Opinion ID: 1796937
Heading Depth: 1
Heading Rank: 3

Heading: Evidence Pertinent to General Damages

Text: Because defendants' primary contention is that the award is not supported by the evidence, and particularly the medical evidence, it is appropriate to review in detail the medical evidence in the record. Dr. Morris Kerstein, the chief of vascular surgery at TMC, first attended to Ms. Boutte in November 1986 for pain in both legs and for cool, blue feet caused by poor circulation. He diagnosed severe vascular disease, with underlying cardiac disease and some lung disease. An arteriogram in June 1987 showed virtually no circulation in the vessels below her knees. To complicate the problem, Ms. Boutte had an abdominal aneurysm which was threatening to rupture, but Dr. Kerstein couldn't perform surgery because of her severe heart problems. Expecting her to die or to lose her legs, he showed the patient and the family the x-rays and informed them of her limited longevity. At the time, she could walk using a quadwalker, but experienced great difficulty because of pain from lack of circulation in the legs. On and off, according to the doctor, she developed ulcers on her feet caused by lack of circulation. Because her condition was constantly worsening and was not operable, Dr. Kerstein saw her every two or three weeks so that she wouldn't get an infection I couldn't catch up with. In November 1987, Ms. Boutte was hospitalized for gangrene in her toes. Dr. Kerstein treated her to prevent infection that would move up the leg, but the toes were dead and not subject to improvement. In March 1988, Ms. Boutte developed cellulitis, an infection on the surface of the feet because of poor circulation. Dr. Kerstein treated her aggressively with antibiotics, attempting to buy time, but warning that she was never going to get better. Dr. Karcioglu, an internist and specialist in geriatric medicine who had treated Ms. Boutte since April 1987, hospitalized her in September 1988 because of congestive heart failure and acute pulmonary edema. She was discharged in a week, but returned to the emergency room on October 7 with severe chest pain, nausea, vomiting and fever. [7] Dr. Karcioglu also diagnosed a dissecting aneurysm of the aorta and severe peripheral vascular disease which caused ulcers on her heels. She was placed in the coronary care unit where she was on the date of her fall. After the fall, Dr. Raoul Rodriguez, an orthopedic surgeon, performed the open reduction. Following surgery, he ordered physical therapy which consisted of her sitting up and walking with a walker with assistance. According to the doctor, her walking was limited to what her heart could tolerate. She was discharged to home health care eleven days after the surgery. In the discharge, Dr. Karcioglu reported that she was ambulatory, and her prognosis was good. Ms. Boutte then continued under the care of Dr. Rodriguez. On October 26, the hip position was excellent, and Dr. Rodriguez advised Ms. Boutte to begin placing weight on her hip while walking with the walker. He noted that she was consulting Dr. Kerstein for leg circulation problems and pressure ulcers on her heels. He did not prescribe any medication. On November 29, the fracture was completely healed, and Ms. Boutte reported virtually no pain in her right hip. He considered her, from an orthopedic standpoint, to be in the same condition as just before the fracture. Not having seen her before the fall, he couldn't say that she was as mobile as she was before the fall, but he didn't believe that the fracture was a factor in any immobility that she may have been experiencing. He noted from the hospital records that family members reported Ms. Boutte before the accident had only been ambulatory short distances within her home using a cane. Ms. Boutte was to return in three months to Dr. Rodriguez for an orthopedic follow-up, but did not return. After the fall and surgery, Dr. Kerstein saw Ms. Boutte several times from her October discharge through January 10, 1989, and he observed non-healing ulcers of the heels. She used a walker when she came to the office, but walked short distances in the office without the walker. Ms. Boutte did not return to Dr. Kerstein until March 21, 1989, when he found that her condition had greatly deteriorated. He attributed her decline in part to her failure to visit him during the ten-week period. She had ulcers on her feet and decubitus ulcers on both buttocks. He diagnosed end stage cardiac disease and end stage vascular disease, and informed the patient and family that she was going to die. He instructed the family that he would hospitalize her if caring for her at home was too difficult for them to handle. Ms. Boutte was hospitalized again on April 9, 1989, and she died nine days later of heart failure. Thus there was no medical evidence that connected Ms. Boutte's deterioration after January 10, 1989 with her October 10, 1988 fall. In fact, the medical evidence established that her hip injury healed completely and that she was virtually free of pain in about seven weeks. The medical evidence further established that the very elderly patient, before her fall, had severe cardiac disease that resulted in very poor circulation and severe vascular problems, particularly in her feet and lower legs, had an aortic aneurysm, and had severe pulmonary fibrosis, all of which required frequent medical attention to keep them under control and all of which could only worsen. Plaintiffs relied on lay testimony to meet their burden of proving that the fall caused such a worsening of Ms. Boutte's condition as to justify the jury's award for damages resulting solely from the fall. Ms. Boutte's daughter and principal caretaker testified that her mother was very active in church and community affairs before her fall; was the church organist for over fifty years until 1984; taught piano lessons (at unidentified times); was on the advisory board of a nursing home; was on the board of directors of a mortuary and attended board meetings monthly; [8] arranged for persons to host weekly rosary recitations; traveled to visit relatives, including a trip to Biloxi two months before the accident; and did her own shopping accompanied by her daughter. The daughter further testified that Ms. Boutte walked with a four-prong cane before the fall, but could only walk with a walker or had to use a wheelchair after the fall. [9] According to the daughter, Ms. Boutte after the surgery constantly complained of hip pain, could not stand up because of the severe pain, begged to remain in bed, and believed she had nothing left to live for. Contrary to the medical evidence, the daughter asserted that the doctors did not tell them of her mother's congestive heart failure and severe vascular problems or of the impending danger of death or amputation caused by these problems. The daughter stated that her mother did not maintain treatment under Dr. Kerstein between November 1988 and March 1989 or keep scheduled appointments with Drs. Kerstein and Rodriguez because her mother was tired.