Campbell v. Delbridge

• Decision Date: 08 October 2003
• Docket Number: No. 02-1007.,02-1007.
• Parties: Lester CAMPBELL, Appellant, v. Arnold DELBRIDGE and Covenant Medical Center, Inc., Appellees.
• Court: Iowa Supreme Court

670 N.W.2d 108

Lester CAMPBELL, Appellant, v. Arnold DELBRIDGE and Covenant Medical Center, Inc., Appellees.

No. 02-1007.

Supreme Court of Iowa.

October 8, 2003.

Douglas V. Coonrad, Hudson, for appellant.

Joseph L. Fitzgibbons and Ned A. Stockdale of Fitzgibbons Law Firm, Estherville, for appellee Covenant Medical Center, Inc.

Allison M. Heffern and James E. Shipman of Simmons Perrine Albright & Ellwood, PLC, Cedar Rapids, for appellee Arnold Delbridge.

Frank Santiago, Iowa City, and Donald T. Ridley, Watchtower Bible and Tract Society of New York, Inc., Patterson, NY, for amicus curiae Christian Congregation of Jehovah's Witnesses.

LARSON, Justice.

Lester Campbell, a surgical patient at Waterloo's Covenant Hospital, sued the hospital and Dr. Arnold Delbridge, Campbell's treating doctor, for reinfusing Campbell's own blood following surgery. The district court dismissed the suit, and Campbell appealed. We reverse and remand.

I. Facts and Prior Proceedings.

Lester Campbell was admitted to Covenant for a total right knee arthroplasty performed by Dr. Delbridge, an orthopedic surgeon. Campbell is a Jehovah's Witness, and he made it clear in his presurgical physical and at his preadmission appointment that his religious beliefs precluded the use of blood or blood products, including his own. His medical chart made numerous references to his refusal to accept blood infusions. Campbell did not receive any blood or blood products during surgery. However, after surgery, Dr. Delbridge ordered the use of a Gish Orthoinfuser (Gish) to collect blood from the surgical site. The doctor decided to use the Gish, as opposed to other devices, because the Gish provided a reservoir where blood can be stored for disposal or possible reinfusion, and it provided the best suction. Further, use of the Gish would preserve Campbell's ability to change his mind about receiving his own blood should it become medically necessary.

The nurse anesthetist who took Campbell to the postanesthesia care unit (PACU) stated in an affidavit that, at the request of Dr. Delbridge, she told the PACU nurses that Campbell was a Jehovah's Witness and was not to be reinfused. The PACU nurses, however, denied receiving this information. The nurse who started the reinfusion admitted in her deposition that she did not look at Campbell's chart for an order to start the reinfusion, as usually required. She based her decision to reinfuse on the fact that the Gish, with its blood reservoir, suggested that reinfusion was to be done. Campbell was reinfused with his own blood for just under an hour.

Campbell sued the doctor and the hospital, alleging negligence, failure to obtain informed consent, breach of contract, medical battery, and invasion of privacy. Campbell had originally indicated he would have an expert witness on the doctor's standard of care, but that witness was withdrawn. Dr. Delbridge moved for summary judgment on the ground that, without expert testimony, Campbell could not make a prima facie showing on any of his theories of recovery. Covenant filed a motion to preclude the plaintiff's medical evidence under Iowa Rule of Civil Procedure 1.508(3) (failure to identify expert) and Iowa Rule of Evidence 5.104(a) (preliminary question of qualification of witnesses to be determined by court).

The court concluded that the plaintiff lacked the necessary expert witnesses to establish liability or damages, and the suit was dismissed.

II. Standard of Review.

The standard of review of a district court's grant of summary judgment is for correction of errors at law. Kelly v. Iowa Mut. Ins. Co., 620 N.W.2d 637, 641 (Iowa 2001). Summary judgment is appropriate only when the moving party shows there are no genuine issues of material fact, and in deciding that issue, we review the record in the light most favorable to the party opposing the motion. Id. Another principle is applicable here:

Because resolution of issues of negligence and proximate cause turns on the reasonableness of the acts and conduct of the parties under all the facts and circumstances, actions for malpractice "are ordinarily not susceptible of summary adjudication."

Oswald v. LeGrand, 453 N.W.2d 634, 635 (Iowa 1990) (quoting Daboll v. Hoden, 222 N.W.2d 727, 732 (Iowa 1974)).

III. The Issues.

The defendants rely on the principle that, ordinarily, expert testimony is required to establish the applicable standard of care and a breach of it. See Oswald, 453 N.W.2d at 635 (to establish prima facie case of medical malpractice, the plaintiff must produce evidence establishing a standard of care, a violation of the standard, and a causal relationship with the injury). The establishment of these criteria must "[o]rdinarily be made through an expert witness." Id.; see also Iowa Code § 668.11 (2001):

1. A party in a professional liability case brought against a licensed professional pursuant to this chapter who intends to call an expert witness of their own selection, shall certify to the court and all other parties the expert's name, qualifications and the purpose for calling the expert ... within one hundred eighty days of the defendant's answer unless the court for good cause not ex parte extends the time of disclosure.

....

2. If a party fails to disclose an expert pursuant to subsection 1 or does not make the expert available for discovery, the expert shall be prohibited from testifying in the action unless leave for the expert's testimony is given by the court for good cause shown.

However, if an issue in a malpractice case may be determined by lay fact finders without the testimony of experts, we have allowed the fact finder to resolve it without expert testimony. For example, in Oswald we ruled that expert testimony was not required as to all of the elements of a medical malpractice case. In that case, the parents of a spontaneously aborted fetus sued the treating doctors and hospital. Susan Oswald, who was pregnant, experienced severe bleeding and cramping well ahead of her expected delivery date. Dr. Clark, one of the defendants, examined her and advised her there was nothing to be done and sent her home. The patient's husband became upset and demanded that his wife be admitted to the hospital. She was admitted, but her ensuing lack of care at the hospital resulted in this lawsuit. A nurse told her if the fetus miscarried it would not be a baby, only a "big blob of blood." One of her treating doctors said, within her hearing, that he did not want to treat her. At one point, the mother screamed in pain and yelled that she was in labor. The doctor did not do a pelvic exam. He suspected, but did not inform the parents, that the mother had a uterine infection. The doctor told the father to calm down his wife, and approximately one-half hour before the doctor's shift ended, he left for vacation. The baby soon began to be born, without medical attention, until the father kicked on a door and got the attention of the medical staff. A one-pound baby girl was delivered, but a nurse announced she was stillborn. One of the doctors examined her for gender but made no further examination. The father called family members to tell them of their loss and, on returning to the room, discovered the baby grasped his finger. The baby, who had been kept on a surgical tray for half an hour, was rushed to a neonatal unit but died twelve hours later. Oswald, 453 N.W.2d at 636-37.

In Oswald the parents sued the medical care personnel and the hospital, but the district court granted summary judgment for the defendants. On appeal we held that some of the plaintiffs' claims, such as whether better care would have saved the baby's life, required expert testimony. The same was true on the question of whether the defendants' callous treatment of the mother added to her medical stress. Id. at 638. We held, however, that to establish emotional distress under these facts

[n]o expert testimony is needed to elaborate on whether the statements by the nurses and Dr. Clark were rude and uncaring; a lay fact finder could easily evaluate the statements in light of the surrounding circumstances to determine whether the language used or message conveyed breached the standard of care expected of medical professionals, and determine the harm, if any, resulting to the plaintiffs....

We are similarly convinced that a lay jury is also capable of evaluating the professional propriety of Dr. Clark's early departure from the hospital, knowing that he had left Susan Oswald unattended in a hospital corridor screaming hysterically that she was about to give birth.

Id. at 639-40.

Oswald relied on a similar New Jersey case, Friel v. Vineland Obstetrical & Gynecological Professional Association, 166 N.J.Super. 579, 584, 400 A.2d 147, 149 (Law Div.1979), which held a doctor's "utter lack of attendance" at critical stages of the delivery "would appear to be within the province of the jury...."

Oswald bore a similarity to the present case also in that it relied in part on admissions of the defendant doctors to establish a breach of the duty of care. Oswald, 453 N.W.2d at 640. Here, Dr. Delbridge testified in his deposition that somebody made an error:

Q. Do you agree that absent an error on somebody's part, Mr. Campbell should not have been reinfused? A. Mr. Campbell's desires were not to be reinfused; that was my intention, and there was an error.

(Emphasis added.)

While Dr. Delbridge concedes the plaintiff should not have been reinfused, he contends he did all he could do to convey the message to the PACU nurses not to do it. He contends he did not order a reinfusion and points to the patient's chart with its "no infusion" notations to defend the claims against him. The nurses, on the other hand, contend they did not get the message about not reinfusing the patient and that this was due in part to the fact that Dr. Delbridge had taken the chart, with its no-infusion notations, with him to write in it. There was even...