Douglas v. Freeman
| Decision Date | 15 August 1991 |
| Docket Number | No. 57266-6,57266-6 |
| Citation | 814 P.2d 1160,117 Wn.2d 242 |
| Parties | Deborah DOUGLAS, Petitioner, v. Mark A. FREEMAN, D.D.S., Defendant, Sisters of Providence in Washington, d/b/a Providence Medical Center, a nonprofit corporation, Respondent. |
| Court | Washington Supreme Court |
Williams, Kastner & Gibbs, Rebekah R. Ross, Mary H. Spillane, Seattle, for respondent.
At issue in this case is whether there was sufficient evidence to support the jury's finding of corporate negligence on the part of Providence Dental Clinic.
On April 27, 1981, Deborah Douglas, plaintiff herein, went to the Providence Dental Clinic (hereafter referred to as the clinic) because of discomfort in the lower left side of her mouth. She saw Dr. Candice McMullan, director of the clinic and a University of Washington Dental School faculty member. Dr. McMullan examined plaintiff and recommended that her three wisdom teeth be extracted.
Plaintiff returned to the clinic on April 29, 1981. She testified that a dental assistant escorted her into a room, asked if she had taken the prescribed medications, put a bib on her and some instruments on a tray, and left. According to plaintiff, the assistant returned to the room only to give her postoperative instructions after the extractions were complete. Dr. Mark Freeman, whom plaintiff had not met previously, extracted her wisdom teeth. After the extractions, plaintiff's tongue and mouth felt numb. It was later determined that her lingual nerve was damaged during the extractions, severely limiting her ability to taste and feel on the right side of her tongue and mouth.
At the time of the extractions, Dr. Freeman was practicing dentistry at the clinic pursuant to a University of Washington residency program. Residents enrolled in the program rotate to various dental clinics in Seattle. Dr. Freeman had graduated from dental school and had passed regional dental board examinations, but was not licensed to practice dentistry in Washington. At the clinic, Dr. Freeman was supervised by Dr. McMullan. Dr. McMullan apparently consulted with Dr. Freeman regarding On April 27, 1984, plaintiff sued Dr. Freeman and the clinic for damages arising from injury to her lingual nerve. Plaintiff sought recovery on theories of negligence, failure to obtain informed consent, corporate negligence, and violation of the Consumer Protection Act.
plaintiff's case and worked in an adjoining room when Dr. Freeman performed the extractions. Plaintiff testified, however, that Dr. McMullan never checked on Dr. Freeman during the extractions
The case was tried to a jury in 1988. The jury returned separate verdicts for Dr. Freeman on the negligence claim, for Dr. Freeman and the clinic on the informed consent and Consumer Protection Act claims, but against the clinic on the corporate negligence claim. The jury awarded plaintiff $250,000 in damages.
The clinic thereupon filed a motion for judgment notwithstanding the verdict or, in the alternative, for a new trial. The trial court denied the motion on the basis that there was evidence from which the jury could have concluded that the clinic's failure to have a dental assistant present during the extractions rendered it liable for corporate negligence. The clinic appealed and the Court of Appeals reversed, finding insufficient evidence to support the jury's corporate negligence verdict. 1 Plaintiff then petitioned this court for review. We granted review and reverse the Court of Appeals.
Three issues are presented.
ISSUE ONE. Was the evidence sufficient to support the jury's verdict against the clinic on the corporate negligence claim?
ISSUE TWO. Did the trial court err in denying the clinic's motion in limine to bar all testimony regarding Dr. Freeman's unlicensed status?
ISSUE THREE. Was the jury properly instructed?
ISSUE ONE.
CONCLUSION. We find ample testimony in the record to support the jury's conclusion that the clinic's negligence was a proximate cause of plaintiff's lingual nerve injury.
The general question underlying this issue is whether the Court of Appeals properly reversed the trial court's denial of the clinic's motion for judgment notwithstanding the verdict on the corporate negligence claim. In ruling on a motion for judgment notwithstanding the verdict, a trial court exercises no discretion. 2 The court must accept the truth of the nonmoving party's evidence and draw all favorable inferences that may reasonably be evinced. 3 The evidence must be viewed in the light most favorable to the nonmoving party; the court may grant the motion only where there is no competent evidence or reasonable inference that would sustain a verdict for the nonmoving party. 4 " 'If there is any justifiable evidence upon which reasonable minds might reach conclusions that sustain the verdict, the question is for the jury.' " 5
The Court of Appeals concluded that a judgment notwithstanding the verdict was appropriate because it found no evidence from which the jury could reasonably infer that the clinic's negligent conduct caused plaintiff's injury. The court thus overturned the jury's verdict finding the clinic liable for corporate negligence. 6
The doctrine of corporate negligence in cases such as this is based on a nondelegable duty that a hospital owes directly to its patients. 7 One commentary finds four such duties owed by a hospital under the doctrine of corporate negligence: (1) to use reasonable care in the maintenance of buildings and grounds for the protection of the hospital's invitees; (2) to furnish the patient supplies and equipment free of defects; (3) to select its employees with reasonable care; and (4) to supervise all persons who practice medicine within its walls. 8 It is this latter duty, the duty of supervision, that is at issue in this case.
The trial court properly instructed the jury that in order to find for plaintiff on the corporate negligence claim, it had to find a duty of care owed to plaintiff by the clinic, a breach of that duty, and proximate cause between the breach and plaintiff's injury. 9 Since the clinic claims that none of these elements was supported by sufficient evidence, we will briefly discuss each.
In a professional malpractice case, the standard of care is based on proof of the customary and usual practices within the profession. 10 This court has held that the standards of care to which a hospital should be held may be defined by the accreditation standards of the Joint Commission on Accreditation of Hospitals and the hospital's own bylaws. 11 Other decisions have found the standard of care for hospitals defined by statute. 12 Usually, the standard of care must be established by expert testimony. 13
The parties agree that the clinic had a statutory duty to supervise unlicensed students under former RCW 18.32.030(3) and (10) of the dentistry code. 14 The code requires a person to obtain a license before practicing dentistry in Washington (RCW 18.32.091), but lists exemptions from this and other code requirements in RCW 18.32.030. The relevant portions of RCW 18.32.030 are as follows:
The following practices, acts and operations are excepted from the operation of the provisions of this chapter:
. . . . .
(3) Dental schools or colleges approved by the board, and the practice of dentistry by students in dental schools or colleges approved by the board, when acting under the direction and supervision of registered and licensed dentists acting as instructors;
. . . . .
(10) Students practicing or performing dental operations, under the supervision of competent instructors, in any reputable dental college;
Former RCW 18.32.030(3), (10).
These statutory exceptions were presented to the jury and several expert witnesses testified regarding the clinic's duty to supervise Dr. Freeman thereunder. The clinic argues, however, that no expert witness testified regarding any duty on the clinic's part to provide Dr. Freeman with a dental assistant.
Plaintiff counters that separate testimony regarding the need for an assistant was unnecessary since the duty to provide the necessary assistance is included within the clinic's duty to supervise student dentists. Plaintiff also contends that Dr. Freeman's testimony that he needed assistance during wisdom tooth extractions constituted sufficient standard of care evidence regarding dental assistants.
We need not decide whether the statutory duty to supervise includes the duty to provide the necessary professional assistance since Dr. Freeman by his own testimony provided ample evidence of such a duty. In his testimony as an adverse witness in plaintiff's case in chief and during examination when testifying for the defense, Dr. Freeman insisted several times that the presence of a dental assistant was essential during a wisdom tooth extraction. "I never do a surgical extraction without an assistant, because ... they are pretty critical in holding the tissue and doing the suctioning and the things that have to be done so that you have some hands free to do the actual elevation of the tooth." In describing a wisdom tooth extraction, Dr. Freeman in his testimony also referred several times to the importance of the assistant's role.
Plaintiff was justified in relying on this testimony by Dr. Freeman to satisfy her burden of proof. 15 Indeed, other jurisdictions have stated expressly that a defendant, testifying as an adverse witness, may provide the expert testimony that establishes the standard of care in a medical malpractice case. 16
Once the applicable standard of care is established by experts, further expert testimony is not required to prove a breach of that standard. 17
The clinic contends that plaintiff introduced no testimony of any kind that it breached its duty to supervise Dr. Freeman. One expert testified that...
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