Yoos v. Jewish Hosp. of St. Louis
| Decision Date | 21 December 1982 |
| Docket Number | No. 44588,44588 |
| Citation | 645 S.W.2d 177 |
| Parties | Eunice YOOS and Richard Yoos, Plaintiffs-Respondents, v. JEWISH HOSPITAL OF ST. LOUIS, Defendant-Appellant. |
| Court | Missouri Court of Appeals |
Parks G. Carpenter, St. Louis, for defendant-appellant.
James F. Koester, St. Louis, for plaintiffs-respondents.
Eunice Yoos and her husband, Richard Yoos, instituted an action against Jewish Hospital of St. Louis and its employee Gene Gardner alleging medical malpractice. The plaintiffs sought money damages resulting from an injury which Eunice Yoos suffered during hip replacement surgery at Jewish Hospital. The injury complained of, and allegedly caused by negligence, was permanent brain damage which rendered Eunice Yoos comatose.
At the trial and before submission of the case to the jury, plaintiffs dismissed their claim against defendant Gene Gardner. No objection to that action is raised on appeal. The claim against Jewish Hospital was submitted to a jury which returned a verdict in favor of the plaintiffs in an aggregate amount of $4,000,000. The defendant Jewish Hospital, after unavailing motions for judgment notwithstanding the verdict and new trial, timely appealed to this court. In this opinion, the parties will be referred to as they appeared in the trial court.
On appeal defendant Jewish Hospital asserts (1) that the evidence adduced by the plaintiffs on the issues of negligence and causation was insufficient as a matter of law to support a verdict or judgment for the plaintiff, (2) that plaintiffs' verdict directing instructions were erroneous in that they illegally assumed a controverted fact at trial, (3) that plaintiffs' damage instructions were ambiguous and allowed the jury to award damages for an occurrence for which defendant was not liable, and (4) a myriad number of evidentiary errors at trial.
A snyoptic review of the evidence is in order before addressing the merits of the contentions on appeal. Plaintiff Eunice Yoos fell at her home on October 31, 1978, injuring her left hip. Eunice was treated by Dr. Robert Lander, an orthopedic surgeon, who took x-rays of the hip and discovered a fracture of the femur immediately below the left hip joint. With Eunice's approval, Dr. Lander ordered surgery to replace the fractured part of the femur with a prosthetic device containing a stainless steel ball designed to fit inside the natural hip joint socket. The surgery, to be performed by Dr. Lander, was scheduled for November 3, 1978, at Jewish Hospital in St. Louis.
From admission on November 2, throughout that night, and until ready for surgery on November 3, Eunice received Demerol for the pain of her broken hip. Immediately before surgery, she received vistaril which increases the effect of Demerol on the patient. Demerol is a narcotic and sedative and is a standard preoperative medication. Standard dosages of the drug were given to Eunice. Since Demerol is a narcotic, it can act to depress respiration. However, Demerol usually does not act as a depressant, especially in the dosage given plaintiff.
In preparation for surgery on November 3, Eunice was given a spinal anesthetic. A spinal anesthetic is a local anesthetic injected into the spinal canal in the lower back. The anesthetic is injected in a glucose solution which makes it heavier than the spinal fluid. The spinal canal is essentially a hollow tube and the height of the spinal anesthetic can be controlled with proper positioning of the patient. By tilting the patient so her head is up and her feet are down, the anesthetic will gravitate downward to bathe and anesthetize the nerves in the lower spinal column. The affected nerves become numb so that the patient has no sensation of pain and no feeling. A surgeon, thus, can operate within the affected area while the patient remains fully conscious. A normal spinal anesthetic is effective for two to six hours.
Gene Gardner, a certified nurse anesthetist employed by Jewish Hospital, administered the spinal anesthetic to Eunice. Before the surgery began, the anesthetic rose to the plaintiff's nipple line. At this level, the anesthetic can temporarily paralyze the intercostal muscles between the ribs which are responsible for about 40% of normal respiration. Dr. Lander commenced the operation twenty-five minutes after the spinal anesthetic was administered to the plaintiff. During this part of the operation, anesthetist Gardner talked with plaintiff to put her at ease and help her relax. Anesthetist Gardner monitored plaintiff's heart beat on a visual scope with accompanying audible beeps, with a stethoscope on her chest, and with a finger on the pulse on her neck. Plaintiff's respiration was heard by anesthetist Gardner through the chest stethoscope and plaintiff's chest was observed rising and falling normally. In addition, the color of plaintiff's face, lips, and finger nails was continuously checked for signs of cyanosis. 1 Plaintiff was given oxygen during this part of the operation and appeared to have full voluntary breathing capability. There were no signs of any oxygen deficiency in plaintiff's blood. Dr. Lander testified that during this part of the operation the plaintiff's blood was bright red at the surgical site--indicating that the blood had adequate oxygen content.
Thirty minutes into the operation the spinal anesthetic began to wear off and the plaintiff experienced pain in her hip. Gardner gave plaintiff an injection of Demerol, hoping that the Demerol would relieve the plaintiff's pain for a sufficient time to allow Dr. Lander to finish the operation. The Demerol did not work and the plaintiff continued to have pain.
Gardner, therefore, proceeded to administer a general anesthetic to the plaintiff which put her to sleep. Initially, plaintiff was given the muscle relaxant Pavulon to reduce muscle twitching. Plaintiff was then given sodium pentothal, a short acting barbiturate which allows the patient to drift off to sleep. Additional amounts of Pavulon were administered to effectively paralyze the voluntary muscles of the plaintiff, some of which control respiration. Additionally, more Demerol and Valium were given to plaintiff.
An endotracheal tube was placed down plaintiff's throat to help her breathe. Through this tube, plaintiff was given an inhalation agent of nitrous oxide, commonly known as laughing gas, mixed with oxygen. This mixture was administered throughout the remainder of the operation to keep plaintiff asleep. The nurse anesthetist "breathed" for the plaintiff by squeezing a rubber bag and forcing the air mixture into plaintiff's lungs. Gardner, thus, manually ventilated plaintiff at a rate of 10 to 12 respirations per minute for the duration of the operation.
The operation continued on for only 20 minutes after the general anesthetic was given to plaintiff. After the operation was completed, Gardner administered several reversal drugs. A reversal drug is a different type of muscle relaxant which takes away or neutralizes the muscle relaxants given during the general anesthetic. This is necessary in order to remove the paralysis of the patient. Atrophine and Prostigmin were given to reverse the Pavulon, Narcan was given to reverse the Demerol, and Antilirium was given to reverse the Valium and sodium pentothal. After these reversal agents were administered to the plaintiff, her voluntary respiration came back to only about 10 respirations per minute. The respiration was not deep enough or regular enough to allow the plaintiff to breathe on her own. Therefore, Gardner continued to manually ventilate her.
At this time, Dr. Muncie came into the operating room. Dr. Muncie is Chief of Anesthesiology at Jewish Hospital and was on call duty during plaintiff's operation. Dr. Muncie checked the dosages of the reversal agents administered to plaintiff and her condition.
Dr. Muncie gave plaintiff some Calcium which is an electrolyte and affects the muscles by giving them more strength. This had no effect and plaintiff's voluntary respiration did not increase. Dr. Muncie then gave plaintiff more Narcan and Antilirium, with no effect. Next, Dr. Muncie gave plaintiff Tensilon, a short acting muscle relaxant designed to determine if other muscle relaxants are still "on board." Plaintiff's reaction was positive. Finally, Dr. Muncie gave plaintiff Pyriodostigimine which is designed to further reverse the muscle relaxant which apparently was still on board.
During Dr. Muncie's administration of plaintiff, Gardner continued to take plaintiff's blood pressure and pulse, checked her breath sounds and color, and manually ventilated her. Neither Gardner nor Dr. Muncie were aware of any problems in plaintiff's respiratory system or vital signs. Plaintiff remained unconscious and, while still being manually ventilated, was taken to the intensive care unit and placed on a respirator. Plaintiff remained comatose thereafter and through trial.
It is undisputed plaintiff suffered severe brain damage to the sensitive area of the brain that is responsible for such things as intelligence, ability to communicate, speak and hear. It is equally undisputed that plaintiff's brain damage was caused by cerebral hypoxia, a lack of oxygen in the tissues of the brain.
The plaintiff's theory of recovery is premised on the alleged negligence of Gene Gardner, the nurse anesthetist employee of defendant Jewish Hospital. The plaintiff's theory is best described in their verdict directing instructions numbers 5 and 6 which were submitted to the jury as follows:
Your verdict must be for the plaintiff Richard Yoos against defendant if you believe:
First, defendant's employee administered a spinal anesthetic which was permitted to spread too high to the nipple line, and
Second, that the spread of the spinal anesthetic...
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