Court of Appeals of Missouri, Eastern District, Fourth Division
SHERRY L. HUELSKAMP, Respondent,
PATIENTS FIRST HEALTH CARE, LLC, Appellant
[Copyrighted Material Omitted]
Appeal from the Circuit Court of Franklin County. 10AB-CC00346. Honorable Stanley D. Williams.
FOR APPELLANT: Theodore D. Agniel, Kevin F. O'Malley, St. Louis, MO.
FOR RESPONDENT: Jamie L. Boock, St. Louis, MO.
Roy L. Richter, P.J., and Lisa S. Van Amburg, J., concur.
ROBERT M. CLAYTON III,
Patients First Health Care, LLC (" Defendant" ) appeals the judgment entered upon a jury verdict awarding Sherry L. Huelskamp (" Plaintiff" ) $525,000 on her medical malpractice claim arising out of medical care provided to Plaintiff by Barbara King (" Nurse King" ), a family practice nurse practitioner employed by Defendant. We affirm.
A. Evidence Adduced at Trial
The following evidence was adduced at the jury trial on Plaintiff's medical malpractice claim.
1. Plaintiff's Treatment with Nurse Neubauer
On November 7, 2008, Plaintiff saw psychiatric nurse practitioner Cathy Neubauer (" Nurse Neubauer" ) for depression. On that same date, Nurse Neubauer prescribed an anti-depressant, Lamictal, to Plaintiff. Nurse Neubauer testified that on November 7, 2008 she told Plaintiff the Lamictal could cause a rash and that if Plaintiff developed a rash she should discontinue the Lamictal and call Nurse Neubauer. Nurse Neubauer also testified she repeated this information to Plaintiff on November 21, 2008 when the medication was refilled. Plaintiff testified at trial she did not remember Nurse Neubauer giving her any warnings about taking Lamictal.
2. Plaintiff's Treatment with Nurse King and Plaintiff's Subsequent Injuries
Plaintiff began treatment with Nurse King, a family nurse practitioner employed by Defendant, in October 2007. On November 13, 2008, Plaintiff saw Nurse King for high blood pressure, and Plaintiff's
medication list indicated she was taking Lamictal. Nurse King admitted she was aware on November 13 that Plaintiff had been prescribed Lamictal.
On November 24, 2008, Plaintiff saw Nurse King for complaints of body aches, and Nurse King prescribed an antibiotic, Amoxicillin, to Plaintiff. Nurse King admitted she was again aware that Plaintiff was taking Lamictal. However, Nurse King did not perform any further research on Lamictal at that time despite having medical resources available to do so. Additionally, Nurse King did not research the side effects of Lamictal or whether it contained any " black box" warnings regarding its use. Nurse King testified it was part of her job to look up medications that she was not familiar with and that she had done so in the past. There was testimony at trial that had Nurse King reviewed the side effects of Lamictal, she would have seen Lamictal contained a black box warning which specifically cautioned of the dangers of a serious rash and the development of Stevens Johnson Syndrome and which instructed health care providers to tell patients to discontinue Lamictal upon the first signs of a rash.
On December 4, 2008, Plaintiff called Nurse King's office with complaints of a rash, and Nurse King agreed to treat Plaintiff's rash. Nurse King concluded the rash was medication related and reviewed Plaintiff's medication list in evaluating the cause of the rash. Nurse King testified she was aware on December 4 that Plaintiff was taking Lamictal but did not know of the drug's potential side effects or that it carried a black box warning regarding serious rashes. Nurse King admitted she did nothing to learn any of the side effects of Lamictal. Nurse King opined she was only responsible for knowing the side effects of medication she prescribed for her patients as opposed to the side effects of medications her patients were taking that were prescribed by other health providers. It is undisputed that Nurse King did not instruct Plaintiff to discontinue the Lamictal on December 4. It is also undisputed that Nurse King did not instruct Plaintiff to call Nurse Neubauer to inquire as to whether she should continue taking the Lamictal. Instead, on December 4, Nurse King concluded Plaintiff's rash was related to her Amoxicillin prescription and instructed Plaintiff to discontinue the medication and take Benadryl. Plaintiff testified she complied with Nurse King's instruction to stop taking the Amoxicillin.
Six days after Plaintiff discontinued taking Amoxicillin, on December 10, 2008, Plaintiff called Nurse King again with continued complaints of a rash. Plaintiff was seen in the office and Nurse King examined the rash. Nurse King admitted that at that time she did not do anything to investigate other medications as potential causes of the rash. Instead, Nurse King prescribed a Medrol Dosepak and told Plaintiff to update her in two days. Nurse King's notes from December 10 indicate Plaintiff was still taking Lamictal. Nurse King testified she did not tell Plaintiff to stop taking the Lamictal on December 10 or to follow up with Nurse Neubauer at that time.
Plaintiff saw Nurse King again on December 12, 2008. Nurse King examined Plaintiff and it appeared the rash had progressively gotten worse from December 4, 2008 until December 12, 2008. Nurse King did not instruct Plaintiff to stop the Lamictal on this date or instruct Plaintiff
contact Nurse Neubauer. Instead, Nurse King recommended Plaintiff see a dermatologist, Dr. Jason Reinberg, and Plaintiff saw him that same day. Dr. Reinberg noted Plaintiff was still taking Lamictal and ordered her to discontinue the Lamictal because of the relationship between the drug and rashes. Plaintiff testified she stopped taking the Lamictal on December 12, 2008 in accordance with Dr. Reinberg's instructions.
On December 14, 2008, Plaintiff went to the hospital and was diagnosed with Stevens Johnson Syndrome, a very serious and potentially deadly disease involving a rash and blistering of the skin and mucous membranes. Plaintiff was later diagnosed with Toxic Epidermal Necrolysis, and she was admitted to the hospital where she remained a patient for approximately three weeks. During this time, Plaintiff's skin turned black as the Toxic Epidermal Necrolysis spread to involve ninety-eight percent of Plaintiff's body. As a result of the disease, Plaintiff incurred medical bills, lost wages, and sustained pain and suffering.
B. Relevant Procedural Posture
Plaintiff filed a medical malpractice claim against Defendant arising out of medical care provided to Plaintiff by Nurse King, and a jury trial took place from July 29, 2013 to August 1, 2013. After the close of Plaintiff's evidence, Defendant filed a motion for a directed verdict alleging Plaintiff failed to make a submissible case, which the trial court denied.
After the close of Defendant's evidence, Plaintiff requested leave to present rebuttal testimony. The trial court overruled Defendant's objection to the testimony and allowed Plaintiff to testify. Plaintiff testified during rebuttal that, (1) if Nurse King had instructed her to discontinue the Lamictal on December 4, 2008, she would have stopped taking the medication; (2) if Nurse King would have instructed Plaintiff to contact Nurse Neubauer on December 4, 2008, she would have called Nurse Neubauer; and (3) if Nurse Neubauer would have instructed Plaintiff to discontinue taking the Lamictal on December 4, 2008, she would have stopped taking the medication.
After the close of all the evidence, Defendant filed a second motion for a directed verdict alleging Plaintiff failed to make a submissible case, which the trial court denied. During the instruction conference, Plaintiff offered Instruction No. 7, which stated:
Your verdict must be for plaintiff and against defendant Patients First Health Care, LLC if you believe:
First, Nurse Practitioner Barbara King either:
Failed to instruct plaintiff to discontinue Lamictal on December 4, 2008; or
Failed on December 4, 2008 to instruct plaintiff to contact the health care provider who had prescribed Lamictal to her to inquire as to whether she should continue taking the medication; and
Second, Nurse Practitioner Barbara King in any one or more of the respects submitted in paragraph First, was thereby negligent; and
Third, such negligence directly caused or directly contributed to cause damage to plaintiff.
Defendant objected to Instruction No. 7 but did not offer an alternate instruction. The trial court overruled Defendant's objection
and allowed Instruction No. 7 to be submitted to the jury. Defendant did not offer a comparative fault instruction and the issue of comparative fault was not submitted to the jury.
The jury subsequently entered a verdict awarding Plaintiff $525,000 on her medical malpractice claim, and the trial court entered a judgment in accordance with the jury's verdict. Defendant filed a motion for judgment notwithstanding the verdict (" JNOV" ) and a motion ...