Procaccini v. Lawrence & Mem'l Hosp., Inc., (AC 38380).

• Decision Date: 22 August 2017
• Docket Number: (AC 38380).
• Court: Connecticut Court of Appeals
• Parties: James M. PROCACCINI, Administrator (Estate of Jill A. Procaccini) v. LAWRENCE AND MEMORIAL HOSPITAL, INC., et al.

175 Conn.App. 692

168 A.3d 538

James M. PROCACCINI, Administrator (Estate of Jill A. Procaccini)

v.LAWRENCE AND MEMORIAL HOSPITAL, INC., et al.

(AC 38380).

Appellate Court of Connecticut.

Argued March 21, 2017

Officially released August 22, 2017

Daniel J. Krisch, with whom were Frederick J. Trotta, Sr., and, on the brief, Logan A. Forsey and Jennifer S. Mullen, for the appellant (defendant Emergency Medicine Physicians of New London County, LLC).

Matthew E. Auger, with whom, on the brief, was Eric W. Callahan, for the appellee (plaintiff).

Prescott, Mullins and Beach, Js.

MULLINS, J.

In this medical malpractice action, the defendant¹ Emergency Medicine Physicians of New London County, LLC, appeals from the judgment of the trial court, after a jury trial, rendered in favor of the plaintiff, James M. Procaccini, administrator of the estate of Jill A. Procaccini (decedent). On appeal, the defendant claims that there was insufficient evidence supporting the jury's verdict and award of noneconomic damages. Specifically, it claims that the plaintiff failed to present sufficient evidence for the jury (1) to find that the defendant's negligence caused the death of the decedent, and (2) to award $150,000 in damages for the destruction of the decedent's capacity to carry on and enjoy life's activities. We affirm the judgment of the trial court.

The following facts, as reasonably could have been found by the jury, and procedural history are relevant to this appeal. On November 30, 2008, the decedent, who was thirty-two years old, died from a methadone overdose

. In the years leading up to her death, the decedent had struggled with polysubstance abuse.

After achieving a period of sobriety early in 2008, the decedent relapsed on November 16, 2008. On that date, the decedent admitted herself to Saint Francis Hospital and Medical Center in Hartford (Saint Francis), seeking treatment for a heroin overdose. On the next day, November 17, 2008, the decedent was transferred to Cedarcrest Hospital, Blue Hills Substance Abuse Services (Blue Hills), in Newington.

The decedent remained at Blue Hills from November 17, 2008, until her discharge on November 28, 2008. During her stay at Blue Hills, the decedent was administered varying doses of methadone

for treatment of her opiate withdrawal symptoms. Methadone, an opioid,² frequently is used by clinicians to alleviate the withdrawal symptoms that patients experience while undergoing opiate detoxification. Although methadone commonly is used in the clinical setting and, thus, administered under a clinician's supervision or pursuant to a prescription, it also can "be purchased [illegally] on the streets as street methadone." The decedent's last dose of methadone, five milligrams, was administered at Blue Hills at 7:45 a.m. on November 21, 2008. The decedent was discharged from Blue Hills on November 28, 2008.

After leaving Blue Hills on November 28, 2008, the decedent made at least two phone calls. One of those calls was to a person from whom the decedent had purchased drugs in the past. Another call was to Charles Hope, a substance abuse counselor and a recovering drug addict with whom the decedent was friendly. Hope agreed to let the decedent stay at his house in New London on the condition that she not use drugs. Hope picked up the decedent from West Hartford on the evening of November 28, 2008, and brought her to his home in New London. Upon their arrival at Hope's home, Hope and the decedent talked briefly and then retired for the night. Hope heard the decedent use the microwave in his kitchen at some point during the night.

On the morning of November 29, 2008, Hope woke up the decedent and noticed that she was "feeling a little sick." Hope left his home sometime in the late morning or early afternoon of November 29. Hope later called the decedent sometime that afternoon and had a conversation with her. When Hope returned to his home at approximately 6:45 p.m., however, he found the decedent lying unconscious on his living room couch. Hope began performing cardiopulmonary resuscitation

, which restored the decedent's breathing. At approximately 6:47 p.m., Hope called 911.

Emergency medical technicians (EMTs) from the New London Fire Department arrived at Hope's house on November 29, 2008, at approximately 6:51 p.m. The EMTs found the decedent unresponsive, lying in a supine position in Hope's living room with pinpoint pupils and agonal respirations. Hope told the EMTs that the decedent "had been on methadone

," that the decedent "had a history of addiction," and that he was unsure if she used drugs that day. Because she was unconscious, however, the EMTs were unable to obtain any medical history from the decedent. The EMTs administered oxygen to the decedent via an oral airway and bag valve mask. Hope and the EMTs briefly searched Hope's house for drugs, drug paraphernalia, and other evidence of drug use. They did not find any such evidence.

Shortly thereafter, at approximately 6:55 p.m., paramedics from Lawrence & Memorial Hospital (Lawrence & Memorial) arrived on the scene. The paramedics placed the decedent in their ambulance. At some point between 6:55 p.m. and 7:03 p.m., the paramedics intravenously administered the decedent 1.4 milligrams of Narcan

.

Narcan

is used as an "antidote" for opiate and opioid overdoses. Narcan, like opiates and opioids, attaches to the opioid receptors located in the body's central nervous system. Narcan, however, does not cause any of the effects that opiates and opioids produce, such as pain relief, a "high" feeling, and respiratory depression. Instead, because opioid receptors have a "stronger affinity for the Narcan molecule than [they do] for [opiates and opioids]," Narcan"just knocks [opiates and opioids] out and takes residency in the receptor[s] ...." "[Once] [t]he Narcan displaces the opiate [or opioid] from the receptor[s] ... the person's opiate effects evaporate ... the person wakes up and [he or she is] breathing and ... alert ...." In other words, "intravenous administration of Narcan... produce[s] a near-instantaneous reversal of the narcotic effect ... within a minute or two at the most ...."

By the time the ambulance arrived at Lawrence & Memorial at 7:03 p.m., the dose of Narcan

had revived the decedent. The decedent was conscious and answering questions asked by the paramedics. The paramedics were able to determine that the decedent was taking several medications, including methadone, Topamax, Seroquel, insulin, and Ambien. In their written report, the paramedics indicated that the "chief complaint" was an "[overdose] on Heroin" and that the decedent was "found in respiratory arrest due to [overdose]."

Upon arriving at Lawrence & Memorial, the decedent was taken to the emergency room, where her condition was triaged. In examining the decedent, the triage nurse, Sarah Zambarano, created an electronic report detailing the decedent's condition at 7:13 p.m. Zambarano indicated in the electronic report that the paramedics informed her that Hope told them that the decedent "took methadone

, ? of heroin."

At approximately 7:15 p.m., the decedent was assessed by another emergency room nurse, Pamela Mays. At 7:36 p.m., Mays recorded the following in her treatment notes: "[the decedent] admits to using heroin toni[ght] ... states off methadone

for several months after detox ... now using again." Mays also indicated that the decedent "appear[ed] comfortable" and was "cooperative," "alert" and "oriented ...." Contrary to May's notes, Hope, who had arrived at the emergency room between 7:30 p.m. and 8 p.m., recalled that the decedent was "very adamant that she did not take any heroin ...." According to Hope, the decedent told Mays that "I did not take any heroin, I took methadone."

At approximately 7:45 p.m., the attending emergency room physician, Thomas E. Marchiondo, examined the decedent. At the time he began treating the decedent, Marchiondo had access to the paramedics' report, which indicated that the decedent had a suspected overdose on heroin

, that the decedent also was taking methadone, and that the decedent had been found in respiratory arrest. Marchiondo detailed his examination of the decedent in his own written report. In his report, Marchiondo noted that the decedent's "chief complaint" was an "unintentional heroin overdose." Although the decedent apparently denied any "other co-ingestion," Marchiondo's report indicated that the decedent's "current medications" included methadone.

Marchiondo's report also indicated that a urine toxicology screen

had been ordered. The results of the screen, of which Marchiondo was aware when treating the decedent, revealed that the decedent's urine tested positive for the presence of methadone

, an unidentified opiate, and unidentified benzodiazepines. Because that screen merely was qualitative, it could not identify the specific type of opiate ingested by the decedent or the exact concentration of that substance or methadone in the decedent's system.

As a result of his review of the drug screen results, as well as his examination of the decedent and review of the treatment notes prepared by the nurses and emergency responders, Marchiondo concluded that the decedent had ingested both methadone

and heroin. Regarding the methadone, although he could not determine specifically when or in what manner the decedent ingested it, Marchiondo concluded that the decedent ingested some quantity of methadone"within the past couple of weeks." In so concluding, Marchiondo relied on the fact that methadone was listed as a medication in her medical history, which caused him to believe that the decedent was taking the methadone"under a doctor's prescription ...." Marchiondo consequently "would have expected [methadone ] to come out positive in her urine." Accordingly, he concluded that the overdose symptoms that the decedent was experiencing "were due to a heroin overdose" and agreed with a statement by the plaintiff's counsel that the...