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

Exercise 14

Facts
Mrs. Anthony was in her first pregnancy under the primary care of Dr. Hawkins, her personal physician. Anthony was in good health, 26 years of age, employed, and about 30 weeks along in her pregnancy. On September 5, 1989, Anthony's husband took her to the emergency department of Norton Hospital. She was experiencing nausea, vomiting, and abdominal pain. Because of her pregnancy, she was referred to the hospital's obstetrical unit. In the obstetrical unit, Anthony came under the immediate care of Moore, a nurse, who performed an assessment.
Hawkins was called, and she issued several orders, including an IV start, blood work, urinalysis, and an antinausea prescription. Later that night, a second call was made to Hawkins, giving her the test results and informing her that the patient was in extreme pain. Believing that Anthony had a urinary tract infection, antibiotics were ordered along with an order for her discharge from the hospital.
That same night, a third call was made to Hawkins because of the pain Anthony was experiencing, as observed by Moore. Mr. Anthony also talked with Hawkins about his wife's pain. Moore became concerned about Hawkins's discharge order. Although aware of Moore's evaluation, Hawkins prescribed morphine sulfate but was unrelenting in her order of discharge.
Love, the resident physician on duty, did not see or examine the patient, although a prescription for morphine was ordered and administered pursuant to the telephoned directions of Hawkins. At approximately 2:00 A.M., the morphine was administered to Anthony. She rested comfortably for several hours but awakened in pain again. At 6:00 A.M., the patient was discharged in pain.
During trial testimony, Hale, a nursing supervisor, admitted that it was a deviation from the standard of nursing care to discharge a patient in significant pain. Moore, who was always concerned about the patient's pain, had grave reservations about her discharge. She suggested that Love examine Anthony. She even consulted her supervisor, Nurse Hale.
At approximately 10:00 A.M., Anthony was readmitted to the hospital. Upon readmission, Hawkins began personal supervision of her patient. It was determined that Anthony had a serious respiratory problem. The next day, the patient was transferred to the hospital's intensive care unit.
The following day, the baby was delivered by cesarean section. It was belatedly determined at that time that Anthony's condition was caused by a perforation of the appendix at the large bowel, a condition not detected by anyone at the hospital during her first admission. Almost 3 weeks later, while still in Norton Hospital, Anthony died of acute adult respiratory distress syndrome, a complication resulting from the delay in the diagnosis and treatment of her appendicitis.
Judgment was brought against the hospital. At trial, Dr. Fields, an expert witness for the estate of Anthony, testified that the hospital deviated from the standard of care. Every patient who presents herself to the labor and delivery area, the emergency department, or any area of the hospital should be seen by a physician before anything is undertaken and certainly before she is allowed to leave the institution. Further, to provide the patient with medication in the form of a prescription without the physician ever seeing the patient was below any standard of care with which Fields was acquainted. An award of more than $2 million was returned, with the apportionment of causation attributable to Hawkins as 65% and to the hospital as 35%. The hospital argued that the trial court erred in failing to grant its motions for directed verdict and for judgment notwithstanding the verdict because of the lack of substantial causation in linking the negligence of the hospital to Anthony's death.
Issue
Was the negligence of the hospital superseded by the negligence of the patient's primary care physician, and was the award excessive?
Holding
The Kentucky Court of Appeals held that negligence of the hospital was not superseded by the negligence of the patient's primary care physician and that the award for pain and suffering was not excessive.
Reason
The hospital's negligence is based on acts of omission, by failing to have Mrs. Anthony examined by a physician and by discharging her in pain. The hospital should have foreseen the injury to Anthony because its own staff was questioning the judgments of Hawkins while, at the same time, failing to follow through with the standard of care required of it. The defense that the hospital's nurses were only following a "chain of command" by doing what Hawkins ordered is not persuasive. The nurses were not the agents of Hawkins. All involved had their independent duty to Anthony.
The evidence presented a woman conscious of her last days on earth, swollen beyond recognition, tubes exiting almost every orifice of her body, in severe pain, and who deteriorated to the point where she could not verbally communicate with loved ones. Among the last things she did was write out instructions about the care for her newborn child. The trial court, when confronted with a motion for a new trial on excessive damages, must evaluate the award mirrored against the facts. It is said, if the trial judge does not blush, the award is not excessive. No question, the award was monumental, but so was the injury.
Was Dr. Hawkins's telephone "assessment" of the patient appropriate?