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Akers v. Miller

12/28/1998



Appeal from a judgment of the Superior Court of Orange County, Byron K. McMillan, Judge. (Retired Judge of the Orange Superior Court, assigned by the Chief Justice pursuant to Cal. Const., art. VI, § 6.) Affirmed.


This single-issue appeal challenges the court's refusal, in an elder abuse case against a nursing home physician, to admit photographs of an 89-year-old woman taken several days after she died. The plaintiff offered the photographs to show the condition of a severe bedsore.


There was no abuse of discretion by the trial court. The jury heard extensive testimony regarding the size and condition of the bedsore and how bedsores should be treated. The defense relied on expert testimony that the bedsore was the unavoidable result of decedent's poor physical condition and could not have been prevented even with reasonable medical care. The photographs had no bearing on this central issue, and it is improbable that their admission or exclusion would have affected the verdict.


I.


Frances Doherty, born in 1902, suffered from the weaknesses of the elderly and multiple medical problems. By her 88th birthday, she was unable to eat, drink, or turn herself in bed, and had a catheter to drain her urine. Chronically bedridden and unable to communicate, she suffered from multiple bedsores and was moved back and forth from hospitals to nursing homes.


The decedent was hospitalized in the spring of 1991, and her relatives were told "that she probably would not last." Although she was subsequently discharged, her condition remained so grave that no Orange County nursing facility would accept her. Among other things, she had a large stage IV (the worst level) decubitus ulcer (bedsore) in the sacral coccyx area that was "responding slowly to treatment."


Doherty's daughter, plaintiff Patricia Akers, finally arranged to have her mother transferred in May 1991 to South Bay Nursing Center, a 192-bed skilled nursing center located near Long Beach. The stage IV bedsore was noted on the admission form.


Defendant Gerald Miller was South Bay's medical director. As Doherty's treating physician, he ordered her placed on an air fluidized bed to manage her bedsore.


Doherty remained at South Bay until February 1992, when she was hospitalized for pneumonia at Woodruff, an acute care facility. She spent 14 of her last 19 days at Woodruff, unable to move and fed through a tube. She died on February 24, the same day she was transferred from Woodruff back to South Bay.


Akers arranged for a private autopsy two days after the death. The pathologist determined the cause of death to be congestive heart failure. He noted a large decubitus ulcer in the mid-sacral area, about three and one-half inches in diameter, which penetrated to the bone.


Akers, as Doherty's sole surviving heir, sued South Bay, Woodruff, and Miller for medical malpractice. She also sought enhanced damages for attorney fees and for her mother's pain and suffering under California's elder abuse laws, which allow recovery against persons who maliciously or recklessly fail to provide reasonable medical care for an elderly or abused person under their care or custody. (Welf. & Inst. Code, §§ 15610.57, 15657; ARA Living Centers - Pacific, Inc. v. Superior Court (1993) 18 Cal.App.4th 1556.)


Plaintiff called the pathologist as a trial witness and sought to introduce evidence of Polaroid photographs he took of the bedsore during the autopsy. The defense moved to exclude them on the ground of undue prejudice because tissue "markedly deteriorates" following death. The court determined the prejudicial impact of the photographs outw

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