STEVEN LUPPOLD v. SUSAN HANLON & Others, 248 N.E.3d 124

Steven Luppold suffered an above-the-knee amputation of his left leg after repeated visits to Lowell General Hospital’s emergency department (ED) in March 2015 for foot pain, discoloration, and numbness, but was not properly diagnosed.
Luppold sued several healthcare providers, including Susan Hanlon (RN), Charles Loucraft (PA), and Carlos Flores (NP), alleging their negligent failure to recognize and communicate indicators of blood clotting led to his injury.
At trial, plaintiff experts testified the standard of care required Hanlon to notify other providers of Luppold’s escalating symptoms; Loucraft testified he would have acted if informed.
The jury awarded Luppold $20 million in damages (split between past and future damages); after adding prejudgment interest, the judgment totaled $28,870,400.
Hanlon appealed, raising issues about cross-examination on a high-low settlement agreement, the jury instructions on causation, denial of postverdict motions, and inclusion of future damages in the prejudgment interest calculation.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Cross-examination on high-low settlement agreement	Not necessary; no bias shown, no material change in testimony	Denial hindered proof of codefendant’s bias due to settlement with plaintiff	Properly excluded; no abuse of discretion, no bias shown
Jury instructions on but-for (causation) standard	Instructions properly conveyed the standard as per recent precedent	Use of "impact" and "and" in instruction misstated law post-Doull	Instructions as a whole were adequate, no error
Denial of judgment n.o.v. / new trial / remittitur	Evidence supported Hanlon's liability within scope of RN practice	Duty required of Hanlon exceeded her scope of practice; others intervened	Sufficient evidence for jury verdict against Hanlon
Prejudgment interest on future damages	Entire award, including future damages, subject to interest under statute	Interest should not be assessed on future damages, analogous to employment cases	Interest applies to entire award per governing precedent

Morea v. Cosco, Inc., 422 Mass. 601 (settlement agreements generally inadmissible to prove liability or amount)
Cottam v. CVS Pharmacy, 436 Mass. 316 (settlement admissible only to show witness bias in limited circumstances)
Doull v. Foster, 487 Mass. 1 (Massachusetts adopted but-for causation standard over substantial factor in medical malpractice cases)
Phelan v. May Dep't Stores Co., 443 Mass. 52 (standard for reviewing motions for judgment notwithstanding the verdict)
Carey v. General Motors Corp., 377 Mass. 736 (prejudgment interest applies to entire tort award, including future damages)
Conway v. Electro Switch Corp., 402 Mass. 385 (prejudgment interest not applied to front pay in employment cases, distinguished here)
N.E. Physical Therapy Plus, Inc. v. Liberty Mut. Ins. Co., 466 Mass. 358 (standard for abuse of discretion in evidentiary rulings)
Greene v. Philip Morris USA Inc., 491 Mass. 866 (reaffirmed but-for causation standard in tort)