Sanchez v. General Hospital

• Decision Date: 25 February 1981
• Citation: 172 Cal.Rptr. 342,116 Cal.App.3d 776
• Court: California Court of Appeals Court of Appeals
• Parties: Irma SANCHEZ, a minor et al., Plaintiffs and Cross-Appellants, v. BAY GENERAL HOSPITAL, Defendant and Appellant. Civ. 18823.

Page 342

172 Cal.Rptr. 342

116 Cal.App.3d 776

Irma SANCHEZ, a minor et al., Plaintiffs and Cross-Appellants, v. BAY GENERAL HOSPITAL, Defendant and Appellant.

Civ. 18823.

Court of Appeal, Fourth District, Division 1, California.

Feb. 25, 1981.

Hearing Denied April 29, 1981.

McCormick & Royce, Patrick A. McCormick, Jr., San Diego, Horvitz & Greines, and Alan G. Martin, Encino, for defendant and appellant.

Goebel & Monaghan, Brian D. Monaghan, Purvin, Hinton & Adkins, and Paul D. Hinton, San Diego, for plaintiffs and cross-appellants.

STANIFORTH, Associate Justice.

The jury awarded plaintiffs, the four surviving minor children of Socorro Sanchez (Sanchez), compensatory damages in the sum of $400,000 for her wrongful death resulting from the negligence of the nursing staff at the defendant Bay General Hospital (Hospital). At the close of evidence in a six-week trial, the Sanchez children moved for a directed verdict on the issue of liability. The trial court granted the motion based upon its conclusion that the doctrine of res ipsa loquitur was applicable as a matter of law. Hospital appeals contending that the basic conditions required for the application of the doctrine of res ipsa loquitur were not established as a matter of law. The minor children on the other hand contend that there was a total failure to rebut the clear presumption of negligence on the part of the Hospital's nursing staff in caring for Sanchez after her operation and release to the recovery room. It is asserted the Hospital failed to produce any conflicting evidence that would warrant the giving of a conditional res ipsa loquitur instruction to the jury.

Following the jury verdict of the $400,000, a separate hearing was held on the question of the Hospital's entitlement to an offset of $45,000 paid by defendants Kriak and Morrell, owners and operators of the other car involved in the accident causing Sanchez' original injury in 1973. Defendants Kriak and Morrell were dismissed from this proceeding upon payment of the $45,000 in settlement.

FACTS

As a result of minor injuries sustained in a 1973 automobile accident, Sanchez filed a personal injury action in the superior court against the defendants Kriak and Morrell, the owners and operators of the other automobile involved in the accident. As a result of the minor physical problems persisting after this accident, Sanchez was referred to Dr. Jeanes, who admitted her to the Hospital on February 24, 1975, for a diagnostic procedure, a cervical myelogram. Following the myelogram, an elective surgery (laminectomy) was suggested and Sanchez consented. The surgery was successfully performed. On the morning of the surgery, Dr. Norman Siderius placed an atrial catheter in Sanchez by inserting a plastic tube with a needle on the end into the vein of her left arm and advancing it up the vein until it entered the upper right mid-atrium of her heart. The purpose of the catheter was to drain off any air embolism that might develop. With the catheter in place, Sanchez was transferred to the recovery room at about 12:35 p. m. in satisfactory condition. In the recovery room, she vomited slightly, a common postoperative event. During the period 12:35 p. m. through 3 p. m., while Sanchez remained in the recovery room, she appeared to be recovering satisfactorily. Her vital signs were checked every 15 minutes and appeared stable. At the time her last vital signs were taken in the recovery room, blood pressure reflected a reading of approximately 120/80. She appeared comfortable and at 3 p. m. she was asleep. At 3:15 p. m. she was transferred to the postoperative ward where a series of complications arose in her condition. The atrial catheter was left in place and apparently used and regarded by the nursing staff as a peripheral "I.V." She departed the recovery room in apparent satisfactory condition but her vital signs were not taken at that time. At approximately 3:20 p. m., Sanchez arrived at the postoperative ward located on the second floor of the Hospital. Again no vital signs were taken by the nursing staff at that time, no neurological examinations were conducted and no tests for responsiveness were taken. The medical chart from the recovery room was not examined and none of the nursing personnel on the postoperative ward were aware that Sanchez had an atrial catheter implanted which had entered her heart.

The nursing staff conducted no examination of Sanchez's pupils on her arrival in the postoperative ward nor did they order any suctioning equipment, though her medical chart, had it been reviewed, reflected Sanchez was vomiting while in the recovery room. At approximately 3:30 p. m., Sanchez's vital signs were taken by nurses aide Sandra Johnson. They reflected a substantial decrease in blood pressure, pulse and respiration rate (96/60, 80, 18). Sandra Johnson made no comparison of the vital signs taken at 3:30 p. m. with the recovery room vital signs, nor were vital signs taken at any increased interval thereafter. No check of medication was undertaken, no neurological examination was done, no test for responsiveness was done, no examination of the pupils was done, no suction equipment was ordered and the nursing staff remained still unaware of the existence of the atrial catheter in Sanchez's heart. No supervisory nurse or physician was contacted or notified of the deteriorating vital signs. Requests by friends for medication and assistance were ignored and no communication of Sanchez's condition was made to the oncoming nursing staff. For example, at 3:40 p. m. Eduardo Vasquez a friend visiting Sanchez who was present from the time of her arrival in the postoperative ward reported to the nursing station Sanchez was vomiting and in pain. He requested medication and water to revive her. The Hospital nursing staff member did not leave the nursing station to verify the report but informed Vasquez "everything has been taken care of" and told him he could get Sanchez water. The operating surgeons' order directed that no water be given. Again no doctor or supervisory nurse was contacted nor was Sanchez's chart consulted.

At approximately 3:45 p. m., nurses aide Delino took Sanchez' vital signs which reflected a further decrease in blood pressure, pulse and respiration rate (90/50, 68, 16). No comparison was made of these vital signs with either the vital signs taken at 3:30 p. m. or in the recovery room; no direction was made that the vital signs be taken at intervals of five minutes or less in view of deteriorating condition. No neurological examination or tests for responsiveness or examination of pupils were undertaken and no physician or supervisory nurses were contacted with respect to Sanchez' decreasing life signs. Sanchez was vomiting so Delino reported this to her team leader, Nurse Marmito. Marmito then went to Sanchez's room and checked the vital signs and found they tallied with those taken by Delino.

At approximately 3:55 p. m. Sanchez' heart arrested. Just before the cardiac arrest she had continued the vomiting which had been occurring consistently since her arrival on the floor. In the midst of this vomiting episode, she jerked violently, her pupils dilated and she became cyanotic. Her pulse stopped and her visiting friend ran for assistance. Delino entered the room, saw Sanchez and ran out in panic. Delino did not check the airway nor blood pressure, pulse or respiration, nor did she perform a cardiopulmonary resuscitation (CPR). Nor did she signal the nursing staff from the room. Thereafter and in response to Delino's cries, Nurse Marmito entered the room and checked the pupils, pulse and blood pressure and she then also panicked and did nothing to assist Sanchez. Again the Sanchez' airway was not checked and no CPR was undertaken.

A few moments later the emergency room physician (Ochs) arrived and attempted to treat Sanchez. Dr. Ochs was not told that what appeared to be a peripheral I.V. was in fact an atrial catheter. As a result of this oversight, all medications ordered by Dr. Ochs were administered through the catheter directly into Sanchez's heart. By 5 p. m. Sanchez was "brain dead" and she was transferred to an intensive care unit in critical condition. She existed in a vegetative state until April 23, 1975, at which time she died.

Sanchez ultimately died after the following incidents occurred: The nursing staff failed to properly inflate and care for a balloon cushion on the cuff of the tracheostomy tube. The nurses note reflects "(n)o nursing personnel on floor will take responsibility for giving tube feeding due to inability to inflate trach cuff completely and knowingly." As a result of this failure, the cuff of the tracheostomy tube gradually worked its way through the posterior of the trachea, eroded part of the left anterior aspect of the thoracic vertebrae and eroded laterally on the right side of the innominate artery. When the innominate artery eroded, Sanchez bled to death. The foregoing facts are essentially uncontradicted taken primarily from the testimony of witnesses presented on behalf of the Hospital.

DISCUSSION

I

The Hospital argues the trial court committed prejudicial error in directing a verdict on the issue of liability because (1) the basic conditions of res ipsa loquitur were not established as a matter of law, (2) there was substantial evidence showing defendant was not negligent and finally (3) no negligence upon the part of the defendant was a proximate cause of the injury.

A directed verdict on the issue of liability may be granted only when disregarding all question of credibility and all unfavorable evidence and construing the evidence most strongly against the moving party and giving the resisting party the benefit of all presumptions and rational inferences drawn from the evidence, it can be said as a matter of law there is still a total lack of evidence of sufficient substance to support a verdict in favor of the...