Helman v. Sacred Heart Hospital, 36393

• Decision Date: 10 May 1963
• Docket Number: No. 36393,36393
• Citation: 381 P.2d 605,62 Wn.2d 136
• Parties: , 96 A.L.R.2d 1193 George E. HELMAN and Verna D. Helman, his wife, Respondents, v. SACRED HEART HOSPITAL, a corporation, Appellant.
• Court: Washington Supreme Court

Page 136

62 Wn.2d 136

381 P.2d 605, 96 A.L.R.2d 1193

George E. HELMAN and Verna D. Helman, his wife, Respondents, v. SACRED HEART HOSPITAL, a corporation, Appellant.

No. 36393.

Supreme Court of Washington, Department 1.

May 10, 1963.

Rehearing Denied June 25, 1963.

John D. MacGillivray, Paul F. Schiffner, Spokane, for appellant.

Etter & Connelly, William L. Bennett, Spokane, for respondents.

HALE, Judge.

Plaintiff husband ¹ brought this action to recover for injuries claimed as a result of a staphylococcus infection contracted while in the hospital. The jury returned a verdict for $67,839.97. Defendant appeals.

George E. Helman was injured in an automobile accident on July 4, 1957, near Wallace, Idaho. His chest was crushed, his left hip was dislocated, and he had multiple fractures in the area of the left hip socket and left pelvic region. After nearly a month in the hospital at Wallace, respondent was transferred to Sacred Heart Hospital, the appellant herein, under the care of two orthopedic surgeons for purposes of hip surgery.

At the hospital, respondent was placed in a two-bed ward; the other bed was occupied by Robert Hagerup, who had been admitted to the hospital with a fractured back on July 9, 1957. He was paralyzed from the waist down.

Extensive surgery was performed on respondent's hip on August 1, 1957; following surgery, respondent was returned to the room shared with patient Hagerup.

On August 9, 1957, Mr. Hagerup complained of a boil under his right arm, and hot compresses were applied. The next day, purulent drainage from the boil appeared. A culture from this drainage was submitted to the hospital laboratory, and, on August 13th, the laboratory reported that the drainage was staphylococcus aureous coagulase positive. Mr. Hagerup was immediately removed to an isolation ward.

The first day following surgery, on August 2nd, respondent developed what was known as a 'spiking septic fever,' the temperature chart of which shows inclines and declines graphically resembling a spike. Between August 10th, the date at which drainage occurred from the boil on Hagerup's arm, and August 13th, when he was removed from Helman's room to an isolation ward, nurses and hospital attendants administered regularly to both bed patients. The nurses and attendants moved from one patient to the other, changed sheets, gave sponge baths, changed dressings, administered back rubs, and, in general, carried out the necessary hospital routine for the care of the two men. They did not observe the sterile techniques prescribed by the hospital in cases where infection is suspected; they did not wash their hands or leave the room between administering to the patients.

On August 13th, the day when Mr. Hagerup was placed in isolation, respondent's surgical wound erupted, discharging a large amount of purulent drainage. A culture of this drainage showed it to have been caused by the presence of staphylococcus aureous coagulase positive. The infection penetrated into respondent's hip socket, destroying bone, tissue and ligaments, so that a second operation was performed on October 28, 1957. In this operation, the respondent's hip was fused in a nearly immovable position. He was discharged from appellant hospital on March 14, 1958, and received further home and office care by his attending physician. His action for injuries and damages arising from the staphylococcus infection resulted in a jury verdict in the amount of $67,839.97.

The foregoing brief narrative does not disclose the real issues here. Principal among appellant's assignments of error are denial of motions for directed verdict at the close of all evidence and for judgment notwithstanding the verdict, and the denial by the court to strike the answer given to a hypothetical question. A more detailed recital of the evidence is necessary to a better understanding of the issues raised by this appeal.

Crucial to an important aspect of the case is the question of the sufficiency of the evidence. Implicit in the broad matter of sufficiency lies the specific query: Did respondent show, by substantial, believable evidence, that he acquired his injuries through a cross infection from his roommate, Hagerup? Essential to this finding is proof that the two patients were infected with the same strain of staphylococcus aureous coagulase positive. It is undisputed that cross infection between patients would be a medical impossibility unless it was of the same strain.

Appellant urges that the evidence not only fails to give proof of cross infection from Hagerup to Helman but actually shows affirmatively that the strains of bacteria were different, thus exonerating the hospital conclusively. If either proposition inheres in the entire evidence, appellant must prevail here. Conversely, if there was sufficient evidence from which the jury could reasonably infer cross infection, appellant's pertinent assignments of error do not lie.

From comprehensive medical testimony, certain medical facts emerge: Staphylococus, a type of germ, is common to all mankind, is present in some form or another in all of us, and is always around us--on nearly everything we touch, in the air we breathe. It is visible under the microscope but seeing it does not enable the scientist to identify the strain. Aureous refers to color, yellow or orange. Coagulase positive describes a broad group of organisms in the staphylococcus family which are capable of producing infection, i.e., virulent. There exists in nature some thirty to fifty strains of staphylococcus aureous coagulase positive, some of which have not yet been categorically identified. One strain of this bacteria cannot induce cross infection of a different strain of the same organism. If the strains are different, the infection has come from different sources.

All modern, well-run hospitals, of which appellant is one, are alert to the dangers of cross infection by staphylococcus aureous coagulase positive among their patients, and the injuries caused by it. They maintain infection committees among medical personnel to trace infections and isolate the sources. Personnel are instructed to observe certain sterile techniques in handling patients suspected of being hosts to staphylococcus aureous coagulase positive in a communicable form. If a person placed his hands in an area near or in the vicinity of an open sore or wound containing this kind of bacteria and then later placed his hands on another patient, he would likely expose the second patient to a massive transfer of the bacteria. Massive transfer would involve many millions or possibly billions of the bacteria. Thus, a massive exposure from one patient to another can occur by transmission of the bacteria on a person's hands. Appellant hospital had rules in effect requiring isolation of all patients known to be infected with staphylococcus and requiring all medical personnel to report open sores, boils and pimples, which emitted purulent drainage, among both patients and hospital personnel.

Two tests were described in the evidence as being used to identify and classify these bacteria for medical purposes, and are pertinent to this case:

(1) The antibiogram sensitivity test is employed to ascertain which particular antibiotic chemical substances may be used to combat a bacteria infection. In this sensitivity test, cultures are made under ideal environmental conditions in the laboratory from staphylococci contained in bodily substances or drainage, and are induced to grow profusely in colonies. Discs impregnated with antibiotic medicines are placed in close contract with these colonies of cultured bacteria. From the reaction of the colonies to the different discs, the scientist can estimate the degree of sensitivity of the bacteria to a specific antibiotic substance. Inhibitions of growth and rate of growth are the determinants. Sensitivity is graded from Nos. 1 to 4, with No. 1 indicating the greater sensitivity and No. 4 the smaller. From the antibiogram, the treating physician can ascertain the particular antibiotic medicine he will prescribe. This test is regularly employed in all large hospitals and was used by Sacred Heart Hospital.

(2) The phage test, the second test pertinent here, is a more sophisticated and precise method for identifying the strains of staphylococcus aureous coagulase positive. Phage is another name for virus. Phages are viruses and produce such diseases as polio, rabies and smallpox. They breed in bacteria. Peculiar to them is the characteristic that they attack staphylococci organisms causing them to dissolve or melt away. By applying these known phages or viruses to the strains of staphylococci sought to be identified, a definitive result is obtained with such precisensee as to warrant giving the identification a classification number. So standardized has the phage test become, that the results in identifying the strains of staphylococcus aureous coagulase positive will be reported to the investigator by their phage numbers.

The phage-type test is not generally employed in hospitals, but is used principally by governmental and centralized agencies for epidemiological investigations, that is, to locate the sources of staphylococci infections which threaten to reach epidemic proportions. Laboratories which conduct phage-type testing are located at the medical school at the University of Washington and at Washington State University. In our neighboring state of Idaho, the state department of health maintains a laboratory at Boise which conducts phage-type tests. These laboratories, among others, stand ready to serve hospitals and other agencies that are unable to locate the source of a staphylococcus infection among their own precincts. Phage-type testing, unlike the antibiogram tests, is not a normal therapeutic tool, but is used largely in broad investigations of a particular institution or area.

Concerning the accuracy and definitive quality of...