Santa Rosa Medical Center v. Robinson

• Decision Date: 21 December 1977
• Docket Number: No. 15803,15803
• Parties: SANTA ROSA MEDICAL CENTER, Appellant, v. James H. ROBINSON, Appellee.
• Court: Texas Court of Appeals

Page 751

560 S.W.2d 751

SANTA ROSA MEDICAL CENTER, Appellant,

v. James H. ROBINSON, Appellee.

No. 15803.

Court of Civil Appeals of Texas, San Antonio.

Dec. 21, 1977.

Paul M. Green, Lang, Cross, Ladon, Boldrick & Green, San Antonio, for appellant.

Phillip D. Hardberger, Donald J. Walheim, Hardberger, Branton & Herrera, San Antonio, for appellee.

KLINGEMAN, Justice.

Appellant, Santa Rosa Medical Center, appeals from a judgment against it in the amount of $445,000.00 for damages for personal injuries allegedly suffered by appellee, James H. Robinson. The parties will sometimes hereinafter be referred to as they were in the trial court, but in some instances plaintiff will be referred to as "Jimmy"; Santa Rosa Medical Center as "Santa Rosa"; and the Villa Rosa Annex as "Villa Rosa."

Trial was to a jury, who, in answer to special issues submitted, found:

1. The nursing staff of defendant was negligent in failing to contact a doctor prior to the time they did.

2. Such failure was a proximate cause of plaintiff's hemiparesis.

3. Plaintiff suffered damages because of such failure as follows:

(a) Past physical pain and mental anguish, $15,000.00;

(b) Future physical pain and mental anguish, $100,000.00;

(c) Past loss of earning capacity, $15,000.00;

(d) Future loss of earning capacity, $200,000.00;

(e) Past physical impairment, $15,000.00; and

(f) Future physical impairment, $100,000.00.

Plaintiff was a patient in the Villa Rosa Annex to the Santa Rosa Medical Center, undergoing psychiatric treatment. On November 18, 1972, at approximately 11:00 p. m., plaintiff was involved in a scuffle with a nursing assistant and sustained head injuries and an extradural hematoma developed, causing permanent brain damage. Plaintiff sued the hospital, for damages caused by the negligence of the hospital personnel in failing to timely notify a physician of the head injury, seeking damages in the amount of $350,000.00. A jury verdict in the amount of $445,000.00 resulted. The trial court, under objections, granted a post verdict trial amendment increasing the ad damnum clause to $445,000.00.

Defendant asserts 28 points of error, which can be broken down into the following categories:

1. Points of error complaining that the trial court erred in overruling defendant's (a) motion for directed verdict, (b) motion for judgment non obstante veredicto, and (c) entering judgment for plaintiff;

2. Points of error pertaining to causation;

3. Points of error pertaining to admissibility of evidence;

4. Points of error pertaining to trial amendments 5. Points of error permitting to jury issues submission;

6. Points of error pertaining to damages.

The parties are in some dispute as to the standard of review in this case. Defendant asserts "no evidence," "insufficient evidence," and "against the great weight and preponderance" points of error, and asks that (a) this case be reversed and rendered; and (b) in the alternative, that it be reversed and remanded. The whole record must be examined not only to determine whether there is some evidence to support the jury's finding to the jury issues involved, but also to determine whether, considering all the evidence, the finding is not manifestly unjust. See In re King's Estate, 150 Tex. 662, 244 S.W.2d 660 (1951); O'Conner, Appealing Jury Findings, 12 Hous.L.Rev. 65 (1974).

The testimony is lengthy and extensive and we will not attempt to set it forth in full detail. Such testimony covers the full area of plaintiff's cause of action, including negligence, proximate cause, and damages.

PROXIMATE CAUSE

It is to be remembered that the jury found that the nursing staff was negligent in failing to contact a doctor prior to the time that they did, and that such failure was a proximate cause of plaintiff's hemiparesis. The trier of the fact is usually allowed to decide the issue of causation in cases of this nature (1) when general experience and common sense will enable a layman to determine the causal relationship between the event and condition; (2) when scientific principles, usually provided by expert testimony, establish a traceable chain of causation from the condition back to the event; and (3) when probable causal relationship is shown by expert testimony. Lenger v. Physician's General Hospital, Inc., 455 S.W.2d 703 (Tex.1970).

The testimony shows that Villa Rosa is an annex to Santa Rosa. It handles psychiatric cases, some of which are in connection with drug addiction problems.

The accident here involved happened at approximately 11:00 p. m. during the night shift (11 to 7). The testimony indicates that plaintiff and George Morales, a nursing assistant, were engaged in a scuffle, and there is some testimony that plaintiff was trying to kick Morales while Morales was stooping and that Morales grabbed plaintiff's ankle. In any event, plaintiff fell and struck his head. There is testimony by some witnesses that they heard a thumping noise. One witness stated that it sounded like a bowling ball dropping and hitting the floor, and another stated that it was like a baseball bat breaking when hitting a ball. There is testimony that plaintiff immediately complained that his head was hurting and that he vomited a number of times during the night. One nursing attendant testified that plaintiff was very lethargic "real out of it." There is testimony that he moaned and groaned throughout the night; that his speech was "kind of" slurred; that he was not too responsive to verbal stimuli; and that he kept complaining of his head.

There is testimony as to varying blood pressures, but generally his blood pressure was not abnormal. There is also testimony by some witnesses that plaintiff talked coherently; that he walked around; and that on occasion he went to the bathroom. The sister in charge during this shift testified that she recalled nothing at all that was unusual or alarming about plaintiff's appearance. She did testify that she did not know that plaintiff had been vomiting and also that she thought that a doctor had been called.

A nursing care coordinator and supervisor testified that she came on duty at about 6:45 a. m.; that sometime thereafter she was told of the injury and after such report she went and looked at plaintiff; he seemed very sluggish and very lethargic; and that she made a number of tests or checks, including blood pressure, pulse, temperature, and pupils. She testified that there was nothing in the Nurses' Record to indicate that plaintiff's blood pressure or pulse rate had been taken between 11:20 p. m. and the A registered nurse testified that the Nurses' Notes were incomplete in that all the vital signs should have been recorded after the accident and should have been taken every 15 minutes until Jimmy's condition stabilized; that the doctor should have been notified; and that complaint of a headache, the vomiting, and distorted memory are all classical symptoms of a head injury.

next morning at about the tour report change or around 7:00 a. m., but the fact that certain signs were not documented would not necessarily mean that they were not taken. She stated she called Dr. Mathis sometime after 7:30 a. m.; and that when she called she told the doctor of her various observations, the vital signs, and so on; that the doctor said he would be out as soon as he could get there; and that the doctor did come quickly. She further testified that the head injury incident should have been documented on the Nurses' Record, but it was not, and she stated that she would have called the doctor if she had been on duty that night. She testified that at 11:30 p. m. on November 18, Jimmy's blood pressure was reported at 170/110, and that this is high.

A professor of nursing at UTSA testified that she was embarrassed and shocked when she read the Nurses' Notes; that in a psychiatric hospital they should be very careful, and that accidents should be reported immediately; that someone in charge and a doctor should have been notified; that she would have been alarmed at the large drop in blood pressure from 11:20 to midnight; that in view of the entries that had been made throughout the night, it wasn't particularly surprising what happened at 8:20 a. m.; that from the first entry at 11:20 through the night, a knowledgeable nurse could see that Jimmy's condition was changing for the worse.

Dr. Edwin Mathis, a psychiatrist, testified that he had been giving Jimmy psychiatric treatment from about August 1972 until the accident. He testified that he was called by a Mrs. Stovall at approximately 8:20 a. m., who asked him if he was aware that Jimmy Robinson had been comatosive or semi-comatosive for some hours and that he had been vomiting; that he told her to get an ambulance immediately and to have Jimmy transferred to Santa Rosa; that either he or the nurse called Dr. Lee, a neurosurgeon, and that within 40 minutes both he and Dr. Lee were at the hospital.

Dr. Mathis stated that he didn't even attempt to take x-rays; that the symptomology was so frightening that he wanted to have neurosurgeon present; that he was reasonably certain from the description that he obtained over the telephone that Jimmy had sustained a serious intercranial hemorrhage. He testified that if he had been called at midnight instead of 8:20 a. m. he would have definitely gone to the hospital; that he would have called Dr. Lee at that time; and that his actions would have been basically the same. He testified that he felt that the nurses should have called him long before they did; and that he should have been called at 11:20 p. m. and that he was at home at such time.

Dr. Fletcher Lee, a specialist in neurological surgery, the doctor who performed the operation on plaintiff, testified in some detail. He testified that the first contact he had with the plaintiff was on Sunday morning after the head injury; that he first carried out an arteriogram and subsequently an operation was performed to remove a...