Legal Aspects Of Health Care Administration 11th Edition by George Pozgar

تمرين 7

Facts
Mrs. LaCroix was admitted to the hospital's women's pavilion for the birth of her first child, Lawryn. She was admitted to the hospital under the care of Dr. Dulemba, her obstetrician. Prior to under going a cesarean section, LaCroix complained several times of breathing difficulty. When Dr. McGehee, the pediatrician, arrived, he noticed that LaCroix appeared to be in respiratory distress and heard her say, "I can't breathe." McGehee asked Nurse Blankenship, a certified registered nurse anesthetist (CRNA), if LaCroix was okay. She responded that LaCroix was just nervous. Mr. LaCroix claimed his wife whispered to him that she could not breathe. Mr. LaCroix then shouted, "She can't breathe. Somebody please help my wife." Blankenship asked that Mr. LaCroix be removed from the operating room because his wife was having what appeared to her to be a seizure.
Blankenship could not establish an airway. She told one of the nurses: "Get one of the anesthesiologists here now!" Dr. Green, who was in his car, was paged. Upon receiving the page, he immediately drove to the women's pavilion, where Dulemba had already started the cesarean section. When Lawryn was delivered, she was not breathing, and McGehee had to resuscitate her. Meanwhile, Blankenship worked to establish an airway for LaCroix. The intubation was, however, an esophageal intubation. Dulemba stated that he thought that the intubation was esophageal. LaCroix's blood pressure and pulse dropped, and she went into cardiac arrest. A physician and nurse from the hospital's emergency department responded to a code for assistance. McGehee testified that the emergency department physician said that he did not know how to resuscitate pregnant women and left without providing any medical care. Dulemba and a nurse began cardiopulmonary resuscitation on LaCroix. McGehee, having finished treating Lawryn, took control of the code. LaCroix suffered irreversible brain damage.
Blankenship and Dr. Hafiz, the Denton Anesthesiology Associates (DAA), PA, anesthesiologist on call for the women's pavilion on the day of LaCroix's incident, settled with the LaCroixes by paying $500,000 and $750,000, respectively. The trial court entered a judgment against the hospital, awarding the LaCroixes approximately $8.8 million in damages.
Issue
Was the evidence sufficient to hold the hospital liable for medical negligence under a theory of corporate liability?
Holding
The evidence was sufficient to hold the hospital liable for medical negligence under a theory of corporate liability.
Reason
The evidence established that the hospital owed a duty to the plaintiff to have an anesthesiologist provide or supervise all anesthesia care, including having an anesthesiologist personally present or immediately available in the operating suite. The hospital's breach of this duty proximately caused the patient's brain damage.
The hospital's anesthesia department policies and procedures required that an anesthesiologist perform the preanesthesia evaluation, that an anesthesiologist discuss with the patient the anesthesia plan, and that an anesthesiologist supervise a CRNA by being "physically present or immediately available in the operating suite."
According to Dr. Via, chairman of the hospital's anesthesiology department in 1991, he complained to Mr. Ciulla, who was in charge of the DAA contract, about the lack of proper CRNA supervision in the women's pavilion. According to Ciulla, he renewed the contract in conjunction with the hospital's medical staff. According to Via, the hospital's medical executive committee recommended to Ciulla that he not renew DAA's contract and that he seek another anesthesia group for the women's pavilion. The hospital's board of directors renewed the contract anyway.
Describe why this outcome occurred and how similar events can be prevented in the future.