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Burchfield v. Wright

Supreme Court of Louisiana

June 27, 2018

ROGER BURCHFIELD AND CAROL BURCHFIELD
v.
FORREST H. WRIGHT, M.D., THOMAS RENDA, M.D., AND WILLIS KNIGHTON MEDICAL CENTER

          ON WRIT OF CERTIORARI TO THE COURT OF APPEAL, SECOND CIRCUIT, PARISH OF CADDO

          GUIDRY, Justice.

         In this medical malpractice case, the defendant surgeon ordered pre-operative tests including a chest x-ray and an electrocardiogram ("EKG") before performing non-emergency gallbladder surgery on the plaintiff. However, the defendant did not review the results of these tests prior to performing the surgery, but had he done so, the tests would have alerted him to potential issues with the plaintiff's heart necessitating the ordering of a cardiac consult prior to surgery. Although the surgery itself was successful and uneventful, some thirty or so hours after discharge, the plaintiff suffered a heart attack and eventually had to undergo a heart transplant. The plaintiff and his wife brought suit against the defendant alleging medical malpractice. The defendant surgeon settled, and the Louisiana Patients' Compensation Fund ("PCF") intervened.

         After a trial against the PCF, the jury declined to find the plaintiffs had proven the defendant's failure to review the test results and to refer his patient to a cardiologist before performing the surgery had caused the patient to suffer the subsequent heart attack that ultimately necessitated a heart transplant. Instead, the jury found the plaintiffs had proven the defendant's breach of the standard of care had resulted in the loss of a less than even chance of a better outcome. The jury awarded the plaintiffs lump sum general damages, which the trial court in its judgment made subject to the Medical Malpractice Act's limitation on the total amount recoverable by the plaintiffs, La. Rev. Stat. 40:1231.2.

         The court of appeal found legal error in what it deemed to be a "patently inconsistent" jury verdict in light of the verdict form, thereby necessitating de novo review of the case. Following its review, the court of appeal nonetheless found the jury's determination that the plaintiffs had proven a lost chance of a better outcome was clearly supported by the record. The court of appeal then awarded general damages (affirming the trial court's award), but it also awarded special damages, including past medicals, future medicals, and lost wages, which it did not subject to the Medical Malpractice Act's limitation on the total amount recoverable. Because we find error in the court of appeal's decision, we hereby reverse that decision and reinstate the jury's verdict, its award of lump sum general damages, and the trial court's judgment.

         FACTS and PROCEDURAL HISTORY

         Referred by his gastroenterologist to resolve gastric complaints, Roger Burchfield, then age 58, was admitted to Willis-Knighton Medical Center on August 14, 2013, for non-emergency gallbladder surgery, specifically a laparoscopic cholecystectomy, to be performed by Forrest Wright, M.D. Though Dr. Wright ordered a pre-operative chest x-ray and EKG, which were completed, neither the chest x-ray nor the EKG was read by Dr. Wright prior to the surgery. The x-ray would have revealed Mr. Burchfield had congestive heart failure, while the EKG indicated possible left atrial enlargement, nonspecific intraventricular block, and two possible prior heart attacks, a septal infarct and an inferior infarct. None of these ailments was apparently known to the patient, according to his testimony at trial.

         Mr. Burchfield was placed under general anesthesia and Dr. Wright performed the surgery successfully. There were no intraoperative complications, and, with no apparent complications, Mr. Burchfield was discharged later that day. Upon discharge, Mr. Burchfield returned home and initially had no issues eating or walking. Approximately thirty hours later, Mr. Burchfield began experiencing edema in his lower extremities and difficulty "getting comfortable." On August 16, 2013, he presented to a local emergency room where he was determined to be in critical condition, and was transferred back to Willis-Knighton and admitted to the intensive care unit.

         At Willis-Knighton, it was determined that Mr. Burchfield had suffered an acute myocardial infarction, respiratory failure, along with worsening of his pulmonary edema, congestive heart failure, and bi-lateral pleural effusions. Mr. Burchfield was intubated and placed into a medically-induced coma. A heart catheterization was performed, an intra-aortic balloon pump was placed to allow his heart to pump, and he was placed on a ventilator.

         Ultimately, it was determined Mr. Burchfield was not a candidate for heart bypass surgery, so he was transported to Baylor Medical Center in Dallas on August 22, 2013, and evaluated. On September 3, 2013, Mr. Burchfield underwent a heart transplant. He has recovered successfully from this surgery, but was unable to return to his previous profession as a mechanic and will necessarily require medical treatment related to the transplant for the remainder of his life.

         Mr. Burchfield and his wife Carol filed a medical malpractice claim naming Dr. Wright, the radiologist, and Willis-Knighton as defendants. The plaintiffs alleged Mr. Burchfield was suffering from congestive heart failure, as revealed by the x-ray, and that Dr. Wright should have either not gone forward with the surgery or taken pre-operative precautions before doing so. Plaintiffs settled their claims against Dr. Wright for $100, 000.00, reserving their rights against the PCF for excess damages. The remaining defendants were ultimately dismissed.

         A Medical Review Panel concluded Dr. Wright had breached the standard of care by failing to review the pre-operative tests he had ordered. The panel opinion observed that the gallbladder surgery was not an emergency. The panel opined that the chest x-ray report "warranted postponing the surgery until a cardiology consult could be obtained [and that] the failure to review the chest x-ray report and request a cardiology consult was a factor of the resultant damages."[1]

         The case proceeded to trial against the PCF. The Verdict Form, which the parties had negotiated and accepted, was answered by the jury in the following manner. Question No 1: "Have the plaintiffs proven, by a preponderance of the evidence, that Dr. Forrest Wright's breach of the applicable standard of care was a substantial factor in contributing to the injuries of Roger Burchfield?" The jury checked the "No" box. The form then indicated: "If your answer is 'yes,' proceed to Question No. 2. If your answer is 'no' then, proceed to Question No. 6." Assuming the jury found causation in Question No. 1, Question Nos. 2-5 concerned damages for past and future pain and suffering, past and future disability, past medical expenses, past lost wages, future lost wages, future medical care, and loss of consortium for Mrs. Burchfield. However, because the jury answered "no" to Question No. 1, it then proceeded as directed on the form to Question No. 6, which provided: "Do you find that Roger Burchfield lost a chance of a better outcome as a result of the breach of the standard of care by Forrest Wright, M.D.?" The jury checked the "Yes" box to Question No. 6. The Verdict Form then instructed: "If your answer to the above question is no, please STOP and have the foreperson sign and call the Bailiff. If 'yes' proceed to Question No. 7." Question No. 7 provided: "What damages do you find that Roger Burchfield and/or Carol Burchfield suffered in connection with a loss of a chance of a better outcome?" The jury answered "$680, 000." The Verdict Form was signed and dated by the foreperson.

         The trial court later issued a judgment against the Patient's Compensation PCF in the amount of $400, 000.00 plus judicial interest from February 20, 2014, and court costs, after crediting the PCF with the $100, 000 settlement with Dr. Wright and applying the limitation on damages under the Medical Malpractice Act. The plaintiffs thereafter moved for a judgment notwithstanding the verdict, which the trial court denied.

         On appeal, the appellate court agreed with the jury that Mr. Burchfield suffered a lost chance of a better outcome as a result of Dr. Wright's breach of the standard of care, but it found the jury's responses to the Verdict Form were "internally inconsistent, contributing to the troublesome reduction by the trial judge of the jury's award." Burchfield v. Wright, 51, 459 p. 4 (La.App. 2 Cir. 6/28/17), 224 So.3d 1170, 1173. The appellate court agreed with the plaintiffs that the trial court had erred in concluding that a lost chance of a better outcome could consist only of general damages, and thereby subject to the Medical Malpractice Act's limitation on the total amount recoverable, reasoning that "the answers to interrogatory numbers one and six on the jury verdict form to be patently inconsistent, leading to an inability of the jury to consider all of the damages suffered by the Burchfields as a result of Roger's heart transplant." Id. [Emphasis in original.] Finding this perceived inconsistency to be legal error, the appellate court reviewed the record de novo and concluded the record clearly supported the jury's determination that Mr. Burchfield had suffered a lost chance of a better outcome. Id. at p. 6, 224 So.3d at 1174. The appellate court found the jury had not been properly instructed on how to quantify the resultant damages on the Verdict Form. The appellate court cited this court's instructions on that precise issue in Smith v. State, Dept. of Health & Hosps., 95-0038 (La. 06/25/96), 676 So.2d 543, but then it found the trial court had erred in considering the jury's award as general damages and subject to the Medical Malpractice Act's limitation on total recoverable damages, without awarding the plaintiffs past medical awards, future medical care, and lost wages. Id. at pp. 7-9, 224 So.3d at 1175. The court of appeal affirmed the trial court's $400, 000 award in general damages, but it additionally awarded past medical expenses of $692, 850.64, future medical care, and lost wages of $493, 020.00, none of which it made subject to the Medical Malpractice Act's limitation on the total amount recoverable by the plaintiffs. Id. at pp. 9-11, 224 So.3d at 1176-77.

         We granted the writ application of the Patient's Compensation Fund to review the appellate court's decision to conduct a de novo review and to award additional and separate damages for past medical bills, future medical care, and lost wages, not subject to the Medical Malpractice Act's limitation on the ...


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