Thomas Laporte and Linda Laporte vs. Baton Rouge General Medical Center, et al
Michael M. Remson
Craig J. Sabottke
Courtenay S. Herndon
Baton Rouge, Louisiana
Counsel for Defendant-Appellant, Baton Rouge General Medical Center
Benjamin B. Treuting
Baton Rouge, Louisiana
Counsel for Plaintiffs-Appellees Thomas Laporte and Linda Laporte
Charles F. Wartelle
Hammond, Louisiana
BEFORE: LANIER, WOLFE, and HESTER, JJ.
This is a medical malpractice action, wherein defendant/appellant, Baton Rouge General Medical Center (“BRGMC“), was cast in judgment for $500,000.00 in general damages, $135,712.68 in special damages, and $50,000.00 in loss of consortium damages to the plaintiffs/appellees, Thomas Laporte and Linda Laporte (collectively, “the plaintiffs“). Following the bench trial in this matter, BRGMC filed this appeal. For the following reasons, we affirm the judgment.
STATEMENT OF FACTS
On March 21, 2018, at 11:21, p.m., Thomas Laporte (“Mr. Laporte“), a 79-year-old male with a history of orthostatic hypotension1, left-sided chest pain, and constipation presented to the emergency department at BRGMC due to loss of consciousness. Specifically, Mr. Laporte reported having recurrent falls, likely secondary to his low blood pressure, and that he had not had a bowel movement in two to three weeks. Mrs. Linda Laporte (“Mrs. Laporte“), Mr. Laporte‘s wife, noted that around 10:30 p.m. that evening, Mr. Laporte fell while getting off the toilet at their home. Mrs. Laporte informed the emergency staff that Mr. Laporte‘s pants were too heavy, and he slipped, but that he did not hit his head or lose consciousness. Further, it was noted that Mr. Laporte used a walker but was not using one when getting up from the toilet at his home. Upon his presentation to BRGMC, the emergency medical staff ordered Mr. Laporte to receive continuous cardiac, pulse oximetry monitoring, and a suppository.
At the time of Mr. Laporte‘s presentation to the emergency department, BRGMC had in place a written policy regarding the assessment of a patient‘s fall risk. The policy requires scoring a patient on several objective measures, including
Nurse Turner checked on Mr. Laporte around 1:30 a.m., administering both nitroglycerin for Mr. Laporte‘s chest pain, as well as the previously ordered suppository, at that time. After Mr. Laporte denied a bedpan from Nurse Turner, she again reminded Mr. Laporte to use the call light if he needed assistance or needed to use the restroom. Nurse Turner, aware that the purpose of the suppository was to induce a bowel movement, and further aware that the published medical literature regarding the suppository stated it would be effective between fifteen and sixty minutes after administration, again checked on Mr. Laporte one hour later, at 2:20-2:30 a.m. Nurse Turner once again asked if Mr. Laporte needed to use the restroom and, at that time, he told her he did not.
Once Mr. Laporte needed to leave the restroom, he activated the pull cord four times and shouted for help, but no assistance came to him. After waiting for a prolonged period of time — Mr. Laporte estimated between thirty and forty minutes — he felt it was best and safest if he returned to his examination room, as he did not want to lose consciousness in the hospital restroom. Unfortunately, while exiting the restroom, Mr. Laporte fell “out [of] the door[,]” hit his head on the door jamb,
A Petition for Damages was filed on November 2, 2018, naming BRGMC as a defendant, and generally asserting that BRGMC‘s failure to render the appropriate care to Mr. Laporte was medical malpractice. Later, an Amended Petition for Damages was filed on May 10, 2019, adding Dustin Vincent, M.D. and Tiffany Scott, M.D., as defendants.3 Further, on February 16, 2022, plaintiffs filed a Second Supplemental and Amending Petition for Damages, adding Mr. Shim and Southern Medical Holding Corporation as defendants. Later, on February 23, 2024, plaintiffs filed a Motion and Order for Partial Dismissal with Prejudice, dismissing Mr. Shim and Southern Medical Holding Corporation with prejudice, following a resolution of the claims against them through settlement. Thus, the only remaining defendant at trial was BRGMC.
Following a three-day bench trial on March 25-27, 2024, the trial court took the matter under advisement. A written judgment was signed by the trial court on July 3, 2024, finding that BRGMC breached the applicable standard of care in its treatment of Mr. Laporte, assigning 90% comparative fault to BRGMC and 10%
ASSIGNMENTS OF ERROR
BRGMC presents the following assignments of error:
- The trial court erred by rubber stamping [p]laintiffs’ judgment and adopting plaintiffs’ written reasons, while providing no independent evaluation.
- The trial court erroneously determined that [p]laintiffs proved by a preponderance of the evidence that [BRGMC] breached the applicable standard of care in its treatment of Thomas Laporte on March 21st and March 22nd of 2018 and caused Mr. Laporte injury.
- The trial court failed to properly apportion fault to Edward Shim and Thomas Laporte, who were both equally responsible for their actions and the role they played in the incident in question, and any resultant harm.
- Alternatively, the trial court erred in its excessive award of damages to the [plaintiffs], considering his limited injuries and treatment, as well as governing damage awards in similar cases.
DISCUSSION
TRIAL COURT‘S FAILURE TO DRAFT INDEPENDENT REASONS FOR JUDGMENT
As an initial matter, BRGMC assigns as error the trial court‘s failure to draft its own independent reasons for judgment, stating, “[t]he trial court judge committed manifest error by essentially rubber-stamping Plaintiffs’ Proposed Judgment and adopting Plaintiffs’ written Reasons for Judgment without any showing of independent evaluation, or drafting of the court‘s own written reasons at all.”
Initially, we note that a trial court‘s reasons for judgment, while defining and elucidating a case, form no part of the official judgment it signs and from which appeals are taken. Regardless of the trier of fact‘s reasons, if a judgment is correct, it should be affirmed. Doe v. Breedlove, 2004-0006 (La. App. 1st Cir. 2/11/05), 906 So.2d 565, 571; see also Burkett v. Crescent City Connection Marine Div., 98-1237 (La. App. 4th Cir. 2/10/99), 730 So.2d 479, 485, writ denied, 99-1416 (La. 9/3/99), 747 So. 2d 543 (“[a]lthough a trial judge might adopt most or almost all of a party‘s suggested reasons for judgment, the reasons and judgment itself will stand as long as the record supports them.“). However, we decline to rule on whether such adoption of reasons by the trial court complies with the mandate of
FACTUAL DETERMINATION REGARDING BREACH OF THE STANDARD OF CARE
In their second assignment of error, BRGMC contends the trial court erred in its determination that the plaintiffs met their burden of proof in showing a breach of the applicable standard of care by BRGMC. Specifically, BRGMC argues that “the evidence at trial clearly shows any injury Mr. Laporte suffered was a direct result of the actions of Edward Shim and Mr. Laporte himself, and not as a result of any actions of the Baton Rouge General staff.” Ultimately, BRGMC claims it used reasonable care to avoid Mr. Laporte‘s injury.
1. Standard of Review
In a medical malpractice action, the plaintiff must prove by a preponderance of the evidence the applicable standard of care, a violation of that standard of care, and a causal connection between the violation and the claimed injuries. Myles v. Hospital Service District No. 1 of Tangipahoa Parish, 2017-1014 (La. App. 1st Cir. 4/6/18), 248 So.3d 545, 549; see also
Under the manifest error standard of review, a factual finding cannot be set aside unless the appellate court finds that it is manifestly erroneous or clearly wrong. Jackson v. Tulane Medical Center Hospital and Clinic, 2005-1594 (La. 10/17/06), 942 So.2d 509, 512. To reverse a factfinder‘s determination, an appellate court must review the record in its entirety and find that a reasonable factual basis does not exist for the finding and further determine that the record establishes that the factfinder is clearly wrong or manifestly erroneous. Id. at 512-13. The appellate court must not reweigh the evidence or substitute its own factual findings because it would have decided the case differently. Id. at 513.
Where there are two permissible views of the evidence, the factfinder‘s choice between them cannot be manifestly erroneous, particularly where the findings are based on determinations concerning witness credibility and weighing of evidence. Where the factfinder‘s determination is based on its decision to credit the testimony of one or two or more witnesses, that finding can virtually never be manifestly erroneous. Myles, 248 So.3d at 550. The trial court‘s credibility determinations, even when based on depositions offered in lieu of live testimony, are accorded great deference. Landry v. Doe, 2019-0880 (La. App. 1st Cir. 6/26/20), 307 So.3d 1064, 1073, writs denied, 2020-00952 (La. 10/20/20), 303 So.3d 313 & 2020-00948 (La. 10/20/20), 303 So.3d 316.
Further, in reaching its conclusions, the trier of fact need not accept all of the testimony of any witness as being true or false and may believe and accept a part or parts of a witness‘s testimony and refuse to accept other parts. These rules apply equally to the evaluation of expert testimony, including the evaluation and resolution of conflicts in expert testimony. Id.
Nurses who perform medical services are subject to the same standards of care and liability as physicians. Johnson v. Morehouse General Hosp., 2010-0387 (La. 5/10/11), 63 So.3d 87, 96; Aymami, 145 So.3d at 446. A nurse‘s duty is to exercise the degree of skill ordinarily employed, under similar circumstances, by members of the nursing profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his or her best judgment, in the application of his or her skill to the case. Granger v. United Home Health Care, 2013-0910 (La. App. 1st Cir. 6/19/14), 145 So.3d 1071, 1081, writ denied, 2014-1665 (La. 10/31/14), 152 So.3d 158. It is well settled that a hospital can be liable for the negligence of its employees, specifically nurses employed by the hospital, under the doctrine of respondeat superior. Myles, 248 So.3d at 550; Aymami, 145 So.3d at 446.
We disagree with BRGMC‘s claim that Mr. Laporte‘s injuries are the sole result of the actions of Mr. Laporte and Mr. Shim and find the record supports two broad categories by which Nurse Turner and other BRGMC staff fell below the appropriate standard of care in their treatment of Mr. Laporte.
The appropriate categorization of Mr. Laporte‘s fall risk is important because once a moderate or high fall risk patient is identified, BRGMC policy and the standard of care require a highly visible yellow fall risk armband to be placed on the patient. Nurse Turner failed to apply this armband, which she described as “nonverbal communication among all of the healthcare providers present” on multiple occasions. Additionally, Nurse Turner admitted that Mr. Laporte lacking this yellow armband resulted in other healthcare providers being unaware of his fall risk status. Nurse Trahant further opined that the lack of a yellow armband
Second, Nurse Turner and other BRGMC staff clearly breached the appropriate standard of care by failing to appropriately monitor and respond to Mr. Laporte. Mr. Laporte was admitted to the emergency department due to chest pain and constipation and, as noted above, was personally administered a suppository laxative at 12:24 a.m. by Nurse Turner. Despite understanding the purpose of the suppository, and the time frame by which it should begin to be effective, Nurse Turner failed to respond to Mr. Laporte‘s use of the call light, the very directive she gave Mr. Laporte should he need to use the restroom. Nurse Trahant agreed that the appropriate standard of care for a high fall risk patient who had been administered a suppository laxative should be “frequently” helped.
Further, Mr. Laporte was administered nitroglycerin for his chest pains and cardiac concerns. Additionally, given the concern for cardiac function, several leads were affixed to Mr. Laporte‘s body and attached to a cardiac and vital signs monitor. When a patient remains attached to the cardiac monitor, it continuously relays critical health information (i.e., cardiac rhythm, heart rate, and oxygen levels) to the electronic tracking board located in the nearby nursing station. In the event a patient gets disconnected from that monitor, the health information would no longer be transmitted, and an auditory alarm would sound, notifying the nursing staff of the disconnection. The record shows that the applicable standard of care required both the primary nurse, and any other employee in the nursing station, to be aware of a patient‘s disconnection at the moment it occurs, due to the sounding alarm; if it is an employee other than the primary nurse, then the standard of care requires that employee to notify the primary nurse. As noted, Mr. Laporte was disconnected from his cardiac monitor and escorted to the restroom by Mr. Shim
Lastly, after being disconnected from the cardiac monitor, Mr. Laporte was escorted to the restroom by Mr. Shim and was instructed on how to use the in-restroom call cord to signal for assistance once finished. Mr. Laporte pulled the cord four times, yelled loudly at least twice, and waited a prolonged period of time for help, but no assistance came to him. Nurse Trahant testified it is a breach of the standard of care for BRGMC‘s employees to fail to respond to the restroom alarm for any period of time longer than five minutes.
We find the trial court was not manifestly erroneous or clearly wrong in its determination that Nurse Turner and any other BRGMC staff breached the standard of care in its treatment of Mr. Laporte, and that a reasonable factual basis exists within the record for such a determination. Accordingly, this assignment of error lacks merit.
APPORTIONMENT OF FAULT
In their third assignment of error, BRGMC asserts the trial court erred by failing to appropriately apportion fault to Mr. Shim and Mr. Laporte, both of whom, BRGMC claims, are responsible for Mr. Laporte‘s injuries. Specifically, BRGMC alleges “[t]he record is overflowing with factual and expert witness testimony which criticizes the actions of Mr. Shim, and finds that his behavior rose to a breach in the standard of care multiple times[,]” such that he should be
In determining the percentages of fault, the trier of fact must consider the nature of each party‘s conduct and the extent of the causal relationship between that conduct and the damages claimed. Watson v. State Farm Fire & Cas. Ins. Co., 469 So.2d 967, 974 (La. 1985). Consideration of several factors aids in the determination of a proper degree of fault: (1) whether the conduct resulted from inadvertence or involved an awareness of the danger; (2) how great a risk was
Regarding Mr. Laporte, we find the trial court did not err in its comparative fault assessment. Mr. Laporte called for help, as instructed to do so by Nurse Turner, before getting out of his bed and, once in the restroom, made multiple attempts to seek assistance before standing up to leave. Once in the restroom, Mr. Laporte either had to choose to stay in the restroom for an indefinite period of time or to walk back to his room. We find his decision to attempt to return to his room was not an unreasonable one, and the trial court did not err in not assigning any comparative fault to him. As to Mr. Shim, while he admitted he did leave Mr. Laporte in the restroom unattended, he also noted that he would have acted differently if he had knowledge regarding Mr. Laporte‘s actual fall risk. Mr. Shim further indicated he could not find other BRGMC staff to inform regarding Mr. Laporte‘s situation. The trial court is owed great deference in allocating comparative fault percentages, and we find it was not manifestly erroneous or clearly wrong in its determination. Accordingly, this assignment of error lacks merit.
TRIAL COURT‘S GENERAL AND SPECIAL DAMAGES AWARDS
In its final assignment of error, BRGMC claims the trial court‘s total general damage award of $500,000.00 is excessive and should be reduced. BRGMC argues that Mr. Laporte “suffers no residual injury to his hip[,]” and has “stipulated that his medical treatment for the alleged injury is complete and he is no longer treating for the injury.” As such, BRGMC suggests that an “appropriate award of
1. General Damages
General damages are those that may not be fixed with pecuniary exactitude; instead, they involve mental or physical pain or suffering, inconvenience, the loss of intellectual gratification or physical enjoyment, or other losses of life or lifestyle which cannot be definitely measured in monetary terms. Jones v. Mkt. Basket Stores, Inc., 2022-00841 (La. 3/17/23), 359 So.3d 452, 464. Much discretion is left to the trier of fact in the assessment of general damages. See
In Pete v. Boland Marine and Manufacturing Company, LLC, 2023-00170 (La. 10/20/23), 379 So.3d 636, the Louisiana Supreme Court explained that the question of whether the trier of fact abused its discretion in assessing the amount of damages remains the initial inquiry. However, to evaluate this issue, an
As an initial matter, we note that BRGMC repeatedly states the total general damage award of $500,000.00 is excessive but is vague and fails to precisely state which specific element — $300,000.00 for Mr. Laporte‘s physical pain and suffering, $50,000.00 for his mental anxiety and distress, or $150,000.00 for his loss of enjoyment of life and community — it objects to. Nevertheless, in ascertaining whether the trial court abused in its discretion in awarding $500,000.00 in total general damages, we turn to a consideration of prior awards in similar cases. We note that, in presenting their assertions, counsel for the plaintiffs have adjusted the awards for inflation in all the cases they cited, whereas counsel for BRGMC did not.4
Of the cases cited by the plaintiffs, none include injuries or circumstances identical to those presented to us in this appeal. See Thibodeaux v. Stonebridge, L.L.C., 2003-1256 (La. App. 5th Cir. 4/27/04), 873 So.2d 755 (78-year-old nursing home resident who was injured after being knocked over by a food cart, suffered hip fracture as a result of a fall, trial court awarded $150,000.00 in general damages which was deemed abusively low by the appellate court and increased to $400,000.00 or $664,536.17 as adjusted for inflation); Monroy v. Hendrix, 2017-9256 (La. E.D., Jan. 7, 2019), 2019 WL 118018 (plaintiff suffers hip fracture in a
Similarly, of the cases cited by BGRMC, none include injuries as exactly presented to us in this appeal. See Fox v. Housing Authority of New Orleans, 605 So.2d 643 (La. App. 4th Cir.), writ denied, 607 So.2d 570 (La. 1992) (trial court‘s award of $20,000.00 for pain and suffering of elderly woman who was injured after tripping over crack in public sidewalk, and who required hip replacement, was not abusively low); and Mouhot v. Twelfth Street Baptist Church, 2006-1283 (La. App. 3d Cir. 2/7/07), 949 So. 2d 668 (award of $55,000.00 in general damages awarded to parishioner, who tripped and fell while walking from one building to another on church property, resulting in broken hip, head injury, and subsequent hip surgery was deemed “modest” but not an abuse of discretion). Using these two cited cases, BRGMC, noting that “Mr. Laporte had a successful hip surgery in March 2018, underwent physical therapy for 28 days following surgery, and ultimately never treated for his hip again after being last seen by Dr. Easton in July of 2018,” argued that general damages in the range of $20,000.00 to $150,000.00 was appropriate.
We disagree. BRGMC would have this court believe that Mr. Laporte‘s injuries were of a relatively routine nature with a simple and straightforward
2. Special Damages
Regarding the trial court‘s award of special damages, BRGMC asserts that the trial court erroneously awarded plaintiffs $135,712.68 in special damages that were reimbursed to Medicare following an earlier third-party settlement between plaintiffs and Mr. Shim, Southern Medical Holding Corporation, Landmark
Imperative to BRGMC‘s argument regarding special damages are the Medicare lien and the proof of satisfaction of the lien, neither of which were admitted into evidence. In fact, the trial court excluded evidence regarding amounts paid by Medicare and the amount paid by settling parties prior to trial. (Vol. 8, R. 1679). While the Medicare lien and the lien satisfaction letter were ultimately proffered, BRGMC failed to assign as error the trial court‘s ruling to exclude this evidence. (Vol. 8, R. 1743). Without briefing, assigning error to, or otherwise mentioning the trial court‘s evidentiary rulings regarding the Medicare lien and the lien satisfaction letter, any potential issues or errors related thereto are deemed abandoned and the trial court‘s exclusion of this evidence stands. See Frandria v. Holden, 2020-0410 (La. App. 1st Cir. 12/30/20), 319 So. 3d 332, 337-38, writ not considered, 2021-00692 (La. 9/27/21), 324 So. 3d 102; see also Rule 2-12.4(B)(4), Uniform Rules of Louisiana Courts of Appeal (requiring that all assignments of error be briefed and permitting appellate courts to consider as abandoned any assignment of error which has not been briefed). Without being able to consider the Medicare lien and the lien satisfaction letter, BRGMC‘s argument that it should not be required to pay this portion of special damages because it would result in a double recovery fails. See Albert v. Farm Bureau Ins. Co., 2005-2496 (La. 10/17/06), 940 So.2d 620, 622 (“Louisiana law does not allow for double recovery of the same element of damages.“) There is simply no proof in the record that payment was made for any portion of the medical expenses claimed by Mr. Laporte to support BRGMC‘s argument; therefore, we pretermit this issue. Accordingly, we affirm the special damage award.
CONCLUSION
For the foregoing reasons, the trial court‘s July 3, 2024 judgment, rendered in favor of plaintiffs/appellees, Thomas Laporte and Linda Laporte, and against defendant/appellant, Baton Rouge General Medical Center, is affirmed. All costs of this appeal are assessed to Baton Rouge General Medical Center.
AFFIRMED.