Case Title: McKowan v. Bentley

Citation: 773 So. 2d 990

Docket Number: 1971357

State: alabama

Court: Alabama Supreme Court

Date: 1999-08-27T00:00:00Z

Document:
773 So. 2d 990 (1999)
David McKOWAN, M.D., and Timothy G. Day, M.D.
v.
Charles C. BENTLEY.
1971357.

Supreme Court of Alabama.
August 27, 1999.
*991 Richard B. Garrett and William H. Webster of Rushton, Stakely, Johnston & Garrett, P.A., Montgomery, for appellants.
James Harvey Tipler of The Tipler Law Firm, P.C., Andalusia; and David Luther Woodward, Pensacola, Florida, for appellee.
*992 PER CURIAM.
This is a medical-malpractice, wrongfuldeath case filed by plaintiff Charles C. Bentley against defendants David McKowan, M.D., Timothy G. Day, M.D., and Community Hospital of Andalusia, Inc. The claims against the hospital, dismissed before trial, are not before us. Bentley's complaint alleges that Drs. McKowan and Day breached the applicable standard of care in performing gastric bypass surgery on his wife, Nellie Bentley, and in failing to manage her post-operative infection and that these breaches in the standard caused her death. A jury found for the plaintiff and awarded $2 million in damages.
The defendants then filed motions for new trial, judgment notwithstanding the verdict, and remittitur. The trial judge held a hearing on these motions on March 4, 1998, and invited briefs and proposed orders from both parties. On March 19, 1998, he issued the following memorandum:
On the same date, the trial court issued the following order:
The facts of the case are as follows: Mrs. Nellie Bentley, a 48-year-old woman who stood 5'4" and weighed 278 pounds, first sought advice about gastric bypass surgery from Dr. McKowan in January 1993. On March 8, 1993, Dr. McKowan, assisted by Dr. Day, performed Roux-En-Y gastric bypass surgery on Mrs. Bentley to alleviate her morbid obesity. Mrs. Bentley was discharged from the hospital two days later with no indication of any complications. Mrs. Bentley was instructed not to eat anything, but only to drink clear liquids. On March 14, Mrs. Bentley returned to see Dr. McKowan with redness and swelling around her incision. Dr. McKowan removed the sutures and found that Mrs. Bentley had a wound infection. There was no indication that she had an intra-abdominal infection at that time. On March 15, the drainage from her wound changed in character and amount and she was admitted to the hospital. A day later, Dr. McKowan, assisted by Dr. Day, operated on Mrs. Bentley to correct the intraabdominal abscesses that she had developed. The surgeons discovered a leakage of the unhealed anastomosis between the small bowel and the stomach and a large amount of purulent material in the abdominal cavity. Dr. McKowan drained the abscesses, washed out the abdominal cavity, and debrided the fascia back to healthy tissue. Mrs. Bentley was placed in intensive care. Mrs. Bentley was scheduled for re-exploratory surgery on March 17, so that the doctors could see the extent to which the surgery had successfully reduced her infection. Dr. McKowan, assisted by Dr. Day, operated again and found no disruption of the wound site. Dr. McKowan again washed the wound with saline solution and maintained her on appropriate intravenous antibiotics.
*995 On March 18, another follow-up surgery was performed. Following that surgery Mrs. Bentley was placed on a ventilator and began receiving total parenteral nutrition intravenously. On March 22, surgery was again performed on Mrs. Bentley. This time Dr. McKowan cut the front part of the stomach and placed a gastrostomy tube in the lower stomach to serve as a pressure relief outlet. On March 26, purulent drainage was discovered around the gastrostomy tube. The gastrostomy site was repaired. Mrs. Bentley showed some improvement on March 27.
At that point Dr. McKowan went on vacation and Dr. Day took over Mrs. Bentley's care. On March 28, Dr. Day performed surgery to remove purulent material in the abdomen. On May 30, Mrs. Bentley's sister had her transferred to UAB Hospital in Birmingham, where she died.
The plaintiff presented expert testimony from Dr. Gary Kirchner, who testified that Mrs. Bentley died because Dr. McKowan and Dr. Day did not properly manage her post-operative infection. Dr. Kirchner testified that the conduct of both physicians in managing the massive intra-abdominal infection fell well below the legally imposed standard of care in Alabama.
The defendants appeal the judgment of the trial court and argue that several trial court errors require a reversal. We first consider the defendants' contention that the trial court erred to reversal in striking veniremember Agnes Sears for cause. The record reflects that Ms. Sears indicated in her voir dire examination that she was a former patient of Dr. McKowan and that she "didn't see where he could go wrong." The defendants contend that as a result of the trial court's ruling, they were deprived of an otherwise impartial jury member. However, the trial court was merely following the reasoning in Dixon v. Hardey, 591 So. 2d 3, 7 (Ala.1991), wherein this Court stated that the relationship of physician and patient constitutes prima facie evidence of probable prejudice on the part of the veniremember. We find no error as to the trial judge's exercise of his discretion in removing Ms. Sears for cause. Id. at 7.
The defendants also contend that the trial court erred in failing to grant a new trial in light of post-trial testimony that jury member Joan Pittman had failed to respond accurately during voir dire. They argue that Ms. Pittman was asked, along with the other members of the venire, whether she had any "negative feelings" regarding either defendant that would interfere with her ability to give each side a fair and impartial trial, and that she failed to respond that she had had a negative experience with Dr. Day when he failed to remember her as one of his patients shortly after he performed a hysterectomy on her. At the post-trial hearing, Ms. Pittman stated that, although she was bothered that Dr. Day did not know who she was, she did not remember the incident at the time that she was asked the question and therefore did not volunteer the information:
This Court has said that the proper inquiry on a motion for a new trial based on improper or nonexistent responses to voir dire questions is whether the response, or the lack of response, resulted in probable prejudice to the movant. Union Mortgage Co. v. Barlow, 595 So. 2d 1335, 1342-43 (Ala.1992). Not every failure of a prospective juror to respond correctly to a voir dire question will entitle the losing party to a new trial. The question of whether the complaining party was prejudiced by a juror's failure to answer voir dire questions is a matter within the discretion of the trial judge, whose ruling will not be reversed except for abusing its discretion. Id. The trial judge stated in his order that there was no evidence of any impropriety, bias, or prejudice on the part of this juror and that she was qualified to serve as a juror in this case. We find no abuse of discretion here.
The defendants next contend that the trial court erred to reversal in refusing to allow the defendants to rebut the plaintiff's counsel's interjections as to the cost of the medical services rendered by the defendants. They argue that the plaintiff was allowed to inquire into the amount of Dr. McKowan's charges for his care and treatment of Mrs. Bentley, but that the trial court prohibited the defendants from presenting evidence as to the plaintiff's health-insurance coverage to rebut that evidence.
In the course of the trial the defendants offered portions of the deposition of Charles Bentley, widower of Nellie Bentley. At a point in the reading, defendant's counsel offered page 76, line 18, which apparently had to do with the fact that Mrs. Bentley had health-insurance coverage. The plaintiff objected, and the trial judge sustained the objection. The colloquy that occurred with the trial judge reads as follows:
The record does not support the defendants' argument that they were prejudiced by the trial judge's ruling. We find no abuse of discretion here.
The defendants assert that there was insufficient evidence that any alleged breach of the standard of care by Dr. Day proximately caused the injury and death of plaintiff's decedent. However, the record reflects that the physician defendants were business partners. One assisted the other in the surgical procedures. The wrongfuldeath statute makes no provision to apportion damages between tort-feasors. § 6-5-410, Ala.Code 1975. The expert witness reasoned that in the face of a non-healing, massive intraabdominal infection, the procedures done three days running, March 16, 17, and 18, by both physicians fell far below the standard of care as it is announced in Alabama. There is substantial evidence from which the jury could infer from the testimony that both physicians breached the standard of care in their treatment of Mrs. Bentley and the management of her post-operative infection and thereby caused her death.
Finally, the defendants contend that the jury's award of $2 million in punitive damages is excessive. The plaintiff responds that the jury's award of punitive damages was not excessive under the circumstances that the patient was released to go home after only two days in the hospital and was subjected to at least seven *998 additional invasive procedures performed before her death.
The determination of damages in wrongful-death cases is governed by § 6-5-410, which authorizes punitive damages, but does not authorize compensatory damages. Estes Health Care Centers, Inc. v. Bannerman, 411 So. 2d 109, 112 (Ala.1982). Claims that a particular jury verdict awarding punitive damages is excessive and contrary to due-process protections must be reviewed by applying the guideposts set out in BMW of North America, Inc. v. Gore, 517 U.S. 559, 116 S. Ct. 1589, 134 L. Ed. 2d 809 (1996). This Court has reviewed the jury verdict by applying not only the three guideposts set out by the United States Supreme Court in BMW but also the factors set forth in Green Oil Co. v. Hornsby, 539 So. 2d 218, 223-24 (Ala. 1989), and Hammond v. City of Gadsden, 493 So. 2d 1374 (Ala.1986):
(1) Ratio of Punitive Damages to Compensatory Damages: This Court addressed the issue of the applicability of this factor in a wrongful death case in Tillis Trucking Co. v. Moses, 748 So. 2d 874 (Ala.1999),[*] in these words:
The punitive-damage award in this case is not disproportional to the loss of life caused by the defendants' malpractice.
(2) Reprehensibility. The trial judge states in his memorandum that there was no evidence that the doctors were incapacitated, that they were acting out of ill will, that they refused to see or treat Mrs. Bentley, or that they did anything other than try to help Mrs. Bentley and to correct her problems. Further, the plaintiffs expert, Dr. Kirchner, acknowledged at one point in the proceedings the honesty of Dr. McKowan's records. On the other hand, the testimony of the plaintiffs expert was emphatic that the defendants disregarded obvious signs of grave complications; omitted obvious, simple, effective measures for stopping the infection which eventually killed the patient; and repeatedly applied inappropriate measures virtually certain to exacerbate the infection. Two passages from the expert's testimony summarize his opinion:
(3) Similar Civil and Criminal Sanctions: Alabama law does not impose specific limits on the amount that may be recovered in wrongful-death actions. This award is not an unusually large amount in comparison with awards affirmed in other wrongfuldeath cases this Court has reviewed. As this Court noted in Cherokee Electric Cooperative v. Cochran, 706 So. 2d 1188 (Ala. 1997) (a wrongful-death case which affirmed a $3-million judgment), this Court affirmed a $7.5-million wrongful-death verdict against General Motors in General Motors Corp. v. Johnston, 592 So. 2d 1054 (Ala.1992) (arising out of allegations of defects in Chevrolet pickup trucks) and remitted a wrongful-death verdict of $15 million to $10 million in Burlington Northern R.R. v. Whitt, 575 So. 2d 1011 (Ala.1990).
(4) Profitability of Conduct. The trial court notes in his memorandum that there is no evidence that defendants profited from their method of treatment as compared to Dr. Kirchner's suggested treatment.
(5) Financial Position of the Defendant. As the trial judge noted, the defendants presented no evidence that the verdict would harm them financially.
(6) Costs of litigation. The trial judge's memorandum recites that the trial court knew from its experience that the bringing of a medical-malpractice action is very expensive. The defendants' briefs do not challenge this finding.
Considering the facts, the law, and the jury award in light of these six factors, we conclude that the judgment of the trial court, entered on the jury's verdict of punitive damages in the amount of $2 million, is due to be affirmed as is the order of the trial court denying the defendants' post-judgment motions.
AFFIRMED.
*1000 MADDOX, COOK, LYONS, BROWN, and JOHNSTONE, JJ., concur.
HOOPER, C.J., and HOUSTON and SEE, JJ., concur in the result.
HOUSTON, Justice (concurring in the result).
I have not had an easy time adjusting to this Court's interpretation of Ala.Code 1975, § 6-5-410, permitting a plaintiff to recover only punitive damages in a wrongful-death case. See Tatum v. Schering Corp., 523 So. 2d 1042, 1047-63 (Ala.1988) (Houston, J., dissenting). However, the Alabama Legislature, by its actions in 1987 and in 1999, appears to have put its imprimatur on what I thought was this Court's mistaken interpretation of § 6-5-410. See Ala.Code 1975, § 6-11-28 (Ala. Acts 1987, Act No. 87-185, § 10, and Ala. Acts 1999, Act No. 99-3581(j)).
Even so, as I have written, I believe the Constitution of Alabama of 1901 gives a right to recover compensatory damages for wrongful death, independently of § 6-5-410. See King v. National Spa & Pool Institute, Inc., 607 So. 2d 1241, 1253-54 (Ala.1992) (Houston, J., dissenting), in which I concluded as follows:
607 So. 2d  at 1254.
I write all of this, somewhat in frustration, seeking to determine what we must do to assure that the amount of punitive damages awarded in an action brought under § 6-5-410 is not excessive, when the amount of punitive damages is challenged as being unconstitutionally excessive.
In Lance, Inc. v. Ramanauskas, 731 So. 2d 1204 (Ala.1999), we remitted a $13-million award to $4 million in a wrongful-death case brought under Ala.Code 1975, § 6-5-391 (cause of action for wrongful death of a minor), for four reasons:
None of these are Hammond-Green Oil factors or BMW v. Gore factors.
In Tillis Trucking Co. v. Moses, 748 So. 2d 874 (Ala.1999), a wrongful-death action brought under § 6-5-410, we remitted a $7 million judgment to $1.5 million, based upon the financial condition of the defendant and the fact that the trial court's award was considerably higher than the awards in other wrongful-death cases. 748 So. 2d  at 888.
My frustration has to do with my belief that when we are dealing with compensatory damages awarded for harm or injury caused by an actionable wrong, our emphasis must be on assuring that the injured *1001 party is fully compensated for losses caused by the tortfeasor's wrong; however, when we are dealing with punitive damages, our emphasis must be on assuring that the tortfeasor is not punished excessively.
Like the trial judge, based upon the record I would have found for the physician defendants; however, again like the learned trial judge, I must acknowledge that I have no right to find the facts in this case. That right belonged to the jury. So, I accept the jury's finding of fact that the physicians negligently breached the standard of care in dealing with postoperative infection. Even so, I cannot say that their negligent postoperative treatment of infection amounted to a $2-million wrong. However, an award of $2 million no longer shocks my conscience.
The trial court wrote: "[T]he financial position of Defendants is the most important of the Hammond and Green Oil factors. This most important factor weighs heavily in favor of sustaining the verdict for it will have little actual financial impact on Defendants personally, as full insurance coverage has been readily acknowledged."
Is it unconstitutional to punish two negligent defendants by imposing on them a $2-million penalty that is explained or justified on the basis that it will have little actual financial impact on them because they have insurance coverage? I do not know; therefore, I cannot say that the trial court abused its discretion in failing to remit this $2-million punitive-damages award. However, I do know that the "guideposts" of BMW of North America, Inc. v. Gore, 517 U.S. 559, 116 S. Ct. 1589, 134 L. Ed. 2d 809 (1996), do not work when a court is considering the question of excessiveness of a punitive damages award in a wrongful-death case brought under § 6-5-410.
[*]  Note from the reporter of decisions: The Court cited here its January 8, 1999, opinion in Tillis Trucking Co. That opinion was withdrawn November 12, 1999, on application for rehearing; on that date the Court substituted a new opinion. The material quoted here also appears in the substituted opinion.