| Nurse Is Second-Guessed For Her Actions After Patient Suffers Severe Mental Retardation |
| Experts Testify They Would Have Done Things Differently Not Enough to Establish Medical Negligence |
Most medical malpractice lawsuits end up as clashes between experts _ the-so-called hired guns brought in by the plaintiff and the defendant. Then the task falls upon the truer of the facts, the jury, to decide whose testimony should carry the weight. Simply because another nurse would have done things differently does not prove that the first nurse was negligent.
The trial court erred in this case by instructing the jury that even if they
believed plaintiff's witnesses, they should nonetheless find no negligence
because the defendant's
experts "disagreed" with the plaintiff's experts.
Facts : On September 28, 1980, appellant Helen Ketchum was admitted to respondent Overlake Hospital Medical Center. Ketchum's physician, Dr. John Maxwell, a neurosurgeon, had diagnosed a subarachnoid hemorrhage. An angiogram revealed that Ketchum was suffering from an aneurysm at the tip of her basilar artery, the primary artery supplying blood to the brain stem.
Ketchum suffered a second hemorrhage on October 6, 1980, which left her in coma for several hours. Following the hemorrhage, Dr. Maxwell diagnosed vasospasm, a condition in which blood vessels constrict, reducing the blood supply to the brain. Such constriction may be severe enough to destroy brain tissue supplied by the blood vessels.
On November 13, 1980, Dr. Maxwell operated on Ketchum. Utilizing a microscope, Dr. Maxwell placed a silver "clip" on the aneurysm to prevent future hemorrhage. The operation lasted from about 11 a.m. to 6 p.m. Ketchum was placed in the intensive care unit (ICU) for recovery.
When examined in 1989, Mrs. Ketchum was found to be suffering from severe mental retardation. The primary basis for this lawsuit is Ketchum's contention that her present condition is the result of negligent nursing care that she received in the ICU of Overlake, during the night shift 11 p.m. to 7 a.m. following the operation.
The testimony at trial focused on the degree to which Ketchum's condition may have deteriorated during night shift, whether the Overlake nurse adequately assessed and documented Ketchum's condition during this period, whether the nurse properly informed Dr. Maxwell of Ketchum's condition during the night, and whether Ketchum's present condition was the result of allegedly negligent care that she received during this shift or whether the damage had occurred prior to the operation.
Patricia Tobis, a registered nurse, testified that the Overlake nurse had inadequately assessed and documented Ketchum's neurological condition during the night shift. According to Tobis, Ketchum's night shift chart indicated that the nurse had failed to document adequate responses to a series of warning signs, including respiratory distress, elevated pulse, and reduced pupilar response, all signs of Ketchum's possibly deteriorating condition. Tobis was concerned that Ketchum's chart did not indicate that Dr. Maxwell had been adequately informed of the warning signs.
Dr. Robert Rand, a professor of neurosurgery, also testified for the plaintiff. Rand, who examined Ketchum in 1989, stated that a reasonably prudent ICU nurse would have reported the warning signs to Dr. Maxwell. In Rand's opinion, the warning signs indicated that Ketchum was experiencing brain stem compression during the night shift. According to Dr. Rand, if Dr. Maxwell had been informed of these warning signs, he could have prescribed a diuretic, which would have relieved the pressure on Ketchum's brain, and the damage causing Ketchum's current condition would probably not have occurred. Dr. Rand further opined that Ketchum's present condition was not caused by two hemorrhages, the vasospasm, or the surgery.
The defense presented several experts who testified that Ketchum's condition had not significantly deteriorated during the night shift and that the nurse's assessment and documentation of Ketchum's condition met the applicable standard of care. These witnesses stated that the nurse had fully and appropriately informed Dr. Maxwell of Ketchum's condition during the three telephone conversations she had with him during the night shift. The defense also presented evidence tending to show that Ketchum may have suffered permanent damage prior to her surgery.
The jury returned a verdict in favor of the defendant, and this appeal timely ensued.
Court Decision: This is not a case in which the medical men called to testify for the plaintiff are in agreement with each other as to the diagnosis or cause of the plaintiff's condition, but are in disagreement with those who testify for the defendant. In such a case, the jury is entitled to choose between the conflicting testimony. But in this case, the doctors called to testify on behalf of the plaintiff were not in accord in their diagnosis of her condition, much less in their theories of its cause...
The testimony of other health care providers that they would have followed a different course of treatment, or disagreement between health care providers as to what the treatment should have been, is not enough to establish negligence.
A health care provider is negligent only if he or she fails to possess and exercise that degree of skill, care and learning which is ordinarily possessed and exercised by reasonably prudent members of that profession in the same or similar circumstances.
Ketchum v. Overlake Hospital Medical Center, 60 Wash. App. 406; 804 P.2d 1283; 1991 Washington.
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