145 Conn. App. 275
Conn. App. Ct.2013Background
- Karla Rosa (morbidly obese) underwent anesthesia for elective hernia surgery on March 27, 2006; an LMA was used, aspiration occurred, she was placed in an induced coma and later diagnosed with critical care neuropathy and permanent foot pain; husband claimed loss of consortium.
- Plaintiffs sued Anesthesia Associates of New London, P.C., alleging the use of an LMA instead of an endotracheal tube violated the standard of care; two alleged negligent providers (Calobrisi and Richeimer) died before trial; Thomas Miett (attending anesthesiologist) was tried and found not liable by the jury.
- At trial plaintiffs’ expert anesthesiologist (Deluty) testified LMA use in morbidly obese patients is contraindicated; defendant experts (Miett and D’Amato) testified LMA use was within the standard of care.
- During cross-examination plaintiffs’ counsel introduced portions of a manufacturer’s LMA manual (contraindication for morbidly obese elective patients); the court admitted excerpts for a limited purpose (credibility), but authentication was deficient.
- Jury awarded plaintiff ~$8.54M and husband $2M (reduced slightly on collateral source); court denied defendant’s postverdict motions for new trial/remittitur and appeal followed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of manufacturer’s manual | Manual shows contraindication supporting Deluty’s opinion and undermines defendant experts’ credibility | Manual was not authenticated, was surprise evidence, and was hearsay; admission improper | Manual admission was error (lack of authentication) but harmless because content was cumulative of defendant expert testimony; judgment affirmed |
| Need for limiting instruction about use of manual | Manual was admitted only to assess credibility; prior limiting instruction was sufficient | Requested explicit limiting instruction during charge that manual cannot establish standard of care | Trial court’s limiting instruction (given at admission and reiterated in charge) was adequate; no reversible error |
| Sufficiency of causation proof for permanent foot pain (critical care neuropathy) | Treating neurologist (Moalli) diagnosed critical care neuropathy and testified it was permanent to a reasonable degree of medical probability | Moalli could not fully separate critical care neuropathy from diabetic neuropathy, so causation was speculative | Moalli’s testimony, read as a whole, supported causation and permanence; trial court did not abuse discretion in denying new trial |
| Excessiveness of damages / remittitur request | Damages supported by lengthy coma, prolonged hospitalization, permanent neuropathy, and long life expectancy | Verdict excessive compared to plaintiffs’ suggested figure and possibly driven by sympathy or the deaths of two alleged defendants | Court correctly reviewed evidence most favorably to sustain verdict; damages not excessive and no abuse of discretion in denying remittitur |
Key Cases Cited
- Quaranta v. King, 133 Conn. App. 565 (Conn. App. 2012) (standard for harmless evidentiary error on appeal)
- State v. Garcia, 299 Conn. 39 (Conn. 2010) (prima facie authentication standard for writings)
- Jarmie v. Troncale, 306 Conn. 578 (Conn. 2012) (elements and expert proof required in medical malpractice)
- Macchietto v. Keggi, 103 Conn. App. 769 (Conn. App. 2007) (requirements for expert causation testimony and "reasonable degree of medical probability")
- State v. Nunes, 260 Conn. 649 (Conn. 2002) (expert testimony must be more than speculation)
- Lappostato v. Terk, 143 Conn. App. 384 (Conn. App. 2013) (standard for remittitur and appellate deference to trial court on excessiveness of verdict)