St. Paul Medical Center v. Cecil

• Decision Date: 19 November 1992
• Docket Number: No. 05-91-01036-CV,05-91-01036-CV
• Citation: 842 S.W.2d 808
• Parties: ST. PAUL MEDICAL CENTER, f/k/a St. Paul Hospital, and Helen Dobbs, Appellants, v. Dennis CECIL and Kathleen Cecil, Individually, and as Next Friend For and in Behalf of Steven Cecil, A Minor, Appellees.
• Court: Texas Court of Appeals

Page 808

842 S.W.2d 808

ST. PAUL MEDICAL CENTER, f/k/a St. Paul Hospital, and Helen

Dobbs, Appellants, v. Dennis CECIL and Kathleen Cecil, Individually, and as Next

Friend For and in Behalf of Steven Cecil, A Minor,

Appellees.

No. 05-91-01036-CV.

Court of Appeals of Texas,

Dallas.

Nov. 19, 1992.

Stephen A. Khoury, Dallas, for appellees.

James A. Williams, Dallas, for appellants.

Before THOMAS, CHAPMAN, and WIGGINS, JJ.

OPINION

THOMAS, Justice.

St. Paul Medical Center (the hospital) and Helen Dobbs (the nurse) ¹ appeal from a judgment rendered in favor of Dennis and Kathleen Cecil, individually, and as next friend for Steven Cecil, their minor son (collectively appellees). In the first eight points of error, appellants challenge the jury's findings of negligence, proximate cause, and rehabilitation and special-education costs. In their final point of error, appellants assert that the trial court erred in admitting certain expert opinion testimony because the nature and extent of the opinions were not adequately disclosed during the discovery process. We overrule all points of error and affirm the trial court's judgment.

FACTUAL BACKGROUND

During her pregnancy, Kathleen was treated by Dr. David Cook, an obstetrician. The pregnancy appears to have been normal and uneventful.

The record reveals the following relevant events surrounding Kathleen's labor and delivery:

1. About 11:00 p.m. on January 28, 1983, Kathleen believed that her water broke. Her husband called Dr. Cook, who instructed them to go to the hospital.

2. Upon arriving at the hospital, Kathleen went to labor and delivery, introduced herself to the nurse, and told the nurse that her water had broken. The nurse placed Kathleen in a labor room and told her to put on a gown and to get into bed.

3. At 12:10 a.m. on January 29, 1983, the nurse performed a pelvic examination, assessed Kathleen's vital signs, contractions, and other conditions, and checked the fetal heart rate by stethoscope.

4. About 1:30 a.m., at the nurse's request, Dr. Michael Steinkampf, a hospital resident, performed a speculum examination. Dr. Steinkampf determined that Kathleen's membranes had ruptured and that meconium ² was present.

5. About 2:45 a.m., the nurse attached an external electronic fetal monitor (EFM) to record the heart rate. The nurse watched the printout strip and then left the room.

6. At 3:20 a.m., Dr. Steinkampf installed an internal EFM. The EFM printout showed severe fetal hypoxia (decrease in oxygen), bradycardia (slow fetal heart rate), and more meconium. Dr. Steinkampf told the nurse to notify Dr. Cook and to prepare Kathleen for emergency cesarean section.

7. After Dr. Cook arrived at the hospital, he decided to use an anesthesiologist rather than a certified nurse anesthetist on call at the hospital, which delayed the delivery.

8. At 4:57 a.m., Dr. Cook delivered Steven by cesarean section.

Steven was born with hypoxic ischemic encephalopathy (HIE), which is a type of brain damage caused by prolonged hypoxia. As a result, he has severe and permanent neurological deficits, cognitive deficits, hearing loss, physical and motor impairment, visual/spacial and visual/perceptual impairment, learning disabilities, and other disabilities associated with cerebral palsy.

Appellees sued Dr. Cook, Dr. Steinkampf, the nurse, and the hospital for negligence. Dr. Cook settled with appellees before trial. The jury found that the negligence of the nurse and the hospital proximately caused appellees' damages and found the nurse and the hospital each fifty-percent negligent. The jury also found that the negligence of Dr. Steinkampf did not proximately cause appellees' damages. The jury awarded appellees $25,000 for past physical pain and mental anguish; $50,000 for future physical pain and mental anguish; $25,000 for past physical impairment; $50,000 for future physical impairment; $1,200,000 for loss of earning capacity; $36,688.26 for medical care provided in the past; $30,000 for rehabilitative care required in the future; and $30,000 for special-education costs required in the future. After crediting the settlement received from Dr. Cook, the trial court entered judgment in favor of appellees for $1,033,879.76.

NEGLIGENCE CLAIM AGAINST THE HOSPITAL

In the first point of error, appellants argue that there is no evidence or, alternatively, factually insufficient evidence to support the jury's finding that the hospital was negligent independent of any conduct of any other defendant. ³ They argue in their second point that this finding is against the great weight and preponderance of the evidence. ⁴ Specifically, appellants complain that appellees introduced no expert testimony on the applicable standard of care for hospitals in the community. They conclude that, because no standard of care was established concerning the allegations against the hospital individually, the jury had to construct or assume its own standard of care. Therefore, appellants contend that any finding of negligence on the part of the hospital individually was based on conjecture. Appellees argue that the issue of the hospital's negligence involved matters that the jury could decide without expert testimony.

A no-evidence point is a question of law. In deciding that question, we consider only the evidence and inferences tending to support the finding and disregard all evidence and inferences to the contrary. Jacobs v. Danny Darby Real Estate, Inc., 750 S.W.2d 174, 175 (Tex.1988). The jury's findings must be upheld if there is more than a scintilla of evidence to support them. Stedman v. Georgetown Sav. & Loan Ass'n, 595 S.W.2d 486, 488 (Tex.1979). Evidence is no more than a scintilla when it is "so weak as to do no more than create a mere surmise or suspicion of [the fact's] existence." Seideneck v. Cal Bayreuther Assocs., 451 S.W.2d 752, 755 (Tex.1970) (quoting Calvert, "No Evidence" and "Insufficient Evidence" Points of Error, 38 TEX.L.REV. 361 (1960)). If the evidence supplies some reasonable basis for differing conclusions by reasonable minds as to the existence of a vital fact, however, then there is some evidence or, in other words, more than a scintilla of evidence. Kindred v. Con/Chem, Inc., 650 S.W.2d 61, 63 (Tex.1983).

In reviewing a factual-insufficiency point, we consider all of the evidence, including any evidence contrary to the judgment. Plas-Tex, Inc. v. U.S. Steel Corp., 772 S.W.2d 442, 445 (Tex.1989); Burnett v. Motyka, 610 S.W.2d 735, 736 (Tex.1980). This Court must consider, weigh, and compare all of the evidence in the record pertinent to the issue under consideration. Sosa v. City of Balch Springs, 772 S.W.2d 71, 72 (Tex.1989) (per curiam); Pool v. Ford Motor Co., 715 S.W.2d 629, 635 (Tex.1986). A finding can be set aside only if it is so contrary to the overwhelming weight of the evidence as to be clearly wrong and unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex.1986) (per curiam). When both no-evidence and insufficient-evidence points are raised, we are to rule upon the no-evidence point first. Glover v. Texas Gen. Indem. Co., 619 S.W.2d 400, 401 (Tex.1981).

In making its findings, the jury weighs the evidence, assesses the credibility of witnesses, and resolves conflicts and inconsistencies. McGalliard v. Kuhlmann, 722 S.W.2d 694, 697 (Tex.1986). The jurors are the judges of the facts proved and of the reasonable inferences to be drawn therefrom. Lockley v. Page, 142 Tex. 594, 598, 180 S.W.2d 616, 618 (1944). This Court is not a factfinder, and we cannot substitute our judgment for that of the jury, even if a different answer could be reached on the evidence. Clancy v. Zale Corp., 705 S.W.2d 820, 826 (Tex.App.--Dallas 1986, writ ref'd n.r.e.).

The only issue raised by appellants under this point of error is whether appellees needed expert testimony concerning the standard of care for hospitals to prove a breach of duty giving rise to liability for negligence. In medical malpractice cases, breach of duty normally is established through expert testimony that the health care provided fell below the standard of care applicable to the medical practice in question. See Martisek v. Ainsworth, 459 S.W.2d 679, 680 (Tex.Civ.App.--Houston [1st Dist.] 1970, writ ref'd n.r.e.). However, the standard of nonmedical, administrative, ministerial, or routine care at a hospital need not be established by expert testimony because the jury is competent from its own experience to determine and apply such a reasonable-care standard. Golden Villa Nursing Home, Inc. v. Smith, 674 S.W.2d 343, 349 (Tex.App.--Houston [14th Dist.] 1984, writ ref'd n.r.e.) (quoting Cramer v. Theda Clark Memorial Hosp., 45 Wis.2d 147, 172 N.W.2d 427, 428 (1969)).

Appellants cite several cases to support their contention that the hospital's standard of care had to be proved by expert testimony. See, e.g., Coan v. Winters, 646 S.W.2d 655 (Tex.App.--Fort Worth 1983, writ ref'd n.r.e.) (care and treatment of patient with berry aneurysm); Williford v. Banowsky, 563 S.W.2d 702 (Tex.Civ.App.--Eastland 1978, writ ref'd n.r.e.) (personal injuries resulting from cut received while obtaining dental treatment); Lee v. Andrews, 545 S.W.2d 238 (Tex.Civ.App.-- Amarillo 1976, writ dism'd by agr.) (failure to diagnose and treat infection resulting from post-operative catheterization); Cleveland v. Edwards, 494 S.W.2d 578 (Tex.Civ.App.--Houston [14th Dist.] 1973, no writ) (failure to correct improper closing of incision resulting in ventricle hernia); Jeffcoat v. Phillips, 417 S.W.2d 903 (Tex.Civ.App.--Texarkana 1967, writ ref'd n.r.e.) (performance of surgery). We note that these cases involve the performance of medical procedures by doctors. Therefore, the nature of the alleged negligence was not within the common knowledge of laymen.

Here, appellees alleged that the hospital was negligent because it assigned the nurse to labor and delivery on the night shift when it knew or should have known that the nurse...