Whittington v. Episcopal Hosp.

• Decision Date: 12 February 2001
• Citation: 768 A.2d 1144
• Parties: Jackie P. WHITTINGTON, administratrix of the estate of Claudette E. Milton, deceased, and Kadijah Nicole Woods, individually, in her own right, Appellees, v. EPISCOPAL HOSPITAL, Appellant.
• Court: Pennsylvania Superior Court

768 A.2d 1144

Jackie P. WHITTINGTON, administratrix of the estate of Claudette E. Milton, deceased, and Kadijah Nicole Woods, individually, in her own right, Appellees, v. EPISCOPAL HOSPITAL, Appellant.

Superior Court of Pennsylvania.

Argued September 19, 2000.

Filed February 12, 2001.

Anna Marie S. Bryan, Philadelphia, for appellant.

Emmanuel O. Iheukwumere, Philadelphia, for Wittington, appellee.

Before McEWEN, President Judge, CAVANAUGH, J. and CIRILLO, President Judge Emeritus.¹

CAVANAUGH, J.:

¶ 1 Episcopal Hospital appeals from the December 21, 1999, order of the trial court which denied its motion for post-trial relief requesting judgment notwithstanding the verdict ("JNOV") or, in the alternative, a new trial and granted appellees' motion for entry of judgment on the jury's verdict as molded by the court to reflect the addition of delay damages. Upon review, we affirm.

¶ 2 This case results from the death of appellees' decedent, Claudette E. Milton, from a medical condition known by all of the following titles: pre-eclampsia, toxemia, or pregnancy induced hypertension ("PIH"). The facts seen most favorably to appellee in accordance with our review are as follows:

¶ 3 The decedent became pregnant and throughout her pregnancy was treated by Dr. Carol Allen, a specialist in obstetrics and gynecology, who was practicing at Episcopal Hospital and at Vanguard OB/GYN Associates in Philadelphia. Decedent was also treated at Episcopal Hospital by Episcopal's resident physicians and nursing staff.

¶ 4 On December 15, 1993, decedent saw Dr. Allen for her continuing pre-natal care. An evaluation of decedent indicated that her blood pressure was elevated. A urine dipstick test also indicated a +2 proteinuria. Dr. Allen ordered a non-stress test ("NST"), biophysical profile, and another blood pressure check at Episcopal Hospital after which decedent was to be released. Decedent went to Episcopal Hospital on the same day where resident physician Dr. DeSilva performed the NST and checked her blood pressure. Additionally, decedent complained of lightheadedness, abdominal swelling, heartburn, and leg pain. Dr. DeSilva ordered a PIH work-up and, consistent with decedent's symptoms, diagnosed her with PIH. Notwithstanding the PIH diagnosis and the need to have labor induction initiated immediately, Dr. DeSilva sent decedent home with only a prescription for iron supplements, which did not relate to the treatment of PIH. No one at Episcopal advised decedent of the risks of PIH, even in light of a documented family history of PIH.

¶ 5 On December 22, 1993, decedent again visited Dr. Allen, this time with complaints of irregular contractions. Her cervix was 1cm dilated and fifty percent effaced. Dr. Allen ordered a NST and urine dipstick at Episcopal Hospital after which decedent was to be released. The NST and urine dipstick were performed that day by Episcopal's nurses and physicians. The dipstick was again +2 proteinura, while the blood pressure checked 170/100. Laboratory tests were not ordered. Notwithstanding the clearly elevated blood pressure and dipstick results, which should have mandated the immediate initiation of labor induction, Episcopal's staff neither admitted Ms. Milton, nor even questioned Dr. Allen's instructions that she should go home and wait until December 23, 1993 for labor induction. Further, Episcopal's staff did not apprise decedent of any dangers she may have been facing due to PIH despite her diagnosis on December 15, 1993, and her elevated blood pressure both on December 15, 1993 and on December 22, 1993.

¶ 6 On December 23, 1993, decedent arrived at Episcopal Hospital for induction of labor and, according to the testimony of the nurse on duty and the nursing note, was admitted 7:30 a.m. Upon admission, decedent was kept in a waiting room known as PM6 until 9:00 p.m. instead of being admitted immediately to the labor and delivery room as provided for by Episcopal's policy. At the time of admittance, Episcopal's resident physician, Dr. Ellen G. Wood, noted that decedent had a family history of PIH and that she was complaining of a headache but ordered no lab work. While in PM6, decedent should have been thoroughly evaluated every three to four hours but was essentially ignored for close to 14 hours.

¶ 7 At 9:00 p.m., decedent, still in the waiting area, complained of headaches and her blood pressure elevated to 181/100. At this time, she was finally transferred to labor and delivery for induction. Once in labor and delivery, the resident physician and nursing assessments showed consistently elevated blood pressure throughout the night but blood pressure lowering drugs, essential for her condition, were not ordered until approximately 7:00 a.m. the next morning. However, decedent did not receive the prescribed drugs until 8:40 a.m. By this point, decedent's condition had deteriorated.

¶ 8 At or about 11:30 a.m. on December 24, 1993, Ms. Milton was rushed to the operating room for an "emergency" C-section. However, the procedure was delayed for at least an hour and performed under clearly unfavorable conditions. Despite her obesity and severe pre-eclampsia, Episcopal's obstetrical physicians and nurses did not order the necessary deep vein thrombosis prophylaxis, such as the initiation of heparin therapy or even put antithrombin hoses on decedent. This omission resulted in the formation of blood clots in decedent's lungs and onset of pulmonary edema, a complication of severe preeclampsia accompanied by the filing of the lungs with fluid.

¶ 9 Decedent briefly regained consciousness following her C-section, but soon thereafter her condition deteriorated, resulting in her being placed on a ventilator. Decedent was transferred to the intensive care unit ("ICU") but remained under the care of the OB/GYN division, which violated another hospital policy. While in the ICU, decedent initially improved then deteriorated again. Throughout her stay in the ICU, decedent's endotracheal tube was consistently malpositioned. Moreover, decedent was not diagnosed with multiple pulmonary emboli, and Episcopal's residents and nurses again failed to timely order the appropriate deep thrombosis prophylaxis. Decedent developed Adult Respiratory Distress Syndrome ("ARDS") and died on January 4, 1994 at the age of 26.

¶ 10 The medical care surrounding decedent's pregnancy and death led appellees to institute litigation in December of 1995, naming Episcopal, all non-Episcopal medical personnel who attended to decedent at either Episcopal Hospital or at Vanguard Associates, decedent's insurance provider, and the insurer's medical quality control management organization as defendants. Prior to trial, some defendants were dismissed, and appellees entered into a joint tortfeasor release with all of the remaining defendants except Episcopal.² The trial court allowed the jury to hear evidence relating to decedent's entire course of medical care in order to render a verdict apportioning total responsibility among Episcopal and the settling defendants. In July of 1999, an eight day jury trial culminated in a verdict in favor of the appellees in the sum of $1,100,000 which was comprised of a $200,000 award in a wrongful death action and a $900,000 award in a survivor action. The jury apportioned liability as follows: Episcopal Hospital, fifteen percent (15%) directly liable for corporate liability and ten percent (10%) for vicarious liability.³ Thus, the verdict, as molded, against Episcopal Hospital aggregated $275,000 ($50,000 as the wrongful death action and $225,000 as to the survival action).⁴

¶ 11 Episcopal filed a motion for post-trial relief requesting JNOV or a reduction of its pro-rata share of the verdict in relation to its apportionment for corporate liability. Alternatively, Episcopal requested a new trial. Appellees also filed a post-trial motion which requested entry of judgment with delay damages. On December 20, 1999, the trial court denied appellant's motion in its entirety, awarded appellees the requested delay damages molding the verdict appropriately, and entered judgment in favor of appellees in the amount of $339,050.24.

¶ 12 From the entry of judgment, appellant filed this instant appeal on January 20, 2000. On March 30, 2000, appellant filed an application for remand for amendment of judgment and to stay briefing schedule with this court. This court denied appellant's application for remand by order on May 8, 2000.⁵

¶ 13 Appellant has raised the following issues, verbatim, for our review:

I. Whether Episcopal Hospital is entitled to a judgment notwithstanding the verdict as to Plaintiff's corporate negligence claim because the testimony of Plaintiff's obstetrical expert failed to establish a prima facie case of corporate negligence?

II. Whether Plaintiff's obstetrical expert was qualified to render opinion testimony against the Hospital as to its alleged corporate negligence?

III. Whether a new trial is required because the Trial Court allowed the Plaintiff's obstetrical expert to render an opinion testimony as to the Hospital's corporate negligence?

IV. Whether Plaintiffs are entitled to recover the excess $75,000 verdict returned against Episcopal Hospital where they executed a Joint Tortfeasor Releasing the Hospital's excess insurer, the CAT Fund, from further recovery, the Hospital is not a party to the release and therefore, did not consent to or have knowledge of the CAT Fund's release of liability, and the Plaintiffs accepted money from the CAT Fund under the release?

¶ 14 Episcopal's primary contention is that appellees failed to make out a prima facie case of corporate negligence; therefore, Episcopal contends that it is entitled to judgment notwithstanding the verdict. Our standard of review is well settled and is as follows:

We will reverse a trial court's denial of a judgment notwithstanding the verdict ("JNOV") only when we find an abuse of discretion or an error

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