More than $100 million in punitive damages award last month in a record $217 million Florida malpractice verdict will go to charities helping patients with spinal cord and brain damages, according to an announcement of from the plaintiff's family and attorneys for the plaintiff, according to reports from the Brevard Lawyer blog.

Punitive damges are rare in malpractice cases and generally indicate the jury was outraged by some element of the case. Punitive jury awards have been under criticism in the courts, where they often are multiples of the compensatory damages awarded.

Compensatory damages include past and future care needs, lost earning capacity, pain and suffering, and other elements particular to each state. In this case, the punitive damages are large, but less than the compensatory damages, and may survive a challenge if the appeas court upholds the compensatory damages.

While initial reactions to such a large punitive verdict are to assume that a clever lawyer enflamed the emotions of the jury, there is at least some reason to wonder whether there is a basis for the award, as the trial judge had to have found reasonable grounds for the award before allowing it to be entered.

The verdict remains on appeal, and the actual damage award and punitive damages remain subject to approval, reversal or modification.

As noted by comments on the Kevin, M.D. blog discussions of this case, the possibilities of such a verdict, even if remote, should have been evident to defense counsel and the insurance companies long before trial, and they elected to take the risk of trial. www.kevinmd.com/blog/2006/10/medicine-behind-navarro-stroke-case.html

According to BrevardLawyer.com, the family was originally offered $300 to settle the case. The final offer before trial or final demand before trial is not known.

Published reports from Brevard Lawyer.com indicate:

Presentation: Sudden onset of head ache, heard "pop", nausea, dizziness, family history of stroke, personal history of high blood presssure and high cholesterol, observed with unstable gait.

Allan Navarro presented to a hosptal emergency department in August 2000 with nausea, headache, dizziness and double vision. He reportedly told the attending nurse he had a family history of strokes. He was discharged with pain pills and a diagnosis of sinus infection. (Other publications indicate that he told the triage nurse of a history of high blood pressure and high cholesterol and was observed with an unsteady gait by another nurse.)

Other online sources indicate that Navarro received two head CT's prior to discharge, which one would presume meant they were read as normal.

Navarro returned the next morning with more serious symptoms and swelling to the brain as a result of a stroke. The complaint alleges that diagnosis of stroke was further delayed until that afternoon when the patient was transferred to another facility where emergency surgery was performed to relieve pressure to the brain.

Navarro spent a month in the hospital, and was transferred to a long term care facility. He spent three months in a coma. A former pro basketball player in the Philippines, he now uses a wheel chair and has a swallowing impairment that puts him at risk of suffocation when he eats.

Navarro sued attending physician Michael P. Austin and two groups contracted to provide emergency room service. During the trial, Navarro testified that the man who performed Allan’s initial exam was an unlicensed physician’s assistant.