Manning v. Twin Falls Clinic & Hosp., Inc.

• Decision Date: 08 April 1992
• Docket Number: No. 18816,18816
• Court: Idaho Supreme Court
• Parties: Margarita MANNING, widow of the decedent Daryl Manning, and Helen Jane Heiskell, James Manning, M.D., Kathleen Rivard, John Manning, Carol Stein, and Henry Manning, Esq., the adult children of plaintiff Margarita Manning, and the decedent Daryl Manning, Plaintiffs-Respondents, v. TWIN FALLS CLINIC & HOSPITAL, INC., Virginia L. Anderson, L.P.N., individually, Defendants-Appellants, and Donna Gay Austin, R.N., individually, and health care providers 1 through 5, Defendants. Twin Falls, November 1991 Term

Page 71777

830 P.2d 1185

122 Idaho 47

Margarita MANNING, widow of the decedent Daryl Manning, and Helen Jane Heiskell, James Manning, M.D., Kathleen Rivard, John Manning, Carol Stein, and Henry Manning, Esq., the adult children of plaintiff Margarita Manning, and the decedent Daryl Manning, Plaintiffs-Respondents, v. TWIN FALLS CLINIC & HOSPITAL, INC., Virginia L. Anderson, L.P.N., individually, Defendants-Appellants and Donna Gay Austin, R.N., individually, and health care providers 1 through 5, Defendants.

No. 18816.

Supreme Court of Idaho,

Twin Falls, November 1991 Term.

April 8, 1992.

Rehearing Denied June 17, 1992.

Rosholt, Robertson, Tolman & Tucker, Chartered, Twin Falls, for defendants-appellants. Steven K. Tolman argued.

Webb, Burton, Carlson, Pedersen & Webb, Twin Falls, for plaintiffs-respondents. Kenneth L. Pedersen argued.

PER CURIAM.

I.

This is a medical malpractice case wherein the decedent's family brought an action seeking an award of damages for the wrongful death of Daryl Manning, negligent and intentional infliction of emotional distress, and punitive damages. We affirm the jury verdict awarding compensatory damages and emotional distress damages. We also affirm the punitive damage award against nurse Anderson. However, we reverse the award of punitive damages against the hospital.

Daryl Manning, a sixty-seven-year-old man with a lengthy history of respiratory ailments, was admitted to the Twin Falls Clinic & Hospital on April 17, 1987, with chronic obstructive pulmonary disease (COPD) with marked hypoxemia and increased CO2 retention. According to the record, COPD is characterized by a decrease in both the body's ability to transfer oxygen into the bloodstream and expel carbon dioxide from the bloodstream. Manning had previously been hospitalized several times, including hospitalization for episodes of COPD that were life threatening, and for two years prior to his last admission to the hospital, he had been on prescribed twenty-four-hour-a-day supplemental oxygen which was administered through a nasal canula.

At the time of his hospitalization on April 17, 1987, Manning's disease was in its final stage and the treating physician, Dr. Kassis, told Manning's family that his death was imminent. Upon his admission, and at the request of the family, the record indicates that Manning was classified as a "no code" patient meaning the hospital and its employees were directed by the family not to place Manning on a respirator or resuscitate him if he were to suddenly expire. The family and Dr. Kassis agreed this was to be Manning's last hospital admission. Subsequent to Manning's admission to the hospital, arterial blood gas tests indicated a continual deterioration of his condition. Virtually all of Manning's strength and energy were needed for breathing and he was unable to sleep or eat.

On April 20, 1987, the day of the event in question, a decision was made by the hospital staff to move Manning to a private room. At that time the treating physician estimated Manning had 24 hours to live. Just prior to the attempted move, an arterial blood gas test was taken. Although the results were not available at the time nurses Anderson and Austin attempted to move Manning, the results of the blood gas test indicated Manning's condition had deteriorated to a point precariously close to cessation of the body's ability to sustain life. Preparatory to the move, Manning's supplemental oxygen was temporarily disconnected. Despite the request of family members present who strenuously urged that Manning be given a portable oxygen unit during the move, the nurses declined to do so because of the relatively short distance of the transfer. Manning's bed was pushed no more than fifteen feet when his condition suddenly and dramatically worsened. In the few seconds that the supplemental oxygen was disconnected, Manning suffered extreme respiratory distress and, according to the record, he may have stopped breathing altogether. Resuscitation efforts were attempted and a doctor was summoned. However, when Manning was identified as a "no code" patient, the doctor provided no treatment. Manning died shortly thereafter.

At the time of Manning's death the hospital had a standing committee in place which was responsible for reviewing all deaths occurring in the facility. After reviewing the circumstances, the committee determined that removal of the supplemental oxygen did not cause Manning's death because an arterial blood gas test taken minutes before the incident indicated his condition had deteriorated to a point nearly incompatible with the sustaining of life. Because the committee concluded the brief removal of the supplemental oxygen probably did not cause Manning's death, the hospital did not reprimand or fire the nurses involved. Even at the time of trial, the hospital and nursing staff maintained the nurses had done nothing wrong because the removal of oxygen did not cause Manning's death. Notwithstanding the committee's determination that the removal of oxygen did not cause Manning's death, a policy was implemented shortly after the incident requiring patients who were on prescribed oxygen to be moved with portable supplemental oxygen.

At trial, evidence was presented indicating nurses at the hospital regularly moved patients from room to room without supplemental oxygen. The director of nursing services testified that the nurses had maintained this practice for at least six years, and there was testimony from another nurse that the practice had been in existence for as long as fourteen years. The nurses defended the practice contending the small size of the hospital allowed patient moves to be made quickly, and that there had never been a problem in the past. The hospital administration and doctors testified this practice was conducted without their knowledge or authorization. At trial, one of the hospital's doctors testified that it was a breach of the standard of nursing care for Manning to be moved without his prescribed oxygen. Dr. Kassis also testified that Manning's death was "caused by a sudden plummet of his already terribly low oxygen level" and that the plummet was the result of Manning's prescribed oxygen being removed.

After a jury trial, plaintiffs were awarded $3,500 compensatory damages and plaintiff Helen Jane Heiskell was awarded $1,000 for emotional distress. In addition, the jury awarded $300 punitive damages against nurse Anderson and $180,000 punitive damages against the hospital. Nurse Austin was relieved of all liability.

The issues we find dispositive on appeal are whether the trial court properly instructed the jury, and whether the issue of punitive damages should have been submitted to the jury.

II.

During trial, the hospital objected to the use of Instruction 16 involving a "substantial factor" causation standard, and Instruction 17 consisting of an "increased risk of harm" instruction.

A.

The standard of review when reviewing jury instructions on appeal requires us to determine whether the jury was properly and adequately instructed. Accordingly, we must review the instructions and ascertain whether the instructions, when considered as a whole, fairly and adequately present the issues and state the applicable law. Leazer v. Kiefer, 120 Idaho 902, 821 P.2d 957 (1991); Matter of Estate of Roll, 115 Idaho 797, 770 P.2d 806 (1989); McBride v. Ford Motor Co., 105 Idaho 753, 673 P.2d 55 (1983). Reversible error only occurs when an instruction misleads the jury or prejudices a party. Salinas v. Vierstra, 107 Idaho 984, 695 P.2d 369 (1985).

Instruction 16 was a modified version of IDJI 230 which removed the language requiring a "but for" causation analysis. Instruction 16 provided:

When I use the expression "proximate cause," I mean a cause which, in natural or probable sequence, produced the complained injury, loss or damage. It need not be the only cause. It is sufficient if it is a substantial factor in bringing about the injury, loss or damage.

In our recent case of Fussell v. St. Clair, 120 Idaho 591, 818 P.2d 295 (1991), we held that application of the "but for" causation contained in the standard IDJI 230 was inappropriate in those cases involving multiple causes or factors. In Fussell, we approved the following modified version of IDJI 230 for application in multiple cause cases:

When I use the expression "proximate cause," I mean a cause which, in natural or probable sequence, produced the damage complained of. It need not be the only cause. It is sufficient if it is a substantial factor concurring with some other cause acting at the same time, which in combination with it, causes the damage.

The instant case involved multiple factors or causes. The plaintiffs asserted the nurses' conduct caused Manning's death while the hospital contended Manning died from his pre-existing illness as evidenced by arterial blood gas tests taken moments before the attempted move. Instruction 16, while not identical to the instruction approved in Fussell, was adequate, and we hold that the trial court did not err by instructing the jury as to "substantial factor" causation in Instruction 16.

B.

The hospital also asserts that reversible error was committed when the jury was instructed as to "increased risk of harm" as a basis for finding the nurses liable for Manning's death. Instruction 17 provided:

A nurse who undertakes to render services to a patient which one in her position should recognize as necessary for the protection of that patient's well-being is subject to liability for death resulting from her failure to exercise the applicable standard of care to perform to the undertaking, if the failure to exercise such care increases the risk of death at the time and place it occurred.

The propriety of the doctrine of "increased risk of harm" is an issue of first impression in this jurisdiction. ¹ The doctrine of "increased risk of harm" along with the corresponding...