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Saint Joseph Healthcare, Inc. v. Thomas

Court of Appeals of Kentucky

December 6, 2013



BRIEF FOR APPELLANT: Robert F. Duncan Lexington, Kentucky

ORAL ARGUMENT FOR APPELLANT: Robert F. Duncan Lexington, Kentucky

BRIEF FOR APPELLEES: Elizabeth R. Seif, Charles A. Grundy, Jr., Darryl Lewis





Following a prior appeal, this Court remanded this matter to the Fayette Circuit Court for a new trial on punitive damages against the Appellant, St. Joseph Healthcare, Inc., d/b/a St. Joseph Hospital ("the Hospital"). At the conclusion of that trial, the jury awarded punitive damages against the Hospital in favor of the Appellee, Larry O'Neil Thomas, as Administrator of the Estate of James "Milford" Gray, ("the Estate"). The Hospital now appeals from orders by the Fayette Circuit Court denying its motion for a directed verdict on the Estate's punitive damages claim, and on its post-judgment motions for a judgment notwithstanding the verdict (JNOV) and for a new trial.

The Hospital argues that a directed verdict was appropriate because the Estate failed to present sufficient evidence that it ratified the conduct of its employees or that the conduct amounted to gross negligence. The Hospital also argues that it was entitled to a new trial based upon misconduct of a juror, errors in the instructions, and the jury's excessive award of punitive damages. With respect to the directed verdict issue, we conclude that the Estate presented sufficient evidence of ratification and gross negligence to submit the matters to the jury. In addition, we find that the trial court did not abuse its discretion by denying the Hospital's motions for a new trial. Hence, we affirm.

I. Facts and Procedural History

In our prior opinion, we set out the facts of this case as follows: The parties vigorously disagree about the facts of this case. However, they agree that James Milford Gray, age 39, arrived at the emergency room of the Hospital on April 8, 1999, at 8:08 p.m. He was complaining of abdominal pain, constipation for four days, nausea and vomiting. He was seen by Physician's Assistant Julia Adkins and Dr. Barry Parsley. He received medication for pain and later received an enema and manual disimpaction of his colon. Although lab tests were ordered, either Gray refused to cooperate, or upon reorder, they were never conducted. Likewise, no x-rays were conducted.

Gray was discharged at 12:40 a.m. on April 9, 1999. He was taken by ambulance to the homes of different family members with whom he had previously stayed. However, no family member agreed to provide a place to stay, so he was returned to the Hospital. Upon his return to the emergency room, the Hospital made arrangements for Gray to stay at the nearby Kentucky Inn.

Gray returned to the Hospital at 5:25 a.m. after the staff of the Kentucky Inn contacted 911 on his behalf. He had been vomiting dried blood for several hours. He was again seen and evaluated by both Adkins and Dr. Parsley. Lab tests and x-rays were conducted during this visit. Subsequently, he was discharged by Dr. Jack Geren at 12:15 p.m.

However, Gray died later that day at a family member's home. The autopsy report listed the cause of death as purulent peritonitis caused by a rupture of a duodenal ulcer due to duodenal peptic ulcer disease. The autopsy report also listed constrictive atherosclerotic coronary artery disease as a contributory cause of Gray's death.

Gray's Estate brought this action on April 8, 2000, alleging medical negligence against the Hospital, Dr. Joseph Richardson (a physician who treated Gray during an earlier visit to the Hospital on March 9, 1999), Dr. Parsley, Dr. Geren, Physician's Assistant Adkins, and several members of the nursing staff. In addition, the Estate alleged that the Hospital violated the Emergency Medical Treatment and Active Labor Act ("EMTALA"). After a lengthy period of discovery, the matter proceeded to trial on October 3, 2005. However, that trial ended in a mistrial.

Prior to the second trial, the Estate settled with Drs. Richardson, Parsley, and Geren. The matter then proceeded to a jury trial on the claims against the Hospital on November 7–9, 14–17, and 21–23, 2005. The jury returned verdicts for the Estate on both the medical negligence and the EMTALA claims. The jury apportioned fault as follows: 15% to the Hospital; 0% to Dr. Richardson; 30% to Dr. Parsley and Physician's Assistant Adkins; 30% to Dr. Geren; and 25% comparative fault to Gray. The jury awarded compensatory damages of $25, 000, of which the Hospital's share was $3, 750. The jury also assessed punitive damages against the Hospital in the amount of $1, 500, 000.

Thereafter, the Hospital filed motions for a judgment notwithstanding the verdict and for a new trial. The trial court denied the motions with respect to the jury's findings of liability and the award of compensatory damages. However, the court concluded that the award of punitive damages was clearly excessive and therefore a new trial on that issue was in order.

The Hospital and the Estate each filed an appeal from the trial court's order. In its cross-appeal, the Hospital argued that it was entitled to a directed verdict on the Estate's EMTALA and negligence claims, that the Estate's claim for unliquidated damages should have been dismissed because it failed to disclose the amount of such damages it was seeking, and that it was entitled to a new trial based upon the Estate's misconduct at trial and other trial errors. The Hospital also argued that the issue of punitive damages should not have been submitted to the jury, or, in the alternative, that the jury instructions regarding punitive damages were inadequate. In its direct appeal, the Estate argued that the award of punitive damages was not excessive and therefore the Hospital was not entitled to a new trial on this issue.

This Court affirmed the trial court in part, reversed in part, and remanded for a new trial on the issue of punitive damages.[1] This Court found that the EMTALA and negligence issues were properly presented to the jury with proper instructions. We also found that the Estate sufficiently supplemented its response regarding unliquidated damages following the first trial, and we concluded that the Hospital was not entitled to a new trial on the EMTALA and negligence claims. This Court further found that the trial court properly set aside the punitive damages award as excessive. However, we further concluded that the instructions on punitive damages were deficient. We directed that the punitive damages instructions on remand must set out the standard of proof and require proof that the Hospital ratified the employee's conduct.

The Hospital and the Estate each filed motions for discretionary review. The Kentucky Supreme Court granted the Hospital's motion. Thereafter, the Supreme Court remanded the action to this Court for reconsideration in light of its recent opinion in Martin v. Ohio County Hospital Corp., 295 S.W.3d 104 (Ky. 2009). On remand, this Court concluded that the facts of Martin were distinguishable and that the law set out involved a different aspect of an EMTALA claim than was presented here. This Court also reaffirmed its prior holdings regarding punitive damages and remanded the matter to the trial court on that issue. Thomas v. St. Joseph Healthcare, Inc., 335 S.W.3d 460 (Ky. App. 2010).

The case returned to the circuit court for a new trial on punitive damages, which commenced on February 6, 2012. At the close of the Estate's case, the Hospital moved for a directed verdict, arguing that the Estate had not produced sufficient evidence of gross negligence or ratification. The trial court denied this motion and the Hospital renewed its motion for a directed verdict at the close of proof.

On February 29, 2012, the jury returned a verdict in favor of the Estate and awarded punitive damages in the amount of $1, 450, 000. The Hospital filed a motion for JNOV on grounds of insufficiency of the evidence supporting an award of punitive damages. The Hospital also moved for a new trial, arguing that the award was excessive and based upon other alleged errors during trial. The trial court denied both motions and this appeal followed. Additional facts will be set out later in the opinion as necessary.

II. Directed Verdict

a. Standard of Review

The Hospital first argues that it was entitled to a directed verdict because the Estate failed to meet its burden of proof on two controlling issues: ratification and gross negligence. In Daniels v. CDB Bell, LLC, 300 S.W.3d 204 (Ky. App. 2009), this Court stated the appropriate standard of review of a ruling on a motion for a directed verdict:

When a directed verdict is appealed, the standard of review on appeal consists of two prongs. The prongs are: "a trial judge cannot enter a directed verdict unless there is a complete absence of proof on a material issue or if no disputed issues of fact exist upon which reasonable minds could differ." Bierman v. Klapheke, 967 S.W.2d 16, 18–19 (Ky. 1998). "A motion for directed verdict admits the truth of all evidence which is favorable to the party against whom the motion is made." National Collegiate Athletic Ass'n By and Through Bellarmine College v. Hornung, 754 S .W.2d 855, 860 (Ky. 1988), citing Kentucky & Indiana Terminal R. Co. v. Cantrell, 298 Ky. 743, 184 S.W.2d 111 (1944).
Clearly, if there is conflicting evidence, it is the responsibility of the jury, the trier of fact, to resolve such conflicts. Therefore, when a directed verdict motion is made, the court may not consider the credibility or weight of the proffered evidence because this function is reserved for the trier of fact. National, 754 S.W.2d at 860 (citing Cochran v. Downing, 247 S.W.2d 228 (Ky. 1952)).
In order to review the trial court's actions in the case at hand, we must first see whether the trial court favored the party against whom the motion is made, including all inferences reasonably drawn from the evidence. Second, "the trial court must determine whether the evidence favorable to the party against whom the motion is made is of such substance that a verdict rendered thereon would be 'palpably or flagrantly' against the evidence so as 'to indicate that it was reached as a result of passion or prejudice.' " If the answer to this inquiry is affirmative, we must affirm the trial court granting the motion for a directed verdict. Id.
Moreover, "[i]t is well argued and documented that a motion for a directed verdict raises only questions of law as to whether there is any evidence to support a verdict." Harris v. Cozatt, Inc., 427 S.W.2d 574, 575 (Ky. 1968). Further, "a reviewing court cannot substitute its judgment for that of the trial judge unless the trial judge is clearly erroneous." Bierman, 967 S.W.2d at 18.

Id. at 215.

b. Ratification

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