I’ve written several times before about where multi-million dollar jury verdicts come from, like in A Look Behind The Scenes Of A Multi-Million Dollar Personal Injury Verdict and Strange Birth Injury Award: $21M Medical Expenses, $0 Pain and Suffering. There’s no secret recipe. Facts win cases; outrage at the defendant’s reckless conduct makes the damage awards larger.

Another example was published yesterday in The Legal Intelligencer:

A Philadelphia jury awarded $21.4 million on Friday to a diabetic man with brain damage over the care he received in the emergency room of Temple University Hospital.

The defense argued in court papers that when Campbell, an insulin-dependent diabetic, was taken to the hospital Oct. 13, 2007, he was administered glucagons and glucopaste by emergency medical technicians. His initial blood sugar was 74 by the time he arrived in the emergency room at 9:10 p.m., 79 by 10:40 p.m. and 118 by 12:14 a.m. Campbell was discharged at 1:05 a.m. in the company of family members and went to bed at 3 a.m.

Campbell’s relatives found him unresponsive at 11 a.m.

According to the defense pretrial memorandum, Campbell’s medical history included schizophrenia, depression, pancreatitis and alcohol abuse. Campbell was brought to the hospital 11 times for high or low blood sugar levels in the five years prior to his Oct. 13, 2007, visit to the emergency room, and he was frequently noncompliant with taking insulin, the defense argued.

Campbell was a “noncompliant” patient. It’s hard to know what that really means — everyone who doesn’t follow their doctor’s words to the letter is “noncompliant” — but the docket includes some references to alcohol abuse. The jury found him to be 10 percent at fault for the metabolic encephalopathy that has left him severely brain damaged and in need of constant custodial care.

So what happened? Why only 10 percent liable for his contributions to his condition? And why such a high award on damages, an award that seems likely to exceed his medical needs?

That’s where both facts win cases and outrage can help develop the award:

[Thomas J. Duffy of Duffy & Partners] said they argued to the jury that because Campbell had visited the emergency room Oct. 11, 2007, due to a severe episode of hypoglycemia, and returned to the emergency room two days later for the same issue, it was a breach of the standard of care to release Campbell without admitting him and investigating why Campbell was repeatedly having hypoglycemic episodes.

Indeed. And it gets worse:

The emergency room doctors differed on whether one of them treated Campbell, Duffy said. Dr. Michael DeAngelis filed a certificate stating he had not treated Campbell, while Dr. Joseph R. Lex Jr. and Dr. Christopher C. Vates disputed DeAngelis’ account, Duffy said.

That sort of dispute is quite striking; it’s exceedingly rare to see emergency department physicians who work together point the finger at one another. They typically all point the finger at the patient.

As far as I can tell, none of the physicians were willing to take responsibility for Campbell’s care. Maybe medical malpractice is over–thinking it; maybe the case is extraordinarily simple. Campbell had already come in two days before for hypoglycemia caused by his own “noncompliance” so the emergency physicians, annoyed by the distraction, told the nurses to give him some shots and send him home again.

On some superficial level that’s understandable. Emergency room nurses and doctors are on the frontline of society’s biggest problems. Their time is often wasted by malingering patients. They’re threatened and berated. They see many of the same patients over and over again for the same conditions. They sometimes have to blow off steam. They’re only human.

But “only human” isn’t the standard to which professionals and institutions are held. Campbell needed more than a couple cursory diabetic shots; he needed a doctor. The jury realized that he didn’t get one, and they were angry about it, angry enough to want to protect their community from that sort of lapse in care and responsibility happening again.

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