Fitting the Punishment to the Crime

The following post is part of our Law Student Blog Writing Project, and is authored by James Haney, a Juris Doctor student at NKU Chase College of Law, Northern Kentucky University.

Fitting the Punishment to the Crime:

Punitive Damages Awarded to Estate of Man Killed by Negligence of the Hospital

Looking for a little more drama in your court cases? Is SVU getting stale? Are you interested in gross negligence committed by hospitals in direct transgression of the Hippocratic Oath? If you’ve answered “yes” to any of these questions, you need look no farther than a recent opinion (which can be read in full, here) published by the Supreme Court of Kentucky. In a case which involves quite possibly the most egregious example of criminal negligence that I, personally, have ever read, the Kentucky Supreme Court upheld an award of $1.45 million in punitive damages against Saint Joseph Healthcare, Inc. This case deserves some historical context in order to be more fully understood.

The Washington Post published an article on May 3, 2016, two (2) days before the Kentucky Supreme Court handed down its opinion, stating that medical errors are now the third leading cause of death in the United States. For comparison, that falls above respiratory disease, accidents, stroke, and Alzheimer’s. Only heart disease and cancer kill more, respectively. 251,000 people, each entrusting their lives to the medical professionals, die, each year, due to medical errors. While the severity of each case varies, one fact remains true: errors are preventable.

First of all, the events detailed in the case occurred in 1999. This legal battle has been going on for over 17 years. The facts of the case in hand were established at the original trial. In appellate decision, the evidence is looked at in a light “most favorable to the verdict.” This is a legal standard in the United States, rather than a single standard used by this court in particular. With that in mind, the court recounted the following facts.

James Milford Gray, the deceased whose estate brought the action against the hospital, arrived at the emergency room on the evening of April 8, 1999. Gray was an uninsured, indigent paraplegic, and was examined by Dr. Barry Parsley and PA Julia Adkins after complaining of abdominal pain, nausea, vomiting, and severe constipation. A witness testified to the distress Gary was in, stating that Gray could be heard crying and calling for help. After being treated with pain medication, an enema, and manual dis-impaction, Gray was discharged, not five hours after his arrival. The ambulance service, without a specific destination given by Gray, ushered him around to various family members. He was declined by each, as none of them had any medical expertise, and they noted his ill-looking pallor and condition. Gray was returned to the hospital by the ambulance service.

Rather than admit Gray to the emergency room, the hospital wheeled him to a motel across the street, paid for him to have a room for the night, and left him. Without a wheelchair. It bears repeating that Gray was a paraplegic, as in, he had no function in his legs. Upon seeing him vomit dried blood, the motel staff called 911, and Gray was taken back to the emergency room. The same doctor and physician’s assistant saw him, in addition to Dr. Jack Geren. Gray was discharged by Geren, with instructions that he would be arrested if he returned to the emergency room. Chestity Roberts, Gray’s niece, finally agreed to take him in. He was urged by family members to return to the hospital, but refused, citing his fear of being arrested. Gray died a few hours later. He succumbed to the rupture of a duodenal ulcer.

The Emergency Medical Treatment and Active Labor Act (EMTALA) denotes two (2) duties to a hospital in the care of a patient: 1) the hospital must screen the patient for treatment at its emergency room, and 2) the hospital must stabilize the patient before he is transferred or discharged. Gray’s estate brought action against the hospital, Dr. Richardson, and Dr. Geren. Settlements were reached with both Richardson and Geren. The jury assessed compensatory damages, the type designed to only replace what was lost, and nothing more, to be $25,000. After distributing fault based on percentage, the hospital was saddled with a whopping $3,750 in compensatory damages. Please note that “whopping” is riddled with sarcasm, in the previous sentence. Due to the perceived level of atrocity of the inaction of the hospital, the court also issued Gray’s estate a $1.5 million punitive award. The Court of Appeals affirmed the compensatory amount, but considered the punitive damages excessive, and remanded the case to the lower court for a new trial on the punitives. The reasoning was that the disparity between the punitive and compensatory damages constituted a potential violation of the 14th Amendment due process clause. The Supreme Court of Kentucky then granted review, and remanded the case to the Court of Appeals, based on a decision in Martin v. Ohio County Hospital Corporation in 2009, involving the EMTALA. The Court of Appeals reaffirmed its original decision, and the case for the punitive amount was heard. This time, the jury returned a verdict for $1.45 million, which was upheld by the Court of Appeals.

Kentucky does not have a cap on the amount that may be awarded to a plaintiff in the case of punitive damages. I think this is a positive stance. In the course of a trial, outcomes often favor those with the deepest pockets. The equalizer is what facts the jury hears. As was shown so starkly in the case of the elderly woman who was burned by McDonald’s coffee, the general public is often swayed by the media (which only makes sense, given the fact that the media determines what information is made readily available at the greatest of ease), and virtually never receives all the facts of a case. I, myself, was guilty of passing judgment on the woman, without hearing all the facts. After being exposed to them, my opinion changed. The point is that the jury is the best able to determine the appropriate amount with which to levy punishment against a bad actor. In the case of a major hospital, $1.5 million is not nearly as damaging as the public relations nightmare that may well come of the case.

Often, punitive damages are based on Gore v. BMW of North America, Inc. The case set out a standard for how to determine an award of punitive damages: 1) the degree of reprehensibility, 2) the disparity between the actual or potential harm suffered and the punitive damages, and 3) the difference between the compensatory and punitive damages awarded. The court notes that “Additional consideration is required where a particularly egregious act has resulted in only a small amount of economic damages.”

I think it’s safe to say that $3,750 is substantially insignificant when compared to the conduct of the hospital and its employees. There are most certainly people that take advantage of the system. That is impossible to argue against. The case, here, though, involves a man who was mere hours away from death, upon first entering the emergency room. The hospital effectively placed a band-aid over a gunshot wound, and then proceeded to tear it off, without so much as a courtesy 3-2-1 countdown. As insane and inexcusable as the actions were, I can almost understand the position of the hospital in trying to be economically efficient. However, paying for a motel room, then leaving a paraplegic without a wheelchair seems asinine. You paid for the room, but can’t spare a wheelchair? C’mon. As to the constitutionality of the award, the ratio is 386 to 1, punitive to compensatory. Typically, the ratio is capped at 9 to 1. This case, though, as described by the Kentucky Supreme Court, is a perfect marriage of situations which would create cause for going outside the single-digit ratio guideline. The single-digit ratio is, after all, a precedent guideline, rather than a hard and fast rule.

The actions of the hospital and its staff surely warrants an imposing punitive award. No business would be allowed to get away with comparable actions, and no establishment in which people entrust their lives should be allowed to, either. The direct and reprehensible way in which the physicians disregarded their duties deserves some form of punishment. It is, in my opinion, perfectly acceptable to have awarded the estate of Mr. Gray such a high value. The value of human life may be debated; what cannot be debated, though, is the fact that the hospital broke the law, and must not be allowed to escape with a slap on the wrist for doing so.