Howard v. St. Edward Mercy Medical
| Decision Date | 20 February 2002 |
| Docket Number | 01-798 |
| Parties | NOT DESIGNATED FOR PUBLICATION EDNA LOU HOWARD, as Administratrix of the Estate of NORMAN L. HOWARD, Deceased APPELLANT V. ST. EDWARD MERCY MEDICAL CENTER, and DR. BRUCE CRABTREE, Jointly and Severally APPELLEES CA 01-798 ARKANSAS COURT OF APPEALS DIVISION IV |
| Court | Arkansas Court of Appeals |
EDNA LOU HOWARD, as Administratrix of the Estate of NORMAN L. HOWARD, Deceased
APPELLANT
V.
ST. EDWARD MERCY MEDICAL CENTER, and DR. BRUCE CRABTREE, Jointly and Severally
APPELLEES
CA 01-798
ARKANSAS COURT OF APPEALS
FEBRUARY 20, 2002
APPEAL FROM THE SEBASTIAN COUNTY CIRCUIT COURT, FT. SMITH DISTRICT, [NO. CIV98-931] HONORABLE JOE MICHAEL FITZHUGH, CIRCUIT JUDGE
AFFIRMED
This is a medical malpractice case. Appellant Edna Lou Howard, administratrix of the estate of her deceased husband Norman Howard, appeals from a directed verdict entered on behalf of appellee St. Edward Mercy Medical Center and a jury verdict entered on behalf of appellee Dr. Bruce Crabtree. Mr. Howard died on the morning of January 22, 1997, allegedly the result of an acute illness brought on by undiagnosed diabetes, and Mrs. Howard filed suit against the hospital and the emergency room physician who participated in Mr. Howard's care. In her appeal, Mrs. Howard alleges that (1) the trial court erred in entering a directed verdict for the hospital at the close of the presentation of all of the evidence based upon a finding that the hospital was not liable for the actions of Dr. Crabtree, and (2) the jury's verdict for Dr. Crabtree is not supported by substantial evidence. We disagree and affirm.
The standards of review on these two issues are distinctly different, and we set them forth prior to addressing the merits of appellant's arguments. As to the hospital, the trial court granted a directed verdict at the close of the evidence. Sexton Law Firm, P.A. v. Milligan, 329 Ark. 285, 297, 948 S.W.2d 388, 394 (1997) (citations omitted).
As to Dr. Crabtree, the case was submitted to the jury for resolution. On appeal challenging a jury verdict, the query is whether the jury verdict is supported by substantial evidence. Substantial evidence is defined as "evidence of sufficient force and character to compel a conclusion one way or the other with reasonable certainty; it must force the mind to pass beyond suspicion or conjecture." Hall v. Grimmett, 318 Ark. 309, 805 S.W.2d 297 (1994). In examining whether substantial evidence exists, all evidence must be examined in the light most favorable to the party on whose behalf the judgment was entered and must be given its highest probative value, taking into account all reasonable inferences deducible from it. Id. It is not the appellate court's province to try issues of fact; the appellate court simply reviews the record for substantial evidence to support the jury's verdict. E.g., City of Caddo Valley v. George, 340 Ark. 203, 9 S.W.3d 481 (2000); Missouri Pac. Transp. Co. v. Jones, 197 Ark. 79, 122 S.W.2d 613 (1938) (). The weight and value of witness testimony is a matter within the exclusive province of the jury; the jury is free to believe or disbelieve the testimony of any witness. Farm Bureau Mut. Ins. Co. of Arkansas, Inc. v. Foote, 341 Ark. 105, 14 S.W.3d 512 (2000). With these standards of review in mind, we examine the evidence presented to the Sebastian County Circuit Court. Mr. Howard was a fifty-two-year-old man and a resident of Fort Smith, Arkansas. Not feeling well, Mr. Howard arrived at the emergency room of St. Edward Mercy Medical Center in Fort Smith on the afternoon of January 21, 1997, at approximately 4:00 p.m. He was accompanied by his eldest daughter Angela, who had driven him to the hospital. A triage nurse took his vital signs at that time and filled in a medical chart, which included a pulse or heart rate of 139. His primary complaints to the nurse were sore throat, fever, and blurred vision.
He was seen by a doctor at approximately 4:20 p.m. Dr. Crabtree, a board-certified emergency-medicine physician who has practiced since 1991, came into the examination room to see Mr. Howard. Mr. Howard primarily complained to Dr. Crabtree of difficulty swallowing and a burning sensation in his chest. It was explained that the previous day, Mr. Howard had presented to the V. A. Hospital in Fayetteville and was to report for studies to address these problems, but he preferred to have those tests run in Fort Smith, which was more convenient. Dr. Crabtree testified that he listened to Mr. Howard's chest and that he was not tachycardic at the time of his examination, in spite of the fact that his heart rate was noted to be elevated to 139 at the time he was triaged by the emergency room nurse. Though this particular examination by stethoscope was not recorded in the medical chart, Mr. Howard's daughter testified that she thought that the doctor did complete such an examination in her presence. Dr. Crabtree testified that he also examined Mr. Howard's mucous membranes in his throat and mouth, noting in the medical chart that they were pink and moist, which would indicate reasonable hydration. Dr. Crabtree denied that anyone told him of Mr. Howard experiencing frequent urination or excessive thirst; the triage nurse stated that if that complaint were made to her, she would have recorded it in the medical chart. This was a critical piece of information that would have changed the manner of treatment, according to Dr. Crabtree. In contrast, the eldest daughter testified that she had expressed to the doctor that her father had been frequently urinating. The daughter also testified that she had to answer the doctor's questions after the examination began because her father was too weak and sick to answer. After concluding his examination, Dr. Crabtree contacted Dr. Van Asche, a gastroenterologist, and an endoscopy was scheduled for the following morning to examine further Mr. Howard's gastric complaints.
Mr. Howard was discharged from the emergency room at 4:54 p.m. and, due to his instability, he was taken by wheelchair to his car. The nurse assisting the family expressed concern to Dr. Crabtree about Mr. Howard's difficulty ambulating and how this was complicated by his size, but he was discharged as planned. Mr. Howard was driven home to convalesce.
Mrs. Howard reported that after getting home, her husband rested on the couch, but he frequently had to go to the bathroom. As the evening progressed, Mrs. Howard stated that her husband became much more ill. She brought take-out food home for dinner, but Mr. Howard could not eat because his throat was too sore. She thought that he had been drinking a lot of fluid, but presumed it was to soothe his throat. By 9:00 p.m., Mr. Howard was confused and disoriented and was still urinating frequently, on one occasion urinating on the floor. His confusion was marked by Mr. Howard mistaking his wife for a nurse. As the evening wore on, Mrs. Howard became frightened by her husband's condition, so she called her eldest daughter, asking that her son-in-law come over to assist in getting Mr. Howard back to the hospital emergency room, and they arrived there at 11:30 p.m. Mr. Howard was partially conscious at that time, and he was somewhat combative. The emergency room nurse recorded the family's report of his vomiting for one week, blurred vision, weakness and excessive sleeping. Examination revealed that Mr. Howard was drowsy, confused, and apparently dehydrated, as evidenced by very dry mucous membranes. A laboratory test was ordered, which revealed that Mr. Howard had a very elevated blood sugar of 1,504 milligrams per deciliter (roughly twelve times the norm). Mr. Howard was admitted directly to the intensive care unit. Intravenous fluid and insulin were administered, however, Mr. Howard's condition continued to deteriorate. Though additional tests revealed that during the night his blood sugar levels began to decline, his condition worsened in that his body temperature elevated to 108 degrees, and by 8:15 a.m., he had slipped into a coma. Just after 9:00 a.m., Mr. Howard suffered respiratory and cardiac arrest, and efforts to resuscitate him ensued. Mr. Howard was pronounced dead at 9:35 a.m., January 22, 1997.
Dr. Crabtree learned later of Mr. Howard's return to the emergency room and his death. Dr. Crabtree's care was isolated to his first presentation to the emergency room; he did not participate in Mr. Howard's care upon his return to the hospital or at any time thereafter.
An autopsy was conducted on Mr. Howard's body, and the immediate cause of death was listed as "diabetes mellitus with acute diagnosis of none [sic] treatment of hyperosmolar coma." In short, Mr. Howard's blood was thick due to dehydration and caused his coma and death. Other underlying conditions were sickle cell trait, bone marrow hypercellularity, a thyroid condition, and chronic gastritis with bacteria associated with ulcers.
At trial, Mrs. Howard presented the testimony of an emergency-room physician who was board certified in family practice, Dr. O'Mara, who testified that Dr. Crabtree breached the standard of care, which resulted in her husband's death. Dr. O'Mara, while not faulting the referral to a gastroenterologist as a reasonable treatment of the later confirmed chronic gastritis, considered Dr. Crabtree's treatment to fall below the standard of care in that Dr. Crabtree did not follow up on Mr. Howard's elevated heart rate. Dr. O'Mara believed that the elevated heart rate was indirectly related to his diabetes because his dehydration required his heart to work harder to maintain cardiac output. Had Dr. Crabtree followed up, the diabetes would have been discovered, treatment for Mr. Howard's diabetes could have been implemented sooner, and it would have been more probable...
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