243 N.C. App. 677
N.C. Ct. App.2015Background
- Decedent Erica Bohn, with long-standing severe mental illness and prior involuntary hospitalizations, was treated at Coastal Carolina Neuropsychiatric Center (CCNC); Jessica Hardin, PA, under Dr. Mikhail’s supervision, managed her medications.
- On 25 May 2010 Hardin prescribed Lamictal and instructed an accelerated titration (25 mg week 1, 50 mg week 2, then increased to 100 mg by week 4) to treat depressive symptoms and reach therapeutic dose sooner due to worsening condition.
- On 23 June 2010 Bohn presented to Onslow Urgent Care with sore throat, lip blisters, and rash consistent with Stevens-Johnson Syndrome (SJS); Urgent Care misdiagnosed her and did not advise stopping Lamictal.
- Two days later Bohn was hospitalized with toxic epidermal necrolysis (TEN) involving 57% body surface, intubated, hospitalized two months, and died of ventilator-acquired pneumonia on 29 August 2010.
- Plaintiff (personal representative) sued for wrongful death/medical malpractice alleging negligent prescribing/titration and sought punitive damages; jury returned verdict for defendants. Trial court granted directed verdict on punitive damages and denied new trial; plaintiff appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Jury instruction & burden re: superseding/intervening negligence | Trial court erred by placing burden on plaintiff to disprove defendants’ affirmative defense of superseding negligence | Insulating/superseding negligence is an aspect of proximate cause; burden remains with plaintiff to prove causation | No error — instruction correct; burden did not shift and issue properly submitted only if jury found negligence |
| Directed verdict on punitive damages | Evidence (accelerated Lamictal titration) showed reckless indifference warranting punitive damages | Titration within clinical judgment; experts testified deviation from label is not per se willful or wanton; no evidence of conscious disregard | Affirmed — insufficient evidence of willful or wanton conduct to submit punitive damages |
| Admission of prior medical, DSS, Social Security records | Records were irrelevant, prejudicial, and some were unavailable to defendants when prescribing | Records were relevant to causation and damages and were relied on by experts; trial court vetted material | Affirmed — plaintiff waived some objections by failing to contemporaneously object; records were relevant and not unduly prejudicial |
| Character evidence argument (propensity) | Prior records improperly admitted as character/propensity evidence | Records were used by experts for opinions, not to show propensity; plaintiff failed to object on Rule 404 grounds at trial | Not preserved on appeal; in any event admissible as bases for expert opinions |
| Denial of motion to bifurcate liability and damages | Bifurcation required because prior records prejudiced liability phase | Trial court discretion; records relevant to both liability and damages and bifurcation motion was untimely | Affirmed — no abuse of discretion; motion on eve of trial was denied appropriately |
| Motion for new trial | Multiple trial errors entitled plaintiff to a new trial | Errors were either unpreserved or not prejudicial; trial was fair | Denied — no prejudicial error shown |
Key Cases Cited
- Variety Wholesalers, Inc. v. Salem Logistics Traffic Servs., LLC, 365 N.C. 520 (discussion of de novo review for summary judgment)
- Harris v. Walden, 314 N.C. 284 (denial of summary judgment not reviewable after full trial on the merits)
- Estate of Hendrickson v. Genesis Health Venture, Inc., 151 N.C. App. 139 (review of jury instructions in their entirety)
- Wall v. Stout, 310 N.C. 184 (plaintiff bears burden to prove proximate cause)
- Childers v. Seay, 270 N.C. 721 (superseding/insulating negligence is an elaboration of proximate cause)
- Muteff v. Invacare Corp., 218 N.C. App. 558 (distinguishing affirmative defenses like contributory negligence from superseding negligence)
- Ellison v. Gambill Oil Co., Inc., 186 N.C. App. 167 (punitive damages require more than scintilla of evidence of reckless disregard)
- Chambliss v. Health Sciences Found., Inc., 176 N.C. App. 388 (in medical context, punitive damages require conscious disregard of known protocols)