Title: Burge v. Parker

State: alabama

Issuer: Alabama Supreme Court

Document:

510 So. 2d 538 (1987)
Stephen BURGE and Montgomery Emergency Physicians, P.A.
v.
Ronnie PARKER, a minor, who sues By and Through his mother and next friend, Willie Mae PARKER, and Willie Mae Parker, individually.
85-69.

Supreme Court of Alabama.
June 19, 1987.
*539 Thomas H. Keene of Rushton, Stakely, Johnston & Garrett, Montgomery, for appellants.
Frank M. Wilson and J. Greg Allen of Beasley and Wilson, Montgomery, for appellees.
ALMON, Justice.
In this medical malpractice case, the jury awarded $445,351.00 to the minor plaintiff and $17,500.00 to his mother. The defendants take issue with the judgment entered on these verdicts on the grounds that the damages were excessive and that the plaintiffs were contributorily negligent as a matter of law.
Ronnie Parker injured his foot early on Saturday morning, April 2, 1983, while climbing across a flatcar owned by Seaboard System Railroad. He was taken to St. Margaret's Hospital, where Dr. Stephen Burge treated him in the emergency room. Dr. Burge cleaned, stitched, and bandaged a laceration on the bottom of Ronnie's foot, but took no X-rays. The reports prepared by the firemedic who arrived at the scene of the injury and by the ambulance personnel indicated that the chief complaint was a fracture of the foot. The admitting clerk at the hospital typed on the admission form a statement that he had a possible fracture of the right foot, but a handwritten entry on the form lists the chief complaint as a laceration of the foot.
Dr. Burge sent Ronnie home and told him to keep his foot elevated. Later that day, Ronnie returned to the hospital complaining of continuing pain. His mother, Willie Mae Parker, asked Dr. Burge if he had taken X-rays, and Dr. Burge responded that it was not necessary to take X-rays. The wound was re-dressed, and Ronnie was released with instructions to keep his foot elevated. On Monday, his pain was worse, so his mother called St. Margaret's Hospital. She was told that St. Margaret's was not operating the city's emergency room that day but would again on Tuesday, so she could bring Ronnie then. When she brought Ronnie to the hospital on Tuesday, April 5, he was treated by Dr. Baker, who ordered X-rays, admitted Ronnie to the hospital, and called in Dr. Warner L. Pinchback, Jr., an orthopedic surgeon, for consultation.
Dr. Pinchback diagnosed Ronnie as having compartment syndrome, a swelling of tissues inside the muscle compartments that causes increased pressure on the blood vessels; this increased pressure decreases circulation and tends to cause the muscles to die. Dr. Pinchback diagnosed three fractures from the X-rays. He opened the wound to clean it and removed 100 cc's, or about half a pint, of clotted blood from the wound. On April 7, Dr. Pinchback again cleaned the wound and removed more dead tissue. On April 11, Dr. Pinchback surgically removed Ronnie's big toe. Because Ronnie had lost a significant amount of muscle and skin from his foot, his doctors transferred him to Baptist Medical Center on April 19 for further treatment by Dr. *540 William E. Noblin, a plastic surgeon. Part of Dr. Noblin's treatment was a cross-leg skin graft, which necessitated Ronnie's immobilization in a body cast for 13 days.
The Parkers filed suit against Seaboard System Railroad, St. Margaret's Hospital, Dr. Burge, and Montgomery Emergency Physicians, P.A. It is acknowledged that Dr. Burge was acting as an agent of Montgomery Emergency Physicians when he treated Ronnie. Seaboard System Railroad and St. Margaret's Hospital entered into pro tanto settlements with the Parkers totalling approximately $206,000.00. The case proceeded to trial against the two remaining defendants, who are the appellants here.
The Parkers presented as an expert witness Dr. Steven J. Davidson, a specialist in emergency medicine from Pennsylvania. Dr. Davidson testified that Dr. Burge fell below the standard of care when he failed to review the reports and take an adequate history, when he failed to order X-rays, and when he closed the wound. There was evidence both from Dr. Davidson and from Dr. Pinchback that the wound continued to bleed after Dr. Burge closed it. Dr. Davidson testified that the fractures themselves would cause swelling and bleeding into the foot, which would lead to compartment syndrome, i.e., increased pressure, loss of circulation, and necrosis of the tissues normally supplied by the blood that was cut off.
Dr. Davidson testified that an X-ray would have shown the fractures and that such compound fractures presented a serious risk of infection and required treatment that would stop the bleeding but allow the wound to drain. He testified that he would have recommended consultation with an orthopedic surgeon and hospitalization, and that if the patient had rejected such a recommendation, he would have applied hemostatic pressure dressings and would have given specific instructions to the patient or, in this case, to the parent about caring for and monitoring the wound. He testified that the most crucial period for the proper care is the first 24 hours. Finally, Dr. Davidson testified that if Dr. Burge had followed standard care for this injury, Ronnie Parker's foot probably would have had a full recovery in approximately six weeks and that "if the wound [had not been] closed, he would not have developed compartment syndrome; and therefore, would not have lost his great toe."
Dr. Morris S. White, the owner of Montgomery Emergency Physicians, P.A., testified that in a case such as Ronnie Parker's he would not have closed the laceration if he were aware of the fractures, that he would have consulted an orthopedic surgeon, and that closing the wound created a risk of compartment syndrome. This and other expert testimony in the case was compatible with Dr. Davidson's conclusion that Dr. Burge did not follow the proper standard of care and that, had he done so, Ronnie probably would have recovered fully in approximately six weeks.
Thus, the jury properly could have found that the surgeries performed by Drs. Pinchback and Noblin, the extensive damage to Ronnie's foot, and the pain and suffering attendant to these injuries and these operations were the proximate result of sub-standard care by Dr. Burge. Such findings would bear heavily on the question of whether the jury awarded excessive damages.
The trial court entered a detailed order denying the defendant's motion for judgment notwithstanding the verdict or, in the alternative, for new trial. Because this order is pertinent to the question of whether the jury awarded excessive damages, we set it forth in full here:
Defendants do not take issue with the court's conclusion that they failed to preserve any alleged error with regard to the testimony about loss of earning power; they simply argue that the evidence showed that Ronnie had no significant loss of earning power. Nevertheless, there was evidence of some occupational disability. Furthermore, there was substantial evidence of pain and suffering. Defendants argue against the verdict in this respect by reference to Ronnie's loss as being only that of his big toe and a portion of his foot and by mentioning only the suffering of being immobilized two weeks during the skin graft treatment. They point out that his treating physicians, Drs. Pinchback and Noblin, stated that they could not say that Ronnie would have kept his toe if his treatment had been any different. The jury could have found, however, from Dr. Pinchback's testimony that Ronnie might well have kept his toe had Dr. Burge not closed the wound on the first visit.
At any rate, there was credible evidence that Dr. Burge negligently failed to obtain X-rays and thereby diagnose the compound fractures, and that he therefore administered the wrong treatment. There was credible evidence that this improper treatment caused Ronnie to suffer a great deal more than he would have if the proper treatment had been administered, that it necessitated extensive surgical procedures to remedy the resulting damage, and that his recovery was much more protracted and less complete than if he had been given the proper treatment. Under these facts, we agree with the trial court that the verdict, while high, cannot be said to have resulted from bias, passion, prejudice, or other improper motive.
Jury verdicts are presumed correct, especially when the damages are for pain and suffering, and that presumption is strengthened where the trial court denies a motion for new trial. Blue Star Ready Mix v. Cleveland, 473 So. 2d 497 (Ala.1985); Coca-Cola Bottling Co. v. Parker, 451 So. 2d 786 (Ala.1984). Under the facts of this case, the judgment of the trial court on the verdict and on its denial of the motion for new trial is not due to be reversed, nor is a remittitur due to be granted by this Court.
Defendants argue that judgment should have been granted in their favor because plaintiffs were guilty of contributory negligence as a matter of law. Plaintiffs correctly point out that defendants did not make a motion for directed verdict at the close of all the evidence and did not assert contributory negligence as a ground for granting JNOV or new trial. Defendants do not reply to this argument in their reply brief, so nothing is presented to persuade us that plaintiffs are incorrect in saying that this asserted ground for reversal is not presented for our review. Moreover, the only arguments as to contributory negligence with respect to the claim against these defendants, such as the argument that Ronnie failed to fully inform Dr. Burge of the circumstances of the accident and the argument that he and his mother *543 failed to follow Dr. Burge's instructions for care, present at most fact questions, not evidence of contributory negligence as a matter of law. Therefore, this argument presents no error.
For the foregoing reasons, the judgment is affirmed.
AFFIRMED.
MADDOX, JONES, SHORES and BEATTY, JJ., concur.