By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News
The Georgia Court of Appeals recently upheld a $75 million jury verdict in favor of a 32-year-old plaintiff who suffered a catastrophic stroke that left him with locked-in syndrome. The plaintiff had arrived at a local hospital with seizure-like symptoms following a chiropractic neck adjustment. Despite signs pointing to a vertebral artery dissection and stroke, the defendant doctor failed to communicate key clinical details to the consulting neurologist. A radiologist also missed signs of dissection on imaging. As a result, the plaintiff’s stroke diagnosis was delayed until it was too late for meaningful intervention.
At trial, the jury found both the defendant doctor and the radiologist grossly negligent under Georgia’s emergency medical care statute. The plaintiff was awarded $75 million in damages: $9 million for past medical expenses, $20 million for future care, and $46 million for pain and suffering. The jury assigned 60% of the fault to the defendant doctor and 40% to the radiologist.
Both the plaintiff and defendants appealed on various grounds, but the appellate court rejected both appeals and affirmed the full $75 million judgment.
Background
In October 2015, the plaintiff became unresponsive during a chiropractic neck adjustment and was taken by ambulance to a local hospital. Upon arrival, the plaintiff showed signs of seizure-like activity. The defendant doctor, an emergency physician, ordered a computed tomography (CT) scan and CT angiogram. He spoke by phone with the on-call neurologist. During that phone consultation, the doctor failed to share several critical pieces of information, including that the plaintiff had undergone chiropractic manipulation just prior to collapse, that he had experienced a second seizure-like episode during a lumbar puncture, and that he showed signs of dissection in his arteries in his neck.
Later that evening, an intensive care unit (ICU) physician assistant evaluated the plaintiff and admitted him to the ICU. Overnight, the plaintiff’s condition deteriorated. The next morning, magnetic resonance imaging (MRI) confirmed a brain stem stroke. At that point, the window for intervention had closed. The plaintiff was left with locked-in syndrome — mentally alert but nearly completely paralyzed.
The plaintiff filed suit against the defendant doctor, the hospital, the radiologist, and others. He alleged that the delayed diagnosis and failure to communicate critical information amounted to gross negligence. At trial, multiple experts testified that the defendant doctor had failed to meet even the minimum standard of care by not informing the neurologist of key symptoms and radiologic findings. The jury agreed, returning a $75 million verdict.
On appeal, the defendant doctor made several arguments. He argued that the evidence did not meet the threshold for gross negligence, which requires proof of a complete absence of care. He argued that ordering diagnostic imaging and consulting a neurologist showed at least slight diligence. He also claimed the jury instructions were unclear and that his expert was improperly impeached using a prior podcast statement. He also raised a cumulative error argument, claiming that the combination of multiple trial mistakes created an unfair result.
The plaintiff also appealed, arguing that the trial court erred in applying the gross negligence standard to the ICU physician assistant, who he claimed was providing ordinary inpatient care rather than emergency treatment. He also appealed the trial court’s refusal to direct a verdict against the hospital for nursing conduct and its decision to exclude evidence about training.
The Georgia Court of Appeals rejected all of these claims. It held that the jury instructions, when read as a whole, fairly stated the law. It affirmed the trial court’s decision to allow impeachment of the defense expert using a podcast in which the expert had commented on post-treatment record alterations. The court concluded that reasonable jurors could differ and that the jury’s verdict was fully supported by the evidence. As to the plaintiff’s arguments, it found that the plaintiff remained in an emergency state when the ICU physician assistant evaluated him, and that the gross negligence standard applied.
What This Means for You
The Georgia Court of Appeals’ decision in this case highlights the demanding standard plaintiffs must meet to prevail in medical malpractice cases governed by Georgia’s emergency medical care statute. It also underscores the importance of clear communication in emergency settings and reinforces how appellate courts evaluate claims of trial error. It also offers important insight into how gross negligence is distinguished from ordinary negligence — and when a jury, not the judge, should be the final decision-maker.
Georgia law requires plaintiffs to show that a defendant acted grossly negligent for a medical claim where the care occurred in an emergency setting. Gross negligence is not simply a mistake or lapse in judgment. Under Georgia law, it means the absence of even slight diligence — the kind of conduct that demonstrates a complete disregard for the consequences. Georgia law grants emergency medical professionals these heightened legal protections to encourage rapid response without fear of routine medical malpractice litigation. But those protections are not absolute. In this case, the court affirmed that when a provider fails to take even basic, expected steps during a crisis, and that failure leads to catastrophic harm, a jury can determine the conduct crosses into gross negligence.
The court focused particularly on the defendant doctor’s failure to communicate critical findings during a phone consultation with the on-call neurologist. The doctor omitted mention of the plaintiff’s chiropractic manipulation just before the event, a second seizure-like episode that had occurred at the hospital, and signs of artery dissection in the plaintiff’s vertebrae in his neck. Each of these facts could have led the neurologist to take a more active role or recommend immediate intervention, which is what the plaintiff required. Multiple experts testified that the omission of these facts deviated from the minimum standard of emergency medical care. That expert testimony gave the jury a valid basis to conclude that the doctor failed to exercise even slight diligence, thereby meeting the gross negligence standard.
The decision also explains when a judge may remove issues from a jury’s consideration through a directed verdict. The defendant doctor sought a directed verdict on the grounds that no reasonable jury could find him grossly negligent given the steps he did take, such as ordering imaging and calling a neurologist. He argued that at a minimum he showed the “slight diligence” required under Georgia law. But the appellate court disagreed. It explained that a directed verdict is only appropriate when the facts are so one-sided that no rational juror could reach a different result. Here, the presence of expert disagreement and disputed interpretations of the medical record meant the case was properly left to the jury. This aspect of the ruling reinforces a basic tenet of civil litigation: judges decide the law, but juries decide close factual calls — especially when expert opinions differ.
From the medical perspective, neurological symptoms are rarely exactly the same from patient to patient. The variability can be enormous and difficult to pinpoint, especially when the patient and patient’s family are not able to support what should be the patient’s baseline status. The clinicians need to avail themselves of as much diagnostic testing as possible in addition to consultation with experts and specialists.
It is curious that the chiropractor, the last individual to see the patient before his condition deteriorated, was not consulted or involved. The patient was in critical condition and unstable at all times and should never have been unmonitored or unattended by critical care professionals. The MRI usually will reveal what the CT scan cannot, and if a stroke is suspected as the prevailing cause, it usually is more revealing several hours after the onset of injury. But that does not warrant a lapse in care while waiting for the result. If a radiological study result does not match the clinical picture, a second review from another radiologist is warranted. Consultants called by emergency department physicians must take into account that these doctors often have many patients, all previously unknown, with multiple possible diagnoses, perhaps multiple being in critical condition, and their only support comes from the dedicated involvement of the consultant physician. An in-person, hands-on examination by the neurologist could mitigate harm in these cases.
The court also rejected the defendant’s claim that trial errors, when considered cumulatively, required a new trial. The defendant cited multiple issues, including allegedly unclear jury instructions and the impeachment of his expert using a podcast clip in which the expert previously stated that changing records post-treatment could be a “death blow” to a case. While no single error was argued to be grounds for reversal, the defendant urged the court to consider their combined effect. The court held that cumulative error does not apply unless each underlying claim has independent merit. Because the jury instructions, when read as a whole, accurately conveyed the law — and because the impeachment was supported by genuine inconsistencies in the expert’s public statements — the court found no reversible error. This reinforces the principle that appellate courts will not piece together harmless or speculative mistakes to overturn a jury verdict.
One of the more nuanced issues in the case was the trial court’s application of the gross negligence standard to the ICU physician assistant who admitted the plaintiff later that evening. The plaintiff argued, that by the time the assistant saw him, he was already in the ICU and being treated under routine inpatient care, not emergency care. Therefore, he argued, the ordinary negligence standard — not the higher gross negligence threshold — should apply. The appellate court disagreed. It clarified that the relevant factor is the patient’s condition, not the provider’s title or physical location. Because the plaintiff was still in a medical emergency at the time, the higher standard remained in effect. This ruling is worth considering as to how parties frame their negligence theories and how courts instruct juries when multiple providers become involved over time.
Lastly, the court’s treatment of the podcast impeachment issue highlights the modern reality that experts’ public statements can be used against them at trial. The defense expert’s comments on a podcast about altered records conflicted with his trial testimony. Although he claimed the podcast was meant to be educational or entertaining, the court found it was still a valid basis for impeachment. This reinforces the idea that any publicly accessible commentary — podcasts, blogs, social media, etc. — can be fair game in litigation if it undercuts credibility or consistency. Medical professionals and facilities should closely scrutinize what is published via social media, especially when litigation is pending or imminent.
Reference
- Decided on March 10, 2025, in the Court of Appeals of Georgia, Case Nos. A24A1463 & A24A1642.
Damian D. Capozzola, Esq., The Law Offices of Damian D. Capozzola, Los Angeles
Jamie Terrence, RN, President and Founder, Healthcare Risk Services, Former Director of Risk Management Services (2004-2013), California Hospital Medical Center, Los Angeles
The Georgia Court of Appeals recently upheld a $75 million jury verdict in favor of a 32-year-old plaintiff who suffered a catastrophic stroke that left him with locked-in syndrome. The plaintiff had arrived at a local hospital with seizure-like symptoms following a chiropractic neck adjustment.
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