Scott v. Ssm Healthcare St. Louis
| Decision Date | 29 January 2002 |
| Docket Number | No. ED 79240.,ED 79240. |
| Citation | 70 S.W.3d 560 |
| Parties | Matthew SCOTT, et al., Plaintiffs/Respondents, v. SSM HEALTHCARE ST. LOUIS, et al., Defendants/Appellants. |
| Court | Missouri Court of Appeals |
David G. Ott, Thomas B. Weaver, Cynthia Sciuto, Armstrong Teasdale, LLP, St. Louis, MO, for defendants/appellants.
W.T. Nolan, Michael D. Stokes, Devereaux, Stokes, Nolan, Rutledge & Fernandez, St. Louis, MO, for plaintiffs/respondents.
Defendant SSM Healthcare St. Louis, d/b/a St. Joseph's Health Care Center in St. Charles ("Hospital") appeals from the judgment in the action of plaintiffs Matthew Scott and his mother, Josephine Scott, against Hospital for medical malpractice. Plaintiffs' claims against Hospital asserted vicarious liability based on the conduct of one of its employees, Dr. Aziz Doumit, and the conduct of Dr. Richard Koch, a radiologist not employed by Hospital but who was found by the jury to be an agent of Hospital. Before trial, plaintiffs settled with Dr. Koch and his employer, Radiologic Imaging Consultants ("RIC"). On appeal, Hospital argues that the trial court erred in (1) failing to rule that the evidence was insufficient to support the jury's finding of agency as to Dr. Koch; (2) failing to apply § 538.230 RSMo (2000),1 rather than § 537.060, as the method for reducing the jury verdict to take into account the settlement with Dr. Koch; (3) allowing the application of more than one statutory damage cap for non-economic damages against Hospital pursuant to § 538.210; (4) denying Hospital's remittitur motion on the damages awarded to Josephine Scott; (5) admitting certain expert testimony; and (6) calculating damages. We affirm.
In 1994 Matthew Scott, then seventeen, sustained serious injuries as a result of a sinus infection that spread into his brain. Matthew was involved in a car accident and was taken to Hospital, where he was treated for minor injuries and released to his father. Two days later Matthew returned to Hospital's emergency room, complaining of a severe headache. Dr. Doumit was Hospital's emergency room physician who examined Matthew that day. Soon after Matthew arrived, a CT scan of his head was conducted. Dr. Richard Koch, a partner in RIC, read the CT film and concluded that the CT scan was normal. Matthew was diagnosed as having a mild concussion from the previous auto accident, was given medication for his headache and sent home.
The next day, Matthew's headache had not improved. His parents called Hospital three times and informed Dr. Doumit that Matthew was lethargic, nauseous and vomiting. Dr. Doumit told them that he was still exhibiting signs of a minor concussion, that he would probably improve within a few days, that they should continue to observe him, but that if they became very concerned about his condition they could bring him back to the emergency room.
Early the next morning, Matthew collapsed in the kitchen, unable to use the right side of his body. He was rushed by ambulance to Barnes Hospital in St. Peters, Missouri. A spinal tap and CT scan revealed an infection at the top of his brain, and his brain was swelling inside his skull. Matthew was taken to Barnes Hospital in St. Louis, where a number of surgeries were performed to remove infected brain tissue and portions of his skull. He remained in a coma for several weeks.
Eventually, after undergoing skull reconstructive surgery and an extensive program of rehabilitation, Matthew was able to achieve a considerable recovery. He also has sustained serious permanent injuries, however, including among others a significant degree of paralysis on the right side of his body, and the requirement of a permanent ventricular drainage tube in his brain.
Matthew and his mother filed this medical malpractice action against Hospital and others, alleging, inter alia, that the negligence of Dr. Doumit and Dr. Koch caused Matthew's injuries. Specifically, plaintiffs alleged that Dr. Koch had acted below the accepted standard of care in misreading the initial CT scan on September 24, and that Dr. Doumit had acted below the standard of care by failing to instruct Matthew's parents, when they called with their concerns, to bring him back to the emergency room. Plaintiffs' suit further alleged that at all relevant times Dr. Koch had been acting as an agent for Hospital, notwithstanding the fact that he was formally employed by RIC, which had contracted to provide radiology services at Hospital. Plaintiffs' action also named Dr. Koch and RIC as defendants. Before trial, plaintiffs settled their claims against Dr. Koch and RIC for the sum of $624,800 (hereinafter, "the Koch settlement"). The case then proceeded to trial against Hospital.
At trial, substantial evidence and the testimony of expert witnesses, including among others radiologists, an infectious disease specialist and the neurosurgeon who treated Matthew at Barnes, supported plaintiffs' allegations of medical negligence.2
The jury found in plaintiffs' favor. It further found that Dr. Koch was Hospital's agent. It assessed Matthew's total damages at $4,445,000, apportioned as follows: $80,000 for past economic damages; $500,000 for past non-economic damages; $600,000 for future medical damages; $1,265,000 for future economic damages excluding future medical damages; and $2,000,000 for future non-economic damages. Josephine Scott's separate damages, all past economic, were assessed by the jury at $500,000. The jury found that Hospital was 25% at fault for the injuries based on the negligence of Dr. Doumit and 75% at fault based on the negligence of Dr. Koch, and that plaintiffs were 0% at fault.
After the verdict, the parties filed various post-trial motions. Hospital's motions sought, inter alia, to have the court determine that only a single statutory cap on non-economic damages applied to Hospital pursuant to § 538.210, and to have the verdict decreased by the percentage of fault (75%) that the jury apportioned to Dr. Koch, pursuant to § 538.230.
In response to the parties' motions, the trial court entered an amended judgment with accompanying explanatory order. The amended judgment reflected several categories of express findings by the court:
1. General
Citing §§ 538.210, 538.230 and 567.060, the court made the general finding that it was required to "enter an appropriate [amended] judgment taking into account equitable shares based on the percentage of fault found by the jury, and taking into account the settlement by Koch as well as the statutory cap on non-economic damages."
2. Applicable Number of Caps on Non-Economic Damages
The court determined that the applicable number of statutory non-economic damage caps in plaintiffs' case, pursuant to § 538.210, was two. The court found that "there were two separate occurrences of malpractice in the instant case, each of which contributed to cause [Matthew's] injuries... and each of which could support the application of a statutory damage cap." Specifically, the court found the two occurrences to be that "Dr. Koch misread the CT film" on September 24 and "Dr. Doumit failed to examine and failed to advise that Matthew return to the Hospital" on September 25. The court thus found that plaintiffs were entitled to recover total non-economic damages of $1,056,000 ($528,000 × 2).3
3. Matthew Scott v. Hospital Based on Negligence of Dr. Doumit
Next, the court found that Matthew had a derivative claim against Hospital based on the negligence of Dr. Doumit, and that Hospital would be vicariously liable for any amount for which Doumit was deemed liable based on his own negligence. The court determined that it was required by §§ 538.230 and 538.210 to (1) reduce both the economic and non-economic damages to Dr. Doumit's equitable share, and then (2) apply the statutory cap to the non-economic damages. Accordingly, the court found that 25% of Matthew's total economic damages was $486,250 and that 25% of Matthew's total non-economic damages was $625,000, but then reduced the latter amount down to the non-economic damage cap of $528,000. The court thus determined that Hospital was liable to Matthew in the amount of $1,014,250 ($486,250 + $528,000) based on the conduct of Dr. Doumit.
4. Matthew Scott v. Hospital Based on Negligence of Dr. Koch
Next, the court determined that Matthew similarly had a derivative claim against Hospital based on the negligence of Dr. Koch. The court found that this claim must (1) be reduced to reflect Dr. Koch's equitable share of fault, and then (2) given a proper offset for the Koch settlement pursuant to § 537.060. (That is, the court found that Hospital was entitled to a set-off, for the Koch settlement, against the amount that it was liable to Matthew based on Dr. Koch's negligence.) The court determined that Dr. Koch's 75% equitable share of Matthew's total economic damages was $1,458,750, and likewise that his equitable share of Matthew's total non-economic damages was $1,875,000. The court next determined that, in order to properly calculate set-off amounts, it must both (a) "allocate the Koch settlement between economic and non-economic damages based on the relationship between these two elements as found by the jury,"4 and then (b) "since the settlement was with both Matthew and Josephine Scott, and since all of the damages awarded to Josephine were economic, the court must also allocate the economic portion of the set-off as between Matthew and Josephine."5
After making these calculations, applying Matthew's share of the economic portion of the Koch settlement as a set-off against Koch's 75% share of Matthew's economic damages,6 applying the non-economic portion of the Koch settlement as a set-off against Koch's 75% share of Matthew's non-economic damages,7 then applying the statutory...
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