Taylor v. Medenica
| Decision Date | 18 September 1996 |
| Docket Number | No. 24528,24528 |
| Citation | 324 S.C. 200,479 S.E.2d 35 |
| Court | South Carolina Supreme Court |
| Parties | Gayle H. TAYLOR and Thomas C. Taylor, Respondents-Appellants, v. Rajko D. MEDENICA, M.D., and Cancer Immuno-Biology Laboratory, Inc., Defendants, of whom Rajko D. Medenica, M.D., is Appellant-Respondent, and Cancer Immuno-Biology Laboratory, Inc., is Respondent-Appellant. . Heard |
Stephen P. Groves and John Hamilton Smith, of Young, Clement, Rivers & Tisdale, LLP, Charleston; David A. Brown, of Aiken; and Hutson S. Davis, Jr., of Davis, Tupper, Grimsley & Seelhoff, Beaufort, for appellant-respondent.
Terry A. Finger, of Finger & Taylor, P.A., Hilton Head Island; Andrew M. Scherffius, Atlanta, GA; and John E. Parker, of Peters, Murdaugh, Parker, Eltzroth & Detrick, Hampton, for respondents-appellants.
M. Dawes Cooke and Matthew H. Henrickson, Barnwell, Whaley, Patterson & Helms, LLC, Charleston, for respondent-appellant.
Respondent-Appellant Gayle H. Taylor (Mrs. Taylor) brought this medical malpractice action against appellant-respondent Rajko D. Medenica (Dr. Medenica) and respondent-appellant Cancer Immuno-Biology Laboratory, Inc. (CIBL) 1 alleging negligence and violation of the South Carolina Unfair Trade Practices Act (the UTPA). 2 Thomas C. Taylor (Mr. Taylor) brought a loss of consortium action against the defendants. Specifically, the Taylors alleged Dr. Medenica recklessly violated the acceptable standard of medical care by including Mitomycin-C (MMC) in Mrs. Taylor's chemotherapy regime, by failing to warn Mrs. Taylor of the potentially fatal side effects of this drug, by failing to obtain Mrs. Taylor's informed consent, by failing to diagnosis Mrs. Taylor's condition, and in causing Mrs. Taylor to undergo unwarranted laboratory tests and studies. Mrs. Taylor alleged CIBL, of which Dr. Medenica is the sole stockholder and medical director, performed and billed her for numerous laboratory tests and studies which it either knew or should have known were unwarranted. She alleged that through this conduct, the defendants violated the UTPA. The defendants denied the material allegations of the complaints.
The jury returned a verdict of $1,000,000 actual damages and $10,000,000 punitive damages on Mrs. Taylor's negligence claim against Dr. Medenica and a verdict of $2,000,000 for Mr. Taylor on his loss of consortium action against Dr. Medenica. The jury returned a $1,000,000 verdict against both defendants on Mrs. Taylor's UTPA cause of action.
After the jury verdict, the trial court granted Mrs. Taylor's motion to reduce the UTPA award from $1,000,000.00 to $543,614.19, which she claimed represented the actual medical bills and family expenses related to her treatment. Finding the defendants had wilfully violated the UTPA, the trial court granted Mrs. Taylor's request to treble the actual damages. 3
Over Mrs. Taylor's objection, the trial court granted the defendants' motion to require her to elect between recovery under negligence or the UTPA. Mrs. Taylor elected to recover under negligence.
In June 1991, Mrs. Taylor was diagnosed with breast cancer and a mastectomy was performed at Hilton Head Island Hospital. At this time Mrs. Taylor was 34 years old and had three young children. After the surgery, hospital doctors suggested Mrs. Taylor contact the hospital oncologist, Dr. Medenica, to determine whether any further treatment was necessary. At their first meeting, Dr. Medenica told the Taylors the removed lymph nodes were negative, indicating the cancer had not spread and while Mrs. Taylor might need some type of further treatment, she would not require chemotherapy.
On July 26, 1991, the Taylors again met with Dr. Medenica. At this appointment, Dr. Medenica stated he had received laboratory reports indicating the tumor was very aggressive and Mrs. Taylor would need six to Dr. Medenica's nurse provided the Taylors with written information on the drugs which would be administered. Regarding MMC, the information stated, in relevant part, as follows:
eight months of chemotherapy. Dr. Medenica informed the Taylors he would treat Mrs. Taylor with a combination of drugs, including MMC. Dr. Medenica assured the Taylors this was standard chemotherapy and Mrs. Taylor would receive the same treatment anywhere. He explained the side effects of this chemotherapy were nausea, vomiting, and hair loss. Dr. Medenica did not mention the chance of contracting a potentially fatal blood disease from the use of MMC.
[c]ommon side effects: decreased white blood cells, bone marrow cells, and platelets three to eight weeks after start of therapy. The drug is relatively well-tolerated! Less common side effects: nausea and vomiting, anorexia ..., hair loss, fatigue, kidney toxicity ... fever. There are medicines that can be given that will minimize some of the above side effects. Most of the above side effects last for a short period of time ...
Mrs. Taylor did not sign an informed consent document.
Mrs. Taylor began chemotherapy at Hilton Head Island Hospital in August 1991. She became ill and her condition became worse through the Fall. Dr. Medenica assured Mrs. Taylor her symptoms were the side affects of the chemotherapy. In January 1992, Dr. Medenica informed the Taylors the cancer was gone and he discharged Mrs. Taylor.
Mrs. Taylor's condition continued to deteriorate. In early February 1992, Dr. Medenica's nurse informed Mrs. Taylor she did not "like the looks" of Mrs. Taylor's last blood test. Mrs. Taylor received two units of blood at the hospital. After the transfusion, Mrs. Taylor felt worse. Two days later, Mrs. Taylor saw Dr. Medenica. He stated she was fine and to continue on the blood pressure medication Dr. Hart, Mrs. Taylor's general practitioner, had prescribed.
On February 10, Dr. Hart admitted Mrs. Taylor into the hospital for two days. Dr. Medenica visited Mrs. Taylor and told her she was feeling the after affects of the chemotherapy and would get better.
Dr. Hart had Mrs. Taylor report to his office every other day. She was swollen, had a continual fever, and high blood pressure. The doctor noted her kidneys were not functioning properly. After conducting more blood tests, Dr. Hart again hospitalized Mrs. Taylor on February 20, 1992.
Dr. Medenica examined Mrs. Taylor in the hospital. He thought she had had a reaction to an antibiotic prescribed by Dr. Hart. Dr. Medenica did not indicate Mrs. Taylor was having a reaction to MMC.
Mrs. Taylor continued to feel worse in the hospital. She was horribly swollen, covered with bruises, had diarrhea, was nauseated, and was weak. A bone marrow aspirant was performed to determine whether the cancer had returned. The results were negative. Dr. Hart contacted Dr. Jon Gockerman, an oncologist at Duke University Medical Center. Dr. Gockerman determined Mrs. Taylor had contracted hemolytic uremic syndrome (HUS). 5 Mrs. Taylor was flown on an emergency basis to Duke.
At Duke, Dr. Gockerman told Mrs. Taylor the HUS was caused by the MMC treatment. Dr. Gockerman told the Taylors not many people survive this disease.
Over the next five months, Mrs. Taylor was a patient at Duke. A permacatheter was surgically placed into her chest and she received 210 plasmapheresis treatments. Mrs. Taylor's kidneys failed and she was placed on dialysis. She had congestive heart failure and was placed in intensive care for several days. Mrs. Taylor had hemorrhages in her eyes, two detached retinas, and lost her sight for six weeks. Mrs. Taylor had bouts of abdominal pain and hypertension. On advice from psychiatrists, Mrs. Taylor's children were brought to Duke and she told them she was going to die.
Mrs. Taylor's kidneys are permanently damaged. Her vision is impaired. Her stamina is limited and she can no longer Three weeks prior to trial, Dr. Gockerman testified Mrs. Taylor was informed her breast cancer had returned in her lungs and liver. Standard methods of treatment will not cure her. Because of the damage to her kidneys, Dr. Gockerman testified Mrs. Taylor is ineligible for very high dose chemotherapy or a bone marrow transplant. Dr. Gockerman testified Mrs. Taylor will die from the cancer.
participate in activities she previously enjoyed.
Dr. Gockerman agreed Mrs. Taylor's breast cancer should have been treated with adjuvant chemotherapy, but testified there are defined adjuvant treatment plans which should have been used. 6 Dr. Gockerman stated he knows of no literature which recommends the use of MMC in an adjuvant chemotherapy setting and it is only used in late breast cancer when standard therapy has failed. Dr. Gockerman concluded Dr. Medenica violated the standard of care by treating Mrs. Taylor with MMC.
Dr. Gockerman further testified Dr. Medenica violated the standard of care by failing to observe the common signs and symptoms of developing HUS in Mrs. Taylor. According to Dr. Gockerman, because Dr. Medenica was treating her with MMC, he should have diagnosed Mrs. Taylor as suffering from HUS during her first hospital admission in early February 1992.
The Taylors' four other expert witnesses offered similar testimony. Dr. Worta McCaskill-Stevens, Dr. Robert Smith, Dr. Howard Ozer, and Dr. Herbert Rappoport testified the MMC therapy caused Mrs. Taylor's HUS, there are no scientific studies or literature which support the use of MMC in the adjuvant treatment of breast cancer, and use of MMC violated the generally accepted standard of medical care. They testified Dr. Medenica's failure to obtain Mrs. Taylor's informed consent was a further violation of the standard of care.
One expert, Dr. Ozer, testified he had had a conversation with Dr. Medenica in September 1992. During this conversation, Dr. Medenica stated MMC was too aggressive and he would probably not use it to treat other patients with similar breast cancer in the future.
Dr. Medenica agreed the accepted standard...
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