Armstrong ex rel. Armstrong v. Brookdale University Hospital & Medical Center
Docket: Docket Nos. 02-780(L), 03-9289(CON)
Court: Court of Appeals for the Second Circuit; September 21, 2005; Federal Appellate Court
Defendants Dr. Leon Lewis and Brookdale University Hospital and Medical Center appeal a $1.35 million verdict awarded to plaintiff Chanel Armstrong in the Eastern District of New York. The jury's verdict was influenced by errors in the verdict sheet, leading to confusion regarding the findings on informed consent and battery claims. The court determined these errors compromised both parties' rights to a fair trial, resulting in the vacating of the judgment and a remand for a new trial on the uninformed consent and battery claims. The judgment against Brookdale was reversed due to insufficient evidence supporting the verdict against it.
The background details a 1995 incident where Chanel, then 11, witnessed her sister rescuing a newborn from a bag. After the police suggested Chanel might be the baby's mother, she and her mother were taken to Brookdale for examination. They alleged that Drs. Lewis and Takla conducted examinations without consent, despite protests. The examinations aimed to determine whether Chanel had recently given birth. Chanel later settled a separate lawsuit against the city for $260,000 and subsequently sued the doctors and Brookdale for various claims, including medical malpractice and violations of New York Public Health Law regarding informed consent. The jury found no malpractice but confirmed that consent was not obtained for the examinations. The verdict sheet's instructions led the jury to address proximate cause and informed consent in a manner that ultimately influenced their verdict.
A plaintiff cannot recover damages for lack of informed consent if the physician obtained consent with appropriate information, as outlined in N.Y. Pub. Health L. 2805-d(1). Recovery is also barred if the procedure was diagnostic without bodily invasion or disruption, or if it occurred due to an emergency, per id. 2805-d(2). Additionally, recovery is contingent upon whether a reasonably prudent individual in the patient's position would have undergone the treatment if fully informed (id. 2805-d(3)).
In the case at hand, the jury determined that the doctors' examinations substantially caused Chanel’s injuries, awarding $150,000 against Dr. Lewis, $200,000 against Dr. Rahman, and no damages against Dr. Takla. The jury found the hospital's conduct was contrary to the standard of care and awarded Chanel $1.5 million for past and future pain and suffering.
During deliberations, defense counsel raised concerns that the jury skipped questions, specifically regarding the proximate cause of the hospital’s malpractice claim. Following a review, the jury confirmed that: (1) the procedure was neither a non-emergency nor an invasive diagnostic procedure; (2) the doctors did not provide appropriate information before obtaining consent; (3) a reasonably prudent person would not have consented if informed; and (4) the hospital’s negligence was the proximate cause of Chanel’s injuries. Plaintiffs counsel noted an inconsistency between the jury's findings regarding the nature of the procedure and the awarded damages.
Defense counsel argued that the jury's answers constituted the verdict, while plaintiffs' counsel suggested that the jury intended to award damages but might have been confused. The court summoned the jury to clarify inconsistencies in their responses, particularly regarding the relationship between Questions 2 and 5 on the verdict form. The foreman explained that the jury initially skipped Questions 2, 3, and 4 due to an instruction error indicating they should move to Question 5 if they found no consent. After realizing the instruction was a typo, the court provided a corrected verdict sheet directing the jury to address Question 2 regardless of their answer to Question 1.
Using the new sheet, the jury confirmed that neither Chanel nor Carol consented to the examinations and re-evaluated their responses to the other questions. They determined that the examinations were neither emergency treatments nor diagnostic procedures without bodily invasion. The jury also found that none of the defendants provided appropriate information regarding the examinations but concluded that a reasonably prudent person would have consented if given proper information. Following this, they found that the procedure was a substantial factor in causing injury and awarded the same damages as before. The jury answered all questions regarding the hospital's malpractice favorably to the plaintiff but did not address any battery questions.
The district court granted post-verdict motions for judgment as a matter of law against Dr. Rahman regarding the Public Health Law verdict and for setoff of a prior $260,000 settlement against municipal defendants. The court denied other motions under Federal Rules of Civil Procedure 50(b) and 59. Defendants appealed, arguing inconsistencies in the verdict warranted a new trial, that New York law restricts recovery for emotional suffering without physical injury, and that evidence was insufficient to support the malpractice verdict against the hospital. The court's review of the judgment as a matter of law is de novo, while denials of new trials are reviewed for abuse of discretion, with new trials generally granted only in cases of serious error or miscarriage of justice.
To establish a medical malpractice claim, a plaintiff must demonstrate that the physician deviated from the standard of care expected of reasonably prudent doctors in the same locality. Even if the physician meets the standard of care during a procedure, the patient may still seek damages for injuries if informed consent was not properly obtained, provided the claim is not barred by New York Public Health Law § 2805-d. This section defines lack of informed consent as the failure to disclose necessary alternatives and foreseeable risks and benefits that a reasonable practitioner would share, allowing the patient to make an informed decision.
The right to sue for malpractice due to lack of informed consent is restricted to non-emergency treatments or procedures that invade or disrupt bodily integrity. Additionally, it must be shown that a reasonable person in the patient's position would have declined the treatment if fully informed, and that the lack of informed consent directly caused the injury.
Battery, on the other hand, occurs when a person intentionally makes contact with another without consent, resulting in offensive bodily contact. In the medical context, battery applies only if there is no consent at all, and the physician intends to cause contact that a reasonable person would find offensive. Cases illustrate that a claim in battery arises when a patient explicitly rejects a procedure, while informed consent issues emerge when consent is obtained without proper disclosure of risks and alternatives.
The original verdict sheet's handling of the informed consent and battery claims was flawed, impacting the defendants adversely. When the jury determined that the doctors did not obtain Carol's consent, they incorrectly proceeded to assess damages without first establishing whether this failure was a proximate cause of Chanel's injuries. For a finding in favor of the plaintiff under informed consent, it was necessary to establish that the procedure was invasive, not emergency-related, that the doctors failed to provide appropriate advice, and that a reasonable person would have consented if properly informed. While defense counsel identified this error, the court partially rectified it by requiring the jury to answer subsequent parts of Question III. However, the court did not have the jury address the battery claim, which they had not reached due to their negligence finding, disadvantaging the plaintiff. The jury’s initial finding suggested they might have ruled favorably on the battery claim had they not been misled about its relationship to negligence.
Under Federal Rule of Civil Procedure 49(b), the court could either enter judgment according to the interrogatories or seek further clarification. The judge opted for clarification, which was deemed the better choice, as entering judgment for the defendants without considering the battery claim could have been unjust. Despite this, the judge's attempt to clarify the jury's inconsistent findings was ineffective. The jury's responses indicated contradictions, particularly after a misdirection in the verdict sheet that led them to answer questions inconsistently. The verdict sheet incorrectly instructed jurors to proceed to Question III(5) based on a 'yes' answer to Question III(4), despite prior conclusions suggesting otherwise. This misdirection should have prompted a request for further jury clarification, which counsel failed to pursue.
Defendants argued inconsistencies between the jury's response to interrogatory III(2) and the general verdict, but did not address discrepancies involving III(4). The court erred by entering judgment on the general verdict, contradicting an interrogatory answer that required a different outcome, violating Fed. R. Civ. P. 49(b). Defendants waived their right to appeal this inconsistency unless they demonstrate 'fundamental error,' defined as significantly undermining trial integrity or depriving the jury of necessary legal guidance. Section 2805-d prohibits recovery if a reasonable person would have consented, yet the verdict sheet incorrectly conditioned recovery on such consent, misleading the jury and compromising trial integrity. Consequently, the verdict was vacated, and a new trial was ordered.
Regarding the battery claim, plaintiff's counsel initially requested the battery question be prioritized on the verdict sheet to avoid current issues. While plaintiff asserted that the jury implicitly ruled in her favor by finding no consent for examinations, this argument was invalid, as establishing battery requires finding both unpermitted and offensive contact. The jury did not address whether the contacts were offensive, and preventing them from doing so constituted fundamental error. The court, exercising discretion to address this unargued legal issue due to potential manifest injustice, determined that a new trial was warranted. The jury's oversight in considering the battery claim was deemed a miscarriage of justice, prompting the directive for a new trial. Dr. Takla was excluded from the appeal following the dismissal of Chanel's cross-appeal, leaving the question of reinstating the battery claim against him unresolved.
Defendants challenge the jury's award for Chanel's emotional suffering, asserting that she suffered no physical injuries, was not threatened with physical harm, and lacked exceptional circumstances that would warrant such damages. Courts typically deny recovery for psychological trauma absent contemporaneous physical injury. However, recovery is possible if a defendant has a direct duty to the plaintiff, with emotional harm stemming from a breach of that duty. In this case, the court finds that the psychological trauma from an unconsented gynecological examination falls within the "orbit of danger," establishing Dr. Lewis's duty to avoid such actions. There is also adequate evidence of a breach and the genuineness of the claims.
Regarding the malpractice verdict against Brookdale, defendants argue it contradicts the jury's findings that individual doctors were not negligent. In New York, hospitals can be liable either through vicarious liability for their employees' negligence or through independent negligence. The jury was instructed to consider the hospital's negligence based on inadequate policies and training rather than vicarious liability, which was not objected to by the plaintiff. The court found no fundamental error in this omission, as it reflects a strategic trial decision that does not hinder the jury's ability to reach a rational conclusion. Thus, arguments regarding Brookdale's negligence based on vicarious liability are not considered.
The court determined that the evidence presented did not support a finding of independent hospital negligence, as required for the jury's verdict against Brookdale. The plaintiff failed to demonstrate a general lack of proper procedures or training among hospital staff, focusing instead on the actions of individual doctors and a social worker. Expert testimonies did not establish deviation from the standard of care by the hospital itself; for instance, Dr. Kildare Clarke's critique regarding informed consent was based solely on the doctors' conduct, and he lacked familiarity with Brookdale's practices. Dr. Joseph Wright's claims regarding supervision by Dr. Rahman were similarly unsupported by sufficient evidence of hospital negligence. Consequently, the court reversed the negligence verdict against Brookdale and ordered a judgment in its favor.
Additionally, the court addressed the defendants' concerns about excluded evidence and the jury's verdict process, noting that issues related to trial evidence are now moot due to the remand for a new trial against Dr. Lewis only. The court did not evaluate claims regarding the excessiveness of damages or equitable setoffs, as the procedural context has changed. The court also noted a lack of clarity in the jury's responses, suggesting that proper instructions could have influenced the outcome. The judgment against Brookdale was reversed, and a new trial for the claims against Dr. Lewis was mandated.
