Brooks v. Coliseum Park Hosp., Inc.

• Decision Date: 02 May 1988
• Docket Number: No. 76287,76287
• Citation: 187 Ga.App. 29,369 S.E.2d 319
• Parties: BROOKS v. COLISEUM PARK HOSPITAL, INC.
• Court: Georgia Court of Appeals

Page 319

369 S.E.2d 319

187 Ga.App. 29

BROOKS v. COLISEUM PARK HOSPITAL, INC.

No. 76287.

Court of Appeals of Georgia.

May 2, 1988.

John A. Draughon, Edward S. Sell III, Macon, appellant.

R. William Buzzell II, Susan S. Cole, Macon, for appellee.

BIRDSONG, Chief Judge.

This is an appeal from judgment entered on a jury verdict for the defendant, Coliseum Park Hospital, Inc., d/b/a Coliseum Psychiatric Hospital, in a medical malpractice action in which Mrs. Lucille M. Sterling, through her guardian, sought damages from the hospital, alleging that the hospital was negligent in not placing side rails on her bed, and in not having an attendant with her, and that because of such alleged negligence, Mrs. Sterling fell and broke her hip. An amended complaint also sought damages for the alleged negligent act of the hospital in failing to provide assistance to Mrs. Sterling in feeding herself, and claiming that because of such failure, she spilled her food and burned her thigh.

On June 20, 1984, Mrs. Sterling was admitted to the Coliseum Psychiatric Hospital, and shortly thereafter was transferred to its Special Care Unit for evaluation and treatment. She was 69 years old and suffering from Alzheimer's disease. She had "severe mood swings," experienced delusions and hallucinations, and had refused to eat or take her medication. Mrs. Sterling's daughter and another friend advised hospital personnel that Mrs. Sterling had been sleeping in a hospital bed at home, with side rails. When they visited her at the hospital, Mrs. Sterling was found wandering around the hospital, and sleeping in other people's beds. Mrs. Sterling's daughter said her mother "basically [was] very confused" and felt more secure in a bed with side rails, and she requested the hospital provide side rails for her mother. During one visit the daughter saw a burn on her mother's thigh, which looked as if it had not been treated and brought it to the attention of the hospital's staff.

At 3:00 a.m. on the morning of July 29, 1984, Mrs. Sterling had been restless that night and the nurse on duty gave her Dalmane, a "hypnotic agent" to assist her in sleeping. Some side-effects of Dalmane are "nocturnal confusion," "restlessness," and "difficulty in walking...." However, these are also the same symptoms exhibited by persons with Alzheimer's disease.

Gregory Land, a psychiatric technician, in the hospital's Special Care Unit, was on duty the morning of July 29, and had seen Mrs. Sterling several times before 4:15 a.m. He was at his desk, completing paperwork, when he heard a noise and saw Mrs. Sterling "was out of bed and walking unevenly toward the door of her room, and within a few steps she ran into the door frame of the door and then fell to the floor." He was aware that the nurse had given Mrs. Sterling Dalmane at 3:00 a.m., and when he saw her, he began to stand up, but he could not get to her before she walked into the door frame. It was only "seconds" before he got to her, checked her briefly, and returned her to her bed where Nurse Brittain checked her and found nothing obviously wrong. There was no apparent injury.

However, x-rays revealed "a base-of-the-neck fracture" of her hip which required a "hip-nailing" device be placed over the area of the fracture. The device used to stabilize the fracture is called a "Ken nail." In September, 1984, x-rays showed "healing was complete" and Mrs. Sterling was discharged from medical treatment for her broken hip. Later, infection manifested itself in the hip and the area where the "Ken nail" had been implanted had to be opened and drained. Finally another operation was required to remove the old Ken nail, cleanse the area, and implant a new Ken nail.

Dr. Jimmy Asbell, testifying for the plaintiff, was of the opinion that the infection could have been implanted at the first operation, or that Mrs. Sterling "herself could have seeded a bacteria to this area where the implant was." On cross-examination, the doctor testified that he would not state with any "reasonable medical certainty that this bacteria was introduced as a result of the fracture or the surgery to repair the fracture...."

Nancy R. Murphy, a registered nurse, graduate of St. Clair's Hospital School of Nursing, also has a BS from Southwest Texas State University, a Master of Education from Mississippi State, and a Juris Doctor degree from Woodrow Wilson College of Law, who is now working as a lawyer, and has appeared as an expert witness for the prosecution in six cases, is of the opinion that "since there were no side rails on the bed, her [Mrs. Sterling's] safety was compromised." In her opinion, "the placing of side rails [is] a matter of a nursing decision ..." and a physician is not required for a nurse to place side rails on a patient's bed. Ms. Murphy was aware of Coliseum's Psychiatric Hospital Policies and Procedures Manual, which stated that "[i]ndications for the use of side rails include, but are not necessarily limited to, (1) 65 years of age or above; (2) requiring restraints; (3) difficulty raising self up in bed, and (4) restless sleeping habits." Ms. Murphy admitted that if Mrs. Sterling's personal physician was of the opinion that side rails would make the patient less safe, she would change her opinion.

Mrs. Sterling's personal doctor, Dr. Ray H. McCard, a physician and a psychiatrist, testified that he was contacted by her family and he recommended Mrs. Sterling be admitted to the Coliseum Psychiatric Hospital's Special Care Unit. The special care unit was "closed" so that patients could not leave, and the patient received more supervision and care. He diagnosed Mrs. Sterling as suffering from Alzheimer's disease, which is also called "organic brain syndrome ... sort of a deterioration ... she had a lot of hardening of the arteries and narrowing of the blood vessels going to her brain ... leading to the cerebral atrophy...." She was severely disturbed mentally and had physical problems. She had paranoid delusions and thought someone was trying to hurt her. The doctor was aware that the hospital was not using side rails, but the beds in the psychiatric unit are closer to the floor and lower than a regular hospital bed. Side rails can be added to the bed, if desired. Dr. McCard was asked: "Q. Did you feel at any time that side rails were appropriate and should have been added to that bed? A. No, I did not ... a philosophy has gradually evolved over a period of time concerning side rails, and side rails in older confused individuals can be quite dangerous because, in a confused state, older people will try to get out of bed, and by trying to get out of bed, they, of course, are not recognizing the danger associated with what they're doing, and they will crawl over the side rails, which increases the length--the distance a person can fall ... the philosophy now is that if you put up side rails in [sic] a person who is confused ... then you should put some form of restraint of them.... So we did not utilize side rails, which, in turn, would have also warranted the use of some type of restraint...."

Dr. McCard stated that in dealing with an individual with Alzheimer's, such as Mrs. Sterling, because she had osteoporosis, "which means fragile bones," and had three compression fractures of her spine, they did not want to keep her restrained, "which would have been safe ... but would not have been for her best...