Grove v. Peacehealth St. Joseph Hosp.

Decision Date11 December 2014
Docket NumberNo. 89902–9.,89902–9.
Citation341 P.3d 261,182 Wash.2d 136
CourtWashington Supreme Court
PartiesRaymond GROVE, Petitioner, v. PEACEHEALTH ST. JOSEPH HOSPITAL, Respondent, St. Joseph Hospital Foundation; Dr. Sara Mostad; and Dr. Dag Jensen, Defendants.

Kevin Keefe, Attorney at Law, Ian S. Birk, Keller Rohrback, LLP, Benjamin Blystad Gould, Seattle, WA, for Petitioner.

D. Jeffrey Burnham, Johnson Graffe Keay Moniz & Wick LLP, Mary H. Spillane, Williams Kastner & Gibbs, Seattle, WA, Timothy Lee Ashcraft, Williams Kastner & Gibbs, Tacoma, WA, for Respondent.

Bryan Patrick Harnetiaux, Attorney at Law, Spokane, WA, George M. Ahrend, Ahrend Albrecht PLLC, Ephrata, WA, amicus counsel for Washington State Association for Justice Foundation.

Gregory Mann Miller, Justin Price Wade, Carney Badley Spellman PS, Seattle, WA, amicus counsel for Washington State Medical Association and amicus counsel for Washington State Medical Association.

Gregory Mann Miller, Justin Price Wade, Carney Badley Spellman PS, Seattle, WA, amicus counsel for Washington State Hospital Association.

Opinion

MADSEN, C.J.

¶ 1 The primary issue in this medical malpractice case is whether the trial court properly granted the defendant hospital's postverdict motion for judgment as a matter of law. Here, the plaintiff patient presented expert testimony establishing that following the patient's lengthy heart surgery, the surgeons in charge of the patient's postoperative recovery failed to meet their standard of care, which required appropriately monitoring the patient for compartment syndrome, a known possible complication following such surgery, and also failed to direct members of the hospital's care team treating the patient during his recovery to so monitor. In light of this evidence, we reverse the trial court and remand for reinstatement of the jury verdict.

FACTS

¶ 2 On December 21, 2006, Raymond Grove underwent a complex six hour cardiac surgery performed by Dr. Richard Leone, who remained Grove's primary physician until December 25, when Dr. Leone traveled for Christmas vacation. In Dr. Leone's absence, other surgeons at PeaceHealth St. Joseph Medical Center (PeaceHealth or hospital) assumed the role of primary physician for Grove. Dr. Edward Zech took over on December 25 and Dr. James Douglas on December 29. Dr. Leone remained Grove's physician of record until Grove was ultimately released from the hospital.

¶ 3 Although Grove's heart surgery went well, he had a difficult recovery. He developed various complications, including pneumonia and a blood infection. His condition required intubation from December 23 through December 26 and the hospital brought in an infectious disease specialist, Dr. Sara Mostad,1 to treat him.

¶ 4 By December 29, Grove's progress chart noted that Grove's left calf was swollen, red, and painful to the touch. Grove's ability to bend his joints in both ankles was weak, particularly on his left leg. Based on these symptoms, Drs. Mostad and Douglas2 suspected that Grove may have had cellulitis, a bacterial infection typically treated with antibiotics, even though Grove was already on antibiotics for the earlier blood infection.

¶ 5 By December 31, Grove could not fully flex his left foot and dragged his left toe when he walked during physical therapy sessions.3 Dr. Mostad then suspected that Grove suffered from compartment syndrome, a complication from lengthy surgical procedures. Typical symptoms of compartment syndrome include hardness, swelling, numbness, tingling, pallor, loss of neurological function, lack of pulse, and severe pain. Grove did not complain of excruciating pain, but throughout his recovery time, he had been heavily pain medicated. Another physician, Dr. James Miller, conducted a compartment pressure test on December 31, which indicated that Grove suffered from the syndrome.

¶ 6 Compartment syndrome can result in irreversible damage but is curable if detected early. Grove underwent surgery to relieve his compartment syndrome, but it was too late. He suffered necrosis, muscle and other cell death within the compartment, resulting in permanent injury to his left leg.

¶ 7 Grove sued PeaceHealth for medical malpractice, asserting that the hospital was vicariously liable for the negligence of its managers, supervisors, agents, and employees who treated him.4 Drs. Leone, Douglas, and Zech testified that PeaceHealth provided medical care on the basis of a team that included surgeons, physician assistants, nurses, students, and other hospital staff. The surgeons related that team members made rounds more than once a day and that the system was designed to keep physicians and staff apprised of the patient's condition. Perpetuation Dep. of Sean D. Ghidella (June 20, 2012) at 37 (surgeons made rounds twice a day and physician's assistants once a day).

¶ 8 Two experts testified for Grove: orthopedic surgeon Dr. Sean Ghidella and cardiovascular surgeon Dr. Carl Adams. Dr. Ghidella testified that the medical care provided to Grove fell below the standard of care because of inadequate monitoring and failure to rule out a known possible postoperation complication. Dr. Ghidella opined that Dr. Leone was ultimately responsible as team leader at the outset of Grove's treatment. He testified that with proper monitoring Grove's compartment syndrome should have been detected earlier. According to Dr. Ghidella, Grove's leg should have been examined on every round. He opined that Grove would not have suffered permanent injuries or would have had a better outcome if the standard of care had been met. He thought it likely that the compartment syndrome began to develop while Grove was intubated, but he could not determine precisely when Grove developed the syndrome, stating that had the standard of care been met, with record entries regarding proper monitoring and testing, he could have determined when the syndrome developed.

¶ 9 Dr. Adams opined that the cardiovascular surgeon in charge of Grove's care failed to meet the standard of care of such practitioners. He identified the three surgeons in charge of Grove's care as Drs. Leone, Zech, and Douglas.5 Dr. Adams also testified that Dr. Leone was responsible for the medical care team; thus, if a physician's assistant made a mistake, Leone was responsible in the same way as the captain of a ship. Dr. Adams explained that the medical care team, as directed by the surgeon in charge, should have checked for compartment syndrome, since it was a recognized complication of a long surgical procedure of the type Grove experienced.6 Dr. Adams further opined that the failure to promptly diagnose Grove's compartment syndrome based on his leg symptoms while being treated with antibiotics fell below the standard of care. Dr. Adams testified that the failure to monitor for compartment syndrome began with Dr. Leone and continued thereafter. In Dr. Adams's opinion, had hospital employees engaged in the care team not breached the standard of care, Grove would have had a better chance of avoiding injury or would have suffered less severe injury.

¶ 10 The trial court instructed the jury on the standard of care applicable to a “physician, surgeon or health care provider.” Clerk's Papers (CP) at 329. The court instructed the jury that a “health care provider” included “an entity” including a hospital or an employee or agent of same acting within the course and scope of his or her employment. CP at 330. And the court instructed the jury that any act or omission of a PeaceHealth employee was an act or omission of the hospital. The jury returned a special verdict for Grove, finding that PeaceHealth was negligent and that its negligence was a proximate cause of Grove's injury, and awarding Grove $583,000 in damages.

¶ 11 The trial court granted PeaceHealth's postverdict motion for judgment as a matter of law,7 ruling that Grove failed to prove breach of the standard of care on the part of any particular PeaceHealth employee. The Court of Appeals affirmed in a published decision. Grove v. PeaceHealth St. Joseph Hosp.,

177 Wash.App. 370, 312 P.3d 66 (2013). This court granted Grove's motion for discretionary review. Grove v. PeaceHealth St. Joseph Hosp., 180 Wash.2d 1008, 325 P.3d 913 (2014).

ANALYSIS

¶ 12 When reviewing an order granting or denying a motion for judgment as a matter of law, this court applies the same standard as the trial court, determining whether, after viewing the evidence in the light most favorable to the nonmoving party, substantial evidence exists to support the verdict for the nonmoving party. Schmidt v. Coogan, 162 Wash.2d 488, 491, 173 P.3d 273 (2007) ; see also Kemalyan v. Henderson, 45 Wash.2d 693, 277 P.2d 372 (1954) (in ruling upon a motion for judgment notwithstanding the verdict, no element of discretion is involved, and the trial court can grant such motions only when it can be held as a matter of law that there is no evidence or reasonable inference from evidence to sustain the verdict); see also Douglas v. Freeman, 117 Wash.2d 242, 247, 814 P.2d 1160 (1991) (same).8

¶ 13 Tort actions based on injuries resulting from health care are generally governed by statute. RCW 7.70.010. A plaintiff seeking damages for medical malpractice must prove that his or her “injury resulted from the failure of a health care provider to follow the accepted standard of care.” RCW 7.70.030(1). The statutory definition of “health care provider” includes physicians, physician assistants, nurses, and any “entity” employing such persons, including hospitals or an employee or agent thereof acting in the course and scope of his or her employment. RCW 7.70.020(1), (3). The plaintiff must prove that the health care provider “failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he or she belongs.” RCW 7.70.040(1). The plaintiff also must prove proximate cause. RCW 7.70.040(2). The...

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