174 So. 3d 1
La. Ct. App.2014Background
- Amy Kirby, 51, with known pancreatic mass, presented repeatedly to Earl K. Long Medical Center (EKL) in August 2008 for severe abdominal pain and opioid-induced constipation; treatment focused on escalating laxatives, enemas, and opioids.
- Over two days her condition worsened: progressive distention, severe pain, vomiting, absence of bowel sounds, and family reports she screamed she was "rupturing"; clinically she had large retained stool and no effective bowel movement despite repeated measures.
- Tests that might have diagnosed obstructive or tension physiology (abdominal CT, colonoscopy, hypaque/gastrografin enema) were not timely performed; staff did not discontinue oral laxatives or make the patient NPO as experts opined they should.
- A surgical consult occurred late; emergency laparotomy showed a perforated/necrotic segment of colon (35 cm removed); patient developed sepsis/DIC and died shortly after life support was withdrawn.
- A unanimous medical review panel found breaches in care (continuation of oral laxatives, failure to obtain GI consult/appropriate imaging) and causation; a jury returned a verdict for plaintiffs, awarding damages reduced to the statutory malpractice cap. EKL appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether hospital administrative staff breached standard of care (staffing/supervision, equipment) | EKL lacked adequate attending supervision, competent staffing, and adequate crash-cart equipment; those failures contributed to harm | EKL contended record/experts did not reasonably support breach findings | Affirmed: record (including medical panel, staffing gaps, missing x-ray, nonfunctioning crash-cart monitor) reasonably supports breach and causation |
| Whether internal medicine physicians/staff breached standard of care (treatment choices) | Physicians improperly continued/enhanced laxatives/enemas and opioids despite worsening condition; should have stopped laxatives, made patient NPO, obtained CT and GI/surgical consult earlier | EKL argued expert conflict and insufficient proof that conduct caused perforation | Affirmed: plaintiffs' experts and some of EKL’s own experts supported that different management (CT, NPO, earlier consult) was indicated; jury verdict not manifestly erroneous |
| Whether trial judge's voir dire comments constituted prejudicial commentary on evidence requiring mistrial | Plaintiffs: judge’s statements were permissible to rehabilitate juror bias and explain jury role | EKL: judge’s remarks implied case was nonfrivolous and commented on merits, tainting jury | Held: No mistrial. Remarks were general, made during voir dire before evidence, and not sufficiently prejudicial; defendant should have objected earlier |
| Whether plaintiffs’ answer seeking frivolous-appeal damages warranted award | Plaintiffs sought fees for a frivolous appeal | EKL believed appeal was colorable | Held: Denied. Appeal not taken solely for delay and counsel reasonably advocated position; award inappropriate |
Key Cases Cited
- Rosell v. ESCO, 549 So.2d 840 (La. 1989) (standard for appellate review of factual findings)
- Johnson v. Morehouse Gen. Hosp., 63 So.3d 87 (La. 2011) (medical-malpractice appellate-review principles)
- Kaiser v. Hardin, 953 So.2d 802 (La. 2007) (two-step manifest-error review on appeal)
- McGlothlin v. Christus St. Patrick Hosp., 65 So.3d 1218 (La. 2011) (admissibility and weight of medical review panel opinion)
- Armand v. State, Dept. of Health & Human Res., 729 So.2d 1085 (La. App. 1 Cir. 1999) (hospital duties: competent staff/facilities)
- Washington v. Waring, 142 So.3d 40 (La. App. 1 Cir. 2014) (trier of fact resolves conflicting expert testimony)