Rhoden v. Mo. Delta Med. Ctr.

• Decision Date: 02 March 2021
• Docket Number: No. SC 98327,SC 98327
• Citation: 621 S.W.3d 469
• Parties: John Henry RHODEN and Dorothy Jean Winfield, Respondents, v. MISSOURI DELTA MEDICAL CENTER, Appellant.
• Court: Missouri Supreme Court

621 S.W.3d 469

John Henry RHODEN and Dorothy Jean Winfield, Respondents,

v.MISSOURI DELTA MEDICAL CENTER, Appellant.

No. SC 98327

Supreme Court of Missouri, en banc.

Opinion issued March 2, 2021

Rehearing Denied June 1, 2021

The medical center was represented by Joseph C. Blanton Jr. and Shaun D. Hanschen of Blanton, Nickell, Collins, Douglas & Hanschen LLC in Sikeston, (573) 471-1000.

The family members were represented by Paul G. Lane, Douglas P. Dowd and Kevin D. Lane of Dowd & Dowd PC in St. Louis, (314) 621-2500.

GEORGE W. DRAPER III, Chief Justice

John Henry Rhoden and Dorothy Jean Winfield (hereinafter and collectively, "Plaintiffs"), as family representatives, filed suit against Missouri Delta Medical Center (hereinafter, "MDMC") for the wrongful death of their father, Roosevelt Rhoden (hereinafter, "Decedent"). Plaintiffs claim the negligent care MDMC and two physicians it employed provided caused Decedent's death. Following a trial, the jury returned a verdict in Plaintiffs’ favor and awarded $269,780.80 for economic damages, $300,000 for noneconomic damages, and $300,000 for aggravating circumstances damages. The circuit court entered judgment, and MDMC appeals. This Court finds no error occurred. Accordingly, the circuit court's judgment is affirmed.¹

Background

Decedent was receiving ongoing care from MDMC and its doctors, Dr. Linza Killion (hereinafter, "Dr. Killion") and Dr. Kevin Rankin (hereinafter, "Dr. Rankin"), for prostate issues. Decedent was in his late seventies and had numerous health issues, including, obesity, hypertension, and insulin-dependent diabetes. Decedent also suffered from chronic kidney disease and respiratory issues.

For years, Decedent's prostrate issues were treated with medication. In September 2012, Decedent noted he felt his urine force was not as strong as he would like and felt as if he could not vacate his bladder fully. Decedent could urinate and had no issue with incontinence or post-void dribbling. Without waiting to determine whether any change in medication would treat Decedent's concerns, Dr. Killion informed Decedent his only treatment options were surgery or self-administering a catheter for the remainder of his life. Decedent opted for surgery, and Dr. Killion performed a transurethral resection of the prostate (hereinafter, "TURP") and a transurethral incision of the bladder neck (hereinafter, "TUIBN").

Following surgery, Decedent's recovery did not proceed as expected. He suffered from multiple complications and later died. Plaintiffs filed a wrongful death action against MDMC, raising issues related to Decedent's need for surgery and the quality of his post-surgical care, which led to his death. The jury returned its verdict in Plaintiffs’ favor. MDMC appeals.

Aggravating Circumstances Damages

MDMC claims there was not substantial evidence to support the circuit court submitting the issue of aggravating circumstances damages to the jury. MDMC asserts the claim for additional damages was not supported by clear and convincing evidence that the health care providers demonstrated willful, wanton, or malicious conduct.

Preservation of error

Initially, this Court must determine whether MDMC preserved its claim of error regarding whether there was not substantial evidence to support an instruction with aggravating circumstances damages for appellate review. "A submissibility-of-the-claim challenge is an attempt to have a claim outright disposed of and, therefore, must be raised in a motion for directed verdict and renewed in a motion for judgment notwithstanding the verdict." Wieland v. Owner-Operator Servs., Inc. , 540 S.W.3d 845, 850 n.3 (Mo. banc 2018).

To preserve the issue of submissiblity in a jury-tried case, a party must file a directed verdict motion and a motion for judgment notwithstanding the verdict (hereinafter, "JNOV") should there be an adverse verdict. Heifetz v. Apex Clayton, Inc. , 554 S.W.3d 389, 395 (Mo. banc 2018). Rule 72.01 governs motions for directed verdict and JNOV.

A party has two opportunities to file a directed verdict motion. The first is "at the close of the evidence offered by an opponent." Rule 72.01(a). Any directed verdict motion is required to "state the specific grounds therefor." Id. Because the directed verdict motion must be presented during trial, there is no requirement the directed verdict motion must be written. See Rule 55.26(a). This Court long has preferred a written directed verdict motion be filed rather than rely upon an oral motion. Manley v. Horton , 414 S.W.2d 254, 258 (Mo. 1967). If this motion is overruled, the moving party may elect to either rest or present additional evidence.

If the moving party elects to present additional evidence, the claim that the circuit court erred in overruling the directed verdict motion at the close of the plaintiff's evidence is waived. Schnatzmeyer v. Nat'l Life Ins. Co. , 791 S.W.2d 815, 819 (Mo. App. E.D. 1990). Accordingly, there must be another directed verdict motion filed at the close of all of the evidence to challenge the submissibility of the plaintiff's case. Rule 72.01(b). While the motion must be specific, the standard for specificity in a challenge to submissibility raised in a motion for directed verdict "is not a demanding one." Tharp v. St. Luke's Surgicenter-Lee's Summit, LLC , 587 S.W.3d 647, 654 (Mo. banc 2019).² Provided a directed verdict motion was submitted at the close of all of the evidence and the motion is overruled, that party may file a motion for JNOV. Id. "Issues not raised in a motion for directed verdict, but raised in the motion for JNOV, are not preserved for appellate review of the motion for JNOV." Holmes v. Kan. City Pub. Sch. Dist. , 571 S.W.3d 602, 612 (Mo. App. W.D. 2018) (quoting Wolf v. Midwest Nephrology Consultants, PC. , 487 S.W.3d 78, 83 (Mo. App. W.D. 2016) ).

MDMC filed a written directed verdict motion at the close of all of the evidence. In addition to the written directed verdict motion, MDMC's counsel orally argued its position.

Plaintiffs’ counsel and the circuit court then engaged in a discussion. At the conclusion of their discussion, the circuit court stated, "I overruled the directed verdict motion at the close of all of the evidence." The complete record reflects both counsel and the circuit court were apprised fully of MDMC's basis for challenging submissibility. Accordingly, the undemanding specificity requirement of Rule 72.01 was satisfied.

Submissibility of the claim

"The standard of review for failures to sustain motions for directed verdict and for JNOV is essentially the same." Robinson v. Langenbach , 599 S.W.3d 167, 176 (Mo. banc 2020) (quoting Fleshner v. Pepose Vision Inst., P.C. , 304 S.W.3d 81, 95 (Mo. banc 2010) ). "This Court must determine whether the plaintiff presented a submissible case by offering evidence to support every element necessary for liability." Id.

"Whether there is sufficient evidence to support an award of punitive damages is a question of law, and this Court's review is de novo. " Gilliland v. Mo. Athletic Club , 273 S.W.3d 516, 520 (Mo. banc 2009). In determining whether a claim is submissible, this Court views the evidence and all reasonable inferences therefrom in the light most favorable to the jury's verdict. Laughlin v. Perry , 604 S.W.3d 621, 625 (Mo. banc 2020). Any adverse evidence and inferences are disregarded. Darks v. Jackson Cnty. , 601 S.W.3d 247, 259 (Mo. App. W.D. 2020). "Only evidence that tends to support the submission should be considered." Blanks v. Fluor Corp. , 450 S.W.3d 308, 401 (Mo. App. E.D. 2014).

When seeking punitive damages against a health care provider in a medical malpractice case, an award "shall be made only upon a showing by a plaintiff that the health care provider demonstrated willful, wanton or malicious misconduct with respect to his [or her] actions which are found to have injured or caused or contributed to cause the damages claimed in the petition." Section 538.210.8, RSMo Supp. 2017.³ "For purposes of punitive damages, acting willfully, wantonly, or maliciously is equivalent to acting with a complete indifference to or in conscious disregard for the rights or safety of others." Bell v. Redjal , 569 S.W.3d 70, 89 (Mo. App. E.D. 2019) ; see also Koon v. Walden , 539 S.W.3d 752, 772 (Mo. App. E.D. 2017).

Viewing the evidence in the light most favorable to the jury's verdict, it is clear Plaintiffs made a submissible case for aggravated circumstances damages because there was complete indifference to or conscious disregard for Decedent's safety.⁴ When Decedent reported mild prostate issues, he was not suffering from a health emergency. Dr. Killion knowingly and incorrectly informed Decedent the only two treatment options were surgery or to self-catheterize for the remainder of his life. Dr. Killion knew there were other non-invasive treatment options, including a transurethral microwave treatment or use of different medications.⁵ These treatments could have addressed Decedent's concerns, especially in light of the fact Decedent was at high risk for surgery. Dr. Killion also negligently resected too much prostate during the TURP surgery and, to remedy his error, he had to conduct the additional TUIBN surgery, which he knew increased the risk of bladder perforation. Dr. Killion's misplacement of the catheter and failure to recognize his error fell below the standard of care.

The events that occurred after breaching the standard of care form the basis for demonstrating aggravated circumstances damages were supported by the evidence. Rather than following the normal course of recovery, Decedent suffered severe abdominal pain immediately after his surgery. This pain indicated something was seriously wrong and needed to be investigated, but it was not. The day after the surgery, Decedent's severe abdominal pain continued. Decedent had difficulty breathing, was experiencing kidney failure, and was showing signs of sepsis. Two days after the surgery,...