Cromer v. Children's Hosp. Med. Ctr. of Akron

[Cite as Cromer v. Children's Hosp. Med. Ctr. of Akron, 2016-Ohio-7461.]
STATE OF OHIO ) IN THE COURT OF APPEALS
)ss: NINTH JUDICIAL DISTRICT
COUNTY OF SUMMIT )
SETH NILES CROMER, MINOR CHILD, C.A. No. 25632
DECEASED, et al.
Appellants
APPEAL FROM JUDGMENT
v. ENTERED IN THE
COURT OF COMMON PLEAS
CHILDREN'S HOSPITAL MEDICAL COUNTY OF SUMMIT, OHIO
CENTER OF AKRON CASE No. CV 2008 07 4775
Appellee
DECISION AND JOURNAL ENTRY
Dated: October 26, 2016
CARR, Judge.
{¶1} Appellants, Melinda Cromer, individually; and Roderick Cromer, Jr., individually
and on behalf of their late son Seth; appeal from a judgment entered on a jury verdict for
Children’s Hospital Medical Center of Akron (“the hospital”) on the Cromers’ medical
malpractice claim against it. This Court originally reversed the judgment for the hospital
because the trial court incorrectly instructed the jury about the hospital’s standard of care.
Cromer v. Children's Hosp. Med. Ctr. of Akron, 9th Dist. Summit No. 25632, 2012-Ohio-5154.
The Ohio Supreme Court reversed that judgment, however, reasoning that the record failed to
demonstrate that the Cromers suffered material prejudice from the improper instruction. Cromer
v. Children's Hosp. Med. Ctr. of Akron, 142 Ohio St.3d 257, 2015-Ohio-229, ¶ 45. Therefore, it
reversed this Court’s judgment and remanded the matter for this Court to address the Cromers’
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remaining two assignments of error. Id. at ¶ 46. Upon review of those assignments of error, this
Court reverses and remands the trial court’s judgment for a new trial.
I.
{¶2} The facts underlying this medical malpractice case, which were recited in more
detail in the decision of the Ohio Supreme Court and this Court’s original opinion, involve the
death of five-year-old Seth Cromer while he was a patient at the hospital. Seth’s parents brought
him to the hospital on the evening of January 13, 2007, because, although he had been taking
antibiotics for several days for an ear infection, his physical condition had worsened. Seth was
assessed by a triage nurse and later moved to an examination room, where a doctor concluded
that he was in shock. Seth was moved to another exam room that was closer to the nurses’
station and had more equipment to monitor his vital signs.
{¶3} The doctor ordered the nursing staff to give Seth normal saline fluids
intravenously. The evidence was not disputed, however, that a hospital nurse mistakenly gave
Seth D5 ½ normal saline, which was not the correct or optimal fluid to treat his dehydration.
When the emergency room doctor realized that Seth was receiving the wrong type of saline
solution, he immediately ordered that the IV bag be switched to the correct fluid and ensured that
Seth began receiving normal saline solution. The parties would later dispute, however, how
much of the D5 ½ saline solution Seth received and what, if any, negative impact it had on his
condition.
{¶4} Seth also received epinephrine intravenously while in the emergency room, and
the parties would also later dispute whether the epinephrine helped or harmed his condition.
Although Seth initially appeared to show signs of improvement because he became more alert,
the doctor later realized that Seth’s body was attempting to compensate for the shock and his
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physical condition was actually declining. Consequently, the emergency room doctor ordered
that Seth be transferred to the pediatric intensive care unit (“PICU”).
{¶5} Shortly after Seth arrived in the PICU, the critical care doctor determined that he
would probably need to be intubated and placed on a ventilator to decrease the carbon dioxide
levels in his blood. The doctor first placed a central venous line to continue administering
epinephrine and other medications, if needed. The doctor then placed an arterial line to draw
blood for testing, which revealed that Seth was suffering from significant acidosis. Next, the
doctor intubated Seth and ordered an echocardiogram. During the echocardiogram procedure,
Seth went into cardiac arrest. Cardiopulmonary resuscitation was unsuccessful and Seth was
pronounced dead at 4:05 a.m.
{¶6} The Cromers filed this medical malpractice action against the hospital and several
individual defendants. The individual defendants were later dismissed and the case proceeded to
trial against the hospital. Although all the experts agreed that Seth died from coronary failure,
they disputed whether his heart failure was caused by an unknown, pre-existing heart defect or
the hospital’s failure to properly treat septic shock that had developed from Seth’s viral infection.
{¶7} According to the results of Seth’s autopsy, he died of heart failure that was the
combined result of a pre-existing narrowing of his left coronary artery and a viral infection that
had spread to his heart. The hospital’s experts testified that a pre-existing heart problem caused
Seth’s acidosis and eventual death and that there was nothing more that the treating physicians
and hospital staff could have done to save his life.
{¶8} The Cromers’ medical expert testified, however, that a pre-existing heart
condition was not the cause of Seth’s death. Instead, the Cromers’ expert opined that Seth died
because the hospital failed to appropriately treat him, so his septic shock progressed to severe
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cardiac and respiratory failure. She testified that the hospital departed from the standard of care
by not intubating Seth sooner, by not assessing him and giving him intravenous fluids sooner,
and by giving him the wrong intravenous fluids.
{¶9} After the presentation of evidence, the trial court submitted written interrogatories
and general verdict forms to the jury. In response to the first interrogatory about whether the
plaintiffs had proven that the hospital was negligent, the jury answered, “no.” Although the trial
court had instructed the jury not to answer the remaining interrogatories if it found that the
hospital was not negligent, it responded, “no” to an additional interrogatory about whether the
hospital’s negligence had caused Seth’s death. The jury also returned a general verdict for the
hospital. The trial court accepted the jury’s verdict and entered judgment for the hospital.
{¶10} The Cromers later moved for a new trial, asserting that the judgment was against
the manifest weight of the evidence and that the jury interrogatories were inconsistent, but the
trial court denied their motion. The Cromers appealed and raised three assignments of error.
Because this Court originally sustained their first assignment of error, it did not reach the merits
of their remaining assignments of error because they had been rendered moot. Following the
reversal and remand by the Ohio Supreme Court, this Court now reviews the Cromers’ second
and third assignments of error.
II.
APPELLANTS’ ASSIGNMENT OF ERROR II
THE JURY’S VERDICT IN THIS MATTER WAS AGAINST THE MANIFEST
WEIGHT OF THE EVIDENCE.
APPELLANTS’ ASSIGNMENT OF ERROR III
THE COURT ERRED IN FAILING TO GRANT APPELLANTS’ MOTION
FOR A NEW TRIAL.
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{¶11} The Cromers’ second assignment of error is that the jury’s verdict was against the
manifest weight of the evidence. Because that argument is also raised through their third
assignment of error, this Court will address them together. The Cromers’ third assignment of
error is that the trial court erred in failing to grant a new trial because the jury’s answers to the
special interrogatories were inconsistent and/or because the jury’s verdict was against the weight
of the evidence. This Court will confine its review to the Cromers’ manifest weight argument
because it is dispositive.
Manifest Weight Standard of Review
{¶12} We begin by clarifying the standard under which we review this assignment of
error. The parties argue this assigned error under the civil manifest weight standard as set forth
in C.E. Morris Co. v. Foley Constr. Co., 54 Ohio St.2d 279 (1978), but the Ohio Supreme Court
has since explained that the “competent, credible evidence” standard applies to a challenge to the
sufficiency of the evidence supporting a verdict, not the manifest weight. In Eastley v. Volkman,
132 Ohio St.3d 328, 2012-Ohio-2179, ¶ 17, the Court held that the standard of review set forth in
State v. Thompkins, 78 Ohio St.3d 380, 387 (1997), applies in civil as well as criminal cases. In
assessing whether a jury’s verdict is against the manifest weight of the evidence, this Court
examines the entire record, “‘weighs the evidence and all reasonable inferences, considers the
credibility of witnesses, and determines whether in resolving conflicts in the evidence, the jury
clearly lost its way and created such a manifest miscarriage of justice that the [verdict] must be
reversed and a new trial ordered.’” Thompkins at 387, quoting State v. Martin, 20 Ohio App.3d
172, 175 (1st Dist.1983). In other words, we review the verdict to determine whether the jury
lost its way in concluding that “the greater amount of credible evidence, offered in a trial,
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[supported] one side of the issue rather than the other.” (Emphasis in original.) Thompkins at
387.
The Verdict
{¶13} The verdict in this case was a general verdict for the hospital on the Cromers’
medical malpractice action against it. The parties disagree, however, about whether the general
defense verdict represents judgment for the hospital on all of the elements of the Cromers’
malpractice claim or only on the issue of negligence (duty and breach). The hospital focuses its
argument on whether the Cromers proved that a breach of duty by the hospital caused Seth’s
death, implicitly arguing that the jury did not lose its way in entering a verdict for the hospital on
all of the determinative issues (duty, breach, causation, and damages). On the other hand, the
Cromers assert that the jury’s verdict for the hospital was based solely on its finding that the
hospital did not breach a duty of care to Seth Cromer. Consequently, because the jury did not
reach the issue of causation, the Cromers assert that the “verdict” upon which this manifest
weight review must focus is the jury’s finding that the hospital breached no duty to Seth. This
Court agrees.
{¶14} If the jury’s verdict had not been tested by special interrogatories, this Court’s
manifest weight review would necessarily be confined to the jury’s ultimate verdict on all of the
determinative issues, including causation. See, e.g., Mid-Ohio Mechanical, Inc. v. Eisenmann
Corp., 5th Dist. Guernsey Nos. 07 CA 000035 and 08 CA 00012, 2009-Ohio-5804, ¶ 78, citing
Bobb Forest Prods., Inc. v. Morbark Industries, Inc., 151 Ohio App.3d 63, 2002-Ohio-5370, ¶
64 (7th Dist.). In this case, however, the jury’s verdict was tested by special interrogatories,
which enables a reviewing court to conduct a more pinpointed review of the jury’s factual
findings. “The essential purpose to be served by interrogatories is to test the correctness of a
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general verdict by eliciting from the jury its assessment of the determinative issues presented by
a given controversy in the context of evidence presented at trial.” Cincinnati Riverfront
Coliseum, Inc. v. McNulty, Co., 28 Ohio St.3d 333, 336-337 (1986).
{¶15} In Miller v. McAllister, 169 Ohio St. 487, 494 (1959), the Ohio Supreme Court
defined “determinative issues” as “ultimate issues which when decided will definitely settle the
entire controversy between or among the parties, so as to leave nothing for the court to do but to
enter judgment for the party or parties in whose favor such determinative issues have been
resolved by the jury.” In this medical malpractice action, the determinative issues included
negligence, proximate cause, and damages. See Richley v. Liechty, 44 Ohio App.2d 359, 363 (3d
Dist.1975), citing Miller; Stant v. Lin, 3d Dist. Allen No. 1-01-90, 2002 WL 396527, *2 (Mar.
13, 2002). Because the jury was asked to complete special interrogatories pertaining to the
determinative issues of negligence, causation, and damages, this Court’s review of the weight of
the evidence is “confined to those determinative issues on which the jury rest[ed] its verdict and
not on whether the evidence could support the same general verdict had the jury made other
findings on the determinative issues.” Seeley v. Rahe, 3d Dist. Hancock No. 5-83-8, 1983 WL
4544, *5 (Dec. 21, 1983), aff'd, 16 Ohio St.3d 25 (1985). See also Wheatley v. Howard Hanna
Real Estate Servs., 9th Dist. Lorain No. 13CA010505, 2015-Ohio-2196, ¶ 14.
{¶16} The special interrogatories in this case reveal that the jury entered a general
verdict for the hospital based on its finding on the first determinative issue of negligence.
Because it found that the hospital did not breach any duty of care to Seth, the jury did not
proceed to weigh the evidence on the remaining determinative issues of causation and damages.
{¶17} Although the hospital points to the fact that the jury answered the third
interrogatory pertaining to causation, as the Ohio Supreme Court noted, that interrogatory answer
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was of no significance because the jury had been instructed not to answer it and the issue of
causation had been “mooted” by the jury’s finding on the determinative issue that the hospital
was not negligent. Cromer, 2015-Ohio-229, at ¶ 42. In other words, given the jury’s written
finding that there had been no negligence by the hospital, it could not plausibly find that the
hospital’s negligence had caused Seth’s death.
{¶18} Consequently, this Court’s review of whether the judgment for the hospital is
against the manifest weight of the evidence is confined to the jury’s finding on the first
determinative issue that the Cromers failed to prove that the hospital breached its standard of
care to Seth.
Review of the Evidence
{¶19} As to the hospital’s alleged breach of duty to Seth, the Cromers presented expert
testimony that hospital employees had departed from the standard of care in several respects: by
not assessing Seth and treating him with intravenous fluids sooner; by initially giving Seth the
wrong IV saline solution; and by not intubating him sooner. On appeal and through their motion
for a new trial, the Cromers have asserted that they presented undisputed evidence that a nurse
breached her standard of care by giving Seth the wrong IV fluids.
{¶20} In reviewing the evidence pertaining to this alleged aspect of the hospital’s
negligence, we begin by emphasizing that the parties do not dispute the facts pertaining to this
issue. Although the parties presented conflicting evidence about some of the facts preceding
Seth’s death, the evidence was not disputed that the emergency room doctor ordered that Seth be
given normal saline solution intravenously, but a nurse mistakenly administered D5 ½ normal
saline solution instead.
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{¶21} The sole dispute between the parties is whether the jury was required to find that
the nurse’s act of giving Seth the wrong saline solution constituted a breach of her standard of
care. The trial court instructed the jury about a nurse’s standard of care, in relevant part:
A nurse commits malpractice when she fails to exercise that degree of skill and
knowledge normally applied by members of that profession in similar
circumstances.
If you find by the greater weight of the evidence that defendant by and through its
employees, the nurses, failed to meet the standard of care, then you shall find the
defendant was negligent.
{¶22} The Cromers contend that they presented undisputed evidence that the nurse’s act
of giving Seth the wrong IV fluids constituted a breach of her standard of care and, for that
reason, the jury lost its way by finding that the hospital was not negligent. In denying the
Cromers’ motion for new trial on this basis, the trial court rejected this argument and concluded
that the hospital had presented “substantial evidence” that the nurse did not breach her standard
of care by administering the wrong saline solution to Seth. The hospital also argues that it
presented evidence to contradict the Cromer’s evidence that the nurse breached her standard of
care in this regard.
{¶23} This Court’s review of the record failed to reveal any evidence to dispute or
undermine the credibility of the opinion of the Cromers’ medical expert that the nurse’s act of
failing to follow a doctor’s orders and instead giving Seth the wrong saline solution constituted a
departure from the standard of care. No one questioned the credibility of that expert opinion
either through cross-examination of the Cromers’ expert or through the testimony of another
witness. Although some of the hospital’s witnesses did not directly concede that the nurse had
been negligent, none of them testified that her act of disobeying a doctor’s orders and/or
administering the wrong saline solution to Seth fell within her standard of care.
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{¶24} The emergency room doctor testified that he ordered that normal saline solution
be administered to Seth because “it is generally understood that we use normal saline [to treat
dehydration].” He further testified that he did not order D5 ½ saline and that he would not have
authorized that fluid because it was not the optimal fluid to treat Seth. The nurse herself testified
that she had attempted to follow the doctor’s order and thought that the IV bag that she grabbed
“said normal saline.” She conceded that she had made a “mistake” by administering the wrong
saline solution to Seth. Other defense witnesses similarly characterized her action as an “error”
or a “mistake.”
{¶25} One of the hospital’s medical experts described D5 ½ saline solution as the
“second fluid,” explaining that it is not used as the first fluid to treat dehydrated patients but is
used as a maintenance fluid after the patient is rehydrated with normal saline. He later conceded
that a nurse giving a patient the wrong fluid was a “medical error” because it was not what the
doctor ordered. He further agreed that a nurse giving a patient the wrong medication is a
departure from the standard of care.
{¶26} Given that the expert testimony on this issue was not contradicted by other
evidence, nor was the credibility of the expert’s opinion challenged in any other manner, the jury
was not free to simply disregard it. Although the trier of fact may sometimes reject the opinion
testimony of an expert witness, there must be reason for it to do so. The trier of fact cannot
“weigh” witness testimony and assess its “credibility,” unless there are conflicts in the evidence
or questions of credibility to be resolved. See Thompkins at 387, citing Martin at 175. For
example, the trier of fact may reject an expert’s opinion based on the contradictory opinion
testimony of another expert or the expert’s own concessions during cross-examination that
question the credibility of his opinion. See, e.g., State ex rel. Unger v. Indus. Comm., 70 Ohio
11St.3d 672, 676 (1994); State v. Pierce, 64 Ohio St.3d 490, 500-501 (1992). The trier of fact
“may not disregard credible and uncontradicted expert testimony[.]” State v. White, 118 Ohio
St.3d 12, 2008-Ohio-1623, ¶ 74.
{¶27} Therefore, because the jury heard undisputed, credible expert opinion testimony
that the nurse giving Seth the wrong saline solution was a departure from her standard of care, it
lost its way in finding that the Cromers failed to prove that the hospital breached its duty of care
to Seth. The Cromers’ second assignment of error is sustained and their third assignment of
error is sustained insofar as it asserts that the jury’s verdict was against the manifest weight of
the evidence.
III.
{¶28} The Cromers’ second and third assignments of error are sustained to the extent
that they challenge the evidence supporting the trial court’s judgment. The judgment of the
Summit County Court of Common Pleas is reversed and the cause remanded for a new trial.
Judgment reversed and
the cause remanded.
There were reasonable grounds for this appeal.
We order that a special mandate issue out of this Court, directing the Court of Common
Pleas, County of Summit, State of Ohio, to carry this judgment into execution. A certified copy
of this journal entry shall constitute the mandate, pursuant to App.R. 27.
Immediately upon the filing hereof, this document shall constitute the journal entry of
judgment, and it shall be file stamped by the Clerk of the Court of Appeals at which time the
period for review shall begin to run. App.R. 22(C). The Clerk of the Court of Appeals is
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instructed to mail a notice of entry of this judgment to the parties and to make a notation of the
mailing in the docket, pursuant to App.R. 30.
Costs taxed to Appellee.
DONNA J. CARR
FOR THE COURT
MOORE, J.
CONCURS.
HENSAL, P. J.
DISSENTING.
{¶29} I do not agree that the verdict in this case is against the manifest weight of the
evidence. Even if I accept the majority’s position that the jury was required to believe
undisputed expert testimony that a nurse breached her duty by giving Seth the wrong IV fluids, it
is the jury’s “verdict” and the trial court’s ultimate “judgment” that is the focus of our manifest
weight review, not the jury’s finding on a single element of the claim. This Court must consider
the verdict as a whole to determine whether evidence on every element (duty, breach, causation,
and damages) met the burden of persuasion. See Eastley v. Volkman, 132 Ohio St.3d 328, 2012-
Ohio-2179, ¶ 19. “The issue then facing this Court is not whether the evidence supported the
jury’s interrogatory answers, but whether the evidence supported the judgment in favor of the
[hospital].” Heise v. Orra, 8th Dist. Cuyahoga No. 66172, 1995 WL 79794, *2 (Feb. 23, 1995).
{¶30} Notably, the Cromers do not point to undisputed evidence about any other aspect
of this case and there was no expert testimony that a nurse giving Seth the wrong IV fluids
caused his death. Instead, the Cromers’ expert opined that Seth’s death had been caused by
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several errors made by hospital employees in the timing of his treatment. There were disputes in
both the factual and expert testimony about whether the hospital breached its standard of care by
not treating Seth sooner with IV fluids and/or intubation. Moreover, the experts sharply disputed
whether any of those potential breaches of care caused Seth’s death. Therefore, the Cromers
failed to demonstrate that the jury lost its way by entering a general verdict for the hospital on
their medical malpractice claim against it.
{¶31} Because I do not agree that the verdict should be reversed on that basis, I would
proceed to address the Cromers’ argument that the trial court also erred in denying their motion
for a new trial based on the jury’s interrogatory answers. The Cromers asserted that the jury
interrogatory answers were inconsistent because, after answering “no” to the first interrogatory
about whether the hospital was negligent, despite the trial court’s instructions not to answer the
remaining interrogatories, the jury completed the third interrogatory and responded that the
Cromers had failed to prove that the hospital’s negligence caused Seth’s death.
{¶32} Although the Cromers raised this issue in their motion for new trial, they raised
no objection before the verdict was accepted and the jury was dismissed. Consequently, they
forfeited all but plain error. Gamble v. Summit Cty. Dept. of Jobs and Family Servs., Inc., 9th
Dist. Summit No. 21450, 2004-Ohio-193, ¶ 7. The Cromers have failed to argue or demonstrate
plain error. In fact, they have failed to demonstrate any error.
{¶33} A party challenging a general verdict must show that the “special findings, when
considered together, are inconsistent and irreconcilable with the general verdict.” Becker v.
BancOhio Nat. Bank, 17 Ohio St.3d 158, 163 (1985), quoting Prendergast v. Ginsburg, 119
Ohio St. 360 (1928), paragraph one of the syllabus. The jury found no negligence, no causation,
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and entered a general verdict for the hospital, all of which were consistent. See Turner v. Elk &
Elk, L.P.A., 8th Dist. Cuyahoga No. 96271, 2011-Ohio-5499, ¶ 66.
{¶34} For these reasons, I would overrule the Cromers’ remaining assignments of error
and affirm the judgment of the trial court. Therefore, I respectfully dissent.
APPEARANCES:
JACK MORRISON, JR., THOMAS R. HOULIHAN, and VICKI L. DESANTIS, Attorneys at
Law, for Appellants.
GREGORY R. ROSSI and GREGG A. PEUGEOT, Attorneys at Law, for Appellee.