Flanagan v. Labe

• Decision Date: 20 February 1997
• Parties: Stephen P. FLANAGAN, Appellant, v. Alexander LABE, M.D., Samuel M. Wilson, M.D., Erwin A. Cohen, M.D., Zaslow-Portner-Cohen, and A.F.L.-C.I.O Hospital Association d/b/a John F. Kennedy Memorial Hospital, Appellees.
• Court: Pennsylvania Supreme Court

Page 183

690 A.2d 183

547 Pa. 254

Stephen P. FLANAGAN, Appellant, v. Alexander LABE, M.D., Samuel M. Wilson, M.D., Erwin A.

Cohen, M.D., Zaslow-Portner-Cohen, and

A.F.L.-C.I.O Hospital Association d/b/a

John F. Kennedy Memorial

Hospital, Appellees.

Supreme Court of Pennsylvania.

Argued Oct. 15, 1996.

Decided Feb. 20, 1997.

[547 Pa. 255] James E. Beasley and Barbara R. Axelrod, Philadelphia, for Stephen F. Flanagan.

Sheila Smith DiNardo, Pittsburgh, for Amicus-American Assoc. of Nurses Consultants.

Kathleen D. Mock and Arthur B. Keppel, Philadelphia, for John F. Kennedy Memorial Hospital.

Before FLAHERTY, C.J., and ZAPPALA, CAPPY, CASTILLE, NIGRO and NEWMAN, JJ.

OPINION OF THE COURT

FLAHERTY, Chief Justice.

This is an appeal by allowance from an order of the Superior Court which affirmed an order of the Court of Common Pleas of Philadelphia County granting summary judgment in favor of the John F. Kennedy Memorial Hospital in a medical malpractice case brought by the appellant, Stephen P. Flanagan. ¹ The case was based on allegedly inadequate care that Flanagan received when he went to the hospital for treatment of a collapsed lung on December 2, 1991. Treatment involved the insertion of a tube into his chest wall. Flanagan claims that he received substandard nursing care after insertion of the tube and that this led to "progressively worsening subcutaneous emphysema." Specifically, he asserts that the nursing staff failed to document his complaints of pain and responses to medication, and that it failed to monitor his breathing and palpate his chest--these being measures that would have detected at an early stage the onset of subcutaneous emphysema. The nursing staff's derelictions allegedly caused Flanagan's condition to worsen so much that, by the time his condition was brought to the attention of a physician, an immediate transfer to intensive care was required.

Flanagan planned to offer the testimony of only one expert witness at trial. That witness was a nurse, Audrey Stephan, Ed.D., R.N. However, when trial was about to commence, a motion in limine was granted in favor of the hospital, thereby precluding Stephan from testifying as to the identity of Flanagan's medical condition and the causes thereof. Stephan would have testified in accordance with her expert report that "it is my nursing expert opinion, to a reasonable degree of nursing certainty, that all of the nurses ... did not meet the standard with respect to their nursing care of Stephen Flanagan and as such were a substantial contributing factor in his progressively worsening subcutaneous emphysema." The trial court concluded that Stephan's testimony went not only to the proper standard of nursing care, which was an appropriate subject for her testimony, but also to a medical opinion regarding the ultimate effect of that care. The court reasoned that the latter called for a medical diagnosis which a nurse is precluded by statute from rendering. Finding that the exclusion of this testimony prevented Flanagan from stating a prima facie case of malpractice, the court granted summary judgment in favor of the hospital.

It is undisputed that Stephan is a well educated and highly experienced nurse who is competent to provide expert testimony regarding applicable standards of nursing care. It is recognized, too, that she is qualified to offer opinion testimony as to whether the nursing procedures followed in Flanagan's case were substandard. What is at issue, however, is her competency to testify regarding the identity and cause of Flanagan's medical condition.

The decision to permit a witness to testify as an expert rests with the sound discretion of the trial court, and, absent an abuse of that discretion, the decision will not be disturbed on appeal. Miller v. Brass Rail Tavern, Inc., 541 Pa. 474, 481, 664 A.2d 525, 528 (1995). To be qualified to testify in a given field, a witness normally needs only to possess more expertise than is within the ordinary range of training, knowledge, intelligence, or experience. Id. at 481, 664 A.2d at 528. Ordinarily, therefore, the test to be applied is whether the witness has a reasonable pretension to specialized knowledge on the subject matter in question. Id. at 480-81, 664 A.2d at 528; Ruzzi v. Butler Petroleum Co., 527 Pa. 1, 10, 588 A.2d 1, 5 (1991). Here, however, the normal test of competency is constrained by a statutory provision limiting the deemed competency of nurses.

Flanagan was not diagnosed by a physician as having subcutaneous emphysema until December 4, 1991. If Stephan had been permitted to testify that Flanagan had progressively worsening subcutaneous emphysema between December 2 and December 4, and to testify that this condition was the result of the nursing staff's deviation from appropriate standards of care, she would necessarily have been providing an opinion that Flanagan was in fact afflicted with subcutaneous emphysema at an earlier point than December 4. Thus, Stephan's testimony would have consisted of a medical diagnosis of Flanagan's condition on December 2 or 3, as well as an opinion as to why that condition existed and worsened. We agree...