103 A.3d 533
D.C.2014Background
- John Willis underwent two surgeries at Providence Hospital (Sept. 5 and Sept. 10, 2008); the surgeon ordered sequential compression devices (SCDs) after the second surgery.
- Hospital nurses failed to apply the SCDs as ordered; Willis later developed DVT/PE and received bilateral below-knee amputations at another hospital.
- A nine-person jury found nurses negligent, found their failure to apply SCDs a proximate cause, and awarded $650,000 ($50,000 past medical; $450,000 future medical; $150,000 non-economic).
- Hospital moved for judgment as a matter of law arguing causation evidence was speculative (experts could not say when DVT began and conceded SCDs are ineffective once DVT is well-established).
- Willis moved for a new trial on damages, arguing the verdict was inadequate and that the trial court erred by refusing a “special susceptibility” jury instruction.
- Trial court denied both motions; the appellate panel affirmed, holding the expert testimony (viewed most favorably to Willis) was sufficient for a jury to find SCDs would likely have prevented a well-established DVT if applied after the second surgery, and the damages award was not so inadequate as to require a new trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of causation evidence | Willis: expert testimony shows nurses’ failure to apply SCDs after Sept. 10 more likely than not caused DVT/PE and amputations | Providence: experts conceded they could not say when DVT began and that SCDs are ineffective once DVT is well-established; therefore causation is speculative | Court: Evidence (particularly Dr. Hall’s testimony and reasonable inferences) was legally sufficient; verdict may stand |
| Burden to exclude alternative timing theory | Willis: only must show negligence more likely than anything else to be a cause (Travers standard) | Providence: Willis must disprove that DVT became well-established before Sept. 10 (i.e., negate the alternate timing) | Court: No requirement that plaintiff rule out all other possibilities; Travers standard governs |
| Special susceptibility jury instruction | Willis: instruction was needed because pre-existing conditions could have increased harm and jury may have discounted damages without it | Providence: did not argue at trial that plaintiff’s pre-existing conditions mitigated damages; argued independent post-discharge infection caused amputations | Court: Instruction not appropriate given how the case was tried; no mitigation argument by defendant warranted it |
| Adequacy of damages award | Willis: $650,000 was inadequate (past medical $50k vs. ~$275k actual) and possibly influenced by missing instruction | Providence: jury reasonably apportioned causation and damages given contested causation and competing expert opinions | Court: Award not so inadequate as to indicate passion, prejudice, or error; within rational range — new trial denied |
Key Cases Cited
- Travers v. District of Columbia, 672 A.2d 566 (D.C. 1996) (plaintiff need only show, to reasonable medical certainty, negligence was more likely than anything else to have been a cause)
- Lasley v. Georgetown Univ., 688 A.2d 1381 (D.C. 1997) (medical expert opinions must be formed with sufficient certainty to support causation findings)
- Derzavis v. Bepko, 766 A.2d 514 (D.C. 2000) (temporal relationship alone is insufficient; causation requires more than contemporaneity)
- Talley v. Varma, 689 A.2d 547 (D.C. 1997) (inconsistent expert testimony may require directed verdict if testimony is inconclusive)
- Bushong v. Park, 837 A.2d 49 (D.C. 2003) (tortfeasor takes victim as found; rule on special susceptibility)
- Gubbins v. Hurson, 987 A.2d 466 (D.C. 2010) (discussion of augmented damages and plaintiff’s pre-existing condition principles)
- Posner v. Holmes, 739 A.2d 358 (D.C. 1999) (standard of review for challenging jury damages award)
- Prins-Stairs v. Anden Grp., 655 A.2d 842 (D.C. 1995) (court should order new trial on damages only when award is contrary to all reason)
- Romer v. District of Columbia, 449 A.2d 1097 (D.C. 1982) (new-trial-on-damages reversal limited to verdicts showing prejudice, passion, or error)