Estate of Smith by Smith v. Lerner
| Decision Date | 21 May 1986 |
| Docket Number | No. 84-1087,84-1087 |
| Citation | 387 N.W.2d 576 |
| Parties | ESTATE OF Dale H. SMITH By and Through Belle L. SMITH, executor, Appellant, v. Ernest N. LERNER, M.D., and the Henry County Soldiers and Sailors Memorial Hospital d/b/a Henry County Health Center, Appellees. |
| Court | Iowa Supreme Court |
Lex Hawkins of Hawkins & Norris, Des Moines, and Thomas J. Vilsack of Bell & Vilsack, Mt. Pleasant, for appellant.
Robert V.P. Waterman and Robert V.P. Waterman, Jr. of Lane & Waterman, Davenport, for appellee Ernest N. Lerner, M.D.
Richard M. Tucker, of Phelan, Tucker, Boyle & Mullen, Iowa City, for appellee Henry County Soldiers and Sailors Memorial Hospital d/b/a Henry County Health Center.
Considered by REYNOLDSON, C.J., and UHLENHOPP, McGIVERIN, CARTER, and LAVORATO, JJ.
After trial to a jury, the district court entered judgment for the defendants, Dr. Ernest N. Lerner and the Henry County Health Center, in this medical malpractice action for the death of Dale H. Smith. The evidence at trial produced two theories on the cause of death. According to the plaintiff, Belle L. Smith, it was due to the decedent's toxic reaction to a dangerous drug and the subsequent failure to properly administer cardiopulmonary resuscitation (CPR). According to the defendants, the drug was safe and effective, and a massive heart attack caused death, which occurred despite their best efforts of prevention and revival.
The court of appeals affirmed the judgment of the district court. On further review, the plaintiff argues the district court erred in refusing to instruct the jury on her claim that the defendant physician abandoned treatment of her husband, the decedent. See Iowa R.Civ.P. 196. She also argues the court erred in giving an instruction on the defendants' decisions to employ particular methods of treatment in caring for her husband. She requests a new trial, which the district court denied. See Iowa R.Civ.P. 244. We affirm the judgment of the district court and the decision of the court of appeals.
Dale Smith was forty-eight-years old at the time of his death and had no previous health problems. He was the owner of a grain elevator in Trenton, where he and his family resided. One morning at his office desk he experienced a burning pain in his chest. He telephoned his wife, and asked her to take him to the health center.
Mrs. Smith met her husband at their house. Although he was feeling better, and the pain in his chest had ceased, they decided to drive eleven miles to Mount Pleasant to see their physician. Upon arriving in Mount Pleasant, however, they were informed that this physician was not available, and a receptionist referred them to Dr. Lerner.
Dr. Lerner briefly examined Mr. Smith, who described his earlier chest pain. Dr. Lerner ordered an electrocardiogram (EKG) for Mr. Smith, but its results did not indicate any abnormality. Unable to determine the cause of the pain, Dr. Lerner advised Mr. Smith to relax that day at home, and to telephone if the pain returned. Mr. Smith followed this advice, except when he returned to the elevator to start the dryer.
That evening Mr. Smith complained his shoulders were sore. He went to bed around 10:30, but an hour later he was awake and experiencing a burning pain under his arms. Mrs. Smith telephoned Dr. Lerner, who advised them to go immediately to the health center in Mount Pleasant. En route to the health center, Mr. Smith's pain subsided.
Dr. Lerner telephoned the health center. He instructed the staff to admit Mr. Smith to the coronary care unit (CCU) and to perform another EKG. Dr. Lerner, who resided about three miles, or five to seven minutes by automobile, from the health center, told the staff to telephone him after the completion of the EKG.
The health center admitted Mr. Smith at 12:15 a.m. Dr. Lerner arrived shortly thereafter, spoke with Mr. Smith, who was then "feeling all right," and performed a brief physical examination. Mr. Smith said that the burning pain in his chest had ceased. He added that the pain had spread to his right arm, and had felt like a "squeezing" one.
Dr. Lerner examined the EKG, and, interpreting its results as abnormal, concluded Mr. Smith's condition had changed since that morning. Dr. Lerner suspected that the pain may have been related to a coronary artery disease, and that Mr. Smith might be subject to a heart attack. Dr. Lerner decided that Mr. Smith should remain overnight in the CCU for observation, and that he undergo further tests the next morning. To prevent a heart attack, Dr. Lerner instructed a nurse to immediately inject lidocaine, inject it five minutes later, and then begin an intravenous flow of a diluted solution of the drug.
Dr. Lerner then informed Mrs. Smith that although he did not believe her husband was having a heart attack, he was being kept overnight for observation and further tests. Dr. Lerner then left the health center.
Around 12:50 a.m. the nurse began the lidocaine drip. Eight minutes later Mr. Smith demonstrated two side-effects of lidocaine: he was drowsy, and his speech became slurred. The lidocaine was discontinued at that time. Around 1:00 a.m., Mr. Smith experienced a seizure, which lasted two minutes, and then he began to turn blue in color. Dr. Lerner was telephoned, and informed of Mr. Smith's seizure. He responded he would immediately return to the health center.
Mr. Smith's heart rate lowered, and by 1:03 a.m. his heart had stopped. In response, the staff administered CPR and electrical shocks. Dr. Lerner, who was preparing to leave for the health center, was telephoned a second time, and informed of the heart stoppage. Around 1:12 a.m., roughly ten minutes after he had received the first telephone call, Dr. Lerner arrived at the health center. More CPR, lidocaine, and electrical shocks were administered, but Mr. Smith was not revived.
If there was substantial evidence to support the plaintiff's claim, the jury should have been instructed on the issue of abandonment. See, e.g., Feldhahn v. RKB Quality Corp., 356 N.W.2d 226, 230 (Iowa 1984). We give the evidence "the most favorable construction it will reasonably bear in favor of the party urging submission." Miller v. International Harvester Co., 246 N.W.2d 298, 301 (Iowa 1976).
The abandonment of, and the lack of diligence in, patient treatment are separate theories of medical malpractice:
Abandonment ... in its classical sense, involves an intent on the part of the physician to terminate ... the contractual relationship. However, closely related to it is the situation in which there is no such intention by the physician, but he is so dilatory in his obligation that he does not see the patient as often as due care in treatment would demand and the patient is thus denied the benefit of the physician-patient relationship. To further differentiate, classical abandonment gives rise not only to an action for negligence, but one for breach of contract. Malpractice involving treatment which results either from failure to see the patient sufficiently often or from an incorrect conclusion that the patient's condition is such that no further treatment is necessary involves an action in negligence alone.
A. Holder, Medical Malpractice Law 374 (1978) (footnotes omitted). Nevertheless, in the gray waters of medical-malpractice actions, these two theories are often indistinguishable:
Refusal to attend to a patient's needs even though the physician may not have made any express declaration to the effect that he does not intend to see the patient further may also be considered abandonment.... if the physician fails to see the patient at intervals necessary for proper treatment.
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Therefore the simple failure to see a patient when necessary may, in the first place constitute abandonment, and in the second it may be negligence in terms of the standard of care of both diagnosis and treatment owed to the patient. If the physician had been properly attentive he might well have known what was wrong with the patient and treated it properly. Thus, even if a physician comes back to see the patient, if he has unreasonably refused to come at the time when the patient needs him, he may well have been so negligent as to be held to have abandoned his patient. The longer the delay, of course, the more likely that a court will find abandonment.
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The principle involved is that the patient has the right to expect that his doctor will keep himself informed as to the patient's condition, which he cannot do if he removes himself from the case without notice or does not visit the patient frequently enough to be aware of what is happening.
Id. at 376, 377 (footnotes omitted). Thus, what distinguishes abandonment from failure to meet the pertinent standard of care is that it requires an intent to terminate the professional relationship.
We have recognized that a physician is liable for abandonment in McGulpin v. Bessmer, 241 Iowa 1119, 1127, 43 N.W.2d 121, 125 (1950). In McGulpin, a physician informed his patient that it was necessary to amputate his foot "right away." The patient, however, was left in a hospital for over five days without the physician or his superiors seeing or treating his condition. Eventually, the patient transferred to another hospital, and because of gangrene, his leg was amputated. He then brought an action for medical malpractice. We held that the district court erred in not submitting the issue of abandonment to the jury, even though the physicians had not stated they were terminating their relationships with him. Id. at 1126, 43 N.W.2d at 125. There was sufficient evidence on the intent of the defendants to abandon the plaintiff with the statement that immediate treatment was necessary, and their subsequent failure to return to him and administer that treatment.
In this case the plaintiff argues the district court erred in refusing her requested instruction that the defendant...
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