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Ferguson v. Baptist Health System2/11/2005
Robert Ferguson appeals from the order of the Jefferson Circuit Court granting a new trial to Baptist Health System, Inc. ("Baptist"), in his medical-malpractice action against it (case number 1022175). Baptist cross-appeals from the court's order denying Baptist's motion for judgment as a matter of law as to Ferguson's wantonness claim and the associated punitive-damages award (case number 1030039). We affirm in case no. 1022175 and reverse and remand with instructions in case no. 1030039.
On May 21, 1999, Ferguson, then 73 years of age, fainted while working in his garage and fell, striking his head; he experienced a period of unconsciousness. He was seen initially at the emergency room of Carraway Methodist Medical Center. He was subsequently transferred, at the request of his regular physician, Dr. Virgil McGrady, to Baptist Medical Center, Montclair, a hospital operated by Baptist ("the hospital"). After Ferguson was admitted, Dr. McGrady called in Dr. James Strong, a neurologist, for a neurological consultation. Dr. Strong and his partners, Dr. Rodney Swillie, Dr. Dallas Russell, and Dr. Kyle Hudgens, thereafter were responsible for Ferguson's neurological care.
Dr. Strong determined that Ferguson was experiencing seizure activity and on May 23 ordered that he receive intravenously a "loading dose" of one gram (1,000 milligrams) of Dilantin, an anticonvulsant medication, to be followed by the administration of 300 milligrams of Dilantin orally every night of Ferguson's hospital stay. Dr. Strong ordered that a blood test be done the morning after the loading dose had been administered to ascertain the level of Dilantin in Ferguson's blood; the test reflected a level of Dilantin in the blood of "13.1 mcg/ml," which was within the therapeutic range of 10.0-20.0.
Pursuant to Baptist's policy, the hospital pharmacy generated each day a "medication administration record" ("MAR"), which listed all of the medications prescribed for a particular patient by his treating physicians. The MAR generated for the 24-hour period following Dr. Strong's order for Dilantin accurately reflected it, as well as all of the other physicians' orders then on record for Ferguson. Dr. Strong's order, and the corresponding MAR entry, used the conventional medical shorthand of "Dilantin 300 mg po QHS" to describe the dosage, method, and time of administration.
Ferguson complained of severe back pain, and it was determined that he had experienced spinal compression fractures, although when they occurred was uncertain. He was also experiencing confusion, especially at night, and his personal history supplied by his family led Dr. McGrady to suspect that he was suffering from dementia as a result of Alzheimer's disease. His treating physicians prescribed a variety of pain medications, Valium, and, starting on May 24, the drug Risperdal, described by Dr. Hudgens in his deposition as "an atypical antipsychotic medication ... used to treat confusion, agitation in a patient."
On May 25, 1999, Ferguson was transferred to the rehabilitation unit of the hospital. For record-keeping purposes, this represented a "discharge" and a new "admission," requiring a new set of physicians' orders and resultant MARs. Dr. Hudgens entered an order on that date directing that Ferguson receive, in specified dosages at specified intervals, a number of different medications, including Risperdal, Valium, and Dilantin, the latter to be at the previously prescribed rate of 300 milligrams "po QHS." A daily MAR was generated by the pharmacy for the "administration period" May 26 at 5:01 a.m. to May 27 at 5:00 p.m. Thirteen different medications were listed for Ferguson, along with their individual dosage level
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