In its opinion filed on May 5, 2016, the Supreme Court of Kentucky (“Kentucky Supreme Court”) affirmed the $1.45 million punitive damages award against the defendant hospital in a Kentucky medical malpractice case, finding that the hospital’s offensive conduct exhibited a gross indifference to, and a reckless disregard for, the plaintiff’s health and safety.
The Kentucky Supreme Court stated that the plaintiff was a paraplegic pauper, unquestionably among the most financially vulnerable members of the community, and the harm that befell him was not accidental; he was intentionally and somewhat forcefully evicted from the defendant hospital while he suffered in severe pain from an illness that turned fatal. The threat to have him arrested if he returned to the hospital emergency room manifested a measure of ill-will commensurate with malice.
The Underlying Facts
The 39-year-old plaintiff, who was an uninsured and indigent paraplegic, went to the defendant hospital’s emergency room on April 8, 1999, complaining of extreme abdominal pain, nausea, vomiting, and severe constipation. The plaintiff was heard crying in pain and calling for help. His severe agony made it difficult to obtain a suitable x-ray image of him. During the initial emergency room visit, the plaintiff was treated with pain medication, an enema, and manual disimpaction of his colon to alleviate his constipation.
The plaintiff was discharged from the emergency room four-and-a-half hours after his arrival, at which time he was put in an ambulance to be transported away from the hospital, without designating a specific destination. The plaintiff was brought to the homes of various family members, who all refused to accept him because they could not care for him (he was moaning in pain, his face was ashen, his lips were white, and he appeared to them to be gravely ill). The ambulance therefore returned the plaintiff back to the defendant hospital.
The defendant hospital refused to accept the plaintiff in the emergency room and instead transported him in a wheelchair to a motel across the street, where the hospital staff paid for the plaintiff’s motel room and left him without a wheelchair. The motel staff observed the plaintiff vomit dried blood and therefore called 911 to have him transported to the hospital.
The plaintiff was discharged from the defendant hospital’s emergency room about seven hours later and he was warned that he would be arrested if he returned to the hospital’s emergency room. He was transported to a family member’s home where he refused to allow his family to return him to the hospital because he feared being arrested. The plaintiff died a few hours later while in his family member’s home.
An autopsy revealed that the plaintiff had duodenal peptic ulcer disease and that his death resulted from purulent peritonitis caused by the rupture of a duodenal ulcer. The autopsy also determined constrictive atherosclerotic coronary artery disease as a contributing factor in his death and that the plaintiff had unprescribed controlled substances in his system.
The man’s estate brought a medical malpractice case against the hospital and others. The Kentucky medical malpractice jury found against the defendants, awarding compensatory damages in the amount of $25,000 against the defendants and punitive damages in the amount of $1.5 million solely against the defendant hospital. Following an appeal, the case was retried on the issue of punitive damages only and the second Kentucky medical malpractice jury awarded punitive damages in the amount of $1,450,000. A second appeal followed, which was affirmed by the lower appellate court, and the Kentucky Supreme Court ultimately agreed to decide the case.
The Kentucky Supreme Court held that it is obvious from clear and convincing evidence that, despite the plaintiff’s gravely-ill condition, the defendant hospital and its emergency department personnel intended to remove the plaintiff from the facility; that they left him unattended in a motel room without a wheelchair; and, they threatened him with arrest if he returned for additional medical assistance, and that cruel and unjust hardship is the foreseeable aftermath of such treatment.
The Kentucky Supreme Court stated that from the totality of evidence, the jury could have reasonably believed, as it apparently did, that the defendant hospital engaged in illegal “patient dumping” in its actions toward the plaintiff and, given the strong public policy against the conduct that EMTALA forbids (the primary purpose of the ‘anti-dumping’ statute is to prevent hospitals from ‘dumping’ patients who lack insurance or cannot pay for their claims, through refusing treatment or referring them to other hospitals), the evidence adequately supported findings of oppression and gross negligence so as to authorize a verdict for punitive damages.
The Kentucky Supreme Court further held that it was satisfied from the totality of circumstances that sufficient evidence was presented to prove that the defendant hospital had knowledge of its employees’ handling of the plaintiff and that it intended to ratify their conduct (a hospital remains liable for compliance with EMTALA, and does not escape responsibility by affiliating independent contractor physicians and other nonemployees to provide EMTALA compliance).
The Ratio Of Punitive Damages To Compensatory Damages
The Kentucky Supreme Court noted that the punitive damages in the amount of $1,450,000.00 and compensatory damages assessed against the defendant hospital in the amount of $3,750.00 equates to a ratio of 386 to 1. The Kentucky Supreme Court stated that while the U.S. Supreme Court has made it clear that the question of the constitutionality of a punitive damages award is not governed by a mathematical formula, it is equally clear that punitive/compensatory damage ratios of 10:1 and greater are burdened with at least the appearance of unconstitutionality and cannot survive appellate scrutiny in the absence of special circumstances.
The Kentucky Supreme Court held that the punitive damage award in this case is not unconstitutionally disproportional to the loss of life which resulted from the defendant hospital’s EMTALA violation (the conduct that exacerbated the plaintiff’s pain and led to his death was particularly offensive and contrary to the public policy statutorily embodied in EMTALA, thus justifying in the minds of reasonable jurors a greater award of punitive damages – it is axiomatic that the amount of punitive damages varies directly with the egregiousness of the offensive conduct). Furthermore, the plaintiff was an impoverished paraplegic with little in the way of economic prospects and quality of life and thus the compensatory damages that would ordinarily arise from his injury would correspondingly be exceedingly small.
Source Saint Joseph Healthcare, Inc. v. Thomas, 2014-SC-000008-DG.
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