Brownsville Medical Center v. Gracia

• Court: Texas Court of Appeals
• Writing for the Court: UTTER
• Citation: Brownsville Medical Center v. Gracia, 704 S.W.2d 68 (Tex. App. 1985)
• Decision Date: 28 June 1985
• Docket Number: No. 13-84-369-CV,13-84-369-CV
• Parties: BROWNSVILLE MEDICAL CENTER and Valley Community Hospital, Appellants, v. Fermin GRACIA, Sr., and Guadalupe C. De Gracia, Parents of Fermin Gracia, Jr., Deceased, Appellees.

Page 68

704 S.W.2d 68

BROWNSVILLE MEDICAL CENTER and Valley Community Hospital, Appellants, v. Fermin GRACIA, Sr., and Guadalupe C. De Gracia, Parents of Fermin Gracia, Jr., Deceased, Appellees.

No. 13-84-369-CV.

Court of Appeals of Texas Corpus Christi.

June 28, 1985.

Rehearing Denied Aug. 30, 1985.

David M. Davis, Davis & Davis, P.C., Austin, for appellant, Valley Community Hospital.

William L. Hubbard, Adams, Graham, Jenkins, Graham & Hamby, Harlingen, for appellant Brownsville Medical Center. Clem V. Lyons, David M. Adkisson, Stephen Dittlinger, Southers & Lyons, Inc., San Antonio, for appellees.

Before UTTER, KENNEDY and BISSETT ¹, JJ.

OPINION

UTTER, Justice.

This is a medical negligence case. Appellees sued numerous health care providers, including appellants, seeking damages for the alleged wrongful death of their child, and received judgment against appellants. We affirm the judgment of the trial court.

The record reveals the following: On July 16, 1979, appellees' nine year old child was kicked in the stomach by another youth and soon thereafter began complaining about stomach pains. The next day, the child continued to complain about stomach pain, he "had a fever," and he vomited "when he tried to eat" and when "anything just touched his stomach." On July 18, 1979, the child "was the same, complaining about the same pain, and had the same symptoms," so appellees took their child to a hospital in Matamoros, Mexico, where he was admitted and remained for approximately four days.

On July 22, 1979, appellees discharged their son from the Matamoros hospital against medical advice because "there was never any change"--"he didn't get any better." Following the discharge, appellees took their child to the emergency room at Brownsville Medical Center.

At the emergency room at Brownsville Medical Center, the child was seen "around 7:00 or 8:00" p.m. by Dr. Elias Lorenzana, who physically examined the child and ordered certain lab tests and x-rays. During the examination, Dr. Lorenzana noted that the child was experiencing some mild tenderness in his right lumbar area, he appeared jaundiced, and his bowels were hyperactive. Because Dr. Lorenzana only spoke English and appellees only spoke Spanish, all communications between them were interpreted by a hospital nurse. According to appellees, Dr. Lorenzana told them that "it was nothing serious, it was a simple case of anemia." Mrs. Gracia testified (1) that Dr. Lorenzana told her that they could take the child home, should place him on a bland diet and should take him on the next morning to Dr. Posnett, a pediatrician, (2) that Dr. Lorenzana never recommended that the child should be hospitalized and (3) that Dr. Lorenzana did not tell her that, if the child became worse during the night, she should return the child to the emergency room. However, Dr. Lorenzana testified and medical records indicated that the primary diagnosis was hepatitis caused by some type of infection. Dr. Lorenzana further testified that he recommended (1) that the child could go home and get some bed rest, (2) that, if the child were to feel worse during the night, the child should be returned to the emergency room and (3) that the child should "by all means" go see the pediatrician the next morning. Dr. Lorenzana stated that "they were given the option" to have their child hospitalized but that he felt that the child was not critically ill and did not require hospitalization at that time. Before he released the child, Dr. Lorenzana personally reviewed the x-rays taken, but he did not have the benefit of the radiologist's report interpreting the x-rays until the following day. At the time he made his diagnosis of hepatitis, Dr. Lorenzana did not consider pancreatitis as a possible diagnosis and, after having reviewed the radiologist's report the following day, he then considered appendicitis as a possible diagnosis. The radiologist's report indicated that there were "some air filled slightly dilated small bowel segments in the right quadrant which may represent a localized ileus possibly due to appendicitis though clinical correlation is necessary."

After appellees and their child returned home that evening, the child still complained about his stomach pain, his fever had diminished, but he "seemed to be doing a little better." The child went to sleep that night; but, when he awoke "early" the following morning, he was feeling worse--he again had stomach pain and a fever.

That morning, July 23, 1979, Mrs. Gracia took her child to Dr. Carlos Monarrez, a pediatrician, who examined the child and ordered certain lab tests and x-rays. After examining the child, Dr. Monarrez concluded (1) that the child had an "acute abdomen" with differential diagnoses including pancreatitis, hepatic abcess, appendicitis and typhoid fever and (2) that the child was "a very strong candidate for surgery." From his office, Dr. Monarrez called a general surgeon, Dr. Raul Rodriguez, at Valley Community Hospital for surgical consultation. Dr. Rodriguez agreed to immediately see the child at Valley Community Hospital. According to Mrs. Gracia, Dr. Monarrez had told her that her child's condition "was quite delicate and he needed surgery"; and, when he called "over there," Dr. Monarrez "told them to prepare to take him into surgery right away." The child was immediately taken by ambulance to Valley Community Hospital to be examined by Dr. Rodriguez.

Upon arrival at Valley Community Hospital at approximately 10:00 a.m. that same morning, July 23, 1979, the child was admitted through a "direct admission" process whereby he was taken directly to be examined by Dr. Rodriguez and then later to a hospital room. In the meantime, Mrs. Gracia provided admission-related information to a receptionist/clerk and a social worker at the hospital. At this time, Mrs. Gracia also signed a "Conditions of Admission" form. Minerva G. Coronado, the social worker, testified that Mrs. Gracia had been referred to her office for "financial evaluation" and that persons would be referred to her office "if they were not able to meet their hospital deposit or were having concerns over the hospital bill" and would be "screened for a possible referral to a financial resource." During the interview between the social worker and Mrs. Gracia, it was determined that appellees did not have medical insurance and could not qualify for financial assistance. The social worker also stated that "the doctors and nurses" were advised regarding the financial evaluation but that she did not make any recommendations regarding whether appellees' child should have been admitted.

While Mrs. Gracia was being interviewed by the receptionist/clerk and the social worker, the child was examined by Dr. Rodriguez, lab tests were performed, x-rays were taken, and the child was taken to a hospital room. Based upon the examination, it was Dr. Rodriguez' impression that the child had suffered a "post-traumatic abdominal injury possibly associated with internal injuries relating to pancreas, liver or an acute inflammatory process, pneumonia, etc." According to several medical experts, certain entries on the child's medical records during this time indicated that the child was being prepared for surgery, but subsequent entries indicated that the child was being transferred to another hospital.

Subsequent to the child's examination and Mrs. Gracia's interview, the social worker visited Mrs. Gracia in the child's hospital room. According to Mrs. Gracia, the social worker at that time (1) told her that they "did not qualify for the boy to stay there in that hospital," (2) suggested that the boy be transferred to John Sealy Hospital (a public hospital) in Galveston and that "he would be better off in Galveston and it would be much cheaper" and (3) instructed that she "had to sign" the "Consent to Transfer" form, which "was already filled out." According to the social worker, John Sealy Hospital in Galveston was "the place where we usually send people that cannot afford to pay." The social worker and Dr. Rodriguez testified that the transfer was recommended only when Mrs. Gracia refused to sign a surgical consent form and "wanted to talk to her husband." However, Mrs. Gracia testified that, if she had been presented a surgical consent form, she would not have refused to sign it and that she would not have waited to get the agreement of her husband. Mrs. Gracia also testified that she signed the "Consent to Transfer" form based upon the representations that her child would receive better care at better facilities with less costs at the Galveston hospital.

Once Mrs. Gracia signed the "Consent to Transfer" form and a physician with the Galveston hospital agreed to accept the child, the social worker made all necessary transportation arrangements for the transfer, Mrs. Gracia contacted by telephone Mr. Gracia at his place of work and he came to the hospital. Mr. and Mrs. Gracia and the minor child were then flown by air ambulance to Galveston, where they arrived around "5:00" p.m. that same day, July 23, 1979, and were taken immediately by ambulance to the Galveston hospital. While in the care of the physicians and staff at the Galveston hospital and without surgical intervention, the child died approximately eight days later on August 1, 1979. The medical experts had different opinions about the cause of death. The exact cause of death was undetermined.

Subsequently, appellees filed suit against numerous health care providers, including appellants. Following severances and dismissals, appellees proceeded to trial in this cause against Dr. Lorenzana and appellants Brownsville Medical Center and Valley Community Hospital.

Prior to the entry of judgment, the trial court found that certain damages awarded by the jury were excessive in the amount of $150,000.00 and ordered a remittitur of said amount. Based upon the finding of the jury, the trial court then rendered...