I N T H E SUPR EM E C O UR T O F M I SS I SS I PPI NO. 2 0 0 6 - CA- 0 1 6 9 7 - S CT W I L L I AM A. CA US

EY , M . D.
v. RE I T HA S AN DERS , I NDI VI DUA L L Y A ND ON BEH ALF O F ALL W

RO NG FU

L DE ATH BENEFICI

ARI ESOF ERS

EL A LL EN
D A T E O F JU D G M E N T : 08/ 15/ 2006 TRI AL J UD GE: HO N. TOM I E T. GR EEN COURT F ROM W HI CH APP EAL ED: HI NDS COUNTY CI RCUI T COURT AT T OR NE YS F OR AP P E L L ANT : J OS E P H L
. M c NAMARA S TE P HAN I E CAS E E DGA R J OHN MI CH AE L CO L E M AN ATTO RN EYS FOR A PP ELLEE: RI CH AR D A RTH UR FREES E DEN NI S C. SW EET DAN I EL F
. M ARS NA TUR E OF THE C ASE: CI VI L - W RO NG FUL D EATH DI S P OS I T I ON: AF F I RMED I N P AR T ; RE VE RS E D AND R E N D E R E D I N PA R T - 10/ 23/ 2008 M OT I ON F OR RE HE AR I NG F I L E D: M ANDAT E I S S UE D:

B E F O R E W A L L E R , P . J. , D I C K I N SO N A N D R A N D O L P H , JJ. RAN DO LPH, J UST I CE, FOR TH E COU RT: ¶1. E r s el A l l en ( “A l l en”) , a 66-year- old f em al e, w as adm i t t ed to the U niver s i ty of M i s s i s s i ppi M edi cal C ent er( “U M C ”) on A pr i l 27, 2001. D oct or s atU M C di agnos ed A l l en
w i th an i noper abl e tum oratthe hea d of herpancr eas and s ever e chr oni c obs truct i ve pul m onary di s eas e.

### 2

¶2. A f

t erf or ty- s i x days a tU M C , A l l en’ s f ami l y w as a dvi s ed heri l l nes s w as t erm i nal and thats ur gery w as notan advi s abl e opt i on. H erp rognos i s f r om U M C r ead thatA l l en “ha s decl i ned si gni f

i cant l y duri ng herhospi t al st ay and he rdepende nce on the s t af f has es cal at ed pr eci pi t ous l y. She has had the opt i m um ther apy f orhe ri l l nes s and i s now r equi r i ng pal l i at i ve
car e. ” U M C re comm ended thatA l l en be tr ans f err ed t o a hospi ce f

aci l i ty. I tw as det erm i ned thatA l l en w oul d be bes ts ui t ed f ora hospi ce f

aci l i ty ra thert han i n- hom e hos pi ce c ar e. A l l en
w as admi t t ed t o H os pi ce M i ni s tr i es , Inc
. (“ H os pi ce” ) i n M adi s on, M i s s i s s i ppi , on June 12, 2 0 0 1
. ¶3. T o be admi t t ed t o H os pi ce, a pat i ent m us t have a t erm i nal progn os i s w i th expec t ed
su rviv al of less tha n six m o n ths. A stat em en t, ex ec u ted b y D r. W ill iam C a u sey , (“D r. C aus ey”) , then the M edi cal D i r ect orof H os pi ce M i ni s tr i es , and a U M C phys i ci an ce r t i f i ed that A l l en w as “t erm i nall y i l l w i th a li fe exp ect ancy o f si x (6) m on ths o r l ess, if the d i sease f ol l ow s i t s norm al cour s e. ” The adm i s s i on agr eement , s i gned by A l l en’ s daught er , s t at ed the p ri m ary go al of H o sp ice w as to p rov ide p ain m an ag em en t and p all iat ive c are . A n intak e fo rm inclu d ed a d iagn o sis of p an cre ati c c an ce r. ¶ 4
. B a se d o n U M C ’s d iag n o s is a n d re c o rd s , D r. C a u se y tre a ted A llen a s a p a n c re a tic
canc erpat i ent , al though bi ops i es per f orm ed on M ay 7 and M ay 15 atU M C w er e nega t i ve f orcanc er . D r . C aus ey, w i th the as s i s t ance of H os pi ce nur s es and i t s pharm aci s t , det erm i ned the dosa ge l evel s of pa i n m edi cat i on t o be admi ni s t er ed t o A l l en. M orphi ne w as admi ni s t er ed b y U M C for p ain c o n tr o l, an d itw as c o n ti n u ed b y H o sp ice u n ti l July 6 , 2 0 0 1 , w h en D r.

### Dil audi d i s an opioi d f or pain. Various witne ss es t es ti fi ed it s potency was four to 1 

### seventimes that o f morp hin e. “Hydromor

phone”was use d int erchangea bly with “ Dil audi d” throughout trial and 2 

### is thegene ri c t er

m f or the dr ug. 3 C aus ey pr es cr i bed D i l audi d. T he i nt er di s ci pl i nary t eam led by D r . C aus ey atH os pi ce 1 al t er ed A l l en’ s m edi cat i on f r om m orphi ne t o hy dromorphone, s eeki ng t o r educe naus ea. 2 C a u se y tes tified th a t th e d o sa g e s o f h y d ro m o rp h o n e w e re in c re a se d in c re m e n tly d u e to A llen ’s c o n tin u e d c o m p lain ts o f p a in . T h e p rin c ip a l fa c to r in c h a n g in g d o s a g e s o f p a in
r el i everw as the degr ee of pai n r el i ef

bal ance d agai ns te xces s i ve s edat i on ors uppr es s i on of
r es pi r at ory act i vi ty. H ow ever , D r . C aus ey f ur thert es t i f

i ed, A s [ A l l en] gotw eake rand w eake r , s he w as aw ake l es s . A nd duri ng thatt i m e, s he w as notgi ven any e xtr a dos es of orbol us es of

the D i l audi d. A s s he got w eaker and beca m e l es s r es pons i ve, w e obs erved herm or e cl os el y and tr i ed to li m itthe a m o u n t of D il au d id sh e w as g ett ing so tha t D il au d id it self w o u ldn ’t b e th e re a s o n fo r h e r b e in g m o re u n re s p o n s iv e o r m o re p o o rl y re s p o n s iv e . ¶5
. O n Jul y 20, 2001, A l l en di ed. A n a ut op s y was pe r f ormed. The pa tho l og i s t w ho per f orm ed the au t ops y t es t i f i ed thatal though the aut ops y r evea l ed thatA l l en had hypert ens i ve heartdi s eas e, cor onary ar t ery di s eas e, and em phys ema, ther e w as no evi dence thatA l l en had pan crea t i c ca ncerand s he had be en mi s di agnos ed. T he pathol ogi s tf ur ther t es t i f i ed thatt o “a r eas onabl e degr ee of pr of es s i onal cert ai nty ther e w as an overw hel m i ng leth al do se o f D il au d id . .
. b ase d o n the to x icolo g y rep o rt ” a n d that A ll en h ad d ied o f a
m as s i ve dose of

hydr om orphone. T he pathol ogi s tt es t i f i ed that6, 900 nanogr ams, the amount f ound i n A l l en’ s s ys t em , w as a t oxi c amountand thathe had ne vers een thatamounti n a h u m a n b e in g . A lo n g w ith o th e r w itn e ss e s, a re tain e d e x p e rt fo r th e D e fe n d a n t, D r. M e lv in G i t l i n, t es t i f

i ed thatthe aut ops y di d notr evea l ga l l s t ones , pancr eat i c ca ncer , a tum oratthe

### 4

head of the panc r eas , orbl ockage s i n the bow el , a l l c ondi t i ons ori l l nes s es f orw hi ch A l l en
w a s tr e a te d a t U M C
. ¶6. D r . Cause y a nd w i tnes s es he pr es ent ed pos i t ed that r egar dl es s of w hether A l l en had p a n c re a tic c a n c e r, sh e still h a d a life e x p e c tan c y o f le ss th a n six m o n th s . D r. D a v id D uddl es t on, an expe r tforD r . C aus ey, t es t i f i ed t o s ame. Fur therm or e, i tw as hi s pos i t i on that ther e i s no m axi m um l i m i ton the dos age of D i l audi d f ora pat i enti n hercondi t i on and f i nal l y, thatA l l en di d notdi e f r om a D i l audi d over dos e, butr atheras the r es ul tof var i ous dis ease processes. P ROCE DURAL HI S TORY ¶7. A l l en’ s daught er , R ei tha Sander s ( “Sander s ”) , f i l ed s ui t . A n amended compl ai nt w as l at erf i l ed. T he def

endant s w er e: ( 1) U M C ; ( 2) M ark W i l l i ams, M D ; (3) Phi l M cC l us key, M D ; ( 4) W i l l i am C aus ey, M D ; ( 4) D
. D ani el , R N ; ( 5) H os pi ce M i ni s tr i es , I nc. ; ( 6) H os pi ce of C entr al M i s s i s s i ppi , I nc. ; and ( 7) J ohn D oes 1- 10. The a m ended compl ai nts t at ed thatbut forthe m i sdi agn oses m ade atU M C , A l l en w ou l d n ot have b een sen tt o H ospice M i nis tri es, wh e r e s h e wa s g i v e n a n o v e r d o s e o f Di l a u d i d
. T h e a me n d e d c o mp l a i n ta v e rr e d b o th UM C and H os pi ce w er e negl i genti n thei rtr eatm entof A l l en, a nd f

ur ther , thatU M C and H os pi ce act ed i n gr os s di s r egar d f orthe r i ght s and s af

ety of A l l en. Sander s r eques t ed j udgm ent
a g a in s t a ll d e fe n d a n ts, jo in tly a n d /o r se v e ra lly a n d so u g h t co m p e n sa to ry , inc id e n tal,
cons equent i al and puni t i ve dam ages . A sepa r at e ans w erw as f i l ed on beha l f

of U M C , w hi ch cl ai m ed i m m uni ty underthe M i s s i s s i ppi Tor tCl ai m s A ct . D r . C aus ey f i l ed an a ns w ers t at i ng h e w a s n o t n e g lig e n t an d th a t h e h a d tre a ted A lle n w ith “ su c h re a so n a b le d ili g e n c e , sk ill , c o mp e t e n c e a n d p ru d e n c e a s p r a c t i c e d b y mi n i ma l l y c o mp e t e n tp h y s i c i a n s i n th e s a me

### Dr. C auseywas n ot p resent at trial, as h e was at th e time of trial an dc urr ently is, 3 

### inc arce rate d at a fe deralc orrec ti ons fa ci lity. Dr
. Caus ey was convi ct ed in a Loui si ana fe deral court andis servin g a tw enty -five-y ear senten ce. Dr
. Cau sey testifiedbydep ositio n. H is absen ce from th e pro ceedin gs is n ot at issu e in th is app eal. 5 s peci al ty or gene r al f

i el d of pr act i ce thr oughoutthe U ni t ed St at es . ” A s epar at e ans w erw as f i l ed on beha l f

of D ani el and H os pi ce, st at i ng t hey had use d re as onabl e and or di nary car e as
w oul d otherm i ni m al l y compet entheal th car e pr ovi der s i n good s t andi ng. ¶ 8
. U M C p h y sic ian s, D rs. W ill iam s a n d M c C lu sk e y , a lo n g w ith H o sp ice n u rse D a n iel,
w e r e v ol un t a r i l y di s mi s s e d f r om thi s a c t i on . UM C r e a c he d s e t t l e mentwi th Sande r s f or $15, 000, and i tw as di s m i s s ed f r om the ac t i on. T r i al t ook pl ace agai ns tthe r emai ni ng def endant s , D r . C aus ey and H os pi ce. 3 ¶9. Subse quent t o Pl ai nt i f f s r es t i ng thei r cas e- i n- chi ef , D r . C aus ey m oved f

or a di r ect ed
v e rd ict, c iti n g ins u ffic ien t ex p e rt t e stim o n y , a n d h is m o tio n w a s d e n ied . P rio r to th e v e rd ict, H os pi ce s ett l ed f

or$1, 000, 000. A unani m ous j ury ver di ctw as r eturned aga i ns tD r . C aus ey in th e a m o u n t o f $ 4 ,0 0 0 ,0 0 0
. ¶1 0
. S u b se q u e n t to th e co m p en sa to ry d a m a g e s a w a rd , the trial ju d g e a u to m a tica lly
s ubm i t t ed t he puni t i ve damages i s s ue t o the j ury. Sander s of f er ed no addi t i onal pr oof of
w ron g d o ing to su p p o rtp u n it ive d am ag es o ther than tha t sub m itted in h er c ase -i n -ch ief. D r. C a u se y o b

jec ted to th e ju ry c o n sid e rin g in su ra n c e a s e v id e n c e o f n e t w o rth . P re se rv in g h is obj ect i on, D r . Cause y s t i pul at ed t o the amount . The j ury a w ar ded Sander s an addi t i onal $500, 000 i n puni t i ve damages , by a vot e of ni ne- thr ee. ¶11. B y agr eement , D r . C aus ey r ece i ved cr edi t f or the s ett l ement am ou nts of U M C and H o s p ic e . J u d g m e n t w a s th u s e n te re d a g a in s t D r. C a u s e y in th e a m o u n t o f $ 3 ,4 8 5 ,0 0 0
.

### We con sider this issue on ly as to Dr. C ausey , as Ho spice is n ot a p arty to this ap peal. 4 

### 6 ¶1 2. Subse quentt o t he entr y o f j ud gmen t , Dr
. Cau s e y f i l e d a M ot i on f

or J udgm ent N otw i ths t andi ng the V er di ct , a M ot i on forR emi t t i turand/ ort o St r i ke Puni t i ve D amages , and
a M o tio n fo r N e w T ri a l. E a c h o f t h e s e p o s t- tr ia l m o tio n s w a s d e n ie d
. ¶13
. D r. C ausey ti m el y p res ented hi s appea l and subm i t t ed the f oll ow i ng i ssues: I
. W hetherthe tr i al c our te rr ed i n al l ow i ng Sander s ’ s expert s t o t es t i f y as t o the s t andar d of

car e appl i cabl e t o D r . C aus ey and t o H os pi ce M i nis tri es. 4 II
. W hetherthe tr i al cou rti m properl y l i m i t ed the t est i m on y of the d efense e x p e rt s . III. W h e th e r th e trial c o u rt c o m m itt e d re v e rsib le e rro r in failin g to a llo c a te fa u lt t o U M C , a s e ttl in g d e fe n d a n t. I V
. W hetherthe tr i al courterr ed i n aut om at i cal l y s ubm i t t i ng puni t i ve d a m a g e s to th e ju ry . V
. W hetherthe tr i al cour terr ed i n denyi ng D r . C aus ey’ s m ot i on f or rem itti tur. V I
. W hetherthe tr i al c our te rr ed i n noti ns truct i ng the j ury as t o “cha nce of re c o v e ry .” A N A L Y S IS I . W he t he r t he t r i alc our t e r r e d i n al l owi ng Sa nde r s ’ s e xpe r t s t o t es t i f y a s t o t he s ta n d a r d o f c a r e a p p lic a b le to D r . C a u s e y . ¶1 4. “The st andar d of r evi ew f

ort he ad mi s s i on o re xc l us i on of t es t i m ony i s abus e of di s cr et i on. T he admi s s i on of expertt es t i m ony i s l ef

tt o the sound di s cr et i on of the tr i al j udge. U nl es s w e concl ude thatthe di s cr et i on w as a rbi tr ary and cl ear l y err oneous , amount i ng t o an
a b u s e o f d is c re tio n , th a t d e c is io n w ill s ta n d .” Cit y of Jac kson v. E state of S tew art , 908 So. 2d 703, 708 ( M i s s . 20 05 ) ( ci t i ng Cr ane Co. v. K it z inger , 86 0 S o. 2d 11 96 , 12 01 (M i ss. 2 0 0 3 )).

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¶15. D ur i ng tr i al , Sander s pr ovi ded the f ol l ow i ng expert s , w hom the tr i al c our tqual i f i ed as expe rt s i n thei r r espect i ve fi el ds: ( a) D r . S t even H ayne: for ens i c pathol ogy. D r . H ayne t es t i f i ed ther e w as no evi dence thatA l l en had pa ncr eat i c ca ncerand thats he had bee n m i s di agnos ed. H e f ur thert es t i f

i ed that t o “a r eas onabl e degr ee of pr of es s i onal cert ai nty ther e w as a n ove rw hel m i ng l ethal dos e of D i l audi d .
. . and thatA l l en had di ed of a mass i ve dos e of

hydr om orphone. H e t es t i f i ed that 6 ,9 0 0 n a n o g ra m s , th e a m o u n t f o u n d in A lle n ’s s y s te m , w a s a to x ic a m o u n t. (b ) C a rm a n M c In tire: fo re n sic to x ico lo g y . M c In tire w a s re q u e ste d b y D r. H a y n e to per f orm a for ensi c t oxi col ogi cal anal ys i s on bi ol ogi cal s peci m ens . T hi s w as done i n the
cour s e and s cope of

hernorm al j ob atthe M i s s i s s i ppi C r i m e Laborat ory. M cI nt i r e w as
r es pons i bl e f

ors endi ng thes e s ampl es t o N at i onal M edi cal S ervi ces ( “N M S”) , a r ef er ence l abor at ory ut i l i zed by the St at e. T he N M S lab de t ect ed hydr om orphone i n the bi ol ogi cal
s peci m en ata conce ntr at i on of 6, 900 nanogr ams perm i l l i l i t er . M cI nt i r e t es t i f i ed thats he had
n ev er se en lab re su lt s sh o w ing that h igh an am o u n t of h y d rom o rph o n e in th e fi ft ee n y ea rs
s h e h a d b e e n fo re n s ic to x ic o lo g is t a t th e c ri m e la b
. ( c) D r . J ames G arr i ot , Ph. D : pha rm acol ogy a nd t oxi col ogy. D r . G arr i ot ti s an adj unct p rofe sso r atth e U n iversity o f T ex as H ea lth S cien ce C en ter. P ri o r t o b ec o m ing a p rofe sso r, D r . G arr i ot tw as C hi ef

T oxi col ogi s tfort he B exarC ounty M edi cal E xami ner ’ s O f f i ce i n San A nt oni o, T exas . H e has appr oxi m at el y thi r ty- f i ve yea r s empl oym entas a pr of es s i onal t oxi col ogi s tand has w r i t t en on the t opi c of D i l audi d, begi nni ng w i th a f or ens i c t oxi col ogy
r es ear ch s tudy on D i l audi d i n 1978. D r . G arr i ot tha s a hi s t ory of pr of es s or s hi ps and t eac hi ng in p atho log y an d p h arm ac o log y an d is bo ard c erti fi ed a s a fo ren sic tox icolo g ist
. A t tri al, D r.

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C aus ey di d notobj ectt o D r . G arr i ot t ’ s qual i f i cat i on as an expe r t . D r . G arr i ot tt es t i f i ed that A lle n w a s a d m in is te re d a le th a l d o s e o f D ila u d id a n d th a t s h e d ie d a s a re s u lt. ( d) D r . Perry H ookm an: gas tr oent er ol ogy and i nt ernal m edi ci ne. D r . H ookm an w as pr of f er ed as an expe r ton the st andar d of ca r e appl i cabl e t o an i nt erni s t . D r . H ookm an hol ds
a ma s t e r s d e g r e e i n He a l th Ad mi n i s tr a t i o n a n d i s b o a r d c e r t i f i e d i n me d i c a l ma n a g e me n t . He is o n fa c u lty a t Jo h n s H o p k in s U n iv e rsity a n d h a s a u th o re d o r c o -a u th o re d a p p ro x im a tely fi fty p u b li ca ti o n s. D r. H o o k m an h as b ee n in p ri v ate p rac ti ce for m o re tha n tw en ty-fi v e y ea rs and i s a t eac hert o otherphys i ci ans , i nt erns and r es i dent s i n i nt ernal m edi ci ne and g a stro e n ter o lo g y . D r. H o o k m a n tes tified th a t h e sa w n o e v id e n c e o f p a n c re a tic c a n c e r in A l l en and thatthe dos es of D i l audi d gi ven t o herw er e “of f the s cal e. ” D r . H ookm an t es t i f i ed th a t itw a s lik e ly A llen c o u ld h a v e su rv iv e d an o th e r six o r se v e n y e a rs b u t fo r th e D ilau d id
o v e rd o s e . ¶1 6
. E ac h o f thes e ex p erts test if ied th at D r. C au sey h ad b rea ch ed the ap p li ca b le st an d ard of car e and thatA l l en w as gi ven l ethal dos es of D i l audi d. ¶ 1 7
. D r. C a u se y su b m its th a t w h ile th e se e x p e rt s a re q u a lif ie d a n d w e ll-v e rse d in th e ir
r es pect i ve f

i el ds, they w er e notqual i f i ed t o t es t i f

y i n the f

i el d of hos pi ce a nd pal l i at i ve
m ed ici n e. D r. C au sey claim s tha t no n e o f th ese ex p erts h ad an y spe ciali ze d training o r bo ard
c e rtifica tio n in th e fie ld s o f p a lli a tiv e m e d icin e , p a in m e d icin e , h o sp ice m e d icin e , o r p a in
m anage m ent . H ow ever , nei therd i d D r. C aus ey. D r . C aus ey as s ert s that“hos pi ce c ar e and pal l i at i ve med i c i ne i s a r e c og ni z e d s pe c i a l ty. ” Attr i a l , Dr
. Cau s e y ob j e c t e d t o e a c h of S an d ers’s ex p erts, stat ing that n o n e o f th e ir e x p e rt s w as fa m il iar w ith the s tand ard o f ca re
a p p lica b le to a h o sp ice p a tien t an d w e re tes tify in g o u tsid e the ir are a o f e x p e rtise . “[W ]hile

### 9

[Plai nti ff s] con t i nu e t o say there’ s no h ospice s t and ard of car e, there i s a st and ard of care
a p p lica b le to th e n u rse s a n d d o c to rs p ra c ticin g in th a t sp e c ialty . A n d th e se e x p e rts h a v e sa id they ’r e no tfam i l i ar w i th that
. T hey ’r e on l y ap proxim at el y fam il iarw i th it
. ” E ach o f these obj ect i ons w er e overrul ed by t he tr i al court . T he f ol l ow i ng excha nge t ook pl ace betw een def ens e couns el and the tr i al j udge: C o u rt: L e t m e a sk y o u th is, w h a t is th e d iffe re n c e b e tw e e n w h a t y o u sh o u ld have done ata hospi ce and w hatyou s houl d have done att he hos pi t al , orw hat a doct ors houl d have done i n hi s of f i ce? D efe n se C o u n sel: In a h ospit al , Y o u r H o n o r, the trea tm en t i s cu rati v e. T h ey ’re try ing to sa v e the p ati en t. . . . In a h o sp ice the y are n o t do ing that. A ll they are d o in g is k e e p in g th e m c o m fo rt a b le u n til th e y d ie
. . . . C o u rt: [ T ] he j ury w i l l be ent i t l ed t o l i s t en t o al l of the expe r t s , t o deci de w h e th e r t h e y w ill a c c e p t o r r e je c t. . . . ¶ 1 8
. D r. C a u se y o ffe re d th e fo llo w in g e x p e rts, a ll o f w h o m a g re e d w ith S a n d e rs’ s e x p e rts th a t itw o u ld h a v e b e e n a v io latio n o f th e sta n d a rd o f ca re to h a ste n A llen ’s d e a th o r to k ill A l l en w i th an over dos e of D i l audi d: (a ) R o n n ie B a g w e ll, P h a rm .D : qu a lified a s a n e x p e rt in p h a rm a c o lo g y . D r. B a g w e ll
serv es ten h o sp ices w ith p h arm ac eu ti ca ls, in c lu d in g the h o sp ice w h ere A ll en d ied. D r. B agw el l w as a m em ber of the int erdis ci pli nary t eam w hich m ade d eci si on s f or pat i ents , in c lu d in g A llen . D r. B a g w e ll t e stifie d th a t b a se d o n h is e x p e rie n c e , the d o s a g e s g iv e n to A ll en w ere n o rm al g iven the p ain s h e w as e x p erien cing
. H o w ev er, w h il e testi fyin g , D r. B agw el l w as as ked i f

he re l i ed on or e ven r ecogni zed pa l l i at i ve ca r e t ext s and he t es t i f i ed that h e d id n o t. (b ) D r. Ja m e s N o rris: q u a lified a s a n e x p e rt in to x ico lo g y . H o w e v e r, D r. N o rris tes tified h e h a d n e v e r w ritten in th e a re a o f p a in m a n a g e m e n t, no r h a d h e stu d ied D ilau d id

### 10

o r oth er o p h ioids. D r. N o rri s rec o g n ized an arti cle c o -au tho red b y S an d ers’s ex p ert, D r. G a rr io tt, a s a u th o ri ta tiv e in th e a re a o f t o x ic ity c a u s e d b y D ila u d id
. ( c) D r . G erry A nn H ous t on: boar d- cert i f i ed i n hos pi ce a nd pal l i at i ve ca r e, and qual i f i ed as an expe r ti n oncol ogy. D r . H ous t on i s al s o the i n-hom e m edi cal di r ect orf or H o sp ice a n d also h elpe d to startH o sp ice. D r. H o u ston , a fri en d an d form er c o ll ea g u e o f D r. C aus ey, t es t i f

i ed that , w hi l e i tw as di s cover ed A l l en di d nothave pa ncr eat i c ca ncer , A l l en
m os tl i kel y s uf

f er ed f r om a panc r eat i c ca r ci nom a, and “t o a r eas onabl e degr ee of m edi cal pr obabi l i ty, i tw as heropi ni on thathos pi ce c ar e w as appr opr i at e. ” H ow ever , D r . H ous t on test if ied th at sh e d id no t determ ine w h ethe r A ll en h ad rec eive d a letha l do se o f D il au d id. D r. H ous t on t es t i f

i ed thatacc or di ng t o T

o p ic s in P a llia tiv e C a r e , that “the re i s no m ax im u m safe dos e of m orphi ne and otherpur e mu ant agoni s topi oi ds
. ” D r . H ous t on f ur thert es t i f

i ed that sh e “ w as n o t aw are o f a to x ic a d m inistrati o n o r do se fo r D il au d id.” S h e testi fi ed that if a p ati ent exhi bit s pai n, the d osage sh ou l d b e i ncreased, w hereas sl eepiness and respi ratory depr es s i on w ou l d di ct at e a de cr eas e i n dos age. D r . H ous t on conce ded thati tw oul d be a di r ectvi ol at i on of

the H os pi ce gui del i nes to hast en any pa t i ent ’ s death and thati f t i tr at i on of m edi cat i on by a hospi ce l ed t o a per s on’ s death, thatact i on w oul d be a br eac h i n the
s ta n d a rd o f c a re fo r a h o s p ic e s e ttin g . ( d) Dr
. M e l vi n G i t l i n: t e nd e r e d a s a n e xp e r ti n the f i e l d of p a i n mana ge mentof ter m in a l pa tien ts, bu t qu a lified as an ex p e rt i n an e sth e sio lo g y b y the tri a l c o u rt . D r. G itl in t es t i f i ed he w as notf

ami l i arw i th c l i ni cal s tudi es s how i ng the aver age amount s of opi oi ds f ound i n a per s on’ s s ys t em w hen they over dos e, a l though he ha d t aughton the us e of opi oi ds i n the tr eatm entof

chr oni c pai n. D r . G i t l i n t es t i f i ed thathe c oul d notc al cul at e a mi cr ogr am

### 11

pernanogr am w hen det erm i ni ng dos age a m ount s . D r . G i t l i n addi t i onal l y t es t i f i ed that“no
ce il ing ” m ea n s tha t th ere is no t a l ev el at w h ich g iving a p erso n m o re w o u ld h av e n o m o re of an ef f ect , butt hat t here i s def i ni t el y an amountthatw i l l ki l l a per s on and ther e i s an
a m o u n t th a t is to o m u c h
. ( e) D r . J ames L aur i ds on: qua l i f i ed as a n experti n f

or ens i c t oxi col ogy. D r . L aur i ds on is th e C h ief M ed ical E x am iner fo r th e A laba m a D ep artm en t of F o ren sic S cien ce s. D r. L aur i ds on t es t i f

i ed he di s agr eed w i th the ca us e of death as s t at ed i n the aut ops y re por t . I tw as hi s opi ni on thatA l l en’ s death w as due t o seve r e l ung di s eas e, coupl ed w i th pneumoni a and pr e- exi s t i ng heartdi s eas e. D r . L aur i ds on addi t i onal l y t es t i f i ed thathe had ne vers een a p a t i e n twi th th a tmu c h Di l a u d i d i n h i s o rh e rs y s t e m a n d th a tn o o n e wi th 6 , 9 0 0 n a n o g r a ms
o f D ila u d id in th e irs y s te m s h o u ld b e a liv e . ( f ) D r . M i chae l B yer s : qual i f i ed as an expe r ti n i nt ernal m edi ci ne. D r . B eyers , w ho
w as form erl y in pri vate pr act i ce w i th D r. C ausey, t est i fi ed h e w as an i nfect i ou s- dis ease
s peci al i s tand w orked part - t i m e atH os pi ce i n l at e 2002. H e bec ame t he co- m edi cal di r ect or
o f in p ati en t H o sp ice in 2 0 0 3 , o n e-a n d -a-h alf ye ars a ft er A ll en ’s de ath. D r. B y ers’s
curr i cul um vi t ae l i s t ed no pr of es s i onal m ember s hi ps r el at ed t o hos pi ce c ar e. H e had not author ed pee r - r evi ew ed art i cl es on hos pi ce car e, orD i l audi d orD i l audi d over dos i ng; norhad he bee n i nvol ved i n any cas e studi es r el at ed t o D i l audi d over dos i ng. D r . B yer s w as al l ow ed t o t e s t i f y tha th e h a d gi ve n the s a me d os a ge s t o s i mi l a r l y s i tua t e d pa t i e nt s , b utcoul d not
r emem berthe exa ctcas es . D r . B yer s w as al l ow ed t o t est i fy t hati tw as hi s opi ni on that Sanders d i d notdi e of

an over dos e and thatthi s amountof D i l audi d di d nots tr i ke hi m as
u n u su a l, as th e p rin c ip a l fa c to r o n e lo o k s a t in tre a tin g a ter m in a l p a tien t is a c h ie v in g p a in

### 12

c o n tr o l. H o w e v e r, D r. B y e rs te s tif ie d th a t if a m e d ic a l p ro v id e r “ titr a te d s o m e o n e to d e a th ,” th e p ro v id e r w a s n o t p ro p e rly titra tin g so m e o n e ’s m e d ica tio n s. H e fu rth e r te stifie d th a t if H os pi c e h a d gi ve n A l l e n a d os e o f Di l a ud i d tha twas e no ug h t o ki l l h e r , Dr
. Cau s ey had f al l en bel ow the s t andar d of car e. D r . B yer s al s o t es t i f i ed he had no c r i t i ci s m of the aut ops y,
a n d th a t h e d id n o t k n o w th e a m o u n t o f a le th a l d o s e o f D ila u d id
. ( g) D r . D avi d D uddl es t on: qua l i f i ed as an expe r ti n i nt ernal m edi ci ne. D r . D uddl es t on t es t i f i ed i n hi s capa ci ty as A l l en’ s tr eat i ng phys i ci an atU M C
. D r . D uddl es t on des cr i bed A l l en as cachecti c, w hi ch he c har act er i zed a s “w as t ed, very, very m al nour i s hed; s unken
c h e e k s , s u n k e n he a d , s h r i v e l e d e x tr e mi t i e s , n o f a ta n y wh e r e . . . i n p a i n . S h e h a d s o me abdomi nal pai n . . . and s he w as j aundi ced. ” D r . D uddl es t on cert i fi ed thatA l l en w as

“ term inally i ll w ith a l if e ex p ec tanc y of si x (6) m o n ths or less, i f th e d iseas e fo llo w s its
norm al c our s e. ” H ow ever , D r . D uddl es t on t es t i f i ed attr i al thatr egar dl es s of w hetherA l l en h a d p a n c re a tic c a n c e r, s h e s till h a d a lif e e x p e c ta n c y o f l e s s th a n s ix m o n th s . ¶ 1 9
. W h ile n o n e o f th e e x p e rt s fo r S a n d e rs w a s q u a lified b y th e C o u rt a s a n e x p e rt in

“ h o sp ice c a re ” o r “ p a lli a tiv e m e d icin e ,” th e p h y sic ian s te stifie d the y h a d ex p e rie n c e in p a in
m anage m entand ca r e of chr oni cal l y i l l pat i ent s . T he expe r t s of f er ed by C aus ey w er e al l ow ed t o tes t i fy that A l l en w as not gi ven a l ethal dose of D i l aud i d an d thatthere w as no ce i l i ng do se fo r D ila u d id w h e n g iv e n in a p a in m a n a g e m e n t s e ttin g . ¶20. D ur i ng tr i al , al l expert s pr es ent ed by both par t i es m et t he s t andar ds as out l i ned by M i s s i s s i ppi R ul e of

E vi dence 702 and D a u b e r t v. Me r r e ll D o w Ph a rm a c e u tic a ls, I n c ., 509 U
. S
. 5 7 9 , 1 1 3 S
. C t. , 1 2 5 L
. E d
. 2 d (19 9 3 ).

### 13

¶21. H ow ever , D r . C aus ey as s ert s Sander s ’ s expert s s houl d have been l i m i t ed t o t es t i f y as t o the s t andar d of

c ar e i n a hos

pi ce s e tti n g , v is-a -v is th e s tan d a rd o f c a re o th e rw ise a p p lica b le t o p hy s i c i a ns . D r . Caus ey ci t es thi s C our t ’ s deci s i ons i n Ch ee ks v. B io-Medical A pp l ication s, I n c ., 908 So. 2d 117 ( M i s s . 2005) , and T r o u p e v. Mc A u le y, 955 So. 2d 848 ( M i s s . 2007) , f or the pr opos i t i on w hi ch thi s C our tes pous ed i n P oo le v. A vara . “A n expertm us texer ci s e the
s ame l evel o f i nt el l ectual r i gorthatchar act er i zes the pr act i ce of an expe r ti n the r elevant field
. ” P o o le v. A v a r a , 90 8 So
. 2d 71 6, 72 4 ( M i s s . 20 05 ) ( c i t i ng Miss. T r ans. Com m ’n v. McL e m o r e, 8 6 3 S o . 2 d 3 1 , 3 7 -3 8 (M is s . 2 0 0 3 ) ( e m p h a s is a d d e d ))
. ¶22. Sander s s ubm i t s that D r . C aus ey s eeks t o expand thi s C our t ’ s hol di ngs r egar di ng the stan d ard o f ca re fo r p h y sici an s, b y cre ati n g a “ p h an tom ‘ho sp ice’ stan d ard o f ca re.” D r. C aus ey, act i ng as m edi cal di r ect orf orH os pi ce, w as an i nt erni s tw i th a s peci al ty i n i nf ect i ous d isease s. S an d ers asse rt s tha t th e ex p erts sh e p rese n ted w ere q u ali fi ed to testi fy a s to A ll en ’s
m ed ical co n d it ion , the e v en ts su rrou n d ing he r dea th, an d th e stan d ard o f ca re to w h ich D r. C aus ey s houl d have been he l d. H os pi ce i s nota party t o thi s appea l , and ther ef or e w e ar e not
re q u ir e d to a d d re s s w h e th e r a s e p a ra te s ta n d a rd o f c a re a p p lie s to h o s p ic e fa c iliti e s . ¶ 2 3
. Itis c e rt a in th a t to p re s e n t a c a s e o f m e d ic a l m a lp ra c tic e ,
a p lain tiff, (1 ) a fte r e sta b lish in g th e d o c to r-p a tien t re latio n sh ip a n d its att endantduty, i s gener al l y r equi r ed t o pr es entexpertt es t i m ony ( 2) i dent i f yi ng and art i cul at i ng the r equi s i t e s t andar d of car e; and ( 3) es t abl i shi ng tha tthe def endantphys i ci an f

ai l ed t o conf

orm t o t he s t andar d of

car e. I n addi t i on, ( 4) the pl ai nt i f

f m us tpr ove the phys i ci an' s no nco m pli ance w i th the s t andar d of car e ca us ed the pl ai nt i f f ' s i nj ury, as w el l as pr ovi ng (5) the ext entof the p la in tif f's d a m a g e s . Ch e e ks, 9 0 8 S o . 2 d a t 1 2 0 (c itatio n s o m itt e d ). F u rth e rm o re , this C o u rt h a s h e ld :

### 14

T he gene r al rul e as t o expertt es t i m ony i n m edi cal m al pr act i ce ac t i ons i s that “ a s p e c ia lis t in a p a rt ic u la r b ra n c h w ith in a p ro fe s s io n w il l n o t b e re q u ir e d .” C . M c C o rm ick , E v id e n c e , § 1 3 (3 d e d . 1 9 8 4 ). M o st c o u rts a llo w a d o c to r to t es t i f y i f they ar e s at i s f

i ed of hi s f ami l i ar i ty w i th the s t andar ds of a s peci al ty, th o u g h h e m a y n o t p ra c tice th e sp e c ialty h im se lf. O n e c o u rt e x p lain e d th a t “it i s the s cope of

the w i tnes s ’ know l edge a nd notthe art i f i ci al cl as s i f

i cat i on by title th a t s h o u ld g o v e rn th e th re s h o ld q u e s tio n o f a d m is s ib ility .” B r ow n v. Mladineo , 5 0 4 S o . 2 d 1 2 0 1 , 1 2 0 2 (M is s . 1 9 8 7 ) (c ita tio n s o m itte d ). ¶24
. T his C ou rt “has con si st entl y st at ed that w hen con si deri ng M i ss. R
. E vid. 70 2 is sues,
o u r tria l ju d g e s a re p lac e d in th e ro le o f g a tek e e p e rs, ‘e n su rin g th a t ex p e rt tes tim o n y is b o th
r el evanta nd r el i abl e. ’ ” T r o u p e, 955 So. 2d at857 ( ci t at i on om i t t ed)
. W e f i nd the tr i al j udge did no tabuse he rdi s cr et i on i n al l ow i ng Sander s ’ s expert s t o t es t i f y as t o the condi t i on of A ll en an d v iolati o n o f th e stan d ard of ca re b y D r. C au sey . Itsho u ld be no ted the tri al co u rt al s o al l ow ed D r . C aus ey’ s expert s t o opi ne as t o A l l en’ s condi t i on and caus e of death, and th a t in th e iro p in io n , D r. C a u s e y d id n o t v io la te th e s ta n d a rd o f c a re . ¶25. I n Danie l

s v. GN B, I nc . , 6 29 S o. 2 d 59 5, 6 03 ( M i s s . 1993) , w e s t at ed that ‘ j udgi ng the expe r t ' s t es t i m ony and w ei ghtt o be ac cor ded ther et o i s the p rov ince o f th e jury
. ’ Id
. at603 (c i t i ng Fo rdMo to r Co . v. Co c k re ll , 211 So. 2d 833, 837 ( M i s s . 1968) )
. I n Chis ol m v. E akes , 573 S o. 2d 76 4, 75 7 (M i ss. 1990) , thi s C our ts t at ed that‘ [ t ] he j ury m ay cons i derthe expe r tt es t i m ony f or w h at th ey fee l th at i t i s w o rth , an d m ay d iscard iten ti rely.’ Flem ing v. Floyd , 9 6 9 S o . 2 d 8 6 8 , 8 7 8 (M is s . 2 0 0 7 ). ¶ 2 6
. A d d iti o n a lly , “[w ]he n th e re is a c o n flict o f ex p e rt m e d ica l op in io n , th is C o u rt h a s h e ld i tt o be w i thi n t he pr ovi nce of t he f act - f i ndert o det erm i ne the ca us e of death. ” D e lta R e

g 'l Med. Ctr. v. V

enton , 9 6 4 S o . 2 d 5 0 0 , 5 0 6 (M iss. 2 0 0 7 ) (cit ati o n o m itted). ¶27. “A j ury' s ver di ct i s gi ven gr eat def er ence by thi s C our t , and ‘ confl i ct s of evi dence pr es ent ed attr i al ar e t o be r es ol ved by the j ury. ’ ” J o h n so n v. S t. D o m in ics -J a c kso n Me m 'l

### 15

Hos p. , 9 6 7 S o . 2 d 2 0 , 2 3 (M iss. 2 0 0 7 ) (cit ati o n o m itted). In the ca se su b jud ice, th e juro rs
w er e pr ovi ded w i th conf l i ct i ng expertt es t i m ony and r ender ed thei rdeci s i on acc or di ngl y. II. W h ether the tri al court i m p rop erl y li m i ted the t est i m on y o f t h e d efense exp erts . ¶ 2 8
. A s n o ted in S a n d e rs’ s b rie f, D r. C a u se y h a s o ffe re d n o a u th o ri ty in su p p o rt o f th is
ar gum ent . “‘ T hi s C our thas hel d thati ti s the duty of an appe l l antt o pr ovi de author i ty and
su p p o rt o f a n a ss ig n m e n t.’ If a p a rty d o e s n o t pr o v id e this su p p o rt th is C o u rt is u n d e r n o d u ty t o cons i deras s i gnm ent s of err orw hen no author i ty i s ci t ed. ” Ho o p s v . Sta te , 681 So. 2d 521, 5 2 6 (M is s . 1 9 9 6 ) ( in te rn a l c ita tio n s o m itte d ). ¶2 9. N ot w i t hs t a nd i ng the p r oc e du r a l b a r , the r e c or d i s r e pl e t e wi th t e s t i mony, s om e of
w h ic h is s u m m a ri z e d in Is s u e I, s u p p o rt iv e o f D r. C a u s e y ’s th e o ry o f t h e c a s e . II I. W h e th e r th e tr ia l co u r t c o m m itte d a r e v e r sib le e r r o r in fa ili n g to a llo c a te fa u lt to U M C , a settli n g d efe n d a n t. ¶ 3 0
. F a ilu re to a llo c a te fa u lt is a q u e stio n o f law , w h ich sh a ll b e re v iew e d d e n o v o b y th is C o u rt . See E nter

gy Mis s . , I

nc. v. H ayes , 8 7 4 S o . 2 d 9 5 2 , 9 5 8 (M is s . 2 0 0 4 ). ¶31. I n her Fi r s t A m ended C om pl ai nt , Sander s named U M C as a def endant , s t at i ng, “The U M C , thro u g h it s a g en ts, d o ctors, n u rses, an d /or m ed ical staff, b rea ch ed the s tand ard o f ca re by di agnos i ng M s . A l l en w i th t erm i nal canc er . . . and tr ansferr i ng M s . A l l en t o H os pi ce M i ni s tr i es t o di e. ” Pr i ort o tr i al , U M C s ett l ed w i t h S ander s f oran amountw hi ch w as kept
c o n fi d e n tia l f

ro m th e ju ry . See R o b le s v. G o llo t a n d S o n s T r a n s fe ra n d S to r ag e, I

n c ., 683 S o . 2 d 3 8 3 , 3 8 5 (M iss. 1 9 9 7 ). ¶ 3 2
. D u rin g trial a n d in h e r b rie f, S a n d e rs a rg u e d th a t th e p ro x im a te c a u se o f A llen ’s d e a th
w as an over dos e of

D i l audi d pr es cr i bed by D r . C aus ey.

### 16

¶ 3 3
. D u rin g trial, D r. C a u se y , w h ile n o t c o n c e d in g th e n e g lig e n c e o f U M C , c o n tin u e d to p u t o n e v id e n c e th a t h e a n d th e sta ff a t H o sp ice w e re led to b e liev e b y th e m e d ica l d iag n o sis and r ecor ds of

U M C thatA l l en had s i x mont hs orl es s t o l i ve and w er e tr eat i ng he rf orpai n,
ra th e r t h a n fo r c u ra tiv e p u rp o s e s . D r. C a u s e y s u b m itte d , T he f acti s , the admi ni s tr at i on of D i l audi d t o M r s . A l l en w as notan i nt erveni ng caus e of he rde ath, buti ns t ead an act i on t aken pur s uantt o [ U M C ’ s] ori ginal di agnos i s . T hus the ad m i nis tr at i on of D i l audi d w as j us ta l i nk i n the ‘ natur al a n d c o n tin u o u s s e q u e n c e ’ t h a t e v o lv e d a s a re s u lt o f [ U M C ’s ] d ia g n o s is
. See P a tte rs o n v. L ib e r ty A s s o c s ., L .P. , 9 1 0 S o . 2 d 1 0 1 4 , ¶ 1 4 (M iss. 2 0 0 4 ). W i thout[ U M C ’ s ] or i gi nal di agnos i s and ce r t i f i cat i on M r s . A l l en w oul d never have bee n sentt o H os pi ce, and t he adm i ni s tr at i on of D i l audi d di d notbr eak the s equenc e of

tr eatm ents uch thati tw oul d di m i ni s h ors ever[ U M C ’ s ] l i abi l i ty. I tw as f or seeabl e that[ U M C ’ s ] di agnos i s w oul d l ead t o pai n m anage m ent tr eatm entand l ack of

f ur thercur at i ve tr eatm ent , and thatthi s w oul d be danger ous , butf

orthe f actthatthe pat i entw as dyi ng. ¶ 3 4
. In h is M o tio n fo r D ir e c te d V e rd ic t, D r. C a u s e y a rg u e d th e fo llo w in g , C o u n sel: [ T] he r e i s e vi de nc e i n thi s c a s e , p l e nty of e vi de nc e tha tU M C w as n e g lig e n t. W e d id n o t p u t th a t o n . T h e p lain tiffs d id a n d w e a re e n tit led to re ly on that
. I f

the j ury com es back and f i nds thatU M C i s negl i gent , w e’ r e ent i t l ed t o an al l ocat i on of

f aul ton thos e gr ounds
. A nd i f they f i nd a hundr ed per cent of l i abi l i ty t o U M C , w e’ r e ent i t l ed t o re l y on that
. A nd w hatI’ m sayi ng i s as a mat t erof

l aw be f or e w e even go t o the j ury, U M C i s the pr oxi m at e ca us e and n o t u s. T h e y p u t in to m o tio n th e a g e n c y b y a n d th ro u g h w h ich th is d e a th occurr ed, w e w oul d neverhave e ven know n aboutM s . A l l en. A nd t hat ’ s w hy I th ink as a m att er o f l aw they ’re the- - - C o u rt: Y ou’ r e cl ai m i ng thatthe Pl ai nt i f f s ar e cl ai m i ng t hatt he over dos e w as caus ed by U M C ’ s negl i gence ? C o u n sel: W e w oul d neverhave know n M s . A l l en exi s t ed i f U M C di d nots end h er to u s. S o b u t f

o r th e m isdiag n o sis , w e c o u ld n ev er h av e g iven h er 1 mi l l i g r a m o f

Di l a u d i d
. An d we d o n ’ tc o n t e n d a n o v e r d o s e o c c u rr e d
. Bu tUM C is th e o n e w h o c e rt if

ie d h e r a s te rm in a l. C o u rt: I f

U M C cert i f

i ed heras t erm i nal and yourcl i ent di d i ndeed tr eather f orthatt erm i nal s i tuat i on, then s he w oul d have di ed w i thoutthe over dos e of D i l audi d? C o u n sel: R ig h t. T h a t’ s o u r d e fe n s e .

### 17

¶35. B as ed on the pleadi ng s and tr ans cr i ptbef or e thi s C our t , an i s s ue w as m ade of the al l eged ne gl i ge nc e of

U M C, a nd tha tbu tf

orU M C’ s mi s di a gn os i s , A l l e n woul d n othave ent er ed hos pi ce. A l though the j ury w as pr es ent ed w i th evi dence r egar di ng the al l eged negl i gence of

U M C , the tr i al courtr ef us ed t o i s s ue an i ns truct i on r egar di ng al l ocat i on of f aul t , s t at i ng, “[ i ] thas no e f f ectw hat s oeveri n det erm i ni ng the i s s ues of w hetherthe H os pi ce
o v e rdo sed or no t. ” A d d it ion all y , th e tr ial co u rtde cli n ed t o all o w th e form of th e v erd ictto cont ai n a ny r ef

er ence t o U M C
. The tr i al c our tde duct ed the s ett l ementa m ountof U M C and H o s p ic e M in is tr ie s fr o m th e v e rd ic t r e n d e re d a g a in s t D r. C a u s e y . See Mack T r ucks, I nc. v. T a c k e tt , 8 4 1 S o . 2 d 1 1 0 7 , 1 1 1 6 (M iss. 2 0 0 3 ). ¶36
. T he tri al cou rt rul ed that the i ssue before the j ury w as w hether there w as an o verdose of D i l audi d by H os pi ce, and i f s o, w as i tthe s ol e orpr oxi m at e ca us e of A l l en’ s death. ¶37
. T his C ou rt has found that for an “interv en i ng and superceding cause t o ex t i ng uis h l i abi l i ty of

the or i gi nal act or , the ca us e mustbe unf or es eeabl e. ” T

h o m a s v . T

h e Co lu m b ia Gr o up , LLC , 969 So. 2d 849, 854 ( M i s s . 2007) ( ci t i ng N ew el l v. S. Jitney Jungle Co. , 830 S o . 2 d 6 2 1 , 6 2 3 (M iss. 2 0 0 2 )). ¶38. T hi s C our t has f

ur ther hel d, “[ t ] he l aw deal i ng w i th the duty t o f or es ee the i m prudent
ac ts of o thers a p p ea rs un d er th e g en era l rub ri c o f th e jurispru d en ce o f ‘i n terve n ing ca u se.’” S o u t h la n d M g mt . Co . v. Br o wn By & Th r o u g h Br o wn , 730 So. 2d 43, 46 ( M i s s . 1998)
. T he Second R es t at ementof

T or t s def

i nes a super s edi ng caus e as “an actof a thi r d per s on orother f or ce w hi ch by i t s i nt ervent i on pre vent s t he act orfr om bei ng l i abl e f orharm t o anotherw hi ch hi s ant ece dentnegl i gence i s a subs t ant i al f act ori n br i ngi ng about
. ” I d . ( ci t i ng R es t at ement ( Second) of

T or t s § 440 ( 1965))
. U nd er thi s theory, an or i gi nal act or ' s negl i gence m ay be

### 18

s up e r c e de d by a s ub s e qu e nta c t or ' s n e gl i ge nc e , i f the s ub s e qu e ntn e gl i ge nc e w as
u n fo re s e e a b le
. See Southland M gm t . Co. , 730 So. 2d at46. Thi s Courtha s hel d that , i f “the i nt erveni ng caus e i s one w hi ch i n ordi nary hum an exper i ence i s r eas onabl y t o be ant i ci pat ed,
orone w hi ch the def

endantha s r eas on t o ant i ci pat e underthe part i cul arci r cumst ance s , ” the
s ubs equentact or ' s negl i gence i s f or es eeabl e and doe s notbr eak the chai n of eve nt s betw een th e n e g lig e n c e o f t h e fi rs t a c to r a n d th e in ju ry . I d. ( ci t i ng W
. Page K eet on e ta l
. , Pr os s erand K e e to n o n th e L a w o f

T o r ts § 4 4 (5 th e d . 1 9 8 4 ))
. See al s o P ar gas of T aylors vil le, I nc. v. Cra ft , 24 9 S o . 2d 40 3 , 40 8 (M iss. 19 7 1 ) ( h o lding th at a de fen d an t is ch arg ea b le o n ly w ith ant i ci pat i ng r eas onabl e pr obabi l i t i es; ther ef or e a pe r s on i s notbound t o ant i ci pat e the
unus ual , i m pr obabl e, orextr aor di nary occurr ence , al though s uch happe ni ng i s w i thi n the
ra n g e o f p o s s ib iliti e s ) ( c ita tio n o m itte d ). ¶ 3 9
. A lth o u g h U M C a n tic ip a te d A llen w o u ld d ie w ith in six m o n th s, it ca n n o t b e fa irly
a rg u e d tha t U M C rea so n a b ly an ticip a ted A llen ’s d e a th w o u ld b e fro m an o v e rd o s e . T h is C our trul ed i n R o b is o n v. McD o w e ll, “negl i gence w hi ch mer el y f urni s hed the condi t i on or
occa s i on upon w hi ch i nj ur i es ar e r ece i ved, butdoes notputi n m ot i on the age ncy by or thr ough w hich t he i nj ur i es ar e i nf l i ct ed, i s notthe pr oxi m at e ca us e ther eof
. ” R obis on v. McD o w e ll , 247 So. 2d 686, 688 ( M i s s . 1971) ( ci t at i ons om i t t ed)
. T hus , “[ i ] f the ac t compl ai ned of

i s onl y a r emot e ca us e, s up ers eded by a n i ndepende nt , ef f i ci enti nt erveni ng
c a u se th a t lea d s in u n b ro k e n se q u e n c e to th e in ju ry , th e o rig in a l n e g lig e n t ac t is n o t a pr oxi m at e, buta r emot e, caus e. T hus , notbei ng f or es eeabl e, the or i gi nal caus e i s not
a c tio n a b le .” R obis on , 2 4 7 S o . 2 d a t 6 8 9
.

### Mississip pi C od e Anno tated S ection85 -5-7 (1) (S up p. 2 00 8) states: 5 

### As u sed inth is sectio n, “fault” means an act o r o missiono f a perso n wh ich is a pro ximate cau se of in

juryor d eath to ano ther perso n or perso ns, d amages to prope rty, tangibl e or intangible , or ec onomi c injur

y, including, but not

limite d to, negl igence , m alpra ctic e, stri ct li abi lity, abs olut e l ia

bil it y or f ai lure to war

n. “Fa ult” s hal l not

inc ludeany tort

whic h re sults from an a ct or omis si on committedwitha specific wron gfu l intent. M i ssi ssi pp i C od e A nn otat ed S ect i on 85 -5- 7(4) ( S up p. 20 08 ) s t at es, 6 ( 4) J oi ntand s ever al l i abi l i ty s hal l be i m pos ed on al l w ho cons ci ous l y and del i ber at el y pur s ue a c om m on pl an ordes i gn t o comm i ta t or t i ous act , or a c tiv e ly tak e p a rt in it. A n y p e rso n h e ld join tly an d se v e ra lly li a b le u n d e r th is se c tio n sh a ll h a v e a rig h t o f c o n trib u tio n fro m h is fe llo w d e fe n d a n ts a c tin g in c o n c e rt. 

### 19 ¶ 4 0
. “ [N ]eg lig e n c e is re m o te a n d n o n -a c tio n a b le w h ich m e re ly c a u se s a p e rso n to b e a t a part i cul arpl ace a ta pa r t i cul art i m e w her e s uch per s on i s i nj ur ed as a r es ul tof the negl i gent actof another , w ho put s i n m ot i on a di f f er entand i nt erveni ng caus e w hi ch ef f i ci ent l y l eads in u n b ro k e n s e q u e n c e to th e in ju ry .” Entr i c an v. Ming , 962 So. 2d 28, 36 n. 2 ( M i s s . 2007) ( ci t at i on om i t t ed)
. B as ed on thi s C our t ’ s pr ece dent , U M C coul d notha ve r e a s onabl y f or es een th a t w h e n A lle n e n te re d th e h o s p ic e , s h e w o u ld b e o v e rd o s e d w ith D ila u d id
. ¶4 1
. F u rth erm o re , D r. C au sey ca n n o t fi n d refu g e in M issi ssipp i C o d e A n n o tat ed 8 5 -5-7 ( Supp. 2008)
. A s s um i ng ar guendo thatU M C w as negl i gent , pr oxi m at e ca us e mustbe
sa tisfie d fo r fa u lt t o b e a llo c a ted p u rsu a n t to M iss iss ip p i C o d e A n n o tate d 8 5 -5 -7 (1 ) a n d it 5
m us tbe pr oved thatU M C and D r . C aus ey cons ci ous l y and del i ber at el y pur s ued a c om m on p la n o r d e s ig n to c o m m it a to rt io u s a c t b e fo re jo in t a n d s e v e ra l lia b ility m a y b e im p o s e d
. See M i s s . C ode A nn. § 85- 5- 7( 4) ( Supp. 2008)
. T her e i s no evi dence t hatU M C actual l y t ook 6 parti n D r . C aus ey’ s deci s i on t o s w i t ch the m edi cat i on t o D i l audi d, ort o es t abl i s h the dos age.

### Bas ed on the dateof this trial, thetrial ju dg e likely was re fe re ncing thi s Cour t’ s 7 

### dec is ion in Bra dfield

v. Sch wa rtz, 2006 Miss . LEXIS 268 (Mis s. 2006), in whi ch this Court issued a subs titut e and finalopini on af ter the opinion wa s f

ir st is sue d in t

his ca se. See Bra dfield v. Sch wa rtz , 93 6 S o. 2 d 9 31 (Miss. 2 00 6). 20 ¶ 4 2
. A c c o rd in g ly , w e fin d th e tr ia l c o u rt d id n o t e rr in n o t iss u in g a n a llo c a tio n o f fa u lt in s tru c tio n . IV . W h eth er th e tri a l co u rt er re d i n au tom a ti ca ll y su b m it ti n g p u n it ive d a m a g es to th e ju r y . ¶43. B ef

or e tr i al comm enced, t he t ri al judge did no tm ent i on the ca s e name, but m ade
r ef er ence t o an opi ni on of thi s C ou rt , and st at ed, “I tbas i cal l y s ai d i f ther e’ s any ki nd of 7
ver di ctof

a do l l a rormor e , I do n’ tha ve a c ho i c e . I a l w a ys s ub mi tpu ni t i ve da mage s t o the j ury. ” S ub sequen tt o the verdi ctbeing rendered for com pen sat ory dam ages, the tr i al co u rt im m e d ia te ly m o v e d in to th e p u n itiv e d a m a g e s p o rt io n , s ta tin g , [I ] f a c o m p e n sato ry d ec isi o n is f o u n d , itw o u ld au tom ati ca ll y g o the ju ry w ith o u t co n sid e ra tio n b y th e c o u rt. U n d e r th e law p rio r to th a t, th e c o u rt w o u ld m ake a ruli ng aft er r eview i ng evidence thathas com e i n thi s case. T his case has been goi ng on f

ort w o w eeks
. I have keptnot es i n t hatre gar d. I f i nd that ther e i s a genui ne i s s ue of m at er i al f

acton the i s s ue of

puni t i ve damages
. T hat i ts houl d go t o the j ury. T hati s notan i s s ue f ort hi s cour tt o deci de as a mat t er of l aw . A nd as s uch, the courtw i l l s ubm i ti tt o the j ury. A nd w hetherthat m eet s t he aut om at i c caus e ornot , I don’ tknow
. B utbeca us e thatcas e has not re a c h e d its fin a l d isp o sitio n , the c o u rt w ill d e c id e u n d e r th e o ld ru lin g s. W ith thatbeing sai d, w e w i l l now pr ocee d w i th the i s s ue of puni t i ve damages e v id e n tia ry h e a ri n g b e fo re th e ju ry a n d s u b m it th e is s u e . ¶44. D r . C aus ey r eads i nt o t he tr i al j udge’ s st at ementthats he “a ut om at i cal l y” s ubm i t t ed p u n iti v e d a m a g e s to th e ju ry . T h e c o u n tera rg u m e n t is th a t th e trial ju d g e w a s d e c id in g th is i s s ue underourpr evi ous rul i ngs ors t atut e. B as ed on the r ecor d before us , w e ca nnotbe

### 21

cert ai n w hi ch i s corr ect . H ow ever, w hetherthe j udge’ s rul i ng w as m ade by s t atut e orby a per cei ved “a ut om at i c” s t andar d i s of no cons equenc e, as ther e i s err ori n both. ¶45. T he us e of

the w or d “aut om at i cal l y” i n B ra d fie ld v. S c h w a rtz , 93 6 S o. 2d 93 1 (M i ss. 2006) has been mi s cons trued b y s om e, and t oday, w e t ake the opportuni ty t o cl ar i f y. T he
w or d “aut om at i c” r ef

er s t o the f

act s i n the B r adf

iel d c a se itse lf. T h e p re c e d in g p a ra g ra p h in B r adf ield cl ear l y l ays outthe pr ocedur e f orw hen and i f

a j ury s houl d cons i derpuni t i ve damages and ther e i s no m ent i on of “aut om at i c” or“aut om at i cal l y. ” If th e ju ry a w a rd s c o m p e n sa to ry d a m a g e s, th e n a n e v id e n tiary h e a rin g is conduct ed i n the pr es ence of the j ury. A tt he cl os e of thi s sec ond phas e of

the tr ial , v ia an ap p rop ri ate m o ti o n fo r a d ir ec ted v erd ict , the ju d g e, as g atek ee p er, then ul t i m at el y deci des w hetherthe i s sue of puni t i ve damages s houl d be su b m itt e d to th e trier -o f-fa c t (ju ry ). If th e ju d g e , fro m th e re c o rd , sh o u ld det erm i ne, as a m att erof l aw , thatthe j ury s houl d notbe al l ow ed t o cons i der the i s s ue of

puni t i ve damages , a di r ect ed ver di cts hal l be ent er ed i n f avorof the def endanton the i s s ue of

puni t i ve damages , and the ca s e w i l l end. I f , on the otherh and, the j udge s houl d al l ow the i s s ue of puni t i ve damages t o be cons i der ed by the j ury, then the j ury, upon bei ng pr oper l y i ns truct ed by the j ud ge o n the pun i t i ve d am ages i ssue, m ay decide t o aw ard pun i t i ve d am ages, and i f s o, i n w hat am ou nt, or the jury m ay d eci de n ott o aw ar d pu nit i ve d am ages. B ra d fie ld v. S c h w a rtz , 936 So. 2d 931, 939 ( M i s s . 2006)
. T he dec i s i on i n B r adf ield does not
s t and f orthe pr opos i t i on thatthe tr i al courts houl d aut om at i cal l y s ubm i tthe i s s ue of puni t i ve damages t o the j ury f

ordet erm i nat i on, b ut only thatthe tr i al j udge s houl d comm ence an evi dent i ary hear i ng bef or e the j ury on the i s s ue of puni t i ve damages , and atthe conc l us i on of t hi s evi dent i ary hear i ng i n the s econd pha s e, the tr i al courthas avai l abl e al l of the tr adi t i onal opt i ons f

ordet erm i ni ng w hetherornotthe puni t i ve- dam ages i s s ue s houl d be
s ubm i t t ed t o the j ury.

### 22

¶4 6
. M iss iss ip p i C o d e A n n o tat ed S ec ti o n 11 -1-6 5 (c) an d (d) ( S u p p . 2 0 0 8 ) (e m p h a sis
a d d e d ) h o ld s , (c) If , bu to nly i f, an aw ard of com pen sat ory dam ages ha s been m ade ag ai nst a party, the cour ts hal lpr om pt l y com m ence an evi dent i ar y hear i ng to det erm i ne w hetherpuni t i ve damages m ay be cons i der ed by the s ame t r i erof fa c t. ( d) T he courts hal l det erm i ne w hetherthe i s s ue of puni t i ve damages m ay be s ubm i t t ed t o the tr i erof

f act ; and, i f

s o, the tr i erof

f acts hal l det erm i ne w hether to a w a rd p u n iti v e d a m a g e s a n d in w h a t am o u n t. ¶ 4 7
. N o a d d iti o n a l e v id e n c e w a s p re s e n ted b y e ith e r p a rty re g a rd in g c o n d u c t th a t w o u ld j us t i f y puni t i ve damages , a nd ther e w as no s epar at e evi dent i ary he ar i ng. The j ury w as i ns truct ed, “[ t ] he courtw oul d then i ns tructyou thatyou ar e t o cons i deral l of the evi dence in th is c a se th a t h a s p re v io u sly b e e n p re se n ted to y o u in th e c o m p e n sa to ry p h a se ju st a s if it
w e re re -f ile d a g a in fo r t h is p a rt ic u la r p h a s e o f t h e tr ia l.” ¶48. “The j ury sho uld be al l ow ed t o cons i derthe i s s ue of puni t i ve damages i f

the tr i al ju d g e d e ter m in e d u n d e r th e to tality o f th e c irc u m sta n c e s a n d in lig h t o f d e fe n d a n t' s a g g re g a te
con du ct , that a r easona ble, h y po theti cal j uror could have i den t i fi ed either m al i ce or gross di s r egar d t o the r i ght s of other s . ” P aracels u s H

ealt h Care Corp. v. W

il lard , 754 So. 2d 437, 4 4 2 (M iss . 1 9 9 9 ) (c itatio n o m itt e d ). F a c tu a lly , w e fin d n o su p p o rt th a t D r. C a u se y a c ted w ith
m a lic e o r w ith g ro s s d is re g a rd fo r t h e ri g h ts o f o th e rs . ¶49. D r. C ausey subm i t s he w as t re at i ng A l l en bas ed on the bel i ef s he w as a t erm i nal p a tien t an d n e e d e d relie f fro m p a in
. A llen ’s d a u g h tera n d g ra n d d a u g h tertes tified th a t w h ile A l l en w as atH os pi ce, they w er e pl eas ed w i t h t he ca r e s he r ece i ved and f el tthe s t af

f w as att ent i ve t o A l l en’ s needs
. B as ed on the r ecor d bef or e thi s C our t , ther e w as no evi dence that D r . C aus ey “de m ons tr at ed a w i l l f ul orm al i ci ous w r ong orthe gr os s , r eckl es s di s r egar d f or

### 23

the r i ght s of

other s . ” R os s -K

ing- W al ker , I nc. v. Hens on , 6 7 2 S o . 2 d 1 18 8, 11 92 (M i ss. 19 96 ) ( ci t at i on s om i t t ed). W e f i nd cl ear err or, i n that the record i s devo i d o f these el em ents , and f ur therm or e, thatpuni t i ve damages s houl d nota ut om at i cal l y be s ubm i t t ed t o a j ury by a tr i al court . A ccor di ngly, w e ar e r equi r ed t o r ever s e and r enderthe aw ar d of puni t i ve d a m a g e s . V . W het her t he t ri al court err ed i n denyi ng D r. C ause y’ s m ot i on f or re m i t t i t ur. ¶50. T he Sander s f

ami l y w as a w ar ded $4, 000, 000 i n compensa t ory damages and puni t i ve damages i n the amountof $500, 000. By agr eementof the part i es , the ver di ctw as of f s etby the set t l em ent am ou nts of U M C and H ospice M i nis tri es. T he fi nal ver dictrendered aga i nst D r. C ausey w as f

orthe amountof

$3, 485, 000. Subse quentt o the ver di ct , D r . C aus ey f i l ed a M ot i on f

orR emi t t i turand/ ort o St r i ke Puni t i ve D amages , w hi ch w as deni ed by or derf r om th e trial c o u rt. ¶51. T hi s C our thas addr es s ed the appr opr i at e pr ocedur e r egar di ng r emi t t i turi n D e de aux
v. P e lle r in L a u n dr

y, I n c .: A n y pa rty ag g ri ev ed by th e am o u n t o f dam ag es aw ard ed pu rsua n t to a ju ry ver di ctm ay f

i l e a mot i on f

oran addi turorr emi t t i tur . M i s s . C ode A nn. § 11- 1- 55. I f the tr i al j udge gr ant s a mot i on f oran addi turor r emi t t i tur , s uch gr antof an ad d itu r o r rem itti tur sh all take effec t on ly if ac ce p ted b y all the p arti es. If a ll th e p a rties d o n o t ag re e to th e ad d itu r o r th e rem itt itu r, th e n e a c h p a rty sh a ll have the r i ghtt o ei therdemand a new tr i al on damages , orappea l the or der as s ert i ng an abus e of

di s cr et i on on the partof the tr i al j udge. D edeaux v. P el

ler in L aundry, I

nc. , 9 4 7 S o . 2 d 9 0 0 , 9 0 8 (M is s . 2 0 0 7 ). ¶52. I n hi s M ot i on f

or R emi t t i tur and i n hi s br i ef , D r . C aus ey ar gues ther e w as l i t t l e orno evi dence puton r el at ed t o damages , and thatthe evi dence r egar di ng A l l en’ s l i f e expe ct ancy

### 24

w as “s pecul at i ve atbes t . ” Exper t s f orboth part i es gav e co ntr ary t es t i m ony on how l ong A ll en w as e x p ec ted to li v e. D r. H ay n e testi fi ed for S an d ers tha t th e p rog n o sis for A ll en ’s l if e expec t ancy w as “guar ded” and s he coul d have l i ved se ver al m or e yea r s , even though s he had otherunde r l yi ng di s eas es . D r . H ous t on, t es t i f yi ng f orD r . C aus ey, s t at ed thatA l l en may not have ha d canc er , butshe w as “f ai l i ng t o thr i ve” a nd “ca chec t i c” a nd that“hos pi ce c ar e w as appr opr i at e f

orher
. ” Tw o nur s es w ho t es t i f i ed on beha l f

of H os pi ce s t at ed A l l en very m uch

“ a p p e a re d to b e te rm in a lly ill” a n d in “ e x tr e m e p a in a t a ll tim e s .” ¶53
. T h e fa m il y exp end ed $6 , 30 0 forA l l en’s bu ri al ex p en ses. T h e S an d ers fam il y ’s t es t i m ony cent er ed on thei rl os s of the enj oym ent , s oci ety, and compani ons hi p of A l l en. A d d iti o n a lly , the ju ry w a s in stru c ted th a t th e w ro n g fu l-d e a th b e n e fic iar ies w e re e n tit led to
r e c o v e rf o rt h e p a i n , s u f

f e r i n g , a n d me n t a l a n g u i s h s u s t a i n e d b y th e d e c e d e n tf r o m th e t i me
o f t h e o c c u rr e n c e o f t h e w ro n g fu l c o n d u c t u n til d e a th
. ¶54. T he det erm i nat i on of damages i s w i thi n t he pr ovi nce of t he j ury, and thi s C our thas held, “[ c] om pen sat i on i n a w ron g ful death act i on i s not l i m i t ed to actual dam ages an d lost
w ages , butext ends t o the pai n and s uf f er i ng of the dec eas ed, as w el l as the l os s of compani ons hi p and s oci ety. ” V enton , 964 So. 2d at506 ( ci t at i on om i t t ed). “[ A ] r emi t t i tur i s appr opr i at e w hen ( 1) the j ury ortr i erof f actw as i nf

l uence d by bi as , pr ej udi ce, orpas s i on
o r ( 2 ) t h e d a m a g e s w e re c o n tr a ry to th e o v e rw h e lm in g w e ig h t o f t h e e v id e n c e .” B olden , 854 S o . 2 d at 10 5 8 (i n terna l ci tat ion s o m itted). ¶5 5
. N o ev iden ce o f eith er w as p rese n ted to the tr ial co u rt , an d there fore w e fi n d n o erro r. W e re affirm o u r pre ce d en t th at w e w il l “ge n era ll y n o t vac ate o r re d u c e a d am ag e a w ard

### 25

unl es s i ti s s o ‘ outof

l i ne as t o s hock the cons ci ence of t he cour t . ’ ” I d . ( ci t i ng Cit

y of J a c ks o n v. L o c k la r

, 4 3 1 S o . 2 d 4 7 5 , 4 8 1 (M is s . 1 9 8 3 ))
. V I . W h ether the tri al cou rt erred in n ot i n st ru ct i ng t he j ury as t o “chance of r e c o v e r y .” “W hen cons i der i ng a cha l l enge t o a j ury i ns truct i on o n appeal , w e do not re v iew ju ry in stru c tio n s in iso latio n ; r a th e r, w e re a d th e m a s a w h o le to determ i ne i f

the j ury w as pr oper l y i ns truct ed. ” Burton e x r e l . Br ad f or d v. B a rn e tt , 615 So. 2d 580, 583 ( M i s s . 1993)
. Si m i l ar l y, thi s C our thas s t at ed that “i n determ i ni ng w hethererr orl i es i n the gr ant i ng orr ef us al of var i ous i nstruct i on s, the i nstruct i on s actuall y given m ustbe r ead as a w ho l e. W hen so r ead, i f the i ns truct i ons f

ai rl y ann ou nce the l aw of the ca s e and c r eat e no i nj us t i ce, no r ever s i bl e err orw i l l be f ound. ” Co lem a n v. S ta te , 697 So. 2d 777, 782 ( M i s s . 1997) ( quot i ng Co llin s v . Sta te , 6 9 1 S o . 2 d 9 1 8 (M iss. 1 9 9 7 )). In o th e r w o rd s, if a ll i n stru c tio n s ta k e n a s a w h o le f a irly , b u t n o t n e c e ss a rily perf ect l y, ann ou nce the app l i cable rules of l aw , no err or r esul t s. Mila n o v. Sta te , 7 9 0 S o . 2 d 1 7 9 , 1 8 4 (M is s . 2 0 0 1 ). ¶ 5 6
. A t tr ia l, D r. C a u s e y s u b m itte d a c h a n c e -o f- re c o v e ry in s tru c tio n w h ic h s ta te d , T he cour tins truct s you thatM i s s i s s i ppi l aw does notperm i tr ecove ry of d am ag es b ec au se o f m ere d i m i nis h m en t of th e “ ch an ce o f reco v ery . ” R ec o v ery i s al l ow ed on l y w hen the ne gli gen ce o f the m edical p rovi der resul t s i n the l oss o f a reasonab l e proba bil i ty o f s ub st anti al i m provem ent of the p l ai nti ff’s condi t i on. T her ef

or e, i f you f i nd thatther e w as no r eas onabl e pr obabi l i ty that M s . A l l en’ s condi t i on w oul d s ubs t ant i al l y i m pr ove, even i n the abs ence of any negl i gence by t he D ef endant s , then you mustr eturn a ver di ctf orthe D e fe n d a n ts . ¶57. D r. C ausey ar gued he w as ent i t l ed t o a chance
- of
- r ecove ry i ns truct i on base d on t he
c o n ten tio n “ th a t sh e w a s te rm in a l p a tien t. A n d so sh e w a s s e n t to u s to d ie a n d to d ie comfort abl y. A nd s o i f

[ Pl ai nt i f f s ] ar e s ayi ng thatw e s om ehow c uts hor tthatamountof t i m e, then they s houl d notbe al l ow ed t o r ecove ron s om e theory thatw e, you know , cutshorther life, h e r a b ili ty to – h e r ch a n c e to re c o v e r b e c a u se sh e w a s te rm in a l.” S a n d e rs o b jec ted to th is

### 26

i ns truct i on, s t at i ng i tw as notan i s s ue br oughtf or th b y t he Pl ai nt i f

f ors uppor t ed by the
e v id e n c e in th is c a s e . T h e in s tru c tio n w a s re fu s e d b y th e tr ia l c o u rt . ¶58. T he tr i al j udge appr opr i at el y s t at ed the i ssues of t his case, w hi ch w er e: a) di d an
over dos e occ urand b) w as t hi s over dos e the pr oxi m at e ca us e of A l l en’ s death? The j ury w as properl y instruct ed as t o these i ssues. Instruct i on P -13 st at es: I f you f i nd f r om a pr eponder ance of the evi dence i n thi s c as e thatE r s el A l l en, d ec ed en t, w h il e a p ati en t atH o sp ice M inistri es, In c . w as in the c are o f D r. W i l l i am C aus ey and otherempl oyees of H os pi ce M i nis tr i es , I nc. w as p re sc rib e d a n o v e rd o se o f th e d ru g H y d ro m o rp h o n e o r D ila u d id ; an d sa id o v e rd o sin g , if an y , o f E rse l A llen w a s th e so le p ro x im a te c a u se o r a p ro x im a te contr i bu t i ng caus e of

E r s el A l l en’ s death and damages , i f any, then your v e rd ict s h a ll b e fo r th e p lain tiffs , a n d y o u m u st a w a rd d a m a g e s, if a n y , in a c c o rd a n c e w ith th e o th e r i n s tru c tio n s g iv e n to y o u . ¶59
. Instruct i on 14 st at es, H ow ever , i f

you fi nd f

r om the evi dence thatthe Pl ai nt i f f s have f ai l ed t o pr ove to y o u , b y a p re p o n d e ra n c e o f t h e e v id e n c e , 1 . T h a t D r. C a u se y w a s n e g lig e n t o r a c ts fe ll b e lo w th e s ta n d a rd o r c a re , in pr es cr i bi ng and havi ng a dm i ni s t er ed an ove r dos e of pai n m edi cat i on t o E r s el A l l en b y n urses w hil e she w as atH ospice M i nis tri es and 2 . T h a t D r. C a u se y ’s n e g lig e n c e , if an y , p ro x im a tely c a u se d o r p ro x im a tely contr i but ed t o Er s el A l l en’ s de ath a nd otherdamages , i f any s us t ai ned by Ers el A ll en an d the P lai n ti ffs, then y o u r ve rdict sha ll b e fo r th e D efe n d an ts D r. W illia m C a u s e y a n d H o s p ic e M in is tr ie s . ¶60. N o evi dence of a po ssi bil i ty of a s ubs t ant i al r ecove ry w as pr es ent ed t o the j ury by ei therPl ai nt i f

f orD ef endant
. D r . C ausey’s br i ef s t at es thatthe evi dence of r ecove ry w as
s pecul at i ve atbes tand thatexpert s t es t i f i ed A l l en cou l d have l i ved “a nyw her e f r om an ad d it ion al si x w ee k s to se v en y e a rs.” S an d ers’s p roo f ca n b e c ap su li ze d as fo ll o w s: D r.

### 27

C aus ey al l egedl y has t ened A l l en’ s death by an over dos e. D r . C aus ey of f er ed evi dence that A lle n w a s te rm in a lly ill a n d w o u ld h a v e d ie d w ith in s ix m o n th s re g a rd le s s . ¶6 1
. L o ss-o f-ch an ce -of-rec o v ery theo ry instruction s are g en era ll y su b m itted b y p lai n ti ffs i n ci r cumst ance s w her e a medi cal pr ovi der ’ s ne gl i gence doe s notc aus e a pat i ent ’ s i nj ury or death, butar guabl y hi nder ed the pat i entf r om achi evi ng r eas onabl y pr obabl e and s ubs t ant i al
r ecove ry fr om i nj ury. In the cas e sub j udi ce, D r . C aus ey w as al l eged t o have caus ed th e d e a th of A l l en due t o an over dos e, nott o have hi nder ed A ll en ’s reco v ery . T h ere fore , the c h an ce -ofre c o v e ry in s tru c tio n is n o t a p p lic a b le in th is c a s e . CO NC L US I ON ¶6 2
. F o r th e re a so n s s tate d h e re in , w e fi n d th is jud g m en t sh o u ld b e a ffirm e d a s to
c o m p e n s a to ry d a m a g e s a n d re v e rs e d a n d re n d e re d a s to p u n itiv e d a m a g e s . ¶63. AFF I RM ED I N PART; REVERSED AND REND ERED I N PART. S M I T H , C .J ., W A L L E R , P .J ., C A R L S O N , D I C K I N S O N A N D L A M A R , J J ., CO NCU R. GR AV ES, J. , CO NCU RS I N PART AND DI S S ENTS I N PART W I TH SE P A R A T E W R I T T E N O P I N I O N JO I N E D B Y D I A Z, P . J. , A N D E A SL E Y , J. GR AVES, J UST I CE, CO NCU RRI NG I N P ART AND DI S S EN TI NG I N PART: ¶64. I agr ee w i th the maj or i ty’ s decis i on today excep tf ori t s tr eatm entof

the puni t i ve damag es i ssue. T he r eas ons f orm y di s agr eementhave be en f ul l y expl ai ned i n m y di s s ent i n P ruden tial I

n suran ce Compa ny of A m erica v. Stew art , 969 So. 2d 17, 28- 35 ( M i s s . 2007) ( G r aves , J
. , di s s ent i ng) as i tr el at es t o B ra d fie ld v. S c h w a rtz , 9 3 6 S o . 2 d 9 3 1 (M iss. 2 0 0 6 ).

### 28

I he r eby i ncorpor at e the ar gum ent s f r om my di s s enti n P r udential
. P r udential , 969 So. 2d at28- 35. DI AZ , P . J . , AND E AS LE Y, J . , J OI N T HI S OP I NI ON.