Macon-Bibb County Hosp. Authority v. Ross, MACON-BIBB

• Decision Date: 10 September 1985
• Docket Number: No. 70785,MACON-BIBB,70785
• Parties: COUNTY HOSPITAL AUTHORITY v. ROSS.
• Court: Georgia Court of Appeals

Page 633

335 S.E.2d 633

176 Ga.App. 221

MACON-BIBB COUNTY HOSPITAL AUTHORITY v. ROSS.

No. 70785.

Court of Appeals of Georgia.

Sept. 10, 1985.

Rehearing Denied Sept. 26, 1985.

Certiorari Denied Oct. 30, 1985.

Joseph W. Popper, Jr., John A. Draughon, Macon, for appellant.

Neal D. McKenney, Jane M. Jordan, Macon, for appellee.

DEEN, Presiding Judge.

The appellee, Annie Mae Ross, commenced this action against the appellant, the Medical Center of Central Georgia, seeking recovery for alleged negligence in its administration of a drug during her hospitalization. The jury returned a verdict of $27,000 for the appellee, and this appeal followed.

While at work on April 8, 1981, the appellee became ill, and her employer took her to the emergency room of the appellant. She arrived at the emergency room at approximately 2:40 p.m., at which time she was having difficulty breathing and had a bluish discoloration of her skin due to lack of oxygen in the blood. The appellee had a slow pulse rate and her blood pressure was 2 50/150, which required immediate medical attention.

At 2:52 p.m., the appellee became unresponsive, and at 2:55 p.m. she went into respiratory arrest. (A respiratory therapist had to insert an endotracheal tube into the appellee's trachea.) At 2:58 p.m., Nipride, a drug extremely effective at decreasing blood pressure, was administered intravenously, and her blood pressure quickly dropped. (By 3:12 p.m. her blood pressure was 1 20/90, and the physician ordered discontinuation of the Nipride, although it appears that the drug actually was administered until 3:31 p.m.) In fact, by 3:28 p.m., the appellee had no blood pressure at all. Because of the rapid drop in pressure, the attending physician ordered intravenous administration of Dopamine, a drug potent at elevating blood pressure, and at 3:20 p.m. it was started in the appellee's right wrist. After the Dopamine was started, the appellee's blood pressure stabilized, and she was transferred to the cardiac care unit at 4:30 p.m.

At midnight a nurse noted the IV in the appellee's arm and a "bruise bluish in color." The next notation in the patient chart was entered at 11:00 a.m. the following morning, at which time the appellee's right arm was swollen, sore, and with a large blistered area around the IV. An identical entry was subsequently recorded at 4:00 p.m. There is no indication in the records that a physician was consulted or informed of this condition until 6:50 p.m., when the blistered right arm was shown to a Dr. Wilcox. Later that evening, another physician cleansed the blistered area and treated it for the burn; a large area of the appellee's lower right arm was permanently scarred. It is undisputed that the injury to the appellee's arm was caused by an infiltration of the Dopamine, i.e., the drug seeped out of the vein into the surrounding tissue. While an infiltration may result from improper technique, it may also be due to the size of the IV needle, the fragility of the patient's veins, or a particular patient's physical intolerance of an IV.

At trial, the appellee's expert witness, Nancy Murphy (a registered nurse), testified that according to the Physician's Desk Reference (PDR), a reference book described by the witness as the Bible for anyone involved in administering medications, Dopamine should be infused into a large vein whenever possible in order to prevent the possibility of extravasation into adjacent tissue. The PDR specifically recommended the large vein at the bend of a patient's elbow; less suitable infusion sites should be used only if the patient requires immediate attention, and if resort is made to such a less suitable site, the IV should be moved to a larger vein as soon as possible. A Dopamine IV should be monitored continuously for free flow. Should an infiltration of Dopamine occur, the PDR suggested treatment of the damaged area as soon as possible, preferably within 12 hours, with a saline solution containing Regitine. A physician's order was required before Regitine could be administered.

Nurse Murphy testified further that from her review of the hospital records, she felt that the hospital personnel had been negligent in inserting the IV in the smaller vein at the appellee's wrist, or at least in the failure to document why it was not placed in the recommended site initially or subsequently. She also suggested that the hospital should have utilized an IV infusion pump, rather than a drip chamber, which would have better regulated the amount of the flow. Perhaps most importantly, Murphy criticized the failure to notify promptly a physician of the appellee's swollen and blistered arm. Held:

1. The appellant contends that the trial court erred in allowing Murphy to testify that an IV infusion pump should have been used rather than a drip chamber, on the basis that she was not qualified as an expert on the standard of care applicable to the defendant hospital because she was not familiar with the standard of care in similar hospitals in similar communities. Whether a witness is qualified to give an opinion as an expert is within the trial court's discretion, which will not be disturbed on appeal unless manifestly abused. Smith v. Hosp. Auth. of Terrell County, 161 Ga.App. 657, 659, 288 S.E.2d 715 (1982).

In the instant case, nurse Murphy testified that she was familiar with several hospitals in the Atlanta, Georgia area and in Forsyth County, Georgia, but she had never worked at a hospital in the vicinity of Macon, Georgia. (The appellant's own nurse expert was familiar with hospitals in Augusta, Georgia, but similarly had never worked in any hospital in the Macon area.) Neither party adduced a comparison of the size and available resources of the defendant hospital with those of the hospitals with which nurse Murphy was familiar. The testimony that the...