Washington v. Washington Hospital Center 579 A.2d 177

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Washington v. Washington Hospital Center 579 A.2d 177 by Mind Map: Washington v. Washington Hospital Center 579 A.2d 177

1. Facts

1.1. Parties

1.1.1. Alma D. Washington, et al.

1.1.1.1. Mother & daughters of the injured woman, LaVerne Alice Thompson

1.1.2. Washington Hospital Center (WHC or the hospital)

1.1.3. Appellants and cross-appellants

1.2. What happened

1.2.1. Morning of 11/7/1987:Ms. Thompson underwent elective surgery at WHC for abortion and tubal ligation under general anesthesia

1.2.2. 10:45am-Adland (nurse-anesthetist), under the supervision of Dr.Walker (physician anesthesiologist) inserted an endotracheal tube into the patient’s throat to oxygenate the patient and to remove carbon dioxide from her

1.2.2.1. Plaintiffs allege that Adland incorrectly inserted the tube into the patient’s esophagus above the stomach

1.2.2.2. after tube was inserted, Adland ventilated the patient while Walker tried to determine if the tube was properly inserted by observing physical reactions

1.2.3. 10:50 am- Dr. Bobrow, the surgeon noticed the abnormally dark color of patient’s blood, an indication that her tissues were not receiving enough oxygen

1.2.3.1. he reported this to Adland who checked patient’s vital signs and found them to be stable

1.2.4. During tubal ligation, patient’s heart rate dropped

1.2.4.1. Patient suffered cardiac arrest and was resuscitated but patient had suffered disastrous brain injuries due to oxygen deprivation

1.2.4.2. Plaintiff’s expert testified that patient is in a vegetative state but she is not brain dead. She is awake but is unaware of her surroundings

1.2.4.3. Ms.Thompson’s life expectancy is 10 to 20 years

1.3. Procedural history

1.3.1. Plaintiffs filed a medical malpractice suit against Dr.Walker,(hospital anesthesiologist),Nurse Adland,the nurse-anesthetist and WHC

1.3.1.1. Midway through the case,Nurse Adland and Dr. Walker reached a settlement with the plaintiffs

1.3.1.2. Case proceeded with a claim against WHC for personal injury to Ms.Thompson and loss of consortium for her husband

1.3.1.2.1. Jury found in favor of the plaintiffs and awarded $4.586 million to Ms. Thompson and $63,000 for her husband, Michael Thompson

1.3.2. Claims against Dr.Bobrow, the surgeon were dimissed without prejudice

1.3.3. Plaintiffs voluntarily withdrew case against Medlantic Health Care Group

1.3.4. Both parties are appealing the verdict of the trial court

1.4. Issue before the court

1.4.1. Whether given all the evidence presented, a reasonable juror would conclude that a reasonably prudent tertiary hospital in November 1987, at the time of Ms.Thompson's surgery and according to national standards,would provide a carbon dioxide monitor to a patient under general anesthesia for elective surgery

1.4.2. Whether the trial court should have declared a mistrial based on a conversation between the plaintiff's expert witness and 2 jurors

1.4.3. Whether the trial court erred in its calculation of credit against the jury verdict

1.4.4. Mother & daughter of injured woman are appealing court's decision in favor of WHC on their claims for loss of consortium

1.5. Rule of Law

1.5.1. Necessary elements for negligence action based on medical malpractice

1.5.1.1. The plaintiff must establish:"1)the standard of care 2)deviation from that standard by the defendant 3)casual relationship between that deviation and the plaintiff's injury"

1.5.1.1.1. "Expert testimony is usually required" when it relates to a specific field or specialty

1.5.1.1.2. Establishing the standard of care:"the course of action that a reasonably prudent [professional] with the defendant's specialty would have taken under the same or similar circumstances"

1.5.2. Pro tanto and Pro rata credits

1.5.2.1. A pro tanto credit is based on the actual settlement amount, “dollar-for-dollar,”while a pro rata credit is based on proportionate shares of liability among joint tortfeasors.

1.5.2.1.1. WHC as the non settling defendant,did not declare its intention to seek pro rata credit by requesting a finding of liability of the settling defendants nor did it file a cross claim for contribution against them

1.5.2.2. "Whether the settlement occurs before trial or during it, a plaintiff facing possible application of a Martello credit should have fair notice that the nonsettling defendant plans to seek a pro rata reduction of the verdict on the ground that his settling counterparts were negligent, and an opportunity to build a rebuttal case"

1.6. Application

1.6.1. WHC argued that the evidence presented by the plaintiff's expert witness, Dr. Steen was not sufficient to prove that the use of carbon dioxide monitors in patients under general anesthesia was the standard of care in November 1987

1.6.1.1. The trial court deemed that carbon dioxide monitoring was the standard of care and that WHC had deviated from this standard based on the following

1.6.1.1.1. 1) Dr Steen's testimony based on his own experience at USC and the recommendations published by the AAA and JAMA  2)use in at least 4 other US hospitals  3)WHC's expert, Dr.Tinker testifying that they were in use at the hospital where he worked & many hospitals were converting to its use   4)procurement order in December 1986 or January 1987 by head of anesthesiology at WHC, Dr.Murray and his statement that without the monitors, WHC was not meeting the standard of care

1.6.2. Calculation of credit

1.6.2.1. WHC did not take the necessary steps needed to grant a pro rata credit

1.6.2.1.1. Court upheld judgment of trial court

1.6.3. Appeals court affirmed verdicts of trial court regarding declaring a mistrial and mother & daughters claim for loss of consortium

1.7. Conclusion

1.7.1. Based on the facts and the evidence presented, the appeals court was right to uphold the verdicts

1.7.1.1. On the issue of standard of care, they did not just base their decision on the expert witness' testimony. Even WHC's own expert testified to the use of these monitors as the standard of care. Most compelling evidence in support of this was Dr.Murray's procurement order and his statment

2. The impact of the decision

2.1. Hill v. Medlantic Health Care Grp., 933 A.2d 314 (D.C. 2007)

2.1.1. Plaintiff cited Washington v. Washington on the use of expert witness testimony to establish national standard of care

2.1.2. Court ruled that expert witness' background & experience was not adequate basis to establish the standard of care and amounted to his personal opinion

2.2. Paul v. Bier, 758 A.2d 40 (D.C. 2000)

2.2.1. Appellant cited Washington v. Washington to support her claim that Appellee, Dr.Brier was entitled to pro tanto credit rather than pro rata credit

2.2.2. The appeals court ruled that there wasn't "an adjucation or stipulation that GWU (the other defendant who settled) and Dr.Brier were joint tortfeasors"

2.2.2.1. Upheld the trial court's decision

2.2.3. Ms.Paul received her total damages from her settlement with GWU (same amount as the jury verdict). Dr Brier paid nothing extra because of pro tanto credit

3. Effect of the decision on business professionals and how business operates

3.1. Appeals court Judge stated that "care and foresight exceeding the minimum required by law or mandatory professional regulation may be necessary to meet [the] standard [of care]”

3.2. Businesses cannot just meet minimum requirements, they must look to see how other similar businesses are practicing or they can also be innovative seeking ways to improve patient outcomes, the locality rule does not apply anymore.

3.3. This is not to suggest that every new technology/way of doing things has to be adopted, there is the issue of cost. But at least they should keep abreast with new developments and conduct cost-benefit analyses.

3.4. Example would be this formula by Judge Hand:  "If the burden B of the proposed safeguard is less than the probability P of injury without the safeguard multiplied by the severity L of the potential injury," then a hospital can be held liable for not adopting the safeguard

4. Current business practices that have been influenced by the holding

4.1. Washington case has been cited in many articles for demonstrating the shift from a “custom based standard of care to a reasonableness standard".

4.2. Hospitals that are slow to adopt new technologies and methods may be found liable of not meeting the national standard of care

4.2.1. Carbon dioxide monitor

4.3. The 2011 ASA Standards  for Basic Anesthetic Monitoring guidelines include carbon dioxide monitoring for patients undergoing anesthesia