## Facts

- Daryl Manning, age 67, had end-stage chronic obstructive pulmonary disease (COPD) and was admitted to the hospital on April 17, 1987, with marked hypoxemia and increased CO₂ retention.
- For two years before admission, he required continuous supplemental oxygen and had a history of life-threatening COPD exacerbations.
- His physician advised the family that death was imminent; at the family’s request, he was designated a “no code” patient, meaning no resuscitation or ventilator support if he arrested.
- Blood gas testing after admission showed continued deterioration; he was extremely weak, could not sleep, and could not eat.
- On April 20, 1987, staff decided to move him to a private room. An arterial blood gas sample was drawn immediately before the attempted transfer; results later reflected a condition very near the point at which life could not be sustained.
- Plaintiffs alleged negligent nursing care during the attempted transfer and related events caused or hastened Manning’s death and caused family emotional distress.
- After the death, the hospital investigated, concluded the nurses were not negligent, imposed no discipline, retained the nurses, and later revised policies aimed at preventing recurrence.
- A jury awarded plaintiffs compensatory damages for wrongful death, emotional distress damages, and punitive damages against both the hospital and nurse Virginia L. Anderson.

## Issues

1. Whether the evidence supported punitive damages against nurse Anderson under Idaho’s standard requiring an extreme deviation from reasonable conduct and conscious disregard of likely harm.
2. Whether the hospital could be assessed punitive damages based on “ratification” of the nurses’ conduct where it did not discipline or discharge them after the incident and retained them following an internal investigation.

## Decision

- The compensatory (wrongful death) and emotional distress awards were affirmed.
- The punitive damages award against nurse Anderson was affirmed.
- The punitive damages award against the hospital was reversed.
- The court held that a hospital’s failure to reprimand, punish, or discharge nurses after an incident, standing alone, is insufficient as a matter of law to establish ratification supporting punitive damages against the hospital.

## Legal Principles

- Punitive damages require proof of conduct constituting an extreme deviation from reasonable standards and a conscious disregard of the likely harmful consequences.
- An employer may be liable for punitive damages for an employee’s acts only if the employer authorized, participated in, or ratified the wrongful acts, or if the employer’s own conduct independently meets the punitive-damages standard.
- Post-incident retention of an employee and a decision not to discipline, without more, does not constitute ratification for punitive-damages purposes.
- Post-incident policy changes may evidence preventive intent and do not, by themselves, show approval of the alleged wrongful conduct.

## Conclusion

The court upheld the jury’s findings of negligence, causation, and emotional distress damages and sustained punitive damages against the individual nurse based on evidence of conscious disregard for a critically fragile patient, but it set aside punitive damages against the hospital because non-discipline and retention after the event, without additional proof of authorization or ratification, could not support institutional punitive liability.


Manning v. Twin Falls Clinic & Hosp., Inc., 122 Idaho 47, 830 P.2d 1185 (Idaho 1992)