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The Massachusetts Supreme Judicial Court has upheld a $20 million jury award in a medical malpractice case that found three medical professionals caused a patient to have an above-the-knee amputation of his leg.

In 2023, a jury found negligence on the part of a registered nurse, a physician assistant, and a nurse practitioner at Lowell General Hospital in their treatment of 38-year old Steven Luppold. Luppold had made several visits to the hospital in 2015 complaining of foot, leg and back pain. The jury found that the three failed to detect and treat blood clots and that his amputation was the result of their negligence.

Only one of three defendants found liable — the registered nurse— appealed, arguing that the trial judge made several errors.

Among her points on appeal, the appellant registered nurse claimed that the trial judge abused his discretion in not allowing cross-examination regarding a “high-low” settlement agreement entered into by the two other defendants in the case. She argued that the agreement led one of the other defendants to change his testimony to be more in agreement with the plaintiff and more critical of her.

A “high-low” agreement caps a defendant’s liability while ensuring that the plaintiff receives a minimum payment amount, regardless of the outcome.

The high court noted that the general rule is that settlement agreements are not admissible to “prove either liability or the amount of a claim.” According to the court, this is the general rule because settlement of litigation is to be encouraged, and disclosing such agreements risks skewing jurors’ required analysis of the parties and their respective liability, leading jurors, for example, to consider such settlement agreements as an admission of liability or alternatively to conclude that a liability determination is not necessary because the injured plaintiff has already been compensated.

The high court found that the record did not include any evidence that the other defendant changed his testimony, or why it would change based on a high-low agreement.

The appellant also took issue with parts of the jury instruction, the denial of her motion for judgment notwithstanding the verdict, and the assessment of prejudgment interest on damages awarded to the plaintiff for future pain and suffering.

The Supreme Court justices found no errors by the trial judge, although they did acknowledge that a minor change in the jury instructions in medical malpractice cases is in order for future cases.

The opinion written by Justice Scott L. Kafker concludes that the trial judge’s jury instructions “more than sufficiently” communicated the necessity and meaning of “but-for” causation. The appellant had complained about additional language the judge used that went beyond the model instruction. However, the high court said that the fact that the trial judge, in keeping with the model jury instructions, opted to use terminology to further explain “but-for” causation in “language that may be more easily understood by jurors” does not in any way negate the fundamentally correct legal principle the trial judge communicated.

The high court said that although it thinks the existing model jury instructions are clear, a minor revision would make the point even more expressly. Accordingly, a sentence in the current model jury instructions should be modified, as indicated by the underlined text, changing the word “and” to the phrase “meaning that.” Thus the model instruction is changed from:

“If [defendant’s] negligence had an impact on [plaintiff’s] injuries (by causing them or worsening them), then it caused those injuries. But if the negligence had no impact on [plaintiff’s] injuries and the same harm would have happened anyway, then [defendant] did not cause the injuries.”

to:

“If [defendant’s] negligence had an impact on [plaintiff’s] injuries (by causing them or worsening them), then it caused those injuries. But if the negligence had no impact on [plaintiff’s] injuries, meaning that the same harm would have happened anyway, then [defendant] did not cause the injuries.”

Topics Massachusetts