Washington v. Washington, 579 A.2d 177 (Aug. 3, 1990)

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Washington v. Washington, 579 A.2d 177 (Aug. 3, 1990) por Mind Map: Washington v. Washington, 579 A.2d 177 (Aug. 3, 1990)

1. Facts

1.1. Parties

1.1.1. Alma D. Washington, Plaintiff/Appellee v. Washington Hospital Center, Defendant/Appellant

1.2. What Happened

1.2.1. November 7, 1987, LaVerne Alice Thompson, a healthy 36-year-old female ("Plaintiff"), had surgery at Washington Hospital Center for an abortion and tubal ligation. Surgery required Plaintiff to receive general anesthesia.

1.2.2. The nurse-anesthetist, Elizabeth Adland, allegedly inserted the endotrachial tube (used to deliver oxygen to the patient's lungs) not into the airway which leads to the lungs, as required, but rather inserted the tube into the esophagus, which would cause the oxygen to be delivered into the stomach (and not into the lungs). The nurse anesthetist was under the supervision of Dr. Sheryl Walker, the physician anesthesiologist.

1.2.3. Following insertion of the tube, the nurse anesthetist pumped oxygen into the patient while the Doctor listened for breath sounds and watched for the rise and fall of Plaintiff's chest to determine if the tube had been properly inserted.

1.2.4. During surgery, the surgeon (Dr. Bobrow) noticed that Plaintiff's blood was abnormally dark, indicating that her tissues were not receiving sufficient oxygen.  Surgeon reported condition to nurse-anesthetist, who checked Plaintiff's vital signs and found them stable.

1.2.5. Further into the surgery, the Plaintiff's heart rate dropped, then she suffered cardiac arrest and was resuscitated.

1.2.6. The lack of oxygen due to the cardiac arrest caused catastrophic brain injury.

1.2.7. Plaintiff remains in a persistent vegetative state and is totally incapacitated; her condition is unlikely to improve.

1.2.8. Plaintiff's life expectancy in this vegetative state is predicted to be ten to twenty years.

1.3. Procedural History

1.3.1. Trial court ruled in favor of Plaintiff related to a medical malpractice action against Defendant, Washington Hospital Center.  Jury awarded a verdict of $4.586 million for Plaintiff, and $63,000 for Plaintiff's husband. Trial court ruled against Plaintiff on the issue of loss of consortium for mother and daughter, which was affirmed by Appellate court without further discussion based on precedent Pleasant v. Washington Sand & Gravel Co., 104 U.S. App. D.C. 374 (1958). The nurse anesthetist and the doctor anesthesiologist both settled all claims against them mid-way through the trial.

1.3.2. Defendant appealed denial of motion for judgment notwithstanding the verdict arguing that Plaintiff's expert's testimony lacked an adequate factual basis. Defendant argued that there was an abuse of discretion by the court in failing to declare a mistrial due to a bench conference that occurred between Plaintiff's expert and two jurors. Defendant also argued that the court made an error in crediting a settlement amount against the jury verdict made between Plaintiff and other defendants (i.e., the nurse anesthetist and the doctor anesthesiologist).

2. Issue before the Court

2.1. Whether the evidence would allow a reasonable juror to find that a reasonably prudent tertiary care hospital, at the time of Plaintiff's injury in November of 1987, and according to national standards, would have supplied a carbon dioxide monitor to a patient undergoing general anesthesia for elective surgery.

2.1.1. Court noted up front that it has rejected the "locality" rule related to determination of standard of care (i.e., standard of conduct reasonably expected of other similarly situated professionals in the same locality or community), and follows the national standard.

2.1.2. Court noted that the Plaintiff's expert defined a "tertiary care hospital" as "a hospital which has the facilities to conduct clinical care management of patients in nearly all aspects of medicine and surgery."

3. Rule of Law

3.1. In a negligence action based on medical malpractice, plaintiff has the burden of proof to demonstrate: (1) Standard of care; (2) Breach of such standard of care by defendant; (3)  Causation that such breach led to plaintiff's injury; and (4) Injury on the part of plaintiff.

3.2. Expert testimony is required to establish each element when it is "distinctly related to some science, profession, or occupation" except when proof thereof is obvious to a lay juror.

3.3. The standard of care is the action that a reasonably prudent professional with the defendant's specialty would have taken under the same or similar circumstances.

3.3.1. Court noted up front that it has rejected the "locality" rule related to determination of standard of care (i.e., standard of conduct reasonably expected of other similarly situated professionals in the same locality or community), and follows the national standard.

4. Application

4.1. Defendant argued that Plaintiff's expert failed to establish the standard of care because he did not establish an adequate factual basis for his opinion that Defendant should have made available a carbon monoxide monitor.

4.1.1. Defendant argued that Plaintiff's expert (i) gave no testimony regarding the number of hospitals having such monitors in place in 1987 (year of injury); and (ii) never referenced any written standards or authorities as the basis of his opinion.

4.1.2. Defendant also argued that use of such monitors was an "emerging" practice and not "mandated" within the profession.

4.2. The court noted that while Plaintiff's expert provided testimony related to his own personal experience, which when applying a national standard (as opposed to local) cannot serve as the basis for expert testimony, Plaintiff also relied on publications such as the American Association of Anesthesiology Standards for Basic Intra-Operative Monitoring which "encouraged" the use of monitors, and a scholarly article published in the Journal of American Medical Association which stated that use of monitors was strongly preferred even in 1985.

4.3. Court stated that the standard of care may exceed what is required under law or mandatory professional regulation if it embodies what a reasonably prudent hospital would do.

4.4. Court analyzed that regardless of whether Plaintiff's expert established a factual basis for testimony, the record contained other evidence which when combined with expert's testimony, could lead a reasonable juror to conclude that monitors were required of reasonably prudent hospitals.

4.4.1. Such additional evidence  consisted of (i) the fact that four other teaching hospitals used the monitors; (ii) testimony of Defendant's Chair of Anesthesiology who had requested Defendant to purchase such monitors for use by Defendant and if such request was denied Defendant "would fail to meet the national standard of care." Moreover, if such request would have been granted, monitors would have been operational at the time of Plaintiff's injury.

5. Conclusion

5.1. Court found that a reasonable juror could find that the standard of care required Defendant to supply monitors at the time of Plaintiff's injury.

5.2. Trial court was correct in denying Defendant's motion for Judgment Notwithstanding the Verdict.

6. Impact of Decision (what cases have cited this case and in what context)

6.1. Case has been followed 19 times and distinguished 3 times (for issues not related to negligence or standard of care).

6.2. Followed by Russell v. Call/D, LLC 122 A.3d 860 (D.C. 2015), in the context that purpose of expert testimony is to avoid jury findings based on mere speculation or conjecture -where plaintiff's expert testimony regarding her source of illness was properly excluded because it was speculative and the expert lacked training, experience, and knowledge.

6.3. Followed by Giordano v. Sherwood, 968 A2d. 494 (D.C.2009) for purposes of showing that expert testimony is necessary to avoid jury findings based on conjecture or speculation (where plaintiff failed to have expert uphold allegations of malpractice)

6.4. Followed by Cardenas v. Muangman, 998 A.2d 303 (D.C. 2010) in the context of expert testimony required to establish standard of care where issues are related to science, profession, or occupation.

7. Why a Business Professional Would Care About Decision and how it has changed the way business operates

7.1. Puts business professional on notice that standard of care may exceed what is required under law or regulation.

7.2. Expenses have increased related to defense of professional malpractice cases because expert testimony is required and it is usually costly.

7.3. All hospitals now follow a "national" as opposed to "local" standard with respect to determining standard of care.

8. Two Current Business Practices Influenced by Holding

8.1. Hospitals' and physicians' use of national standards for patient care.

8.2. Physicians' practice of routinely offering/providing mammograms to all women over 40 notwithstanding certain national studies which have shown that this may not be necessary based on risk of breast cancer.