University Hosp. Bldg., Inc. v. Gooding, VV-93
| Decision Date | 20 August 1982 |
| Docket Number | No. VV-93,VV-93 |
| Citation | 419 So.2d 1111 |
| Parties | UNIVERSITY HOSPITAL BUILDING, INC., d/b/a Memorial Hospital of Jacksonville, its nurses, agents, servants and employees, Appellants, v. Emily GOODING, as Personal Representative of the Estate of T. Hagood Gooding, deceased, Appellee. |
| Court | Florida District Court of Appeals |
Rutledge R. Liles, of Howell, Howell, Liles, Braddock & Milton, Jacksonville, for appellants.
V. James Facciolo, of Searcy & Facciolo, P.A., Jacksonville, for appellee.
This cause is before us on appeal from a final judgment entered in a wrongful death action against appellant, University Hospital Building, Inc., 1 in favor of Emily Gooding, the widow and personal representative of T. Hagood Gooding, the deceased. On appeal, appellants contend that the verdict was against the manifest weight of the evidence; that the trial judge erred in failing to grant the hospital's motions for directed verdict and motion for judgment notwithstanding the verdict; and that the trial judge erred in giving plaintiff's requested jury instruction number 16.
Decedent, a 61-year-old man, experienced the onset of pain in his lower abdomen while at home. After contacting the office of his doctor, Dr. Borland, decedent was transported to the emergency room by ambulance. The emergency room staff was advised that decedent was coming to meet Dr. Borland, a gastroenterologist. That doctor, though present in the hospital and paged following decedent's arrival, did not, through circumstances not at issue here, 2 come to the emergency room until a few minutes before his patient's death.
The uncontradicted medical evidence was that decedent suffered a ruptured abdominal aortic aneurysm 3 prior to his admission to the hospital, a critical condition which will, in the absence of surgical intervention, cause death, usually within a few minutes, and that it did in fact cause his death after his admission to the emergency room.
In support of the charge of negligence and, specifically, the requisite causal connection between failure to exercise due care and the death of plaintiff's decedent, plaintiff relied on the testimony of Dr. Charles Bailey, an eminent cardiologist, who testified that the conduct of the emergency room staff did not meet acceptable medical standards in that there was a failure to take an adequate history and do an adequate physical examination or laboratory work.
The evidence shows that the emergency room staff was expecting, momentarily, the arrival of Dr. Borland, who was known to be in the hospital and aware of his patient's pending arrival. The patient did not appear to be in extremis on arrival, and there was testimony that he was reluctant to be examined by the emergency room doctor.
Emergency rooms are used for several types of patients: (1) true emergencies, and (2) convenient places for a doctor and his patient, needing prompt though not emergency care, to meet either while the doctor is in the hospital or after the doctor's regular office hours. Although there was evidence that patients of the second type, who enter the emergency room in order to meet their doctor there, are not generally treated by emergency room staff, Dr. Bailey testified that "good teaching hospitals" and the Joint Commission on Accreditation of Hospitals accord hospital staff concurrent responsibility for the immediate care of such patients.
In the instant case, the patient entered the hospital expressly to be seen by a doctor who was present in the hospital. However, unknown to anyone, the patient suffered a life-threatening condition which required immediate surgical intervention. The jury found that the failure of the emergency room staff to diagnose and immediately operate, even though awaiting the arrival of the patient's doctor, constituted negligence. The question is an extremely close one, but it is difficult to overturn the jury verdict on this point in view of the testimony of Dr. Bailey.
On the issue of causation, the diagnosis of a ruptured aortic aneurysm is concededly a difficult one to make, particularly in an obese patient such as decedent. Dr. Bailey testified to various diagnostic methods which have been used and to the percentages of success of each method in detecting the existence of a ruptured aneurysm. Dr. Bailey also testified that, had some appropriate diagnostic procedure been used and been successful in detecting the ruptured aneurysm, there was a 50 percent chance of saving the patient's life by immediate surgery. 4 Bailey testified that the 50 percent chance diminished minute-by-minute after the patient's arrival at the hospital and terminated when the patient attempted to use the bedpan shortly after 4:45 p.m. Therefore, under Dr. Bailey's testimony, if the emergency room staff had been able to diagnose the aneurysm and perform immediate surgery, within 45 minutes after the patient's arrival at the emergency room, the patient would have had a 50 percent chance of survival.
Causation in fact is proved by evidence that more likely than not defendant's negligence caused the injury. This same burden of proof applies regardless of whether the "but for" or the "substantial factor" 5 test is used. The rule is stated by Prosser as follows: 6
On the issue of the fact of causation, as on other issues essential to his cause of action for negligence, the plaintiff, in general, has the burden of proof. He must introduce evidence which affords a reasonble basis for the conclusion that it is more likely than not that the conduct of the defendant was a substantial factor in bringing about the result. A mere possibility of such causation is not enough; and when the matter remains one of pure speculation or conjecture, or the probabilities are at best evenly balanced, it becomes the duty of the court to direct a verdict for the defendant. (emphasis added)
The testimony of plaintiff's expert, the strongest evidence presented on plaintiff's behalf, establishes that...
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...Hoeke v. Mercy Hospital of Pittsburgh, 299 Pa.Super. 47, 445 A.2d 140 (1982).8 As noted in University Hospital Building, Inc. v. Gooding, 419 So.2d 1111, 1114 (Fla.App.1982), the intermediate courts of appeal are divided over the issue and the question is on certification to the Florida Sup......
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...District. A different result was reached in the First District of the same appellate court. In University Hosp. Bldg., Inc. v. Gooding, 419 So.2d 1111 (Fla.Dist.Ct.App.1982) (First District), the patient had a condition when brought to the hospital which, with proper medical treatment, he h......
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