A Houston jury has ordered a Texas hospital to pay $12 million in punitives as part of a $40.6 million medical malpractice verdict, finding that the hospital had acted with actual malice in granting surgical credentials to a doctor who had been sued 11 times before for alleged negligence.

The jury on April 7 determined, according to the verdict form, that Columbia Kingwood Medical Center “had actual, subjective awareness of the risks involved” in allowing Dr. Merriman Baker to operate at the hospital, “but nevertheless proceeded with conscious indifference to the rights, safety or welfare of others.” The jury also found that this failure to prevent Baker from operating at Kingwood was a proximate cause of a devastating injury to plaintiff Ricardo Romero.