Rio Grande Reg'l Hosp. Inc. v. Villarreal

• Decision Date: 30 September 2010
• Docket Number: No. 13-08-00542-CV.,13-08-00542-CV.
• Citation: 329 S.W.3d 594
• Parties: RIO GRANDE REGIONAL HOSPITAL, INC. and Columbia Rio Grande Healthcare, L.P. d/b/a Rio Grande Regional Hospital, Appellants, v. Diana Lopez VILLARREAL, individually and as Representative of the Estate of Hermes Villarreal, Deceased, and as Next Friend of Sarah Villarreal, Lauren Villarreal, and Hermes Alejandro Villarreal, Minors, and Hermalinda Villarreal, Appellees.
• Court: Texas Court of Appeals

329 S.W.3d 594 RIO GRANDE REGIONAL HOSPITAL, INC. and Columbia Rio Grande Healthcare, L.P. d/b/a Rio Grande Regional Hospital, Appellants, v. Diana Lopez VILLARREAL, individually and as Representative of the Estate of Hermes Villarreal, Deceased, and as Next Friend of Sarah Villarreal, Lauren Villarreal, and Hermes Alejandro Villarreal, Minors, and Hermalinda Villarreal, Appellees. No. 13-08-00542-CV. Court of Appeals of Texas, Corpus Christi-Edinburg. Sept. 30, 2010.

Kirsten M. Castaneda, Michael A. Hatchell, Locke Lord Bissell & Liddell, Austin, Robert W. Clore, Thomas F. Nye, Gault, Nye & Quintana, LLP, Corpus Christi, for Appellants.

Clem V. Lyons, Mary Wilson, Lyons & Rhodes, Curtis L. Cukjati, Martin, Cukjati & Richman, LLP, Elizabeth Conry Davidson, J. Thomas Rhodes III, Rhodes & Vela, Laura R. Pazin Porter, San Antonio, Raymond L. Thomas, Kittleman, Thomas & Gonzalez, McAllen, Robert B. Gilbreath, Dallas, for Appellees.

Before Chief Justice VALDEZ and Justices YAÑEZ and BENAVIDES.

OPINION

Opinion by Chief Justice VALDEZ.

This appeal stems from a wrongful death and survival action based on a health care liability claim brought by appellees, Diana Lopez Villarreal, individually and as representative of the estate of Hermes Villarreal, deceased, and as next friend of Sarah Villarreal, Lauren Villarreal, and Hermes Alejandro Villarreal, minors, and Hermalinda Villarreal, individually, against appellants, Rio Grande Regional Hospital, Inc. and Columbia Rio Grande Healthcare, L.P. d/b/a Rio Grande Regional Hospital. Appellees' cause of action pertains to the suicide of former McAllen attorney, Hermes Villarreal, while he was in appellants' care. After a trial, the jury concluded that appellants were 75% responsible for Hermes's injuries and death and awarded damages to appellees; however, the trial court signed a final judgment awarding appellees $685,600 in actual damages, after applying the applicable damage caps, $43,380.98 in pre-judgment interest, and court costs.

By four issues, appellants argue that: (1) the record contains no evidence establishing that appellants should have reasonably foreseen that Hermes would commit suicide; (2) there is no evidence that the nurses' alleged acts or omissions were a substantial factor in bringing about Hermes's death; (3) appellees failed to establish that any of appellants' actions were the cause-in-fact of Hermes's death; and (4) the jury erred in rejecting appellants' affirmative defense of suicide. See Tex. Civ. Prac. & Rem.Code Ann. § 93.001(a)(2) (Vernon 2005). On cross-appeal, appellees assert that: (1) the trial court erred in allowing the jury to consider Hermes's proportionate responsibility incausing his own death; and (2) the trial court erroneously applied the $250,000 damages cap outlined in section 74.301 of the civil practice and remedies code and, instead, should have applied the damages cap provided in section 74.303 of the civil practice and remedies code, which caps damages at $500,000 adjusted by the consumer price index. See id. §§ 74.301, 74.303 (Vernon 2005). We affirm.

I. Background

This dispute pertains to a jury verdict entered by a Hidalgo County jury involving the treatment and, ultimately, the death of Hermes. Hermes was a lawyer who ran his own law firm in Pharr, Texas. Hermes was married and had three children, Sarah, Lauren, and Alejandro. In addition, Hermes was very close to his mother, Hermalinda, and he often offered various forms of assistance, including money, to Hermalinda.¹ By all accounts, Hermes had a close and loving relationship with his family.

Beginning in April 2005, Hermes began experiencing strange sensations in his ears, insomnia, anxiety, and severe, unrelenting headaches. Hermes believed that these maladies were related to his ear, and he complained that he felt "air coming out of one of his ears." Because of these symptoms, Hermes was unable to sleep, concentrate, think clearly, and follow what people were saying, and, because he had never experienced symptoms such as these before, he became "extremely anxious." As a result, Hermes scheduled an appointment with a local neurologist, Ruy Mireles, M.D. In an attempt to determine the cause of his abnormal symptoms, Dr. Mireles recommended that Hermes undergo an MRI on his brain. Hermes agreed, and the MRI was conducted on April 14, 2005.

While awaiting the results of the MRI, Hermes continued to suffer anxiety, insomnia, and severe headaches. Hermes began to consider traveling to San Antonio to seek additional help for these symptoms. Hermes was very worried and concerned about his health. He was described as a "type A personality" at trial and someone who was "driven," "self-motivated," and did not take shortcuts. By April 16, 2005, Hermes had experienced these symptoms for three or four days and had not slept at all. Hermes's sister, Edna Eckroat, testified that shortly before April 16th, she and Hermalinda met Hermes for lunch. At that meeting, Hermes appeared to be sleep-deprived, and he disclosed to them some of the health problems he was having.

In the early morning hours of April 16, 2005, Diana, Hermes's wife, awoke to find Hermes sitting at the kitchen table. Diana was immediately concerned because it appeared that Hermes, once again, had failed to sleep. Hermes asked Diana to sit at the table, and he began to explain that the symptoms were not going away and that he intended to travel to a hospital in San Antonio to find out what was causing the symptoms. At this time, he handed Diana a letter, which was admitted into evidence at trial.² Hermes felt like he was losing his mind and suggested that he may be committed to a mental institution inSan Antonio. Diana panicked and argued that the San Antonio hospital was too far away for her to be with him. Diana convinced Hermes to go to Rio Grande Regional Hospital in McAllen, Texas, instead.

A. Hermes's Admission to Rio Grande Regional Hospital

Once Diana had convinced Hermes to go to Rio Grande Regional Hospital for treatment, it was between four and five in the morning on April 16. Because the children were asleep, Diana arranged for Hermes's sister, Eckroat, to meet Hermes at the hospital. Diana agreed to join Hermes shortly thereafter, once she made arrangements for the care of the children.

Upon arriving at Rio Grande Regional Hospital, Hermes was admitted and attended to by Marvin Tavarez, M.D. Hermes relayed his symptoms to Dr. Tavarez, and Dr. Tavarez noted the complaints in Hermes's medical records. Regarding Hermes's initial complaints, Dr. Tavarez testified that:

This 41-year-old male [Hermes] that [sic] was sent to the hospital because of recurrent severe headaches. His headache had gotten so severe especially in the past several days, three to four days, where he feels that he passes out and all of a sudden turns black.

....

He has to grab unto [sic] something for a few seconds and then he feels better. Further, Dr. Tavarez's notes for trial, entitled "Death Summary," indicate that:

[Hermes] has been extremely anxious, he is nervous, complaining that this headache has been severe and he cannot sleep for the past 3 to 4 days. The patient has not slept day and night. He complains that when he goes to the office[,] he was not able to think clearly. He is exhausted. He has been under a lot of pressure. He is very busy. Other than this, the patient did not have any syncopal[³]episode, although he does complain of some tingling sensation sometimes in his face and all his extremities compatible with hyperventilation. This patient has denied any problem with depression, etc. He has never expressed any problem with depression. However, in talking to Dr. Mireles, he also never had any suggestion that the patient was depressed.

Dr. Tavarez admitted Hermes with a diagnosis of "[s]evere recurrent headaches, fatigue, fainting-like spells, and questionable hyperventilation." Dr. Tavarez admitted that Hermes's symptoms warranted hospitalization and noted that the hospital staff would evaluate Hermes further. Dr. Tavarez ordered that Hermes be assigned to a private room in the hospital. Lab work was also ordered, and Hermes was placed on a Holter monitor—a telemetry monitor—because Hermes had complained that his heart was racing and that he was dizzy. An EKG, otherwise known as an electrocardiogram, was also ordered in addition to a daily dose of ten milligrams of Lexapro, an antidepressant medication.

Hermes was then directed to the telemetry unit, where his chest was shaved and five EKG transmitters, which monitor the heart, were placed on his chest. These transmitters relayed information to the nurses' station in the hospital for further evaluation; if the transmitters were ever removed, the equipment would immediately notify the nurses of the disconnection.

Once Hermes was outfitted with the EKG transmitters, Tommy Yee, M.D., a neurologist, visited with Hermes.⁴ After speaking with Hermes, Dr. Yee made notes similar to those of Dr. Tavarez regarding Hermes's symptoms. Dr. Yee noted that there was a family history of schizophrenia, but admitted that Hermes denied being depressed. Dr. Yee recommended that Dr. Tavarez wait on the results of the April 15 MRI conducted by Dr. Mireles to determine further treatment. Dr. Yee prescribed Hermes "a mild anti[-]anxiety medication" ⁵ and suggested that Hermes undergo a psychiatric consultation; however, Dr. Yee stated that the necessity of the psychiatric consultation was left to Dr. Tavarez's discretion.

B. Nurse Gaye Lapura Bergado's Care of Hermes on the Evening of April 17

At 7:00 p.m. on April 17, 2005, Gaye Lapura Bergado, R.N., began serving as Hermes's attending nurse. In her deposition, Nurse Bergado remembered first seeing Hermes walking the halls of the hospital a little before 9:00 p.m. on April 17. Nurse Bergado assessed Hermes's health and noticed that doctors had diagnosed Hermes with "recurrent severe headaches, anxiety, and ... fainting spells or...