Echard v. Barnes-Jewish Hosp.
| Decision Date | 20 August 2002 |
| Docket Number | No. ED 79788.,ED 79788. |
| Citation | 98 S.W.3d 558 |
| Parties | Dorothy Christine ECHARD, Personally, and as Personal Representative of Robert L. Echard, Deceased, Respondent, v. BARNES-JEWISH HOSPITAL, Appellant. |
| Court | Missouri Court of Appeals |
Williams Venker & Sanders LLC, Paul N. Venker, Lisa A. Larkin, St. Louis, MO, for appellant.
Suelthaus & Walsh, P.C., Richard G. Byrd, St. Louis, MO, for respondent.
Appellant, Barnes-Jewish Hospital ("BJH"), appeals the judgment, after a jury trial, of the Circuit Court of the City of St. Louis in favor of respondent, Dorothy Christine Echard ("plaintiff'). Plaintiff, both individually and as the representative of the estate of her husband, Robert L. Echard ("husband"), sought damages arising out of an alleged medical malpractice that occurred during husband's admission at BJH. The jury awarded $78,000 to plaintiff individually and $43,799.01 to husband's estate. We affirm.
On October 22, 1993, husband, a forty-two-year-old disabled minister, was admitted to BJH1 for surgery on his left knee. Husband, who weighed approximately 450 pounds at the time, had a history of knee problems dating back to high school. Husband was diagnosed with degenerative arthritis in both knees around 1974. In 1984, husband had a surgery in which his right knee was removed and his bones were fused leaving his right leg in a permanently straight position. Prior to husband's admission to BJH in October 1993, he had three surgeries on his left knee. Additionally, in the summer of 1993, husband fell at home on his left knee and fell again on his left knee in a gas station parking lot.
Following the fall at the gas station, husband consulted with Dr. Charles Sutherland, who recommended husband have surgery on his left knee. On October 22, 1993, Dr. Sutherland performed a partial knee replacement at BJH. The surgery involved opening the knee and replacing a portion of the left knee joint, suturing the two layers of subcutaneous tissue and stapling the outer layer of skin. A drain was inserted to remove blood from husband's knee following the surgery. The drain was removed on October 24, 1993.
After the surgery, husband remained hospitalized and an immobilizer splint was placed on his left knee. During the first few days after the operation, if husband needed to be placed in a wheelchair, four orderlies would assist him. Physical therapy notes entered one day following surgery stated "[d]oubt he could tolerate the pressure at this time on his left lower extremity to go sit to stand." Post-surgery notes also reflected that husband could not be transferred from bed without the assistance of a wooden sliding board and orderlies. Husband had a limited range of motion in his left knee and no range of motion in his right knee due to the right leg being previously fused.
On October 27, 1993, husband was discharged to the rehabilitation unit of BJH. At that time, there was no indication of bleeding at the surgical site nor was there an indication of a hematoma. A hematoma is a collection of blood under the skin, which occurs over a period of time, and is a common occurrence after surgery.
Upon being discharged to the rehabilitation unit, husband was met by Nurse Pam Dowling, the assistant nurse manager of the rehabilitation unit. Nurse Dowling made an assessment of husband based upon her observations, husband's medical chart and information from husband himself. The assessment included checking husband's vital signs, his mobility, and any pain he was experiencing. Nurse Dowling also observed the stapled incision on husband's left knee which, at the time, was not bandaged and was without a leg immobilizer. Husband's transfer orders which, in regard to his ability to transfer, had the box next to "bed to chair" checked. However, the box regarding husband's ability to transfer from a sitting to standing position was not checked.
While still seated in a wheelchair, husband needed to use the bathroom. Due to husband's size, Nurse Dowling decided to have him use a bedside commode rather than take him into the bathroom. Nurse Dowling, along with another female nurse, stood on either side of husband's wheelchair. Nurse Dowling planned to have husband stand up from the wheelchair, and while holding onto a walker, use the bedside commode.
What happened next was disputed at trial. Nurse Dowling testified that neither she nor the other nurse assisted husband when he began "shifting" in his wheelchair. In her notes, Nurse Dowling referred to husband "doing push up in wheelchair." Additionally, she noted that husband "did not even move buttocks off wheelchair."
However, husband would later tell plaintiff that he told Nurse Dowling that he had not gotten out of his wheelchair without the assistance of a "lift team" composed of four orderlies. Husband also told plaintiff that he attempted to stand up and upon putting pressure on his left leg he felt a tearing and popping in his left knee.
After the attempt to transfer husband to the bedside commode from his wheelchair, there was a flow of blood from husband's incision on his left knee and he cried out in pain. The two layers of subcutaneous sutures tore through husband's tissue at the surgical site causing what is known as a "wound dehiscence."
After husband cried out in pain, he was moved from his wheelchair to the bed with the assistance of five persons. Husband was then transferred back to the surgical unit for emergency surgery. Prior to the emergency surgery, Dr. Sutherland made the following entry in husband's surgical notes 2 The surgical report of Dr. Sutherland indicated the presence of a tense hematoma which extended into the knee joint and was evacuated during surgery.
Husband stayed at BJH after his emergency surgery on October 27, 1993. Husband was discharged, after rehabilitation, on November 5, 1993. After discharge from BJH, husband resigned his position as a minister with a teen program. Also, husband complained of pain in his left knee.
On July 15, 1998, plaintiff and husband filed a petition against BJH alleging medical malpractice and loss of consortium.3 The petition alleged that employees of BJH improperly lifted husband from wheelchair and during the course of this maneuver seriously re-injured his left knee. While this suit was still pending, husband died in an unrelated auto accident on September 13, 1999. On January 25, 2000, plaintiff, as personal representative of husband's estate, was substituted for husband.
Prior to both the settlement of his claim against the gas station and his death, husband responded to interrogatories prepared by BJH. Interrogatory number seven asked husband, in pertinent part, the following:
Describe each injury you claim to have suffered as a result of the act(s) of negligence alleged in your petition. Please differentiate to the extent possible said loss as a result of the fall at [the gas station] and the incident at [BJH] as alleged in your petition and for each injury state:
(a) Whether the injury is currently causing you any pain or suffering...
Husband answered, in pertinent part, the following:
I suffered severe muscle and joint injuries to my knee, which remains painful, stiff, and which has deteriorated. I also suffered pain that spread to my hip. I cannot differentiate the loss and pain I suffered because of my fall on the slippery floor at [the gas station] from the loss and pain I suffered because of the negligent acts of [BJH].
(a) Yes, the injury is currently causing me pain ....
On February 5, 2001, the case went to trial before a jury. Three witnesses testified for plaintiff: plaintiff herself, Nurse Dowling (who was also called by BJH as a witness), and plaintiffs expert, Nurse Patricia McCollom.4
BJH objected to Nurse McCollom's expert testimony believing it to be "dangerously close to having some kind of medical causation opinion come out of [Nurse McCollom's] mouth." A voir dire examination of Nurse McCollom was conducted outside the presence of the jury. After the voir dire, the trial court overruled BJH's objection as to whether plaintiff could ask Nurse McCollom if it was her opinion that the failure of BJH's employees in the rehabilitation unit to meet the standard of care caused or contributed to husband's wound dehiscence. The following, in pertinent part, was the testimony of Nurse McCollom:
Q. [Plaintiff's Counsel]: Based upon your review of the documents in this case, the depositions, your experience your background, and the standards we discussed today have you formed an opinion within a reasonable degree of scientific certainty regarding the care given by [BJH] to [husband] on October 27th, 1993, have you reached an opinion?
[BJH's Counsel]: Object to, again, Your Honor, to the form of the question.
THE COURT: Overruled.
[Nurse McCollom]: Yes, I have achieved an opinion.
Q. [Plaintiff's Counsel]: Would you tell the jury what that opinion is?
A. There essentially were two standards that were violated. First of all, the nurses did not employ their skill and knowledge in providing an assessment that rehabilitation nurses would usually do in the same or similar circumstance. The second thing they did not do is provide the degree of care and caution that was necessary for a man in this man's condition, that is the 450 pounds, fused leg, and so on.
Q. This in respect to the assessment and transfer, is that correct?
A. Correct.
Q. Miss McCollom, again, based upon your review of the documents and everything I just described is it your opinion that [BJH's] failure to...
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