Doe v. Yale University

• Decision Date: 11 April 2000
• Docket Number: (SC 15955)
• Citation: 252 Conn. 641,748 A.2d 834
• Court: Connecticut Supreme Court
• Parties: JOHN DOE v. YALE UNIVERSITY

252 Conn. 641

748 A.2d 834

JOHN DOE v. YALE UNIVERSITY

(SC 15955)

Supreme Court of Connecticut.

Argued October 28, 1999.

Officially released April 11, 2000.

Borden, Palmer, Sullivan, Callahan, Hennessy, Vertefeuille and Leuba, JS. Mark R. Kravitz, with whom were Wesley W. Horton, Susan M. Cormier and, on the brief, William J. Doyle, Alex V. Chachkes, and Jonathan M. Freiman, Allison A. Wood, Bageshree R. Blasius and Daniel J. Krisch, legal interns, for the appellant (defendant).

Michael P. Koskoff, with whom was David N. Rosen, for the appellee (plaintiff).

Suzannah K. Nigro, for the appellee (intervening plaintiff).

Opinion

BORDEN, J.

The defendant, Yale University, appeals¹ from the judgment of the trial court, rendered after a jury trial, in favor of the plaintiff, John Doe.² The defendant claims that: (1) the plaintiff's claim is not a cognizable cause of action because it is in effect a claim for educational malpractice; (2) the trial court improperly struck the defendant's special defense of exclusivity under the Workers' Compensation Act (act); General Statutes § 31-284 (a);³ and (3) the trial court improperly instructed the jury that it could find the defendant liable on the basis of its own determinations of reasonableness, rather than on the basis of expert testimony. We agree with the second and third of these claims and, accordingly, we reverse the trial court's judgment.

The plaintiff brought this action against the defendant for alleged negligence in causing her to contract the human immunodeficiency virus (HIV). The trial court, Silbert, J., denied the defendant's motion for summary judgment, and struck the defendant's special defense of immunity under the act. Thereafter, the trial court, Pittman, J., rendered judgment on the verdict in favor of the plaintiff.⁴

The jury reasonably could have found the following facts. At the time of the incident underlying this case, the plaintiff was a medical intern in the second month of her first year in the residency program⁵ at Yale-New Haven Hospital (hospital), and a graduate student at the defendant, Yale University d/b/a Yale University School of Medicine.

To put the facts that follow in the proper context, we describe at the outset the incident that caused the plaintiffs injury and a brief summary of the procedure that she was performing at the time. The plaintiff sustained her injuries as a result of her attempt to perform an arterial line insertion during her rotation in the hospital's medical intensive care unit. An arterial line insertion requires the insertion of a hollow needle, called a stylet, and a catheter, which is a thin flexible tube, into a patient's artery in order to permit monitoring of the patient's blood pressure and to obtain samples of the patient's blood. If the artery is punctured by the needle, blood will flow into a clear plastic cap located at the top of the needle—a result known as a flashback. If the catheter is inserted properly into the artery, blood will start to come out of the hub, the now-open end of the catheter, once the needle is withdrawn. A pressure transducer is then hooked up to the catheter.

A three day orientation period for the residency program began on June 20, 1988. Shortly thereafter, the plaintiffs first rotation in the residency program began in a general medicine program at the hospital, called the Fitkin Service. Deborah Erenthal, a senior resident physician at the time of the events at issue, was the plaintiffs supervisor during that rotation. At some time during that approximately four week rotation, Erenthal directed the plaintiff to attempt her first arterial line insertion.⁶ The plaintiff told Erenthal that she had never performed one, and Erenthal instructed her to make the attempt anyway and to let Erenthal know if there was any problem. During this unsupervised attempt,⁷ the plaintiff punctured the artery, as evidenced by a flashback, and withdrew the needle in order to determine whether the catheter was in the artery. When no blood came out of the catheter, the plaintiff understood that to mean that she had been unable to cannulate the artery, or thread the catheter into the artery. She then reinserted the needle in order to manipulate the catheter into the artery, and was again unsuccessful and removed the catheter. After making another attempt using a new catheter kit, the plaintiff still could not cannulate the artery, and called Erenthal, who finished the procedure outside the presence of the plaintiff, who had been paged out of the room. After her rotation in the Fitkin Service, the plaintiff spent approximately four weeks at the West Haven Veterans Administration Hospital, where she did not perform any arterial line insertions.

Thereafter, on August 15, 1988, the plaintiff began a rotation at the hospital's medical intensive care unit. Alison Heald, a third year resident physician, was the plaintiffs supervisor during this rotation. On August 16, 1988, Heald asked the plaintiff to perform an arterial line insertion. Because the plaintiff had never performed one successfully before, she asked Heald to accompany her, which Heald did. Heald described to the plaintiff a method of the procedure by which one punctures the artery, punctures the back wall of the artery upon flashback, then advances the catheter into the artery, and withdraws the needle and holds it in one's hand. Heald did not describe how to control the bleeding once the catheter was in the artery. The plaintiff attempted the procedure, but because she was unable to cannulate the artery, Heald took over and completed the procedure. The plaintiff observed Heald: puncture the artery; get the flashback; advance the needle through the back wall of the artery until there was no more blood coming back; withdraw the needle and hold it in her hand near the catheter; thread the catheter into the artery; put the needle down; and then hook up the transducer. Heald did not describe to the plaintiff how she controlled the bleeding.

Later that day, Heald instructed the plaintiff to attempt another arterial line insertion. During this attempt, with Heald present at the plaintiff's request, the plaintiff inserted the needle into the artery, experienced the flashback, advanced the needle through the back arterial wall, removed the needle and held it in her hand, and attempted to thread the catheter into the artery. No blood, however, came out of the hub of the catheter when the plaintiff removed the needle from it, indicating to the plaintiff that the catheter was not properly positioned in the artery. In Heald's presence, the plaintiff reinserted the needle in order to reposition the catheter. Because she was still unsuccessful in threading the catheter into the artery, however, she removed the needle and the catheter. There was no discussion between the plaintiff and Heald regarding the reinsertion of the needle.

The plaintiff then began the procedure again with a new catheter kit and completed the procedure successfully. During this attempt, still in Heald's presence, the plaintiff had removed the needle from the catheter and held it in her hand, close to the opening of the catheter. When she did so, blood came out of the catheter at a very slow pace because the patient had an unusually low blood pressure. The plaintiff then hooked up the pressure transducer to the catheter. There was no further discussion with respect to the methods employed by the plaintiff during that attempt.

On August 18, 1988, Heald directed the plaintiff to perform an arterial line insertion without her supervision⁸ on a patient known to suffer from acquired immune deficiency syndrome (AIDS). During this attempt, the plaintiff inserted the needle into the artery, advanced the catheter, withdrew the needle from the catheter and kept it close to the opening of the catheter. Immediately upon the plaintiff's withdrawing of the needle, the patient's blood began spurting out.⁹ In order to stop the bleeding, the plaintiff placed her thumb over the top of the catheter and, in the course of doing so, pricked her thumb on the needle, which was contaminated with the patient's blood. After attempting to clean her injured hand, the plaintiff completed the arterial line insertion. As a result of the puncture, the plaintiff developed the HIV infection.¹⁰ Thereafter, the plaintiff brought this action against the defendant alleging negligence.¹¹ The hospital intervened as a coplaintiff, pursuant to General Statutes § 31-293,¹² to assert its right to recover past and future workers' compensation payments that it was obligated to make as a result of the injuries alleged in the plaintiffs action against the defendant.

The defendant asserted two special defenses. In the first special defense, the defendant alleged that the plaintiffs own negligence proximately caused her injuries. In the second special defense, the defendant alleged that, because the hospital was obligated to provide workers' compensation benefits to the plaintiff as a result of the same incident and injuries alleged in her complaint against the defendant, it enjoyed immunity from suit under the exclusivity provision of the act; General Statutes § 31-284 (a);¹³ by virtue of its participation in a joint venture with the hospital, namely, the residency program.¹⁴

The defendant moved for summary judgment, claiming that the plaintiffs claim sounded in educational malpractice, which the trial court, Silbert, J., denied. The plaintiff moved to strike the defendant's second special defense contending that: (1) joint ventures do not fall within the definition of an "employer" in General Statutes § 31-275 (10);¹⁵ (2) the defendant was not the plaintiff's employer because it did not pay her for her services; (3) the defendant is not entitled to immunity because it did not obtain workers' compensation insurance as required by § 31-284 (b);¹⁶ (4) the defendant is not a joint venturer because it...