539 S.W.3d 752
Mo. Ct. App.2017Background
- Brian Koon was treated by Dr. Henry Walden (an SLU physician) from 2008–2012 for chronic low back pain and was escalated to extremely high opioid doses (average daily MED rising from ~50 in 2008 to ~1,556 by 2012).
- Evidence showed early refills, dose escalation, use of multiple opioids plus sedatives, withdrawal symptoms, and eventual diagnosis of severe opioid use disorder; plaintiff and spouse sought damages for addiction-related harms.
- Plaintiffs’ experts testified that prescribing at those levels and without adequate risk–benefit discussions, monitoring, or a medication management system breached the standard of care and caused injury.
- SLU conceded Dr. Walden was its employee and accepted responsibility for care; SLU had minimal opioid-monitoring policy and did not track opioid prescribing at the institutional level.
- The jury found liability (67% to Defendants, 33% to Koon), awarded compensatory damages and $15,000,000 in punitive damages; defendants appealed on multiple evidentiary, instructional, and submissibility grounds.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of opioid-epidemic evidence | Epidemic context is probative of physician/SLU knowledge, customary practice, and punitive-damages reprehensibility | Irrelevant and highly prejudicial; invited juror bias against defendants for national problem | Admitted: probative of standard, knowledge, and punitive factors; trial court did not abuse discretion |
| Mistrial requested during voir dire | No prejudice; juror comments reflected existing views and did not mislead jury about punitive damages | Voir dire exchange implied punitive award funds would address the epidemic; mistrial required | Denied: no reasonable likelihood jurors were misled; no manifest abuse of discretion |
| Submissibility of negligence claims against Walden and SLU | Evidence (expert guidelines, practice norms) established standard of care and deviations; SLU vicariously liable | Standard evidence relied on post-treatment or out-of-state guidance; SLU argued only negligent-supervision theory was submitted requiring other standards | Submitted: expert testimony showed applicable standards existed and SLU conceded respondeat superior; negligent-supervision instruction was not actually submitted |
| Punitive-damages instruction & sufficiency | MAI 10.07 language ("complete indifference or conscious disregard") correctly states law and equates to statutory standard for punitive damages against healthcare providers | Statute requires "willful, wanton or malicious" misconduct; MAI language is a lesser standard and conflicts with statute | Affirmed: MAI phrasing legally equivalent to "willful, wanton or malicious" per precedent (Dodson); instruction was proper and punitive damages were submissible on clear-and-convincing evidence |
Key Cases Cited
- Crow v. Crawford & Company, 259 S.W.3d 104 (Mo. App. 2008) (relevance and admissibility principles)
- Cox v. Kansas City Chiefs Football Club, Inc., 473 S.W.3d 107 (Mo. 2015) (logical relevance low threshold; balancing probative vs. prejudicial)
- Carlson v. Saint Louis University, 495 S.W.3d 777 (Mo. App. 2016) (standard for disturbing evidentiary rulings)
- Cluck v. Union Pacific Railroad Company, 367 S.W.3d 25 (Mo. banc 2012) (respondeat superior vicarious liability principles)
- Dodson v. Ferrara, 491 S.W.3d 542 (Mo. banc 2016) (application of punitive-damages standards in healthcare cases; court relied on MAI language equivalent to statutory standard)
- Reel v. Consolidated Investment Company, 236 S.W. 43 (Mo. 1921) (historic articulation that conscious disregard/recklessness can support punitive damages)