Shirley Langley, Et Ux. v. American Legion Hospital

NOT DESIGNATED FOR PUBLICATION

STATE OF LOUISIANA
COURT OF APPEAL, THIRD CIRCUIT

11-1521

SHIRLEY LANGLEY, ET UX.

VERSUS

AMERICAN LEGION HOSPITAL

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APPEAL FROM THE
FIFTEENTH JUDICIAL DISTRICT COURT
PARISH OF ACADIA, NO. 209-10573
HONORABLE DURWOOD WAYNE CONQUE, DISTRICT JUDGE

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ELIZABETH A. PICKETT
JUDGE

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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

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$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

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The Langleys did not introduce evidence regarding their medical expenses; therefore, no
award was made for those expenses.
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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

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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

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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

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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

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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

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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.

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