Procaccini v. Lawrence & Memorial Hospital, Inc.

JAMES M. PROCACCINI, ADMINISTRATOR

(ESTATE OF JILL A. PROCACCINI)

v. LAWRENCE AND MEMORIAL

HOSPITAL, INC., ET AL.

(AC 38380)

Prescott, Mullins and Beach, Js.

Syllabus

The plaintiff administrator of the estate of the decedent sought to recover

damages from the defendant E Co. for medical malpractice in connection

with the death of the decedent by a methadone overdose. On November,

29, 2008, the decedent was found unresponsive and was brought to a

hospital emergency department, where she was treated for a suspected

drug overdose by M, the attending emergency department physician.

After the decedent’s vital signs improved and stabilized, she was dis-

charged and returned to the home of a friend, where she was found

unresponsive the next morning and pronounced deceased. The plaintiff

alleged that E Co. was vicariously liable for the medical malpractice of

M in treating the decedent for a suspected drug overdose. The plaintiff

claimed that M’s discharge of the decedent after only four and one-half

hours of observation was premature in that M should have kept the

decedent under medical monitoring for twenty-four hours, which is the

period of time during which the fatal side effects of methadone toxicity

may occur, and that if the decedent had remained under medical monitor-

ing for the full twenty-four hours, the fatal overdose side effects she

experienced after her discharge would have been treated and her even-

tual death from methadone toxicity would have been averted. The jury

returned a verdict for the plaintiff, and the trial court rendered judgment

in accordance with the verdict, from which E Co. appealed to this court.

E Co. claimed, inter alia, that there was no direct evidence as to when the

decedent consumed the fatal dose of methadone, and that the undisputed

scientific evidence established that if she had actually overdosed on

methadone on November 29, 2008, she would have had a recurrence

of overdose symptoms before she was discharged from the hospital’s

emergency department. Held:

1. There was sufficient evidence to support the jury’s finding that E Co.’s

negligence caused the decedent’s death:

a. The jury had before it sufficient evidence from which it could have

inferred, without resorting to speculation, that the decedent had con-

sumed the fatal dose of methadone before she was brought to the

emergency department on November 29, 2008: although the jury was

presented with conflicting expert testimony as to how soon a methadone

overdose patient would experience recurring overdose symptoms after

receiving a certain medication that is used as an antidote for opiate and

opioid overdoses, the jury was free to believe the opinion of the plaintiff’s

expert witness, S, on the standard of care, that delayed, recurring respira-

tory depression can occur in methadone overdoses, even if such a

phenomenon defied certain undisputed and settled toxicology princi-

ples, and to disbelieve those portions of the testimony of E Co.’s expert

witness, P, on causation, that attempted to refute that phenomenon,

and E Co.’s claim that it was improper for the jury to consider S’s

testimony concerning the concept of delayed, recurring respiratory

depression as it related to causation was unavailing because even if S’s

testimony was offered strictly for standard of care purposes, E Co.

failed to pursue any preemptive or remedial measures that would have

precluded or limited S’s testimony on the issue of delayed, recurring

respiratory depression, and the court never instructed the jury that it

should disregard S’s testimony thereon or that it should consider such

testimony only for standard of care purposes, and, therefore, the evi-

dence regarding delayed, recurring respiratory depression was before

the jury to use for any purpose, including causation; moreover, the fact

that the decedent did not immediately experience recurring overdose

symptoms one hour after the overdose medication was administered

did not require the jury to conclude that the decedent’s overdose on

November 29, 2008, was caused by a narcotic other than methadone,

as the jury could have concluded, instead, that the delayed, recurring

respiratory depression that the decedent eventually experienced was

consistent with her ingestion of a toxic dose of methadone before her

visit to the emergency department on November 29, 2008.

b. E Co. could not prevail on its claim that because the plaintiff failed

to present evidence demonstrating that the decedent would have been

admitted to the hospital had M not discharged her from the emergency

department, the jury could not reasonably have found that E Co. caused

the decedent’s death: although the plaintiff’s expert, S, initially testified

that the standard of care applicable to possible methadone overdoses

required M to admit the decedent to the hospital for continuous monitor-

ing, S subsequently clarified that the applicable standard of care required

only that M monitor the decedent for twenty-four hours for signs of

recurrent opiate overdose, and the jury reasonably could have accepted

that portion of S’s testimony indicating that monitoring was required

and rejected that portion of his testimony suggesting that admittance

was required; accordingly, to prove causation, the plaintiff needed to

show only that the decedent could have been monitored sufficiently for

twenty-four hours, and the jury reasonably could have inferred that

from the evidence presented.

2. The trial court did not abuse its discretion in denying E Co.’s motion to

set aside the jury’s award of $150,000 in damages for the destruction

of the decedent’s capacity to carry on and enjoy life’s activities; the jury

reasonably could have forecast the decedent’s life expectancy from its

own knowledge and from the substantial evidence presented by the

plaintiff of the decedent’s age, health, physical condition and habits, all

of which were relevant to determine life expectancy, and, therefore, the

jury’s award of damages for the destruction of the decedent’s capacity to

carry on and enjoy life’s activities was not unreasonable or speculative.

Argued March 21—officially released August 22, 2017

Procedural History

Action to recover damages for medical malpractice,

and for other relief, brought to the Superior Court in

the judicial district of New London, where the action

was withdrawn as against the named defendant et al.;

thereafter, the plaintiff filed an amended complaint as

against the defendant Emergency Medicine Physicians

of New London County, LLC; subsequently, the matter

was tried to the jury before Hon. Joseph Q. Koletsky,

judge trial referee; verdict for the plaintiff; thereafter,

the court denied the motions to set aside the verdict and

for a directed verdict filed by the defendant Emergency

Medicine Physicians of New London County, LLC, and

rendered judgment in accordance with the verdict, from

which the defendant Emergency Medicine Physicians

of New London County, LLC, appealed to this court.

Affirmed.

Daniel J. Krisch, with whom were Frederick J.

Trotta, Sr., and, on the brief, Logan A. Forsey and

Jennifer S. Mullen, for the appellant (defendant Emer-

gency Medicine Physicians of New London County,

LLC).

Matthew E. Auger, with whom, on the brief, was Eric

W. Callahan, for the appellee (plaintiff).

Opinion

MULLINS, J. In this medical malpractice action, the

defendant1 Emergency Medicine Physicians of New

London County, LLC, appeals from the judgment of the

trial court, after a jury trial, rendered in favor of the

plaintiff, James M. Procaccini, administrator of the

estate of Jill A. Procaccini (decedent). On appeal, the

defendant claims that there was insufficient evidence

supporting the jury’s verdict and award of noneconomic

damages. Specifically, it claims that the plaintiff failed

to present sufficient evidence for the jury (1) to find

that the defendant’s negligence caused the death of the

decedent, and (2) to award $150,000 in damages for the

destruction of the decedent’s capacity to carry on and

enjoy life’s activities. We affirm the judgment of the

trial court.

The following facts, as reasonably could have been

found by the jury, and procedural history are relevant

to this appeal. On November 30, 2008, the decedent,

who was thirty-two years old, died from a methadone

overdose. In the years leading up to her death, the

decedent had struggled with polysubstance abuse.

After achieving a period of sobriety early in 2008, the

decedent relapsed on November 16, 2008. On that date,

the decedent admitted herself to Saint Francis Hospital

and Medical Center in Hartford (Saint Francis), seeking

treatment for a heroin overdose. On the next day,

November 17, 2008, the decedent was transferred to

Cedarcrest Hospital, Blue Hills Substance Abuse Ser-

vices (Blue Hills), in Newington.

The decedent remained at Blue Hills from November

17, 2008, until her discharge on November 28, 2008.

During her stay at Blue Hills, the decedent was adminis-

tered varying doses of methadone for treatment of her

opiate withdrawal symptoms. Methadone, an opioid,2

frequently is used by clinicians to alleviate the with-

drawal symptoms that patients experience while under-

going opiate detoxification. Although methadone

commonly is used in the clinical setting and, thus,

administered under a clinician’s supervision or pursu-

ant to a prescription, it also can ‘‘be purchased [illegally]

on the streets as street methadone.’’ The decedent’s last

dose of methadone, five milligrams, was administered

at Blue Hills at 7:45 a.m. on November 21, 2008. The

decedent was discharged from Blue Hills on November

28, 2008.

After leaving Blue Hills on November 28, 2008, the

decedent made at least two phone calls. One of those

calls was to a person from whom the decedent had

purchased drugs in the past. Another call was to Charles

Hope, a substance abuse counselor and a recovering

drug addict with whom the decedent was friendly. Hope

agreed to let the decedent stay at his house in New

London on the condition that she not use drugs. Hope

picked up the decedent from West Hartford on the

evening of November 28, 2008, and brought her to his

home in New London. Upon their arrival at Hope’s

home, Hope and the decedent talked briefly and then

retired for the night. Hope heard the decedent use the

microwave in his kitchen at some point during the night.

On the morning of November 29, 2008, Hope woke

up the decedent and noticed that she was ‘‘feeling a

little sick.’’ Hope left his home sometime in the late

morning or early afternoon of November 29. Hope later

called the decedent sometime that afternoon and had

a conversation with her. When Hope returned to his

home at approximately 6:45 p.m., however, he found

the decedent lying unconscious on his living room

couch. Hope began performing cardiopulmonary resus-

citation, which restored the decedent’s breathing. At

approximately 6:47 p.m., Hope called 911.

Emergency medical technicians (EMTs) from the

New London Fire Department arrived at Hope’s house

on November 29, 2008, at approximately 6:51 p.m. The

EMTs found the decedent unresponsive, lying in a

supine position in Hope’s living room with pinpoint

pupils and agonal respirations. Hope told the EMTs

that the decedent ‘‘had been on methadone,’’ that the

decedent ‘‘had a history of addiction,’’ and that he was

unsure if she used drugs that day. Because she was

unconscious, however, the EMTs were unable to obtain

any medical history from the decedent. The EMTs

administered oxygen to the decedent via an oral airway

and bag valve mask. Hope and the EMTs briefly

searched Hope’s house for drugs, drug paraphernalia,

and other evidence of drug use. They did not find any

such evidence.

Shortly thereafter, at approximately 6:55 p.m., para-

medics from Lawrence & Memorial Hospital (Law-

rence & Memorial) arrived on the scene. The

paramedics placed the decedent in their ambulance.

At some point between 6:55 p.m. and 7:03 p.m., the

paramedics intravenously administered the decedent

1.4 milligrams of Narcan.

Narcan is used as an ‘‘antidote’’ for opiate and opioid

overdoses. Narcan, like opiates and opioids, attaches

to the opioid receptors located in the body’s central

nervous system. Narcan, however, does not cause any

of the effects that opiates and opioids produce, such as

pain relief, a ‘‘high’’ feeling, and respiratory depression.

Instead, because opioid receptors have a ‘‘stronger

affinity for the Narcan molecule than [they do] for [opi-

ates and opioids],’’ Narcan ‘‘just knocks [opiates and

opioids] out and takes residency in the receptor[s]

. . . .’’ ‘‘[Once] [t]he Narcan displaces the opiate [or

opioid] from the receptor[s] . . . the person’s opiate

effects evaporate . . . the person wakes up and [he or

she is] breathing and . . . alert . . . .’’ In other words,

‘‘intravenous administration of Narcan . . . pro-

duce[s] a near-instantaneous reversal of the narcotic

effect . . . within a minute or two at the most . . . .’’

By the time the ambulance arrived at Lawrence &

Memorial at 7:03 p.m., the dose of Narcan had revived

the decedent. The decedent was conscious and answer-

ing questions asked by the paramedics. The paramedics

were able to determine that the decedent was taking

several medications, including methadone, Topamax,

Seroquel, insulin, and Ambien. In their written report,

the paramedics indicated that the ‘‘chief complaint’’

was an ‘‘[overdose] on Heroin’’ and that the decedent

was ‘‘found in respiratory arrest due to [overdose].’’

Upon arriving at Lawrence & Memorial, the decedent

was taken to the emergency room, where her condition

was triaged. In examining the decedent, the triage

nurse, Sarah Zambarano, created an electronic report

detailing the decedent’s condition at 7:13 p.m. Zambar-

ano indicated in the electronic report that the paramed-

ics informed her that Hope told them that the decedent

‘‘took methadone, ? of heroin.’’

At approximately 7:15 p.m., the decedent was

assessed by another emergency room nurse, Pamela

Mays. At 7:36 p.m., Mays recorded the following in her

treatment notes: ‘‘[the decedent] admits to using heroin

toni[ght] . . . states off methadone for several months

after detox . . . now using again.’’ Mays also indicated

that the decedent ‘‘appear[ed] comfortable’’ and was

‘‘cooperative,’’ ‘‘alert’’ and ‘‘oriented . . . .’’ Contrary

to May’s notes, Hope, who had arrived at the emergency

room between 7:30 p.m. and 8 p.m., recalled that the

decedent was ‘‘very adamant that she did not take any

heroin . . . .’’ According to Hope, the decedent told

Mays that ‘‘I did not take any heroin, I took methadone.’’

At approximately 7:45 p.m., the attending emergency

room physician, Thomas E. Marchiondo, examined the

decedent. At the time he began treating the decedent,

Marchiondo had access to the paramedics’ report,

which indicated that the decedent had a suspected over-

dose on heroin, that the decedent also was taking meth-

adone, and that the decedent had been found in

respiratory arrest. Marchiondo detailed his examination

of the decedent in his own written report. In his report,

Marchiondo noted that the decedent’s ‘‘chief complaint’’

was an ‘‘unintentional heroin overdose.’’ Although the

decedent apparently denied any ‘‘other co-ingestion,’’

Marchiondo’s report indicated that the decedent’s ‘‘cur-

rent medications’’ included methadone.

Marchiondo’s report also indicated that a urine toxi-

cology screen had been ordered. The results of the

screen, of which Marchiondo was aware when treating

the decedent, revealed that the decedent’s urine tested

positive for the presence of methadone, an unidentified

opiate, and unidentified benzodiazepines. Because that

screen merely was qualitative, it could not identify the

specific type of opiate ingested by the decedent or the

exact concentration of that substance or methadone in

the decedent’s system.

As a result of his review of the drug screen results,

as well as his examination of the decedent and review

of the treatment notes prepared by the nurses and emer-

gency responders, Marchiondo concluded that the dece-

dent had ingested both methadone and heroin.

Regarding the methadone, although he could not deter-

mine specifically when or in what manner the decedent

ingested it, Marchiondo concluded that the decedent

ingested some quantity of methadone ‘‘within the past

couple of weeks.’’ In so concluding, Marchiondo relied

on the fact that methadone was listed as a medication

in her medical history, which caused him to believe

that the decedent was taking the methadone ‘‘under a

doctor’s prescription . . . .’’ Marchiondo consequently

‘‘would have expected [methadone] to come out posi-

tive in her urine.’’ Accordingly, he concluded that the

overdose symptoms that the decedent was experiencing

‘‘were due to a heroin overdose’’ and agreed with a

statement by the plaintiff’s counsel that the decedent’s

symptoms ‘‘[were] in no way related to the methadone

that was in her system.’’3

The decedent remained in the Lawrence & Memorial

emergency room from 7:13 p.m. to approximately 11:53

p.m. on November 29, 2008. ‘‘All throughout her stay

. . . [the decedent] remained awake, alert, and aware,

nontoxic. And through time . . . her vital signs had

improved.’’ Hope, who had stayed with the decedent

at her bedside, also observed that, although initially the

decedent seemed, as characterized by the defendant’s

counsel, ‘‘sluggish,’’ her condition continued to improve

and she was ‘‘laughing and making jokes.’’ During her

hospitalization at Lawrence & Memorial, the decedent

was not administered any Narcan. Marchiondo had

determined that it was not necessary to treat the dece-

dent with Narcan because her vital signs had improved

while she was at Lawrence & Memorial.

Throughout her stay, the decedent was monitored by

Mays, who noted in her report that the decedent’s vital

signs improved and stabilized. At approximately 8 p.m.,

the decedent was ‘‘awake and alert and asking to leave

. . . [but was] told that she was here for the night.’’ At

this point, the decedent’s respiration rate had improved

to sixteen breaths per minute, and her oxygen satura-

tion level had risen to 99 percent. These levels were

‘‘basically normal.’’ The decedent also had been taken

off supplemental oxygen.

At 9 p.m., the decedent was ‘‘resting soundly’’ and

her ‘‘[respiration was] easy/even.’’ Her respiration rate

and oxygen saturation level had not changed since 8

p.m. At 10 p.m. and 11:30 p.m., the decedent’s respira-

tion rate still was sixteen breaths per minute, and her

oxygen saturation level still was 99 percent. At some

point between 11:35 p.m. and 11:53 p.m., the decedent

was discharged and was provided instructions for a

‘‘narcotic overdose,’’ which advised the decedent to

‘‘[r]eturn to the ER if [her condition] worse[ned].’’

Upon being discharged from Lawrence & Memorial,

the decedent left with Hope. Hope and the decedent

stopped for food and coffee before returning to Hope’s

home. At Hope’s home, Hope and the decedent con-

versed until approximately 1:30 a.m. on November 30,

2008, at which point, Hope went to bed. When Hope left

the decedent to go to bed, the decedent was kneeling on

the corner of the bed in Hope’s guest bedroom, watch-

ing television and looking at photographs. Hope did not

hear any activity during the night.

After waking up at approximately 9:45 a.m. later that

morning, Hope found the decedent unresponsive. The

decedent’s body was ‘‘frozen stiff’’ and kneeling in the

same position in which she had been on Hope’s guest

bed when Hope last saw her at 1:30 a.m. earlier that

morning. Hope called 911 at approximately 10:39 a.m.

New London police, accompanied by New London

Fire Department EMTs, arrived at Hope’s home on

November 30 at approximately 11 a.m. The decedent

was pronounced deceased by the EMTs at approxi-

mately 11:05 a.m. Thereafter, Hope assisted the police

in searching his entire house for drug paraphernalia

and other evidence of drug use. Neither Hope nor the

five law enforcement officers searching the scene found

anything relating to drug activity.

At approximately 1:34 p.m., Penny Geyer, an investi-

gator with the Office of the Chief Medical Examiner,

arrived at Hope’s home. At the scene, Geyer performed

an external examination of the decedent’s clothed body.

She did not find any illicit drugs or drug paraphernalia

on or around the decedent’s body, and she did not

observe any signs of drug ingestion on the decedent’s

body, such as needle marks or residue in the decedent’s

nose or mouth.

Deputy Chief Medical Examiner Edward T. McDo-

nough III performed the decedent’s autopsy on Decem-

ber 1, 2008. A toxicology screen ordered by McDonough

detected the presence of methadone in the decedent’s

blood. Specifically, the report indicated that the concen-

tration of methadone in the decedent’s blood was 0.39

milligrams per liter. The postmortem toxicology screen

did not detect any opioids or opiates other than

methadone.

As a result of his review of the toxicology report and

his examination of the decedent, McDonough con-

cluded that the final cause of the decedent’s death was

‘‘methadone toxicity.’’ In so concluding, McDonough

determined that the postmortem concentration of meth-

adone in the decedent’s blood, 0.39 milligrams per liter,

was ‘‘within the fatal range.’’ McDonough also deter-

mined that the decedent died sometime between 5 a.m.

and 7 a.m. on November 30, 2008, although this was

merely a ‘‘crude’’ approximation because the time of

death could have been ‘‘much earlier.’’

In November, 2010, the plaintiff, acting as the admin-

istrator of the decedent’s estate, brought this medical

malpractice action seeking damages for the decedent’s

death. The plaintiff’s initial complaint asserted one

count against Marchiondo, one count against Law-

rence & Memorial Hospital, Inc., and Lawrence &

Memorial Hospital Corporation, and one count against

the defendant. Following the plaintiff’s withdrawal of

the separate counts against Marchiondo and Law-

rence & Memorial Hospital, Inc., and Lawrence &

Memorial Hospital Corporation; see footnote 1 of this

opinion; the plaintiff amended his complaint to seek

recovery from only the defendant.

The plaintiff’s operative complaint alleges that the

defendant is vicariously liable for the medical malprac-

tice that its employee,4 Marchiondo, committed in treat-

ing the decedent for a suspected drug overdose on

November 29, 2008. The gravamen of the plaintiff’s com-

plaint is that Marchiondo’s discharge of the decedent

after only four and one-half hours of observation at

Lawrence & Memorial was premature. According to

the plaintiff, because the decedent presented with a

possible methadone overdose, Marchiondo should have

kept her under medical monitoring for twenty-four

hours, which is the period of time during which the

fatal side effects of methadone toxicity may occur.

Accordingly, the plaintiff alleges, if the decedent had

remained under medical monitoring for the full twenty-

four hours, the fatal overdose side effects she experi-

enced after her discharge would have been treated and

her eventual death from methadone toxicity would have

been averted.

In his complaint, the plaintiff sought both economic

and noneconomic damages resulting from the dece-

dent’s death. The claim for economic damages included

medical expenses and funeral costs, and the claim for

noneconomic damages sought compensation for the

decedent’s permanent loss of her ability to carry on

and enjoy life’s activities.

After the plaintiff rested, the defendant moved for a

directed verdict. Specifically, the defendant argued that

‘‘the plaintiff [had] not submitted sufficient evidence to

establish a prima facie case with respect to causation.’’

(Emphasis added.) The defendant did not challenge the

sufficiency of the evidence regarding the appropriate

standard of care and the defendant’s breach thereof.

The court reserved decision on the defendant’s motion

for a direct verdict.

The jury returned a plaintiff’s verdict and awarded

$12,095 in economic damages and $500,000 in noneco-

nomic damages. The award consisted of $350,000 for

the decedent’s death and $150,000 for the destruction

of the decedent’s capacity to carry on and enjoy life’s

activities.

After the jury returned its verdict, the defendant

renewed its motion for a directed verdict.5 As in its

initial motion, the defendant challenged the sufficiency

of the evidence only with respect to causation: ‘‘[T]he

evidence presented by the plaintiff during his case-in-

chief [was] insufficient to support a conclusion that any

alleged negligence on the part of the defendant was the

cause in fact of the death of [the decedent].’’ Specifi-

cally, the defendant argued that there were ‘‘two miss-

ing links in the plaintiff’s chain of causation: (1) that

[the decedent] overdosed on methadone on [November

29, 2008]; and (2) that [the decedent] met the criteria

for admission to [Lawrence & Memorial].’’

Regarding the first ‘‘missing link,’’ the defendant con-

tended that ‘‘the jury had no basis—other than conjec-

ture—to find that [the decedent] overdosed on

methadone on November 29, [2008]. To the contrary,

science and the chronology of events point only to the

‘reasonable hypothesis’ that [the decedent] took the

lethal dose of methadone after Dr. Marchiondo dis-

charged her.’’ (Emphasis in original.)

Regarding the second ‘‘missing link,’’ the defendant

contended that ‘‘the jury could only guess about another

critical piece of the puzzle: admission to [Lawrence &

Memorial]. . . . [T]here was no evidence about [Law-

rence & Memorial’s] criteria for admission, or whether

[the decedent] met those criteria.’’ According to the

defendant, the applicable standard of care required

Marchiondo to admit the decedent to Lawrence &

Memorial. Thus, the defendant posited, the plaintiff

could not prove that Marchiondo’s breach of that stan-

dard of care caused the decedent’s death without evi-

dence that the decedent likely would have been

admitted to Lawrence & Memorial.

After holding a hearing on the defendant’s renewed

motion for a directed verdict, the court denied the

motion. This appeal followed. Additional facts will be

set forth as necessary.

I

SUFFICIENCY OF EVIDENCE ON CAUSATION

The defendant’s first claim on appeal is that the plain-

tiff failed to present sufficient evidence from which the

jury reasonably could have found that the defendant

caused the decedent’s death. Specifically, the defendant

argues that ‘‘there are two gaping holes in the evidence:

(1) proof that the decedent consumed the fatal dose of

methadone before her discharge from the emergency

room on November 29, [2008], and (2) proof that she met

the criteria for admission to [Lawrence & Memorial].’’

two causation challenges seriatim.

A

In its first challenge to the sufficiency of the evidence

on causation, the defendant contends that there ‘‘was

no direct evidence [regarding] when the decedent con-

sumed the fatal dose of methadone. . . . [O]nly cre-

ative guesswork supports the jury’s inference that the

decedent did so before, and not after, her discharge

from the emergency room.’’ (Emphasis added; internal

quotation marks omitted.) In particular, the defendant

argues that the jury’s finding regarding causation is

inconsistent with ‘‘time and science, i.e., the mechanical

details disclosed by the evidence . . . .’’ (Internal quo-

tation marks omitted.) According to the defendant, the

‘‘undisputed’’ scientific evidence presented at trial dem-

onstrated that ‘‘[i]f the decedent had actually overdosed

on methadone on November 29, [2008], she would have

had a recurrence of overdose symptoms long before

she was discharged [from Lawrence & Memorial].’’

(Emphasis added.) Thus, because the decedent did not

experience recurring overdose symptoms ‘‘long before’’

her discharge, she had not consumed a toxic amount

of methadone on November 29. We disagree.

The following additional facts and procedural history

guide our resolution of this claim. A substantial part of

the evidence presented by both parties at trial came in

the form of expert testimony. Both parties presented

expert testimony on the issue of causation. McDonough,

who was disclosed as the plaintiff’s causation expert,

also was the medical examiner who performed the dece-

dent’s autopsy. He testified that the postmortem level

of methadone in the decedent’s blood, 0.39 milligrams

per liter, was a toxic concentration and caused her

death. He further testified that the specific ‘‘mechanism

of death’’ probably was respiratory depression, in which

the methadone intoxication would have ‘‘[shut] down

[the decedent’s] breathing.’’ McDonough’s determina-

tion of the cause of death called into doubt Marchi-

ondo’s diagnosis of the decedent, which was that she

had overdosed on heroin, not methadone.

Dr. Steven Pike, the defendant’s expert on causation,

initially testified that he could not determine within a

reasonable degree of medical probability whether the

decedent’s cause of death was methadone toxicity. He

later testified, however, that ‘‘it’s probably more likely

than not’’ that methadone toxicity was the cause of the

decedent’s death.

The defendant’s strategy in contesting causation

essentially was to demonstrate that the decedent

ingested the fatal dose of methadone after she was

discharged from Lawrence & Memorial. According to

the defendant, if the plaintiff could not establish that

the decedent ingested the fatal dose before her dis-

charge, there would be no causal connection between

the allegedly negligent treatment she received at Law-

rence & Memorial and the methadone toxicity to which

she eventually succumbed. Critically, during the defen-

dant’s cross-examination of McDonough, McDonough

conceded that he could not rule out the possibility that

the fatal dose of methadone was ingested after the

decedent’s discharge.

Without direct evidence of when the decedent con-

sumed the fatal dose, the parties largely relied on indi-

rect evidence from which the jury could infer the timing

of the decedent’s ingestion of methadone. In turn, such

indirect evidence required the application of the toxico-

logical concepts and biochemical processes that govern

how the human body absorbs, metabolizes, and

excretes Narcan and various opiates and opioids. The

following evidence relating to those scientific principles

was presented through the parties’ expert testimony.

For the most part, the parties’ experts were in

agreement on several fundamental toxicological con-

cepts and biochemical processes. The first important

concept about which the experts provided testimony

was half-life. A half-life is the time it takes for the con-

centration of a drug in a person’s system to be reduced

by one-half. It takes approximately the lapse of five

half-lives for a drug to be eliminated completely from

a person’s system. Because the body does not start to

eliminate a drug until it is absorbed, the first half-life

of a drug will not begin to run until after the drug

is absorbed.

The second concept about which the parties’ experts

testified was duration of effect. Although related to the

concept of half-life, duration of effect ‘‘is not equivalent

to the half-life of the drug. In some cases, it may be

less than the half-life of the drug. In some cases, it may

be longer than the half-life of the drug.’’ While half-life

refers to the rate at which an absorbed drug is elimi-

nated from the body, duration of effect refers to how

long a drug produces physiologic effects.6 To illustrate

this distinction, it is possible that a small concentration

of a drug still is in the body after several half-lives,

yet that small concentration has ceased producing any

effects. The converse also applies in the case of some

drugs: ‘‘[A drug] may go through a couple half-lives,

[but] still be producing some effect . . . .’’

The parties’ experts also generally agreed regarding

the half-lives and durations of effect of Narcan, long-

acting narcotics, and short-acting narcotics. The half-

life of Narcan, approximately thirty to eighty minutes,

is much shorter than the half-lives of both long-acting

narcotics and short-acting narcotics. Additionally, the

half-lives of short-acting narcotics are shorter than the

half-lives of long-acting narcotics. For instance, the

plaintiff’s expert testified that the half-life of metha-

done, a long-acting narcotic, ranges from fifteen to fifty-

five hours, and the defendant’s expert testified that it

could range from eighteen to sixty hours. In contrast,

according to the plaintiff’s expert, the half-life of heroin,

a short-acting narcotic, is two to five hours, and the

defendant’s expert stated that it is three to four hours.

The durations of effect of Narcan, short-acting nar-

cotics, and long-acting narcotics largely were undis-

puted as well. The duration of Narcan’s antidotal effect

begins almost instantaneously upon administration and

lasts for thirty to ninety minutes.7 Generally, Narcan

‘‘wears off much sooner than . . . [opiates and opioids

such as] heroin . . . or methadone.’’ Heroin ‘‘has an

effect of four to six hours,’’ while methadone produces

‘‘a[n] . . . effect of twelve to twenty-four hours.’’

The parties’ experts also noted, however, that there

are some ‘‘interindividual’’ variations in those durations

of effect and half-lives because ‘‘each individual metab-

olizes materials differently.’’ Furthermore, the method

of administration, the dosage size, and the individual’s

tolerance for the drug all affect how quickly after inges-

tion the drug will begin to produce effects. In particular,

because intravenous administration delivers the drug

directly into the bloodstream, it causes an individual

to absorb the drug faster than oral administration and,

therefore, produces effects sooner than oral administra-

tion. For instance, because oral administration of meth-

adone is ‘‘not an instantaneous absorption,’’ ‘‘it takes

time for the methadone to be absorbed . . . .’’ Thus,

it could take as long as two and one-half hours after

ingestion for orally administered methadone to be

absorbed fully and to reach a peak concentration in

the blood.

Having agreed that the effects produced by long-act-

ing and short-acting narcotics generally outlast Nar-

can’s antidotal effects, the parties’ experts also agreed

that overdose symptoms, including respiratory depres-

sion, may return after Narcan wears off. In other words,

if the concentration of a narcotic still is at a toxic level

after Narcan wears off, there will be ‘‘a recurrence of

the symptoms that prompted . . . [the initial dose of]

Narcan.’’ The overdose symptoms reappear because

Narcan only temporarily displaces the narcotic from

the body’s opioid receptors. Once the Narcan has worn

off, the remaining concentration of the narcotic reatta-

ches to the opioid receptors.

Despite their agreement on the foregoing principles,

the parties’ experts disagreed on a critical point. Specifi-

cally, their testimony differed with respect to the issue

of how soon recurring overdose symptoms return after

the administration of Narcan. When asked by the defen-

dant’s counsel what happens to ‘‘patients if they still

have a toxic or rising dose of opiate or opioid after the

Narcan wears off,’’ Pike answered: ‘‘[A]n hour after

Narcan, they’re going to have a recurrence of the symp-

toms that prompted the paramedics or . . . physician

to give the Narcan.’’ (Emphasis added.) Regarding meth-

adone overdoses in particular, Pike further testified that

‘‘patients who do overdose on methadone . . . have to

be admitted because you’re going to be standing there

administering Narcan every hour, hour and a half . . . .

[T]hey need a continuous infusion of Narcan . . . until

they get below that concentration that was causing the

overdose effects, and that could take as long as a

day . . . .’’

In applying those principles to the decedent’s case,

Pike made the following three observations. First, if a

methadone overdose had caused the initial respiratory

depression the decedent was experiencing when Hope

found her on November 29 at 6:45 p.m., then the respira-

tory depression should have returned ‘‘at about 8

o’clock,’’ i.e., approximately one hour after the para-

medics administered Narcan. This conclusion was pred-

icated on the assumption, acknowledged by both

parties’ experts, that methadone is a long-acting nar-

cotic that has a long half-life and duration of effect.

Thus, according to Pike, if the concentration of metha-

done was sufficiently toxic to cause respiratory depres-

sion at 6:45 p.m., then it probably still would have been

sufficiently toxic when the Narcan wore off at 8 p.m.

Second, according to Pike, the record revealed that

the respiratory depression in fact did not return when

the Narcan should have been wearing off. To be sure,

the respiratory depression did not return at any point

during the decedent’s hospitalization at Lawrence &

Memorial. On the contrary, the decedent’s vital signs,

including her respiration rate and oxygen saturation

levels, stabilized at normal levels hours before her dis-

charge. Furthermore, the decedent’s condition did not

warrant another administration of Narcan at Law-

rence & Memorial.

Third, Pike inferred from those first two observations

that the decedent’s initial respiratory depression was

caused by a short-acting narcotic, not a long-acting

narcotic. According to Pike, a short-acting narcotic, by

virtue of having a relatively short half-live and duration

of effect, would not have caused a recurrence of over-

dose symptoms after Narcan wore off. That is, there

would have been a ‘‘rapid decay’’ of the short-acting

narcotic’s concentration during Narcan’s period of

effectiveness, leaving a nontoxic concentration after

Narcan wore off. Therefore, the absence of any recur-

ring overdose symptoms after Narcan’s period of effec-

tiveness is consistent with an overdose on a short-acting

narcotic, not a long-acting narcotic like methadone.

On the basis of those three observations, Pike opined

that the decedent had not ingested a fatal concentration

of methadone before she was hospitalized at Law-

rence & Memorial. Pike attributed the positive metha-

done finding in the Lawrence & Memorial drug screen

to the methadone that the decedent was administered

at Blue Hills. He had ‘‘[n]o doubt whatsoever’’ that the

Blue Hills methadone caused the positive methadone

finding on November 29, 2008, notwithstanding the fact

that the last Blue Hills dose was administered to the

decedent on November 21, 2008. Pike reasoned that the

Blue Hills methadone would have been detected on

November 29 because five half-lives had not passed

since the November 21 dose. In so reasoning, Pike

apparently assumed that the Blue Hills methadone’s

half-life was substantially longer than twenty-four

hours, even though he previously had used twenty-four

hours as ‘‘a reasonable estimate’’ of methadone’s

half-life.

Testimony provided by one of the plaintiff’s experts,

Eric Schwam, controverted Pike’s opinion that recur-

ring respiratory depression always presents approxi-

mately one hour after the administration of Narcan. An

emergency medicine physician who opined mainly on

the standard of care,8 Schwam testified that the ‘‘experi-

ence of decades of . . . [caring for] patients [overdos-

ing on] long-acting opiates’’ has shown that ‘‘delayed

respiratory depression can occur . . . .’’ (Emphasis

added.) According to Schwam, ‘‘you don’t know when

[the] return of respiratory depression is going to occur.

One might think that it would occur when the Narcan

wears off, and that’s a widely held misconception

. . . . [T]hat’s a very easy thing to assume if you know

a little bit about opiate toxicology, but decades of expe-

rience have shown that if that’s the way you think and

you discharge a patient, a lot of them will be dead the

next day.’’ (Emphasis added.)

Schwam also described two specific cases of delayed

recurring respiratory depression that he had encoun-

tered in his medical practice. In the first case, ‘‘[a]

patient took an overdose of methadone, was seen in

the emergency department, was monitored for six

hours, was discharged by the physician, thinking that

everything was okay, and the person had recurrence

of respiratory depression. Fortunately, they survived.’’

In the second case, which was ‘‘very similar to [the

decedent’s case],’’ a ‘‘patient was discharged home and

was found dead the next day.’’ According to Schwam,

‘‘these cases . . . have been going on for years, and

apparently, they continue to happen.’’ For these rea-

sons, Schwam testified, the appropriate standard of

care for a suspected methadone overdose is ‘‘monitor[-

ing] . . . for twenty-four hours for signs of recurrent

opiate overdose.’’ (Emphasis added.)

Although Schwam was not a causation expert,9 the

defendant never objected to counsel’s questions per-

taining to delayed recurring respiratory depression on

the ground that they were outside the scope of the

subject matter of Schwam’s testimony.10 Moreover, the

defendant never moved, on that specific ground, to

strike Schwam’s answers regarding delayed recurring

respiratory depression.11

The plaintiff’s other expert, McDonough, also dis-

agreed with Pike’s assertion that the Blue Hills metha-

done caused the positive methadone finding in the

decedent’s drug screen at Lawrence & Memorial. He

opined that the Blue Hills methadone was not the same

methadone that was detected in the drug screen on

November, 29, 2008. McDonough reasoned that the

amount of methadone the decedent received at Blue

Hills on November 21, 2008, ‘‘is basically the smallest

dosage you can have’’ and that the drug screen was

conducted ‘‘eight and one-half days from the last inges-

tion of that five milligram tablet . . . .’’ In so reasoning,

McDonough apparently refused to assume, like Pike,

that the Blue Hills methadone’s half-life was substan-

tially longer than twenty-four hours.

In analyzing the defendant’s first challenge to the

sufficiency of causation evidence, we begin by setting

forth our standard of review. ‘‘A party challenging the

validity of the jury’s verdict on grounds that there was

insufficient evidence to support such a result carries a

difficult burden. In reviewing the soundness of a jury’s

verdict, we construe the evidence in the light most

favorable to sustaining the verdict. . . . Furthermore,

it is not the function of this court to sit as the seventh

juror when we review the sufficiency of the evidence

. . . rather, we must determine . . . whether the total-

ity of the evidence, including reasonable inferences

therefrom, supports the jury’s verdict . . . . [I]f the

jury could reasonably have reached its conclusion, the

verdict must stand, even if this court disagrees with

it. . . .

‘‘Two further fundamental points bear emphasis.

First, the plaintiff in a civil matter is not required to

prove his case beyond a reasonable doubt; a mere pre-

ponderance of the evidence is sufficient. Second, the

well established standards compelling great deference

to the historical function of the jury find their roots in

the constitutional right to a trial by jury.’’ (Citations

omitted; internal quotation marks omitted.) Doe v. Hart-

ford Roman Catholic Diocesan Corp., 317 Conn. 357,

370–71, 119 A.3d 462 (2015).

‘‘[I]t is [the] function of the jury to draw whatever

inferences from the evidence or facts established by

the evidence it deems to be reasonable and logical. . . .

Because [t]he only kind of an inference recognized by

the law is a reasonable one . . . any such inference

cannot be based on possibilities, surmise or conjecture.

. . . It is axiomatic, therefore, that [a]ny [inference]

drawn must be rational and founded upon the evidence.

. . . However, [t]he line between permissible inference

and impermissible speculation is not always easy to

discern. When we infer, we derive a conclusion from

proven facts because such considerations as experi-

ence, or history, or science have demonstrated that

there is a likely correlation between those facts and the

conclusion. If that correlation is sufficiently compelling,

the inference is reasonable. But if the correlation

between the facts and the conclusion is slight, or if a

different conclusion is more closely correlated with the

facts than the chosen conclusion, the inference is less

reasonable. At some point, the link between the facts

and the conclusion becomes so tenuous that we call it

speculation. When that point is reached is, frankly, a

matter of judgment. . . .

‘‘[P]roof of a material fact by inference from circum-

stantial evidence need not be so conclusive as to exclude

every other hypothesis. It is sufficient if the evidence

produces in the mind of the trier a reasonable belief in

the probability of the existence of the material fact. . . .

Thus, in determining whether the evidence supports a

particular inference, we ask whether that inference is

so unreasonable as to be unjustifiable. . . . In other

words, an inference need not be compelled by the evi-

dence; rather, the evidence need only be reasonably

susceptible of such an inference. Equally well estab-

lished is our holding that a jury may draw factual infer-

ences on the basis of already inferred facts. . . .

Finally, it is well established that a plaintiff has the

same right to submit a weak case as he has to submit

a strong one. (Citations omitted; emphasis added; inter-

nal quotation marks omitted.) Curran v. Kroll, 303

Conn. 845, 856–57, 37 A.3d 700 (2012).

We next set forth the legal principles governing medi-

cal malpractice actions. ‘‘[T]o prevail in a medical mal-

practice action, the plaintiff must prove (1) the requisite

standard of care for treatment, (2) a deviation from that

standard of care, and (3) a causal connection between

the deviation and the claimed injury.’’ (Internal quota-

tion marks omitted.) Gold v. Greenwich Hospital Assn.,

262 Conn. 248, 254–55, 811 A.2d 1266 (2002). ‘‘Generally,

expert testimony is required to establish both the stan-

dard of care to which the defendant is held and the

breach of that standard.’’ (Internal quotation marks

omitted.) Id., 255. Likewise, ‘‘[e]xpert medical opinion

evidence is usually required to show the cause of an

injury or disease because the medical effect on the

human system of the infliction of injuries is generally

not within the sphere of the common knowledge of

the lay person.’’ (Internal quotation marks omitted.)

Milliun v. New Milford Hospital, 310 Conn. 711, 725,

80 A.3d 887 (2013).

The defendant does not argue that there is insufficient

evidence supporting the jury’s findings regarding the

appropriate standard of care and Marchiondo’s devia-

tion from that standard of care. Thus, we focus on the

principles pertaining to causation. ‘‘All medical mal-

practice claims, whether involving acts or inactions of

a defendant physician, require that a defendant physi-

cian’s conduct proximately cause the plaintiff’s injuries.

The question is whether the conduct of the defendant

was a substantial factor in causing the plaintiff’s injury.

. . . This causal connection must rest upon more than

surmise or conjecture. . . . A trier is not concerned

with possibilities but with reasonable probabilities.

. . . The causal relation between an injury and its later

physical effects may be established by the direct opin-

ion of a physician, by his deduction by the process of

eliminating causes other than the traumatic agency, or

by his opinion based upon a hypothetical question.’’

(Internal quotation marks omitted.) Sargis v. Donahue,

142 Conn. App. 505, 513, 65 A.3d 20, cert. denied, 309

Conn. 914, 70 A.3d 38 (2013).

‘‘[I]t is the plaintiff who bears the burden to prove

an unbroken sequence of events that tied his injuries

to the [defendants’ conduct]. . . . This causal connec-

tion must be based upon more than conjecture and

surmise.’’ (Citations omitted; internal quotation marks

omitted.) Paige v. St. Andrew’s Roman Catholic Church

Corp., 250 Conn. 14, 25–26, 734 A.2d 85 (1999). A plain-

tiff, however, ‘‘is not required to disprove all other possi-

ble explanations for the accident but, rather, must

demonstrate that it is more likely than not that the

defendant’s negligence was the cause of the accident.’’

(Emphasis added.) Rawls v. Progressive Northern Ins.

Co., 310 Conn. 768, 782, 83 A.3d 576 (2014). ‘‘[T]he issue

of causation in a negligence action is a question of fact

for the trier . . . .’’ (Internal quotation marks omitted.)

Burton v. Stamford, 115 Conn. App. 47, 87, 971 A.2d

739, cert. denied, 293 Conn. 912, 978 A.2d 1108 (2009).

With the relevant legal framework in mind, we turn

to the present case. As an initial matter, we highlight

that the parties’ dispute regarding causation revolves

around the issue of when the decedent ingested the

fatal dose of methadone. That issue, in turn, depends

principally on the application of the toxicological princi-

ples governing the relative half-lives and durations of

effect of Narcan and long-acting and short-acting nar-

cotics. Thus, we begin by reviewing the expert evidence

relating to those toxicological principles.

The thrust of the defendant’s argument is that the

undisputed ‘‘physical facts of human biology’’ and ‘‘set-

tled scientific principles’’ ‘‘permit[ted] only one conclu-

sion: If the plaintiff had consumed the fatal dose of

methadone before her discharge from the emergency

room, there would have been some sign of the drug’s

resurgent effect before 1:30 a.m.’’ The fundamental flaw

in this argument is that the relevant ‘‘physical facts’’

and ‘‘scientific principles’’ were disputed at trial. Our

review of the record reveals that, although the parties’

experts concurred on much of the relevant science,

their testimony diverged on a crucial point. As pre-

viously explained in considerable detail, the parties’

experts disagreed as to how soon after receiving Narcan

a methadone overdose patient experiences recurring

overdose symptoms.

The defendant’s causation expert, Pike, testified that

recurring methadone overdose symptoms should pre-

sent, if at all, one hour after the administration of Nar-

can. This testimony, however, was contradicted directly

by the testimony of Schwam, the plaintiff’s standard of

care expert. In particular, Schwam testified that

‘‘delayed respiratory depression can occur’’ in cases of

overdoses on long-acting narcotics and that ‘‘you don’t

know when [the] return of respiratory depression is

going to occur.’’ (Emphasis added.) According to

Schwam, ‘‘[o]ne might think that [the return] would

occur when the Narcan wears off, [but] that’s a widely

held misconception . . . .’’ (Emphasis added.)

Schwam recalled from his experience two cases in

which delayed recurring respiratory depression

occurred. Although the defendant correctly points out

that these two cases may not be exactly analogous to

the decedent’s case, they still, nonetheless, are illustra-

tive of the broader point that delayed recurring can

occur in cases of methadone overdose.

Despite some testimony suggesting that delayed

recurring respiratory depression violates certain scien-

tific principles, Schwam testified that it is a medical

phenomenon that actually has been observed in prac-

tice. Indeed, Schwam opined not only that the phenome-

non can occur, but that it occurs despite what the

defendant characterizes as ‘‘undisputed’’ and ‘‘settled’’

scientific principles. Specifically, Schwam testified that

‘‘a little bit [of knowledge pertaining to] opiate toxicol-

ogy’’ has given rise to the ‘‘widely held misconception’’

that recurring overdose symptoms return ‘‘when the

Narcan wears off . . . .’’ (Emphasis added.) In other

words, the evidence did not establish, as the defendant

suggests, that delayed onset of recurring respiratory

depression was scientifically impossible. On the con-

trary, the jury heard expert testimony that delayed

recurring respiratory depression can occur in metha-

done overdoses, even if such a phenomenon seems

to defy the ‘‘undisputed’’ and ‘‘settled’’ toxicological

principles of half-life and duration of effect.

‘‘Conflicting expert testimony does not necessarily

equate to insufficient evidence.’’ (Internal quotation

marks omitted.) Dallaire v. Hsu, 130 Conn. App. 599,

603, 23 A.3d 792 (2011). Rather, ‘‘[w]here expert testi-

mony conflicts, it becomes the function of the trier of

fact to determine credibility and, in doing so, it could

believe all, some or none of the testimony of either

expert.’’ (Internal quotation marks omitted.) DelBuono

v. Brown Boat Works, Inc., 45 Conn. App. 524, 541, 696

A.2d 1271, cert. denied, 243 Conn. 906, 701 A.2d 328

(1997). It is axiomatic that in cases involving ‘‘conflict-

ing expert testimony, the jury is free to accept or reject

each expert’s opinion in whole or in part.’’ (Internal

quotation marks omitted.) Shelnitz v. Greenberg, 200

Conn. 58, 68, 509 A.2d 1023 (1986).

In the present case, the jury certainly was free to

believe and accept the opinion of the plaintiff’s expert

that the phenomenon of delayed recurring respiratory

depression can occur in methadone overdoses. Like-

wise, it was free to disbelieve and reject the parts of

the testimony of the defendant’s expert that attempted

to refute that phenomenon. Therefore, contrary to the

defendant’s assertion, the fact that the decedent did not

immediately experience recurring overdose symptoms

one hour after Narcan was administered did not require

the jury to conclude that the decedent’s overdose on

November 29, 2008, was caused by a short-acting nar-

cotic rather than methadone. The jury could have con-

cluded, instead, that the delayed recurring respiratory

depression the decedent eventually experienced was

consistent with her ingestion of a toxic dose of metha-

done before her visit to Lawrence & Memorial on

November 29, 2008.

Notwithstanding our conclusion that the parties pre-

sented conflicting expert testimony on the concept of

delayed recurring respiratory depression, the defendant

argues that it is improper to consider Schwam’s testi-

mony in reviewing the evidence on that concept. Specif-

ically, the defendant argues that ‘‘Schwam testified as

an expert on the standard of care, not causation. [Thus]

[the jury] had no basis to transplant that standard of

care testimony to the foreign soil of causation—and no

guidance from an expert on how to make it grow there

if [it] did.’’ According to the defendant, ‘‘[t]he plaintiff

put on Dr. Schwam for one purpose; his testimony can-

not be used for another and totally different purpose.’’

(Internal quotation marks omitted.) We find this argu-

ment unpersuasive.

As an initial matter, we note that it is unclear from

the record whether Schwam’s testimony was offered

solely for standard of care purposes. The plaintiff’s dis-

closure of Schwam’s testimony indicated that Schwam

would testify on a wide range of subject matter, includ-

ing how delayed recurring respiratory depression

caused the decedent’s death.12 Additionally, the record

is silent as to how the plaintiff actually offered the

testimony and if at that time he in fact limited his offer

to standard of care purposes.

Notwithstanding the ambiguity surrounding the plain-

tiff’s proffer of Schwam’s testimony, the parties appar-

ently agree that Schwam’s testimony was offered only

for standard of care purposes.13 Schwam, nonetheless,

was an emergency medicine physician who had experi-

ence treating overdose patients and reviewing overdose

cases in his capacity as a hospital’s director of quality

assurance. Thus, his testimony regarding delayed respi-

ratory depression was an ‘‘expert’’ opinion in the sense

that it was based on his expertise and experience in

practicing emergency medicine, a field apparently

requiring knowledge of the toxicological and pharmaco-

logical properties of narcotics. The fact that the parties’

dispute over the standard of care and causation both

centered primarily on those properties reveals that the

issues of standard of care and causation clearly were

intertwined in the present case.

Even if Schwam’s testimony was offered strictly for

standard of care purposes, the defendant failed to pur-

sue any preemptive or remedial measures that would

have precluded or limited Schwam’s testimony on the

issue of delayed recurring respiratory depression. The

defendant did not file a motion in limine on that issue;

it did not object to questions on that issue asked of

Schwam by the plaintiff’s counsel;14 it did not move to

strike Schwam’s testimony regarding that issue;15 and

it did not request a limiting instruction directing the

jury to consider Schwam’s testimony on that issue only

for standard of care purposes. See State v. Dews, 87

Conn. App. 63, 69, 864 A.2d 59 (rejecting claim that trial

court, sua sponte, should have ‘‘stricken . . . testi-

mony and offered a limiting instruction as to its use’’

because ‘‘defendant did not object to . . . testimony,

he failed to seek to have the testimony stricken . . .

he did not request a limiting instruction . . . [and] he

[did not] take exception to the court’s failure to give a

limiting instruction’’), cert. denied, 274 Conn. 901, 876

A.2d 13 (2005).

Accordingly, the court never instructed the jury that

it should disregard Schwam’s testimony on delayed

recurring respiratory depression or that it should con-

sider such testimony only for standard of care purposes.

In the absence of any such instruction from the court,

the evidence regarding delayed recurring respiratory

depression was before the jury for it to use for any

purpose, including causation. See Curran v. Kroll,

supra, 303 Conn. 863–64 (‘‘We also are not persuaded by

the . . . argument that the Appellate Court improperly

concluded that evidence of the decedent’s telephone

call to [the defendant physician] would support an infer-

ence that the decedent would have called [the defen-

dant] about her leg pain if she had been warned about

it because the evidence was not presented for that pur-

pose . . . . This evidence was admitted in full, without

limitation. In the absence of any limiting instruction,

the jury was entitled to draw any inferences from the

evidence that it reasonably would support.’’ [Emphasis

added.]); see also State v. Carey, 228 Conn. 487, 496, 636

A.2d 840 (1994) (‘‘If [inadmissible] evidence is received

without objection, it becomes part of the evidence in

the case, and is usable as proof to the extent of the

rational persuasive power it may have. The fact that it

was inadmissible does not prevent its use as proof so far

as it has probative value. . . . This principle is almost

universally accepted. . . . The principle applies to any

ground of incompetency under the exclusionary rules.’’

[Internal quotation marks omitted.]).

The defendant also argues that, even if the jury could

consider Schwam’s testimony for causation purposes,

the combined expert testimony of Schwam and McDo-

nough still was insufficient to establish causation. Spe-

cifically, the defendant argues that ‘‘[e]ven if the

plaintiff could dress up standard of care testimony in

causation clothes, Dr. Schwam did not opine that

delayed respiratory depression caused the decedent’s

death. No [expert] witness did.’’ (Emphasis altered.)

The defendant also contends that McDonough’s opinion

as to the decedent’s cause of death was inadequate

because McDonough could not determine if the dece-

dent consumed the fatal dose of methadone before her

discharge from Lawrence & Memorial. Thus, the grava-

men of the defendant’s challenge to the expert evidence

on causation is that the opinions of McDonough and

Schwam were deficiently unspecific. We are unper-

suaded.

The defendant correctly states that a plaintiff in a

medical malpractice action generally must prove causa-

tion with expert testimony. See Milliun v. New Milford

Hospital, supra, 310 Conn. 725. We disagree with the

defendant, however, that the cumulative effect of the

expert evidence and other evidence presented in this

case did not establish a causal connection between the

defendant’s negligence and the decedent’s death.

First, although McDonough did not testify specifically

that the respiratory depression responsible for the dece-

dent’s death was ‘‘delayed,’’ he did opine that the cause

of death was respiratory depression resulting from

methadone toxicity. McDonough also provided subse-

quent testimony indicating that the ‘‘presumed time to

onset’’ of respiratory depression in methadone over-

doses ‘‘could be quite long’’ because ‘‘the respiratory

depression comes on much later than the pain relief.’’

(Emphasis added.) Furthermore, expert testimony pro-

vided by Schwam, which we presume the jury credited,

described in considerable detail the phenomenon of

delayed recurring respiratory depression in methadone

overdoses. The occurrence of fatal respiratory depres-

sion hours after the decedent’s consumption of metha-

done was consistent with the expert testimony provided

by McDonough and Schwam. Thus, when all of the

expert testimony is considered together, the jury rea-

sonably could have inferred that the decedent suc-

cumbed to delayed respiratory depression.

Second, the fact that McDonough could not deter-

mine the specific time at which the decedent consumed

the fatal dosage of methadone does not render his opin-

ion inadequate. Rather, the specific timing of the dece-

dent’s ingestion of methadone was a fact that the

plaintiff could have proven with circumstantial evi-

dence. See Shelnitz v. Greenberg, supra, 200 Conn. 66

(‘‘[in a medical malpractice action] [c]ausation may be

proved by circumstantial evidence and expert testi-

mony’’ [emphasis added; internal quotation marks omit-

ted]). On direct examination, the plaintiff asked

McDonough whether it was his opinion that, if the dece-

dent had consumed methadone before her discharge

but not afterward, the methadone consumed before her

discharge on November 29, 2008, caused the decedent’s

death. McDonough answered that question in the affir-

mative. In answering that question, McDonough clearly

had to assume that the decedent ingested methadone

only before, and not after, her discharge. In other words,

McDonough offered a conditional opinion that the

methadone consumed before the decedent’s discharge

caused her death, the condition being that the plaintiff

prove that the methadone in fact was consumed before,

and not after, her discharge. McDonough’s testimony

was not the exclusive means of proving that fact.

Having determined that the jury reasonably could

have credited expert testimony supportive of the phe-

nomenon of delayed recurring respiratory depression,

we now examine the other evidence relating to when

the decedent consumed the fatal dose of methadone.

Our review of the record leads us to conclude that there

was sufficient evidence from which the jury could infer,

without resorting to speculation, that the decedent con-

sumed the fatal dose of methadone before her dis-

charge.16

In particular, the jury was presented with the follow-

ing relevant evidence. At approximately 6:45 p.m. on

November 29, 2008, the decedent was found to be suffer-

ing from symptoms that are consistent with an opiate

or opioid induced overdose. The decedent’s improve-

ment in response to a dose of Narcan confirmed that

she had been experiencing an overdose on an opioid

or opiate. The paramedics who treated the decedent

were able to determine that the decedent’s ‘‘current

medications’’ included methadone. Hope searched his

home upon finding the decedent overdosing on Novem-

ber 29, and he did not find any drugs, drug parapherna-

lia, or evidence of drug use.

There were conflicting accounts as to whether the

decedent admitted to taking methadone, but the jury

certainly was free to credit the account wherein the

decedent told the emergency room nurses that she took

methadone and not heroin. Critically, a toxicology

screen performed in the emergency room on November

29, 2008, detected the presence of methadone in the

decedent’s urine. The jury heard expert testimony that

the positive finding for methadone in that screen could

not have been caused by the therapeutic doses of metha-

done the decedent received eight days earlier.

From the time she was discharged, 11:53 p.m. on

November 29, 2008, until 1:30 a.m. on November 30,

2008, the evidence showed that the decedent was in

the company of Hope, who did not observe her ingest

any more drugs. At some point between 1:30 a.m. and

9:45 a.m., the decedent experienced another episode of

respiratory depression, which the jury could have found

to be the type of delayed recurring respiratory depres-

sion that Schwam opined is consistent with methadone

overdoses. Hope testified that he did not hear any move-

ment from the decedent between 1:30 a.m. and 9:45

a.m. on November 30, unlike the night of November 29,

when he had heard the decedent use the microwave in

his kitchen. Hope found the decedent’s body in the

same position in which it had been when he last saw

the decedent at 1:30 a.m.

The medical examiner determined that the concentra-

tion of methadone present in the decedent’s blood at

the time of death was at a toxic level. The decedent’s

death occurred approximately seven to fifteen hours

after she initially overdosed on November 29, 2008.

Hope and law enforcement officials searched Hope’s

home on November 30, 2008, and did not find any evi-

dence relating to drug activity. In addition, Geyer, an

investigator with the medical examiner’s office, did not

find any drugs, drug paraphernalia, or signs of drug use

on or near the decedent’s body.

Construing all of the evidence in the light most favor-

able to sustaining the verdict, as we must; Saint Ber-

nard School of Montville, Inc. v. Bank of America, 312

Conn. 811, 834, 95 A.3d 1063 (2014); we conclude that

it is sufficient to support the jury’s finding that the

decedent consumed a fatal dose of methadone before

she was brought to the emergency room at Lawrence &

Memorial on November 29, 2008.

B

In its second challenge to the sufficiency of causation

evidence, the defendant contends that ‘‘there is a

[another] missing link in the plaintiff’s causal chain.

. . . [T]he jury could only guess whether the decedent

would have been admitted to [Lawrence & Memorial]

if Dr. Marchiondo had not discharged her.’’ According

to the defendant, in order to prove that Marchiondo’s

negligence caused the decedent’s death, the plaintiff

was required to present evidence regarding ‘‘[Law-

rence & Memorial’s] admission standards . . . and

whether the decedent met them.’’ Because the plaintiff

failed to present such evidence, the defendant contends,

the jury reasonably could not have found that the defen-

dant caused the decedent’s death. We disagree.

The defendant’s second sufficiency challenge suffers

from the basic flaw of misunderstanding Schwam’s tes-

timony regarding the applicable standard of care. As

the defendant argues, Schwam did testify initially that

the standard of care applicable to possible methadone

overdoses required Marchiondo to ‘‘admit [the dece-

dent] to the hospital for continuous monitoring . . .

for a minimum of twenty-four hours.’’ (Emphasis

added.) Schwam subsequently clarified, however, that

the applicable standard of care only required Marchi-

ondo ‘‘to monitor her. He needed to ideally admit her

to an intensive care unit, but certainly to monitor her

for twenty-four hours for signs of recurrent opiate over-

dose.’’ (Emphasis added.) The jury, of course, could

have accepted the part of Schwam’s testimony indicat-

ing that monitoring was required and rejected the part

suggesting admittance was required.

Consequently, in order to prove causation, the plain-

tiff needed to show only that the decedent could have

been monitored sufficiently for twenty-four hours, not

admitted for that period of time. Zambarano, an emer-

gency room nurse at Lawrence & Memorial, testified

that the decedent was monitored in a room called the

‘‘observation room’’ during her hospitalization. Nurses

assigned to the observation room monitor the vital signs

of patients in that room both in person and through

remote telemetric monitoring displays at a nearby

nurses’ station. Thus, nurses can respond immediately

to a crash in the vital signs of an observation room

patient. According to Zambarano, patients can stay

overnight in the observation room. Alternatively, Zamb-

arano testified, patients can be monitored in less acute

areas, such as hallway beds. With that testimony, along

with the evidence that the decedent was ‘‘told that she

was here for the night,’’ the jury reasonably could have

inferred that it was more likely than not that the dece-

dent could have been monitored medically for twenty-

four hours at Lawrence & Memorial.

Accordingly, in construing all of the evidence in the

light most favorable to sustaining the verdict, as we

must; Saint Bernard School of Montville, Inc. v. Bank

of America, supra, 312 Conn. 834; we conclude that

there was sufficient evidence supporting the jury’s find-

ing that the defendant’s negligence caused the dece-

dent’s death.

II

SUFFICIENCY OF EVIDENCE SUPPORTING

JURY’S AWARD OF DAMAGES

The defendant’s second claim is that the plaintiff failed

to present sufficient evidence supporting the jury’s

award of $150,000 in damages for the destruction of

the decedent’s capacity to carry on and enjoy life’s

activities. Specifically, the defendant contends that a

plaintiff seeking damages for the destruction of a dece-

dent’s capacity to carry on and enjoy life’s activities

must present evidence of the decedent’s life expec-

tancy. According to the defendant, the plaintiff failed

to present evidence of the decedent’s life expectancy

in the present case, and, therefore, the jury’s award of

damages for the destruction of the decedent’s capacity

to carry on and enjoy life’s activities was ‘‘speculative

and unreasonable.’’ We disagree.

The following additional facts and procedural history

are necessary to our resolution of the defendant’s sec-

ond claim. At trial, the plaintiff presented evidence of

the decedent’s (1) age, (2) health, (3) physical condition,

and (4) habits and activities. Regarding the decedent’s

age, a photograph of the decedent’s driver’s license,

which contained the decedent’s date of birth, was

admitted into evidence.

Regarding the decedent’s health, the plaintiff offered

some of the decedent’s medical records. Those records

indicated that, in addition to polysubstance abuse, the

decedent suffered from diabetes, hypothyroidism, high

cholesterol, high blood sugar, anxiety, and depression.

The records also indicated that, since 2000, the dece-

dent had completed several inpatient and outpatient

substance abuse treatment programs and had been hos-

pitalized several times for diabetes related compli-

cations.

Regarding the decedent’s physical condition, McDo-

nough’s autopsy report, wherein he detailed the obser-

vations of his external and internal examinations of

the decedent, was admitted into evidence. McDonough

testified that he observed ‘‘no evidence of acute trauma’’

as a result of his external examination of the decedent’s

body. Furthermore, McDonough’s internal examination

revealed no evidence of disease afflicting the decedent’s

cardiovascular, hepatobiliary, lymphoreticular, gastro-

intestinal, genitourinary, and central nervous systems,

nor was there evidence of disease afflicting the dece-

dent’s head, neck, internal genital organs, or abdominal

and chest cavities. McDonough’s examination did

reveal, however, that the decedent’s thyroid exhibited

signs of chronic inflammation and that her lungs were

congested with fluid.

Regarding the defendant’s habits and activities, as

previously set forth, there was considerable evidence

presented of the decedent’s lengthy struggle with polys-

ubstance abuse and her alternating periods of sobriety

and relapse. In addition to her drug problems, however,

there was evidence presented regarding the decedent’s

other habits and activities. The decedent’s father, James

Procaccini, testified that in the summer of 2008 the

decedent was a ‘‘very happy person’’ who was ‘‘able to

function in life very well.’’ According to her father,

the decedent helped him and his wife with household

chores, submitted ‘‘an awful lot’’ of job applications, and

attended Alcoholics Anonymous meetings. The ‘‘bright

spot in [the decedent’s] life’’ at that time, however, was

helping her father and mother care for her two year

old twin niece and nephew. Prior to the summer of

2008, the decedent had graduated from the University

of Vermont with a bachelor of science degree and had

taken a cross-country trip to Mount Rainier in Wash-

ington.

Following the jury’s return of a plaintiff’s verdict, the

defendant filed a motion to set aside the verdict on

the ground that the jury’s award of damages for the

destruction of the decedent’s capacity to carry on and

enjoy life’s activities was ‘‘speculative.’’ Specifically, the

defendant argued that the plaintiff failed to present

evidence of ‘‘[h]ow long the plaintiff likely would have

lived,’’ and, therefore, ‘‘[w]ithout a life expectancy table,

or some other evidence on this topic,’’ the jury’s award

‘‘[could not] stand.’’ The court denied the defendant’s

motion to set aside the verdict.

We begin our analysis by outlining our standard of

review. ‘‘The standard of review governing our review

of a trial court’s denial of a motion to set aside the

verdict is well settled. The trial court possesses inherent

power to set aside a jury verdict which, in the court’s

opinion, is against the law or the evidence. . . . [The

trial court] should not set aside a verdict where it is

apparent that there was some evidence upon which the

jury might reasonably reach [its] conclusion, and should

not refuse to set it aside where the manifest injustice

of the verdict is so plain and palpable as clearly to

denote that some mistake was made by the jury in the

application of legal principles . . . . Ultimately, [t]he

decision to set aside a verdict entails the exercise of a

broad legal discretion . . . that, in the absence of clear

abuse, we shall not disturb.’’ (Internal quotation marks

omitted.) Kumah v. Brown, 160 Conn. App. 798, 803,

126 A.3d 598, cert. denied, 320 Conn. 908, 128 A.3d

953 (2015).

We now turn to the legal principles governing dam-

ages awards in wrongful death actions. ‘‘In actions for

injuries resulting in death, a plaintiff is entitled to ‘just

damages’ together with the cost of reasonably neces-

sary, medical, hospital and nursing services, and includ-

ing funeral expenses.’ General Statutes § 52-555. ‘Just

damages’ include (1) the value of the decedent’s lost

earning capacity less deductions for her necessary liv-

ing expenses and taking into consideration that a pre-

sent cash payment will be made, (2) compensation for

the destruction of her capacity to carry on and enjoy

life’s activities in a way she would have done had she

lived, and (3) compensation for conscious pain and

suffering.’’ (Emphasis added.) Katsetos v. Nolan, 170

Conn. 637, 657, 368 A.2d 172 (1976).

Regarding compensation for the destruction of a

decedent’s capacity to carry on and enjoy life’s activi-

ties, our Supreme Court has stated the following: ‘‘[T]he

parties in a death action are entitled to attempt to pre-

sent an over-all picture of the decedent’s activities to

enable the jury to make an informed valuation of the

total destruction of his capacity to carry on life’s activi-

ties. . . . So, for example, evidence bearing on how

pleasurable the decedent’s future might have been is

admissible . . . as is evidence as to the decedent’s hob-

bies and recreations.’’ (Citations omitted; emphasis

added; internal quotation marks omitted.) Waldron v.

Raccio, 166 Conn. 608, 616–17, 353 A.2d 770 (1974); id.,

617 (evidence of ‘‘decedent’s attachment to his family’’

relevant to claim for destruction of capacity to carry

on and enjoy life’s activities); see also Katsetos v. Nolan,

supra, 170 Conn. 658 (evidence that decedent ‘‘was hap-

pily married,’’ ‘‘had four children,’’ ‘‘was a very happy

person and in good health,’’ ‘‘was a dedicated mother

and homemaker,’’ ‘‘[was] active in many outside activi-

ties,’’ ‘‘was a state-licensed hairdresser,’’ and had

worked in pizza restaurant and office relevant to her

capacity to enjoy life’s activities); cf. Bruneau v. Quick,

187 Conn. 617, 635–36, 447 A.2d 742 (1982) (in personal

injury action for surgeon’s malpractice, evidence that

plaintiff no longer could undertake ice skating, sailing,

ballroom and jazz dancing, and gardening as she had

before botched surgery was relevant to her ‘‘ability to

carry on and enjoy certain activities’’).

A claim for the destruction of a decedent’s capacity

to carry on and enjoy life’s activities requires proof of

the decedent’s life expectancy. See Sims v. Smith, 115

Conn. 279, 286, 161 A. 239 (1932) (‘‘damages based upon

the loss to the estate of a decedent by his death neces-

sarily involves a consideration of the probable duration

of his life’’); cf. Acampora v. Ledewitz, 159 Conn. 377,

384–85, 269 A.2d 288 (1970) (in personal injury action,

trial court erred in allowing jury to consider damages

for permanent pain and suffering because ‘‘no evidence

was introduced as to [plaintiff’s] life expectancy’’).

With respect to the type of evidence that can be used

to prove one’s life expectancy, our Supreme Court has

stated the following: ‘‘A mortality table17 is not the exclu-

sive evidence admissible to establish the expectancy

of life, since age, health, habits and physical condition

may afford evidence thereof.’’ (Emphasis added; foot-

note added.) Johnson v. Fiske, 125 Conn. 445, 449, 6

A.2d 354 (1939). ‘‘[Mortality] tables only give the average

of a large number of lives, and in the individual case

the expectancy may be higher or lower than the average.

While generally held admissible, they are not conclu-

sive, nor are they the exclusive evidence admissible in

proof of that fact, which the jury may determine from

other evidence . . . .’’ (Emphasis added.) Donoghue v.

Smith, 114 Conn. 64, 66, 157 A. 415 (1931); see also

Tampa v. Johnson, 114 So. 2d 807, 810 (Fla. App. 1959)

(‘‘[a] jury is not bound by mortality tables, but these

constitute only one of many factors that may be consid-

ered in estimating life expectancy’’ [emphasis added]);

Glover v. Berger, 72 Wyo. 221, 250, 263 P.2d 498 (1953)

(‘‘[d]irect evidence as to plaintiff’s expectancy of life,

however, is not essential, but the jury may determine

such fact from their own knowledge and from the proof

of the age, health, and habits of the person and other

facts before them’’ [internal quotation marks omitted]).

Use of a mortality table is not the exclusive means of

proving life expectancy because ‘‘our rule for assessing

damages in death cases gives no precise mathematical

formulas for the jury to apply. . . . [T]he assessment

of damages in wrongful death actions must of necessity

represent a crude monetary forecast of how the dece-

dent’s life would have evolved.’’ (Citations omitted;

emphasis added; internal quotation marks omitted.)

Katsetos v. Nolan, supra, 170 Conn. 657. Indeed, ‘‘[t]he

life expectancy of the deceased, for the purpose of

assessing damages in a wrongful death action, is a ques-

tion of fact for the jury to decide . . . .’’ (Emphasis

added.) 22A Am. Jur. 2d 353, Death § 221 (2013).

Consequently, ‘‘jurors may determine such fact from

their own knowledge and from the proof of the age,

health, and habits of the person and other facts before

them.’’ (Emphasis added.) 29A C.J.S. 493, Damages

§ 141 (2012); see also 22A Am. Jur. 2d, supra, § 349, pp.

469–70 (‘‘if age, sex, health, and mental capacity are

proven, the jury is entitled to determine from these

facts and circumstances . . . in its sound judgment

. . . the decedent’s life expectancy, without resort to

mortality tables’’). ‘‘The law does not require the pro-

duction of . . . life expectancy tables whenever there

is an issue of life expectancy, and does not regard them

as essential to the establishment of that issue or to the

recovery of damages based on life expectancy.’’ 29A

Am. Jur. 2d 723, Evidence § 1383 (2013).

Thus, insofar as the defendant argues that the plain-

tiff’s proof of the decedent’s destroyed capacity to enjoy

life’s activities is insufficient because he did not present

‘‘government mortality tables,’’ we disagree. As pre-

viously addressed in considerable detail, the plaintiff

presented substantial evidence of the decedent’s age,

health, physical condition, and habits, all of which are

relevant to determining life expectancy. The decedent’s

age was established by her driver’s license; the dece-

dent’s sundry illnesses were established by her medical

records; the decedent’s physical condition at the time

of her death was expounded in McDonough’s autopsy

report and trial testimony; and the jury was familiar

with the decedent’s enduring drug habits. Moreover,

the jury heard testimony from the decedent’s father

regarding the activities in which the decedent enjoyed

partaking, including her strong attachment to her niece

and nephew. Waldron v. Raccio, supra, 166 Conn.

616–17 (decedent’s ‘‘attachment to his family’’ relevant

to his capacity to enjoy life’s activities). Thus, the jury

reasonably could have made a ‘‘ ‘crude . . . forecast’ ’’;

Katsetos v. Nolan, supra, 170 Conn. 657; of the dece-

dent’s life expectancy from its own knowledge and from

proof of the decedent’s age, health, physical condition,

and habits.

In light of the foregoing evidence that the plaintiff

presented with respect to the decedent’s life expectancy

and activities that she enjoyed, we conclude that the

jury’s award of damages for the destruction of the dece-

dent’s capacity to carry on and enjoy life’s activities

was not unreasonable or speculative. Accordingly we

conclude that the court did not abuse its discretion in

refusing to set aside the jury’s award of damages for

the destruction of the decedent’s capacity to carry on

and enjoy life’s activities.

The judgment is affirmed.

In this opinion the other judges concurred.

1

Lawrence & Memorial Hospital, Inc., Lawrence & Memorial Corporation,

and Thomas E. Marchiondo, a physician, were initially named as defendants

in this action. Prior to trial, the plaintiff withdrew the action as against

Lawrence & Memorial Hospital, Inc., and Lawrence & Memorial Corporation,

and filed an amended complaint naming Emergency Medicine Physicians

of New London County, LLC, as a defendant. After filing this appeal, but

before oral argument was heard, the plaintiff withdrew the claims as against

Marchiondo, who died before trial began. Accordingly, because those three

other defendants are not involved in this appeal, we refer to Emergency

Medicine Physicians of New London County, LLC, as the defendant through-

out this opinion.

2

The jury heard expert testimony explaining the differences between

opiates and opioids. An opiate is a ‘‘naturally occurring’’ narcotic that is

derived from poppy plants. There are four opiates: opium, heroin, codeine,

and morphine. An opioid is a ‘‘synthetic or semisynthetic narcotic . . . .’’

Examples of well-known opioids include oxycodone, hydrocodone, fentanyl,

and methadone.

3

Marchiondo also diagnosed the decedent with pneumonia.

4

The parties stipulated at trial that Marchiondo was ‘‘an employee, agent,

representative, or servant of [the defendant] and acting within and pursuant

to the scope of his employment, agency, representation, and authority with

[the defendant].’’ Accordingly, the court instructed the jury: ‘‘If you find that

. . . Marchiondo’s treatment of [the decedent] was negligent, that is, devi-

ated from the applicable standard of care, and that negligence was a substan-

tial factor in bringing about her death, then [the defendant] is responsible

for . . . Marchiondo’s conduct and, in that event, you should find against

[the defendant].’’

5

The court reserved decision on the defendant’s renewed motion for a

directed verdict when it granted the defendant’s motion for an extension

of time to file other postverdict motions. Subsequent to the court’s granting

of the motion for an extension of time, the defendant filed a motion to set

aside the jury’s verdict, wherein the defendant again renewed its motion

for a directed verdict. The trial court denied both the motion to set aside

and the motion for a directed verdict, the latter of which was denied nunc

pro tunc.

6

Throughout trial, it appears that the parties, and even their expert wit-

nesses, occasionally blurred the distinction between half-life and duration

of effect. Indeed, although he warned against ‘‘confus[ing] duration of effect

with half-life,’’ Pike himself provided a definition of ‘‘half-life’’ that seemingly

incorporated the concept of the duration of effect: ‘‘half-life . . . has . . .

to do with how long th[e] physiologic response that the drug is producing

will be effective . . . .’’ (Emphasis added.) As another example, when asked

by the defendant’s counsel to provide the ‘‘durational effect’’ of Narcan,

McDonough replied: ‘‘It would be similar to the half-life of thirty to eighty

minutes.’’ (Emphasis added.)

Nevertheless, it is of little importance whether the technical scientific

distinction between half-life and duration of effect was preserved consis-

tently at trial. As explained previously in greater detail, the crucial issue at

trial pertained to Narcan’s relative effectiveness as compared to both long-

acting and short-acting narcotics. The parties’ experts agreed that ‘‘[Nar-

can’s] effectiveness is much shorter than the effect of the longer-acting

[and] even short-acting narcotic[s] . . . .’’ (Emphasis added.) Moreover, as

also explained previously in greater detail, it was undisputed that the half-

lives and durations of effect of short-acting narcotics are shorter than those

of long-acting narcotics.

7

The defendant, but not the plaintiff, asserts that the ‘‘parties stipulated

that the maximum effective duration of the Narcan given to the decedent

was ninety minutes.’’ (Emphasis added.) Although the record reveals that

the plaintiff offered to stipulate that the effective duration of Narcan is

‘‘twenty to ninety minutes,’’ neither the defendant nor the court accepted

this proposed stipulation. Furthermore, the court never submitted any such

stipulation to the jury.

8

Although the defendant does not challenge the jury’s finding with respect

to the standard of care, we note that Schwam opined that Marchiondo’s

treatment of the decedent deviated from the appropriate standard of care

for a possible methadone overdose. Schwam testified that Marchiondo

improperly ruled out methadone as a potential cause of the decedent’s

overdose because there was ‘‘sufficient evidence to at least raise the possibil-

ity that the overdose was . . . partly methadone.’’ Consequently, having

wrongly excluded methadone, Marchiondo also failed to provide the dece-

dent with the appropriate care for a methadone overdose, which is ‘‘monitor[-

ing] . . . for twenty-four hours for signs of recurrent opiate overdose.’’

9

The plaintiff conceded at oral argument before this court that Schwam’s

testimony was offered only for standard of care purposes.

10

The defendant did file two motions in limine regarding the scope of

Schwam’s testimony. The second, which sought to preclude Schwam from

testifying on the ‘‘effective duration of Narcan,’’ effectively was granted

when the court stated that it would sustain any ‘‘objection that fairly impli-

cates . . . [the] effective duration of Narcan.’’ The first motion sought to

preclude Schwam from testifying regarding the standard of care with respect

to Marchiondo’s diagnosis of pneumonia. The plaintiff agreed to not elicit

any testimony from Schwam regarding the pneumonia diagnosis. Neither

of those two motions, however, sought to preclude or limit in any respect

Schwam’s testimony regarding delayed recurring respiratory depression.

11

The defendant did move to strike the following testimony from Schwam’s

direct examination: ‘‘Well, [the belief that respiratory depression would

return when Narcan wears off is] a very easy thing to assume if you know

a little bit about opiate toxicology, but decades of experience have shown

that if that’s the way you think and you discharge a patient, a lot of them

will be dead the next day.’’ The court, however, denied the motion to strike.

Critically, the defendant’s stated ground for the motion to strike was that

Schwam’s answer was not responsive to the question asked by the plaintiff’s

counsel. At no point did the defendant move to strike Schwam’s testimony

on the ground that it was outside the scope of the plaintiff’s offer of Schwam’s

testimony for standard of care purposes.

12

Specifically, the plaintiff stated in the disclosure that Schwam would

testify as to (1) ‘‘all subject matter arising from his expertise in the field

of emergency medicine, including the treatment of patients suspected of

suffering from drug overdose’’; (2) ‘‘all subject matter arising from his educa-

tion, training, and experience’’; (3) ‘‘the care and treatment [the decedent]

received from the defendant during her emergency department admission

on November 29, 2008’’; (4) ‘‘the decedent’s medical history, her presenting

symptoms, the course of treatment she received by the defendant, the diagno-

sis provided, the laboratory results, and the medical course that could and

should have occurred, but did not’’; and (5) ‘‘certain aspects of the testimony

provided by the defendant’s experts.’’

In outlining the subject matter of Schwam’s testimony, the disclosure also

stated: ‘‘Please see the attached five page opinion letter . . . that capture[s]

the expected subject matter of his expected testimony.’’ In the attached

opinion letter, Schwam opined, among other things, that (1) ‘‘when Narcan

is administered to counteract methadone, the Narcan usually wears off long

before the methadone, and patients may seem well for several hours, only

to relapse and become unconscious much later’’; (2) ‘‘when the effects of

Narcan [administered to the decedent] wore off, the effects of methadone

returned and she suffered unresponsiveness and fatal respiratory depression;

and (3) ‘‘to a reasonable medical certainty, it can be determined that the

delayed toxic effects of the methadone caused [the decedent’s] death.’’

13

See footnote 9 of this opinion.

14

See footnote 10 of this opinion.

15

See footnote 11 of this opinion.

16

The defendant’s reliance on Paige v. St. Andrew’s Roman Catholic

Church Corp., supra, 250 Conn. 14, is unavailing. The defendant cites Paige

as support for its position that the jury in the present case resorted to

improper speculation in finding that the defendant caused the plaintiff’s

death. We are unpersuaded by the defendant’s reliance on Paige because

it is distinguishable from the present case.

In Paige, our Supreme Court held that there was insufficient evidence

supporting the jury’s finding that the defendant caused the plaintiff’s injuries.

Id., 17. The plaintiff in Paige was cleaning a boiler located in the defendant’s

church when someone activated the boiler, causing the plaintiff to sustain

serious burn injuries. Id., 16–17. There was no direct evidence presented at

trial that affirmatively established that the person who activated the boiler

was an employee, servant, or agent of the defendant. Id., 34. Thus, the

plaintiff’s case relied principally on two alternative theories of negligence:

(1) the defendant failed to supervise and instruct its employees, servants,

and agents with respect to the boiler’s operation; and (2) the defendant

failed to restrict public access to the boiler’s controls. Id., 27.

In returning a plaintiff’s verdict, the jury answered several interrogatories

regarding the plaintiff’s theories of negligence. Id., 26–27 n.13. Its responses

to the interrogatories indicated that it had found that the defendant was

not negligent in failing to restrict public access to the boiler’s controls. Id.,

27–28. It did find, however, that the defendant was negligent in failing to

supervise and instruct its employees, agents, and servants with respect to

the boiler’s operation. Id., 27. Notwithstanding its finding that the defendant

negligently supervised and instructed its employees, agents, and servants,

the jury indicated in another interrogatory that the defendant’s custodian

was not the person who activated the boiler. Id., 27 n.13.

The jury’s responses to the interrogatories were central to our Supreme

Court’s analysis of the sufficiency of the evidence on causation. Id., 28–31.

Specifically, the court reasoned that those responses indicated that the jury’s

finding of negligence ‘‘was limited to the manner in which [the defendant]

dealt with its own employees, servants and agents.’’ (Emphasis added.) Id.,

28. Therefore, ‘‘[i]n order for there to have been a causal connection between

the defendant’s negligent conduct and the plaintiff’s injuries . . . it would

have had to have been an employee, agent or servant of the defendant who

activated the [boiler]. . . . [T]he converse [was] equally true . . . . [T]he

defendant’s conduct [could not have been] causally linked to the plaintiff’s

injuries if the [boiler] was activated by a person who was not an employee,

agent or servant of the defendant.’’ (Emphasis in original.) Id., 28–29.

In reviewing the sufficiency of the evidence on causation, the court in

Paige examined only the evidence relating to whether the person who

activated the boiler was an employee, servant, or agent of the defendant.

The plaintiff’s evidence unquestionably suggested that there was only one

employee, agent, or servant of the defendant who was near the boiler con-

trols at the time of the accident and who knew how to use those controls—

the defendant’s custodian. Id., 24, 34. As previously explained, however, the

jury’s response to an interrogatory indicated that it specifically found that

the defendant’s custodian was not the person who activated the boiler. Id.,

27 n.13. Thus, the Supreme Court held that the ‘‘jury could not have con-

cluded that it was an employee of the defendant who had activated [the]

boiler . . . .’’ Id., 34.

The defendant argues that Paige guides our resolution of its sufficiency

claim. Specifically, it contends that ‘‘[l]ike the possibility that a member of

the public may have turned on the church boiler [in Paige], nothing . . .

in this case [eliminated] the possibility that the decedent took the fatal dose

[of methadone] after she left the emergency room.’’ We are not persuaded

by the defendant’s analogy.

We conclude that Paige presented a distinct situation involving a logical

inconsistency in the jury’s verdict. In responding to a set of highly detailed

and specific interrogatories, the jury revealed that its finding of negligence

was based solely on the defendant’s conduct with respect to its employees,

agents, and servants. Yet, its responses to those interrogatories also revealed

that it exonerated the only employee of the defendant who, according to

the plaintiff’s evidence, could have activated the boiler. There are no jury

interrogatories in the present case that reveal a similar inconsistency in the

jury’s verdict, nor is any such inconsistency otherwise apparent. Further-

more, the plaintiff in Paige failed to present any evidence from which the

jury reasonably could infer that the person who activated the boiler was

an employee, agent, or servant of the defendant. In the present case, however,

there is ample evidence from which the jury could infer that the decedent

consumed the lethal dose of methadone before her discharge. In particular,

there was evidence that the decedent exhibited opioid overdose symptoms

prior to her discharge, that her urine tested positive for methadone at the

time of her hospitalization, and that the delayed respiratory depression she

experienced after her discharge was consistent with the consumption of a

toxic dose of methadone prior to her discharge.

17

A mortality table, also termed an ‘‘actuarial table,’’ is ‘‘[a]n organized

chart of statistical data indicating life expectancies for people in various

categories . . . .’’ Black’s Law Dictionary (10th Ed. 2014).