The Texas Supreme Court issued a long-awaited opinion today regarding periodic payments in medical malpractice cases. The case is styled Columbia Valley Healthcare System, L.P. d/b/a Valley Regional Medical Center v. A.M.A., a minor; No. 20-0681. You can read the opinion here.
The opinion presents a mixed bag for victims of medical malpractice.
The underlying case
This case arose from tragic injuries related to poor nursing communication by labor and delivery nurses at Valley Regional Medical Center.
A mom presented to the hospital for premature labor after her water broke (membranes spontaneously ruptured) at 33 weeks into her pregnancy. The obstetrician (OB/GYN) instructed the nurses to monitor the fetal heart rate. The mom and baby were connected to electronic fetal monitoring, which showed drops in the fetal heart rate for 2 minutes, 20 minutes later a drop for 7 seven minutes, and then the fetal heart rate dropped so low it was undetectable 20 minutes later.
Shockingly, the nurses waited for 20 minutes after the unborn baby’s heart rate was undetectable before calling the OB.
The OB arrived at the hospital in less than 20 minutes. By the time the baby was delivered, the OB/GYN saw that the umbilical cord was tightly wrapped around the baby’s neck. The baby had suffered a loss of oxygen and was diagnosed with cerebral palsy.
At trial in the medical malpractice case, the jury awarded over $10.3 million to the plaintiffs, with over $9 million allocated to future health care expenses.
Future health care expenses
I’ve written a lot about the comprehensive Texas tort reform laws that apply uniquely to medical malpractice claims. Not surprisingly, there is a special provision that applies to how future health care expenses are paid out after a jury verdict in favor of the plaintiff.
Texas Civil Remedies & Procedures Code Section 74.503 is known as the period payments statute. It provides that if a defendant physician or health care provider requests that a trial award for medical, health care, or custodial services be paid in period payments instead of a lump-sum payment, then the trial court shall order it.
It’s hard for me to imagine a competent defense attorney not making a timely election of periodic payments, rather than a lump-sum payment, for future medical and health care expenses a medical malpractice case. Thus, this Texas Supreme Court opinion will be critical in many large medical malpractice claims.
After a jury verdict in favor of the plaintiff, the Texas Supreme Court has held that the party requesting periodic payments must identify for the trial court evidence regarding each of the findings required by the periodic payments statute. The trial court’s obligation to structure, in whole or in part, future medical expenses in periodic payments must be guided by evidence.
In other words, it would be an abuse of the trial judge’s discretion to make a period payment plan that’s not guided by evidence. In fact, that’s what the Supreme Court ruled happened here and so it remanded the case back to the trial court for further proceedings.
Life expectancy
Valley Regional Medical Center appealed a related issue that is an important one in many serious medical malpractice cases, particularly those involving people with labor and delivery, birth, or catastrophic brain injuries.
In a medical malpractice trial, each side will introduce expert evidence concerning the life expectancy of the injured plaintiff. It’s up to the jury to determine the plaintiff’s life expectancy based on this evidence.
It’s easy to see why life expectancy is of critical importance. If the life expectancy is too low, then a jury award for future medical expenses will be insufficient to take care of the patient’s health care needs that were caused by the negligence of the hospital or other health care defendants.
In this case, the plaintiffs produced expert evidence that the baby would live a life expectancy of 32 years. Valley Regional Medical Center entered expert testimony that the baby’s life expectancy was 7 or 8 years and that he was “highly unlikely†to live past the age of 10.
At trial, the hospital requested that the trial court include a specific question to the jury to decide on the plaintiff’s expected life expectancy. The hospital also requested jury charge questions asking the jury to decide on the patient’s medical expenses for each year of his life expectancy. The trial judge rejected the requests. The hospital appealed, arguing that both the court reform statute and Texas Constitution require a separate jury question about life expectancy.
The Texas Supreme Court rejected the hospital’s argument. It noted that neither the Texas Constitution nor the tort reform statute requires the jury to make findings of life expectancy or to specify the annual medical expenses. This means that the jury’s ultimate damages award automatically takes into account these considerations.
I think this is the best part of the opinion. If the jury had to answer these complex questions, I believe it would lead to frustration and confusion.
