## Facts

- Seventeen-year-old Matthew Scott was treated at a hospital after an automobile accident and was released with minor injuries.
- Two days later, he returned to the emergency room with a severe headache; an emergency-room physician examined him and ordered a CT scan.
- A radiologist, not employed by the hospital, interpreted the CT scan as normal; Matthew was diagnosed with a mild concussion, given medication, and discharged.
- Over the next day, Matthew’s parents called the hospital multiple times reporting lethargy, nausea, and vomiting; the emergency-room physician advised continued observation and suggested the symptoms were consistent with concussion.
- The following morning Matthew collapsed with right-sided weakness; testing at another facility showed a brain infection and swelling.
- Matthew underwent multiple surgeries, remained in a coma for weeks, and suffered permanent injuries including significant right-sided paralysis.
- Matthew and his mother sued the hospital, the emergency-room physician, and the radiologist and his group; the hospital’s liability theory was vicarious liability for the physician (undisputed) and the radiologist (disputed).
- Before trial, plaintiffs settled with the radiologist and his group; the case proceeded against the hospital.
- The jury found the radiologist was an agent of the hospital, apportioned fault between the emergency-room physician and radiologist, and awarded damages to Matthew and his mother; the court reduced the judgment to account for statutory limits and the settlement credit.
- The hospital appealed, challenging agency, settlement reduction, application of noneconomic-damages caps, and rulings on damages and evidence.

## Issues

1. Whether sufficient evidence supported the jury’s finding that the non-employee radiologist acted as the hospital’s agent for vicarious-liability purposes.
2. Whether the verdict was improperly reduced (or not reduced further) after the plaintiffs’ settlement with the radiologist and his group.
3. Whether Missouri’s medical-malpractice noneconomic-damages cap applied once to the hospital or could be applied more than once based on separate negligent acts.
4. Whether the mother’s damages were excessive or otherwise required remittitur, and whether evidentiary and damage-calculation rulings warranted reversal.

## Decision

- The appellate court affirmed the judgment in full.
- The court held substantial evidence supported submitting and sustaining the jury’s finding that the radiologist was the hospital’s agent despite his non-employee status.
- The court upheld the trial court’s settlement credit methodology and rejected further reduction based on the radiologist’s allocated percentage of fault because the hospital was vicariously liable for the agent’s negligence.
- The court approved applying more than one noneconomic-damages cap where the proof permitted treating the emergency-room physician’s conduct and the radiologist’s conduct as separate negligent occurrences.
- The court rejected the hospital’s claims of excessive damages, evidentiary error, and miscalculation of damages.

## Legal Principles

- A physician’s independent medical judgment does not, by itself, foreclose a finding of a principal-agent relationship between a hospital and a physician.
- Agency is a fact question for the jury when the evidence allows reasonable disagreement; substantial evidence of hospital control and integration of services can support an agency finding even absent direct employment.
- When a defendant is vicariously liable for an agent, the defendant may be responsible for the agent’s negligence notwithstanding the agent’s separate settlement, and a settling agent’s allocated fault does not necessarily entitle the principal to an additional percentage-based reduction.
- For Missouri medical-malpractice noneconomic-damages limits, an “occurrence” may be treated as a distinct negligent act; multiple caps may apply when separate negligent acts are proven to have contributed to the injury.
- Remittitur is improper absent a showing that an award is so excessive as to indicate bias, prejudice, or that it shocks the conscience; trial-court evidentiary rulings are reviewed for abuse of discretion.

## Conclusion

The court affirmed a large malpractice judgment against the hospital, holding that the evidence supported treating the non-employee radiologist as the hospital’s agent, the settlement credit did not require additional percentage-based reduction against a vicariously liable principal, and separate negligent acts permitted applying more than one statutory cap on noneconomic damages.


Scott v. SSM Healthcare St. Louis, 70 S.W.3d 560 (Mo. Ct. App. 2002)