Delilah Stephens, M.D. v. Charles Rakes, etc.
235 W. Va. 555
| W. Va. | 2015Background
- Decedent Gary Rakes (65) with COPD/chronic hypercapnia was admitted to Bluefield Regional Medical Center Sept. 3–5, 2010; Dr. Delilah Stephens was the attending hospitalist.
- During admission the patient had elevated CO2 on ABG, was given sedating antipsychotics (Haldol and Seroquel), remained obtunded, was not placed on continuous monitored BiPAP with follow-up ABGs, and died early Sept. 5, 2010. DRs Muncy and Razzaq ordered Seroquel; Stephens signed off but did not personally place the Seroquel order. A pulmonology consult was not obtained.
- Plaintiff (personal representative) sued Stephens for medical malpractice and sought compensatory and punitive damages, alleging Stephens’ deviations from the standard of care (failure to monitor ABGs, delay/incorrect BiPAP orders, failure to consult pulmonology, failure to counteract Seroquel) proximately caused death and were reckless.
- Defendants moved for summary judgment on proximate causation and punitive damages; the court denied both motions and the case proceeded to a jury trial. The jury awarded $500,000 non-economic and $500,000 punitive damages; judgment entered for about $810,000 after offsets.
- Stephens renewed a Rule 50(b) motion for judgment as a matter of law and alternatively sought a new trial on several grounds (insufficient causation evidence, Batson challenge to a peremptory strike, violation of an in limine order, inflammatory argument, refusal to give a DNR instruction). The circuit court denied relief; the Supreme Court of Appeals of West Virginia affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Summary judgment on proximate causation | Stephens’ deviations (failure to monitor ABGs, delay/incorrect BiPAP, failure to consult) proximately caused death | Stephens says she did not order Seroquel, nurses/other physicians’ acts break causation, and BiPAP order wasn’t followed so an intervening cause absolves her | Denial affirmed — expert testimony raised genuine fact issues that her own deviations could be proximate causes; causation for jury to decide. |
| Summary judgment on punitive damages | Plaintiff: evidence shows willful, wanton, reckless conduct warranting punitive damages | Stephens: conduct at most simple negligence; punitive damages require gross fraud/malice/wantonness | Denial affirmed — expert testimony supported reckless/wanton conduct sufficient to submit punitive claim. |
| Renewed JMOL (Rule 50(b)) — sufficiency of evidence | Plaintiff: trial evidence (experts) supports breach and proximate causation; punitive damages supported | Stephens: evidence shows intervening/superseding causes and fails to prove punitive standard | Denial affirmed — viewing evidence favorably to nonmoving party, reasonable juror could find proximate cause and punitive conduct. |
| Trial rulings/new-trial claims (Batson, in limine, inflammatory argument, DNR instruction) | Plaintiff defended trial conduct: peremptory strike had race-neutral reasons; opening remarks didn’t state Stephens ordered Seroquel; curative instructions addressed argument; DNR not relevant to proximate causation | Stephens: Batson violation when sole African-American juror struck; in limine violation and prejudicial opening/closing; DNR instruction should have been given | Denial affirmed — court accepted nondiscriminatory reasons for strike; alleged in limine implication was harmless; curative/limiting instructions addressed inflammatory comments; proposed DNR instruction misstated law or was irrelevant to causation. |
Key Cases Cited
- Painter v. Peavy, 192 W. Va. 189, 451 S.E.2d 755 (W. Va. 1994) (summary-judgment standard reviewed de novo)
- Aetna Casualty & Surety Co. v. Federal Ins. Co. of N.Y., 148 W. Va. 160, 133 S.E.2d 770 (W. Va. 1963) (standards for granting summary judgment and burden on movant)
- Fredeking v. Tyler, 224 W. Va. 1, 680 S.E.2d 16 (W. Va. 2009) (Rule 50(b) renewed JMOL standard; view evidence in favor of nonmoving party)
- TXO Production Corp. v. Alliance Resources Corp., 187 W. Va. 457, 419 S.E.2d 870 (W. Va. 1992) (punitive damages standard includes extremely negligent/reckless conduct)
- Batson v. Kentucky, 476 U.S. 79 (U.S. 1986) (three-step framework for objecting to race-based peremptory strikes)