Washington v. Washington Hospital Center, 579 A.2D 177 (1999)

1. IMPACT

1.1. 82 cases have cited this holding in the context of negligence, purpose of expert witness and calculating pro rata credit to name a few.

1.1.1. Bederson v United States, 935 F.SUPP.2D 48 (D.D.C 2013)  Three elements of evidence to prove negligence 1. what is the standard of care 2. did the defendant deviate from the standard of care 3. does a casual relationship exist between the action and injury

1.1.2. Arias v Dyncorp, 928 F.SUPP.2D 1 (D.D.C 2013)  "The purpose of expert opinion testimony is to avoid jury findings based on mere speculation or conjecture."

1.1.3. Paul v Bier, 758 A.2D 40 (D.C. 2000)  Pro rata credit

2. AFFECT ON BUSINESS

2.1. This decision would make facilities look at their standards of care and make sure that they fall into line with national standards of care, not just local.  As a business making sure that standards of care are implemented sooner than later and insuring compliance would reduce lability.

3. CURRENT BUSINESS PRACTICE

3.1. 100k Lives Campaign by the Institute for Healthcare Improvement, in 2004 initiated to improve national standards of care to reduce preventable patient deaths by 100,000 patients a year.

3.2. Medical/Medicaid reimbursements being directly linked to standards and quality of care and compliance by healthcare facilities.

4. FACTS

4.1. Parties

4.1.1. Alma D. Washington, et al - Appellants

4.1.2. Washington Hospital Center - Appellee

4.1.3. Washington Hospital Center - Appellant

4.1.4. Alma D. Washington, et all - Appellees

4.2. What Happened

4.2.1. November 7, 1987 LaVerne Thompson (original plaintiff) 36, elected to have an abortion and tubal ligation at Washington Hospital Center.  She was previously healthy.  at 10:45 am, the nurse anesthetist placed an endotracheal (ET) tube into Mrs. Thompson's throat while she was under anesthesia.  The purpose of an ET tube is to provide oxygen to the patient and remove carbon dioxide from her lungs.  A properly placed ET tube should rest in the trachea just above the lungs.  Dr. Walker, the nurse's attending confirmed placement of the ET tube, although it was in her esophagus and not trachea.  5 minutes into the operation the surgeon recognized that Mrs. Thompson's blood was abnormally dark which indicates a lack of oxygen to tissue and alerted the nurse.  The nurse reviewed vitals which were said to be normal at that time.  Mrs. Thompson's heart rate began to drop, she went into cardiac and arrest and was subsequently resuscitated.  She suffered a catastrophic brain injury due to lack of oxygen and remains in a persistent vegetative state.  While she has full respiratory, cardiac and digestive function, Mrs. Thompson is totally incapacitated.  She has a life expectancy of 10 to 20 years.

4.3. Procedural History

4.3.1. Mrs. Thompson's family filed a medical malpractice action against the physicians for negligence in placement of the ET tube, and against Washington Hospital Center for not providing the anesthesiologists with an end title carbon dioxide monitor which would have allowed them to detect the lack of oxygen sooner, preventing the brain injury.  During the trial, Mrs. Thompson's expert witness, Dr. Steen gave evidence that it was becoming a national trend to use carbon dioxide monitors during surgical procedures and that several hospitals were already using them.  He identified several applicable journals that also recommended their use as best practice.  Washington Medical Center used their chair of anesthesiology department as their expert witness, Dr. Murray.  Dr. Murray testified that there was no national standard to use these monitors at the time of Mrs. Thompson's surgery, but also testified that he had created a requisition for these monitors to be used, and in his requisition he stated that the hospital would "fail to meet the national standard of care" if they did not use these monitors starting 4 months prior to Mrs. Thompson's surgery.  There was a mid trial settlement with the physicians named, so ultimately Washington Hospital Center was the sole defendant in the personal injury and loss of consortium claim.  There was a partial summary judgement regarding the loss of consortium claim for Mrs. Thompson's daughter and mother in favor of the defendent.

4.3.2. The jury found in favor of  Mrs. Thompson and awarded damages, and also awarded her husband for loss of consortium.

4.3.3. The partial summary judgement dismissing Alma D Washington et al., claim to loss of consortium was upheld based on precedent case of Pleasant  v. Washington Sand & Gravel Co

4.3.4. Washington Hospital Center cross appealed, after filing a motion for a judgement notwithstanding the verdict claiming Dr. Steen lacked enough factual evidence.  This motion was denied.

5. RULE OF LAW

5.1. In a medical malpractice case, current standards of care in relation to the particular case needs to be proven.  The patient, through an expert witness, must prove that the physician or facility was not following those standards and that action was the cause of injury to the patient.

6. APPLICATION

6.1. Dr. Steen gave testimony that monitors were available to hospitals by 1985, and that by 1986 it had become a standard of care in many hospitals including Harvard and USC.  He also cited the American Association of Anesthesiology Standards for monitoring that encouraged the use of monitors in 1986 and The Journal of American Medical Association citing the use of monitors at Harvard and called them the "emerging standard".

6.2. Dr. Murray testified that carbon dioxide monitors were  not the national standard at the time of Mrs. Thompson's surgery, but his own requisition form to put these monitors into use by July 1987 seemed to contradict his own statements.  The requisition form stated that without these monitors the hospital would "fail to meet the national standard of care".

7. CONCLUSION

7.1. After hearing Dr. Steen's testimony, a jury could reasonably find that the national standard of care would include the use of monitors in Mrs. Thompson's surgery.  The decision was affirmed.