Hastings v. Baton Rouge General Hosp.
| Decision Date | 24 November 1986 |
| Docket Number | No. 86-C-1034,86-C-1034 |
| Citation | 498 So.2d 713 |
| Parties | David HASTINGS and Audrey Hastings v. BATON ROUGE GENERAL HOSPITAL, et al. |
| Court | Louisiana Supreme Court |
David Robinson, Baton Rouge, for applicants.
Felix Weill, Watson, Blanche, Wilson & Posner, Donald Phelps, Seale, Smith & Phelps, William Wilson, Taylor, Porter, Brooks & Phillips, and Daniel Reed, Baton Rouge, for respondents.
*
In this malpractice suit by the surviving parents 1 of Cedric Paul Hastings, who died of stab wounds at Baton Rouge General Hospital after an unsuccessful attempt to transfer him to Earl K. Long Charity Hospital, it is alleged that Baton Rouge General Hospital, the emergency room physician on duty, and the thoracic surgeon on call, were negligent.
On March 1, 1981, Cedric Hastings was admitted to the emergency room of Baton Rouge General Hospital at 11:56 P.M. with two stab wounds and weak vital signs. It is customary to take an emergency patient to the closest hospital, which was Baton Rouge General. Dr. Samuel Reed, the emergency room physician on duty, was due to be relieved by Dr. Joseph R. Gerdes, Jr., at midnight. Both doctors worked on resuscitating Cedric, who had no vital signs, and was moribund. His only respiration was a gasping type which appeared to be ineffectual. Because of a stab wound in the parasternal area, a chest tube connected to an Emerson pump was installed to drain air and blood from the chest. An IV was started to restore circulation and a blood sample was drawn for testing. By 12:25 A.M., Cedric's vital signs had been restored: he was breathing; his blood pressure was up to 90 over 52; and he had a pulse of 112. The next entry by staff nurse Sandra S. Kelly showed blood pressure of 100 over 60 and respiration of 36. Cedric had continued to lose a large amount of blood, at least 1,000 cubic centimeters.
A chest x-ray at 12:15 A.M. showed blood, the tube and a degree of tension. In Dr. Gerdes' opinion, the tension that was present was not enough to compromise the patient's circulation or respiration and was not dramatic or lethal enough to be termed tension hemothorax. Cedric's blood had been typed and cross-matched and two units of whole blood were started at 1:00 A.M. Although unmatched blood could have been used, the patient was not close to exsanguination at 1:00 A.M. when he began receiving the whole blood.
Dr. Gerdes had concluded that a thoracotomy had to be performed. Because he was not qualified by training or experience to perform that surgery, Dr. Gerdes contacted the thoracic surgeon on call that evening, Dr. Edward McCool, and described the condition of the nineteen year old stabbing victim, who had apparently been stabbed in one of the "major blood vessels". 2 Dr. McCool asked if the patient had insurance. After receiving a negative reply, Dr. McCool asked Dr. Gerdes to transfer the patient to Earl K. Long Hospital. In Dr. Gerdes' opinion, the patient was not in stable enough condition for transfer, and he told Dr. McCool: "I can't transfer this patient." 3 Dr. McCool replied, "No. Transfer him." 4 Frustrated by Dr. McCool's lack of cooperation, Dr. Gerdes explained that the only thing he could do for the patient was to put in another chest tube. Dr. McCool said that this would only increase the bleeding, whereupon Dr. Gerdes hung up the telephone. This conversation took place prior to 12:25 A.M.
An emergency thoracotomy takes a matter of minutes. In Dr. Gerdes' opinion, if a thoracotomy had been performed and the bleeding stopped, there was a possibility that Cedric would have survived. Nurse Kelly had observed emergency thoracotomies in emergency rooms which had sometimes saved the lives of patients with stab wounds.
Between 12:25 and 12:45 A.M., Dr. Gerdes reported to nurse Kelly that Dr. McCool wanted the patient transferred to Earl K. Long. Nurse Kelly was not comfortable with the idea of transferring the patient and offered to attend him in the ambulance. Dr. Gerdes was also upset about transferring the patient but gave the appearance of having no alternative.
After receiving a negative response from Dr. McCool, Dr. Gerdes contacted Earl K. Long Hospital. Baton Rouge General had two heart-lung machines: Earl K. Long had none. The emergency room doctor at Earl K. Long said they would be ready for the patient. An ambulance was called, and Dr. Gerdes re-evaluated the patient who still had marginal vital signs, was restless and draining blood from his chest. The ambulance answering service received the call at 1:03 A.M.
When the ambulance personnel arrived at the hospital, driver Tom Crittenden questioned the stability of the patient. It is unusual to transport a patient who is receiving whole blood and has suction draining from a chest tube. Crittenden had never transferred a patient in that condition from one hospital to another.
To transfer Cedric from the critical care area to the ambulance, it was necessary to disconnect the Emerson pump. Cedric's blood pressure was then 96 over 60, his pulse was 120, and his respiration 32. Cedric's vital signs had remained stable from 12:25 A.M. until he was strapped into the ambulance at 1:30 A.M. After removal of the pump, Cedric began to fight wildly, the chest tube came out, and the bleeding increased. During five minutes, his pulse was reduced to 44 and his respiration to 16: his color became ashen, and his pulse weak. His condition deteriorated dramatically. When Dr. Gerdes went to the ambulance, Cedric had virtually bled to death. However, Dr. Gerdes inserted a larger tube and ordered the patient returned to the emergency room. Cedric died of cardiac arrest at 2:00 A.M., after he had been transferred back into the emergency room.
Under the hospital regulations, when a doctor cannot be reached or refuses a call, the chief of the service should be notified so that another physician can be obtained. 5 A physician who is on call must respond to an emergency room summons except when attendance is judged unnecessary.
Dr. Gerdes was employed by the Emergency Physicians Association of Baton Rouge. He is a certified member of the American Board of Emergency Medicine and is a specialist in that field.
Dr. McCool is a board certified thoracic and cardiovascular surgeon, primarily a chest surgeon who operates on the heart, the great vessels, the esophagus and the lungs. Dr. McCool is familiar with an emergency room thoracotomy or ERT. In the case of a penetrating wound to the chest in the parasternal area with copious bleeding, surgery is indicated to repair any damage to the heart or great vessels. There is a chance of survival with immediate surgery. Fifty percent of such patients die from loss of blood or exsanguination before they reach the hospital. Dr. McCool agreed that in the case of unconscious patients without vital signs or spontaneous respiration, an excellent survival rate is 32.1%. When a patient is agonal: semi-conscious with a thready pulse and gasping respiration, an excellent survival rate is 33.3%. In a third group, conscious, with a measurable blood pressure of seventy millimeters or less, in profound shock, an expectable survival rate is 40%. In 1981, there were no trauma center hospitals in the Baton Rouge area, and these survival rates were measured at a trauma center. Dr. McCool admitted that the primary difference between a trauma center and the facilities at Baton Rouge General is the length of time required for surgeons on call to reach the hospital.
When Dr. Gerdes telephoned, Dr. McCool had the impression that the patient was stable from the fact that he had a blood pressure of 90 over 50 and therefore inquired about insurance. After receiving a negative answer, Dr. McCool decided that the patient was stable enough to be transferred to Earl K. Long Hospital.
Dr. McCool was told that the patient had been stabbed in the chest and admitted that he should have asked if the wound were in the parasternal area. He did not recall Dr. Gerdes telling him that the wound might involve a major blood vessel. If Dr. McCool had understood that the wound was in the parasternal area, he would have felt it necessary to go to the hospital. According to Dr. McCool it would have taken him approximately thirty minutes to reach the hospital, twenty minutes to get ready and ten to drive.
An investigator testified that the trip between Dr. McCool's residence and Baton Rouge General Hospital, a distance of 3.9 miles, could have been driven within the speed limit in seven and a half minutes.
If Dr. McCool had gone to the hospital, he would have operated as rapidly as possible to give Cedric a chance of survival. According to Dr. McCool, he would have reported to the hospital if he had known that the patient had continued to bleed profusely.
Dr. McCool testified that he was self-employed and on the medical staff of the Baton Rouge General Hospital with full privileges in thoracic and cardiovascular surgery. In Dr. McCool's opinion, even if he had arrived at the hospital at 12:45 or 12:50, Cedric's lacerations of the liver and heart left almost no likelihood of survival. There was a thoracotomy tray in the emergency room with a hemostat, a rib splitter, and clamps.
Dr. McCool agreed that if he had been present at the scene he would not have transferred Cedric at 1:30 A.M. In retrospect, he did not think the transfer should have been attempted. If he had been present by 1:00 A.M., he could probably have gotten into the chest within fifteen minutes.
At the time of his death, Cedric Hastings was a nineteen year old athlete, approximately six feet three inches tall.
Dorothy M. Gray, the medical staff secretary for Baton Rouge General Hospital, identified the regulation governing the Emergency Service Committee of the hospital, 6 and the hospital's Bylaws which establish an Emergency Service Committee and give rules and regulations governing emergency service by the hospital's...
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