Supreme Court Affirms $10M Punitive Damages In Wrongful Death Case

John Dewy West, Jr. was 59 years old on June 4, 2014 when he accidently sliced most of the tip of his left thumb off when he was using a table saw in his shop. He drove himself to the emergency room of Springhill Memorial Hospital (“SMH”) where a surgeon was able to operate and save his thump up to the nail bed…, Alabama Supreme Court Affirms $10M Punitive Damages In Medical Malpractice Wrongful Death Case, Sep 2023


After the surgery, the surgeon prescribed Dilaudid, which is at least seven times more powerful than morphine and carries a risk of inducing respiratory depression, sometimes referred to as Opioid Induced Respiratory Depression (“OIRD”), or oversedation, which can be fatal.


According to the SMH Medical Administration Record (“the MAR”), at 10:00 p.m. on the night of June 4, 2014, Nurse Elenwa administered a 4-milligram dose of Dilaudid to Mr. West, as per the surgeon’s orders. Nurse Elenwa returned to Mr. West’s hospital room and administered a second 4-milligram dose of Dilaudid to Mr. West. A proper starting dose of Dilaudid is .2 milligrams to 1 milligram. It is undisputed that Nurse Elenwa administered Dilaudid to Mr. West that was equivalent to giving Mr. West 56 milligrams of morphine in a span of less than 2 hours.


The MAR states that Nurse Elenwa checked on Mr. West a half-hour later and he rated his pain level as having slightly decreased from before the administration of the second dose of the Dilaudid. Nurse Elenwa testified during her deposition that if she had given Mr. West 8 milligrams of Dilaudid in less than 2 hours it would have been “egregious and a gross violation of the standard of care.”


At 3:45 a.m. on June 5, a nurse’s aide returned to Mr. West’s room and discovered that he was not breathing and was unresponsive. The aide called Nurse Elenwa into the room. At 3:58 a.m., an emergency code was called, and an SMH code team arrived to perform CPR in an effort to resuscitate Mr. West. Those efforts failed, and Mr. West was pronounced dead at 4:25 a.m. on June 5, 2014.


The Alabama Supreme Court stated “several pieces of evidence supported the trial court’s inference that SMH attempted to cover up the mistakes that led to Mr. West’s death. We do not believe that it was inappropriate for the trial court to consider that evidence in determining the degree of reprehensibility … Only punitive damages are awarded in wrongful-death actions. Consequently, a ratio between compensatory and punitive damages is not available … the remitted award in the instant case is not an unusually large amount in comparison with awards affirmed in other wrongful-death cases, particularly in light of inflation.”


The Alabama Supreme Court further stated, “because SMH does not assert that it would be financially burdened by the amount of the remitted award of $10 million, we must conclude that SMH has the available assets and liability insurance to pay the remitted award, even though that likely would not be the case for an individual medical provider. Moreover, because one purpose of a punitive-damages award is to punish the wrongdoer, the size of the award matters in relation to the particular defendant’s financial position … it is notable that SMH has not contended that the level of services it provides to the community surrounding it would be reduced to any extent by having to pay the remitted amount of $10 million. Therefore, the goal of punishment and the factor of economic impact both weigh against further remittitur of the award.”


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