Procaccini v. Lawrence & Memorial Hospital, Inc.
168 A.3d 538
| Conn. App. Ct. | 2017Background
- Decedent (32) with history of polysubstance abuse was treated in an ER after being found unresponsive on Nov. 29, 2008; paramedics administered IV naloxone (Narcan) and she improved. She was observed in the ER ~7:13–11:53 p.m. and discharged. She was later found dead the next morning; autopsy found methadone toxicity (blood methadone 0.39 mg/L).
- Plaintiff (administrator) sued Emergency Medicine Physicians of New London County, LLC (vicarious liability for ER physician Marchiondo) alleging premature discharge: plaintiff’s theory was that a suspected methadone overdose required 24-hour monitoring and that earlier discharge caused death from delayed respiratory depression.
- Key disputed medical evidence: pharmacology of naloxone and timing of recurring respiratory depression for long‑acting opioids (methadone) vs short‑acting opioids (heroin). Defendant’s expert said recurrence would occur within ~1 hour after naloxone; plaintiff’s expert (and medical examiner) testified delayed recurrence can occur hours later.
- Jury returned a verdict for plaintiff: economic damages ~$12k and noneconomic damages $500,000 (including $150,000 for destruction of capacity to enjoy life). Trial court denied defendant’s motions for directed verdict and to set aside. Defendant appealed claiming insufficient evidence on causation and that life‑expectancy evidence was lacking for the noneconomic award.
- Appellate court affirmed: held there was sufficient circumstantial and expert evidence to permit a reasonable inference that the fatal methadone dose was taken prior to ER discharge and that 24‑hour monitoring was practicable; also held the noneconomic award was supported by evidence of age, health, habits and activities (mortality tables not required).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence that defendant’s negligence caused death (timing of methadone ingestion / causation) | Evidence and expert testimony supported delayed recurring respiratory depression from methadone and circumstantial evidence (positive methadone screen at ER, no evidence of post‑discharge ingestion, autopsy toxicology) made it more likely than not the fatal dose was taken before discharge. | No direct proof when fatal methadone was ingested; undisputed toxicology principles show recurrence would have occurred within an hour after naloxone if methadone caused initial arrest—thus fatal dose likely taken after discharge; plaintiff’s proof speculative. | Affirmed: conflicting expert testimony permitted jury to credit plaintiff’s experts and infer delayed recurrence; circumstantial evidence was sufficient to support causation. |
| Requirement to prove patient would have been admitted/monitored (admission standard as element of causation) | Standard of care required 24‑hour monitoring (admission not strictly required); plaintiff need only show that 24‑hour monitoring was reasonably available. | Plaintiff failed to show hospital admission criteria or that decedent met them, so cannot prove negligence caused death. | Affirmed: expert clarified standard required monitoring for 24 hours (admission ideal but not required); testimony about observation/monitoring capability supported inference monitoring could have occurred. |
| Admissibility / use of standard‑of‑care testimony for causation (Schwam testimony) | Schwam’s testimony that delayed respiratory depression can occur was proper and probative; defendant did not object or seek limiting instruction. | Schwam was a standard‑of‑care witness only; his testimony could not be transplanted to prove causation. | Affirmed: because defendant did not object, seek to strike, or request limiting instruction, the testimony was before the jury and could be considered for causation. |
| Sufficiency of evidence for noneconomic damages (destruction of capacity to enjoy life) | Plaintiff presented age, medical records, autopsy findings, testimony about decedent’s activities and attachments—jury may estimate life expectancy from that evidence without mortality tables. | Absent life‑expectancy evidence or actuarial tables, award was speculative. | Affirmed: mortality tables are not required; jury could reasonably forecast life expectancy from age, health, habits and other evidence. |
Key Cases Cited
- Doe v. Hartford Roman Catholic Diocesan Corp., 317 Conn. 357 (2015) (standard on reviewing sufficiency of evidence and deference to jury findings)
- Curran v. Kroll, 303 Conn. 845 (2012) (jurors may draw reasonable inferences from admitted evidence absent limiting instruction)
- Gold v. Greenwich Hospital Assn., 262 Conn. 248 (2002) (elements of medical malpractice: standard, breach, causation)
- Milliun v. New Milford Hospital, 310 Conn. 711 (2013) (expert testimony usually required to prove causation in medical malpractice)
- Paige v. St. Andrew’s Roman Catholic Church Corp., 250 Conn. 14 (1999) (insufficient causation where jury findings undermined link to defendant’s employees)
- Katsetos v. Nolan, 170 Conn. 637 (1976) (wrongful death damages components, including destruction of capacity to enjoy life)
- Waldron v. Raccio, 166 Conn. 608 (1974) (evidence of decedent’s activities and family attachments relevant to damages for loss of capacity to enjoy life)
- Shelnitz v. Greenberg, 200 Conn. 58 (1986) (causation may be proved by circumstantial evidence and expert testimony)
- Dallaire v. Hsu, 130 Conn. App. 599 (2011) (conflicting expert testimony does not automatically render evidence insufficient)
- DelBuono v. Brown Boat Works, Inc., 45 Conn. App. 524 (1997) (trier of fact resolves conflicts in expert testimony)