In its March 29, 2018 decision, the Court of Appeal of the State of Florida Fifth District (“Florida Appellate Court”) held that the trial court had abused its discretion in granting the Florida Medical Malpractice plaintiff’s motion for new trial, “because the record does not support the trial court’s reasons for granting a new trial.”

The Florida Medical Malpractice case that the Florida Appellate Court was deciding involved a 60-year-old male patient who had a platelet count of 1,000 when he arrived at a hospital emergency room on February 9, 2010 (a platelet count of 10,000 is considered critically low; a normal count is about 250,000 for a 60-year-old). At a 1,000 platelet count, life-threatening and organ-threatening bleeds are a concern because the human body cannot adequately form blood clots with so few platelets.

Later that evening, the man was diagnosed with acute immune (or idiopathic) thrombocytopenia purpura (“ITP”), a blood disorder that required treatment to halt his body’s destruction of platelets. One of the defendant physicians ordered that the man receive prednisone, a corticosteroid, and intravenous immunoglobulin (“IVIG”), to treat his ITP but did not order a platelet transfusion (another physician recommended a platelet transfusion only in the event of a “life-threatening hemorrhage”).

The man had an adverse reaction to the IVIG within fifteen minutes (sweating and vomiting), so the nurse discontinued the IVIG and notified the hematologist, who ordered the nurse to restart the IVIG as soon as the man stabilized. Later that night, the nurse called the hematologist again to report on her inability to restart the IVIG due to the man’s continuing condition. The hematologist ordered the nurse to discontinue the IVIG (the nurse never administered the ordered prednisone to the patient).

The following morning, the man was found unresponsive and without a pulse, which was about twelve and a half hours after he presented to the emergency room. A CT scan of the man’s brain showed a catastrophic intracerebral hemorrhage. The man was pronounce dead later that morning and his cause of death was acute cerebral hemorrhage from thrombocytopenia.

During the Florida medical malpractice trial, all of the experts for the parties agreed that IVIG and prednisone take at least twenty-four hours to take effect, and usually longer. Therefore, given that the man suffered a catastrophic intracerebral hemorrhage about twelve and a half hours after presenting to the hospital, and was declared brain dead about seventeen hours after presentation, the experts agreed that platelets were the only treatment that could have saved the man.

The parties’ experts disagreed, however, on the propriety of ordering a platelet transfusion: the defendants’ expert testified that there are medical risks to ordering platelets, and that platelets should only be ordered in the event of a life-threatening bleed, which the experts agreed the man did not have when he was examined; the plaintiff’s expert testified that the only proper course of action was to order platelets “stat” immediately upon the man’s admission. The plaintiff’s expert conceded that there are medical risks associated with a platelet transfusion, but testified that the risk of not administering platelets outweighed the risks of doing so.

The Florida medical malpractice jury returned its verdict in favor of the defendants, after which the plaintiff filed a motion for new trial. The trial court granted a new trial, finding that the jury’s verdict was against the manifest weight of the evidence (“the Plaintiff’s expert witnesses were clearly more credible than the Defendants’ expert witnesses. Plaintiff’s experts concisely ‘zeroed in’ on the relevant facts of the case and applied those facts to the standards of care applicable to the health care providers. On the other hand, Defendants’ experts gave more general opinions, and were not as knowledgeable to the hematological intricacies of the case”). The defendants appealed, arguing that the record does not reflect that the defendants’ expert witnesses testified only generally or that they were less knowledgeable regarding the hematological intricacies of the case.

Florida Appellate Court Decision

The Florida Appellate Court stated that a trial judge should grant a new trial if the manifest weight of the evidence is contrary to the verdict; if the jury has been deceived as to the force and credibility of the evidence or has been influenced by considerations outside the record. The trial judge must necessarily consider the credibility of the witnesses along with the weight of all of the other evidence. Nevertheless, the trial court may not act as a seventh juror by substituting its verdict for that of the jury, and should only intervene when the manifest weight of the evidence dictates such action; not every verdict which raises a judicial eyebrow should shock the judicial conscience.

The Florida Appellate Court stated that in the present case, the trial court abused its discretion because its reasons for granting a new trial are not supported by the record. The Florida Appellate Court stated, “We have reviewed the expert testimony at trial and find no support for the trial court’s conclusion that Appellee’s experts ‘zeroed in’ on the relevant facts of the case any more than Appellants’ experts. Nor did Appellants’ experts give more general opinions or demonstrate less knowledge of the ‘hematological intricacies of the case’ … the case turned on whether [the man’s] treating physicians should have ordered a platelet transfusion. [The man] coded and remained in an unresponsive state about twelve and a half hours after admission to the hospital. The evidence was undisputed that IVIG and prednisone do not take effect for at least twenty-four hours. Thus, IVIG and prednisone were irrelevant to the cause of [the man’s] death, and Appellee’s hematologist conceded as much when he testified that only platelets could have saved [the man’s] life.”

The Florida Appellate Court therefore reversed the trial court granting the Florida medical malpractice plaintiff a new trial.

Source Hasmi-Alikhan v. Staples, Case No. 5D16-3735.

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