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.


Missouri Supreme Court Strikes Down Cap on Punitive Damages

In Lewellen v. Franklin, a fraud and Missouri Merchandising Practices Act (“MMPA”) case, the Missouri Supreme Court has struck down the cap on punitive damages enacted by the Missouri legislature during its 2005 tort reform in certain cases. Lillian Lewellen (“Lewellen”) obtained a verdict against Chad Franklin National Auto Sales North, LLC (“National”) and its owner, Chad Franklin (“Franklin”), for $25,000 in actual damages and $1,000,000 in punitive damages on both claims, fraudulent misrepresentation and violation of the MMPA. Lewellen elected to take judgement for actual and punitive damages for fraudulent misrepresentation against Franklin and for actual and punitive damages for violation of the MMPA against National. Pursuant to section 510.265, RSMo,the trial court reduced the punitive damages verdict against Franklin and National to $500,000 and $539,050, respectively. On appeal, the Missouri Supreme Court found this statute unconstitutional as applied to Lewellen’s fraudulent misrepresentation claim and reinstated the full amount of the punitive damages.

Lewellen asserted that the reduction of her punitive damages award against Franklin violated her right to trial by jury as guaranteed by article I, section 22(a) of the Missouri Constitution, which provides “[t]hat the right of trial by jury as heretofore enjoyed shall remain inviolate.” In other words, if there was a right to a trial by jury before the adoption of the Missouri Constitution, then the legislature can not enact laws that affect that right. In Lewellen’s case, the right to trial by jury on claims of fraud existed at common law before the enactment of the first Missouri Constitution in 1820. Similarly, a party had a right to have a jury decide the amount of punitive damages in a fraud case as of 182o. Therefore, when applied to a fraudulent misrepresentation claim or any claim for which the right to a trial by jury existed prior to the adoption of the Missouri Constitution, section 510.265 infringes on the right to trial by jury and is unconstitutional.

Note that the defendants also argued that the award of punitive damages violated their due process rights. After analysis, the Court disagreed, but did acknowledge that there may be cases in which the reduction of punitive damages is warranted due to their affect on the defendants’ due process rights.