Ramage v. Central Ohio Emergency Serv., Inc.

• Decision Date: 24 June 1992
• Docket Number: 91-370 and 91-371,Nos. 91-351,s. 91-351
• Citation: 592 N.E.2d 828,64 Ohio St.3d 97
• Parties: RAMAGE et al., Appellees, v. CENTRAL OHIO EMERGENCY SERVICES, INC., et al., Appellants.
• Court: Ohio Supreme Court

Page 97

64 Ohio St.3d 97

592 N.E.2d 828

RAMAGE et al., Appellees, v. CENTRAL OHIO EMERGENCY SERVICES, INC., et al., Appellants.

Nos. 91-351, 91-370 and 91-371.

Supreme Court of Ohio.

Submitted Jan. 8, 1992.

Decided June 24, 1992.

SYLLABUS BY THE COURT

1. In a negligence action involving the professional skill and judgment of a nurse, expert testimony must be presented to establish the prevailing standard of care, a breach of that standard, and that the nurse's negligence, if any, was the proximate cause of the patient's injury.

2. Pursuant to the Ohio wrongful death statute, R.C. 2125.02, other next of kin, although not presumed to have sustained damages, may recover damages for mental anguish and loss of society upon proper proof thereof, even though there is a surviving parent, spouse, or minor children.

3. Although Civ.R. 49(B) mandates that a trial court submit interrogatories to the jury once requested to do so, the court retains limited discretion to reject submission of the interrogatories where the request is untimely or the proposed interrogatories are ambiguous, confusing, redundant, or otherwise legally objectionable. Proper jury interrogatories must address determinative issues and must be based upon the evidence presented.

4. Where there is competent expert testimony, based on reasonable medical probability, that the negligent acts of a physician were the direct and proximate cause of the patient's death, a trial court correctly denies a motion for directed verdict on the issue of proximate cause. (Cooper v. Sisters of Charity of Cincinnati, Inc. [1971], 27 Ohio St.2d 242, 56 O.O.2d 146, 272 N.E.2d 97; and Strother v. Hutchinson [1981], 67 Ohio St.2d 282, 21 O.O.3d 177, 423 N.E.2d 467, construed and followed.)

5. A party may, during the direct examination of its expert witness, inquire whether that expert agrees with the opinions expressed in publications by the adverse party's expert witness.

6. The allowing or refusing of leading questions in the examination of a witness must very largely be subject to the control of the court, in the exercise of a sound discretion. In the absence of an abuse of discretion, the trial court's ruling must stand. (Seley v. G.D. Searle & Co. [1981], 67 Ohio St.2d 192, 204, 21 O.O.3d 121, 128, 423 N.E.2d 831, 840, followed.)

This case involves the death of Ashley Ramage, a two-year-old child. Ashley was the daughter of Richard A. Ramage ("Ramage") and lived with her father at her grandparents' home in Byesville, Ohio. On the night of February 28, 1987, Ramage left Ashley with neighbors, the McJessys, so that he could socialize with friends. The McJessys, particularly Jill McJessy, had babysat for Ashley on a number of occasions.

The McJessys picked up Ashley at her grandparents' home at approximately 6:00 p.m. and took her back to their home. During the evening and when she went to bed at 10:00 p.m., Ashley did not exhibit any signs of being ill. Ashley slept in Jill's twin bed with her.

At approximately 1:00 a.m., Jill awoke and found Ashley shaking. Ashley was hot, and, according to Jill, appeared to be having a convulsion. Jill called her mother, Judy McJessy, who was in her bedroom. Judy told Jill to undress Ashley while she drew a bath. Jill and Judy placed Ashley in the bathtub and began to rinse her body off. They then located Ramage by telephone and, as they prepared to leave for Guernsey Memorial Hospital (the "hospital"), he arrived. Mr. McJessy then drove his wife, daughter, Ashley and Ramage to the hospital.

Dr. Eugene J. Coles, an employee of appellant Central Ohio Emergency Services, Inc. ("COES"), was the physician on duty in the emergency room when Ashley arrived. The hospital had a contract with COES whereby COES provided physicians as independent contractors for staffing the hospital's emergency room. The emergency room was also staffed by Carol Hoskins, a registered nurse, and Anita J. Meker, a licensed practical nurse, both employees of the hospital.

Ramage, Ashley, and the McJessys arrived at the hospital at approximately 1:35 a.m. At that time, there were no other patients in the emergency room. Nurse Meker was the first to examine Ashley and to speak with Jill and Judy McJessy. When Meker asked what was wrong, Jill stated that at around 1:00 a.m., Ashley had had "a temperature" and was having a convulsion, and that Ashley had vomited while at home. When questioned as to what she meant by the term "convulsion," Jill indicated it was just like what Ashley was doing in the emergency room--she was shaking. Meker noted in the medical record that Ashley was having chills and was shaking when Jill made this comment.

As Ashley was brought into the emergency room, she vomited again. Meker described the vomit as a small amount of clear fluid. That observation was disputed by Jill, Judy and Ramage, who remembered that Ashley vomited a large amount of undigested food after she was seated on one of the tables in the emergency room.

Ashley was undressed and placed in a hospital gown. Meker took Ashley's temperature rectally, which was recorded as 104.6 degrees. Ashley's pulse was 128, her respiration was 28, and her blood pressure was 90 over 50. Meker examined Ashley for any visible marks or bruises but found none. At approximately 1:45 a.m., pursuant to Dr. Coles' orders, Meker gave Ashley a Tylenol suppository to help reduce her fever.

Ashley was then seen by Dr. Coles, who also took a history from Jill and Judy as well as from Ramage. Dr. Coles examined the child and ordered a complete blood count, chest x-rays, and a strep screen. He examined her ears, throat and torso, but failed to find a cause for the fever. According to Dr. Coles, during his examination, Ashley was alert and her skin was dry indicating that she was not dehydrated. At that time, it was his impression that Ashley had suffered a simple febrile seizure.

According to Meker, minutes after being given the Tylenol, Ashley's condition began to improve. Ashley appeared to be alert and talkative and, prior to her discharge, wanted to get down from the examining table. Jill, Judy and Ramage, however, each testified that Ashley's physical appearance never changed from the time of her arrival until her discharge.

Dr. Coles reviewed Ashley's chest x-rays and blood tests and found nothing unusual. He examined her a second time and ordered a second set of blood tests. While in the emergency room, Ashley ate two popsicles that the nurses gave her to help with her fever, to give her fluids, and to distract her while blood was being drawn. According to the nurses, after eating the popsicles, Ashley was alert and talkative. Within forty-five minutes after her arrival, her temperature began to decrease. By 2:21 a.m., her temperature was recorded as 103.2 degrees.

Ashley was discharged from the emergency room at 2:50 a.m. Both Dr. Coles and the nurses continued to monitor and observe her prior to her discharge. Her condition had improved, and her temperature had continued to decrease. Neither Dr. Coles nor the nurses recalled any episode of a seizure, other than some "shaking," during this time nor did they recall being told by either Ramage, Jill or Judy of another seizure. Nor, apparently, are additional seizures noted in the medical records. Jill, Judy and Ramage, however, each testified that he saw what appeared to be the start of a second seizure while Ashley was in the emergency room.

By 2:45 a.m., Ashley's temperature was recorded as 101.4 degrees. Dr. Coles diagnosed Ashley as having a flu syndrome and made the decision that Ashley should be allowed to return home with instructions that Ramage monitor her fever. Dr. Coles instructed Ramage and Jill and Judy to give Ashley plenty of fluids to avoid dehydration as well as Tylenol liquid every four hours to control the fever.

The nurses also gave Ramage further instructions, which included a written instruction sheet that reiterated that Ashley be given plenty of fluids and medications as directed, including one and one-half teaspoons of Tylenol every four hours so long as she continued to show a fever. Ramage was given two prepackaged doses of Tylenol to give to Ashley for the next two four-hour periods.

On the way home from the hospital, the McJessys and Ramage stopped at a store and purchased some fruit juice and additional Tylenol. Once home, Ramage put Ashley to bed immediately.

According to Ramage, he woke Ashley around 4:15 a.m. (approximately forty-five minutes after putting her to bed), and gave her another dosage of Tylenol. When he went to again awaken her between 9:00 a.m. and 9:15 a.m., she was dead in her crib.

On February 18, 1988, Ramage, individually, and as administrator of the estate of Ashley Ramage ("appellee" herein), filed suit against Dr. Coles, COES, and the hospital, alleging that they or their employees or both were negligent in the treatment of Ashley on March 1, 1987 in the emergency room of the hospital. Ramage further alleged that this negligent treatment was the proximate cause of Ashley's death. Ramage sought damages under both survivorship and wrongful death causes of action.

At trial, the court granted the motions of Dr. Coles, COES, and the hospital for a directed verdict on Ramage's survivorship claim. The court also declined to submit interrogatories proposed by the appellants asking the jury to state the manner in which Dr. Coles, COES and the hospital nursing staff were negligent and the manner in which their negligence was the proximate cause of Ashley's death. The court, after initially objecting to the wording of the proposed interrogatories, gave no reason for the denial, despite counsel's attempted amendment of the wording.

On November 20, 1989, the jury returned a verdict in favor of Ramage, finding Dr. Coles to be seventy-five percent liable and the hospital to be twenty-five percent liable. The jury awarded Ramage $750,000 in damages, and judgment was entered upon...