HARTFORD, Conn. (Legal Newsline) - A Connecticut appeals court upheld a multimillion-dollar verdict for a man who argued a nurse with improper enema technique tore a hole in his rectum, leading to a severe infection and multiple hospitalizations.
The Connecticut Appellate Court rejected arguments by Bristol Hospital that the plaintiff’s medical expert couldn’t identify which of two nurses was negligent in the incident or that the jury ruled without seeing critical evidence including anything tying the enema to the injury.
Bruce Cockayne went to Bristol Hospital in January 2014, suffering diarrhea and vomiting. He was treated with bedrest, medication and a colonoscopy and discharged on Feb. 3, with a prescription for Rowasa enemas to be administered at home. Cockayne’s wife said she tried to administer an enema but was unsuccessful. After that, she said, no foreign body was inserted into Bruce Cockayne’s rectum.
He was readmitted to the hospital on Feb. 11 and received enemas on the next two days from two different nurses, including one who had never before administered a Rowasa enema. On Feb. 14, he suffered a “massive rectal bleed” which a doctor diagnosed as being caused by an internal hemorrhoid. The doctor also discovered a two-centimeter “older appearing perforation” which he treated to prevent feces from infecting nearby tissue.
The plaintiff nevertheless developed a necrotizing infection and sepsis and required multiple procedures at several hospitals.
Cockayne and his wife sued in 2016 and a jury awarded him $2.5 million in damages and his wife $720,000 for loss of consortium.
The hospital moved for a judgment notwithstanding the verdict and a new trial, arguing the plaintiffs didn’t offer evidence of when the perforation occurred or to support the idea the enema tube was long enough to cause it. The trial judge rejected both motions and the Connecticut Appellate Court agreed.
Writing in a Feb. 8 opinion, Judge Joan K. Alexander rejected both arguments. The plaintiff presented testimony from Dr. Mark Korsten, who said an enema tip was the likely cause of the tear and that incorrect procedure was to blame. He rejected other explanations, such as the plaintiff’s Crohn’s disease or that the perforation occurred during his colonoscopy. He also testified that the enema tip was 1.75 inches long, long enough to cause the tear in an average adult male.
On appeal, the defendant argued Korsten didn’t provide any evidence about Cockayne’s actual physical measurements to support his opinion. The appeals court said that wasn’t necessary.
“The jury heard different expert opinions regarding whether the Rowasa enema could have caused the perforation and was tasked with determining which opinion to believe,” the appeals court ruled.
The hospital also argued the plaintiffs didn’t provide any evidence that the nurses improperly administered the enemas, citing another decision that held the mere fact an injury followed a medical procedure isn’t enough evidence to establish negligence. The defendant also took issue with the plaintiff expert’s use of “differential diagnosis” to rule out other causes of the tear, including the plaintiff’s wife’s attempt to perform an enema at home.
Differential diagnosis is the process doctors use to determine the underlying cause of an illness. The term is also used by courtroom experts to describe the more expansive process of ruling in or out causes of a plaintiff’s injury.
Finally, the hospital argued there was no evidence for the jury to conclude which of the nurses, if either, cause the injury. When asked which of the nurses had not acted negligently, Korsten said “I can’t tell you. I don’t know.’’ He then said he assumed it was the first nurse, who was performing her first unsupervised enema.
The jury actually assigned blame to the second nurse, the appeals court said, but that didn’t matter. There was enough other evidence for the jury to rule the way it did, the court concluded.