Opinion ID: 1862642
Heading Depth: 1
Heading Rank: 6

Heading: motions for a new trial or a remittitur

Text: The defendants contend that the jury's verdict was contrary to the weight of the evidence, and, in the alternative, that the amount awarded was so large as to be excessive and thereby violate their constitutional rights to due process. Because our disposition of the latter contention necessarily encompasses the former, we shall examine the facts considered by the jury in light of the due process analysis applied in Pacific Mutual Life Insurance Co. v. Haslip, ___ U.S. ___, 111 S.Ct. 1032, 113 L.Ed.2d 1 (1991). In Haslip, the United States Supreme Court expressly approved the use of the following factors routinely employed by this Court in reviewing punitive damages awards alleged to be excessive: (a) whether there is a reasonable relationship between the punitive damages award and the harm likely to result from the defendant's conduct as well as the harm that actually has occurred; (b) the degree of reprehensibility of the defendant's conduct, the duration of that conduct, the defendant's awareness, any concealment, and the existence and frequency of similar past conduct; (c) the profitability to the defendant of the wrongful conduct and the desirability of removing that profit and of having the defendant also sustain a loss; (d) the `financial position' of the defendant; (e) all the costs of litigation; (f) the imposition of criminal sanctions on the defendant for its conduct, these to be taken in mitigation; and (g) the existence of other civil awards against the defendant for the same conduct, these also to taken in mitigation. Haslip, ___ U.S. at ___, 111 S.Ct. at 1045. See also Green Oil Co. v. Hornsby, 539 So.2d 218 (Ala.1989).
One of the most hotly contested issues at trial was the cause of deaththe evidence focusing primarily on the catheterization procedure performed by Dr. Atkins approximately 90 minutes before the seizure. The plaintiffs sought to contravene the testimony of Dr. Atkins, who insisted that he had safely and successfully changed the catheter over a wire, with evidence that Dr. Atkins, while effecting a new placement of the intravenous catheter, had punctured the child's heart. Following the unsuccessful attempt to revive the child, Dr. David Kelly, a pathologist at the Hospital, performed an autopsy. Dr. Kelly's examination of the child's heart revealed a number of abnormalities. Specifically, he found that the pericardial sac, a membrane encasing the heart, was bulging with blood. He testified that the blood had entered the pericardial sac, an area normally devoid of blood, through four or five areas of hemorrhage, which he observed on both the outer and inner surfaces of the right atrium and ventricle of the heart. In a number of these areas, Dr. Kelly located what he believed to be puncture wounds perforating the heart wall. At the site of at least one of the possible puncture wounds, Dr. Baldwin, who assisted Dr. Kelly in the autopsy, was able to insert a small probe. When inserted through the heart wall, the probe pointed upward toward the tip of the intravenous catheter, which was still positioned inside the superior vena cava at the time of the autopsy. Dr. Kelly concluded that the heart had been pierced from the inside outward during the catheterization procedure. He concluded that blood had escaped through the perforations, filled the pericardial sac, and caused a fatal cardiac tamponade, that is, an arrest of the natural movement of the heart. Dr. Kelly's testimony was reinforced in many respects by the testimony of the defendants' expert witness, Dr. Caulfield, who also concluded that the heart had been pierced by the catheter a very short time before the child died. Thus, the evidence justified a finding that Dr. Atkins's catheterization procedure had caused the child's death.

The second crucial factual issue before the jury was whether Dr. Atkins had effected a new placement of the catheter. Throughout the trial, Dr. Atkins insisted that he had merely changed the catheter over a wire, that is, that he had inserted a guidewire through the existing, properly positioned catheter, which he then withdrew, and, after withdrawing the former catheter, had inserted another catheter into the same vein using the guidewire and the length of the former catheter, in conjunction with the location of the sutures that had secured it, as reference points. According to this account, Dr. Atkins merely used the incision made earlier by Dr. Hendron in the child's right side to change the catheter. Within an hour after the procedure, Dr. Atkins met Dr. Baldwin while Dr. Baldwin was making his evening rounds. At that time, Dr. Atkins told Dr. Baldwin that the catheter had been changed over a wire, and that the procedure had been accomplished without problems or complications. Dr. Atkins testified that the procedure was accomplished without difficulty in approximately 20 minutes. In contrast to Dr. Atkins's version, nurse Cheryl Castner testified that Dr. Atkins did not merely change the catheter over a wire, but, rather, that he effected a new placementa more hazardous procedure according to all the witnesseswhich required the doctor to introduce a guidewire through a needle into a subclavian vein, probing the vein without the benefit of the former catheter as a reference point, and, ultimately, stopping the tip of the catheter just short of the heart's upper receiving chamber. She described the procedure as a very difficult, traumatic placement. She recalled that Dr. Atkins had a very difficult time inserting the catheter. Nurse Castner estimated that the procedure took approximately one hour, [7] during which Dr. Atkins, whose hands, according to nurse Castner, were shaking so hard that he was having a hard time feeding [the] catheter and the wire and all of [the] parts together, was successful in inserting the catheter only after he had made numerous attempts to push it into place. Nurse Castner's account of events was corroborated by Dr. Kelly's autopsy report, which indicted that Charles was catheterized on the left side of the body at the time of the autopsy. These contradictions are significant because of the degree of difficulty of the respective procedures in relation to Dr. Atkins's level of experience and because of the accuracy of the information relayed to Dr. Baldwin. Dr. Atkins testified that before the incident giving rise to this suit, he had never, in a pediatric patient, made an unsupervised catheter placement or changed a catheter over a wire. Dr. Baldwin testified that although a change over a wire was a very simple procedure, one that a resident could be expected to perform without prior notification of the attending physician, he would expect Dr. Atkins or any resident to notify him before undertaking a new placement. (Emphasis added.) Elsewhere, Dr. Baldwin stated: [I]t would have been my policy that I would want to have been informed about a new placement. He also testified that Dr. Atkins was obligated to inform him regarding difficulties encountered during the procedure. The evidence thus suggested that if the catheterization had not been over a guide-wire, Dr. Atkins not only violated the policy of Charles's attending physician, but also lied to that physician about his conduct. Dr. Atkins contends that, because Dr. Baldwin by casual observation so easily could have determined which catheterization procedure had been performed, the jury could not reasonably have concluded that he had lied to Dr. Baldwin. We disagree. [8] Under the evidence presented, the jury reasonably could have interpreted Dr. Atkins's conduct as follows: (1) notwithstanding Dr. Baldwin's policiesof which he was, or should have been, awareDr. Atkins, for personal reasons, decided to undertake an unsupervised new placement for which he perceived himself to be competent; (2) Dr. Atkins made a new incision on the right side near the pre-existing incision; (3) Dr. Atkins expressly rejected nurse Castner's suggestion that he use a heart monitor [9] and nurse Taylor's suggestions of a post-procedure X-ray [10] because the recordation of such devices on the chart would have indicated to Dr. Baldwin that he had made a new placement; (4) notwithstanding the difficulties that developed, he told Dr. Baldwin that the procedure had gone well in order to prevent further inquiry into the matter; [11] and (5) following the fatal cardiac arrest, he attempted to perpetuate the deception. [12] This interpretation so charges Dr. Atkins with awareness of the impropriety of his conduct and with attempts at concealment as to weigh heavily in favor of sustaining the judgment of the trial court. Haslip, ___ U.S. at ___, 111 S.Ct. at 1045.
The record provides ample evidence to support a finding of the Hospital's culpability predicated on its own policies and conduct. James Schmerling, a former associate administrator for operations at the Hospital, testified that the Hospital received no information regarding the capabilities of the residents used pursuant to its agreement with UAB and that the Hospital had no credentialing process for those residents. He also stated that the Hospital had no orientation or monitoring procedures for the residents. The jury could have concluded that this evidence indicated a policy of no policy, which was woefully inadequate to prevent this occurrence and similar occurrences. Additionally, in its order denying the defendants' post-judgment motions, the trial court observed that counsel for the Hospital had participated with his client in withholding the name of a material witness. More specifically, the court stated: Following [Dr. Atkins's] testimony, the plaintiffs presented Nurse Cheryl Castner. Her testimony was in clear contradiction of Dr. Atkins. There was evidence from which the jury could find that Children's Hospital had full knowledge of her whereabouts, but intentionally withheld her name from answers to interrogatories ordered by the court. It was undisputed that Ms. Castner had been contacted by the attorney for the defendant, Children's Hospital. The evidence would allow the jury to conclude that the attorney attempted to intimidate her and urged her not to become involved in the case.... .... Children's Hospital called as its only witness Mr. Pete VanPelt. He is the Risk Manager at Children's Hospital and was the last witness to testify in the case. The hospital had previously been ordered to answer interrogatories, which called for it to identify hospital employees who treated the Lee child. In response to that order, the hospital listed some 57 names. The request and the answer to this interrogatory were admitted into evidence during Nurse Geraci's testimony [`Geraci' was nurse Castner's former name]. Despite the numerous... times Nurse Geraci had been involved in the Lee child's care, her name was not on the list. Mr. VanPelt testified that Nurse Geraci's name had been left off unintentionally because they could not read her name in the chart. In place of her name, the hospital listed the fictitious name of Nurse Cathy Guardanio. When asked to do so on cross-examination, Mr. VanPelt had no problem reading Nurse Geraci's name from the chart, and he readily admitted the hospital had payroll records from which it could have given more detailed information had it chosen to do so. The jury was free to draw the inference from the evidence that the hospital had intentionally withheld Nurse Geraci's name from the list of employees in an effort to preclude the jury from having the benefit of her observations.... .... Nurse Castner testified that the attorney for Children's Hospital had contacted her some time before trial and had recommended that she not talk to anyone, that she could not be subpoenaed, and that he was aware nurses did not have a lot of money and was trying to `protect her.' ... Without question, if this evidence is believed by the jury, these matters would support a conclusion of reprehensible conduct on behalf of this defendant. (Emphasis added.) These observations of the trial court are fully supported by the record. C & D. Removal of Profitability and Defendants' Financial Positions Post-trial discovery revealed that the Hospital's net assets in 1989 exceeded $40,000,000. Financial statements revealed that the Hospital's operations had produced substantial profits from 1985 to 1989. Dr. James Dearth, the Hospital's chief executive officer and medical director, estimated that the Hospital's net income would, in 1990, exceed $10,000,000. In addition, the Hospital is insured on a nondeductible basis through the Alabama Hospital Association Trust (AHAT), whose investments exceeded $44,000,000 the end of 1989. Dr. Atkins is also insured on a nondeductible basis through the UAB Professional Liability Trust, which has enjoyed substantial profits annually since its inception. Based on this evidence, it scarcely can be contended that the judgment entered in this case exceeds that which is necessary in order to serve the purposes of punitive damages awards. [13] After a thorough review of the voluminous record and exhibits and the excellent briefs of counsel, and after our analysis of the evidence in the light of Haslip, we are unable to conclude that the trial court erred to reversal in any respect. Consequently, the judgment of the trial court is affirmed. AFFIRMED. MADDOX, SHORES, HOUSTON, STEAGALL, KENNEDY and INGRAM, JJ., concur.