Gaines v. Comanche County Medical Hosp.

• Decision Date: 13 June 2006
• Docket Number: No. 100,598.,100,598.
• Citation: 2006 OK 39,143 P.3d 203
• Parties: Stephen GAINES, Appellant, v. COMANCHE COUNTY MEDICAL HOSPITAL and Nursefinders, Inc., Appellees.
• Court: Oklahoma Supreme Court

143 P.3d 203

2006 OK 39

Stephen GAINES, Appellant, v. COMANCHE COUNTY MEDICAL HOSPITAL and Nursefinders, Inc., Appellees.

No. 100,598.

Supreme Court of Oklahoma.

June 13, 2006.

As Corrected June 20, 2006.

Rehearing Denied September 11, 2006.

Certiorari to the Court of Civil Appeals, Division 4.

¶ 0 While hospitalized for multiple gunshot wounds, the appellant, Stephen Gaines (Gaines/patient), developed decubitus ulcers (bedsores). The patient filed a medical malpractice suit against his doctor and the appellees, Comanche County Medical Hospital (hospital) and Nursefinders, Inc. (Nursefinders). After the doctor was dismissed from the cause, the hospital and Nursefinders moved for summary judgment on grounds that Gaines had not presented expert physician testimony to support his claims. The trial court sustained the motion and the Court of Civil Appeals reversed. Under the facts presented, we hold that: 1) as a matter of first impression in Oklahoma law, a registered nurse—with eighteen years of experience, who is familiar with the standards of nursing care for the elderly and critically ill and who has a certification for wound care— may offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, care and cause of bedsores; and 2) the existence of genuine issues of material fact concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable requires the reversal of summary judgment. CERTIORARI GRANTED.

COURT OF CIVIL APPEALS OPINION VACATED; REVERSED AND REMANDED.

Mike Markey, Wichita Falls, TX, for appellant, Stephen Gaines.

Inona Jane Harness, Leslie D. Guajardo, Pierce Couch Hendrickson Baysinger & Green, L.L.P., Oklahoma City, OK, for appellee, Comanche County Memorial Hospital.

Monty B. Bottom, Jason T. Rogers, Foliart, Huff, Ottoway & Bottom, Oklahoma City, OK, for appellee, Nursefinders, Inc.

Stephen Peterson, Michael McMillin, Fenton, Fenton, Smith, Reneau & Moon, Oklahoma City, OK, for amici curiae, Oklahoma State Medical Association & Oklahoma Hospital Association.

WATT, C.J.

¶ 1 The cause presents a question of first impression in Oklahoma law: whether a registered nurse—with eighteen years of experience, who is familiar with the standards of nursing care for the elderly and critically ill and who has a certification for wound care— may offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, treatment and cause of bedsores. Under the facts presented, we determine that the registered nurse's expertise makes her qualified to give such expert testimony and express her opinion.

¶ 2 In allowing the nurse-expert's testimony as to the practices of other nurses, we align Oklahoma jurisprudence with all other jurisdictions considering whether a nurse may offer expert opinion testimony concerning decubitus ulcers.¹ Our determination is also consistent with the legislative directive in 12 O.S.2001 2702² providing that witnesses may qualify as experts "by knowledge, skill, experience, training or education."

¶ 3 The second question requires that we consider whether a material issue of fact exists militating against the entrance of summary judgment. Here, the only physician testimony contained in the record indicates that the doctor does not consider himself an expert on decubitus ulcers.³ In contrast, the patient's nurse expert has eighteen years of experience, is familiar with the standard of nursing care for the elderly and critically ill and is certified for wound care practice. Furthermore, her affidavit provides that: 1) the standard of care for the critically ill patient was not carried out by the hospital's nurses; 2) the failure to reposition the patient was a direct contributor to the development of severe decubitus ulcers; 3) the nurses failed to meet the standard of care when they did not place heel protectors on Gaines' heels or feet and that this negligence was a direct and foreseeable cause of the development of decubitus ulcers; and 4) the decubitus ulcers could have been avoided if the standard of care had been followed.⁴

¶ 4 When presented with the review of summary judgment, all inferences and conclusions to be drawn from the underlying facts contained in the record are considered in the light most favorable to the patient.⁵ Summary judgment is improper if, under the evidentiary materials, reasonable individuals could reach different factual conclusions.⁶ We are constrained to reverse summary judgment when it appears there are disputed facts.⁷

¶ 5 Here, genuine issues of material fact exist concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable. Therefore, we determine that the judgment should be reversed and the cause remanded for a resolution of these issues by the trier of fact.

RELEVANT FACTS

¶ 6 On December 1, 2000, following injuries from multiple gunshot wounds, the appellant, Stephen Gaines (Gaines/patient), was admitted to Comanche County Memorial Hospital (hospital), an appellee herein. Gaines was a large man, approximately six feet four inches tall and weighing three hundred and eighty pounds. Following his initial surgery, Gaines suffered two abdominal eviscerations requiring surgical repair. The repairing physician, Kelly Means, M.D. (Means), instructed that Gaines not be moved for forty-eight hours following the second procedure.

¶ 7 Gaines left the Hospital on January 17, 2001, when he was transferred to another facility. Before his transfer and while in the hospital, Gaines developed bedsores on his sacral area, feet, heels and head.

¶ 8 The doctor who was originally a defendant in the cause testified that he did not consider himself any kind of an expert on bedsores and that he would find it difficult to identify the stage of the ulcers.⁸ The nurse's affidavit offered as plaintiff's evidentiary material provides that: 1) the standard of care for the critically ill patient was not carried out by the hospital's nurses; 2) the failure to reposition the patient was a direct contributor to the development of severe decubitus ulcers; 3) the nurses failed to meet the standard of care when they did not place heel protectors on Gaines' heels or feet and that this negligence was a direct and foreseeable cause of the development of decubitus ulcers; and 4) the decubitus ulcers could have been avoided if the standard of care had been followed.⁹

¶ 9 The patient filed a malpractice suit against Means, the hospital and the appellee, Nursefinders, Inc. (Nursefinders), in October of 2002. Subsequently, the doctor was dismissed from the malpractice cause leaving only the hospital and Nursefinders as defendants. The hospital and Nursefinders filed a motion for summary judgment on February 17, 2004, on grounds that Gaines had not come forward with any expert physician testimony to support his malpractice claims. Gaines opposed the motion and requested additional time to provide a more detailed vitae on the nurse's qualifications. Nevertheless, on April 1, 2004, the trial court sustained the motion. Recognizing the management of pressure sores is the responsibility of nurses, the Court of Civil Appeals reversed.

DISCUSSION

¶ 10 a. The registered nurse's expertise makes her an appropriate professional to offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, treatment and cause of bedsores.

¶ 11 The patient argues that a registered nurse with the experience of his nurse-expert should be allowed to offer an expert opinion as to the practices of other nurses and the standards of care in the avoidance, treatment and cause of bedsores. The hospital and Nursefinders assert that the nurse is not qualified to give an expert opinion in a medical malpractice action. Their assertion is supported by the amici curiae, Oklahoma State Medical Association and the Oklahoma Hospital Association (collectively, Associations), who submitted their statement in support of granting certiorari. We disagree with the hospital, Nursefinders and the Associations.

¶ 12 It is a rarity when all courts addressing any particular question are in agreement. Nevertheless, our research reveals that, in all causes in which the issue of a nurse's expert testimony arose in response to inquiries concerning a patient's development of and the treatment for bedsores, all jurisdictions having addressed the issue allow the testimony.¹⁰

¶ 13 The Kansas Court did so in Mellies v. National Heritage, 6 Kan.App.2d 910, 636 P.2d 215 (1981). Mellies shares two important and persuasive factors with this cause. In Mellies, the testimony was offered by nurses who had special training in wound care. Here, the nurse had eighteen years of experience, worked in an area where she treated the elderly and critically ill and was certified for wound care practice. In Mellies, the testimony was offered to demonstrate the negligence of the nursing staff. Here, after the physician had been dismissed from the cause, the nurse's testimony was offered as evidence of substandard care administered by the hospital's staff.

¶ 14 The Mellies Court concluded that the trial judge abused his discretion in disallowing the nurse's testimony as expert on decubitus ulcers. It concluded that, with the proper foundation, nurses should be qualified as experts as to causation and as to treatment and cure of bedsores. In doing so, it recognized that such skin eruptions are "primarily a nursing problem . . . nurses are experts . . .".

¶ 15 Mellies represents the position taken by all deciding tribunals concerning nurse-expert testimony in relation to bedsores.¹¹ Research reveals no decision, turning on the issue of whether a nurse may offer expert testimony relating to bedsores, which has disallowed such evidence.

¶ 16 The Kansas Court's stance is consistent with 12 O.S.2001 2702's¹²...