This medical malpractice claim by Natalie Brown, the executor of Christine Riley’s estate, sought damages for injuries stemming from bedsores Riley allegedly suffered while a patient at DeKalb Medical’s nursing home. The trial court directed a verdict in DeKalb’s favor on the issue of punitive damages. After a jury returned a $165,000 verdict of compensatory damаges for the estate, the court granted DeKalb a j.n.o.v. Riley’s executor, Brown, appeals on behalf of the estate. “[I]n reviewing a [j.n.o.v.], an appellate cоurt must view the evidence in the light most favorable to the party who secured the jury verdict.”
Atlanta Obstetrics &c. v. Coleman,
In April 1992, Riley spent a month in DeKalb’s “skilled nursing facility” after she suffered a stroke. On admission, she was noted to suffer from bedsores on her bottom. One day after she left the nursing home, according to Brown and to a home health care nurse who examined her, she exhibited “bloоd blisters” on the heels of her feet. Although the home health care nurse described these blisters as “intact” and stated they could have formed in a 24-hour period, Brown testified thеse sores were “open” and “bloody.” Riley’s expert witness, a nurse skilled in caring for and preventing pressure sores, stated that in her opinion, these sores formed while Riley wаs at DeKalb’s nursing home. Some of the sores apparently healed, and Riley later developed other ulcerated sores on her left foot and lower left leg. In December 1992, a physician concluded that because of poor blood circulation in Riley’s left leg, the ulcers, including a large ulcer on her left heel, were unlikely tо heal; therefore, he amputated her left leg below the knee.
Riley’s nursing expert testified as to measures which “could be taken to prevent [a patient] from devеloping pressure sores,” including the use of a special mattress, elevation of the patient’s feet, and turning the patient every two hours. She also stated the “general practice” is to inspect a patient’s skin during each shift. The expert stated she was familiar with the standard of care applicable to nurses in nursing homes in preventing аnd treating pressure sores. Because Riley’s medical records did not reflect that these measures had been consistently followed, the expert concluded, DeKаlb Medical breached the standard of care in its duty to prevent and treat *5 Riley’s pressure sores.
1. We first address the trial court’s direction of judgment for DeKalb on its liability to Riley. A grant of j.n.o.v. is allowed оnly where there is no conflict as to any material issue and the evidence introduced, including all reasonable deductions from that evidence, is such that only one reasonable conclusion may be drawn as to the proper judgment.
Goggin v. Goldman,
The trial court properly directed judgment for DeKalb as to Brown’s claim for damages resulting from the bedsore on her sacral area. She presented no evidence, other than mere speculation, showing this ulcer developed while Riley was in DeKalb’s care. Her expert testified this ulcer became no worse during Riley’s stay at DeKalb and, therefоre, DeKalb had properly cared for that ulcer. Because Brown presented no evidence to rebut the presumption that DeKalb properly treated this problem, Riley’s estate could not recover for this injury. See
Slack v. Moorhead,
But the evidence, however slim, did crеate a jury question as to whether DeKalb’s professional negligence caused the pressure sores on Riley’s left and right heels. Although the DeKalb nurses presented circumstаntial evidence that they followed the routine measures needed to prevent these pressure sores, their evidence also indicates no pressure sores were documented when Riley was discharged from the hospital. Because Riley’s expert was allowed to opine, without objection, that the pressure sores develоped in the hospital, the probative value of the nurses’ circumstantial evidence that Riley suffered no pressure sores was for the jury. See
Thomas v. Newnan Hosp.,
Although Riley’s expert did not use the magic words, “the standard of care requires,” she did state, however unartfully, the parameters of the standard of care applicable to DeKalb’s treatment and the method in which DeKalb deviated from that standard. See
Jackson v.
*6
Gershon,
The DeKalb nurses testified they followed all their usual procedures and did not document any bedsores on Riley’s heel because none existed. But because other witnesses contradicted the assertion that there were no bedsores on Riley’s heels, the jury was entitled to rеject DeKalb’s testimony and to infer the records upon which the expert based her opinion indicated the actual treatment given. See
Kapsch,
supra at 769 (circumstantial еvidence may be used to prove the facts on which the expert relies). Because the standard of review requires us to construe the evidence and all inferenсes from the evidence strongly in Brown’s favor, we must conclude that the evidence allowed the jury to find Riley developed pressure sores in the nursing home, and that the expert testimony allowed the jury to find the nursing home negligently failed to prevent the sores from forming on her heel. See
Austin v. Kaufman,
Although the expert provided evidence which would allow the jury tо infer that inadequate treatment caused these pressure sores, the jury was given no sufficient causal connection between DeKalb’s medical records documentation practices and any injury. It is the inadequate provision of care, not the failure to describe in detail the care given, that is alleged to have caused Rilеy’s bedsores. Thus, to the extent Brown claimed damages on the theory of inadequate documentation, the trial court properly directed judgment for DeKalb on that theory. See
McQuaig v. McLaughlin,
Based on the evidence presented, the jury could also infer that Riley’s ultimate injury, the amputation of her leg, resulted from DeKalb’s negligence, and that this complication was a foreseeable result of its negligence. See Coleman, supra at 570.
2. The trial court properly directed a verdict on the issue of punitive damages, however. The evidence Brown presented, while enough to allow the jury to find DeKalb provided negligent care, was far from the clear and convincing evidence of an entire want of care required to support a verdict for punitive damages. See
Roseberry v. Brooks,
3. The trial court’s order reflects that upon any reversal of its judgment in this case, DeKalb shall be entitled to a new trial. This procedure is proper pursuant to OCGA § 9-11-50 (c) (1). The trial court’s reasons for its ruling included its determination that the verdict was strongly against the weight of the evidencе, a proper ground for the grant of a new trial. OCGA § 5-5-21. Where, as here, the facts do not demand a verdict for either party, an appellate court will not interfere with a trial court’s first grant of a new trial.
Lister v. Scriver,
Judgment affirmed in part, reversed in part, and remanded for new trial.