Mobile Infirmary Medical Center v. Hodgen

Decision Date31 October 2003
Citation884 So.2d 801
PartiesMOBILE INFIRMARY MEDICAL CENTER v. James HODGEN.
CourtAlabama Supreme Court

Walter W. Bates and Robert P. MacKenzie III of Starnes & Atchison, LLP, Birmingham; and W. Christian Hines III and John Peter Crook McCall of Starnes & Atchison, LLP, Mobile, for appellant.

Andrew T. Citrin and Michael S. McGlothren of Citrin & McGlothren, P.C., Daphne, for appellee.

Robert A. Huffaker and R. Austin Huffaker, Jr., of Rushton, Stakely, Johnston & Garrett, P.A., Montgomery, for amicus curiae Medical Association of the State of Alabama, in support of the appellant.

Deborah Alley Smith of Christian & Small, LLP, Birmingham; and Joana S. Ellis of Hill, Hill, Carter, Franco, Cole & Black, P.C., Montgomery, for amicus curiae Alabama Defense Lawyers Association, in support of the appellant.

David G. Wirtes, Jr., and George M. Dent III of Cunningham, Bounds, Yance, Crowder & Brown, LLC, Mobile; R. Edwin Lamberth of Heninger, Burge, Vargo & Davis, LLP, Birmingham; and Nancy L. Eady of Morris, Haynes & Hornsby, Alexander City, for amicus curiae Alabama Trial Lawyers Association, in support of the appellee.

PER CURIAM.

Mobile Infirmary Medical Center appeals from the trial court's judgment, entered on a jury verdict, in favor of James Hodgen. We affirm conditionally.

Facts and Procedural History

In February 2000, 58-year-old James Hodgen was a patient in the intensive care unit of the Mobile Infirmary Medical Center recovering from cardiac bypass surgery. Hodgen's recovery progressed normally until he began to develop cardiac arrhythmia, or abnormal heart rhythms, two days after the surgery. The Mobile Infirmary employee overseeing Hodgen's care, Dawn Byrd, a recent nursing school graduate, informed a supervising nurse, Tammy Espiritu, that Hodgen was experiencing arrhythmia. Espiritu instructed Byrd to telephone Hodgen's cardiologist, Dr. Chris Brown. When Byrd telephoned Dr. Brown and advised him of Hodgen's condition, Dr. Brown prescribed .25 milligrams of digoxin. Byrd mistakenly informed Espiritu that Dr. Brown had prescribed 1.25 milligrams of digoxin, and Espiritu telephoned the order to the pharmacy.

Espiritu, believing that Hodgen's condition was worsening, told Byrd not to wait for the pharmacy to deliver the medication. Instead, Espiritu instructed Byrd to obtain the digoxin from the stock of medicine maintained in the intensive care unit and to administer it to Hodgen. Without supervision from Espiritu, Byrd obtained three vials, or ampules, of digoxin and emptied at least two and a half of the vials directly into Hodgen's intravenous tube. Shortly after Byrd had administered the digoxin to Hodgen, the pharmacy called Espiritu, questioning the amount of digoxin she had ordered. It was then that Byrd and Espiritu realized that Byrd had administered to Hodgen five times the amount of digoxin Dr. Brown had actually prescribed.

When Hodgen began to experience complications the next evening resulting from digoxin toxicity, he was administered Digibind, an antidote for digoxin toxicity. After the Digibind was administered, Hodgen's heart stopped beating and one of the nurses began to "mechanically pace his heart." Hodgen's blood pressure then dropped to a very low level and the oxygen-saturation level in his blood became extremely low. Hodgen stopped breathing, and the hospital staff began CPR and other forms of intervention to revive Hodgen. Hodgen was revived, but he suffered damage to various organs as a result of severe oxygen deprivation. Hodgen later underwent surgery to remove a portion of his intestines and to amputate his right leg. Hodgen is now unable to walk, must use a colostomy bag, and claims that his mental capacity is diminished.

On January 29, 2001, Hodgen sued Mobile Infirmary in the Mobile Circuit Court under the Alabama Medical Liability Act, § 6-5-480 et seq., Ala.Code 1975 (hereinafter referred to as the "AMLA"). Specifically, Hodgen alleged that Mobile Infirmary had been negligent and/or wanton in administering the digoxin and in supervising its employees. James's wife, Judy Hodgen, also sued Mobile Infirmary, stating a derivative claim alleging loss of consortium. The Hodgens sought both compensatory and punitive damages. The case went to trial in April 2002.

The evidence at trial indicated that Byrd, although assigned to care for various patients in the intensive care unit at Mobile Infirmary, was not a licensed nurse. She was a recent graduate of nursing school and, when she administered the digoxin overdose to Hodgen, she had taken but had not yet received the results from her nursing board examination.1 The supervising nurse that evening, Espiritu, had passed her nursing board examination only seven months before the overdose was administered and had never worked with Byrd before that occasion. Additionally, the charge nurse for that evening had assigned Byrd and Espiritu separate patients, instead of having Byrd work under Espiritu's direct supervision. Espiritu testified that she understood that her responsibility in supervising Byrd was merely to answer any questions Byrd might have had.

Byrd testified that she had never administered digoxin before she administered it to Hodgen. Byrd stated that although normally her "nursing mentor" made telephone calls to a doctor about a patient, she believed that the nursing staff, in having her make the telephone calls to the doctor, was trying to help her get experience in speaking with the doctors. She said that she had telephoned doctors to advise them of the condition of their patients no more than five times before her call to Dr. Brown, and that she found such calls difficult. Byrd further admitted that when Dr. Brown prescribed the digoxin, she did not attempt to repeat his order to him or to confirm in any way the dosage he had prescribed. Byrd acknowledged that too much digoxin can be harmful to a patient.

Dr. Ray Lash, the Hodgens' medical expert, testified that Hodgen's symptoms after the digoxin overdose were consistent with digoxin toxicity. Dr. Lash further testified that, generally, digoxin that is to be given intravenously is delivered to hospitals in prepackaged vials, or ampules. According to Dr. Lash, a normal dosage of digoxin is about one-half of a vial, but the maximum dosage that should be administered to an average person is one vial. Dr. Lash testified that a medical professional in an intensive care unit should have known that medications are generally packaged so that one container is the maximum dose for one person. He further stated that a qualified nurse should have known something was wrong when, to administer the prescribed dose of digoxin to a patient, she had to use three vials of the medicine. Dr. Lash expressed his opinion that Byrd was inadequately trained, that she was put in a position where she was "in over her head," and that Mobile Infirmary failed to put safeguards into place to prevent Byrd's inexperience from hurting patients.

Mobile Infirmary elicited testimony at trial indicating that James Hodgens's medical bills were paid by Medicare and by a private insurer.

After the close of all of the evidence, the trial court charged the jury on negligence and wantonness and on compensatory damages and punitive damages. The jury deliberated for one day and returned the following verdict form:

"Claim of James Hodgen
"I. We, the Jury, find in favor of the Plaintiff, James Hodgen, and assess damages as follows:

"Past Damages: $ 0 ____________ "Future Damages: $ 0 ____________ "Punitive Damages (if applicable): $ 2,250,000.00 ____________ "Total Damages: $ 2,250,000.00 ____________

"Claim of Judy Hodgen
"II. We, the Jury, find in favor of the Plaintiff, Judy Hodgen, and assess damages as follows:

"Past Damages: $ 0 ____________ "Future Damages: $ 0 ____________ "Total Damages: $ 0 ____________ "[Signature] "Foreman

"OR
"I. We, the Jury find for the Defendant, Mobile Infirmary Medical Center."

"___________ "Foreman"

After consulting with counsel for both parties as to any possible concerns they might have about the jury's verdict, the trial court entered a judgment in favor of James Hodgen awarding him $2,250,000 in punitive damages and a judgment in favor of Judy Hodgen awarding her $0. The trial court denied Mobile Infirmary's posttrial motions and refused to remit the punitive-damages award. In support of its refusal to remit the award, the trial court purported to find that, at trial, James Hodgen produced evidence that he had incurred $1,600,000 in compensatory damages. Mobile Infirmary appeals the judgment entered in favor of James Hodgen.

Discussion
I.

Mobile Infirmary argues that the trial court erred in entering a judgment on the jury verdict because it awarded the plaintiff only punitive damages and, Mobile Infirmary argues, the jury must award compensatory damages before it can award punitive damages. See Life Ins. Co. of Georgia v. Smith, 719 So.2d 797 (Ala.1998)(a jury must award compensatory or nominal damages to a plaintiff before it can award punitive damages). Thus, Mobile Infirmary argues that this Court should reverse the judgment in favor of Hodgen and render a judgment in favor of Mobile Infirmary. Hodgen responds that any error by the trial court in entering a judgment awarding only punitive damages was invited by Mobile Infirmary when its own counsel affirmatively represented to the trial court that the jury could make such an award. We agree.

Immediately after the jury read its verdict in this case, the trial court dismissed the jurors into the jury room to await a final discharge from their duties. The following discussion then took place:

"The Court: Let me see the lawyers.
"Court Reporter: Do you want me, Judge?
"The Court: Yeah.
"Here it is. I think it's not—it's acceptable but it's an odd verdict. It doesn't make sense but it's—I think it's a good verdict. What do you think, Billy
...

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