Garfield Memorial Hospital v. Marshall

• Decision Date: 30 April 1953
• Docket Number: No. 10984,10808.,10984
• Citation: 204 F.2d 721
• Parties: GARFIELD MEMORIAL HOSPITAL v. MARSHALL et al. MARSHALL et al. v. O'DONNELL
• Court: U.S. Court of Appeals — District of Columbia Circuit

204 F.2d 721 (1953)

GARFIELD MEMORIAL HOSPITAL v. MARSHALL et al.

MARSHALL et al. v. O'DONNELL

Nos. 10984, 10808.

United States Court of Appeals District of Columbia Circuit.

Argued November 14, 1952.

Decided April 30, 1953.

Mr. H. Mason Welch, Washington, D. C., with whom Messrs. John R. Daily and J. Harry Welch, Washington, D. C., were on the brief, for appellee in Case No. 10,808 and on the brief for appellant in Case No. 10,984.

Mr. James W. Lauderdale, Washington, D. C., with whom Messrs. Manuel J. Davis and Karl Michelet, Washington, D. C., were on the brief, for appellants in Case No. 10,808 and on the brief for appellees in Case No. 10,984.

Before WILBUR K. MILLER, PROCTOR and FAHY, Circuit Judges.

WILBUR K. MILLER, Circuit Judge.

Noel Frances Marshall suffered an injury which produced an intracranial hemorrhage when she was prematurely born in Garfield Memorial Hospital January 23, 1947. As a result she is in a spastic condition, ninety per cent deficient and incurable. Through her father, George C. Marshall, as next friend, she sued the hospital, alleging its negligent failure to provide proper care and attention during Mrs. Marshall's labor and delivery caused the injury and produced the spastic condition. Marshall also sued in his individual capacity. The jury awarded $55,000 to the infant plaintiff, and $2,000 to her father. On the appeal, No. 10,984, by Garfield Hospital from the judgment entered pursuant to the jury's verdict, the principal questions are whether the hospital was negligent and, if so, whether there was a causal connection between its negligence and the child's injury.

It is essential, therefore, to ascertain what took place at the hospital during the afternoon and evening of January 23rd. The principal participants in those events were Mrs. Marshall, Misses Holloway and Heinsohn, who were the ward nurses on duty, and Dr. Irani, a physician employed by the hospital, who was the "assistant resident" in charge of the obstetrical ward. We shall summarize the testimony of each of those four persons with respect to Mrs. Marshall's care from the beginning of labor at 2:00 p. m. until delivery at 11:20 p. m., with occasional references to the hospital records and other evidence necessary to complete the narrative.

On January 6, 1947, when Mrs. Marshall, already the mother of two children, was in the seventh month of pregnancy, she suffered a rupture of the uterine membranes. At the direction of her private physician, Dr. Howard D. Parker, she entered Garfield the next day. The ruptured condition of the membranes, which made probable a premature and rapid delivery, was noted on the hospital's record of admission.

Dr. Parker visited Mrs. Marshall each day until about January 15, when he left on a vacation trip and turned her case over to Dr. Roger O'Donnell, Jr., his associate. From then until the day of birth Dr. O'Donnell saw the patient each day, the last time before delivery being some time during the morning hours of January 23. Dr. Irani also saw Mrs. Marshall daily, sometimes more than once.

On the day of Noel's birth, Miss Holloway was the ward nurse on duty from 3:00 p. m. until she was relieved at 11:00 p. m. by Miss Heinsohn. According to the hospital record and other evidence in the case, labor began at 2:00 p. m. Mrs. Marshall, who had herself been a nurse, carefully observed the progress of her labor, timed the frequency and duration of her contractions, and testified as to their progressive intensity. The following synopsis of her testimony as to the events from 2:00 p. m. until 11:40 p. m. is largely in her own words.

Contractions started at 2:00 p. m. and were from 5 to 8 minutes apart. They gradually grew more severe, more regular, until at 5:30 p. m. they were 5 minutes apart. At that time she refused supper except liquids, whereupon Miss Holloway called Dr. Irani. He did not come until 7:30 p. m., when the pains were very severe, made a rectal examination (the purpose of which is to determine whether the patient has dilated), and left. "They the pains progressed, became harder, closer, until about 9:30, they were two minutes apart and, at that time, they were lasting from forty to seventy seconds." About 9:30, in response to a call from Miss Holloway, Dr. Irani came in, felt the contractions, and told Mrs. Marshall she had nothing to worry about. He then stepped outside, telephoned Dr. O'Donnell, gave him a report on the 7:30 rectal, told him she was having "a few mild contractions," and re-entered the room. Mrs. Marshall asked him to get Dr. O'Donnell and to do something for her. He felt the contractions and said again, "You have nothing to worry about."

Mr. Marshall, who was visiting his wife at the time, followed Dr. Irani into the hall and talked with him briefly. The following from Marshall's testimony was not denied by Dr. Irani:

"Q. Will you tell us what was said by Dr. Irani and by you? A. I told Dr. Irani that that baby was going to be born before midnight; that Mrs. Marshall knew what she was saying when she told him that she was in definite labor. I told him that I had seen her in labor twice before, and that this was no different from the other two times.

"Q. What did he say? A. He said, `I am in touch with Dr. O\'Donnell and he says we will save that baby for another week or ten days.\'"

Seconal and demerol were administered and the patient dozed. About 10:15 she was awakened by what she described as a "terrific pain," after which the pains were wave-like. There was no definite break in them and around 10:40 or 10:45 she was struck by one continuous pain which did not abate until the child's head was down, had left the uterus.

When the pain awakened her at 10:15, Mrs. Marshall shouted for Miss Holloway, who responded at once, felt the contractions and within 5 minutes telephoned Dr. Irani, after which she reported to the patient the doctor had said to call back later. Miss Holloway tried twice after that to reach Dr. Irani by telephone, the last time at 11:00 p. m., when the response was that he was "scrubbed," that is, he was sterilized and in an operating or delivery room, and could not come.

Miss Heinsohn, who had just arrived to relieve Miss Holloway, was given by the latter a detailed report of the patient's condition during the preceding eight hours, including the regularity and severity of the pains, and the fact that her several efforts to get Dr. Irani, beginning about 10:20, had been unsuccessful. Miss Heinsohn had hardly come on duty when Mrs. Marshall told her "the baby's head is down." The nurse made a visual examination, telephoned the delivery room that she was coming with a patient, and brought in a delivery cart, which she held while Mrs. Marshall, without any assistance, worked herself upon it from the bed. The baby's head was then protruding from the vagina, plainly visible. Warning Mrs. Marshall to keep her elbows in, Miss Heinsohn pushed the cart rapidly through the corridors and arrived at the delivery room in about 2 minutes.

Mrs. Marshall thus described her mental and nervous condition from the time she awakened at 10:15 p. m. until she reached the delivery room:

"I was nervous. I was apprehensive. My pains were wave-like; no doctor, no resident, no one in attendance except the nurse when I called her.

* * * * * *

"I became more apprehensive, more nervous, more tense as the pain increased in severity because no doctor was there; the baby was on its way; no one to help me until I became quite panicky before the baby was born."

Upon arrival at the delivery room, two nurses were there making hurried preparations. The cart was placed alongside the delivery table and was held while Mrs. Marshall, without assistance, rolled over upon it. As she did so she "was trying to prevent any pressure from my legs on the baby's head or to prevent bumping the baby's head." "I had barely gotten onto the table after much struggling," she said, "when the baby was born. * * * She shot out more than her own length on the delivery table. * * * There was a thud," caused by "The baby hitting the table."

The two nurses were still on the other side of the room. One said to the other, "Get a doctor quick; any doctor." One left and returned with Dr. Radford Brown, a private obstetrician who happened to be nearby. A delivery room nurse was severing the umbilical cord when Dr. Brown arrived. He was not scrubbed and was in street clothes, but he completed the third stage of labor, which consisted of expelling the placenta. Dr. Lois Platt, an interne, arrived after Dr. Brown had left, and Dr. O'Donnell, who had hurriedly dressed and come from his home after being notified of the birth, came in at 11:40. Dr. Irani did not see Mrs. Marshall after his visit about 9:00 p. m.

Such is the story of the labor and delivery as told to the jury by Mrs. Marshall. It was corroborated in the main, except for slight variations as to the time of events, by Misses Holloway and Heinsohn. The former said Dr. Irani told her on his second visit, between 8:30 and 9:00, that Mrs. Marshall was not in labor. She administered the seconal and demerol about 8:30. When Mrs. Marshall awakened from the subsequent sleep, which the nurse thought was about 9:30, Miss Holloway attempted to telephone Dr. Irani but was unable to get him, and then called the delivery room and told the nurse who answered to send a resident or an interne over to see the patient. Miss Holloway telephoned for assistance three or four times from the time Mrs. Marshall awakened until she went off duty, but no one came in response. On one of the calls, which she thought was between 10:00 and 10:30, she talked to Dr. Irani, who told her he would be over, but he did not come.

When Miss Heinsohn arrived about 11:00 p. m., Miss Holloway said she told her "About Mrs. Marshall's pains, how frequent they were, and trying to get Willard the hospital name for the delivery room and no one coming." She tried to...