COURT OF APPEALS OF OHIO, EIGHTH DISTRICT COUNTY OF CUYAHOGA NOS. 60932, 60495 RACHEL LEAH RAMOS : : : PLAINTIFF-APPELLEE : JOURNAL ENTRY : v. : AND : ADOLPH KUZAS, M.D., ET AL. : OPINION : : DEFENDANT-APPELLANT : DATE OF ANNOUNCEMENT OF DECISION: FEBRUARY 13, 1992 CHARACTER OF PROCEEDING: Civil appeal from Common Pleas Court, Case No. 149703. JUDGMENT: AFFIRMED. DATE OF JOURNALIZATION: APPEARANCES: For Plaintiff-appellee: R. Eric Kennedy, Esq. Weisman, Goldberg, Weisman & Kaufman 1600 Midland Building 101 Prospect Avenue West Cleveland, Ohio 44113 For Defendant-appellant: Charles W. Kitchen, Esq. William F. Schmitz, Esq. Kitchen, Messner & Deery 1100 Illuminating Building Cleveland, Ohio 44113 -2- SWEENEY, JAMES D., J.: Defendant-appellant Marymount Hospital appeals both the jury verdict awarding plaintiff-appellees Rachel Ramos, Cheryl Ramos and Norberto Ramos $4,820,000, and the award by the trial judge of prejudgment interest. On April 3, 1984, at 1:30 a.m., Mrs. Cheryl Ramos was admitted to Marymount Hospital in active labor. Mrs. Ramos reported bleeding from approximately 12:30 a.m. The pregnancy had been otherwise normal and trouble-free. Mrs. Ramos was under the nursing care of Diane Porter, who notified the in-house obstetrician, Dr. William Harris, who then evaluated Mrs. Ramos and consulted by telephone with her private obstetrician, Dr. Adolph Kuzas. Dr. Harris diagnosed an abruption, which can decrease oxygen to the fetus. Dr. Kuzas indicated that he was on his way to the hospital. Dr. Harris left orders for Nurse Porter and then retired to his sleeping quarters down the hall. Nurse Porter attached an external fetal monitor to Mrs. Ramos. This device, which is attached to the mother's stomach, records the infant's heart rate and the mother's contractions. The monitor indicated there were late declarations and a loss of beat-to-beat variability, both of which are signs of fetal distress. Nurse Porter was responsible for recognizing these signs of distress, and reporting them to Dr. Harris. She did neither. -3- Dr. Kuzas arrived at the hospital at approximately 2:15 a.m. He also did not recognize the signs of fetal distress from the monitor, nor did Nurse Porter draw it to his attention. There was expert testimony that Nurse Porter failed to meet the standard of care in the community and this failure resulted in injury to Rachel Ramos. Dr. Harris testified that had the signs of distress been brought to his attention, he would have expressed his concern to Dr. Kuzas, and that he was sure he could have convinced Dr. Kuzas to perform an immediate caesarean section (C-section) to deliver the child. Dr. Harris testified that had Nurse Porter consulted with him, the child would have been delivered by 2:45 a.m. Dr. Kuzas, who admitted his negligence at trial, finally ordered a C-section, and Rachel Ramos was born at 6:20 a.m. Rachel was severely depressed: she was blue; not breathing; her body was limp; and there was conflicting testimony as to whether or not a heart beat was present. In short, she was in immediate need of resuscitation. Dr. David Biagiotti was the anesthesiologist for the surgery, and although his primary responsibility was Mrs. Ramos, he provided resuscitation for Rachel. According to the notes constructed afterwards by Nurse Porter, Rachel was not resuscitated for twelve minutes after birth. Dr. Biagiotti testified that the notes were not contemporaneous, and were highly inaccurate, and that, in fact, resuscitation was complete within five minutes. While Dr. Biagiotti was resuscitating -4- Rachel, he was also trying to ensure that Mrs. Ramos did not go into shock. At trial, it was evident that Marymount Hospital had no plan for the provision of resuscitation to a newborn infant. Dr. Nicholas DePiero, former head of the anesthesia department, testified that he knew of no rules, regulations or policies regarding resuscitation; and that he was not aware that the Policy and Procedure Manual for the hospital designated the department of anesthesia as responsible for such resuscitation; and that he thought the department of pediatrics would be responsible for resuscitation. He also stated that where both mother and child were in need of care by the anesthesiologist "It was a 64 dollar question" as to who should care for the child. (T. 311, 312). Dr. Charles Brandon, former head of the department of obstetrics, gynecology and pediatrics, testified that he thought the department of anesthesiology was responsible for resuscitation and that under these circumstances it was a "grab bag" as to who should provide resuscitation (T. 507). There was expert testimony that the hospital's lack of a plan to address this issue did not meet the standard of care in the community. The jury returned a verdict against Marymount Hospital and Dr. Kuzas. After a hearing, the trial judge awarded prejudgment interest to appellee. Appellant's first assignment of error. -5- THE TRIAL COURT ERRED IN NOT GRANTING DEFENDANT-APPELLANT'S MOTION FOR DIRECTED VERDICT AT THE CLOSE OF THE PLAINTIFF'S CASE, CLOSE OF THIS DEFENDANT-APPELLANT'S CASE, CLOSE OF ALL THE EVIDENCE. Appellants properly made their motions for a directed verdict pursuant to Civ. R. 50(A). The test for when to grant such a motion after evidence has been presented is set forth in Civ. R. 50(A)(4): (4) When granted on the evidence. When a motion for a directed verdict has been properly made, and the trial court, after construing the evidence most strongly in favor of the party against whom the motion is directed, finds that upon any determinative issue reasonable minds could come to but one conclusion upon the evidence submitted and that conclusion is adverse to such party, the court shall sustain the motion and direct a verdict for the moving party as to that issue. In Brentson v. Chappell (February 1, 1990), Cuyahoga App. No. 56500, unreported, this court held: If there is substantial competent evidence to support the non-moving party, upon which evidence reasonable minds might reach different conclusions, the motion must be denied. Hawkins v. Ivy (1977), 50 Ohio St. 2d 114. A motion for directed verdict does not involve the weight of evidence nor the credibility of witnesses, but rather concerns the legal sufficiency of the evidence to take the case to the jury. Ruta v. Breckenridge-Remy Co. (1982), 69 Ohio St. 2d 66, 68. In Bruni v. Tatsumi (1976), 46 Ohio St. 2d 127, at syllabus one, the court set forth the plaintiff's burden to establish medical malpractice: -6- In order to establish medical malpractice, it must be shown by a preponderance of evidence that the injury complained of was caused by the doing of some particular thing or things that a physician or surgeon of ordinary skill, care and diligence would not have done under like or similar conditions or circumstances, or by the failure or omission to do some particular thing or things that such a physician or surgeon would have done under like or similar conditions and circumstances, and that the injury complained of was the direct and proximate result of such doing or failing to do some one or more of such particular things. In the case sub judice, appellant argues that the motions for directed verdict should have been granted because: Nurse Porter had no duty to communicate with Dr. Harris before the arrival of Dr. Kuzas; that Nurse Porter had no further obligation once Dr. Kuzas arrived; and even if Nurse Porter had a duty and had performed that duty there was no certainty that an earlier C- section would have been performed. We find these contentions to be without merit. Appellant first argues that Nurse Porter had no duty to communicate with Dr. Harris prior to the arrival of Dr. Kuzas, and therefore, a directed verdict should have been granted in favor of Marymount. The trial court heard testimony that Nurse Porter did, in fact, have a duty to communicate with Dr. Harris and inform him of any signs of fetal distress noted on the monitor. Dr. Harris himself testified: Q. Now, in this situation, sir, at Marymount Hospital, if the private attending -7- physician has not yet arrived, the nurse reports to you, the house officer; is that correct? A. Yes. Q. So if you left sometime before 1:42 and Dr. Kuzas arrived here at 2:15, is that what the records indicate? A. Yes. Q. Between 1:40, 1:41 and 2:15 Nurse Porter would have the duty and responsibility to report to you with respect to her monitoring of this fetus; is that correct? A. Yes. Q. Was it your understanding, sir, that on that evening that was Nurse Porter's very responsibility to monitor the well being of this fetus with the fetal monitor machine? A. Yes, it was. (T. 157.) The doctor continued: Q. And if Nurse porter were to say, or there were to be signs of fetal distress on this tape, she would have the responsibility, then, to come to you? A. Yes. Q. And would you expect Nurse Porter, Doctor, with this responsibility that you were relying on would have to have the skill and the ability to be able to recognize late decelerations? A. Yes. Q. And during this fetal monitoring strip, we talked about it before, but from 1:42 to 2:40 is there not a consistent pattern of late fetal deceleration, sir? A. Yes. (T. 158.) * * * -8- Q. And would you agree, Doctor, that Nurse Porter, given your reliance upon her, given the responsibility which you have defined at Marymount Hospital and every hospital in the community, failed in that responsibility to report to you what is seen on this fetal monitoring strip? A. Yes. (T. 160, 161.) * * * Q. And Nurse Porter in this case, Doctor, did not meet the standards of appropriate and safe care for this fetus? A. That's correct. Q. Now Doctor, does this tape also show a decrease in beat to beat variability? A. Yes, it does. Q. And if Nurse Porter, if you are relying upon Nurse Porter to utilize this fetal monitoring equipment to monitor this child, would you not expect that she should have the skill and the competence and the knowledge to understand the significance of decreased variability when seen on an external monitor? A. Yes. (T. 161.) Plaintiff also presented the testimony of Dr. Bernard Gore from the University of California, San Francisco. Dr. Gore stated that Nurse Porter was responsible for the welfare of the patient and fetus (T. 86); and to monitor the fetus with the electronic fetal monitor (T. 87). Dr. Gore testified that Nurse Porter breached her duty to inform Dr. Harris of the patient's condition. Q. Doctor, I want you to assume that Dr. Harris went back to the call room some ten -9- yards down the hall before the fetal monitor strip was hooked up in this case, and that therefore we have a fetal monitor strip that we see here. I want you further to assume that at no time did Nurse Porter go get Dr. Harris to report to him her findings on the fetal monitor strip before 2:15 when Dr. Kuzas arrived. Given those facts, Doctor, do you have an opinion as to whether or not the failure of Nurse Porter to get Dr. Harris back out of the bed or get him from the call room met with standards of appropriate nursing care? A. It did not. Q. And if after 2:15, I want you to assume that at 2:15 and after Nurse Porter was present when Dr. Kuzas evaluated the fetal monitor strip and decided to wait and watch and monitor further, do you have an opinion, Doctor, under those circumstances as to whether or not her conduct considering she was the one put in charge of the monitoring with this electronic fetal monitor, do you have an opinion as to whether that conduct met with standards of appropriate care? A. It did not. (T. 87, 88.) Given this testimony, the trial court correctly denied appellant's request for a directed verdict on the responsibility of Nurse Porter to report to Dr. Harris before the arrival of Dr. Kuzas at the hospital. Appellant's next contention is that Nurse Porter did not have a duty to advocate to Dr. Kuzas that he should proceed with a C-section. Appellants argue that to conclude that Nurse Porter had a duty to advocate for an earlier delivery would have -10- required her to make a diagnosis, and engage in an unauthorized practice of medicine. We disagree. Again, the appellee presented the testimony of Dr. Gore, who testified as to the responsibilities of a Nurse Porter (T. 86-87) and explained: Q. Can you explain to us, Doctor, the responsibility of Nurse Porter from 2:15 on with respect to this child, and considering what we have on the monitor strip? A. Miss Porter's responsibility was to recognize this was not a normal finding, and it is blatant. I mean it is not a judgment call. This is as significant a series of repetitive late deceleration that you can find. If she does not get the appropriate response from the physician, it is her responsibility to either seek counsel from another physician who she happens to have available, but she does not contact, which is Dr. Harris. Or failing to do that, she needs to contact a supervisory individual to get support in which she feels is true and what she feels is something that is going on that should not be happening. That's her ultimate responsibility. (T. 88-89.) This testimony was sufficient for the trial court to deny appellant's motion for a directed verdict. Next, appellant asserts that even if Nurse Porter had recognized the blatent sign of fetal distress and promptly notified Dr. Harris; or had drawn the distress to the attention of Dr. Kuzas upon his arrival; or after Dr. Kuzas arrived had she advocated to him another doctor or a supervisor to perform a C- section, that no causation existed upon which to find the hospital liable through its employee. -11- While it is true that Dr. Harris testified that although he believed he could have convinced Dr. Kuzas to perform the C- section earlier, it was speculation (T. 165), he also stated: Q. Page 61. Again, Doctor, referring to your deposition, if you will follow along to make sure I'm accurate. Question at line 9: "And under the circumstances had you brought this to the attention of Dr. Kuzas, and I am assuming that you would have brought this to his attention, you would have brought to him your opinion or feeling that this fetus should be delivered; would that be correct? Answer: "Yes." Question: "And if he disagrees with your assessment at that point in time, what are your options at that point in time, if any?" Answer: "I am sure I could have convinced him to do the section. If he wouldn't believe me, I always carry in my attache case, as I mentioned before, that manual on obstetrical care. I would have, it has this in here. I would have shown it to him, and he would have understood. I like to believe that that is true." Now Doctor, let me conclude by asking you this: In the middle of the night at Marymount Hospital, they can do a cesarean (sic) section in 20 minutes; is that correct? A. Yes. Q. Had Nurse Porter come to you, brought to your attention this fetal monitoring tape, and you told us you would have gone then and evaluated it yourself, sir? A. Yes. Q. And had you done that and been present when Dr. Kuzas arrived, and had you been able to, as you told us in your deposition you are -12- sure you would have been, had you been able to talk Dr. Kuzas into doing this cesarean (sic) section at 2:15, this baby would have been delivered within 20 minutes before 2:45? A. Yes. Q. And not 6:20, four hours later? A. That's correct. (T. 166, 167.) In addition to this testimony, appellees expert, Dr. Gore, testified: Q. Had Nurse Porter provided the standard and appropriate care which you have outlined in this case, again leading to a Cesarean (sic) section between 2:15 and 2:45, do you have any reasonable medical opinion what this child's condition would be today? MR. KITCHEN: Objection. THE COURT: Overruled. A. I believe it would be normal. Q. And is the failure of Nurse Porter one of the direct and proximate causes of the injury and damages to this child? A. I believe yes. (T. 106, 107.) There was sufficient evidence before the trial court on which to deny appellant's motion for a directed verdict. And finally, appellants argue that appellee presented no evidence of causation that the hospital's failure to plan for the emergency resuscitation of both a mother and a newborn resulted in the devastating injuries sustained by Rachel. Appellee presented the testimony of Dr. DePiero and of Dr. Brandon, heads of the department of anesthesiology and obstetrics respectively. It was evident not only that no plan existed, but -13- that each department believed the other was responsible for the resuscitation of the newborn. There was testimony that this breached the standard of care in the medical community. (T. 355- 358.) As a result of this failure to plan, there was apparent confusion in the operating room. Dr. Biagotti testified that he was running back and forth between Mrs. Ramos and Rachel (T. 750- 751, 768, 806.) There was not even blood in the operating room for Mrs. Ramos (T. 747). Construing these facts in the light most favorable to appellee, the trial court correctly denied appellant's motion for a directed verdict. Appellees met their burden as set forth in Bruni, supra, and presented expert testimony on all of the issues contested by appellee. Once this competent evidence was presented, it became a matter for the jury to decide. The trial judge correctly denied appellant's motions. Appellant's first assignment of error is overruled. Appellant's second assignment of error. THE TRIAL COURT ERRED IN NOT GRANTING A POST- JUDGMENT MOTION TO REDUCE GENERAL DAMAGES TO $200,000 UNDER THE PROVISIONS OF SECTION 2307.43 OHIO REVISED CODE OR IN THE ALTERNATIVE IN NOT SEVERING ANY CONSTITUTIONALLY INFIRM APPLICATION OR CIRCUMSTANCE FROM THE OTHERWISE VALID LEGISLATION. The Supreme Court has recently held that R.C. 2307.43 is unconstitutional. Morris v. Savoy (1991), 61 Ohio St. 3d 684. -14- The trial court, therefore, correctly refused to apply the statute. Appellant's second assignment of error is not well taken. Appellant's third assignment of error. THE TRIAL COURT ERRED IN INSTRUCTING THE JURY THAT A SEPARATE DAMAGE AWARD COULD BE MADE FOR LOSS OF FUTURE ENJOYMENT OF LIFE AND IN NOT REDUCING THE VERDICT WITH RESPECT TO SAME SAME (SIC) IN THE AMOUNT OF $250,000. In the trial court's charges, the jury was instructed to: Consider each of the following: (1) The injuries to her mind and body, both physical and mental, which Rachel has undergone up to the present date, and those injuries which you find she is reasonably certain to suffer in the future or permanently. (2) The disability and impairments, mental and physical, which Rachel has sustained up to the present date, and those disabilities and impairments which she is reasonably certain to suffer in the future or permanently. (3) The loss of enjoyment of a normal life that Rachel has sustained up to the present date, and such loss of enjoyment of a normal life as she is reasonably certain to sustain in the future. (4) The cost of future medical and other care after Rachel Ramos reaches the age of 18. (5) The future lost wages of Rachel Ramos. (T. 895-896.) Appellant contends that the loss of enjoyment of life, or hedonic damages, are not recognized in Ohio. However, in Bennis -15- v. Fredendall (1987), 32 Ohio St. 3d 244, at syllabus 3, the court held: Recovery for negligently inflicted emotional and psychiatric injuries accompanied by contemporaneous physical injury may include damages for mental anguish, emotional distress, anxiety, grief or loss of enjoyment of life caused by the death or injury of another, provided the plaintiff is directly involved and contemporaneously injured in the same motor vehicle and accident with the deceased or other injured person. (Emphasis added.) Although Bennis, supra, is not factually on point, the Supreme Court does recognize the existence of damages for loss of enjoyment of life. We therefore find no error by the trial court in instructing the jury to consider the loss of future enjoyment of life to Rachel Ramos, and no error in not reducing the verdict by the sum awarded by the jury for this injury. The appellant's third assignment of error is overruled. Appellant's fourth assignment of error. THE TRIAL COURT ERRED IN GRANTING PLAINTIFF'S MOTION FOR PREJUDGMENT INTEREST IN THE SUM OF $3,133,000. Prejudgment interest is provided for in R.C. 1343.03(C) which reads as follows: (C) Interest on a judgment, decree, or order for the payment of money rendered in a civil action based on tortious conduct and not settled by agreement of the parties, shall be computed from the date the cause of action accrued to the date on which the money is paid, if, upon motion of any party to the action, the court determines at a hearing held subsequent to the verdict or decision in the action that the party required to pay the -16- money failed to make a good faith effort to settle the case and that the party to whom the money is to be paid did not fail to make a good faith effort to settle the case. Appellant contends that the appellees did not meet their burden of proof under Kalain v. Smith (1986), 25 Ohio St. 3d 157. In the syllabus, the Supreme Court set forth the following standard for determining when to award prejudgment interest: A party has not "failed to make a good faith effort to settle" under R.C. 1343.03(C) if he has (1) fully cooperated in discovery proceedings, (2) rationally evaluated his risks and potential liability, (3) not attempted to unnecessarily delay any of the proceedings and (4) made a good faith monetary settlement offer or responded in good faith to an offer from the other party. If a party has a good faith, objectively reasonable belief that he has no liability, he need not make a monetary settlement offer. The court went on to hold: The decision as to whether a party's settlement efforts indicate good faith is generally within the sound discretion of the trial court. Huffman v. Hair Surgeon, Inc. (1985), 19 Ohio St. 3d 83. This court will not overturn a finding on this issue unless the trial court's actions indicate an abuse of discretion. The standard for abuse of discretion was set forth in Huffman v. Hair Surgeon, Inc. (1985), 19 Ohio St. 3d 83 as the court discussed prejudgment interest. The court stated: We now turn to the issue concerning the correctness of the award of prejudgment interest. We first note that such awards are within the sound discretion of the trial -17- court. Cincinnati Ins. Co. v. First Natl. Bank (1980), 63 Ohio St. 2d 220, 226 [17 O.O.3d 136]. We have repeatedly held that "[t]he term 'abuse of discretion' connotes more than an error of law or of judgment; it implies that the court's attitude is unreasonable, arbitrary or unconscionable. Steiner v. Custer (1940), 137 Ohio St. 448 [19 O.O. 148]; Conner v. Conner (1959), 170 Ohio St. 85 [9 O.O.2d 480]; Chester Township v. Geauga Co. Budget Comm. (1976), 48 Ohio St. 2d 372 [2 O.O.3d 484]." State v. Adams (1980), 62 Ohio St. 2d 151, 157-158 [16 O.O.3d 169]; Blakemore v. Blakemore (1983), 5 Ohio St. 3d 217, 219. "'[A]n abuse of discretion involves far more than a difference in * * * opinion * * *. The term discretion itself involves the idea of choice, of an exercise of the will, of a determination made between competing considerations. In order to have an "abuse" in reaching such determination, the result must be so palpably and grossly violative of fact and logic that it evidences not the exercise of will but perversity of will, not the exercise of judgment but defiance thereof, not the exercise of reason but rather of passion or bias. * * *'" State v. Jenkins (1984), 15 Ohio St. 3d 164, 222. The trial court did not abuse its discretion in awarding prejudgment interest in the case sub judice. The court properly held a hearing and heard competent, credible evidence to substantiate the award. The hearing on plaintiff's motion for prejudgment interest, pursuant to R.C. 1343.03, was held on November 7, 1990. One witness was presented, Ms. Deborah Hallal, the claims representative of appellant Marymount's insurance carrier, St. Paul Insurance Company. At the hearing, appellee contended that Marymount, through its insurance carrier, St. Paul, failed to -18- reasonably evaluate the case and failed to make a reasonable offer of settlement. (T. 8.) Under its policy, Marymount had a one million dollar retention or deductible. At the final pretrial, Marymount made its first offer as a structured settlement of $700,000. The demand from appellee was 1.6 million. Marymount then offered their whole deductible of one million dollars, but St. Paul refused to offer additional monies on behalf of their insured. Discussions continued, but no further offer or demand resulted until the fourth day of trial. On the fourth day of trial, the judge permitted a recess for settlement negotiations. Based on the evidence, appellee raised their demand of Marymount from 1.6 million to 1.8 million dollars. Marymount had already offered its one million, and St. Paul made its first and last offer of $200,000. At the hearing, appellee questioned Ms. Hallal on both the reasonableness of St. Paul's offer, and on the reasonableness of St. Paul's evaluation of their insured's liability. On the issue of the reasonableness of St. Paul's refusal to offer more than $200,000, Ms. Hallal acknowledged that St. Paul had received sufficient discovery, and in addition, had the case evaluated by their own experts. St. Paul hired the Crawford Co., who placed the economic loss of appellees at six million dollars. This estimate did not include the past and future pain and suffering of Rachel, for which the jury awarded one million dollars; the loss of services and companionship to her parents for which the jury awarded one million dollars; and loss of the -19- normal enjoyment of life, for which the jury awarded $250,000. As to future lost earnings, appellee had an undisputed expert who placed the loss at $500,000. Ms. Hallal testified that St. Paul reserved only $750,000 to cover the losses of Rachel Ramos. This $750,000 was the total reserve, and included the deductible to be paid by the insured. Appellants argue that at the time of the negotiations there were other defendants involved. However, presumably the appellants were aware of joint and severable liability which, if a verdict for plaintiff resulted, would hold them liable for the entire award. Ms. Hallal testified that the jury's verdict did not surprise her, and that was within the projected range. (T. 80.) On the issue of St. Paul's evaluation of their insured's liability, Ms. Hallal was questioned as to both Nurse Porter's actions, and Marymount's lack of an adequate plan to insure the safety of both a mother and an infant in need of resuscitation at the time of delivery. Ms. Hallal recognized that Nurse Porter's failure to correctly assess the signs of fetal distress on the monitor left Marymount with a significant exposure. She testified that Dr. Gore, plaintiff's expert; Dr. Harris, defendant; Dr. Suchon, expert for Dr. Harris; Dr. Klavan, expert for Dr. Biagotti; and Dr. Parker, expert for Marymount; all agreed that Nurse Porter was incorrect in her belief that the readings from the fetal monitor were nothing to be concerned over. As a former obstetric -20- nurse, Ms. Hallal also realized that Nurse Porter was in error. Ms. Hallal knew that on these issues, the loss of beat to beat variability and the late decelerations, there was significant evidence in favor of the plaintiff. St. Paul hired an expert, Dr. Klein, to evaluate Nurse Porter's decisions. Dr. Klein opined that the loss of beat to beat variability was nothing to be concerned over. In his report, Dr. Klein also stated that late decelerations were present on the monitor strip, however, at his deposition, he testified that he could not determine whether or not the decelerations that were present were late or not. Because of these contradictions, Ms. Hallal knew that Dr. Klein's credibility would be in question if he testified at trial; and that his credibility would be damaged because he would be testifying contra to every other expert. Dr. Klein also testified that the actions of Dr. Kuzas were acceptable, even though Dr. Kuzas stipulated as to liability. Ms. Hallal also testified that she recognized the testimony of both Dr. DePiero and Dr. Branden would have a negative impact on the jury. Neither doctor appeared to have any clear knowledge of the rules of their department or any idea as to who should have been responsible for resuscitation under the circumstances presented here. Ms. Hallal testified that the settlement decisions were made at St. Paul's home office, and the decision makers did not attend any portion of the trial. -21- Given this evidence before the trial judge, we can find no abuse of discretion in the award of prejudgment interest. Appellant's fourth assignment of error is overruled. Judgment of the trial court is affirmed. -22- It is ordered that appellees recover of appellant their costs herein taxed. The court finds there were reasonable grounds for this appeal. It is ordered that a special mandate issue out of this court directing the Common Pleas Court to carry this judgment into execution. A certified copy of this entry shall constitute the mandate pursuant to Rule 27 of the Rules of Appellate Procedure. Exceptions. FRANCIS E. SWEENEY, P.J., and PATRICIA A. BLACKMON, J., CONCUR. JAMES D. SWEENEY JUDGE N.B. This entry is made pursuant to the third sentence of Rule 22(D), Ohio Rules of Appellate Procedure. This is an announcement of decision (see Rule 26). Ten (10) days from the date hereof this document will be stamped to indicate journalization, at which time it will become the judgment and order of the court and time period for review will begin to run. .