Court: Court of Appeals of Mississippi; September 21, 2004; Mississippi; State Appellate Court
Diane B. Perkins, on behalf of her daughters, filed a medical malpractice lawsuit against Dr. Alton Dauterive, claiming that his negligence led to the wrongful death of her husband, Daniel Walter Perkins. The jury found in favor of Dr. Dauterive, prompting Perkins to appeal, asserting that the trial court wrongly denied her motion for a new trial on the grounds that the verdict contradicted the overwhelming evidence and that the jury was exposed to extraneous prejudicial information. The court affirmed the trial court's decision.
The case's facts, presented during the May 2001 trial in Hancock County, detail the events of November 25, 1994, when Walter was stabbed at a fishing camp. Upon arrival at Hancock Medical Center around 7:45 a.m., he was treated by Dr. Sean Appleyard, who stabilized his condition but suspected a serious injury to the right subclavian artery. Despite Walter's reports of being stabbed with a longer knife and experiencing numbness in his right arm, initial x-rays did not reveal air or blood in his chest.
At approximately 8:15 a.m., Dr. Appleyard contacted Dr. Dauterive, who was performing surgery elsewhere, informing him of Walter’s critical condition and requesting his assistance. Dr. Dauterive advised maintaining Walter's stability and promised to arrive as soon as possible. By 8:45 a.m., Walter's family arrived and expressed concerns about the delay. Dr. Appleyard called Dr. Dauterive again at 9:15 a.m. to discuss the possibility of transferring Walter to another facility, but it was decided to keep him at Hancock Medical, as transferring would be risky and time-consuming. The family agreed to this course of action.
Dr. Dauterive examined Walter and identified a serious arterial injury beneath the stab wound, likely affecting the proximal axillary or distal right subclavian artery, requiring surgical intervention. He began surgery at 12:05 p.m., aiming to locate and repair the damaged artery. An infraclavicular incision was made, exposing the right subclavian artery. Walter's condition worsened, leading to an emergency median sternotomy due to massive internal bleeding. The true extent of the arterial damage was found to be more severe than initially thought, with the proximal subclavian artery nearly transected.
A blood clot had temporarily masked the injury, but it dislodged during surgery, causing exsanguination. Dr. Dauterive controlled the bleeding by clamping the artery, transfusing Walter with packed red blood cells, and installing monitoring lines. Despite these efforts and subsequent transfusions of fresh frozen plasma and platelets, Walter developed coagulopathy, complicating his recovery. He was transferred to intensive care for further treatment, but the condition persisted, leading family members to decide to discontinue life support. Walter was pronounced dead at 10:18 p.m. Subsequently, Diane Perkins and her children initiated a wrongful death lawsuit against Drs. Dauterive and Appleyard, Hancock Medical Center, and Van Meter and Associates, associated with Dr. Appleyard.
Hancock Medical Center was dismissed from the case before trial, and Perkins settled with Dr. Appleyard and Van Meter and Associates during the trial, leaving Dr. Dauterive as the only defendant. The jury ultimately voted 9-3 in favor of Dr. Dauterive. Following the verdict, Perkins filed a motion for a new trial, claiming the verdict was against the overwhelming weight of the evidence. The trial court denied this motion, leading Perkins to appeal.
The appellate court affirmed the trial court's decision, stating that the granting or denial of a new trial is at the lower court's discretion and will only be reversed for an abuse of that discretion. The court emphasized that a verdict could only be disturbed if it was so contrary to the evidence that it would result in an unconscionable injustice. The review process involves examining all evidence in favor of the jury's decision.
As the plaintiff, Perkins bore the burden of proving medical malpractice by a preponderance of the evidence, which includes establishing a doctor-patient relationship, presenting expert testimony on the standard of care, proving the physician's failure to meet that standard, connecting that failure to the injury sustained, and demonstrating the extent of damages. Perkins contended that the evidence indicated Dr. Dauterive breached the standard of care, which led to Walter’s death. Experts agreed that the primary surgical goal was to manage Walter’s arterial injury, with disagreement centering on whether an arterio-gram should have been ordered preoperatively.
An arteriogram, involving the injection of contrast dye into an artery, is used to assess blood flow. Dr. Stephen Smith testified that if Dr. Dauterive had ordered an arteriogram, he would have identified Walter’s arterial injury location, altered his surgical approach, and managed the transected artery before a blood clot became dislodged. Experts agreed that a preoperative arteriogram is necessary when the entrance wound is within specific surgical zones of the neck. The consensus identified Walter’s injury in surgical zone 1, which mandates an arteriogram, although there was disagreement about the wound's exact location.
Dr. Dauterive contended that his clinical judgment allowed him to forego the arteriogram, asserting that Walter's entrance wound was outside zone 1, located over the distal clavicle. He believed immediate surgery was warranted due to the pulseless arm indicating vascular injury, and that an arteriogram would have delayed treatment by one to two hours and posed risks given Walter's condition.
Dr. Smith maintained that the entrance wound fell within zone 1's boundaries, which extend from the cricoid cartilage to the clavicles. He cited surgical protocols for hemodynamically stable patients in zone 1 with vascular injury signs, stating that the risk of complications from an arteriogram was minimal. He concluded that Dr. Dauterive’s failure to order the arteriogram breached the standard of care and contributed to Walter’s death. In contrast, Dr. Dauterive's expert, Dr. Kennan Buechter, opined that Dr. Dauterive did not breach the standard of care.
Walter's treatment did not contribute to his death, as stated by Dr. Buechter, who pointed out that there were no signs of a proximal subclavian artery injury at the time of treatment. Dr. Buechter supported Dr. Dauterive's conclusion regarding the nature of Walter's injuries and deemed the initial surgical approach reasonable, noting the entrance wound's location as outside zone 1, which negated the need for an arteriogram. Evidence presented included an autopsy report with conflicting details about the entrance wound's position, but Dr. Buechter maintained the wound was not in zone 1.
Perkins challenged Dr. Dauterive's performance, particularly regarding the timing of administering clotting factors. Dr. Smith argued that earlier administration of plasma and platelets would have improved Walter's outcome, while Dr. Dauterive contended that such treatment was unnecessary at that stage. Additionally, Dr. Smith criticized the delay in Walter's care in the emergency room, suggesting a failure to transfer him promptly, but evidence indicated Dr. Dauterive did not breach the standard of care regarding his arrival time.
The trial included conflicting expert testimonies on the standards of care applicable to Walter's treatment, with the jury responsible for evaluating witness credibility and resolving evidentiary conflicts. The court declined to examine the knife involved in the stabbing, stating that such analysis was complex and better suited for the jury. Ultimately, the evidence suggested a reasonable juror could find that Perkins did not prove Dr. Dauterive committed malpractice in his treatment of Walter.
The trial court upheld the verdict, determining it was not contrary to the overwhelming weight of the evidence, and found no abuse of discretion in denying Perkins' motion for a new trial. Perkins claimed jury misconduct, alleging that during deliberations, a juror, identified as a nurse, made a prejudicial statement suggesting that a verdict for the plaintiffs would result in a doctor losing his medical license. This statement allegedly influenced the jury's decision, which resulted in a 9-3 vote for the defendant. Perkins noted that the jury's inquiries during deliberations indicated they were swayed by this statement, arguing it led to indecision being resolved in favor of the defendant.
The trial court rejected Perkins' motion, and he contended this was erroneous. According to Mississippi Rule of Evidence 606(b), jurors cannot testify about statements made during deliberations, nor can they discuss influences on their decisions unless it involves extraneous prejudicial information or outside influences. The rule prevents jurors from revealing how their own information may have affected the verdict.
A juror is permitted to testify only about extraneous information or outside influences introduced by others, not about how such information affected the verdict. The process for jury inquiry begins when evidence of potential juror misconduct is presented, necessitating a balance between the right to investigate the verdict and the jurors' right to be free from harassment. Inquiry cannot be conducted as a "mere fishing expedition." If misconduct evidence is sufficient to establish good cause for suspicion of improper influence or prejudicial information, an investigation is warranted. The standard for this showing should clearly substantiate a specific, non-speculative impropriety, overcoming the presumption of jury impartiality.
If an investigation is deemed necessary, the trial court is to hold a post-trial hearing, but it cannot delve into jurors' internal deliberations or the subjective effects of extraneous information. The court must assess whether the communication in question could have reasonably affected the verdict and may order a new trial if the extraneous information is material and qualitatively different from the evidence presented at trial.
In the analyzed case, the court examined Juror Bourgeois’s affidavit and concluded that it did not pertain to the critical issue of whether Dr. Dauterive breached the standard of care. The affidavit failed to demonstrate that jurors were exposed to extraneous information that materially influenced the verdict. Thus, according to the Gladney procedure, further inquiry was unnecessary. The trial court's denial of an investigative hearing is reviewed for abuse of discretion. The parties have extensively debated this issue, with Perkins asserting that Bourgeois's affidavit indicated a reasonable possibility of an altered verdict.
Perkins claims that a statement from a juror, a nurse, suggesting a verdict for him could lead to Dr. Dauterive's suspension or loss of medical license was prejudicial, particularly due to the juror's professional background. He argues that the jury’s inquiries to the court indicate they were influenced by extraneous matters rather than the evidence presented. The timing of the jury’s verdict, which occurred about 20 minutes after the nurse’s statement, is cited as evidence of potential bias. Dr. Dauterive contends that the statement does not constitute an outside influence since it came from a fellow juror, and asserts that Juror Bourgeois, alleged to be related to Perkins, provided an affidavit to assist Perkins in contesting the verdict.
The excerpt references the Brake case, noting that any information outside the court record is deemed an outside influence, regardless of its source. However, the APAC-Mississippi case illustrates that jurors' use of a prohibited calculation method did not warrant a new trial, as it wasn't seen as reliance on external influences. Similarly, in Payton v. State, the court rejected a motion for a new trial based on jurors' personal acquaintances with a witness, as it did not involve outside influence affecting deliberations.
The statement in question from the juror related to Dr. Dauterive’s licensing was based on the juror's personal knowledge and did not originate from outside the jury. The rulings in APAC-Mississippi and Payton support that jurors can incorporate personal knowledge into their deliberations without invalidating their verdict. The trial court found no reasonable possibility that the nurse’s comment influenced the majority jurors to disregard the substantial evidence against Perkins. The court emphasized the importance of finality in litigation, affirming the Circuit Court's judgment and stating that Perkins's appeal did not adequately address the sufficiency of evidence, limiting the review to the weight of the evidence. The record lacked sufficient evidence to confirm the familial relationship between Perkins and Juror Bourgeois.
