RANDY VICKNAIR JR INDIVIDUALLY AND ON BEHALF OF RANDY VICKNAIR III AND MAE BELLA VICKNAIR v. KEVIN PLAISANCE AND ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO ST TAMMANY PARISH HOSPITAL (2025)

In this medical malpractice case, the defendant doctor, Kevin M. Plaisance, M.D., and the intervenors, the Louisiana Patient's Compensation Fund and the Louisiana Patient's Compensation Fund Oversight Board (collectively, the PCF), appeal a judgment in favor of the plaintiff, Capital First Trust Company, Inc., as the Trustee of the Randy P. Vicknair, III Irrevocable Settlement Trust and as the Trustee of the Mae B. Vicknair Irrevocable Settlement Trust.¹ For the following reasons, we affirm.

BACKGROUND

In 2015, Andrea Vicknair was 33 years old and pregnant with her second child. The defendant, Dr. Kevin Plaisance, was her obstetrician. At her 29th week prenatal appointment on May 13, 2015, Andrea presented with elevated blood pressure and protein in her urine. Andrea was admitted that date to St. Tammany Parish Hospital (the “hospital”) and diagnosed with preeclampsia. Testing revealed low amniotic fluid, which prompted Dr. Plaisance to deliver Andrea's daughter, Mae Bella Vicknair (“Mae”), via emergency cesarean section on May 15, 2015. Mae was just over two pounds at birth and was admitted to the Neonatal Intensive Care Unit (NICU). Andrea continued to experience high blood pressure in the days leading up to her discharge on May 19, 2015. On May 24, 2015, Andrea died at home. The cause of Andrea's death was “hemopericardium (500 ml) due to ruptured aortic dissection.”²

Thereafter, a request for a Medical Review Panel (MRP) was filed alleging negligence on the part of Dr. Plaisance and the hospital. The MRP convened on August 21, 2017, and found that Dr. Plaisance breached the standard of care. Specifically, the MRP concluded “[i]t was a deviation from the standard of care to discharge a post-partum patient with uncontrolled hypertension for a period of less than 24 hours.” However, the MRP was unable to find causation; i.e., the MRP could not conclude that the failure to properly treat Andrea's high blood pressure was a “factor of the resultant damages.” The MRP found no breach of the standard of care on the part of the hospital or its employees.

On November 16, 2017, Andrea's husband, Randy P. Vicknair, Jr. (“Randy, Jr.”), individually and on behalf of Randy P. Vicknair, III (“Randy, III”), and Mae, the surviving minor children of Andrea, filed this medical malpractice suit against Dr. Plaisance and the hospital, alleging that Dr. Plaisance was negligent in his treatment of Andrea regarding stabilization of her blood pressure and caused or contributed to her death by aortic dissection.³ On June 17, 2020, the trial court signed an order substituting Capital First Trust Company, Inc., as the Trustee of the Randy P. Vicknair, III Irrevocable Settlement Trust and as the Trustee of the Mae B. Vicknair Irrevocable Settlement Trust as the plaintiff herein. Randy, Jr. voluntarily dismissed his individual claim.

Multiple motions in limine were filed by both parties attempting to exclude or limit expert testimony in this case. Pertinent to this appeal is Dr. Plaisance's motion to exclude the testimony of plaintiff's expert critical care physician and general surgeon, Dr. Eric Kraut, regarding the timing of the aortic dissection and causation. Dr. Plaisance contended that Dr. Kraut's opinions were unreliable and irrelevant under La. R.S. 9:2794, unsupported as required by La. C.E. art. 702, and unfairly prejudicial, confusing, and misleading as prohibited by La. C.E. art. 403. The various motions in limine were heard on April 20, 2023. On May 3, 2023, the trial court denied Dr. Plaisance's motion to exclude or limit the expert testimony of Dr. Kraut.⁴

A jury trial was held August 28-31, 2023. Following trial, the jury returned a verdict in favor of the plaintiff and allocated 75 percent fault to Andrea and 25 percent fault to Dr. Plaisance. The jury awarded a total of $3,400,000 in general damages, $1,200,000 to Randy, III, and $2,200,000 to Mae.⁵

On September 28, 2023, the trial court rendered judgment adopting the jury's verdict and reducing the monetary awards commensurate with the allocation of fault. The monetary damage award was further reduced to the statutory cap of $500,000 pursuant to La. R.S. 40:1231.2. The PCF intervened in October of 2023. The trial court granted Dr. Plaisance's motion for new trial and an amended judgment was rendered on January 29, 2024. The amended judgment reduced Dr. Plaisance's liability to $100,000 plus taxable costs and legal interest, and imposed liability on the PCF for the remaining $400,000 plus taxable costs and legal interest. A subsequent motion for judgment notwithstanding the verdict filed by the plaintiff requesting Andrea's percentage of fault be reduced to zero was denied.

Dr. Plaisance and the PCF appeal, arguing that the trial court erred in allowing Dr. Kraut to testify concerning causation and that the jury's verdict is not supported by the evidence. The PCF also urges that the damages awarded are excessive.

EVIDENCE ADDUCED AT TRIAL

The plaintiff introduced Andrea's medical records and testimony from the following: Dr. Michael Litrel, expert in obstetrics and gynecology; Dr. Eric Kraut, general surgeon specializing in critical care medicine and professor at John Hopkins University; and Dr. Jonathon Arden, expert in forensic pathology. Dr. Plaisance was called as a witness by the plaintiff. Randy, Jr. and Diane Vicknair, the children's grandmother, also testified on behalf of the plaintiff. Testifying for Dr. Plaisance were Dr. Michael Wiedemann, expert in obstetrics and gynecology and MRP panelist; Dr. Rachel Reitan, expert in obstetrics and gynecology; Dr. Victor Todesco IV, cardiovascular/thoracic surgeon; and Dr. Plaisance. Pertinent documentary evidence and testimony presented at trial is summarized as follows.

Medical records

Andrea's medical records from the hospital were introduced into evidence as a joint exhibit. As an overview, we note that our review of the medical records reveals that 152 total blood pressure readings were taken during Andrea's hospitalization, and of those, over 100 fell within the category of “hypertensive emergency,”⁶ before delivery and post-partum. Five of those readings were taken on her date of discharge.

Andrea was admitted to the hospital on May 13, 2015, on which date Dr. Plaisance ordered “Apresoline 5 mg IV with Apresoline 5 mg IM for blood pressure greater than 150/110, may repeat after 15 minutes if needed.” On May 14, 2015, Dr. Plaisance ordered Hydralazine [Apresoline] IVP and 10 mg IM in 15 minutes with blood pressure greater than 150/110 as needed.

The nurses’ notes indicate that Andrea denied “CP,” or chest pain, on several occasions before and after Mae's birth. The nurses’ notes from May 14, 2015, state that Andrea felt “as though her heart was pounding” and she vomited. Dr. Plaisance was on the “unit” during this time, and he adjusted Andrea's blood pressure medication; however, the readings remained high. The following day, May 15, 2015, Andrea's blood pressure remained emergent and she complained of a “mild headache.” In addition to her blood pressure, tests revealed low amniotic fluid, which prompted Dr. Plaisance to perform the emergency cesarean section that afternoon. During the operation, Andrea's blood pressure was controlled. Dr. Plaisance's post-operative orders included blood pressure checks every four hours for 24 hours, then every 12 hours, and he instructed that he be notified if Andrea's systolic pressure was greater than 160 or less than 90 or her diastolic pressure was greater than 101 or less than 60. At 6:28 p.m. on May 15, 2015, after delivery, Andrea's postpartum blood pressure was documented as “162/81 mm Hg.” On May 16, 2015, Dr. Plaisance ordered Labetalol 400 mg by mouth every 12 hours, revised later that day to every 8 hours. Over the subsequent approximate 48 hours, Andrea had 24 blood pressure readings at the hypertensive emergency level.

At 7:16 a.m. on May 18, 2015, Andrea's blood pressure was recorded as “196/120 mm Hg.” The nurses’ notes indicate that at 7:21 a.m., Dr. Plaisance was in the room with Andrea, was informed of her blood pressure, and ordered that Andrea's 9:00 a.m. Labetalol dose be given early. At 1:07 p.m., Dr. Plaisance was again notified of Andrea's emergent blood pressure. Dr. Plaisance ordered “Apresoline 5 mg IM/IV as needed for blood pressure greater than 160/110 mm Hg.” Throughout that day, ten blood pressure readings were recorded, the last nine of which indicated Andrea was still in hypertensive emergency.

Andrea was discharged the next day, May 19, 2015. Five blood pressure readings were taken after midnight on that date, each of which fell within the ACOG's definition of hypertensive emergency. Two hours before discharge Andrea's blood pressure was recorded as “190/102 mm Hg.” The last blood pressure reading before Andrea was discharged was recorded as “174/94 mm Hg” at 5:21 p.m.

The discharge summary indicates that Andrea's “[p]ost-operative course has been unremarkable” and her blood pressure “remained labile and required occasional treatment with further doses of hydralazine [Apresoline].” The discharge summary further states “[b]lood pressure medication has been adjusted to attempt to have better long-term control.” Andrea was discharged in “stable” condition and instructed to take Labetalol 400 mg. every 8 hours for blood pressure. Dr. Plaisance instructed that he would “see her back in two weeks or she is to call sooner for any other questions, complaints, or problems.”

Testimony for the plaintiff

Randy, Jr., Andrea's husband and father to Randy, III, and Mae, testified about Andrea's medical history, their family, and the events leading up to Andrea's death. He testified that Andrea had a history of depression, for which she had been previously hospitalized, and a history of alcohol abuse. She also had anxiety disorder and had experienced panic attacks.

Randy, Jr. testified that he stayed with Andrea in the hospital from May 14th to 19th, 2015. He heard Andrea complain of chest pain to the staff on “several” occasions, and specifically to Dr. Plaisance. Randy described Andrea's discharge on May 19th as “insane” because of her continued hypertension. He testified “I told Kevin Plaisance that, you know, ‘[w]hy are you discharging her with blood pressure higher than when you admitted her? It doesn't seem right.’ ” According to Randy, Jr., Dr. Plaisance responded by explaining that the cure for preeclampsia was taking the baby out and that the high blood pressure would resolve itself. Randy, Jr. explained that he shook the doctor's hand and said “Okay, Doc. I trust you.” Randy, Jr. further testified that the only instruction he and Andrea were given was to chart Andrea's blood pressure and if she were to have an emergency, Dr. Plaisance “could possibly fit her in earlier than the 10-day or two-week follow-up ․.”

According to Randy, Jr., two days after Andrea was discharged, she complained of chest pains. On May 21, 2015, Andrea placed two calls to Dr. Plaisance's office and on May 22nd, she placed a third call. Randy, Jr. testified that he was present when Andrea made the calls. Andrea did not get through to Dr. Plaisance and received no return call. Documentary evidence of those calls was admitted into evidence. Randy, Jr. further testified that on May 23, 2015, the day before Andrea died, she told him “I'm having a heart attack.” While on the way to the emergency room, Andrea told him “she was having tightness in her chest and did not feel right.” Randy, Jr. testified that he just as they were nearing the hospital, Andrea grabbed his arm and told him to “stop” and that “it was an anxiety attack” because it was gone and “a heart attack wouldn't just come and go.” The couple returned home. When asked if he would have reacted differently if Dr. Plaisance had warned him to watch for signs and symptoms of a stroke or aortic dissection, Randy, Jr. answered that had Dr. Plaisance done so, Andrea “would probably still be alive,” because he would have “gotten her to an emergency room to a cardiologist.” Randy also confirmed that Andrea checked her blood pressure regularly after discharge and she never had a systolic reading under 160 mm. Hg. He explained that in the mornings, he would wake her to pump breastmilk, after which she took the Labetalol to ensure it was not passed through the breastmilk. In the evenings, Andrea would pump and then take her medication. Randy, Jr. stated that she did not miss a dose of the blood pressure medication after discharge from the hospital.

Next, Randy, Jr. was asked about the evening of May 23rd and morning of May 24, 2015. That evening, he and Andrea watched a movie, laying on separate couches. Andrea moved to the bedroom during the night. Randy, Jr. woke up the following morning, watched television, took a shower, and took the breast pump to Andrea's bedside. When he nudged her arm, it was “room temperature” and he knew she was dead.

Randy, Jr. also testified about his children. Randy, III was 10 years old when his mother died and 18 years old at the time of trial. He has “pervasive developmental disorder not otherwise specified,” which falls under the category of autism. According to Randy, Jr., his son has also been diagnosed with schizoaffective disorder. Andrea was the only person with whom Randy, III had a close emotional connection, and no one has been able to fill that void. Randy, Jr. stated that his son blames his sister, Mae, for Andrea's death, telling her that she killed their mom and will never have one. Although Randy, III has been in therapy, he refuses to talk about his mother. Randy, Jr. testified that when he asks his son about his mother, Randy, III says “[t]here are some things in this life, like, that if you think about them, they will just eat you up.” Mae was nine days old when her mother died and eight years old at the time of trial. Randy, Jr. testified that Mae asks about her mother often and he and his mother, Diane Vicknair, have tried to fill that void for her.

On cross-examination, Randy, Jr. acknowledged that Andrea had not been prescribed the pain medication Tramadol, which was found to be present in her postmortem toxicology screen, but posited that perhaps his mother had given it to Andrea for pain.

Dr. Litrel was qualified by the trial court as an expert in obstetrics and gynecology and testified by video deposition. Dr. Litrel testified that the standard of care that applied to Dr. Plaisance's treatment of a pregnant patient with preeclampsia in 2015 was not to discharge the patient after she delivers unless the blood pressure is controlled, or under 140 systolic, for 24 hours. He further explained that “obstetricians and gynecologists, we're not trained in blood pressure management passed [sic] a certain point, and if a patient's not responding well to the, you know, limited medication that we use, then you have to bring in someone with greater skills in managing blood pressure.” Dr. Litrel was shown Andrea's medical records, specifically the postpartum blood pressure readings, and agreed that she remained in hypertensive emergency the day after delivery despite the medication. He opined that when the blood pressures lowered slightly it was due to the medication, but the blood pressure remained high indicating the right type of medications were not being used. Dr. Litrel further agreed that through May 19, 2015, the date of discharge, Andrea's blood pressure remained emergent and uncontrolled. Dr. Litrel opined that Andrea was not ready for discharge. When asked about the efficacy of prescribing Labetalol three times a day post discharge, Dr. Litrel opined that while inpatient, Andrea needed Apresoline in addition to the Labetalol to bring her blood pressure below hypertensive emergency levels. He explained that did not have reason to believe the Labetalol alone would control her blood pressure at home.

Dr. Litrel stated that the risks to a postpartum patient sent home with uncontrolled blood pressure included stroke, cardiac anomaly, and dissecting aortic aneurysm. Dr. Litrel agreed that the standard of care required Dr. Plaisance to consult critical care, cardiology, internal medicine, or “just someone that takes care of blood pressure in an emergent setting.” An obstetrician/gynecologist is trained to deal with acute problems during pregnancy, but “after that ․we don't treat blood pressure problems.” In addition, Dr. Litrel noted that it is not a new concept that aortic dissections can occur in pregnant patients; while hypertension increases anyone's risk for aortic dissection, pregnancy compounds that risk due to increased blood volume.

Dr. Litrel was questioned extensively regarding Andrea's alleged prior substance abuse, including her alleged use of Adderall. However, Dr. Litrel noted that her drug screen at the hospital was negative. Dr. Litrel opined that while he may not know what was causing Andrea's hypertension, it was not Adderall.

The plaintiff called Dr. Plaisance to testify. He agreed that Andrea's blood pressure remained uncontrolled on May 16, 2015, the day after delivery. Dr. Plaisance stated that he did not consult a specialist at that point because “[i]t was not usually standard of care at the time.” He later testified that he did not seek a critical care consult in Andrea's case because he believed he was correctly managing Andrea's high blood pressure. He acknowledged, however, that the ACOG guidelines state that “[i]f the patient fails to respond to first-line agents, recommend emergency consultation with a specialist in one of the following areas for second time or second-line management decision: Maternal fetal medicine, internal medicine, anesthesiology, critical care.”

Dr. Plaisance disagreed that Andrea was in hypertensive emergency by the end of the day on May 17, 2015, or on May 18, 2015. Dr. Plaisance testified that the ACOG guidelines, including the definition of hypertensive emergency, are suggestions and expressly state they are not meant to be the standard of care. He opined that there “were many conflicting standards” for blood pressure numbers to be considered safe for discharge in 2015. Dr. Plaisance agreed, however, that a postpartum patient like Andrea should be well-controlled on oral blood pressure medication prior to discharge. He further testified that on May 19, 2015, Andrea had “no hypertensive emergency, and her clinical picture was stable.” After reviewing Andrea's blood pressure readings from the medical records, Dr. Plaisance testified that he continued to believe that she was ready for discharge on May 19, 2015. Regarding the three phone calls placed by Andrea to his office after her discharge, Dr. Plaisance testified that he did not personally receive those calls and his staff did not receive any voicemail messages from those calls.

Dr. Plaisance conceded during his testimony that at the time of Andrea's admission to the hospital, he was aware she had the following risk factors for aortic dissection: she was a smoker; she was overweight; she was pregnant; and, she was hypertensive.

Next, Dr. Kraut, an expert in general surgery and critical care medicine, testified next by video deposition. Dr. Kraut is double board-certified in general surgery and critical care medicine, practices both full-time, and has practiced since 1998. At the time of trial, Dr. Kraut was an assistant clinical professor at John Hopkins University. Dr. Kraut testified that aortic dissection is not common; in the course of his career he has treated three pregnant women for aortic dissection, all of whom survived. He has cared for hypertensive patients and provided critical care for patients suffering from complications of pregnancy and aortic dissections and aneurysms.

Dr. Kraut identified four main bases for his opinion that “to a reasonable degree of medical probability, involvement of a critical care physician or cardiologist in the care of Andrea Vicknair would have decreased the chances of an aortic dissection or it would have led to the diagnosis of aortic dissection prior to discharge improving her chances of survival.” Those bases were: 1) failure to control Andrea's blood pressure before delivery; 2) failure to control Andrea's blood pressure after delivery; 3) failure to consult with critical care or cardiology when Andrea's blood pressure could not be controlled; and, 4) discharging Andrea without having her blood pressure under control.

First, prior to delivery, the medication given to Andrea failed to sufficiently treat her high blood pressure. The fact that her blood pressure was controlled during the cesarean section indicated to Dr. Kraut that it was a “controllable blood pressure, with the right medications ․.” Second, Dr. Kraut testified that Andrea's blood pressure postpartum was uncontrolled by the medications. As to the third basis, Dr. Kraut opined that because Dr. Plaisance's responses to multiple notifications of Andrea's hypertension were not effective in controlling her blood pressure, a consult was required either with a critical care physician, or “a cardiologist, an anesthesiologist, an internist ․ somebody who's going to be focused on blood pressure control.”

Dr. Kraut agreed that because Dr. Plaisance could not achieve 24 hours of sustained blood pressure control, the ACOG recommends getting a consult for patients like Andrea. Dr. Kraut further stated that in his experience there are several specialties to consult on blood pressure management, including the anesthesiologist, hospitalist, and ICU intensivist. In his experience a consult with one of these specialists is not difficult to obtain. When asked about Andrea's alleged Adderall use, Dr. Kraut opined, like Dr. Litrel, that due to Andrea's negative toxicology screens, Adderall was not a factor in Andrea's high blood pressure. He further noted that, while Adderall can have an effect on blood pressure, the record indicated Andrea took Adderall only once, years prior, with no effect on her blood pressure.

Dr. Kraut also suggested that Dr. Plaisance could have transferred Andrea to the ICU, where the same or more fast acting medications could be delivered by drip IV, rather than orally, and monitoring is more frequent. In this regard, Dr. Kraut mentioned that Andrea's complaints of chest pain, headache, and pounding heart, along with her other risk factors such as smoking and obesity, would support a decision to transfer her to the ICU. Dr. Kraut explained that in the ICU, an EKG would likely have been ordered, Andrea's troponin levels would have been checked, which would reveal heart cell damage, and an echocardiogram and/or CT could have been done, either of which would have detected an aortic dissection. Dr. Kraut further opined that “based on when Randy stated that [Andrea's] chest pain started,” it was his “best guess” that the aortic dissection began while Andrea was in the hospital. He further explained that Andrea experienced a “Type A dissection,” which requires surgical intervention. Dr. Kraut agreed that 75 percent of Type A aortic dissection patients survive the surgery.

The fourth and final basis identified by Dr. Kraut was Dr. Plaisance's discharge of Andrea before her blood pressure was controlled for a period of 24 hours. Dr. Kraut agreed that had Andrea remained hospitalized until her blood pressure was under 160 mm. Hg. systolic for 24 hours, he could conclude, to a reasonable degree of medical certainty, “[t]hat could have prevented her death, in my opinion” and would have given her a greater chance of survival.

On cross-examination, Dr. Kraut agreed that high blood pressure is a common problem, while aortic dissection is not. The vascular defect that causes the aortic dissection could happen more remotely in time, but Dr. Kraut maintained that it “would typically correlate with when the symptoms started.” Dr. Kraut further stated that “[t]he specific phrase, chest pain, is in [Randy, Jr.’s] deposition. The other chest-related complaints were in the medical record.” Dr. Kraut recognized that the medical record indicates that Andrea denied chest pain, but he accepted Randy, Jr.’s testimony because he “describes it in a lot of detail, so I - - I - - I followed it, and it kind of makes sense ․.” Dr. Kraut acknowledged that the aortic dissection could have happened after discharge and that “the timing of the dissection is when symptoms start, because that's usually the hallmark of it.”

Dr. Kraut also clarified that sometimes there is chest pain associated with aortic dissection and sometimes there are no signs or symptoms before the dissection occurs and results in death. Dr. Kraut explained that he was not opining about the “OB part of management of preeclampsia” and would defer to a cardiovascular surgeon on the surgical treatment of an aortic dissection. Those issues are “specific and apart from” the management of hypertension, which does fall within his area of expertise. On redirect examination, Dr. Kraut testified that the medical records support that Dr. Plaisance was notified of Andrea's high blood pressure readings “enough that he knew that was an ongoing problem.” Dr. Kraut further agreed that while a patient's reported history is important and may have helped with a determination of what was causing it, Andrea's high blood pressure under Dr. Plaisance's care was an “objective finding” persisting for days that “you need to control.”

The video deposition testimony of Dr. Jonathon Arden, a forensic pathologist, was also played for the jury. Dr. Arden testified regarding the cause of Andrea's death. Dr. Arden opined that Andrea's cause of death was hemopericardium. In his opinion, however, there should have been a secondary or contributary cause of death listed as her recent postpartum state complicated with severe preeclampsia. Dr. Arden explained that this was “another factor medically involved that would be the only other explanation for why a young woman would have an aortic dissection.” Dr. Arden further testified that in his opinion Adderall did not play a role in Andrea's death. Dr. Arden testified that Tramadol, which was present in Andrea's toxicology screen, is a synthetic opioid pain medication that does not raise blood pressure, thus, he “would not expect it to be a mechanism by which an aortic dissection would be caused.” Finally, Dr. Arden testified that screens for antihypertensive medications, such as Labetalol, are not routinely done in post-mortem testing and, to the best of his knowledge, Andrea's post-mortem toxicology report did not show that Andrea failed to take her blood pressure medication as prescribed after discharge.

Diane Vicknair, Randy, Jr.’s mother and grandmother to Randy, III and Mae, was the plaintiff's final witness. She testified about Andrea not feeling well after she was discharged from the hospital. Ms. Vicknair denied giving Andrea medication. She described Andrea's close relationship with Randy, III, and testified about family trips. Ms. Vicknair stated that her disability from previous strokes keeps her from doing as much with Mae as she would like. Mae stays with Ms. Vicknair during the school week so that Randy, Jr. can work. Mae stays with her father and brother on weekends and during the summer. Ms. Vicknair is unable to be active at Mae's school and foster relationships with Mae's friends; her neighborhood does not have small children. Mae asks about her mother's taste in music and considers herself an artist like her mother. Ms. Vicknair testified that she worries about who will take care of the children if Randy, Jr. suffers a health setback. According to Ms. Vicknair, Mae worries about something happening to her grandmother and has nightmares about it.

Testimony for Dr. Plaisance

Dr. Rachel Reitan was accepted by the trial court as an expert in obstetrics and gynecology and testified regarding whether Dr. Plaisance's treatment of Andrea adhered to the standard of care. Dr. Reitan testified that Dr. Plaisance's treatment of Andrea in every phase of her hospitalization, including Andrea's discharge, was appropriate and met the standard of care. She testified that Andrea's postpartum medical records reveal no signs or symptoms of an aortic dissection, which is extremely rare in pregnant women. According to Dr. Reitan, high blood pressure alone is not suggestive of an impending aortic dissection. Dr. Reitan agreed that high blood pressure would persist for a while after delivery in a woman who had experienced severe preeclampsia. In addition, Dr. Reitan opined that obstetricians are experts in treating preeclamptic hypertension and would not consult another specialist absent another “cardiac issue” along with the severe preeclampsia. Dr. Reitan further testified that Dr. Plaisance “did everything right according to the guidelines of our college, the College of Obstetrics and Gynecology,” by sending Andrea home with instructions to take blood pressure medication. Dr. Reitan stated that because the postmortem toxicology screen did not reveal the presence of Labetalol, she did not believe Andrea had been compliant with the medication. She further noted that Andrea did not go to the emergency room when she began having symptoms. It was Dr. Reitan's opinion that the aortic dissection could not have occurred while Andrea was in the hospital “because she never, ever had chest pain in the hospital.” Dr. Reitan noted that when Andrea began to experience chest pain at home after discharge, she should have gone to the emergency room. Dr. Reitan denied that Dr. Plaisance would have had any reason to anticipate or prevent an aortic dissection based on Andrea's medical records. She opined that Dr. Plaisance met the standard of care and did not cause the aortic dissection.⁷

Dr. Michael Wiedemann, an expert in obstetrics and gynecology and a member of the MRP, testified he and another member of the MRP believed that 50 to 60 percent of obstetricians would have handled Andrea's treatment the way Dr. Plaisance did. He explained that at the time of the MRP, he had never heard of aortic dissection being a complication of preeclamptic hypertension. Thus, according to Dr. Wiedemann, an obstetrician would not counsel a postpartum patient being discharged on the possibility of aortic dissection.

Dr. Wiedemann further denied that it is the standard of care to consult another specialty in the treatment of preeclamptic hypertension. Dr. Wiedemann stated “[w]e just see this so much, and we know most of the time it's going to get better. You have to wade through it and treat them, but we rarely ever consult another field of physicians.” Dr. Wiedemann concluded that there was no reason for Dr. Plaisance to have expected aortic dissection absent a symptom such as chest pain. He explained that when the MRP was reviewing the case, “we were kind of taken back that this even happened, and we had - - we were saying in the panel this has to be something else that set this up, maybe she was genetically apt to it or something else that could cause this because it's usually not seen.” On cross-examination, Dr. Wiedemann stood by the decision of the MRP that Dr. Plaisance breached the standard of care insofar as his discharge of Andrea without controlled blood pressure for 24 hours.

Dr. Plaisance testified on his behalf. He referred to records from Andrea's previous obstetrician, Dr. Agena,⁸ who initially confirmed her pregnancy, pointing out that while Andrea reported a history of hypertension to Dr. Agena, she failed to do so on her initial visit with Dr. Plaisance. He further recognized that there were “some elevated readings on her chart” from her primary care doctor as well. Dr. Plaisance testified about Andrea's prenatal visits, admission to the hospital, diagnosis of preeclampsia, and emergency cesarean section. He followed with a history of her care postpartum, explaining that on May 16th and 17th of 2015, he was at Andrea's bedside, found her without complaints, ambulating, and recovering appropriately with continued blood pressure monitoring and medication. On May 14th, 15th, and 16th, the medical records reflect Andrea denied having chest pain. Regarding his decision to discharge Andrea, Dr. Plaisance noted her lack of other complaints and that she was ambulating without difficulty, tolerating her diet, and taking her medication. Dr. Plaisance stated:

[Andrea's] blood pressures were not ideal, but we, at that time, worked on blood pressure control to prevent emergency. And with her blood pressures in a stable status, meaning not spiking up to severe, elevated areas, or having end organ damage or symptoms, I thought from what I knew that she was a reliable patient, they would be able to go home and report back to me any problems, that's always something we want to make sure.

Dr. Plaisance testified that he did not recall having any conversation with Randy, Jr. at the time of discharge. Dr. Plaisance testified that he saw Andrea in the NICU at Mae's bedside on more than one occasion and she appeared to be recovering appropriately for a cesarean patient. When questioned about an unusually high blood pressure reading taken post discharge by an NICU nurse, Dr. Plaisance opined that Andrea's high blood pressure may have been caused by her failure to take the Labetalol as prescribed. Dr. Plaisance testified that obstetricians were the experts in treating preeclampsia and would not normally consult another specialist. He explained that in pregnant women, as opposed to older chronically hypertensive patients, the goal was to control the high blood pressure and not dramatically decrease the pressure. On cross-examination, Dr. Plaisance conceded that there was no evidence of alcohol or drug use by Andrea during her pregnancy prior to her death.

The final witness for Dr. Plaisance was Dr. Victor Todesco, IV, who testified as an expert in cardiovascular/thoracic surgery. Dr. Todesco first noted that aortic dissection in pregnancy is extremely rare and not always tied to high blood pressure, as it is in elderly patients. Based on his research, Dr. Todesco agreed “that a physician of any specialty would not be able to foresee an aortic dissection in [Andrea's circumstance].” Dr. Todesco then read into the record and to the jury his affidavit executed after his review of this case. Dr. Todesco opined that because of the extreme rarity of an aortic dissection in a young, healthy patient, and considering the lack of familial connective tissue disorder or additional risks factors presented by Andrea, Dr. Plaisance “could not have anticipated or prevented her death after discharge due to an aortic dissection.”

On cross-examination, Dr. Todesco acknowledged that he was not challenging the MRP opinion that Dr. Plaisance breached the standard of care by discharging Andrea without controlled blood pressure for 24 hours.

On this evidence, the jury determined Andrea to be 75 percent at fault and allocated 25 percent fault to Dr. Plaisance. Damages were awarded as set forth hereinabove.

DISCUSSION

In their first assignment of error on appeal, Dr. Plaisance and the PCF argue that the trial court legally erred by allowing Dr. Kraut, an expert in general surgery and critical care medicine, to testify regarding the timing of Andrea's aortic dissection and causation. Dr. Plaisance and the PCF argue that the trial court committed legal error in allowing Dr. Kraut's testimony, thus a de novo review is warranted. The PCF also argues that Dr. Kraut was not competent to render an opinion on the breach of the standard of care or causation in this case because he is a critical care physician, not an expert in obstetrics and gynecology.

In assignment of error number two, Dr. Plaisance and the PCF challenge the jury verdict, arguing that the plaintiff failed to prove by a preponderance of the evidence the applicable standard of care, a breach thereof by Dr. Plaisance, and a causal connection between the alleged breach and the resulting injuries. Thus, they submit that the jury verdict is unsupported by the evidence and should be reversed.

In a third assignment of error, the PCF challenges as excessive the damages awarded by the jury.

Standard of Review/Evidentiary Issues

Generally, the trial court is granted broad discretion in making evidentiary rulings, including the admission and scope of expert testimony, and its determinations will not be disturbed on appeal absent a clear abuse of discretion. Robinson v. Pelican Waste & Debris, LLC, 2023-0943 (La. App. 1 Cir. 09/03/24), 394 So. 3d 893, 898, writ denied, 2024-01208 (La. 12/11/24), 396 So. 3d 961; Giavotella v. Mitchell, 2019-0100 (La. App. 1 Cir. 10/24/19), 289 So. 3d 105 8, 1069-70, writ denied, 2019-01855 (La. 01/22/20), 291 So. 3d 1044. However, if a trial court commits evidentiary error such that the jury verdict is tainted, the appellate court then conducts a de novo review. See McLean v. Hunter, 495 So. 2d 1298, 1304 (La. 1986). Absent a prejudicial error of law, this Court is generally precluded from reviewing the appellate record de novo. See Rosell v. ESCO, 549 So. 2d 840, 844 n.2(La. 1989). Thus, alleged evidentiary errors are addressed first on appeal. Devall v. Baton Rouge Fire Department, 2007-0156 (La. App. 1 Cir. 11/02/07), 979 So. 2d 500, 502.

It is well established that to meet the burden of proof in a medical malpractice action, the plaintiff generally is required to produce expert medical testimony. Methvien v. Our Lady of the Lake Hospital, 2022-0398 (La. App. 1 Cir. 11/04/22), 3 54 So. 3d 720, 724. The decision to admit or exclude expert testimony in ruling on a motion in limine is within the sound discretion of the trial court, and its judgment will not be disturbed by an appellate court unless it is clearly erroneous. See Foster v. Rosas, 2012-1218 (La. App. 1 Cir. 03/22/13), 2013 WL 1189326, *1 (unpublished) citing Devall, 979 So. 2d at 503. See also Certain Underwriters at Lloyd's London v. United States Steel Corp., 2019-1730 (La. 01/28/20), 288 So. 3d 120, 121-22.

The qualifications of an expert in a medical malpractice case are governed by La. R.S. 9:2794. If the proposed expert “has knowledge of accepted standards of medical care for the diagnosis, care, or treatment of the illness, injury, or condition involved in the claim” and “is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of care” he or she may qualify to testify regarding a breach of the standard of care. La. R.S. 9:2794 (D)(1)(b) and (c).

Once a witness is qualified, the admissibility of expert testimony is governed by La. C.E. art. 702, which at the time of trial in this matter provided, in pertinent part:⁹

A. A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

(1) The expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine at fact in issue;

(2) The testimony is based on sufficient facts or data;

(3) The testimony is the product of reliable principles and methods; and

(4) The expert has reliably applied the principles and methods to the facts of the case.

Article 702 creates a five-element test to determine the admissibility of expert testimony.¹⁰ The first element requires the expert witness to be qualified as an expert by knowledge, skill, experience, training, or education. Failure of the witness to qualify as an expert pursuant to the introductory paragraph of Article 702(A) or failure of the testimony to meet any of the indicia of reliability or relevancy set forth in Article 702(A)(1) through (A)(4) will render the testimony inadmissible. Crawford v. Ordoyne, 2024-0716 (La. App. 1 Cir. 03/20/25) 410 So. 3d 998, 1006; Williams v. State Farm Mutual Automobile Insurance Company, 2020-0787 (La. App. 1 Cir. 03/11/21), 322 So. 3d 795, 798, citing, Blair v. Coney, 2019-00795 (La. 04/03/20), 340 So. 3d 775, 779.

The trial court performs the important gatekeeping role of ensuring that any and all scientific testimony or evidence admitted is not only relevant, but reliable. See Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 597, 113 S.Ct. 2786, 2798, 125 L.Ed.2d 469 (1993). The factual basis for an expert's opinion determines the reliability of the testimony. The trial court's inquiry must be tied to the specific facts of the particular case. Carrier v. City of Amite, 2008-1092 (La. App. 1 Cir. 02/13/09), 6 So. 3d 893, 897, writ denied, 2009-0919 (La. 06/05/09), 9 So. 3d 874.

With reference to the evidentiary challenges set forth on appeal, this Court must consider whether the particular rulings complained of were erroneous and whether the error was prejudicial, for unless it is, reversal is not warranted. Brumfield v. Guilmino, 93-0366 (La. App. 1 Cir. 03/11/94), 633 So. 2d 903, 911, writ denied, 94-0806 (La. 05/06/94), 637 So. 2d 1056. Moreover, the party alleging error has the burden of showing the error was prejudicial to his case. Id.

We first address the PCF's argument that Dr. Kraut should have been precluded from testifying “on the grounds that his area of expertise is general surgery only” and his “testimony on the applicable standard of care for obstetrics/gynecology [were] unsupported and baseless.” The plaintiff maintains that Dr. Kraut's testimony was properly admitted and weighed by the jury. We agree. Trial courts are generally given wide discretion in determining whether a question or subject falls within the scope of an expert witness's field of expertise. Landry v. Doe, 2019-0880 (La. App. 1 Cir. 06/26/20), 307 So. 3d 1064, 1075, writs denied, 2020-00952, 2020-00948 (La. 10/20/20), 303 So. 3d 313, 316. Upon our review of the record, we find that the trial court did not abuse its vast discretion in permitting Dr. Kraut to testify as to the cause of Andrea's aortic dissection. Contrary to the argument of the PCF, as a double board-certified critical care physician and general surgeon, Dr. Kraut appropriately testified within his field of expertise. Dr. Kraut testified that treatment of Andrea's hypertension and subsequent aortic dissection are conditions falling within the critical care medicine specialty, notwithstanding that she was postpartum and had been preeclamptic.¹¹ Dr. Kraut expressly declined to give an opinion as to an OB/GYN standard of care or breach thereof. Indeed, the MRP opinion cites “discharge [of] a post-partum patient with uncontrolled hypertension for a period of less than 24 hours” as the breach of the standard of care by Dr. Plaisance. Dr. Kraut opined about Dr. Plaisance's negligent management of Andrea's hypertension, not Dr. Plaisance's obstetric care of his patient. The PCF's argument is without merit.

Dr. Plaisance and the PCF further argue that Dr. Kraut improperly based his opinion on the erroneous assumption that Andrea had chest pain in the hospital, relying solely on the testimony of Randy, Jr. They contend this finding was contrary to the medical records, which reveal that Andrea repeatedly denied having chest pain while in the hospital. Dr. Kraut's reliance on Randy, Jr.’s testimony that Andrea experienced chest pain goes to the weight of the testimony as determined by the trier of fact. Questions of credibility are for the trier of fact, even when applied to expert testimony. Ryan v. Zurich Am. Ins. Co., 2007-2312, (La. 07/01/08), 988 So. 2d 214, 222. This rule “applies to the evaluation of expert testimony, unless the stated reasons of the expert are patently unsound,” which, as earlier stated, is not the case herein. See Patrick v. Center for Restorative Breast Surgery, LLC, 2022-0550 (La. App 4 Cir. 09/22/22), 348 So. 3d 176, 181. In Blair, the Supreme Court explained:

The relaxation of the usual requirement that a witness have firsthand knowledge and the permission granted to an expert to express opinions not based on firsthand knowledge or observation “is premised on an assumption that the expert's opinion will have a reliable basis in the knowledge and experience of the discipline.” Indep. Fire Ins. Co. v. Sunbeam Corp., 99-2181 (La. 02/29/00), 755 So. 2d 226 (citing Daubert, 509 U.S. at 591-92, 113 S. Ct. 2786). On the other hand, we recognize that “[v]igorous cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence.” Daubert, 509 U.S. at 596, 113 S. Ct. 2786.

Blair, 340 So. 3d at 781. See also Robinson, 394 So. 3d at 900. In this regard, we would be remiss not to point out that while the medical records indicate that Andrea denied chest pain while in the hospital, she did complain of a “pounding” in her chest and a headache.

Dr. Plaisance and the PCF further challenge, as speculative and unreliable, Dr. Kraut's testimony regarding the fact that had Dr. Plaisance consulted a specialist regarding management of Andrea's hypertension, she would have been less likely to suffer from aortic dissection. According to Dr. Plaisance and the PCF, the trial court committed legal error by failing to properly apply Article 702 and allowing Dr. Kraut's testimony on causation. They further argue that much of Dr. Kraut's testimony was guesswork, not based on sufficient facts or data, and misled the jury in violation of La. C.E. art. 403.¹²

We conclude the trial court was within its discretion in permitting Dr. Kraut's opinion that Dr. Plaisance should have consulted a specialist when Andrea's blood pressure was not responding to the treatment provided. Such an opinion was within Dr. Kraut's expertise, properly admitted, and appropriately weighed by the jury.

Dr. Kraut was subject to vigorous cross-examination on these and other points argued by Dr. Plaisance and the PCF. Credibility determinations were then made by the jury. Having concluded that the trial court did not abuse its vast discretion in admitting the testimony of Dr. Kraut, we consequently find that the jury did not err in relying on such testimony in rendering its verdict. This assignment of error is without merit.

Jury Verdict

Liability/Allocation of Fault

Dr. Plaisance argues that the plaintiff failed to prove causation and, thus the jury verdict must be reversed, finding him zero percent at fault. The PCF further submits that “[e]ven with Dr. Kraut's testimony, Plaintiff failed to present any evidence of any identifiable breach in the OB/GYN standard of care by Dr. Plaisance” and that the jury's general damage award was clearly excessive and must be reversed.

To establish a claim for medical malpractice, a plaintiff must prove the following by a preponderance of the evidence: (1) the standard of care applicable to the defendant; (2) the defendant breached that standard of care; and (3) there was a causal connection between the breach and the resulting injury. See La. R.S. 9:2794(A); See also Schultz v. Guoth, 2010-0343 (La. 01/19/11), 57 So. 3d 1002, 1006; Pfiffner v. Correa, 94-0924 (La. 10/17/94), 643 So. 2d 1228, 1233; McKay v. Hosp. Serv. Dist. No. 1 of Tangipahoa Par., 2023-1244 (La. App. 1 Cir. 10/11/24), 405 So. 3d 869, 874.

Where the testimony of expert witnesses differs, it is the responsibility of the trier of fact to determine which evidence is the most credible. Sistler v. Liberty Mutual Ins. Co., 5 5 8 So. 2d 1106, 1111 (La. 1990). The trier of fact may accept or reject any expert's opinion, in whole or in part, and may substitute its common sense and judgment for the expert's opinion when the substitution appears warranted on the record as a whole. Johnston v. Vincent, 2021-01196 (La. 02/01/23), 359 So. 3d 896, 916. If the trial court's findings are reasonable in light of the record reviewed in its entirety, the court of appeal may not reverse, even if convinced that had it been sitting as trier of fact, it would have weighed the evidence differently. Johnston, 459 So. 3d at 917.

Under Louisiana's comparative fault regime, “in any action for damages where a person suffers injury, death, or loss, the degree or percentage of fault of all persons causing or contributing to the injury, death, or loss shall be determined, regardless of whether the person is a party to the action or a nonparty.” La. C.C. art. 2323(A). See also, Landry 307 So. 3d at 1080-81. The trier of fact is owed great deference in its allocation of fault, and such allocation should be affirmed unless it is manifestly erroneous or clearly wrong. Blake v. City of Port Allen, 2014-0528 (La. App. 1 Cir. 11/20/14), 167 So. 3d 781, 790.

As described herein, the jury was presented with the MRP opinion finding Dr. Plaisance breached the standard of care in his management of Andrea's postpartum hypertension and by discharging her before her high blood pressure was controlled. In addition, the jury heard conflicting testimony from expert witnesses and assigned varying weight and credibility within its discretion. After a thorough review of the record, we find no manifest error in the jury's verdict finding that Dr. Plaisance breached the standard of care, which contributed to Andrea's death by aortic dissection. Nor do we find the jury's allocation of 25 percent fault to Dr. Plaisance to be manifestly erroneous. It is notable that, although the jury credited the MRP opinion and the testimony of the plaintiff's experts on the issues of standard of care, breach, and causation, the jury was also mindful of the evidence presented by Dr. Plaisance, which reflected in its allocation of fault in this case.

General Damages

The PCF asserts that the general damages awarded by the jury are excessive and inconsistent with prior verdicts in cases involving similar injuries. The PCF cites cases where children received lower general damage awards than the instant case.¹³ Plaintiff maintains that the jury's general damage award of $1,200,000 and $2,200,000 awarded to Randy, III and Mae, respectfully, was within its discretion and the amounts were appropriate given the tragic circumstances. We agree.

Much discretion is left to the trier of fact in the assessment of general damages. See La. C.C. art. 2324.1. Even so, general damage awards must not be the result of passion or prejudice and should bear a relationship to the elements of proved damages. See Barber Brothers Contracting Company, L.L.C. v. Capitol City Produce Company, L.L.C., 2023-0788 (La. 12/19/24), 397 So. 3d 404, 408. To reduce a factfinder's award, a reviewing court must conclude from the entirety of the evidence in the light most favorable to the plaintiff, that a rational trier of fact could not have fixed the awards of general damages at the level set by the factfinder or that this is one of those “exceptional cases where such awards are so gross as to be contrary to right reason.” Id. (citing Davis v. Hoffman, 2000-2326 (La. App. 4 Cir. 10/24/01), 800 So. 2d 1028, 1030, quoting Bartholomew v. CNG Producing Co., 832 F. 2d 326, 331 (5th Cir. 1987).

In Pete v. Boland Marine and Manufacturing Company, LLC, 2023-00170 (La. 10/20/23), 379 So. 3d 636, 641-650, the Louisiana Supreme Court explained that “the question of whether the trier of fact abused its discretion in assessing the amount of damages remains the initial inquiry. However, to evaluate this issue, an appellate court is to include a consideration of prior awards in similar cases, as well as the particular facts and circumstances of the case under review.” Id. at 644. If an abuse of discretion is found, the court is to then also consider those prior awards to determine “the highest or lowest point which is reasonably within that discretion.” Id. at 644, citing Jones v. Market Basket Stores, Inc., 2022-00841 (La. 03/17/23), 359 So. 3d 452, 464. Further, “No two cases will be identical.” Pete, 379 So. 3d at 64.¹⁴ Following Pete, we look to Louisiana jurisprudence.¹⁵

In Stauder v. Shell Oil Co., 22-0593, 409 So. 3d 1, 2 (La. App. 4 Cir. 06/03/24), writ denied, 2024-00860 (La. 04/23/25), 406 So. 3d 1175, the father was diagnosed with mesothelioma and subsequently died as a result of the condition. Wrongful death actions were brought by the decedent's daughters, and the court upheld the jury's awards of general damages of $2,750,000 for each daughter. Id. at 8. In Rachal v. Brouillette, 2012-794, (La. App. 3 Cir. 03/13/13), 111 So. 3d 113 7, 1140, writ denied, 2013-0690 (La. 05/03/13), 113 So. 3d 217, a father filed a wrongful death action on behalf of his minor son, against a motorist that killed the mother. In that case, the court did not disturb the $2,500,000 in general damages and found that following his mother's death the son “endured severe physical and mental trauma as a result of this tragedy.” Id. at 1143. See also Brown v. State ex rel. LSU Med. Ctr. Health Care Servs. Div., 2008-273 (La. App. 3 Cir. 12/10/08), 998 So. 2d 367, writ denied, 2009–72 (La. 03/06/09), 3 So. 3d 491 (where the court did not disturb the $725,000 in general damages for a woman who brought a medical malpractice claim for a hysterectomy performed). Looking at the jurisprudence, we find that past awards anchor the jury's general award in the case at bar.

We find there was sufficient evidence presented to support the damage award to two minor children who suddenly lost their mother after giving birth. As noted in Stauder, 409 So. 3d at 8 that “[l]arge wrongful death awards have often been upheld on appeal in Louisiana courts where the decedent ․ and minor children had extraordinarily close and loving relationships.” The jury heard testimony from Randy, Jr. stating he does his best to fill the void left by Andrea, but Randy, III, who suffers from mental disabilities, has been unable to bond with anyone like he did with his mother. Randy, III faces tremendous difficulties in his life and now faces them without his closest parent. Diane Vicknair testified that her disability limits what she can do for Mae. The record paints Mae as an engaging young child who is curious about her mother whom she will never meet. Considering Andrea's devastating death and the life altering loss to these young children, and given the much discretion afforded to the trier of fact, we cannot say that the jury abused its discretion. The evidence presented at trial supports the awards under these specific circumstances, and we do not find that it exceeds the highest reasonable awards in similar cases. Accordingly, we find no abuse in discretion and affirm the general damage award.

CONCLUSION

For the foregoing reasons, the trial court's January 29, 2024 judgment is affirmed. Costs of this appeal in the amount of $16,906.75 are assessed one-half to defendant-appellant, Dr. Kevin M. Plaisance, and one-half to intervenors-appellants, the Louisiana Patient's Compensation Fund and the Louisiana Patient's Compensation Fund Oversight Board.

AFFIRMED.

I respectfully dissent from the majority's affirmance of the wrongful death awards to the two minor children totaling $3,400,000. No unique or extraordinary circumstances exist in this case to justify wrongful death awards of this magnitude, when compared to similar decisions.

Although it is impossible to place a monetary value on the life of a person, our jurisprudential system has established that a monetary award is the appropriate remedy to one who has suffered the loss of a loved one as a result of the fault of another. Glaser v. Hartford Fire Insurance Company, 2022-0534 (La.App. 1 Cir. 8/30/23), 375 So.3d 479, 493, writ denied, 2023-01346 (La. 1/10/24), 376 So.3d 130. While much discretion is afforded the trier of fact in the award of general damages, such discretion is not unfettered. Pete v. Boland Marine and Manufacturing Company, 2023-0170 (La. 10/20/23), 379 So.3d 636, 641. In determining “whether a trier of fact abused its discretion in its award for general damages, an appellate court is to consider the particular facts and circumstances of a case, in conjunction with a review of prior awards. This applies to claims of excessiveness as well as insufficiency in an award.” Id. at 644. Pete provides a two-step analysis for appellate review of a damage award: (i) determining whether abuse of discretion occurred by examining the particular facts and circumstances of the case under review while including a “consideration of prior awards in similar cases,” and (ii) if abuse of discretion is found, “the court is to then also consider those prior awards to determine ‘the highest or lowest point which is reasonably within that discretion.’ ” Barber Brothers Contracting Company, LLC v. Capitol City Produce, LLC, 2023-00788 (La. 12/19/24), 397 So.3d 404, 409, citing Pete, 379 So.3d at 644.

The only case cited by the majority that involved a minor child's general damage award for the wrongful death of a parent is Rachal v. Brouillette, 2012-794, (La.App. 3 Cir. 03/13/13), 111 So. 3d 1137, 1143, writ denied, 2013-0690 (La. 05/03/13), 113 So. 3d 217. In Rachal, a majority of my colleagues on the Third Circuit Court of Appeal affirmed an award of $2,500,000 for a minor son's loss of his mother. However, two judges dissented from the en banc panel's affirmance of the general damage award. Judge Conery stated in his dissent, referencing Raymond v. Gov't Employees Ins. Co., 2009-1327 (La.App. 3 Cir. 6/2/10), 40 So.3d 1179, writ denied, 2010-1569 (La. 10/8/10), 46 So.3d 1268, that $750,000 was the “highest award ever affirmed by a Louisiana appellate court for the wrongful death of a parent on behalf of a minor child.” Rachal, 111 So.3d at 1149. Considering the award in Raymond, along with other prior awards, Judge Conery indicated that he would have reduced the award to $750,000 as the highest award that was within the factfinder's discretion. Id.

The majority also cites Stauder v. Shell Oil Company, 2022-0593 (La.App. 4 Cir. 6/3/24), 409 So.3d 1, 6, writ denied, 2024-00860 (La. 4/23/25), 406 So.3d 1175, wherein the fourth circuit affirmed a $2,750,000 damage award for two adult daughters for the wrongful death of their father who died of mesothelioma. The Stauder court, after citing numerous cases with significantly smaller awards made to adult children, acknowledged that its award “is substantially greater than the range of jurisprudential awards,” but averred that the extraordinary award was warranted “under the unique facts presented at trial ․ detailing the devastating effects Mr. Stauder's extended and debilitating illness has had on both his daughters.” Id. Cf. Glaser, 375 So.3d at 495 (award of $1,500,000 each to seven adult children for the loss of their 89-year-old father was an abuse of discretion and this court reduced the award to $500,000 each); and Chaisson v. Avondale Indus., Inc., 2005-1511 (La.App. 4 Cir. 12/20/06), 947 So.2d 171, writ denied, 2007-0411 (La. 4/5/07), 954 So.2d 145 (awards of $562,000 each to two adult children whose mother died nine months after a mesothelioma diagnosis was not an abuse of discretion).¹

In comparison to the cases cited by the majority, the court in McGrail v. Lee, 35,756 (La.App. 2 Cir. 4/3/02), 814 So.2d 729, writ granted, 2002-1496 (La. 10/4/02), 826 So.2d 1110, order recalled, 2002-1496 (La. 4/9/03), 874 So.2d 66, and writ denied as improvidently granted, 2002-1496 (La. 4/9/03), 874 So.2d 66, affirmed an award of $750,000 each in wrongful death damages to two adult sons (ages 18 and 21) and a nine-year-old daughter following the death of their mother. In affirming the awards, the second circuit indicated that “these awards approach, but do not exceed, the highest amount reasonably within the broad discretion in assessing damages.” Id. at 736.

Also, in Maldonado v. Kiewit Louisiana Co., 2012-1868 (La.App. 1 Cir. 5/30/14), 152 So.3d 909, 939, writ denied, 2014-2246 (La. 1/16/15), 157 So.3d 1129, this court found that the jury abused its discretion in awarding $3,000,000 each to two minor children who were seven and three on the date of their father's death. This court recognized that the children “face a future without their father's affection, care, assistance and advice,” but concluded that $450,000 “is the highest amount the jury could have reasonably awarded to each minor child[.]” Id. See also Scott v. Pyles, 1999-1775 (La.App. 1 Cir. 10/25/00), 770 So.2d 492, 505, writ denied, 2000-3222 (La. 1/26/01), 782 So.2d 633, wherein this court reduced awards of $750,000 and $500,000 to $500,000 and $400,000 to a 13-year-old and 10-year-old, respectively, for the loss of their father as “the highest amounts within the [factfinder's] reasonable discretion.” See further Estate of Francis v. City of Rayne, 2007-359 (La.App. 3 Cir. 10/3/07), 966 So.2d 1105, 1117, writ denied, 2007-2119 (La. 2/15/08), 976 So.2d 176 (award of $650,000 to a minor who was 10 years old at the time of trial for wrongful death of his father is “in the upper range of permissible awards,” but not an abuse of discretion); Brossett v. Howard, 2008-535 (La.App. 3 Cir. 12/10/08), 998 So.2d 916, 934, writ denied, 2009-0077 (La. 3/6/09), 3 So.3d 492 (no abuse of discretion in the award of $500,000 to a nine-month-old for wrongful death of their father); Monk v. State ex rel. DOTD, 2005-97 (La.App. 3 Cir. 6/29/05), 908 So.2d 688 (award of $500,000 each to three minor children for wrongful death of their mother was not an abuse of discretion); and Horton v. Blackrock Aggregates, L.L.C., 2015-1095, 2015-1096 (La.App. 4 Cir. 3/8/17), 213 So.3d 429, 446 (awards of $350,000 and $500,000 to 13-year-old daughter and 7-year-old son, respectively, for the loss of their father was not “so unreasonable as to constitute an abuse of discretion”).

In this case, testimony was presented of the close emotional connection Andrea had with her son, Randy, III, prior to her death. Randy, III, who was 10 years old at the time of Andrea's death and 18 years old at the time of trial, had been diagnosed with “pervasive developmental disorder not otherwise specified” and schizoaffective disorder. As noted by the majority, no one has been able to fill the void left by his mother, and Randy, Jr. testified that Randy, III has “just gone on a decline ever since she's died[.]” As to the minor daughter, Mae, she was only 9 days old when her mother died, and her father and paternal grandmother have raised her since that time. Unlike Randy, III, who had a very close emotional bond with his mother, Mae had not yet had the opportunity to establish the same bond. Randy, Jr. testified that he tries his best, but it is difficult because he is “not really sure what [little girls] like to do.” Although Mae's paternal grandmother plays a significant role in her life, she acknowledges that she is unable to do “as much as [she] would like for [Mae]” given her age and health.

Based on the particular facts and circumstances of this case in light of prior awards in similar cases, and considering the dates those decisions were rendered, I find that the jury abused its discretion in awarding $1,200,000 to Randy P. Vicknair, III and $2,200,000 to Mae Bella Vicknair. Accordingly, I would reduce the award to Randy P. Vicknair, III for the wrongful death of his mother to $900,000 and the award to Mae Bella Vicknair for the wrongful death of her mother to $850,000, the highest reasonable awards within the factfinder's discretion.

FOOTNOTES

1.   In a companion case, Dr. Plaisance appeals the taxing of costs against him. See Vicknair v. Plaisance, et al, 2024-1169 (La. App. 1. Cir. --/--/--), _ So. 3d _ (also decided this date). The two appeals were consolidated by this Court for argument and submission only.

2.   As explained by Dr. Eric Kraut, the plaintiff's expert in general surgery and critical care medicine, hemopericardium from an aortic dissection occurs when blood leaks out of the aorta into the sac around the heart, which is a confined space. This occurrence, also referred to as tamponade, prevents the heart from filling with blood and pumping blood to the rest of the body. The patient loses consciousness. Relief from tamponade comes from removing the blood from around the heart. Dr. Kraut's testimony is discussed in detail, infra. Dr. Jonathon Arden, forensic pathologist, testified that aortic dissection is a “particular type of splitting or separation of the wall of the aorta, which is the largest artery in the body ․ which allows the bleeding․ collected in the sac around the heart and basically strangles the heart, if you will.” Dr. Arden's testimony is also discussed in further detail, infra.

3.   On March 8, 2019, the trial court granted the plaintiff's motion to dismiss the hospital as a defendant.

4.   The only motion in limine granted by the trial court was to limit the testimony of Dr. Plaisance's expert, Dr. Rachel Reitan, to testimony within her field of expertise, obstetrics and gynecology, and disallowing her testimony as to causation. All other expert witness testimony was held to be admissible.

5.   The plaintiff did not request special damages.

6.   Hypertensive emergency is defined by the American Congress of Obstetricians and Gynecologists (ACOG) as a systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure ≥ 110 mm Hg persisting ≥ 15 minutes in the antepartum, intrapartum, or postpartum period.

7.   The plaintiff notes in its original brief that Dr. Reitan was prohibited from testifying as to causation by the trial court's ruling granting its motion in limine. Nonetheless, testimony was elicited from Dr. Reitan regarding causation contrary to the trial court's ruling. However, no objection was made regarding the testimony at trial.

8.   The record does not indicate a first name.

9.   Louisiana Code of Evidence article 702 was amended by La. Acts 2024, No. 88, § 1, effective August 1, 2024. The amendments did not change the law, but brought the language of the article into alignment with Rule 702 of the Federal Rules of Evidence. See La. C.E. art. 702 comments - 2024.

10.   Dr. Plaisance argues that an earlier 2014 revision to Article 702 added two substantive requirements for expert testimony to the pre-revision trio of requirements recognized by the Supreme Court in Cheairs v. State, 2003 (La. 12/03/03), 681 So. 2d 536. On the contrary, the revision merely enumerated five criteria, all of which were subsumed in the Cheairs and Daubert analyses. See Blair v. Coney, 2019-00795 (La. 04/03/20), 340 So. 3d 775, 780-81.

11.   Dr. Kraut testified that in his experience as a critical care physician, he had been involved in the treatment of several aortic dissection patients involving pregnancy. However, to the extent Dr. Plaisance and the PCF complain that Dr. Kraut was not an expert in obstetrics, we note that, generally, the fact that a medical doctor is not a specialist in a particular field applies only to the effect or the weight to be given such testimony, not to its admissibility. Howard v. United Servs. Auto. Ass'n, 14-1429 (La. App. 1 Cir. 07/22/15), 180 So. 3d 384, 398, writ denied, 2015-1595 (La. 10/30/15), 179 So. 3d 615; Pennington v. Ochsner Clinic Found., 2017-0647 (La. App. 4 Cir. 04/25/18), 245 So. 3d 58, 65, writd denied, 18-1034 (La. 10/08/18), 253 So. 3d 791, 2018-1020 (La. 10/08/18), 253 So. 3d 801. See also Denton v. Vidrine, 2006-0141 (La. App. 1 Cir. 12/28/06), 951 So. 2d 274, 285, writ denied, 2007-0172 (La. 05/18/07), 957 So. 2d 152 (wherein a physician, who was not a neurologist or vascular surgeon, was permitted to testify as to the causation of a plaintiff's post-accident stroke); Hunter v. Bossier Medical Center, 31-026 (La. App. 2 Cir. 09/25/98), 718 So. 2d 636, 644 (wherein the court found it was not error for the trial court to allow a general surgeon to testify as to an orthopedic procedure); Williams v. State Farm Mut. Auto. Ins. Co., 2020-248 (La. App. 5 Cir. 02/17/21), 314 So. 3d 1010, 1019, writ denied, 2021-00402 (La. 05/11/21), 315 So. 3d 871(wherein a general surgeon who had experience treating stroke patients was permitted to testify regarding the cause of a patient's stroke though he was not board certified in neurology or vascular surgery).

12.   Louisiana Code of Evidence article 403 provides:Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, or waste of time.

13.   In Welch v. Willis-Knighton Pierremont, 45,554 (La. App. 2 Cir. 11/17/10), 56 So 3d 242, writs denied, 2011-0075, 2011-0109 (La. 02/25/11), 58 So. 3d 457, 459, the award was to an adult daughter. In Moss v. State, 2007-1686 (La. App. 1 Cir. 08/08/08), 993 So. 2d 687, writ denied, 2008-2166 (La. 11/14/08), 996 So. 2d 1092, the plaintiffs appealed the amount of the wrongful death damage awards, which they contend were abusively low. This court agreed, and found that the lowest reasonable amounts that could be awarded to the adult children was $100,000 and amended the judgment accordingly. And, in Shilling ex rel. Shilling v State ex rel. Dept of Transp. & Dev., 2005-0172 (La. App. 1 Cir. 12/22/05), 928 So. 2d 95, writ denied, 2006-0151 (La. 04/24/06), 926 So. 2d 541, this Court found that the award of to a 4-year-old was not abusively low given the total sum award for the wrongful death of a father, who was fatally injured when he drove off the roadway into a roadside ditch, including $145,000 for lost financial support, $11,620.85 for funeral and burial expenses, in addition to the $70,000 specifically designated as wrongful death damages.

14.   In Pete, the supreme court granted certiorari to address the issue of quantum. More specifically, whether the jury's award of approximately $10 million in general damages to the plaintiff, who developed mesothelioma as a result of his exposure to asbestos, was excessive. The Pete Court ultimately found that based on the evidence adduced at trial, $5,000,000 was a more reasonable amount. Id. at 644.

15.   The dissent relies on several pre-Pete jurisprudence that are all distinguishable based on the “particular facts and circumstances of the case under review.” Pete, 379 So. 3d at 644. Further, we note the majority of cases cited by the dissent are at least ten years old, and “equity would demand” we consider the possible effect of inflation on a similar general damage award made today. See Barr v. Smith, 631 So.2d 76, 78-79, n.1 (La. App. 2nd Cir.), writ denied, 637 So. 2d 466 (La. 1994).

1.   Recently, the Fifth Circuit affirmed a $700,000 award to two adult daughters for the wrongful death of their 83-year-old mother. See Perry v. Employers Insurance of Wausau, 24-535 (La.App. 5 Cir. 8/6/25), --- So.3d ---, 2025 WL 2233825. In a dissenting opinion, Judge Schlegel indicated that he would have lowered the award to $500,000 each because there were no “extraordinary or unique circumstances regarding the relationship they had with their mother or the effect her death had on their lives” to warrant “a high-end wrongful death award.” 2025 WL 2233825 at *21.

BALFOUR, J.

McClendon, C.J. dissents in part for reasons assigned.