Court Opinion

ID: 9950638
Source: CourtListenerOpinion
Date Created: 2024-03-14 16:09:17.792367+00
Date Added: 2024-06-11T14:36:08.231945
License: Public Domain

140 Nev., Advance Opinion I LI
                    IN THE SUPREME COURT OF THE STATE OF NEVADA

                VALLEY HEALTH SYSTEM, LLC, A              No. 79658
                NEVADA LIMITED LIABILITY
                CORPORATION, D/B/A CENTENNIAL
                HILLS HOSPITAL MEDICAL CENTER,
                Appellant,
                vs.                                           FILED
                DWAYNE ANTHONY MURRAY,
                INDIVIDUALLY, AS AN HEIR, AS                  MAR 14 2024
                GUARDIAN AND NATTJRAL PARENT                ELI
                                                          CLEM'
                OF BROOKLYN LYSANDRA MURRAY,             BY
                AND AS SPECIAL ADMINISTRATOR                   EF DEPUTY CLERK

                OF THE ESTATE OF LAQUINTA
                ROSETTE WHITLEY-MURRAY,
                DECEASED,
                Respondent.

                VALLEY HEALTH SYSTEM, LLC, A              No. 80113
                NEVADA LIMITED LIABILITY
                CORPORATION, D/B/A CENTENNIAL
                HILLS HOSPITAL MEDICAL CENTER,
                Appellant,
                vs.
                DWAYNE ANTHONY MURRAY,
                INDIVIDUALLY, AS AN HEIR, AS
                GUARDIAN AND NATURAL PARENT
                OF BROOKLYN LYSANDRA MURRAY,
                AND AS SPECIAL ADMINISTRATOR
                OF THE ESTATE OF LAQUINTA
                ROSETTE WHITLEY-MURRAY,
                DECEASED,
                Respondent.

                VALLEY HEALTH SYSTEM, LLC, A              No. 80968
                NEVADA LIMITED LIABILITY
                CORPORATION, D/B/A CENTENNIAL
                HILLS HOSPITAL MEDICAL CENTER,
                Appellant,
                vs.
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                DWAYNE ANTHONY MURRAY,
                INDIVIDUALLY, AS AN HEIR, AS
                GUARDIAN AND NATURAL PARENT
                OF BROOKLYN LYSANDRA MURRAY,
                AND AS SPECIAL ADMINISTRATOR
                OF THE ESTATE OF LAQUINTA
                ROSETTE WH1TLEY-MURRAY,
                DECEASED,
                Respondent.

                             Consolidated appeals from a district court judgment pursuant
                to a jury verdict and orders awarding attorney fees and costs in a medical
                malpractice action. Eighth Judicial District Court, Clark County; Joseph
                T. Bonaventure, Sr. Judge, and Jacqueline M. Bluth, Judge.
                             Affirmed in part, reversed in part, vacated in part, and
                rernanded.

                Pisanelli Bice PLLC and Jordan T. Smith, Las Vegas; Greenberg Traurig,
                LLP, and Tami D. Cowden and Kara B. Hendricks, Las Vegas, and Kendyl
                T. Hanks, Austin, Texas; Hall Prangle & Schoonveld, LLC, and Michael E.
                Prangle and Jonquil L. Whitehead, Las Vegas,
                for Appellant.

                Lewis Roca Rothgerber Christie LLP and Daniel F. PoIsenberg and
                Abraham G. Smith, Las Vegas; The Gage Law Firm, PLLC, and David O.
                Creasy, Las Vegas,
                for Respondents.

                Hutchison & Steffen, PLLC, and Michael K. Wall, Las Vegas,
                for Amicus Curiae Your Nevada Doctors.

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                     Shook, Hardy & Bacon, LLP, and Jennifer Odell Hatcher, Kansas City,
                     Missouri,
                     for Arnici Curiae American Medical Association and Nevada State Medical
                     Association.

                     BEFORE THE SUPREME COURT, EN BANC.1

                                                      OPINION
                     By the Court, STIGLICH, J.:
                                 LaQuinta Whitley-Murray passed away at Centennial Hills
                     Hospital Medical Center during a sickle cell crisis. Respondent, on behalf
                     of LaQuinta's estate and heirs, filed a negligence action against appellant
                     Valley Health Systems, which operates Centennial Hills. A jury awarded
                     respondent over $48 million in compensatory and punitive damages
                     combined. Concluding respondent had prevailed under a theory of breach
                     of fiduciary duty, the district court upheld the awards and declined to apply
                     NRS Chapter 41A's statutory caps on damages in professional negligence
                     actions.
                                 We clarify that hospitals do not owe a fiduciary duty to their
                     patients in connection with medical treatment. Accordingly, we vacate the
                     compensatory damages awards and remand to the district court to apply
                     the damages cap to the award of noneconomic damages and to reduce both

                           1The Honorable Elissa F. Cadish, Chief Justice, and the Honorable
                     Patricia Lee, Justice, voluntarily recused themselves from participation in
                     the decision of this matter. The Honorable Michael Cherry and the
                     Honorable Abbi Silver, Senior Justices, have been assigned to participate in
                     the determination of this matter in their places.
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                        economic and noneconomic damages to the hospital's 65-percent pro rata
                        share. And because respondent's breach of fiduciary duty claim against

                        Centennial fails, we also reverse the award of punitive damages.              We

                        further vacate the award of prejudgment interest and remand for
                        recalculation so that prejudgment interest is awarded solely on past
                        damages. But we conclude that the district court did not abuse its discretion
                        in awarding attorney fees and costs, and we accordingly affirm in that
                        relevant part.
                                                 PROCEDURAL HISTORY
                                    Appellant Valley Health Systems operates Centennial Hills
                        Hospital Medical Center. On April 20, 2013, LaQuinta Whitley-Murray was

                        admitted to Centennial for a sickle cell crisis, complaining of extreme pain.
                        The hospital pharmacy recommended ketorolac,               a non-opioid pain
                        medication better known as Toradol, in part because sickle cell disease

                        increases the risk associated with opiate drugs. Toradol's "black box" insert
                        warns that a daily dose should not exceed 120 mg to alleviate the risk of
                        adverse reactions, including renal failure.
                                    The attending physician ordered 30 mg of Toradol to be
                        administered     every   six   hours.       Because   Centennial's   policy   for
                        administering non-time-sensitive medications, as Toradol was designated,
                        allows nurses to administer the drug within one hour of the scheduled time,
                        LaQuinta's dosage sometimes exceeded 120 mg per 24 hours. On April 24,
                        LaQuinta went into cardiac arrest and passed away.           She had suffered

                        multiorgan failure, including renal failure.
                                    Respondent Dwayne Anthony Murray, on behalf of LaQuinta's
                        estate and heirs, filed a negligence action against Centennial, its staff, and
                        the treating physicians.       Notably, Murray alleged that hospital staffs
                        treatment of LaQuinta fell below the standard of care and, before trial,
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                amended the complaint to allege that Centennial breached a fiduciary duty
                to LaQuinta by intentionally understaffing the hospital.         At trial,
                Centennial's primary defense was that it had not breached the standard of
                care and that the Toradol had not caused LaQuinta's death, and both sides
                presented substantial expert testimony on those points.2 Regarding breach
                of fiduciary duty, no witness testified that Centennial intentionally
                understaffed the hospital; to the contrary, testimony established that the
                hospital was not understaffed on the day LaQuinta died. During trial and
                particularly closing arguments, Murray argued for the first time that
                Centennial's medication administration policy was meant to increase the
                hospital's profitability to the patients' detriment.    No discovery was
                conducted on the medication administration policy or on whether
                Centennial prioritized profits over patients, as Murray contended. The
                district court—over Centennial's objection—nevertheless allowed Murray's
                experts to criticize the policy.
                             The jury was presented a verdict form that first asked whether
                Centennial had breached the standard of care, proximately causing
                LaQuinta's death.       The jury answered in the affirmative, awarding
                $16,210,000 in compensatory darnages and apportioning 65-percent of the
                fault to Centennial. The verdict form then asked whether Centennial had
                intentionally breached its fiduciary duty to LaQuinta and instructed the
                jury to stop and sign the last page if it answered "NO." The jury also
                answered this question in the affirmative, as well as the next question
                regarding whether that breach was a proximate cause of LaQuinta's death,
                leading it to the final question: whether Centennial engaged in fraud,

                      2 Senior Judge Bonaventure presided over the trial.

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                oppression. or malice toward LaQuinta.        The jury also answered that
                question in the affirmative and thereafter awarded $32,420,000 in punitive
                damages.
                             The district court did not apply NRS 41A.035's cap on
                noneconomic compensatory damages, concluding the awards fell under the

                claim for breach of fiduciary duty, which did not sound in professional
                negligence and was not subject to that cap.        R.elying on Centennial's
                rejection of a pretrial offer of judgment from Murray, the district court
                awarded Murray $511,200 for attorney fees, $169,895.61 for expert witness
                fees, and $37,374.21 for other court costs.
                             Centennial separately appealed the judgment upon the jury

                verdict (Docket No. 79658), order awarding attorney fees (Docket No.
                80113), and order awarding costs (Docket No. 80968).              This court
                consolidated the appeals.
                                               DISCUSSION
                             Centennial does not contest the jury's negligence findings,
                instead primarily arguing that the district court erred by entering judgment
                for intentional breach of fiduciary duty because Nevada law does not
                support imposing a heightened fiduciary duty on hospitals in this context.3

                      3The   American Medical Association and Nevada State Medical
                Association jointly filed an amicus brief supporting Centennial, arguing
                that caps on noneconomic damages rationally respond to rapidly rising
                noneconomic damages, Nevada enacted such caps to address a healthcare
                crisis caused by increasing liability costs, these caps have been effective in
                safeguarding available and affordable health care, and this court should not
                allow Murray to plead around Nevada medical liability laws and undermine
                their benefits. Your Nevada Doctors also filed an amicus brief supporting
                Centennial, arguing that Centennial does not owe a fiduciary duty to
                LaQuinta and that Nevada's policy of limiting liability for noneconomic
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                  We agree and address that issue before addressing the application of NRS
                  Chapter 41A and considering whether the punitive damages award was

                  proper, the district court erred by awarding prejudgment interest on future
                  damages, and the district court abused its discretion in awarding attorney
                  fees and costs.4

                  Nevada does not recognize a fiduciary duty owed by a hospital to a patient
                  in the provision of medical services
                              Centennial argues that Nevada law does not recognize a

                  heightened fiduciary duty owed by a hospital to a patient in the
                  administration of medicine and thus the district court erred in entering
                  judgment against Centennial on Murray's claim for intentional breach of
                  fiduciary duty. Murray responds that this court should recognize hospitals
                  as fiduciaries that owe their patients a duty to establish and follow policies
                  for the health and safety of patients.
                              Because the existence of a duty of care presents a question of
                  law, we review the district court's decision de novo. See Peck v. Zipf, 133
                  Nev. 890, 892, 407 P.3d 775, 778 (2017); Scialabba v. Brandise Constr. Co.,
                  112 Nev. 965, 968, 921 P.2d 928, 930 (1996). A fiduciary relationship exists
                  when one places heightened confidence in another such that the latter must
                  then act in good faith and for the other's benefit. See Long v. Towne, 98
                  Nev. 11, 13, 639 P.2d 528, 529-30 (1982) (discussing the elements for a claim
                  of constructive fraud). Although physicians may owe a duty of fiduciary

                  damages, medical malpractice liability, and punitive damages must not be
                  defeated by creative lawyering.

                        41n view of our decision, we need not reach Centennial's alternate
                  argument that NRS Chapter 41A should apply because the breach of
                  fiduciary duty claim sounded in malpractice.
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                care to their patients in certain circumstances,5 cf. Hoopes v. Harnmargren,
                102 Nev. 425, 431, 725 P.2d 238, 242 (1986), a majority of courts to consider
                the present issue have rejected the argument that hospitals likewise owe a
                fiduciary duty to patients. For example, a Mississippi federal district court
                recognized the fiduciary duty a doctor owed to a patient but distinguished

                that from the duties owed by a hospital, as the plaintiff emergency room
                patient failed to plead facts supporting "that she placed any special trust or
                confidence in" the hospital "beyond what is reasonably anticipated in an
                arms-length transaction." Henley v. Biloxi H.M.A., LLC, 489 F. Supp. 3d
                580, 590-91 (S.D. Miss. 2020), rev'd on other grounds, 48 F.4th 350 (5th Cir.
                2022). Without the patient demonstrating more in that particular instance,
                the relationship between an emergency room provider and a patient does
                not exhibit the degree of trust or confidence exceeding that of a routine
                business relationship in which parties must exercise simply reasonable care
                for each other. Id. at 590. Along these lines, the Arizona Court of Appeals
                rejected the reasoning that, because a "hospital is subject to the same

                      5We have previously recognized that the physician-patient
                relationship is based on an elevated level of trust and that a physician must
                accordingly exercise an elevated degree of good faith in acting in the
                patient's best interest. Hoopes v. Harnmargren, 102 Nev. 425, 431, 725 P.2d
                238, 242 (1986). This duty may be violated where a physician abuses the
                trust inherent in the physician-patient relationship to exploit the patient in
                a context distinct from providing medical services. Id. at 432, 725 P.2d at
                243. In other circumstances, we have recognized a fiduciary duty in
                situations involving particular care and trust, such as a partnership or an
                agency relationship, Bynum v. Frisby, 73 Nev. 145, 149, 311 P.2d 972, 974
                (1957), an attorney-client relationship, see Stalk v. Mushkin, 125 Nev. 21,
                28, 199 P.3d 838, 843 (2009) (recognizing that an attorney has a fiduciary
                relationship with a client in connection with the duties of loyalty and
                confidentiality owed the client), or a marriage, Williams v. Waldman, 108
                Nev. 466, 472, 836 P.2d 614, 618 (1992).
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                      standard of care in a malpractice action as a doctor," and "because a doctor

                      owes a patient a fiduciary duty," a hospital likewise "owes a patient a
                      fiduciary duty." Gonzales v. Palo Verde Mental Health Servs., 783 P.2d 833,
                      835 (Ariz. Ct. App. 1989).
                                  Similarly, the California Supreme Court rejected the claim that

                      a hospital owner, medical researcher, and two interested corporations owed
                      a fiduciary duty to a patient and thus were obligated to obtain a patient's
                      informed consent regarding a procedure, in contrast to the fiduciary duty

                      owed by the patient's physician. Moore v. Regents of the Univ. of Cal., 793
                      P.2d 479, 486 (Cal. 1990) (recognizing, however, that a hospital may be
                      vicariously liable for a supervised physician's violation of that physician's

                      own fiduciary duty to the patient). The Connecticut Supreme Court noted
                      that professional negligence involved breaching a duty of care, while
                      breaching a fiduciary duty involved violating a duty of loyalty and honesty,
                      before concluding that "[t]he plaintiff has provided scant reason to conclude
                      that a hospital owes a patient the duty of a fiduciary." Sherwood v. Danbury
                      Hosp., 896 A.2d 777, 797 (Conn. 2006). And a Louisiana federal district
                      court rejected that any authority existed to support the proposition that
                      such a fiduciary duty might arise from a healthcare-provider-and-patient
                      contract between those parties.6 Harrison v. Christus St. Patrick Hosp., 430
                      F. Supp. 2d 591, 595 (W.D. La. 2006).

                            6Murray nevertheless relies on DiCarlo v. St. Mary Hosp.,     530 F.3d
                      255 (3d Cir. 2008), to impliedly support the proposition that a hospital owes
                      a patient a fiduciary duty. But Murray misconstrues DiCarlo. DiCarlo
                      observed "that nonprofit hospitals owe a fiduciary duty to the public with
                      regard to staffing decisions" to ensure that hospitals had adequate capacity
                      to provide medical services before concluding that no fiduciary duty was
                      owed to an individual patient in a billing context. Id. at 268-69 (emphasis
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                            We agree with these courts.      No authority supports a broad
                finding that hospitals owe patients a fiduciary duty. Further, recognizing

                a claim for breach of fiduciary duty against a hospital in relation to a
                patient's medical care would be duplicative, and therefore improper, where
                the allegation boils down to one of medical malpractice by the hospital. For
                example, the United States Supreme Court explained that a decision by an
                HMO physician that mixed the HMO's financial incentive with medical
                considerations and resulted in a negative patient outcome would not
                support a claim for breach of fiduciary duty, as "for all practical purposes,
                every claim of fiduciary breach by an HMO physician making a mixed
                decision would boil down to a malpractice claim, and the fiduciary standard
                would be nothing but the malpractice standard traditionally applied in
                actions against physicians."    Pegram v. Herdrich, 530 U.S. 211, 234-35
                (2000). The Colorado Court of Appeals likewise rejected as duplicative a
                fiduciary duty claim against a physician "because the same issue was before
                the jury in the context of plaintiffs' negligence claims." Spoor v. Serota, 852

                P.2d 1292, 1294-95 (Colo. App. 1992); see also Neade v. Portes, 739 N.E.2d
                496, 505 (Ill. 2000) (declining to recognize a fiduciary duty claim against a
                physician for failing to disclose financial incentives in a medical malpractice
                action and holding that "a breach of fiduciary duty claim is duplicative of a
                medical negligence claim" in such circumstances).

                added). DiCarlo thus pertains to a hospital's obligation to ensure access to
                care to the public. It does not support the existence of a fiduciary duty owed
                by a hospital to an individual patient in connection with medical treatment.
                We have considered the other foreign authorities Murray proffers and
                observe that none directly supports the proposition that a hospital owes a
                fiduciary duty under these facts.
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                            Here, Murray initially based the breach-of-fiduciary-duty claim
                on allegations of intentional understaffing, but at trial, Murray reversed

                course and argued what he failed to allege in his complaint: Centennial's
                medication administration policy prioritized profits over patient safety and
                constituted an intentional breach of fiduciary duty because the policy

                allowed staff to administer niedication in violation of Toradol's black box
                warning. Upon concluding Centennial owed a heightened duty of care to
                LaQuinta by virtue of her status as a patient who came to the hospital with
                an expectation of being cared for, the district court upheld the full damages
                award on grounds that NRS Chapter 41A did not apply to a claim of breach
                of fiduciary duty.   This was error in light of the majority view and the
                absence of any compelling authority to the contrary.       Centennial owed
                LaQuinta the same duties that hospitals owe patients in providing medical
                services, that is, "to employ that degree of skill and care expected of a
                reasonably competent hospital in the same or similar circumstances."
                Wickliffe v. Sunrise Hosp., Inc., 101 Nev. 542, 548, 706 P.2d 1383, 1388

                (1985). It did not owe a heightened duty beyond that.7
                The compensatory damages award rnust be reduced
                            As only the negligence claim remains, NRS Chapter 41A
                applies. Where relief is warranted for a claim sounding in professional
                negligence such as medical malpractice, the noneconomic compensatory
                damages that may be recovered are limited to $350,000.8        NRS 41A.035

                      7 Because we conclude that Centennial owed no such duty as a matter
                of law, we need not address Centennial's related evidentiary claim.

                      8Pursuant to recently enacted legislation, the amount of this cap will
                increase over time, beginning January 1, 2024. A.B. 404, 82d Leg., § 2 (Nev.
                2023); 2023 Nev. Stat., ch. 493, § 2, at 3023.
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                 (2015); 2015 Nev. Stat., ch. 439, § 3, at 2526. Noneconomic damages in this
                 context refer to "damages to compensate for pain, suffering, inconvenience,
                 physical impairment, disfigurement and other nonpecuniary damages."
                 NRS 41A.011. These are distinguishable from economic damages, which
                 "include[ ] damages for medical treatment, care or custody, loss of earnings
                 and loss of earning capacity." NRS 41A.007. And when a defendant is liable
                 for professional negligence, it will be severally, not jointly, liable for both
                 economic and noneconomic damages for the percentage of negligence
                 attributable to it. NRS 41A.045(1).
                                The jury here found Centennial and its staff to be 65-percent
                 liable. It awarded $5,000,000 for loss of companionship, comfort, and
                 consortium; $7,000,000 for grief and sorrow; $1,700,000 for loss of probable
                 support; $10,000 for funeral expenses; and $2,500,000 for LaQuinta's pain
                 and suffering. Of these, loss of companionship, comfort, and consortium;
                 grief and sorrow; and pain and suffering are noneconomic damages and are
                 accordingly capped at an aggregate amount of $350,000.           Centennial's
                 liability is further limited severally to its share according to its 65-percent
                 contribution to the negligence.     Accordingly, we vacate the judgment's
                 damages award for loss of companionship, comfort, and consortium; grief
                 and sorrow; and pain and suffering and remand for the district court to issue
                 a judgment awarding $227,500 in aggregate for these damages and to
                 determine what portion of the $227,500 is attributable to each of those loss
                 categories.9     The damages for loss of support and funeral expenses are
                 likewise subject to the pro rata cap, and we vacate that portion of the

                       9Given the reduction of damages to those allowable, we need not reach
                 Centennial's contention that the award of $2,500,000 for pain and suffering
                 was excessive.
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                damages judgment and remand for the district court to issue a judgment
                against Centennial awarding $1,105,000 for loss of probable support and
                $6,500 for funeral expenses.
                Punitive darnages were improper
                            Centennial argues the record does not support an award of

                punitive damages.     We agree that the punitive damages award was

                improper. Critically, the verdict form allowed the jury to reach punitive
                damages only if the jury first determined Centennial breached a fiduciary
                duty. The district court later upheld that award on the ground that the
                medication administration policy supported the breach of fiduciary duty
                claim.   But Murray did not plead facts regarding the medication
                administration policy      in   the   amended   complaint,   instead   alleging

                understaffing and raising the medication administration policy only during
                trial. Regardless, our determination that Centennial did not owe a fiduciary

                duty here precludes the punitive damages award, as under the verdict form
                the jury could not reach punitive damages if Centennial did not owe, and
                therefore could not breach, a fiduciary duty to LaQuinta. Accordingly, we
                reverse the punitive damages award without reaching the parties'
                arguments on this point.
                The district court erred in awarding prejudgment interest on the entire
                award, rather than the portion attributable to past damages
                            Centennial argues that the district court erred in awarding
                prejudgment interest on future damages. Murray argues that this claim
                was waived because it was not timely raised and the district court
                accordingly did not consider it. If the claim is entertained, Murray asserts
                that the only future damages are those for grief and sorrow. Centennial
                replies that relief is nevertheless warranted for plain error. Again, we agree
                with Centennial.
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                             Nevada law is clear: prejudgment interest cannot be awarded
                on future damages. See NRS 17.130(2) (stating that "the judgment draws
                interest from the time of service of the summons and complaint until
                satisfied, except for any amount representing future damages"). It is error
                to award prejudgment interest for the entire verdict when it cannot be
                determined what part of the verdict represents past damages. Albios 1).
                Horizon Cmtys., Inc., 122 Nev. 409, 428, 132 P.3d 1022, 1035 (2006). A
                defendant's challenge to the award of prejudgment interest, when raised for
                the first time on appeal, is reviewable under the plain error rule. Id. at 429,
                132 P.3d at 1035 (reviewing sua sponte an award of prejudgment interest
                for plain error).
                             The jury here awarded a combination of past and future
                damages. It awarded past damages for LaQuinta's pain and suffering and
                funeral expenses.     Damages for loss of companionship, comfort, and
                consortium and loss of support reflected future damages.             See NRS
                41.100(3). The grief and sorrow damages explicitly commingle "[p]ast and
                future grief and sorrow." The district court ordered prejudgment interest
                on the aggregate amount of compensatory damages and plainly erred in
                doing so. Accordingly, we vacate the award of prejudgment interest. Given
                that the award of noneconomic damages has been vacated and must be
                recalculated consistent with NRS 41A.035, on remand the district court
                must determine what portion of the noneconomic damages was attributable
                to pain and suffering and recalculate prejudgment interest as to LaQuinta's
                pain and suffering and funeral expenses. Also, we direct the district court
                to consider whether the damages for grief and sorrow may be separated into
                past and future damages in that regard and to recalculate and award
                prejudgment interest only as to the portion constituting past grief and
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                sorrow. Should the district court be unable to separate past and future grief
                and sorrow, it may not order prejudgment interest as to that portion of the

                damages.10
                The district court did not abuse its discretion in awarding attorney fees and
                costs
                             Centennial argues that the district court should not have
                awarded more than $700,000 in attorney fees and costs. It argues that its
                refusal of LaQuinta's offer of judgment was not grossly unreasonable or in

                bad faith.   It argues that the court should have credited its theories of
                defense in determining whether it rejected Murray's offer of judgment in
                good faith and that Murray's attorneys' hourly rates were not reasonable.
                Centennial also argues that Murray's experts' fees were unreasonable,
                considering that two experts opined on similar topics. We disagree.
                             Where a party rejects an offer of judgment and fails to obtain a

                more favorable outcome, the offering party may recover attorney fees and
                costs incurred after the offer was made. NRCP 68(f)(1)(B). In deciding
                whether to award attorney fees under NRCP 68, the district court must
                consider the factors set forth in Beattie v. Thornas, 99 Nev. 579, 588-89, 668
                P.2d 268, 274 (1983):
                             (1) whether the plaintiffs claim was brought in
                             good faith; (2) whether the defendants' offer of
                             judgment was reasonable and in good faith in both
                             its timing and amount; (3) whether the plaintiff s

                      "Centennial alternatively argues that a new trial is warranted
                because the verdict was improperly the product of "passion and prejudice,"
                highlighting the large awards for punitive damages and compensatory
                damages for pain and suffering. Given that our disposition reverses the
                punitive damages award and reduces considerably the compensatory
                damages for pain and suffering, we decline to reach this alternative
                argument.
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                                    decision to reject the offer and proceed to trial was
                                    grossly unreasonable or in bad faith; and
                                    (4) whether the fees sought by the offeror are
                                    reasonable and justified in amount.
                        Where a plaintiff rather than a defendant makes an offer, the first factor
                        looks to whether the defendant raises its defenses in good faith. Yamaha

                        Motor Co., U.S.A. v. Arnoult, 114 Nev. 233, 252, 955 P.2d 661, 673 (1998).
                        To determine whether the fees sought are reasonable with respect to the
                        fourth Beattie factor, the court looks to the Brunzell factors:
                                    (1) the qualities of the advocate: his ability, his
                                    training, education, experience, professional
                                    standing and skill; (2) the character of the work to
                                    be done: its difficulty, its intricacy, its importance,
                                    time and skill required, the responsibility imposed
                                    and the prominence and character of the parties
                                    where they affect the importance of the litigation;
                                    (3) the work actually performed by the lawyer: the
                                    skill, time and attention given to the work; (4) the
                                    result: whether the attorney was successful and
                                    what benefits were derived.
                        Brunzell v. Golden Gate Nat'l Bank, 85 Nev. 345, 349, 455 P.2d 31, 33
                        (1969). Until the statutory limit in NRS 18.005(5) was raised in 2023, A.B.
                        76, 82d Leg., § 1 (Nev. 2023); 2023 Nev. Stat., ch. 70, § 1, at 342, recoverable
                        costs to retain expert witnesses were limited to $1,500 per expert for up to
                        five experts unless the court determined that the circumstances required
                        allowing a larger fee, Logan v. Abe, 131 Nev. 260, 267, 350 P.3d 1139, 1144
                        (2015); see 2007 Nev. Stat., ch. 440, § 7(5), at 2191. We review the district
                        court's award of attorney fees and costs for an abuse of discretion and will
                        uphold an award supported by substantial evidence. Logan, 131 Nev. at
                        266-67, 350 P.3d at 1143-44.

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                               The district court found that Centennial rejected an offer of
                   judgment for $300,000 and did not obtain a more favorable outcome. The

                   court specifically found that the Beattie and Brunzell factors warranted
                   attorney fees. It found that the offer was in good faith and reasonable in
                   light of the trial preparation that had already been undertaken at that time

                   and that the rejection of the offer was unreasonable because Centennial
                   knew the evidence supporting the claims and the substantial damages
                   alleged.   The court found that the attorney fees were justified and
                   reasonable considering that counsel were experienced trial attorneys and
                   that one of Murray's attorneys was also a board-certified medical doctor,
                   who accordingly brought medical expertise to the representation. Further,

                   the court found that the case was complex and heavily contested with
                   extensive pretrial litigation and trial preparation and that counsel's work
                   led to a substantial jury verdict. As to expert costs, the district court found

                   that both doctors were highly qualified and needed to address different
                   areas of medicine pertinent to the cause of death. The court found that their
                   testimony was not duplicative, that their preparation required reviewing
                   thousands of pages of medical records, that each expert spent a significant
                   amount of time preparing and testifying, and that exceeding the $1,500
                   statutory amount was justified because the expert testimony was important
                   to Murray's theory of the case. The district court. awarded attorney fees in
                   the amount of $511,200 and costs totaling $207,269.82, including expert
                   fees of $169,895.61.
                               The record demonstrates that the district court considered the
                   relevant standards and that substantial evidence supports the award of
                   attorney fees and costs. See id. at 266, 350 P.3d at 1143 ("[Tjhe district
                   court need only demonstrate that it considered the required factors, and the

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                award must be supported by substantial evidence."). Centennial has not
                shown to the contrary. Further, this matter required a nine-day jury trial
                in 2019 and ongoing appellate litigation to resolve.        Had Centennial
                accepted Murray's good-faith offer of judgment in 2016, each party would
                have forgone considerable time and expense. Cf. Dillard Dep't Stores, Inc.
                v. Beckwith, 115 Nev. 372, 382, 989 P.2d 882, 888 (1999) (remarking that
                "[t] he purpose of     NRCP 68 is to save time and money for the court
                system, the parties and the taxpayers" and to "reward a party who makes a
                reasonable offer and punish the party who refuses to accept such an offer").
                We conclude that Centennial has not shown the district court abused its
                discretion in awarding attorney fees and costs in the amounts ordered.
                                            CONCLUSION
                            A hospital does not owe a fiduciary duty to its patients in
                relation to medical care. Under NRS Chapter 41A, Centennial was liable
                for no more than $350,000 in noneconomic compensatory damages. The
                district court erred in awarding a larger sum. Further, both economic and
                noneconomic compensatory damages are limited to the hospital's 65-percent
                pro rata contribution to the negligence, given that the hospital is severally,
                not jointly, liable.   We vacate the compensatory damages awards and
                remand to the district court to apply the damages cap to the award of
                noneconornic damages and to reduce both economic and noneconomic
                damages to the hospital's 65-percent pro rata share, that is, noneconomic
                compensatory damages totaling $227,500 and economic compensatory
                damages of $1,105,000 for loss of probable support and $6,500 for funeral
                expenses. Because we do not recognize a breach of a fiduciary duty claim
                between a hospital and a patient, we reverse the award of punitive damages
                that the jury awarded for that cause of action. We also conclude that the

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                district court erred in awarding prejudgment interest on both past and
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                  future compensatory damages and vacate on that ground, remanding for
                  recalculation so that prejudgment interest is awarded solely on past
                  damages. Lastly, considering the offer of judgment below, we conclude that
                  the district court did not abuse its discretion in awarding attorney fees and
                  costs and accordingly affirm the orders awarding fees and costs.

                                                                                     J.

                  We concur:

                       aut.1                  ,   J.
                  Pickering

                                                  J.
                  Herndon

                    CIAN.                         J.
                  Parraguirre

                                                  Sr. J.

                                              ,   Sr • J •
                  Silver
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