Punitive Damages in Medical Negligence Cases, Part 1

The Missouri Western District Court of Appeals recently held that punitive damages should have been submitted to the jury in a medical negligence trial.

Facts of Case

Joyce Oyler was hospitalized at Heartland Regional Medical Center for fluid buildup on her lungs. When she was discharged, a nurse phoned in multiple prescriptions to a Hy-Vee pharmacy. Nina Pecora was the pharmacy technician who took the phone-in prescriptions. One of the prescriptions was for metolazone, a diuretic. Pecora had no formal pharmacy training and had worked in the floral department before moving to the pharmacy.

Pecora made a number of errors in taking the prescriptions. These included misspelling several medications, misspelling the nurse’s name, entering an incorrect birth date for Oyler, and recording the wrong dosage for one prescription. Most importantly, Pecora recorded the order for daily metolazone as an order for daily methotrexate, which is primarily used in chemotherapy and to treat rheumatoid arthritis. When taken daily for more than a week, methotrexate can have lethal side effects. A pharmacist reviewed the prescription and did not catch the fact that the methotrexate was to be taken daily. In addition, Hy-Vee did not have a computer system that would prevent a prescription label for daily methotrexate to be printed.

Unfortunately, Oyler filled the prescription for methotrexate and took it daily. As a result, she died. He surviving husband and children filed a wrongful death claim. In the claim, they requested damages for aggravating circumstances (punitive damages).

The Trial Court Ruling

At trial, Hy-Vee admitted negligence, but moved  for a directed verdict on the claim for aggravating circumstances damages. The trial court granted that motion and did not allow the jury to award punitive damages. The jury eventually returned a verdict against Hy-Vee for $2,000,0000.

The Ruling on Appeal

The Oylers appealed the trial court’s ruling on their claim for punitive damages. They contended the presented sufficient evidence to support an award of punitive damages. The Western District Court of Appeals agreed and reversed the trial court’s decision not to allow the jury to consider an award of punitive damages.

Punitive damages are generally not available in a negligence claim. To recover punitive damages in a negligence claim, the plaintiff must show  the defendant knew or had reason to know a high degree of probability existed that the defendant’s conduct  would result in injury. The plaintiff must also show that the defendant acted with complete indifference to or a conscious disregard for the safety of others in circumstances that present a high probability of injury. The court found the evidence in this case justified allowing the jury to decide whether punitive damages should be awarded.


Rarely do negligence cases, especially medical negligence cases, result in an award of punitive damages. The particular facts of this case seem to make this one an exception to that general rule. Having said that, defendants should not approach these cases in a cavalier manner. Diligent discovery may unearth facts that would allow the court to let a jury decided punitive damages.

The decision can be found here.