doctors about her condition. The children believed that their mother’s condition was terminal and that the treatment was unnaturally prolonging her life. But, in fact, their mother’s condition was not terminal; there was a high likelihood that she would have recovered if treatment had been continued.
¶2 After Ms. Birt died, her daughter, Jenafer Meeks, sued the doctors for medical malpractice—individually, and on behalf of Ms. Birt’s heirs and estate—alleging, in part, that the doctors did not properly inform Ms. Birt’s children of their mother’s condition before allowing them to request that her care be withdrawn. Ms. Meeks sought damages for two different types of harm—harm done to the heirs as a result of the death through a wrongful death action and harm done to Ms. Birt before her death through a survival action.
¶3 At trial, the district court informed the jury of the elements of medical malpractice in instruction 23. That instruction, which was based on the Model Utah Civil Jury Instructions, told the jury, "Plaintiffs have the burden of proving two things: (1) a breach of the standard of care and (2) that the breach was a cause of Plaintiffs’ injuries." The doctors objected to instruction 23, arguing that it failed to inform the jury that the plaintiff had the burden to prove what standard of care applied in this situation. The district court disagreed. It reasoned that by stating the plaintiff had to prove "a breach of the standard of care," the instruction implied that the jury must first determine the standard of care.
¶4 The jury ultimately found that the doctors acted negligently in connection with the withdrawal of care and awarded damages to the heirs on the wrongful death claim and to the estate on the survival claim. The doctors moved for judgment as a matter of law on the estate’s survival claim, which was meant to compensate the estate for the harm done to Ms. Birt before her death due to the doctors’ negligence. The doctors argued, in part, that Ms. Meeks did not provide any evidence allowing a jury to reasonably infer that Ms. Birt had experienced pain and suffering in the hours before her death. The district court denied the motion, finding that the jury could use evidence of Ms. Birt’s experience before doctors withdrew life-sustaining care to infer that she experienced pain and suffering after that care was withdrawn.
¶5 The doctors raise two issues on appeal. First, they argue that they are entitled to a new trial because instruction 23 did not explicitly tell the jury that Ms. Meeks had the burden to prove the standard of care. Second, the doctors argue that the district court erred when it declined to grant them judgment as a matter of law on the survival claim because Ms. Meeks did not provide any evidence that Ms. Birt experienced pain, suffering, or inconvenience in the hours between the doctors’ negligence and her death.
¶6 We hold that the district court correctly instructed the jury that Ms. Meeks had the burden of proving the standard of care to establish medical malpractice. But we hold that the court erred in denying the doctors’ motion for judgment as a matter of law on the survival claim. Ms. Meeks failed to provide evidence—medical or otherwise—that Ms. Birt experienced pain, suffering, or inconvenience during the period between the doctors’ negligence and her death.
¶7 We affirm in part and reverse in part.
[1] ¶8 After experiencing complications from a surgery performed by Dr. Christina Richards, Lillian Birt was diagnosed with pneumonia and sepsis and was placed on life support. She was later admitted to the ICU, where she was treated primarily by Dr. Wei Peng.
¶9 Over the next several days, Ms. Birt remained on life support because she was still suffering from respiratory failure, septic shock, and decreased heart function.
¶10 A few days before Ms. Birt’s death, the hospital staff conducted "weaning trials" to determine whether Ms. Birt could be taken off the ventilator. During these weaning trials, the doctors took Ms. Birt off sedatives and pain medication, woke her up, and removed the ventilator to see if she could breathe on her own. Ms. Meeks testified that during the weaning trials, the medical staff "had to take her [mother] off what was keeping her asleep or not in pain." She described her mother’s experience this way:
¶11 Despite the negative prognosis and the failed weaning trials, Ms. Birt was not terminal. Dr. Peng testified that she "had a very good chance to return to another care facility if we [had kept] going." He estimated she had up to a twenty percent chance of mortality. In other words, there was likely over an eighty percent chance that she would have survived if care had been continued.
¶12 After discussing their mother’s condition with Dr. Peng, Ms. Birt’s children understood that their mother would never come off the ventilator. Ms. Meeks understood that Dr. Peng was proposing two options: Ms. Birt could either undergo a tracheostomy and spend the remainder of her life in a nursing home or be taken off life support. Ms. Meeks Dr. Peng did not tell Ms. Meeks that her mother was improving or that she was likely to recover. Likewise, Ms. Meeks’s brother understood that his mother would be kept on a ventilator for ten to fourteen days and then transferred to a long-term care facility where she would spend her last days. No one told the children that their mother could have a meaningful recovery and could potentially go home. And even though both Dr. Richards and Dr. Peng knew that Ms. Birt had a good chance of surviving, because they wanted to respect the family’s wishes, they did not attempt to dissuade the children from withdrawing care.
¶13 Reluctantly, the children agreed to withdraw Ms. Birt’s life support. After his conversation with the children, Dr. Peng gave Ms. Meeks a form to sign indicating that Ms. Birt’s condition was "terminal" and that "[t]o continue providing life-saving procedures would only serve to unnaturally prolong the moment of death and unnaturally postpone or prolong the dying process." Dr. Richards, as the treating surgeon, also signed this consent form asserting that continuing Ms. Birt’s treatment would unnaturally prolong the dying process. Unbeknownst to the children, the statements on the form were untrue.
¶14 Ms. Birt was taken off the ventilator but remained on palliative care, including sedation and pain management. According to Ms. Meeks, her mother made no effort to breathe after care was withdrawn. She died eight hours after Ms. Meeks signed the form to withdraw life-sustaining care.
¶15 Ms. Meeks brought a lawsuit against the doctors on behalf of her mother’s heirs and estate. The complaint alleged two causes of action seeking different types of damages that resulted from alleged medical malpractice. The first, a wrongful death claim, sought to recover damages incurred by the heirs as a result of Ms. Birt’s death. The second, a survival claim, sought to recover damages for the estate based on the harm suffered by Ms. Birt before her death.2
¶16 Ms. Meeks’s theory at trial was that Dr. Peng and Dr. Richards failed to properly inform the children that their mother had a high likelihood of recovery and that the doctors failed to dissuade the children from withdrawing care. The parties agreed that the doctors had the duty to gain the family’s informed consent before withdrawing care. However, the parties disagreed about whether the standard of care required the doctors to take additional steps to actively dissuade the family from choosing to withdraw care because Ms. Birt had a high chance of surviving and making a meaningful recovery. For example, Ms. Meeks argued that the doctors had a duty to bring in others to communicate with the family, to take the matter "to the ethics committee," or to "say[ ] no and go[ ] to court."
¶17 In the end, the jury returned a verdict for Ms. Meeks on both the wrongful death and survival claims. The jury awarded Ms. Birt’s children $4 million for the wrongful death of their mother and awarded the estate $1 million in noneconomic damages for Ms. Birt’s pain and suffering before her death. After a motion from the doctors, the district court reduced the noneconomic damages to $450,000 in accordance with Utah Code section 78B-3-410(1)(d).
¶18 On appeal, the doctors contend that two errors occurred at trial: (1) the district court incorrectly instructed the jury on the elements of medical malpractice, and (2) the doctors were entitled to judgment as a matter of law on the survival action.
¶19 To instruct the jury on the elements of medical...
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