Kirksey, R. v. Children's Hospital of Pittsburgh

Citation: Not availableDocket: 421 WDA 2018

Court: Superior Court of Pennsylvania; October 9, 2019; Pennsylvania; State Appellate Court

Original Court Document: View Document

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Robert Kirksey, Jr. appeals a judgment from the Allegheny County Court of Common Pleas following a jury trial on medical malpractice claims against Dr. Satyanarayana Gedela and his employers, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh Physicians. Kirksey alleged that Gedela's negligent prescription practices led to his development of Stevens-Johnson Syndrome, which caused significant blistering and scarring. The jury found no negligence on Gedela's part, resulting in a judgment favoring the Appellees.

Kirksey's medical history includes seizure treatment beginning at age two with Depakote, which was later adjusted by Gedela to include Lamictal. After the medication changes, Kirksey was hospitalized with Stevens-Johnson Syndrome. In 2014, he filed a lawsuit claiming medical negligence and respondeat superior. Before trial, Kirksey successfully sought to redact parts of his medical records. The jury ultimately determined that Gedela did not act negligently.

Post-trial, Kirksey raised several issues, including a claim that a juror had ties to the Appellees. The court denied his post-trial motions, and Kirksey subsequently filed a notice of appeal, adhering to procedural requirements. The Appellees also filed a cross-appeal but later discontinued it. The court addressed procedural issues regarding the inclusion of documents in Kirksey's reproduced record, stating that only items in the certified record would be considered for the appeal. The court affirmed the lower court's judgment.

Following the filing of notices of appeal, the Court mandated the parties to request judgment, as per Pa.R.A.P. 301, which was subsequently entered by the trial court prothonotary. The appeals are thus considered filed post-judgment. Kirksey argues that Appellees breached a pretrial order by failing to disclose the origin of a demonstrative exhibit and misquoting his expert's report, claiming this warranted a new trial. The Court disagrees, stating that to grant a new trial, there must be an identified legal error or abuse of discretion by the trial court. Pretrial motions aim to exclude prejudicial evidence before trial, and violation of court orders typically necessitates a new trial to uphold fairness and respect for the judicial process. Kirksey's pretrial motion sought to clarify the origin of exhibits, referencing a prior case. Although the court granted this motion, it did not consider the prior case. During trial, Appellees presented a demonstrative exhibit, "Panel One," which included a statement from Kirksey’s expert. Kirksey's assertion of a violation is unsubstantiated, as he acknowledges the statement's source was indeed his expert's report. He did not provide evidence suggesting otherwise and failed to object to the exhibit's introduction at trial, leading to the waiver of this claim under Pa.R.A.P. 302(a).

Kirksey challenges the trial court's decision to admit evidence regarding Table 11, which outlines a dosage escalation plan for Lamictal for patients over 12 years old, arguing it should not have been considered since he was only 12 when the drug was administered. He claims the jury was misled by Appellees’ arguments regarding his age at the time of his reaction to Lamictal, and asserts that the trial court erred in allowing this evidence. The court's discretion in evidentiary matters means a ruling will only be reversed if there is an abuse of discretion resulting in harm or prejudice to the complaining party. Relevant evidence is admissible if its probative value outweighs any prejudicial effect. Kirksey had introduced Table 11 himself, which undermines his argument against its relevance. The case focused on whether Dr. Gedela was negligent for prescribing a higher dose than recommended for a typical 12-year-old, and excluding Appellees’ explanation of their deviation from the dosing chart would have unfairly favored Kirksey. Appellees argued that Table 11 was applicable based on Kirksey's weight, as confirmed by his expert witness who stated that pediatric dosing is primarily weight-based. Kirksey's assertion that Appellees misrepresented age-related evidence is dismissed, as their argument correctly linked the dosing chart to Kirksey's weight. Additionally, Kirksey's appeal includes two claims regarding the court's allowance of evidence about potential side effects of Lamictal and its failure to instruct the jury on assumption of risk.

To establish a claim of medical negligence, a plaintiff must demonstrate that a doctor's treatment fell below acceptable medical standards. While defendants cannot avoid negligence claims by asserting a patient assumed treatment risks, evidence of such risks may be admissible if it shows the doctor's awareness of potential complications. This evidence can help define the standard of care. Trial judges have considerable discretion in instructing juries, and their instructions are reviewed for abuse of discretion or legal error.

In this case, Kirksey sought to exclude evidence regarding the risk of rash from taking Lamictal, but the court denied this motion and allowed testimony about the risk, which included a warning from the prescribing doctor, Gedela. Testimony also indicated that the standard of care required Gedela to weigh the risk of rash against the risk of seizures. The court declined to give Kirksey's requested jury instruction that assumption of risk was not a valid defense, stating it had not been presented during the trial, which was deemed appropriate.

The court did not abuse its discretion in admitting the risk evidence to establish the standard of care, as it was relevant to Gedela's awareness of potential side effects. Furthermore, Kirksey's challenge regarding the court's decision not to release requested exhibits to the jury was also deemed meritless. Although Kirksey acknowledged the court's discretion in this matter, he argued that the exhibits would clarify confusion about inconsistencies in the defense. The jury had asked for eleven exhibits during deliberations, including expert reports and medical records, but the court ultimately denied the request after considering arguments from both sides.

The court expressed concern that the jury might focus on aspects of exhibits not addressed during the trial, particularly lengthy notes in Kirksey's medical records. Kirksey did not demonstrate that the court abused its discretion in denying access to these exhibits, as his argument regarding juror confusion depended on other rejected claims. The court believed that withholding these exhibits would help jurors rely on their memory of key trial facts, thus preventing confusion. 

Kirksey also contended that the court erred by allowing expert Dr. Harry Abram to testify outside the scope of his expert report, citing Pennsylvania Rule of Civil Procedure 4003.5, which aims to prevent unfair surprise at trial. The court found that Abram’s testimony about Stevens-Johnson Syndrome as an allergic reaction was consistent with his report, which discussed Kirksey’s reaction as idiosyncratic and unpredictable. Kirksey's counsel acknowledged that the report included this risk, and since Kirksey was able to present a meaningful response through his own expert, the court upheld Abram's testimony.

Lastly, Kirksey sought a new trial based on a juror's undisclosed conflict of interest, having learned post-trial that Juror Number Seven had affiliations with UPMC. He argued that this situation warranted a presumption of prejudice. The court disagreed, maintaining that no new trial was necessary.

The court reviews de novo the trial court's decision on juror exclusion due to potential prejudice related to relationships with parties involved. The right to an impartial jury is protected under the Pennsylvania Constitution. During the voir dire process, jurors with biases or close ties to parties are examined and potentially excluded. A presumption of prejudice arises with sufficiently close relationships, but not all familiar or financial connections necessitate dismissal. 

In this case, Kirksey's counsel submitted an affidavit alleging that Juror No. 7 behaved inappropriately during the trial and failed to disclose a relationship with UPMC, claiming she had worked there. The affidavit noted that Juror No. 7 was an alternate juror who had previously disclosed her medical training at the University of Pittsburgh, affiliated with UPMC, but Kirksey’s counsel failed to demonstrate a close relationship or concealment of relevant information. The trial court dismissed these allegations as "reckless," and the appellate court found no substantial evidence of bias or relationship sufficient to presume prejudice. 

Kirksey's claim that Juror No. 7 concealed prior employment with UPMC Shadyside was undermined by evidence showing her disclosure of medical training at the University of Pittsburgh and current employment at a competing hospital. The court emphasized that UPMC is not a party in this case, only its affiliate, Children’s Hospital of Pittsburgh of UPMC. Ultimately, the court affirmed the trial court's judgment, finding that Kirksey did not establish grounds for relief.