Harris County Hosp. Dist. v. Estrada

• Decision Date: 04 November 1993
• Docket Number: No. 01-92-00130-CV,01-92-00130-CV
• Citation: 872 S.W.2d 759
• Parties: HARRIS COUNTY HOSPITAL DISTRICT, Appellant, v. Joe ESTRADA, Stella Paredes, Reynaldo Estrada, Mary Elizabeth Landin, Deborah Luna, Anthony Luna, Herman Luna, Armando Luna, Mike Martinez, and John Luna, All Individually and as Surviving Heirs at Law and Next of Kin of Carolina R. Gonzales, Deceased; Linda Vega, Individually and as Surviving Heir at Law and Next of Kin of Carolina R. Gonzales, Deceased, and as Next Friend of Jesus Gonzales, Jr.; and Rebecca Gonzales, Individually and as Surviving Heir at Law and Next of Kin of Carolina R. Gonzales, Deceased, and as Personal Representative of the Estate of Carolina R. Gonzales, Deceased, Appellees. (1st Dist.)
• Court: Texas Court of Appeals

Page 759

872 S.W.2d 759

HARRIS COUNTY HOSPITAL DISTRICT, Appellant, v. Joe ESTRADA, Stella Paredes, Reynaldo Estrada, Mary Elizabeth Landin, Deborah Luna, Anthony Luna, Herman Luna Armando Luna, Mike Martinez, and John Luna, All Individually and as Surviving Heirs at Law and Next of Kin of Carolina R Gonzales, Deceased; Linda Vega, Individually and as Surviving Heir at Law and Next of Kin of Carolina R Gonzales, Deceased, and as Next Friend of Jesus Gonzales Jr.; and Rebecca Gonzales, Individually and as Surviving Heir at Law and Next of Kin of Carolina R. Gonzales, Deceased, and as Personal Representative of the Estate of Carolina R. Gonzales, Deceased, Appellees.

No. 01-92-00130-CV.

Court of Appeals of Texas, Houston (1st Dist.).

Nov. 4, 1993.

Mike Driscoll, Daniel J. Simms, Houston, for appellant.

Tom Edwards, Patrice M. Barron, Houston, for appellees.

Before OLIVER-PARROTT, C.J., and MIRABAL and COHEN, JJ.

OPINION

COHEN, Justice.

This is an appeal from a wrongful death and survival action brought against appellant, Harris County Hospital District (the District), under the Texas Tort Claims Act. The principal question is whether the District's liability is limited to $100,000 when one person was killed, but multiple claimants brought two claims, wrongful death and survival. The trial judge awarded a total of $200,000, divided equally between the two causes of action. We hold this was error. Consequently, we reform the judgment by reducing it to $100,000. As so reformed, we affirm.

Facts

On January 27, 1988, 73-year-old Carolina Gonzales went to the District's West End Medical Clinic. Dr. John Bradberry, a Baylor College of Medicine resident physician, saw Gonzales as an out-patient and prescribed bactrim, a sulfa drug. Gonzales was allergic to sulfa drugs, and the day after taking one bactrim, she became sick and went to another hospital. Gonzales suffered a severe allergic reaction to the drug and died 16 days later.

Before filing this suit, appellees settled with Bradberry and Baylor College of Medicine for $230,000. Appellees then sued the District, alleging that errors in record keeping by the nurses and medical-clerical personnel, as well as the lack of cross-referencing for allergy history at the hospital pharmacy, caused the prescription and dispensation of the sulfa drug, which led to Gonzales' death.

In a non-jury trial, the judge found the District's negligence was 35 percent responsible for appellee's damages, which totaled $350,000, and granted judgment against the District for $200,000, awarding $100,000 to the wrongful death claimants and $100,000 for the estate's survival claim. ¹ Appellees moved to dismiss the appeal for lack of jurisdiction, but this Court overruled that motion. This appeal followed.

In point of error two, appellant claims the trial judge erred in allowing an unqualified witness to testify as an expert. The District contends that Deborah Lessard, appellees' nurse expert, was not qualified to testify as an expert because she had no experience, familiarity, or certification in nursing or health care administration, demonstrated no knowledge or familiarity with transcription of medication procedures or the applicable standard of care, was not certified in nursing administration, and offered no testimony to show she was certified in health care administration.

Whether a witness qualifies as an expert is within the trial judge's discretion and will be reversed only for abuse of discretion. Sears v. Cooper, 574 S.W.2d 612, 615 (Tex.Civ.App.--Houston [14th Dist.] 1978, writ ref'd n.r.e.). A nonphysician nurse, even one who is not a registered nurse but is familiar with the standard of care at another similar hospital, can qualify by experience to testify as a medical expert in a medical malpractice action. Johnson v. Hermann Hosp., 659 S.W.2d 124, 126 (Tex.App.--Houston [14th Dist.] 1983, writ ref'd n.r.e.). The nurse need not be certified or familiar with the standard of care in a particular locale, so long as the nurse is familiar with the standard of care at another hospital that is similar. Id.

Lessard was a registered nurse with clinical experience, including four years work experience at clinics within the Hospital District, as well as an attorney experienced in evaluating cases from the standpoint of hospital liability. Although she could not specifically testify as to the clinics' individual division of duties, she was familiar with general nursing duties within the Hospital District.

Moreover, Lessard testified she was familiar with the applicable standard of care for nurses, particularly as to the standard of care regarding allergies and prescriptions. For example, she testified that after the doctor has seen a patient and written prescriptions, it was then the discharge nurse's independent duty to compare the prescription with the patient's chart for contradictions, such as allergies, and to bring any inconsistencies to the doctor's attention for correction. Further, Lessard testified that after the discharge nurse reviews the written prescription and compares it to the chart, but before sending the patient to the on-premises pharmacy with the written prescription, the nurse is supposed to instruct the patient or the caretaker what to do if there is an adverse reaction. In sum, the record reflects Lessard was experienced and familiar with the standard of care. The trial judge here did not abuse his discretion by allowing her to testify as an expert.

We overrule point of error two.

In point of error five, appellant contends the trial judge erred in not granting the District a directed verdict because appellees failed to prove causation. Appellant argues there was no proof that faulty record keeping caused Gonzales' death.

Appellees claim the evidence shows that the District's breach of duty in their record keeping, the failure to properly cross-check the prescription with known allergies, and the failure to instruct Gonzales on how to proceed in the event of an allergic reaction, proximately caused the sulfa drug to be dispensed to Gonzales, which caused the allergic reaction and her death.

Dr. Chi C. Mao, the physician who admitted Gonzales to the Heights Hospital emergency room after she ingested the sulfa drug testified that the main cause of Gonzales' death was a severe allergic reaction to a sulfa drug. Moreover, Gonzales' death certificate states the cause of death was a severe allergic reaction to the sulfa drug. Thus, there is factually and legally sufficient evidence to show the sulfa drug caused Gonzales' death.

We next consider whether there was sufficient evidence that the nurses' negligence caused the dispensation of the sulfa drug.

Dr. Bradberry testified that in prescribing the sulfa drug, he relied on the District's computer printout that showed Gonzales had no allergies. The one-page computer printout sheet comes with the patient file given to the doctor when he sees the patient. The printout sheet is supposed to summarize the medical data contained in the chart, so that the doctor does not have to examine the entire chart. The medical records clerk is responsible for including relevant medical information in the updated computer sheet. In this case, however, the computer printout on top omitted the fact that Gonzales was allergic to sulfa drugs, a fact known to the clinic and contained in the records underneath the cover sheet.

Lessard testified that the sole proximate cause of the misprescription and death was the negligent recordkeeping by the District's nurses and staff. She testified it was foreseeable that the inconsistency in Gonzales' records could lead to the misprescription and death. Specifically, Lessard testified that after the doctor has seen a patient and written prescriptions, it is the discharge nurse's independent duty to compare the prescription with the patient's chart for contradictions and to bring any inconsistencies to the attention of the doctor to clarify or correct. Lessard and Bradberry testified clinic records showed several omissions and inconsistencies concerning Gonzales' allergy that should have been corrected by District employees. Lessard also testified that pointing out any inconsistency between the prescription and the chart is particularly important with a resident doctor, such as Bradberry, as opposed to a medical doctor who had completed the residency. Lessard testified the inconsistency could and should have been identified several times before it was too late, but it was not.

Finally, Lessard and nurse Loughron, the District's witness, testified that the clinic staff should have told Gonzales what to do if she had an adverse reaction to the drug. Evidence showed the staff should have instructed Gonzales to seek medical attention within 20 minutes to an hour of any adverse reaction because, if treated quickly, the reaction could be reversed. Lessard testified this failure to properly instruct was a proximate cause of the death, because, if Gonzales had been properly instructed and had sought treatment immediately after her reaction started, it would have been possible to reverse that reaction. We hold the evidence was sufficient.

We overrule point of error five.

In points of error one, three, and four, appellant challenges the factual and legal sufficiency of the evidence and also challenges some implied factual findings of the trial judge.

Appellant did not request any findings of fact, and none were filed. Thus, we will imply all the findings necessary to support the judgment. Worford v. Stamper, 801 S.W.2d 108, 109 (Tex.1990). In determining whether some evidence supports the implied findings of fact, we consider only the evidence favorable to the judgment and disregard all evidence to the contrary. Id. The judgment will be affirmed on any legal theory supported by the evidence. Id.

In point of error one, appellant claims appellees failed to prove proximate cause. We...