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Secret settlement didn't bias testimony in $20 million amputation case, court rules

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Monday, February 17, 2025

Secret settlement didn't bias testimony in $20 million amputation case, court rules

State Supreme Court
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BOSTON (Legal Newsline) - There was no need to cross-examine a physician assistant who entered into a secret settlement agreement before testifying against a nurse in a medical malpractice case that resulted in a $20 million jury verdict, the Massachusetts Supreme Judicial Court ruled. 

While the settlement capped the liability of the physician assistant, it didn’t appear to give him a financial incentive to bias his testimony against a co-defendant accused of negligence that led to the plaintiff’s leg being amputated, the court ruled. 

Steven Luppold sued nurse Susan Hanlon, PA Charles Loucraft and Carlos Flores, a nurse practitioner, after he developed a deep-vein thrombosis and had his leg amputated above the knee. Luppold went to the emergency department of Lowell General Hospital in 2015 complaining of a painful foot that was cold and turning blue. 

A triage nurse asked if Luppold had stuck his foot in a snow bank and when he denied it she referred him to the ambulatory section of the ED where Loucraft saw him.

Loucraft didn’t read the triage note, diagnosed Luppold with sciatica and prescribed pain medications and muscle relaxants. Hanlon discharged the patient without any testing. Luppold returned to the ED several days later, where Flores saw him, again prescribed pain medications and failed to do any testing. 

Five days later a physician ordered an ultrasound, found the blood clots and had Luppold’s leg amputated.

At trial, Loucraft testified that he wasn’t aware of Luppold’s foot pain and had Hanlon reported this too him, he would have treated the symptoms as a clot “until proven otherwise,” ordering an ultrasound or physician consult. The jury awarded Luppold $20 million, increased to $28 million with prejudgment interest.

Lawyers for Hanlon’s insurers moved to reverse the judgment, saying they were blocked from cross-examining Loucraft about a “high-low” settlement his insurers reached after his first deposition but before he testified at trial. 

When the subject came up at trial, Judge C. William Barrett said "We're not going to get into any of that." With a high-low agreement, the defendant agrees to pay a minimum amount regardless of the outcome of the trial, but to pay no more than the limit of insurance.

On appeal, Hanlon’s lawyers didn’t provide any specific examples of how Loucraft’s testimony changed between the deposition in the trial. In closing arguments, the plaintiff’s lawyer told the jury to "give a lot of credit to Charles Loucraft," because he admitted he didn’t read the triage nurse’s note. Although Loucraft "didn't throw anybody under the bus," he also testified that, had Hanlon "[told] him about a purple, cool foot," he "would have [ordered] an ultrasound."

The Supreme Court, in an opinion written by Justice Scott Kafker, refused to reverse the verdict, ruling the judge did not abuse his discretion. A high-low is different than a “Mary Carter” agreement, where a co-defendant guarantees the plaintiff a certain amount of money but has his liability reduced in direct proportion to the increase in liability for defendants who don’t settle.

“A settlement agreement directly incentivizing and rewarding blame-shifting is different from a settlement agreement that only defines a minimum and maximum recovery,” the court concluded.

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