Jackson County Hosp. Corp. v. Aldrich

• Decision Date: 27 December 2002
• Docket Number: No. 1D01-4079, No. 1D01-4042.
• Citation: 835 So.2d 318
• Parties: JACKSON COUNTY HOSPITAL CORPORATION d/b/a Jackson Hospital, Appellant/Cross-Appellee, v. Darlene ALDRICH and Michael Coniglio as Co-Representatives of the Estate of William E. Roddenberry, Jr., on Behalf of the Estate and Survivors, Appellees/Cross-Appellants; and Bay Anesthesia, Inc., Appellant/Cross-Appellee, v. Darlene Aldrich and Michael Coniglio as Co-Representatives of the Estate of William E. Roddenberry, Jr., on Behalf of the Estate and Survivors, Appellees/Cross-Appellants.
• Court: Florida District Court of Appeals

835 So.2d 318

JACKSON COUNTY HOSPITAL CORPORATION d/b/a Jackson Hospital, Appellant/Cross-Appellee, v. Darlene ALDRICH and Michael Coniglio as Co-Representatives of the Estate of William E. Roddenberry, Jr., on Behalf of the Estate and Survivors, Appellees/Cross-Appellants; and Bay Anesthesia, Inc., Appellant/Cross-Appellee, v. Darlene Aldrich and Michael Coniglio as Co-Representatives of the Estate of William E. Roddenberry, Jr., on Behalf of the Estate and Survivors, Appellees/Cross-Appellants.

Nos. 1D01-4079, 1D01-4042.

District Court of Appeal of Florida, First District.

December 27, 2002.

Rehearing Denied January 27, 2003.

G. Bruce Hill and Daniel S. Green, of Hill, Adams, Hall & Schieffelin, P.A., Winter Park, for Appellant/Cross-Appellee Jackson Hospital.

V. James Facciolo, of Hayden & Facciolo, P.A., Fernandina Beach, for Appellant/Cross-Appellee Bay Anesthesia, Inc. Donald M. Hinkle, of Hinkle & Foran, Tallahassee; and Louis K. Rosenbloum, of Louis K. Rosenbloum, P.A., Pensacola, for Appellees/Cross-Appellants.

LEWIS, J.

As these two cases originated from one trial and as many of the factual and legal issues apply in both cases, we have consolidated the two cases for purposes of this opinion. Appellant Jackson Hospital ("JH") challenges the jury verdict finding it liable for the reckless disregard of one of its emergency room physicians. JH raises two issues on appeal. JH argues that the trial court erred in failing to grant its motions for directed verdict, motion for new trial, and motion for judgment notwithstanding the verdict as the evidence presented at trial was legally insufficient to prove both reckless disregard and causation. In viewing the facts in the light most favorable to appellees, Darlene Aldrich and Michael Coniglio ("appellees"), the co-representatives of the estate of William E. Roddenberry ("Roddenberry"), we conclude that the trial court erred in denying JH's motions for directed verdict and motion for judgment notwithstanding the verdict. We, therefore, reverse and remand for entry of judgment in favor of JH. We affirm JH's other argument on appeal without further discussion.

Appellant Bay Anesthesia, Inc. ("Bay") raises three issues on appeal.¹ Bay first argues that the reckless disregard standard set forth in section 768.13(2)(b)1., Florida Statutes (1997), applies to its contract nurse anesthetist who provided care to a critically burned patient in JH's emergency room. In addition to this argument, Bay contends that unless section 768.13(2)(b)1. is construed to extend to contract health care providers who provide care in hospitals, such denial would violate the constitutional protection of equal protection. We affirm on this issue and hold that because Bay's contract nurse anesthetist is not a member of any of the classes clearly enumerated in section 768.13(2)(b)1., Bay was properly held to the lesser standard of negligence. We affirm Bay's second and third arguments without further discussion. Appellees argue on cross-appeal that if this Court affirms liability as to either JH or Bay but reverses as to the other, the party for whom the liability has been affirmed should be responsible for 100 percent of appellees' damages. Because we reverse the judgment as to JH and affirm liability as to Bay, we agree with appellees and hold that Bay is responsible for 100 percent of appellees' damages. Accordingly, we reverse the judgment against Bay for forty percent of appellees' damages and remand with instructions that the trial court enter judgment against Bay for 100 percent of the jury's damages award.

I. Factual Background

Both cases arose from a wrongful death complaint filed against appellants by appellees on behalf of Roddenberry. Roddenberry was severely burned at his place of employment when he used a cutting torch on a barrel containing flammable liquid. Following the initial explosion that occurred, Roddenberry was engulfed in flames for approximately thirty seconds. As a result, he suffered second and third degree burns over eighty-five percent of his body. A paramedic arrived at the scene of the accident shortly thereafter and transported Roddenberry to JH in order that he could be stabilized while waiting to be transported by helicopter to a major burn institution. Roddenberry arrived at JH at 9:50 a.m., approximately thirty-five minutes after the paramedic had initially arrived at Roddenberry's place of employment. A Foley catheter was immediately inserted into Roddenberry's bladder, indicating clear urine. However, despite having received 100 percent oxygen for thirty minutes in the ambulance, Roddenberry's arterial blood-gas level was only 66.2 and he was noted to be breathing twenty-eight times per minute as compared with the normal rate of twelve to fourteen respirations per minute. These levels indicated that Roddenberry was suffering from severe oxygen deprivation. As such, Dr. Griffin, JH's emergency room physician, decided that Roddenberry required an endotracheal intubation. Thus, Teresa Cruce, a certified registered nurse anesthetist ("CRNA") employed by Bay, was called to the emergency room to perform the intubation. Cruce was working at JH pursuant to a contract between JH and Bay. Pursuant to this contract, JH and Bay agreed that Bay at all times would act as an independent contractor and not as a partner of JH. The anesthetists were not permitted to act or hold themselves out to third parties as a partner, employee, or agent of JH.

At trial, Cruce testified that, after assessing Roddenberry's condition, she was unable to see Roddenberry's vocal cords due to the swelling in his upper airway and the burns, which were particularly severe around his neck and face. These burns prevented Cruce from being able to tilt Roddenberry's head to look down his airway. Roddenberry's short mandible also added to Cruce's difficulty in seeing his vocal cords. Although Cruce recommended a nasal intubation as Roddenberry would still be conscious and able to breathe independently, Dr. Griffin instructed her to conduct a rapid sequence oral tracheal intubation. To do so, Cruce administered a paralytic agent to Roddenberry that, while preventing aspiration, caused Roddenberry to be entirely dependent upon the intubation tube for his oxygen supply.

Unable to see Roddenberry's vocal cords, Cruce performed a "blind" intubation at 10:07 a.m., according to the notes recorded by an emergency room nurse who used her own watch to gauge the time. Because Cruce was not entirely certain that she had properly placed the intubation tube into Roddenberry's trachea, as opposed to his esophagus, she informed Dr. Griffin of her uncertainty. At this time, a respiratory technician informed the medical team working on Roddenberry that a carbon dioxide detector was not detecting the emission of carbon dioxide, which would be present if Roddenberry's lungs were receiving oxygen. Therefore, Dr. Griffin, Cruce, another physician in the emergency room, and other members of the medical team took steps to alleviate their concerns about proper placement of the intubation tube. The medical team, listening to Roddenberry's lungs, heard bi-lateral breathing sounds and saw his chest expand and contract. Moreover, Dr. Griffin ordered an x-ray and listened to Roddenberry's stomach for sounds of oxygen possibly being pumped into his stomach rather than into his lungs. Dr. Griffin and another physician examined the x-ray and determined that it established that the intubation tube was in the correct place, the trachea. Furthermore, although Roddenberry's oxygen saturation levels did not increase following the intubation, which would be expected if the intubation tube was properly placed, Roddenberry's levels did not decrease either, which would be expected if the intubation tube was improperly placed. As a result of the foregoing, both Dr. Griffin and Cruce were convinced that Cruce had properly placed the intubation tube into Roddenberry's trachea.

Seven minutes after Cruce inserted the intubation tube, Roddenberry's urine changed from a clear color to a reddish color. Red urine in a burn victim can indicate either a fatal condition known as hemolysis, which is caused by the breakdown of the burn victim's red blood cells, or a non-fatal condition known as rhabdomyolysis, which is caused by the breakdown of the burn victim's muscle pigment. At trial, no expert for either side testified as to which of the two conditions, if not both, caused Roddenberry's urine to turn red in color. Yet, all experts agreed that if, in fact, Roddenberry had been suffering from hemolysis, such a condition would be fatal. Although the lab report indicated that Roddenberry's blood sample, taken subsequent to the discovery of the red urine, was badly hemolyzed, experts for both appellants and appellees testified that this finding could have indicated some other interference with the interpretation of the results, such as elevated potassium levels.

Nineteen minutes after Cruce inserted the endotracheal tube, morphine was administered to Roddenberry. Twenty-three minutes after Cruce inserted the endotracheal tube, Roddenberry had no pulse, which led the medical team to begin cardiopulmonary resuscitation. As their efforts were unsuccessful, Roddenberry was declared dead shortly thereafter.

During the autopsy, which the medical examiner performed the following day, the examiner found the endotracheal tube in Roddenberry's esophagus. Although the examiner found some evidence of damage to Roddenberry's lungs, she did not have lung samples examined to ascertain the extent of the inhalation injury. The examiner also did not determine whether the red urine had been caused by hemolysis or rhabdomyolysis. According to the examiner, Roddenberry's cause of death was morphine poisoning which caused him to go "over the edge" when he was already hypoxic from the esophageal intubation.

At trial, Dr. DeRespino, appellees' expert...