NOT DESIGNATED FOR PUBLICATION
STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
11-1521
SHIRLEY LANGLEY, ET UX.
VERSUS
AMERICAN LEGION HOSPITAL
**********
APPEAL FROM THE FIFTEENTH JUDICIAL DISTRICT COURT PARISH OF ACADIA, NO. 209-10573 HONORABLE DURWOOD WAYNE CONQUE, DISTRICT JUDGE
ELIZABETH A. PICKETT JUDGE
Court composed of Ulysses Gene Thibodeaux, Chief Judge, Sylvia R. Cooks, and Elizabeth A. Pickett, Judges.
AFFIRMED AS AMENED.
Nicholas J. Sigur Attorney at Law Post Office Box 81834 Lafayette, Louisiana LA 70598 (337) 205-2353 Counsel for Defendant/Appellant: American Legion Hospital Benjamin P. Mouton Eric E. Helm McGlynn, Glisson & Koch Post Office Box 1909 Baton Rouge, Louisiana 70821 (225) 344-3555 Counsel for Plaintiffs/Appellants: Shirley Langley Gregory Langley PICKETT, Judge.
Husband and wife sued hospital for damages they claim to have suffered as a
result of the wife’s having been administered epinephrine intravenously rather than
subcutaneously. For the following reasons, we amend and affirm the judgment of the
trial court.
FACTS
On December 5, 2007, Shirley Langley sought treatment in the emergency
room (ER) at the American Legion Hospital (the hospital) in Crowley after
experiencing an allergic reaction to a bee sting. The initial treatment of epinephrine
injected subcutaneously, as ordered by the ER physician, was successful, but
Mrs. Langley developed a rebound reaction to the bee sting. To address the rebound
reaction, the ER physician ordered that a second dose of epinephrine be administered
subcutaneously, but it was administered intravenously.
The hospital’s records show that immediately after the intravenous
administration of the epinephrine, Mrs. Langley complained of pain in her head. Her
heart rate increased from 101 beats per minute to 180-190 beats per minute, and her
blood pressure rose from 136/55 to 205/129. Her reaction was diagnosed as sudden
onset of supraventricular tachycardia, which is a regular fast heart beat caused by
rapid firing of electrical impulses that originate above the heart’s ventricles. 1 This
reaction required the ER physician to perform “vagal massage,” i.e., massage of the
carotid artery in Mrs. Langley’s neck. 2 The episode associated with the intravenous
administration of the epinephrine lasted approximately one minute. Mrs. Langley was
then admitted to the Intensive Care Unit with a diagnosis of allergic reaction to bee
1 As defined in “Supraventricular Tachycardia–Topic Overview,” MedicineNet.com, August 9, 2010, http://www.MedicineNet.com/ heart-disease. 2 This explanation is garnered from the ER physician’s history because a definition for the term “vagal massage” could not be found. See also, “Vagal Maneuvers for A Fast Heart Rate,” WebMD.com, August 9, 2010, http://www.WebMD.com/a-to-z-guides. sting and supraventricular tachydardia secondary to epinephrine. She was treated and
monitored for approximately eight hours before being discharged.
Mrs. Langley and her husband Gregory sued the hospital for damages they
claim to have suffered as a result of the episode. They claim the evidence introduced
at trial shows this medication error caused measurable, permanent damage to
Mrs. Langley’s heart and permanent damage to the “peripheral nerves in her upper
and lower extremities, resulting in pain and loss of sensation.” They further claim the
error caused Mrs. Langley to experience nightmares, intrusive memories, anxiety,
panic attacks, sleep deprivation, weight loss, and bouts of sadness/tearfulness which
she will likely continue to experience. They also assert Mr. Langley has suffered a
loss of consortium with Mrs. Langley as a result of the episode.
At trial, the parties stipulated that the nurse’s administration of the epinephrine
intravenously, rather than subcutaneously as ordered, constituted a breach of the
standard of care by the hospital. Therefore, the parties addressed only the issues of
causation and damages at trial.
Mrs. Langley testified the episode caused her to suffer the worst pain she had
ever suffered. Additionally, she testified she saw bugs crawling everywhere; she
ground her teeth; her stomach hurt badly; her chest felt tight and painful; she felt as if
she were constantly gasping for breath; and she felt anxious and agitated. Thereafter,
Mrs. Langley sought treatment for pain and numbness in her extremities, anxiousness,
nightmares, and other mental/emotional complaints. She was diagnosed with having
five percent damage to her heart. Mr. and Mrs. Langley also testified that the effects
of the episode on Mrs. Langley impacted their relationship with each other.
At the conclusion of the trial, the trial court took the matter under advisement
and subsequently issued Reasons for Judgment in which it awarded Mrs. Langley
2 $25,000 in general damages3 but denied Mr. Langley’s claim for loss of consortium.
Thereafter, the trial court signed a written judgment in accordance with its Reasons
for Judgment. The Langleys and the hospital appealed the judgment.
ASSIGMENTS OF ERROR
In their appeal, the Langleys assign two errors in the trial court’s judgment:
(1) The trial court committed a legal error or, in the alternative, committed manifest error when it failed to award Gregory Langley damages for his loss of consortium, given that the following three requirements were met: (a) the parties stipulated that the defendant breached the standard of care, (b) the trial court confirmed that Shirley was injured by the breach through its award of general damages, and (c) both Gregory and Shirley’s testimonies relevant to his loss of consortium claim were uncontested.
(2) The trial court’s award of $25,000 to Shirley Langley was abusively low considering the severity of her physical and emotional injuries and the higher awards given in similar cases for similar injuries.
The hospital assigns one error:
(1) The trial court erred in awarding damages to Mrs. Langley in that there was no evidence that any act of the hospital caused damage to her.
DISCUSSION
Proof of Causation
In its assignment of error, the hospital contends no evidence established the
episode caused Mrs. Langley’s reaction and argues the reaction Mrs. Langley suffered
may have been caused by the epinephrine itself.
The Langleys had to prove by a preponderance of the evidence that the
intravenous administration of the epinephrine caused Mrs. Langley’s injuries and
damages. Clark v. Parker, 08-941 (La.App. 3 Cir. 2/4/09), 2 So.3d 1262, writ denied,
09-401 (La. 4/13/09), 5 So.3d 165. “Proof is sufficient to constitute a preponderance
when the entirety of the evidence, both direct and circumstantial, shows the fact
sought to be proved is more probable than not.” Hebert v. Rapides Parish Police
3 The Langleys did not introduce evidence regarding their medical expenses; therefore, no award was made for those expenses. 3 Jury, 06-2001, 06-2164, p. 7 (La. 4/11/07), 974 So.2d 635, 642. We cannot reverse
the trial court’s determination that the Langleys met their burden of proof unless we
find its factual findings are manifestly erroneous. Miller v. PNK, 11-216 (La.App. 3
Cir. 10/5/11), 76 So.3d 122.
In its Reasons for Ruling, the trial court determined:
The defendant hospital is responsible only for those damages which are directly attributable to [its] breach of the standard of care required by the law of medical malpractice.
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NOT DESIGNATED FOR PUBLICATION
STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
11-1521
SHIRLEY LANGLEY, ET UX.
VERSUS
AMERICAN LEGION HOSPITAL
**********
APPEAL FROM THE FIFTEENTH JUDICIAL DISTRICT COURT PARISH OF ACADIA, NO. 209-10573 HONORABLE DURWOOD WAYNE CONQUE, DISTRICT JUDGE
ELIZABETH A. PICKETT JUDGE
Court composed of Ulysses Gene Thibodeaux, Chief Judge, Sylvia R. Cooks, and Elizabeth A. Pickett, Judges.
AFFIRMED AS AMENED.
Nicholas J. Sigur Attorney at Law Post Office Box 81834 Lafayette, Louisiana LA 70598 (337) 205-2353 Counsel for Defendant/Appellant: American Legion Hospital Benjamin P. Mouton Eric E. Helm McGlynn, Glisson & Koch Post Office Box 1909 Baton Rouge, Louisiana 70821 (225) 344-3555 Counsel for Plaintiffs/Appellants: Shirley Langley Gregory Langley PICKETT, Judge.
Husband and wife sued hospital for damages they claim to have suffered as a
result of the wife’s having been administered epinephrine intravenously rather than
subcutaneously. For the following reasons, we amend and affirm the judgment of the
trial court.
FACTS
On December 5, 2007, Shirley Langley sought treatment in the emergency
room (ER) at the American Legion Hospital (the hospital) in Crowley after
experiencing an allergic reaction to a bee sting. The initial treatment of epinephrine
injected subcutaneously, as ordered by the ER physician, was successful, but
Mrs. Langley developed a rebound reaction to the bee sting. To address the rebound
reaction, the ER physician ordered that a second dose of epinephrine be administered
subcutaneously, but it was administered intravenously.
The hospital’s records show that immediately after the intravenous
administration of the epinephrine, Mrs. Langley complained of pain in her head. Her
heart rate increased from 101 beats per minute to 180-190 beats per minute, and her
blood pressure rose from 136/55 to 205/129. Her reaction was diagnosed as sudden
onset of supraventricular tachycardia, which is a regular fast heart beat caused by
rapid firing of electrical impulses that originate above the heart’s ventricles. 1 This
reaction required the ER physician to perform “vagal massage,” i.e., massage of the
carotid artery in Mrs. Langley’s neck. 2 The episode associated with the intravenous
administration of the epinephrine lasted approximately one minute. Mrs. Langley was
then admitted to the Intensive Care Unit with a diagnosis of allergic reaction to bee
1 As defined in “Supraventricular Tachycardia–Topic Overview,” MedicineNet.com, August 9, 2010, http://www.MedicineNet.com/ heart-disease. 2 This explanation is garnered from the ER physician’s history because a definition for the term “vagal massage” could not be found. See also, “Vagal Maneuvers for A Fast Heart Rate,” WebMD.com, August 9, 2010, http://www.WebMD.com/a-to-z-guides. sting and supraventricular tachydardia secondary to epinephrine. She was treated and
monitored for approximately eight hours before being discharged.
Mrs. Langley and her husband Gregory sued the hospital for damages they
claim to have suffered as a result of the episode. They claim the evidence introduced
at trial shows this medication error caused measurable, permanent damage to
Mrs. Langley’s heart and permanent damage to the “peripheral nerves in her upper
and lower extremities, resulting in pain and loss of sensation.” They further claim the
error caused Mrs. Langley to experience nightmares, intrusive memories, anxiety,
panic attacks, sleep deprivation, weight loss, and bouts of sadness/tearfulness which
she will likely continue to experience. They also assert Mr. Langley has suffered a
loss of consortium with Mrs. Langley as a result of the episode.
At trial, the parties stipulated that the nurse’s administration of the epinephrine
intravenously, rather than subcutaneously as ordered, constituted a breach of the
standard of care by the hospital. Therefore, the parties addressed only the issues of
causation and damages at trial.
Mrs. Langley testified the episode caused her to suffer the worst pain she had
ever suffered. Additionally, she testified she saw bugs crawling everywhere; she
ground her teeth; her stomach hurt badly; her chest felt tight and painful; she felt as if
she were constantly gasping for breath; and she felt anxious and agitated. Thereafter,
Mrs. Langley sought treatment for pain and numbness in her extremities, anxiousness,
nightmares, and other mental/emotional complaints. She was diagnosed with having
five percent damage to her heart. Mr. and Mrs. Langley also testified that the effects
of the episode on Mrs. Langley impacted their relationship with each other.
At the conclusion of the trial, the trial court took the matter under advisement
and subsequently issued Reasons for Judgment in which it awarded Mrs. Langley
2 $25,000 in general damages3 but denied Mr. Langley’s claim for loss of consortium.
Thereafter, the trial court signed a written judgment in accordance with its Reasons
for Judgment. The Langleys and the hospital appealed the judgment.
ASSIGMENTS OF ERROR
In their appeal, the Langleys assign two errors in the trial court’s judgment:
(1) The trial court committed a legal error or, in the alternative, committed manifest error when it failed to award Gregory Langley damages for his loss of consortium, given that the following three requirements were met: (a) the parties stipulated that the defendant breached the standard of care, (b) the trial court confirmed that Shirley was injured by the breach through its award of general damages, and (c) both Gregory and Shirley’s testimonies relevant to his loss of consortium claim were uncontested.
(2) The trial court’s award of $25,000 to Shirley Langley was abusively low considering the severity of her physical and emotional injuries and the higher awards given in similar cases for similar injuries.
The hospital assigns one error:
(1) The trial court erred in awarding damages to Mrs. Langley in that there was no evidence that any act of the hospital caused damage to her.
DISCUSSION
Proof of Causation
In its assignment of error, the hospital contends no evidence established the
episode caused Mrs. Langley’s reaction and argues the reaction Mrs. Langley suffered
may have been caused by the epinephrine itself.
The Langleys had to prove by a preponderance of the evidence that the
intravenous administration of the epinephrine caused Mrs. Langley’s injuries and
damages. Clark v. Parker, 08-941 (La.App. 3 Cir. 2/4/09), 2 So.3d 1262, writ denied,
09-401 (La. 4/13/09), 5 So.3d 165. “Proof is sufficient to constitute a preponderance
when the entirety of the evidence, both direct and circumstantial, shows the fact
sought to be proved is more probable than not.” Hebert v. Rapides Parish Police
3 The Langleys did not introduce evidence regarding their medical expenses; therefore, no award was made for those expenses. 3 Jury, 06-2001, 06-2164, p. 7 (La. 4/11/07), 974 So.2d 635, 642. We cannot reverse
the trial court’s determination that the Langleys met their burden of proof unless we
find its factual findings are manifestly erroneous. Miller v. PNK, 11-216 (La.App. 3
Cir. 10/5/11), 76 So.3d 122.
In its Reasons for Ruling, the trial court determined:
The defendant hospital is responsible only for those damages which are directly attributable to [its] breach of the standard of care required by the law of medical malpractice. The plaintiff in this case has symptoms of pain and anxiety that her doctors have been unable to explain fully. There is a great deal of uncertainty in the medical testimony, and the court has found a definite lack of proof to a medical probability that Mrs. Langley’s present day complaints and medical issue [sic] are causally connected to the incident at the defendant hospital.
....
For these reasons and considering the arguments of counsel in post-trial briefs, the court awards general damages to . . . Shirley Langley in the amount of $25,000 for physical and emotional damages suffered as a result of the mistakenly IV injected epinephrine. For lack of proof, the court awards no damages to Gregory Langley for loss of consortium.
(Emphasis added.)
The hospital argues the trial court determined the Langleys failed to carry their
burden of proof; therefore, it erred in awarding her damages. This reading of the trial
court’s Reasons for Ruling is too narrow and overlooks the totality of the evidence.
Mrs. Langley had a liver transplant in August 2007 and was recovering without
complication when the episode occurred. Prior to her liver transplant, Dr. Sayed
Feghali, a cardiologist, examined Mrs. Langley as part of the transplant protocol.
After the episode, he examined her at the request of her transplant doctor. Dr. Feghali
explained that when medication is administered intravenously as opposed to
subcutaneously, it immediately enters circulation and has a “very acute” effect.
Further, he explained that epinephrine is “a very, very potent simulant [sic] to the
heart” and that the effects of epinephrine are complex. He described those effects as
causing the heart rate to speed up extremely and blood pressure to increase to a very
4 high level. He also stated that epinephrine can cause the heart to spasm and result in
the heart working overdrive because the oxygen supplied to the heart is less than the
demand. Importantly, Dr. Feghali observed that when Mrs. Langley went to the
hospital after the bee sting, her pulse and blood pressure were reasonably stable and
remained so until the second dose of epinephrine was administered, indicating her
response to the subcutaneous injection of epinephrine was normal.
Dr. Feghali’s explanation of the effects of epinephrine administered
intravenously, Mrs. Langley’s normal reaction to the subcutaneous injection of
epinephrine, the hospital’s documentation of her physical reaction to the epinephrine
administered intravenously, and her description of her physical and psychological
reaction to it supports the trial court’s determination that the Langleys proved the
hospital’s actions caused her damage. Accordingly, we find no error in its
determination.
General Damages
The Langleys urge the trial court’s award of $25,000 in general damages is
excessively low. Trial courts are vested with “vast” discretion in awarding damages.
Guillory v. Lee, 09-75, p. 14 (La. 6/26/09), 16 So.3d 1104, 1117. Damage awards are
findings of fact and can be disturbed on review only if the record “clearly” shows the
fact finder “abused its discretion in making its award.” Id. (quoting Wainwright v.
Fontenot, 00-492, p. 6 (La. 10/17/00), 774 So.2d 70, 74). Appellate courts must view
relevant evidence “in the light which offers the most support to the trial court’s
judgment” when considering whether the fact finder abused its discretion. Hardy v.
Augustine, 10-946, p. 5 (La.App. 3 Cir. 2/2/11), 55 So.3d 1019, 1023, writ denied, 11-
470 (La. 4/25/11), 62 So.3d 92 (citing Youn v. Maritime Overseas Corp., 623 So.2d
1257 (La.1993), cert. denied, 510 U.S. 1114, 114 S.Ct. 1059).
The Langleys contend Mrs. Langley sustained injuries to her heart and
peripheral nervous system, which have caused and will continue to cause her pain and
5 severely limit her quality of life. They also assert the episode caused her to
experience severe mental and emotional effects which have not subsided or
diminished. Moreover, they deny the injuries suffered by Mrs. Langley in an
automobile accident in March or April 2008, which required her to be hospitalized for
thirty days, caused any of these injuries or complaints. The Langleys’ assessment of
the medical evidence differs from our assessment of that evidence, and we find no
abuse of discretion in the trial court’s damage award of $25,000. Specifically, we
examine Mrs. Langley’s medical treatment pertinent to the episode.
After the episode, Mrs. Langley sought treatment from four doctors for
complaints that she related to the episode: Dr. Feghali; Dr. Fabian Lugo, a
neurophysiologist; Dr. Jennifer Pate, a psychiatrist; and a general practitioner she
identified as Dr. Patel. Less than two weeks after the episode, Mrs. Langley sought
treatment from Dr. Lugo, complaining that after the episode, she experienced
significant pain and numbness in her upper and lower extremities. Dr. Lugo’s initial
examination did not reveal any objective evidence supporting Mrs. Langley’s
subjective complaints, and testing recommended by him was normal and revealed no
signs of sensory or motor dysfunction.
Dr. Lugo initially testified that because Mrs. Langley had no such problems
before the episode, he assumed there was a direct connection between the epinephrine
and her complaints, which indicated a cause-effect relationship. He later explained,
however, that he thought “something else was going on, not just the initial insult” of
the episode. Moreover, throughout his testimony, Dr. Lugo stated he was not satisfied
that the episode caused any nerve damage in Mrs. Langley. Ultimately, Dr. Lugo
testified, “All I can say is that she has symptoms of neurological dysfunction. I do not
know exactly why. I just want to make it clear.”
Mrs. Langley next saw Dr. Feghali. Contrary to Mrs. Langley’s testimony,
Dr. Feghali did not determine she had suffered a massive heart attack as a result of the
6 episode. Rather, he opined that while her heart was damaged, the damage was minor,
quantifying it at five percent or less, and that her overall heart function was very good.
With regard to whether the episode caused her heart damage, Dr. Feghali testified it
was “conceivable” the damage was “secondary to the allergic reaction to the bee sting
and/or the epinephrine IV injection.” (Emphasis added.) Dr. Feghali opined that
Mrs. Langley would live a normal life, unless some as yet unknown health issue
combined with the minor damage to her heart to increase that the damage.
Dr. Feghali recommended that Mrs. Langley see a psychiatrist due to the
anxiety and stress she exhibited during an appointment with him, and
Mrs. Langley sought treatment from Dr. Pate. She first saw Dr. Pate on June 16,
2009. Dr. Pate recorded Mrs. Langley’s complaints on her first visit as chronic back
pain from an automobile accident; being anxious and traumatized following injury
from the episode; experiencing frequent nightmares and intrusive memories;
experiencing frequent episodes of tearfulness; being anxious about her lawsuit against
the hospital; having decreased appetite and weight loss due to pain; experiencing
sadness; having low interest and variable energy; and limping “due to nerve damage.”
In July 2009, Mrs. Langley reported to Dr. Pate that she was better, but anxious.
During Mrs. Langley’s last visit in April 2010, Dr. Pate recorded that she was
preoccupied with the aftermath of the episode and that her sister had died six months
earlier.
While the medical evidence does not establish to a medical probability that
Mrs. Langley suffered heart damage or nerve damage as a result the episode, it clearly
shows she experienced physical pain and psychological distress during the episode
and continued to experience psychological distress after the episode. The trial court
agreed but concluded Mrs. Langley did not prove she continued to suffer such pain
and/or distress at the time of trial. Mrs. Langley testified Dr. Pate recommended
additional treatment, but she did not pursue that treatment or any other treatment for
7 her emotional distress and/or anxiety for more than one year before trial. Dr. Pate
also recommended a foot evaluation that Mrs. Langley never obtained. Additionally,
Mrs. Langley did not pursue additional testing recommended by Dr. Lugo. Therefore,
we find no error with the trial court’s conclusion that the Langleys failed to prove
Mrs. Langley continues to suffer physical pain or suffering or psychological suffering.
For these reasons, we conclude the medical evidence does establish that
Mrs. Langley suffered physical and psychological damages as a result of the episode,
but it does not establish those damages are so extensive that the trial court’s $25,000
award is insufficient.
Loss of Consortium
The Langleys complain the trial court erred in refusing to award Mr. Langley
damages for loss of consortium. To succeed on Mr. Langley’s loss of consortium
claim, they had the burden of proving: “(1) the liability of the defendant, (2) his . . .
spouse’s damages, and (3) his . . . consequent loss of consortium damages.” Bellard
v. S. Cent. Bell Tel. Co., 96–1426, p. 21 (La.App. 3 Cir. 8/27/97), 702 So.2d 695, 707,
writ denied, 97–2415 (La. 12/12/97), 704 So.2d 1202.
As argued by the Langleys, we need only consider the last element of
Mr. Langley’s loss of consortium claim because the stipulation regarding the
hospital’s standard of care beach and the trial court’s award of damages to
Mrs. Langley satisfy the first two elements of his claim. In reviewing this assignment,
we are mindful that: “Loss of consortium is more than just a loss of general overall
happiness, it also includes love and affection, society and companionship, sexual
relations, the right of performance of material services, the right of support, aid, and
assistance, and felicity.” Id.
The Langleys each addressed this element of Mr. Langley’s claim in their
testimony. Mr. Langley testified that Mrs. Langley’s injuries have affected their
romantic life and greatly limited their ability to do activities they previously enjoyed
8 together, like fishing, dining, and traveling outside the home. He also testified that
Mrs. Langley has frequent nightmares which wake him during the night and that he is
so concerned for her when she is alone that he often calls twenty to thirty times a day
to check on her. Mr. Langley further testified that there are times he must “walk on
eggshells” because one of her medications causes her to have mood swings and he
does not know when “she’s going to explode.” Both testified that their sex life has
been curtailed. Mrs. Langley explained her fear that any exertion during sex could
have a negative impact on her heart. Both testified that Mrs. Langley’s inability to
drive, due to side effects of one of her medications, and her other limitations restrict
Mr. Langley’s freedom.
This testimony shows that the trial court erred in finding that Mr. Langley did
not prove his loss of consortium claim, and we award him $2,500.
DISPOSITION
The judgment of the trial court is amended to award Gregory Langley $2,500 in
damages for loss of consortium; it is affirmed in all other respects. The costs of this
appeal are assessed to the American Legion Hospital.
AFFIRMED AS AMENDED.