Busta v. Columbus Hosp. Corp.

• Decision Date: 10 May 1996
• Docket Number: No. 95-050,95-050
• Citation: 276 Mont. 342,916 P.2d 122
• Parties: Ida O. BUSTA, as Personal Representative of the Estate of Delbert F. Busta, on behalf of the heirs of Delbert F. Busta, Plaintiff and Respondent, v. COLUMBUS HOSPITAL CORPORATION, Defendant and Appellant.
• Court: Montana Supreme Court

Page 122

916 P.2d 122

276 Mont. 342

Ida O. BUSTA, as Personal Representative of the Estate of Delbert F. Busta, on behalf of the heirs of Delbert F. Busta, Plaintiff and Respondent, v. COLUMBUS HOSPITAL CORPORATION, Defendant and Appellant.

No. 95-050.

Supreme Court of Montana.

Submitted on Briefs Jan. 17, 1996.

Decided May 10, 1996.

James R. Walsh and Dennis P. Clarke, Smith, Walsh, Clarke & Gregoire, Great Falls, for Appellant.

Dennis Patrick Conner, Great Falls, for Respondent.

TRIEWEILER, Justice.

The plaintiff, Ida O. Busta, filed her complaint in the District Court for the Eighth Judicial District in Cascade County in which she sought compensation for damages to Delbert F. Busta pursuant to § 27-1-501, MCA, and to his heirs pursuant to § 27-1-513, MCA, based on her allegation that Delbert's death was caused by the negligence of the defendant, Columbus Hospital Corporation. Following trial of the issues raised by the parties' pleadings, a Cascade County jury returned its verdict in which it found that Delbert's injuries and death were caused by the negligence of Columbus and the contributory negligence of Delbert and apportioned seventy percent of fault to the Hospital and thirty percent of fault to Delbert. The jury found that Delbert and his estate were damaged in the amount of $5,000 and that his heirs were damaged in the amount of $800,000 as a result of his death. Based on the jury's apportionment of liability, the District Court entered judgment in favor of Delbert's estate in the amount of $3,500 and in favor of his heirs in the amount of $560,000. Columbus appeals from the judgment of the District Court, from the order of the District Court denying its motion for a new trial, and from the District Court's denial of its motion for offset against the judgment pursuant to § 27-1-308, MCA. We affirm the judgment and orders of the District Court.

The issues raised by Columbus on appeal are as follows:

1. Did the District Court err when it admitted a photographic exhibit offered by the plaintiff which depicted the decedent, Delbert Busta, and included a tribute from his granddaughter?

2. Did the District Court err when it refused to admit the defendant's proposed exhibit which consisted of a letter written by the plaintiff's attorney to the Veterans' Administration which attributed Delbert Busta's death to a military-related mental illness?

3. Did the District Court err when it refused to give the defendant's proposed instructions which defined proximate cause and stated the requirement that the decedent's injuries be foreseeable before causation could be established?

4. Did the District Court err when it refused to offset benefits received by Ida Busta from the Veterans' Administration against the damages awarded for the decedent's wrongful death?

DISCUSSION

Delbert Busta was an American veteran who had been captured by the Japanese Army, forced to participate in the Bataan Death March, and was subsequently imprisoned in a Japanese prisoner of war camp for over three years.

Subsequent to his release as a prisoner of war and his return to the United States, he was treated for his mental and physical debilitation and discharged from the Army. At the time of his discharge, he was diagnosed with simple schizophrenia, and on that basis was awarded a service-related disability by the Veterans' Administration. Testimony given at this trial explained that at that time the diagnosis of simple schizophrenia was ascribed to someone who had become withdrawn and uninterested in social interaction. It did not indicate the kind of bizarre behavior or delusions that are commonly associated with other forms of schizophrenia. At any rate, the undisputed testimony was that from then until the date of his death on December 1, 1991, Delbert displayed no outward indication of mental or emotional problems and that not even his wife and children were aware of the basis for his service-related disability benefits.

On November 26, 1991, Delbert was admitted to the Columbus Hospital in Great Falls for surgical treatment of prostate cancer and inguinal hernia repair. Surgery was performed on that date.

Following successful surgery, Delbert was transferred to a room on what was designated the third floor of the hospital, although the floor was actually four stories above ground level as viewed from the outside. During the early morning hours of December 1, Delbert cut himself free from his Foley catheter, pulled out the tubings from his IVs, tied two sheets and a hospital gown together, attached one end of the makeshift rope to a clothing hook, and attempted to leave the hospital through his third floor window. He was found on the ground below his window a short time later suffering from injuries caused by his fall. He died from those injuries later that day.

Kathy Fitzgerald was the nurse who was employed by and on duty at Columbus Hospital on the evening of November 30 and the morning of December 1, and who was assigned to care for Delbert. She testified that he was normally a cooperative patient, but that on her last visit with him on the evening of November 30 he had refused to take his medication, refused to be repositioned, requested that the sequential compression devices be removed from his legs, and asked to be left alone. She also noted that at the time Delbert's blood pressure was elevated and his pulse rate was abnormally rapid. He was experiencing a condition known as tachycardia. However, Fitzgerald did not report Delbert's change in attitude or his constellation of symptoms to his treating physician, and after observing at midnight that he appeared to be asleep, she did not check his blood pressure or pulse again.

At the time, Delbert was being treated with ten regular medications and three medications which were administered "as needed."

Delbert attempted to leave the hospital through the three foot by four foot opening in his third floor window at approximately 2:15 a.m. on December 1.

Peter Horst, M.D., was the surgeon who admitted Delbert to the hospital and performed prostate cancer surgery on November 26. He acknowledged that confusion, psychosis, and anxiety are listed side effects for several of the medications which were being administered. He admitted that given the constellation of findings reported in Fitzgerald's notes, Delbert's condition should have been medically assessed on November 30, and that had he been advised of those findings, he would have performed various tests to see whether Delbert's oxygenation was adequate and his electrolytes were normal. He would also have tried to determine whether Delbert was rational or irrational. However, he was not notified.

Ida's complaint was filed on October 7, 1993. In her complaint she alleged that as a result of mind-altering medication following his surgery, Delbert suffered from delirium, confusion, and disorientation; that he was inadequately supervised and cared for at the hospital; and that the hospital failed to maintain its facilities in a safe condition. She alleged that the hospital's omissions were negligent and that its negligence was the cause of her husband's injuries and death.

In response, the hospital denied that it was negligent and alleged that any claim by Ida was barred by Delbert's own contributory fault, the contributory fault of unspecified third parties, and her own failure to advise the hospital of Delbert's preexisting mental condition. In its pretrial contentions, the hospital specifically alleged that Delbert's death was caused by his preexisting mental illness.

At trial, plaintiff called as a witness Richard Rada, M.D., who had extensive experience as a psychiatrist and hospital administrator. He had been asked to review Delbert's medical records in an effort to determine what caused him to leave the hospital through the window on the night of his death. He reviewed Delbert's Veterans' Administration records, as well as his records from the Great Falls Clinic where he had been treated over the years and his records from Columbus Hospital. He formed the opinion that at the time Delbert attempted to leave the hospital he was suffering from delirium or an acute confusional state caused by the fact that his brain was receiving inadequate oxygen and possibly contributed to by the numerous medications which were being administered. He explained that delirium is a common side effect in hospitals and is experienced by about fifteen percent of all patients. It leads to altered behavior, including panic, fear, hallucination, delusions, and aggressive behavior.

Dr. Rada explained that by definition, simple schizophrenia is not characterized by hallucination or delusions. He therefore ruled out any preexisting mental illness as a cause of Delbert's behavior on the night of his death.

Dr. Rada expressed the opinion that Fitzgerald was negligent by failing to adequately monitor Delbert on the night before his death and by failing to report his constellation of signs and symptoms to his treating physician. He also expressed the opinion that the hospital was negligent by providing a window on a third floor patient's room that could be opened to the extent that a patient could either intentionally or inadvertently fall from the window.

His opinion regarding the standard of care for Fitzgerald was corroborated by Wendy Haack, a clinical nurse specialist from Portland, Oregon, who had been a Montana college instructor on the subject of critical care nursing and physical assessment. Dr. Rada's opinion regarding the inadequacy of the window design at the hospital was corroborated by J. Armand Burgun, a New York architect who specializes in hospital design.

It was Dr. Rada's opinion that Delbert's death could have been prevented by proper care and proper window design.

Horatio Bales, M.D., who is a staff physician at the Veterans' Administration Hospital at Fort Harrison, also testified. He explained that h...