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Mobile Infirmary Mudical Center v. Hodgen10/31/2003
Mobile Infirmary Medical Center appeals from the trial court's judgment, entered on a jury verdict, in favor of James Hodgen. We affirm conditionally.
Facts and Procedural History
In February 2000, 58-year-old James Hodgen was a patient in the intensive care unit of the Mobile Infirmary Medical Center recovering from cardiac bypass surgery. Hodgen's recovery progressed normally until he began to develop cardiac arrhythmia, or abnormal heart rhythms, two days after the surgery. The Mobile Infirmary employee overseeing Hodgen's care, Dawn Byrd, a recent nursing school graduate, informed a supervising nurse, Tammy Espiritu, that Hodgen was experiencing arrhythmia. Espiritu instructed Byrd to telephone Hodgen's cardiologist, Dr. Chris Brown. When Byrd telephoned Dr. Brown and advised him of Hodgen's condition, Dr. Brown prescribed .25 milligrams of digoxin. Byrd mistakenly informed Espiritu that Dr. Brown had prescribed 1.25 milligrams of digoxin, and Espiritu telephoned the order to the pharmacy.
Espiritu, believing that Hodgen's condition was worsening, told Byrd not to wait for the pharmacy to deliver the medication. Instead, Espiritu instructed Byrd to obtain the digoxin from the stock of medicine maintained in the intensive care unit and to administer it to Hodgen. Without supervision from Espiritu, Byrd obtained three vials, or ampules, of digoxin and emptied at least two and a half of the vials directly into Hodgen's intravenous tube. Shortly after Byrd had administered the digoxin to Hodgen, the pharmacy called Espiritu, questioning the amount of digoxin she had ordered. It was then that Byrd and Espiritu realized that Byrd had administered to Hodgen five times the amount of digoxin Dr. Brown had actually prescribed.
When Hodgen began to experience complications the next evening resulting from digoxin toxicity, he was administered Digibind, an antidote for digoxin toxicity. After the Digibind was administered, Hodgen's heart stopped beating and one of the nurses began to "mechanically pace his heart." Hodgen's blood pressure then dropped to a very low level and the oxygen-saturation level in his blood became extremely low. Hodgen stopped breathing, and the hospital staff began CPR and other forms of intervention to revive Hodgen. Hodgen was revived, but he suffered damage to various organs as a result of severe oxygen deprivation. Hodgen later underwent surgery to remove a portion of his intestines and to amputate his right leg. Hodgen is now unable to walk, must use a colostomy bag, and claims that his mental capacity is diminished.
On January 29, 2001, Hodgen sued Mobile Infirmary in the Mobile Circuit Court under the Alabama Medical Liability Act, ยง 6-5-480 et seq., Ala. Code 1975 (hereinafter referred to as the "AMLA"). Specifically, Hodgen alleged that Mobile Infirmary had been negligent and/or wanton in administering the digoxin and in supervising its employees. James's wife, Judy Hodgen, also sued Mobile Infirmary, stating a derivative claim alleging loss of consortium. The Hodgens sought both compensatory and punitive damages. The case went to trial in April 2002.
The evidence at trial indicated that Byrd, although assigned to care for various patients in the intensive care unit at Mobile Infirmary, was not a licensed nurse. She was a recent graduate of nursing school and, when she administered the digoxin overdose to Hodgen, she had taken but had not yet received the results from her nursing board examination. The supervising nurse that evening, Espiritu, had passed her nursing board examination only seven months before the overdose was administered and had never worked with Byrd before that occasion. Additionally, the charg
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