ST. LOUIS (CN) — A jury was not unduly influenced or confused by evidence of the nation’s opioid epidemic when it a hit a St. Louis doctor and hospital with $15 million in punitive damages for overprescribing painkillers to a man suffering from chronic back pain, a Missouri appeals court ruled this week.
The Missouri Court of Appeals for the Eastern District affirmed the verdict in favor of Brian and Michelle Koon on Tuesday, against physician Henry Walden and his employer St. Louis University Hospital.
They defendants said the trial court should have declared a mistrial because the nation’s devastating opioid epidemic had come up during jury selection, and the court allowed experts on both sides to expound on the issue in a way that prejudiced the defense’s case.
The three-judge panel disagreed and affirmed on all points. Presiding Judge Robert Dowd wrote the unanimous ruling, which was joined by Appeals Court Judge Sherri Sullivan. Appeals Court Judge Kurt Odenwald wrote a separate, concurring opinion, to comment on the claim of instructional error raised in the appeal.
The Koons sued Dr. Walden and St. Louis University Hospital in June 2014. Walden prescribed Brian Koon hydrocodone in 2008, and later Oxycodone and Oxycontin, for chronic back pain that was disrupting his ability to work.
Walden prescribed all three opioids at the same time, in increasing doses. In 2012, Koon was diagnosed as being dependent on the drugs, according to the 39-page appeals court ruling.
Koon and his wife told the trial court that they had called Walden frequently at his office for early refills when Koon ran out of the medication and when he was suffering from withdrawal.
They said Walden would refill the prescriptions and sometimes increase the dose without a consultation. Walden also prescribed morphine to Koon to when he could not refill the prescription, the appeals court found.
In 2008, Koon was taking a daily dose of 49.67 milligrams of the drugs. By 2012 he was being prescribed 1,555.94 milligrams. That is 13 times higher than the recommended upper limit of 120 milligrams, according to the ruling.
In June 2016, a jury ruled for the Koons, finding Walden was negligent. The court entered a judgment of $938,000 for Koon, $804,000 for his wife, and punitive damages of $15 million.
According to the St. Louis Post-Dispatch, a jury of eight women and four men initially awarded $1.4 million to Koon, and $1.2 million to his wife.
Walden and the hospital argued on appeal that the trial court should not have allowed the plaintiffs’ counsel to inject multiple references to the nation’s opioid epidemic, evidence they called irrelevant and prejudicial.
But Judge Dowd said that testimony about the epidemic was relevant and “tended to make more or less probable the facts necessary to show the relevant standards for imposing liability and punitive damages.”
In any case, most of the evidence the jury heard was related to Walden’s conduct, Dowd found. Because jurors attributed some of the blame to Koon in making its determination, that made clear that “they were not confused and did not simply impose liability of defendants because of the opioid epidemic.”
The appeals court also found clear and convincing evidence to justify punitive damages.
“In short, the evidence shows that Dr. Walden knew or had information from which he should have known there was a high probability that prescribing Koon these amount of opioids for this length of time would result in injury,” Dowd wrote.
“His decision to prescribe these amounts for this length of time was done in conscious disregard of, and with complete indifference to, Koon’s safety and the safety of other. We find this to be tantamount to intentional wrongdoing. Plaintiffs made a submissible case of punitive damages against Dr. Walden.”
In concurrence, Judge Odenwald asked whether the trial court had improperly instructed jurors on punitive damages. Odenwald said the defendants raised a legal question that merited review by the Missouri Supreme Court.