Background
In July 2019, 27-year-old Holly Baumstark underwent a cesarean section at Piedmont Rockdale Hospital and developed placenta accreta spectrum (PAS), causing a massive hemorrhage that required an emergency hysterectomy lasting five to six hours. She was transferred to the ICU under the care of Dr. Luis Cayamcela, an internal medicine hospitalist, where her condition deteriorated — she suffered respiratory arrest and then cardiac arrest, and died the following morning.
Her fiancé, Lee Blasingame, sued on behalf of Baumstark’s estate and their two children, alleging that Cayamcela and his staffing employer, Hospitalist Services of Georgia P.C., committed medical malpractice by, among other things, failing to ensure adequate IV access and arterial line placement, administering insufficient fluids and blood products, failing to treat electrolyte imbalances, and failing to recognize that Baumstark needed to return to surgery. Most defendants settled; only Cayamcela and Hospitalist Services proceeded to trial.
The jury returned a $42 million verdict — $10 million to Baumstark’s estate for pain and suffering and $32 million to her children for wrongful death. The trial court denied defendants’ motions for a new trial and for reduction of the verdict under Georgia’s $350,000 noneconomic damages cap (OCGA § 51-13-1), and awarded plaintiffs approximately $11.8 million in attorney fees under OCGA § 9-11-68 after finding that defendants had rejected a qualifying settlement offer.
The Court’s Holding
The Supreme Court of Georgia affirmed on all grounds. On the evidentiary issue, the Court held that the trial court did not abuse its broad discretion in excluding defense expert Dr. Steven Clark’s ICU-related testimony under OCGA § 24-7-702(b), because Clark’s own deposition admissions — that he had not reviewed the ICU records carefully and lacked sufficient information to opine on Baumstark’s critical care — provided an adequate basis to find his testimony unreliable. On the instructional error claim, the Court found defendants had affirmatively waived the issue by proposing and then withdrawing the contrary instruction, and thereafter repeatedly confirming they had no objections to the charge as given.
On the damages cap, the Court relied on its companion decision issued the same day, Clark v. Leigh (S26A0349), to hold that OCGA § 51-13-1(b)’s $350,000 cap on noneconomic damages cannot constitutionally be applied where any portion of the jury’s award covers noneconomic damages governed by the right to a jury trial under the Georgia Constitution — a principle first established in Atlanta Oculoplastic Surgery, P.C. v. Nestlehutt, 286 Ga. 731 (2010). Because the cap statute operates by aggregating all noneconomic damages and imposing a single ceiling with no mechanism to carve out constitutionally protected categories, it cannot be applied without violating that right.
On attorney fees, the Court upheld both the award and its amount. It held that plaintiffs’ settlement offer satisfied OCGA § 9-11-68(a)(7) because it expressly stated that plaintiffs would bear their own attorney fees and expenses — meaning the proposal did not “include” such fees as part of the settlement amount. As to the fee calculation, the Court rejected defendants’ argument that the trial court improperly relied on the contingency fee agreement, finding the court used the agreement only to establish total fees incurred while proving reasonableness through independent expert testimony, hourly estimates, and a detailed work chart, consistent with OCGA § 9-15-16.
Key Takeaways
- Georgia’s $350,000 cap on noneconomic damages in medical malpractice cases (OCGA § 51-13-1(b)) cannot be applied to any verdict that includes noneconomic damages subject to the jury-trial right — Nestlehutt remains controlling precedent and the cap’s all-or-nothing aggregation mechanism prevents constitutional partial application.
- A defense expert’s testimony may be excluded under Rule 702(b) for insufficient factual basis when the expert’s own deposition admissions reveal he did not adequately review the relevant records and disclaimed the ability to opine on the contested issues.
- Defendants who propose a jury instruction, then withdraw it and affirmatively represent they have no objections to the charge as given, cannot later seek appellate relief under OCGA § 5-5-24(c)’s substantial-error exception — the waiver is complete.
- Under OCGA § 9-11-68, a plaintiff’s settlement offer is valid even if it states that plaintiffs will bear their own attorney fees, so long as the offer clearly discloses that fees are not included in the proposed settlement amount.
- A contingency fee agreement may be used to establish total fees incurred, but reasonableness must be proved through independent evidence such as expert testimony and billing records; that distinction satisfies OCGA § 9-15-16.
Why It Matters
This decision, alongside the companion ruling in Clark v. Leigh, firmly forecloses any path for defendants to apply Georgia’s medical malpractice damages cap whenever a jury awards noneconomic damages — effectively rendering the cap a dead letter in jury-tried malpractice cases unless the legislature redesigns the statute to surgically exclude constitutionally protected categories of damages. For plaintiffs’ counsel, the case also confirms that OCGA § 9-11-68’s fee-shifting mechanism is a powerful tool: a $3 million settlement offer that defendants rejected led to an $11.8 million attorney fee award on top of a $42 million judgment.
For litigators, the opinion reinforces two important trial-practice lessons: expert witnesses whose own depositions reveal they did not review the relevant records are vulnerable to Daubert-style exclusion regardless of their credentials, and defense counsel who acquiesce to jury instructions at the charge conference surrender the right to challenge those instructions on appeal — even instructions that, as here, may have shifted the burden of proof.