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Hospital Vicarious Liability for Physician and Care Team; Compartment Syndrome


A man underwent a complex, six-hour, cardiac surgery. The doctor who performed the procedure went on vacation four days later. In his absence, other doctors assumed the role of the man’s primary physician.

 

Although the man’s heart surgery went well, he had a difficult recovery. He developed various complications, including pneumonia and a blood infection. His condition required intubation for four days starting the second day after the surgery. The hospital brought in an infectious disease specialist to treat him.

 

Eight days after the surgery, his chart noted that his left calf was swollen, red, and painful to the touch. His ability to bend his joints in both ankles was weak, particularly on his left leg. Based on these symptoms, the infectious disease specialist and his acting primary physician suspected that he had cellulitis, a bacterial infection typically treated with antibiotics, even though he was already on antibiotics for the earlier blood infection.

 

Two days later, he could not fully flex his left foot and dragged his left toe when he walked during physical therapy sessions. The infectious disease specialist then suspected that he suffered from compartment syndrome, a complication from lengthy surgical procedures. Typical symptoms of compartment syndrome include hardness, swelling, numbness, tingling, pallor, loss of neurological function, lack of pulse, and severe pain. The man did not complain of excruciating pain, but throughout his recovery time, he had been on heavy doses of pain medication. Another physician conducted a compartment pressure test, which indicated that the man suffered from compartment syndrome.

 

Compartment syndrome can result in irreversible damage but is curable if detected early. The man underwent surgery to relieve his compartment syndrome, but it was too late. He suffered necrosis, muscle and other cell death within the compartment, resulting in permanent injury to his left leg.

 

The man sued the hospital for medical malpractice. The complaint asserted that the hospital was vicariously liable for the negligence of its managers, supervisors, agents, and employees who treated him. The complaint’s list of the responsible agents and employees included the doctor who performed the surgery, one of the doctors who took over the man’s care when the first doctor left on vacation, and a physician's assistant.

 

The man’s expert orthopedic surgeon testified that the medical care provided to the man fell below the standard of care because of inadequate monitoring and failure to rule out a known possible postoperation complication. The expert orthopedic surgeon opined that the doctor who performed the procedure was ultimately responsible as team leader at the outset of the man's treatment. The expert testified that with proper monitoring the man’s compartment syndrome should have been detected earlier. His leg should have been examined on every round, which occurred twice per day. The expert opined that the man would not have suffered permanent injuries or would have had a better outcome if the standard of care had been met. He thought it likely that the compartment syndrome began to develop while the man was intubated for four days starting the second day after the surgery. The expert could not determine precisely when the man developed compartment syndrome due to the lack of record entries regarding monitoring and testing.

 

The man’s expert cardiovascular surgeon opined that the cardiovascular surgeon in charge of the man's care failed to meet the standard of care of such practitioners. He testified that the doctor who performed the procedure was responsible for the medical care team. Thus, if a physician's assistant made a mistake, the doctor who performed the procedure was responsible in the same way as the captain of a ship. The expert cardiovascular surgeon explained that the medical care team, as directed by the surgeon in charge, should have checked for compartment syndrome, since it was a recognized complication of a long surgical procedure of the type the man experienced. He further opined that the failure to promptly diagnose the man's compartment syndrome based on his leg symptoms while being treated with antibiotics fell below the standard of care. He testified that the failure to monitor for compartment syndrome began with the doctor who performed the procedure and continued thereafter. In the expert’s opinion, had the hospital employees not breached the standard of care, the man would have had a better chance of avoiding injury or would have suffered a less severe injury.

 

The Whatcom County Superior Court instructed the jury that any act or omission of an employee was the act or omission of the hospital corporation. The jury returned a special verdict for the man, finding that the hospital was negligent and that its negligence was a proximate cause of his injury, awarding him $583,000 in damages.

 

The trial court granted the hospital's postverdict motion for judgment as a matter of law. The trial court ruled that the man failed to prove a breach of the standard of care on the part of any particular hospital employee. The Court of Appeals affirmed.

 

The Supreme Court of Washington reversed and remanded for reinstatement of the jury verdict. The court held that the trial court erred in ruling that the man failed to prove a breach of the standard of care on the part of any particular hospital employee; groups of health care providers may be held liable under the medical malpractice statutes; and a jury may determine that a particular physician did not breach the standard of care but that other physicians and health care providers did, allowing hospital liability under respondeat superior principles.

 

The trial court erred in ruling that the man failed to prove a breach of the standard of care on the part of any particular hospital employee. The man’s expert orthopedic surgeon and expert cardiovascular surgeon identified the doctor who performed the surgery as individually negligent. The expert cardiovascular surgeon testified that the negligent failure to properly monitor the man started with the doctor who performed the surgery and continued when the man’s care was transferred to the other surgeon and employees of the hospital. The expert orthopedic surgeon testified that the doctor who performed the surgery was ultimately responsible. The expert orthopedic surgeon also testified that the initial onset of the man's compartment syndrome likely occurred while the man was intubated for four days starting the second day after the surgery. Three of those four days the doctor who performed the surgery remained the man’s primary physician. There was no evidence that the doctor who performed the surgery monitored the man for compartment syndrome or directed members of the hospital's care team treating the man during his recovery to so monitor him. The court reasoned that the jury could have relied on that testimony to determine that one or all of the doctors who acted as the man's primary care physician during his postoperative recovery period breached the standard of care, resulting in the hospital's vicarious liability.

 

Groups of health care providers may be held liable under Washington’s medical malpractice statutes. The court explained that the statutory definition of “health care provider” was nonexclusive, extending to an entity employing one or more individual health care providers. The hospital was specifically identified as one such entity. The court reasoned that a hospital medical team collaborating in providing treatment to an individual patient in accordance with hospital policies could constitute yet another type of entity. The court found that the jury instructions comported with this reading of the statute and the instructions were not challenged.

 

Where evidence of the applicable standard of care in a medical malpractice case was presented, a jury may determine that a particular physician did not breach the standard of care but that other physicians and health care providers did, allowing hospital liability under respondeat superior principles. The court reasoned that given the man's experts' testimony regarding the standard of care and breach of that standard by identified doctors who were “health care providers” as defined by statute, the Court of Appeals erred in affirming the trial court's grant of the hospital's motion for judgment as a matter of law.

 

The Supreme Court of Washington reversed the trial court’s grant of the hospital’s postverdict motion for judgment as a matter of law and remanded for reinstatement of the jury verdict.

 

See: Grove v. Peacehealth St. Joseph Hosp., 2014 WL 7003800 (Wash., December 11, 2014) (not designated for publication).

 

 

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