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Judgment on verdict v. hospital for $2.2 million reversed.

CASE ON POINT: Griffin v. Univ. of Pittsburgh Med. Ctr., Braddock Hospital, (05/19/2008) A.2d -PA

ISSUE: Can an appellate court overrule the denial of a motion for JNOV? That was the issue in this Pennsylvania case.

CASE FACTS: Rita Griffin presented to the University of Pittsburgh Medical Center (UPMC) on August 20, 2003, complaining of abdominal discomfort, off and on, for several weeks. She had a history of Crohn's Disease, and was admitted for a work-up. Testing revealed a possible mass involving the terminal ileum. On August 25, 2003, an exploratory laparotomy and ileocolectomy were performed. Post-operatively, the patient exhibited some confusion and agitation in the early morning hours of August 26, 2003. At approximately 8 a.m., on August 26, 2003, she began to complain of right shoulder pain. She was diagnosed with a right posterior shoulder fracture/dislocation, which required open reduction and internal fixation with subscap transfer, which was performed on August 29, 2003. She required three additional surgeries thereafter, including a shoulder replacement and a later revision thereof: The patient was found to have a permanently dysfunctional shoulder with decreased range of motion, which resulted in a limited ability to do things involving "lifting her arm overhead, repetitive overhead activities, reaching out in front of her, and lifting anything heavy." Her ability to perform activities of daily living however, such as sell-care, feeding, bathing and dressing, were not significantly impaired. The patient filed suit for medical malpractice against UPMC. During a jury trial, the patient presented the videotaped testimony of her expert medical witness, Dr. Kevin Speer, an orthopedic surgeon and shoulder surgery specialist. Dr. Speer opined, inter alia, that Griffin's shoulder injury was caused either by a grand real seizure (with "49%" certainty) or forcible restraint (with "51%" certainty), the latter of which would constitute negligence. On the other hand, the hospital presented the expert witness testimony of Dr. Mark Baratz, an orthopedic surgeon with additional training in shoulder, elbow, and hand surgery. Dr. Baratz opined, to a reasonable degree of medical certainty, that the shoulder injury was caused by a "classic nocturnal grand mal seizure" and not by forcible restraint as was alleged. He further opined that the patient's documented amnesia, thrashing of agitation in bed, and the specific type of shoulder injury incurred were indicative of a grand mal seizure. The jury returned a verdict against the hospital in the amount of $2,277,131.00. The hospital filed a motion for Judgment Notwithstanding the Verdict (JNOV). The trial court denied the hospital's motion and entered judgment on the verdict. The hospital appealed.

COURT'S OPINION: The Superior Court of Pennsylvania reversed the judgment entered by the trial judge on the jury verdict and remanded the case back to the trial judge ordering that the hospital's motion for JNOV be granted since the trial judge erred in denying the hospital's motion for JNOV. The court held, inter alia, that an appellate court may overrule a trial court's denial of a motion for JNOV when there is clear and convincing evidence that the trial judge erred. The court concluded that this was such a case.

LEGAL COMMENTARY: The court noted that the plaintiff's expert medical witness failed to express his opinion, however, close the call was, to a reasonable degree of medical certainty. Obviously, the plaintiff's expert's 51% to 49% margin made it sell-evident that his opinion was, under any circumstances, "a close call." JNOV can be entered upon two grounds: (1) where the movant is entitled to judgment as a matter of law; and/or (2) the evidence was such that no reasonable mind could disagree that the verdict should have been rendered for the party moving for JNOV, which in this case was the hospital. The court made it crystal clear that ordinarily appellate courts will not interfere with a trial judge's denial of a motion for JNOV. However, the court found that the evidence presented both to the trial judge and the jury made it crystal clear that no reasonable mind could come to the conclusion that the jury did in this case, and that accordingly, the trial judge should have had no recourse but to have granted the hospital's motion for JNOV. The court noted that although Dr. Speer did titter the so-called "magic words," "reasonable degree of medical certainty," cross examination shed further light on his opinion and revealed his misunderstanding of what is legally required to render an opinion to that degree. The court noted that Dr. Speer readily admitted that one of two possibilities created the shoulder injury, lie admitted that unfortunately, there was a void of evidence and/ or a lack of documentation to support either position. Further he went on to state that by a 51 to 49% margin, the possibility that the restraints placed on the patient by those attending the patient was "the more plausible" of the two theories. Dr. Speer stated that the alleged cause "could very properly account" for the injury or that it "more likely than not" caused the injury, both of which did not meet the requisite degree of medical certainty required for a plaintiff to prevail in a medical malpractice case, keeping in mind that the plaintiff has the burden of proof in all such cases. The court concluded that the plaintiff failed to meet that burden.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout die United States In addition to his writings as Editor of Medical Law's. Nursing Law's & Hospital Law's Regan Reports. his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers. Marquis Who's Who in American Law, Who's Who in America and Who's in the World.
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Article Details
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Title Annotation:Legal Focus on Hospital Law Issues
Author:Tammelleo, A. David
Publication:Hospital Law's Regan Report
Article Type:Case overview
Date:Jul 1, 2008
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