Thomas v. Greenview Hosp., Inc., No. 2002-CA-001223-MR.

• Decision Date: 06 February 2004
• Docket Number: No. 2002-CA-001272-MR.,No. 2002-CA-001223-MR.
• Citation: 127 S.W.3d 663
• Parties: Georgia THOMAS (as Executrix of the Estate of Lena M. Rhodes, Deceased), Appellant/Cross-Appellee v. GREENVIEW HOSPITAL, INC. (d/b/a Greenview Regional Hospital), Appellee/Cross-Appellant.
• Court: Kentucky Court of Appeals

127 S.W.3d 663

Georgia THOMAS (as Executrix of the Estate of Lena M. Rhodes, Deceased), Appellant/Cross-Appellee v. GREENVIEW HOSPITAL, INC. (d/b/a Greenview Regional Hospital), Appellee/Cross-Appellant.

No. 2002-CA-001223-MR.

No. 2002-CA-001272-MR.

Court of Appeals of Kentucky.

February 6, 2004.

D. Brian Rattliff, Louisville, KY, for appellant/cross-appellee.

John R. Grise, Scott D. Laufenberg, Bowling Green, KY, for appellee/cross-appellant.

Before BUCKINGHAM, COMBS, and TACKETT, Judges.

OPINION

TACKETT, Judge.

Georgia Thomas, acting as executrix of the estate of Lena M. Rhodes, has brought a direct appeal from the judgment of the Warren Circuit Court following a jury verdict, which awarded her $62,000.00 in medical expenses and punitive damages on a claim of medical negligence against Greenview Hospital, Inc., d/b/a Greenview Regional Hospital. Thomas contends the trial court erred in refusing to grant a new trial based on the admission of alleged improper "habit" evidence and the jury's failure to award any damages for pain and suffering. On the other hand, Greenview Hospital has cross-appealed challenging the sufficiency of the evidence for submission of the punitive damages instruction to the jury, the admission of evidence on the identity of the owner of the hospital, the qualification of Thomas's nursing expert to provide opinion testimony on the treatment of Lena Rhodes's wound condition, and the trial court's failure to limit the evidence on medical expenses to those actually paid to Greenview, rather than the total amount billed. After reviewing the record and the applicable law, we affirm.

In early July 1999, Georgia Thomas's mother, Lena Rhodes, who had been living with Thomas, experienced shortness of breath and anxiety while undergoing kidney dialysis and was admitted to T.J. Samson Community Hospital suffering from pulmonary edema.¹ At that time, Rhodes suffered from numerous medical problems including diabetes, diabetic retinopathy, neuropathy, peripheral vascular disease, hypertension, hyper-glycemia, end stage renal disease, and anemia secondary to renal insufficiency. She required periodic hemodialysis and had had her right leg amputated below the knee. On July 6, 1999, Rhodes was transferred from T.J. Samson Hospital to the acute care unit at Greenview Hospital because the dialysis that she needed was unavailable at T.J. Samson. At Greenview, Rhodes was diagnosed with congestive heart failure secondary to non-compliance with dialysis, hypertension, renal disease, and diabetes. After exhibiting signs of improvement, on July 10, 1999, she was transferred to the transitional care unit (TCU) at Greenview by Dr. Scott Sims, a nephrologist, where she was monitored and received physical therapy and dialysis on an outpatient basis.

On July 12, 1999, Rhodes returned to Greenview's TCU from an off-site kidney dialysis center. She exhibited confusion, stating that she believed she was in her daughter-in-law's house, refused to go to bed, and later was found in another patient's room. In order to allow greater observation, Rhodes was placed in a chair unrestrained next to the nurses' station, but she fell when she rose from the chair and attempted to walk away. Rhodes complained of hip pain upon returning to her room and an x-ray revealed that she had fractured her right hip. On July 13, 1999, Dr. Keith Morrison performed a right hip hemiarthroplasty and Rhodes was placed in the acute care unit. Rhodes tolerated the surgery well but required continued dialysis, so she was transferred back to the TCU on July 21.

Upon her return to the TCU, Rhodes was considered "at risk" for development of bedsores given her poor nutritional status, lack of mobility, and various medical problems. Dr. Sims ordered that she be turned every two hours and as needed, which was consistent with Greenview's own policies and procedures. Drs. Sims and Morrison examined Rhodes upon her readmission to the TCU. A Braden Scale skin risk assessment was conducted for evaluation of appropriate precautions for potential development of pressure ulcers, often referred to as bedsores.

On July 22, 1999, examination by the nursing staff noted erythema (redness) of the coccyx (tailbone). In response to a request by the family, Dr. Sims ordered an airbed mattress, application of a special cream, and placement of a DuoDERM dressing on the coccygeal area. Over the next few days, the skin in the coccygeal area continued to deteriorate, so Bonnie Spears, a registered nurse in the hospital's wound care center, was consulted on July 26, 1999, about the developing ulcer wound. She noted a 30 millimeter by 20 millimeter eschar (scab) with a black center and yellow area suggestive of heavy fibrin and pink granulation tissue at the outer edge. Nurse Spears recommended evaluation by Dr. Timothy Hulsey, a plastic surgeon specializing in wound treatment. Dr. Hulsey noted that Rhodes was anemic and malnourished. He identified a sacral decubitus ulcer or wound approximately 4 centimeters in diameter that appeared to be superficial with a dry eschar. Dr. Hulsey ordered application of a Betadine solution on the sacral wound.

On August 3, 1999, a nurse noted that the sacral decubitus appeared to have worsened to a stage 2 level with black eschar present with an open red area and fluid drainage. The nursing staff allegedly sent a message to the wound care center requesting additional consultation, but Nurse Spears did not see Rhodes again until August 6, 1999. Nurse Spears and Dr. Sims both examined Rhodes. Dr. Sims noted that the decubitus looked bad, but he ordered continuation of the current treatment.

On August 7, 1999, a nurse noted a foul odor and greenish-red drainage from the wound while changing the sacral bandage. Rhodes also was weak and not tolerating her physical therapy well. After discussing Rhodes's deteriorating condition with her family, they decided not to utilize a feeding tube. On August 10, 1999, the family consented to cessation of Rhodes's dialysis treatment. Dr. Sims also ordered a culture of the decubitus and cleansing of the area with antiseptics.

On August 11, 1999, Rhodes was transferred to T.J. Samson Hospital in large part to be closer to her family given the belief that her overall condition was terminal. The sacral decubitus was noted to be at the stage 3 level measuring approximately 17 centimeters by 15 centimeters with a very foul odor. On August 12, 1999, Rhodes died with the cause of death being diagnosed at that time as chronic renal failure.

On July 12, 2000, Thomas filed a civil complaint for negligence by the agents and employees of Greenview Hospital. She requested compensatory and punitive damages. Discovery by the parties included extensive interrogatories, production of documents, and numerous depositions. On February 15, 2002, Greenview filed motions in limine² to prohibit any reference to its parent corporation, Columbia HCA Healthcare, and to limit Thomas's proof on medical expenses to the actual amounts incurred by the estate, rather than the total amounts initially charged and not subject to payment to the hospital because of agreements with healthcare payors such as the federal government through the Medicare program. On February 18, 2002, Greenview filed a motion in limine to limit or exclude the testimony of one of Thomas's proposed expert witnesses, Holly Strader, a registered nurse, under Kentucky Rules of Evidence (KRE) 702. On February 19, 2002, Thomas filed a motion in limine to preclude "habit" testimony concerning whether the nurses had turned Rhodes off her back every two hours to relieve pressure on her sacral area.

On February 28, 2002, the trial court held a hearing on the various motions. On March 6, 2002, the court entered a written order denying Thomas's motion to preclude testimony by the nurses on their routine in rotating or turning Rhodes and denying Greenview's motion to exclude testimony by Holly Strader as an expert witness. The trial court orally granted Greenview's motion on references to Columbia HCA Healthcare except for purposes of inquiries during voir dire and denied Greenview's motion to limit evidence of medical expenses to the amount requested for payment, but the court stated it would entertain a motion from Greenview after the trial to reduce any medical expense awarded by the jury to the amount actually paid or payable to the hospital for purposes of the judgment.

The trial court conducted a jury trial lasting six days between March 13-15, 26-28, 2002. During the trial, Thomas alleged that Rhodes's injury from the fractured hip and the development of the pressure ulcer was a direct result of the negligence of the nursing staff at Greenview. Thomas maintained that the nursing staff breached its standard of care by failing to provide proper supervision to prevent Rhodes's fall, failing to properly assess the potential for the pressure ulcer and take appropriate actions to prevent its development, especially turning or rotating Rhodes at required intervals, failing to obtain appropriate treatment orders, and failing to take the necessary interventions to prevent the ulcer from developing further and becoming worse. Thomas alleged the negligent care resulted in pain and suffering, and ultimately Rhodes's death. Greenview presented testimony that the nursing staff acted properly, and that the development of the pressure ulcer was inevitable because of her various medical problems, declining medical condition, and the failure of several internal systems. Greenview moved for a directed verdict and exclusion of an instruction on the claim for punitive damages because of the lack of evidence, which the trial court denied. The jury returned a verdict finding Greenview negligent and awarded the estate $30,814.03 for medical expenses covering the period between July 10-August 11, 1999, and $31,185.97 in punitive damages, but awarded $0 for mental and physical pain...