Belmon v. St. Frances Cabrini Hosp.

• Decision Date: 03 February 1983
• Docket Number: No. 82-526,82-526
• Citation: 427 So.2d 541
• Parties: Jessie BELMON, Jr., et al., Plaintiffs-Appellees, v. ST. FRANCES CABRINI HOSPITAL, et al., Defendant-Appellant.
• Court: Court of Appeal of Louisiana — District of US

Page 541

427 So.2d 541

Jessie BELMON, Jr., et al., Plaintiffs-Appellees, v. ST. FRANCES CABRINI HOSPITAL, et al., Defendant-Appellant.

No. 82-526.

Court of Appeal of Louisiana Third Circuit.

Feb. 3, 1983.

Rehearing Denied March 22, 1983.

Gist, Methvin, Hughes & Munsterman, Howard B. Gist, Jr., Alexandria, for defendant-appellant.

Eugene Cicardo, and Antoon, Dalrymple & Beck, Joseph Dalrymple, Alexandria, for plaintiffs-appellees.

Before CUTRER, YELVERTON and KNOLL, JJ.

YELVERTON, Judge.

This is a hospital malpractice damage case. Plaintiffs are Jessie and Alice Belmon. Defendant is St. Frances Cabrini Hospital of Alexandria, Inc., (Cabrini). ¹ The trial court found that the actions of two of Cabrini's employees amounted to a breach of the duty of care owed by the hospital to Mrs. Belmon while she was a patient there on August 12, 1980. The court found that this breach of duty was a cause in fact of the injuries suffered by Mrs. Belmon to her right arm and hand. From a judgment awarding plaintiffs damages totalling $57,376.15, Cabrini appeals. We affirm.

Before considering the specific issues raised on appeal we will narrate the facts as found by the district court.

Facts

Mrs. Belmon was admitted to Cabrini on August 11, 1980, with a diagnosis of a possible pulmonary embolus (a blood clot lodged in the lung). Her treating physician, Dr. James D. Knoepp, prescribed Heparin therapy, the recognized treatment for a suspected pulmonary embolism. Heparin is a potent anti-coagulant drug. Dr. Knoepp ordered the immediate administration of a 7500 unit bolus of Heparin in the emergency room. He then placed Mrs. Belmon in the hospital's intensive care unit (ICU), and ordered that she receive the anti-coagulant by continuous I.V. (intravenous) drip at the rate of 2000 units per hour to achieve maximum Heparinization. Mrs. Belmon was to remain overnight in ICU. Several tests were scheduled for the following day. Dr. Knoepp did not see the patient after admission until noon on August 12.

Mrs. Belmon spent the night uneventfully. At about 5:00 a.m. on August 12 Cabrini's medical technician, John Mabry, took a blood sample from her right arm.

At 6:30 a.m. Dr. Bryan Cole, a cardiologist, checked on plaintiff and found that she was alright.

Around 7:30 a.m. Mrs. Belmon began to experience pain in the right arm both below and above the elbow, as well as discoloration and swelling. She and her husband, who was with her in ICU, declared that they immediately called this to the attention of the ICU nurse, Shelia Bardwell. Nurse Bardwell saw the patient at least six times that morning between 7:30 and 11:50. The nurse noted on the patient's record that there were complaints of pain in the right arm at 9:30 a.m. and the upper arm was slightly swollen, but no hematoma was present. She checked the patient's blood pressure at 10:00 and again at 11:00. She made no notation of complaints of pain on either occasion and cannot remember whether or not the patient's arm was still swollen. At 11:50 the patient was still complaining of pain so she called Dr. Knoepp. Nurse Bardwell stated that she saw no hematoma (which would have been evidenced by discoloration) at 11:50 or any other time.

Dr. Knoepp did not learn that something untoward was occurring until he received Nurse Bardwell's message at 11:50. Arriving ten minutes later at ICU, he discovered a large hematoma. He wrapped the arm and elevated it and immediately reduced the Heparin therapy by one-half. Two hours later Dr. Cole, by then having the benefit of a lung scan which ruled out pulmonary embolism, discontinued the Heparin completely.

Thereafter, the symptoms for which she was originally hospitalized having disappeared, Mrs. Belmon was treated only for the injury to her right arm and hand, the subject of damages in this case.

The medical testimony was unanimous that hemorrhage is a substantial risk in Heparin therapy. The most common is bleeding into the skin or soft tissue at needle puncture sites.

It was Dr. Knoepp's opinion that Mrs. Belmon's hematoma was a secondary hemorrhagic complication due to the combination of heparin, venepuncture and blood pressure cuff trauma. Further explaining, he said that the blood pressure cuff could have ruptured smaller blood vessels, or she could have had a venous or an arterial hematoma from the needle stick and this was aggravated by the blood pressure cuff.

The blood pressure cuff was on Mrs. Belmon's arm throughout the night and was there at 5:00 a.m. when the med-tech Mabry stuck her for the blood sample. Routine blood pressure checks using the cuff were made through the night and on an hourly basis during the morning of August 12.

Against this background of basic facts, we will now take up the issues raised by Cabrini on appeal. They are:

1. Was the conduct of Cabrini's employees the cause in fact of plaintiff's injuries?

2. What was the duty of care owed by the hospital to the plaintiff?

3. Did the duty of care owed by the hospital to the plaintiff encompass the risk of injury which occurred?

4. Did the defendant hospital breach the duty of care owed to the plaintiff?

5. Did the trial court improperly admit Nurse Kevil's testimony beyond her expertise?

6. Did the trial court err in assessing the amount of damages recoverable by plaintiffs?

Cause in Fact

In order for negligent conduct to be a cause in fact of a plaintiff's harm, it must be shown to be a substantial factor in causing the injury. Ducote v. Voorhies, 350 So.2d 1289 (La.App. 3rd Cir.1977).

The trial court found that the failure of John Mabry, the medical technician, to take proper precautions in drawing blood from the patient's arm at 5:00 A.M. on August 12 was a substantial factor in causing plaintiff's injury.

The preponderance of the medical testimony was that extra precautions should be taken in drawing blood from a Heparinized patient. The extra precautions require an exact stick and also that the puncture wound be held longer than in routine sticks. Mabry treated the taking of blood as a routine matter. He was unaware that the patient was Heparinized. Mrs. Belmon said he had to stick her five times. The medical testimony was that excessive bleeding from a vein puncture would take some time to be observable in the form of a hematoma. The trial court found that Mrs. Belmon's original symptoms began at 7:30 a.m. The proximity in time between the onset of symptoms and the taking of blood caused the court to think that this was a substantial cause in fact.

The lower court also blamed the inaction on the part of Nurse Bardwell for permitting Mrs. Belmon's injury to reach serious proportions before medical help was summoned. The court found as a fact that Mrs. Belmon had voiced complaints of pain, discoloration and swelling, continuously after 7:30. The doctor was not called until noon. When Dr. Knoepp reached her bedside in ICU, he immediately commenced corrective measures. Had Nurse Bardwell called him sooner, the extent of damages more probably than not could have been minimized.

Causation is a question of fact, and our duty on appellate review of this finding of fact, as well as all factual findings hereafter to be considered, requires us to affirm in the absence of manifest error. Harris v. State, through Huey P. Long Mem. Hosp., 378 So.3d 383 (La.1979). We find no manifest error in the court's determination that the actions of Cabrini's employees were causes in fact of Mrs. Belmon's injuries. But for the drawing of the blood without the proper aftercare and the inaction of the duty nurse when faced with the signs of hemorrhage, the injury would not have happened.

The Hospital's Duty of Care

The duty owed by a hospital to its patients is to exercise the degree of care, skill and diligence that the particular patient's condition may require and protect the patient from his incapacities and external circumstances peculiarly within the hospital's control. Ulmer v. Baton Rouge General Hospital, 361 So.2d 1238 (La.App. 1st Cir.1978); Bryant v. St. Paul Fire and Marine Ins. Co., 365 So.2d 537 (La.App. 3rd Cir.1978), writ denied 367 So.2d 1184 (La.1979); Harris v. State, through Huey P. Long Hospital, 371 So.2d 1221 (La.App. 3rd Cir.1979), affirmed 378 So.2d 383 (La.1979).

Cabrini's liability is vicarious, based on the substandard conduct of its ICU nurse, Shelia Bardwell, and its medical technician, John Mabry.

Nurses and medical technicians who undertake to perform medical services are subject to the same rules relating to the duty of care and liability as are physicians in the performance of professional services. Butler v. Louisiana State Board of Education, 331 So.2d 192 (La.App. 3rd Cir.1976); Harris v. State, through Huey P. Long Memorial Hospital, supra.

The standard of care of a physician is to exercise the degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his best judgment, in the application of his skill to the case. Meyer v. St. Paul-Mercury Indemnity Co., 73 So.2d 781 (La.1953); Butler v. Louisiana State Board of Education, supra; Harris v. State, through Huey P. Long Memorial Hospital, supra.

Duty/Risk

A hospital's standard of care requires that a patient be protected from dangers that may result from the patient's particular condition or which a reasonable person under the circumstances would anticipate. The medical evidence is uncontradicted that the major known complication in the use of Heparin is hemorrhage. The risk of bleeding at needle puncture sites is well known. Pressure, such as might be caused by a blood pressure cuff, may...