Court: Louisiana Court of Appeal; December 27, 2016; Louisiana; State Appellate Court
In this medical malpractice case, Louisiana State University Health Sciences Center in Shreveport is appealing a jury's judgment that awarded Barbara Wise $1,455,740 for future medical care and related benefits, $517,000 for economic damages, and additional amounts for future medical expenses and pain and suffering. The court has reduced the award for future medical care but affirmed the judgment in all other respects.
Barbara Wise underwent surgery by Dr. Anil Nanda for right shoulder weakness, during which a dura tear occurred, leading to neurological weakness and ultimately quadriparesis. Post-surgery complications included fluid accumulation pressing on her spinal cord, requiring further surgical intervention. Following a series of treatments and rehabilitation, the Wises filed malpractice claims against Dr. Nanda and LSU, which were consolidated.
A Medical Review Panel found no standard of care violation. However, the jury found LSU negligent and attributed fault, resulting in the aforementioned damages. LSU's appeal specifically contests the future medical care award and the economic loss damages. The appellate court emphasized that it rarely disturbs general damage awards due to the discretion granted to the trier of fact in such determinations.
The review of an award for general damages centers on whether the trier of fact abused its discretion in the damage assessment. Prior awards may only be consulted after determining such abuse, to establish reasonable bounds of discretion. Special damages, defined as those with a "ready market value" (e.g., medical expenses, lost wages), require a two-step appellate review: confirming no reasonable factual basis exists for the trial court's conclusions and establishing that the findings were clearly wrong.
LSU challenges a jury's award of $1,455,740 for future medical care, arguing it reflects manifest error. According to La. R.S. 40:1237.1, "future medical care and related benefits" include all necessary medical and support services post-injury, excluding nonessential items. Prior cases affirm that gratuitous medical services do not preclude recovery of their value, but claims for nonprofessional family care must meet stringent proof requirements regarding necessity, reasonableness, and duration.
LSU asserts that evidence for nonprofessional family custodial care was insufficient, lacking proof of need, reasonable rates, and duration. While LSU acknowledges $464,096.88 in past medical expenses, it argues the future medical benefits should not exceed this amount. Testimony indicated that Barbara required assistance with mobility post-injury, including necessary lift aids and support from family members.
Barbara, after returning to Promise due to blood clots, participated in occupational and physical therapy. She could walk up to 150 feet with assistance, and her therapy progress was noted as good in her discharge summaries. In occupational therapy, she required moderate assistance with feeding and maximum assistance with grooming, bathing, and toileting. Her physical therapy summary indicated she was independent with wheelchair mobility but needed varying levels of assistance with bed mobility, transfers, and ambulation, with fair to good balance noted.
Nathan, determined to help Barbara walk again despite prior warnings about her mobility, converted their living room into a makeshift gym and made several modifications in their home, including a ramp and adjusted steps. However, he later removed the ramp due to Barbara's fear of slipping. She was able to navigate stairs by turning sideways and using the rail for support.
Dr. Marco Ramos diagnosed Barbara with incomplete quadriparesis, noting her labored ambulation and the need for assistance from her wheelchair. Observations by acquaintances indicated that she walked slowly while relying on a walker or other supports. Karen Luckett, an expert in life care planning, assessed her ambulation and balance as impaired, confirming her dependence on a walker and labeling her a high fall risk due to weakness and instability. She had experienced falls, requiring assistance to get upright afterward.
Barbara sleeps in a hospital bed, needing Nathan's help to get in and out, and she has had past issues controlling her bowels, necessitating the use of adult diapers. Her physical deficits extend beyond her lower extremities.
Barbara has limited use of her right arm, while her left hand exhibits spasticity. Initially, her left hand was closed in a fist, but through exercises designed by Nathan, including holding progressively larger objects and searching for coins in rice or beans, she has gained some functionality. Despite these efforts, her left hand significantly hinders her daily activities, requiring assistance for dressing, using the bathroom, and bathing. Nathan helps her with tasks such as pulling up her pants and washing her after using the toilet, and he has installed support bars for her.
Barbara can perform some kitchen tasks like making a sandwich and washing clothes, but she struggles with more complex activities, such as cutting food and lifting heavy pots. She can operate the washing machine but relies on Nathan for transferring clothes to the dryer. Although she has resumed some hobbies like calligraphy and painting, her capabilities are limited to small projects.
Driving has been a challenge, requiring six to eight months to relearn how to steer, and she needs help getting in and out of the car due to her mobility issues. Nathan has made adjustments, such as replacing her vehicle with a more accessible Jeep Cherokee. Barbara has also utilized a golf cart for outdoor mobility with Nathan's assistance. In 2010, she co-managed a barbeque restaurant for six months, working part-time depending on her health, where she took orders and collected payments, with help from employees for transportation.
Linda Morgan testified about the assistance she provided to her sister Barbara, noting that Barbara required help with activities such as using the bathroom, dressing, grooming, and bathing. Barbara could sometimes walk with support but struggled with grasping and releasing objects. Dr. Law indicated that Barbara needed long-term occupational and physical therapy, estimating that she would require 4-6 hours of daily assistance, influenced by her independent nature. Luckett, who assessed Barbara, disagreed and stated that Barbara should not be left alone for more than a few minutes due to her significant care needs.
The jury faced challenges in determining the reasonable rate for care. LSU argued that the jury's use of an $18 per hour figure, derived from averaging quotes from local agencies, was unreasonable. Luckett advised against relying on private sitters due to their unreliability, instead emphasizing the importance of professional services. While she valued Nathan's caregiving equally to that of an agency worker, the jury was tasked with valuing the non-professional care provided by Nathan from the date of injury to the verdict. It was concluded that $8 per hour would have been the highest reasonable rate for this period.
Although Barbara was occasionally alone, Linda testified that she often stayed over to provide support, allowing Nathan to rest. Dr. Law noted that Barbara was receiving professional care as of December 2007, and records confirmed multiple visits for therapy and nursing care in early 2008.
Nathan was deeply involved in caring for his wife, Barbara, after her discharge from the hospital, making significant modifications to their home to accommodate her needs. He adjusted the kitchen counter and cabinets to assist her mobility and daily activities. Testimonies from family members, including Nathan’s sister Margie and a witness from LSU, highlighted Nathan’s extensive support, stating he handled Barbara’s basic needs and participated in her rehabilitation. Nathan’s daily routine included assisting Barbara with personal care, meals, and transportation for errands. Although Barbara sometimes stayed alone, Nathan arranged for caregivers when he was unavailable. The jury awarded $1,455,740.00 for future medical care, which, after removing past medical expenses of $464,096.88, suggested a significant sum for custodial services. LSU argued that the award's calculation was flawed, mischaracterizing the duration of care as six years instead of over seven, leading to an average of 21.26 hours of care per day. Ultimately, the award for future medical care was amended to $904,944.24, which included $440,847.36 for custodial care and the prior past medical expenses.
LSU challenges the jury's award of $517,000 in economic damages, arguing that the evidence only supports an award of $46,378 for one year of economic loss. They highlight Barbara's status as a rehired retiree, noting that, under Louisiana regulations, she could only work in areas with a certified shortage of teachers. The relevant Louisiana Administrative Code states that retired teachers must have their employment certified by the school superintendent and personnel director due to these shortages. Despite her retirement in 2005, Barbara intended to return to teaching in fall 2007 and had secured a position, motivated by her desire to interact with students. Testimony from Margie Clements indicates Barbara was enthusiastic about returning to the classroom, and a letter from principal D.B. Mitchell confirmed that her position would be held for her. Barbara expressed a wish to teach until age 75, contingent on her health, and was open to teaching beyond that age if feasible. After reviewing the case, the court found no manifest error in the jury’s award of $517,000 in lost wages. The award for future medical care was amended to $904,944.24, while the remainder of the judgment was affirmed, with each party bearing its own costs. The appellate court costs of $649 will be paid by the appellant per Louisiana law.
