210 Conn.App. 450
Conn. App. Ct.2022Background
- Bruce Cockayne was hospitalized in February 2014 and received three Rowasa (mesalamine) enemas administered by two hospital nurses (Jordan Kaine on Feb. 11–12 and Elaine Lapaan on Feb. 13).
- On Feb. 14 a physician discovered a ~2 cm, older-appearing perforation in the posterior right rectum; Cockayne developed necrotizing infection and sepsis and required multiple surgeries.
- Plaintiffs sued The Bristol Hospital (vicarious liability for its nurses) for medical malpractice and sought damages; trial occurred in Jan. 2020.
- Plaintiffs presented experts (gastroenterologist Mark Korsten and nurse expert Natalie Mohammed) who (1) testified the Rowasa enema tip could reach and perforate the rectum based on average anatomy and tip length and (2) used differential diagnosis to rule out other causes (colonoscopy, home enema attempt, Crohn’s spontaneous rupture).
- After a jury verdict for plaintiffs (substantial economic and noneconomic awards), the hospital’s motions for JNOV and to set aside the verdict/new trial were denied; the hospital appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Was there sufficient evidence that the Rowasa enema could physically cause the rectal perforation? | Korsten and treating notes showed tip length and average anal‑canal measurements made it reasonably probable the enema could reach and perforate the rectum. | Plaintiffs lacked patient‑specific anatomical measurements; enema tip may not reach beyond anal canal and is too flexible to cause the posterior 2 cm tear. | Affirmed: expert testimony about average anatomy plus tip length and clinical reasoning was sufficient to let the jury find physical capability. |
| Was there sufficient evidence that hospital nurses negligently caused the perforation (causation/breach)? | Experts used differential diagnosis to eliminate other causes and opined to a reasonable degree of medical probability that an improperly administered enema (misdirection/excessive force) caused the tear; testimony tied administrations to the relevant time frame. | Evidence was speculative; Mozzer-style gaps (no direct evidence who acted negligently) meant causation/breach not proved. | Affirmed: differential diagnosis and expert testimony supplied reasonable‑probability causation; jury could find one or both nurses negligent. |
| Did the court err by denying motion to set aside verdict because jury may have found liability as to the nurse unsupported by evidence (and because no interrogatories identified which nurse)? | Vicarious liability means it did not matter which nurse; jury instructions used "and/or"; experts provided evidence implicating one or the other; general verdict rule applies absent special interrogatories. | Jury may have found Lapaan solely liable though plaintiffs’ causation expert favored Kaine; without unanimous identification verdict could rest on unsupported ground, requiring new trial. | Affirmed: plaintiffs presented sufficient evidence as to either nurse; trial court properly refused interrogatories and the general verdict stands because at least one valid ground supported liability. |
Key Cases Cited
- Curran v. Kroll, 303 Conn. 845 (Conn. 2012) (whether evidence suffices to withstand directed verdict is a legal question reviewed plenarily)
- Bagley v. Adel Wiggins Group, 327 Conn. 89 (Conn. 2017) (standard for directed verdict/JNOV; view evidence in plaintiff’s favor)
- Console v. Nickou, 156 Conn. 268 (Conn. 1968) (circumstantial evidence and reasonable inferences can establish causation)
- Milliun v. New Milford Hospital, 310 Conn. 711 (Conn. 2013) (treating‑physician reports and differential diagnosis are permissible bases for causation opinions; exclusions affect weight not admissibility)
- Klein v. Norwalk Hospital, 299 Conn. 241 (Conn. 2010) (differential diagnosis may undergird expert opinions on causation and breach; disclosure of causation testimony sufficient)
- Procaccini v. Lawrence + Memorial Hospital, 175 Conn. App. 692 (Conn. App. 2017) (elements of medical malpractice and role of expert testimony on standard of care and causation)