BY: Brendan Kirby, Press-Register

BAY MINETTE, Alabama – The family of a Daphne woman who received a lethal dose of medicine due to an error made by workers in India hired to save money on the preparation of medical records has won a $140 million judgment.

The verdict, handed down this week in Baldwin County Circuit Court, holds Thomas Hospital and three other firms responsible for the 2008 death of Sharron Juno. It may be the richest civil verdict in the history of Baldwin County, renowned for its conservative juries.

George “Skip” Finkbohner, an attorney who represented Juno’s son, attributed the large jury award to the facts of the case.

“They’re just really egregious,” he said.

In a statement, Thomas Hospital Administrator Bill McLaughlin said the verdict was excessive and that the hospital would appeal.

“Thomas Hospital expresses our condolences for the family involved in this matter," he said in the statement. "Furthermore, we are disappointed with the jury’s decision and do not believe the verdict reflects the care and compassion provided to the patients of Thomas Hospital by its providers and staff. Thomas Hospital has served the people of Baldwin County for more than 50 years and is recognized as one of the top 100 hospitals by Thomson Reuters.”

Rodney Cate, an attorney who represented an Indian company named Medusind Solutions, said he reached a settlement with the plaintiff just before the jury rendered its verdict.

“We resolved the case before the verdict was received,” he said. “We were disappointed with the verdict, but for our purposes, it was in consequential.”

Attorneys for the other defendants could not immediately be reached for comment.

Juno, a diabetic since age 4, went to Thomas Hospital in March 2008 because the access port for her kidney dialysis became clogged. Finkbohner said the 59-year-old woman spent more than a week at the hospital and that, after returning home, developed complications. Her doctor directed her to Mercy Medical for additional treatment.

Operating from the doctor’s discharge summary and a physician admission order prepared by the hospital, Mercy Medical staffers gave Juno 80 units of Levemir insulin – 10 times the dosage prescribed by her doctor.

What followed was a four-year investigation by lawyers at Cunningham Bounds LLC that Finkbohner said revealed a combination of attempts by the hospital to cut costs by offshoring key functions and critical errors at the Fairhope institution, itself.

It began with a mistake made halfway around the world. Juno’s doctor reviewed his patient’s medical chart and certified on a form the medication and dosages that she should take. He then dictated that same information into a phone line.

In the past, a medical transcriptionist at the hospital would have written the information from the dictation onto a discharge summary. But Finkbohner said the average pay for medical transcriptionists in the United States is $19.50 an hour. A U.S company, Precyse Solutions LLC, promised to perform the work cheaper.

That company – the second-largest in the U.S. industry, according to testimony – subcontracted its work to a pair of Indian companies, Medusind Solutions in Mumbai, and Sam Tech Datasys in New Delhi. Testimony indicated that the highest-paid Indian workers make $350 per month.

As a result of the arrangement, information dictated by the doctor went via a computer in Atlanta to India, where the Medusind and Sam Tech employees prepared the discharge summary and sent it back to Thomas Hospital.

Finkbohner said the hospital saved 2 cents per line of text by using the outside firm. But he said it came at a price: Testimony indicated that the Indian firms operate under quality standards that are one half to one twelfth that of the United States in terms of acceptable error rate.

He said Precyse officials claimed that the Indian subcontractors used American standards but that officials from those companies testified that they did not.

“What you’ve got is a transcription industry in India using quality standards that are not up to U.S. standards,” he said.

Still, Finbohner said, the error never should have resulted in Juno’s death because the nurse at Thomas Hospital should have used the original document prepared by the doctor – the so-called medication reconciliation form. She testified that the original form was not available because it was being scanned.

So she used the discharge summary prepared in India and wrote the medication information onto the physician admission order containing the doctor’s signature. It made it appear as if the doctor had confirmed the information about the medication when he had not, Finkbohner said.

“It was not a valid order,” he said. “It was not an order at all.”

The medical system failed to stop the death-causing error at multiple points, Fingbohner said.

“If the transcription had been correct, there would have been no death,” he said. “If the nurse had been allowed to get the document from the records department, there would have been no death.”

Finkbohner said hospital staff generally did not know that the transcription work was not being performed in house, let alone on another continent. He said hospital administrators did not even know the names of the Indian subcontractors until he told them during a deposition.

“My suspicion is that many people know nothing about this,” he said. “The doctors certainly didn’t know.”

Finkbohner said he does not expect the $140 million verdict to stand without changes. A post-verdict settlement that would avert an appeal is possible, he said. Another option is that the plaintiff and defendants could agree to a floor and a ceiling on any outcome in the appellate courts.

Lawyers Involved: