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

Exercise 8

Facts
While at the Philadelphia College of Osteopathic Medicine (PCOM) and under the care of her physician, Dr. Bryant, Greer was diagnosed with preeclampsia, a condition characterized by high blood pressure in the mother that poses a risk to the unborn child. On September 20, the patient suffered symptoms of fetal distress and was examined by the hospital's interns and residents. Tests ordered at the time of her visit revealed that the fetus was suffering from "decelerations," a periodic lowering of the heartbeat. Following her examination, Greer was instructed to return to the hospital on September 23. During that visit, it was noted that the fetus was experiencing "poor beat-to-beat variability." Greer was once again sent home with instructions to return to the hospital on September 27. However, on September 26, Greer, experiencing severe pains, called the hospital emergency department. She was told to wait until her scheduled appointment the following day. Her appointment was subsequently canceled because of weather. Upon the insistence of her sister, Greer went to the hospital on September 27, where she delivered her child. The infant, suffering from "severe meconium aspiration" (inhalation by the fetus of its own fecal matter while in utero), died several days later.
The plaintiff alleged that the hospital, through its negligence, contributed to her child's death. Greer sued Bryant and PCOM separately. She alleged that based on the prenatal test results during her September 23 visit to PCOM, she should have been delivered on that date by Bryant. The plaintiff argued that even if the test results had been communicated to Bryant and he decided to send her home, the residents should have recognized the serious condition of the fetus and, if necessary, sought approval from their superiors to keep her at the hospital.
Bryant made an offer to settle, and the plaintiff accepted. The Court of Common Pleas, upon jury verdict, entered judgment for the mother, finding PCOM 41% liable to the plaintiff. PCOM appealed. The plaintiff's expert witness, Dr. Gabrielson, opined in her medical report that Greer should have been admitted and the child delivered despite the private physician's instructions to send her home.
Issue
Was Bryant properly notified that the fetus was suffering heart decelerations, and did the plaintiff's expert witness, Dr. Gabrielson, exceed her scope of opinion in her medical report by stating that the plaintiff should have been admitted and the child delivered despite the private physician's instructions to send her home?
Holding
The Pennsylvania Superior Court determined that the jury could find that the hospital's staff was negligent by not reporting the fetal distress of the unborn child to Bryant and that the plaintiff's expert witness did not exceed her scope of opinion in her medical report.
Reason
Although a resident and intern claimed that they had called Bryant, neither could testify as to the content of their conversation with him. Bryant testified that he did not recall receiving any telephone calls. He stated that if he had been aware of the decelerated heart rate, he would have ordered delivery of the child. "Since many of the critical events occurred on September 23, the jury could have determined that PCOM's employees' crucial nonfeasance occurred on that date... we must assume that the jury drew this inference" ( Id. at 1002).
Gabrielson, in three written reports and through oral testimony, testified that if the test results had not been reported to Bryant, such conduct, in her opinion, fell below the required standard of care. PCOM argued that this new "failure to override [Dr. Bryant's possible orders to send Rachel home] theory" was not contained in the reports and that they were unfairly surprised by the opinion. The superior court did not agree. The following is an excerpt from a report that presents questioning of Gabrielson by the plaintiff's counsel:
3. Ms. Greer was sent to Osteopathic Hospital on three occasions for non-stress and contraction stress testing. On the second occasion... it was noted that the baby's heart rate showed poor variability.... Could you explain the significance of this finding with regard to the health and well-being of the fetus?
A. The episode of bradycardia observed on September 20 was a very ominous sign and very suggestive of cord compression probably resulting from oligo-hydramnios. This would result in fetal distress with meconium passage and aspiration. It could result in sudden intrauterine death.
4. Once the fetal distress was detected, did the hospital act appropriately by sending Ms. Greer home?
A. No.
5. What measures, if any, should have been taken to ensure the health and well-being of the fetus?
A. Ms. Greer should have been admitted and delivered. [ Id. at 1004]
The question of hospital negligence in sending the plaintiff home was within the fair scope of Gabrielson's oral testimony and written reports. "PCOM's decision to send Rachel home was contemplated and counsel should have anticipated that the 'failure to override theory' was looming" ( Id. at 1004).
What effect, if any, should such cases have upon the training of students and residents?