Taylor v. Fletcher Allen Health Care

Dooley, J.,

¶ 16. concurring and dissenting. I concur in the dismissal of plaintiff’s claims that FAHC was negligent in its failure to recognize and diagnose the problems with the hardware and in its treatment of the pain complaints as well as her claim for negligent infliction of emotional distress. I do not concur with the dismissal of the claim that FAHC was negligent when plaintiff fell while attended by a nurse. The majority transforms a routine hospital-fall case into a complex medical-malpractice action requiring expert evidence on the strength of a pro se litigant’s passing reference to a “gait belt.” The essential issue, however, is simply whether plaintiff fell because she was inadequately attended to by a hospital nurse. The case requires no sophisticated technical or medical judgments beyond the' experience of the ordinary layperson. I therefore respectfully dissent.

¶ 17. Plaintiff’s complaint alleged that, about a week after her spinal surgery, she “was being assisted to the bathroom by a nurse . . . when said nurse withdrew support and assistance to Plaintiff unexpectedly and without warning and caused Plaintiff to fall violently on the toilet.” The fall allegedly caused plaintiff severe pain and emotional distress, further damaged her spine, *426loosened the screw from the original surgery, and required a second surgery to correct the damage. The hospital moved for summary judgment, asserting — among other arguments — that plaintiff had failed to present expert evidence establishing “the proper standard of care” for assisting a recovering surgical patient to the bathroom. Plaintiff filed a pro se opposition, claiming that the case fell within “the common sense exception” to the general rule requiring expert evidence in medical malpractice actions. The trial court granted the hospital’s motion in a two-line entry order stating that plaintiff could not prove her case “[wjithout a medical expert.”

¶ 18. In affirming the judgment, the majority acknowledges the “ ‘common sense exception’ ” to the general rule that medical malpractice plaintiffs must use an expert witness to prove medical negligence. Ante, ¶ 9. While not cited by the majority, there is — in fact — ample authority to support the conclusion that a case where a nurse drops a patient fits into this exception. See, e.g., Massey v. Mercy Med. Ctr. Redding, 103 Cal. Rptr. 3d 209, 215 (Ct. App. 2009) (holding that, where post-operative patient fell while under nurse’s supervision, expert testimony on standard of care was not required since “common knowledge and experience can be used to determine whether the patient fell because she . . . was insufficiently attended to by medical personnel”); Davis v. Montgomery Cnty. Mem’l Hosp., No. 05-0865, 2006 WL 1896217, at *1, *4 (Iowa Ct. App. July 12, 2006) (rejecting hospital’s claim that “the process of transferring a skilled-care patient from a bed to the bathroom required expert testimony on the standard of care involved” because it involved “nonmedical and routine” procedure within common knowledge of jurors); Dimora v. Cleveland Clinic Found., 683 N.E.2d 1175, 1180 (Ohio Ct. App. 1996) (holding that patient who fell while being assisted by nurse fit within “common-knowledge exception” and patient was not required to produce expert testimony to establish professional standard of care); McGraw v. St. Joseph’s Hosp., 488 S.E.2d 389, 395-96 (W. Va. 1997) (holding that patient who fell while nurses were attempting to assist him back to bed raised issue involving “routine hospital care” that did not require expert medical evidence to establish standard of care); Cramer v. Theda Clark Mem’l Hosp., 172 N.W.2d 427, 428-29 (Wis. 1969) (holding that patient’s fall involved “custodial or routine hospital care” that was not so “complex or technical” as to require expert testimony on *427standard of care). This Court has similarly recognized a “common knowledge” exception to the normal expert-testimony requirement in malpractice cases involving “routine care, ministerial and not technical” where, for example, a hospital patient whose call-light went unanswered fell while trying to go to the bathroom on her own. Newhall v. Cent. Vt. Hosp., Inc., 133 Vt. 572, 573-74, 349 A.2d 890, 892 (1975).

¶ 19. The majority concludes, however, that the instant case is distinguishable because plaintiff, in her pro se opposition to the motion for summary judgment, claimed that the proper standard of care for assisting patients recovering from spinal surgery was to use a “gait belt” device, which was not done in her case, and to use a procedure specified by a head nurse, who had assisted her prior to the incident. She also attached a page containing two short paragraphs purporting to be from nursing manuals that refer to the use of a “gait belt” and a “transfer belt” for assisting a patient with ambulation. From this the majority concludes that the case is too “complex” for a layperson to judge, as only an expert would enable a jury to properly determine whether the nurse breached her duty of care by not using the device. Ante, ¶¶ 10-11. It adds that plaintiff cannot rely on the hearsay statements of the first nurse to supply the expert evidence.

¶ 20. I doubt that the reference to the gait belt turns this case into one of complex, multivariate analysis that only an expert can perform. After all, a gait or transfer belt is a simple strap that is placed around the waist to help move a person from one place to another. It can be purchased inexpensively in almost any well-stocked retail pharmacy or online for home use. Nurses are undoubtedly better trained in their use than laypersons, and nursing manuals undoubtedly recommend them. But this does not make their use so complex to require an expert witness.

¶21. My main point here, however, is different. Under the majority’s analysis, plaintiff’s claim would survive if she never mentioned the gait belt or the head nurse, but fails because she did. I disagree. While she suggested that the use of the gait belt may have prevented the fall, and she would not have fallen if the procedure developed by the first nurse had been followed, her claim remained that the second nurse was negligent in allowing *428the fall to occur. As the cases from other jurisdictions hold, this is a claim that can and should be resolved by the jury.2

¶ 22. I agree with the majority that expert evidence was required to determine whether plaintiffs fall caused further damage to her spine or loosened the surgically placed screw, as she alleged. Plaintiff also sued, however, for the severe pain and emotional distress that resulted from the fall, and this did not require expert evidence. See Human Rights Comm’n v. LaBrie, Inc., 164 Vt. 237, 247-49, 668 A.2d 659, 667-68 (1995) (noting that expert medical testimony on causation has not been required to support a finding that employee suffered disabling pain from workplace injury, and holding similarly that “[n]o expert testimony on causation was necessary” to support award for emotional distress from discrimination); see also Williams v. Lucy Webb Hayes Nat'l Training Sch., 924 A.2d 1000, 1003 (D.C. 2007) (holding that plaintiff was not required to present expert medical testimony that her negligent transfer from hospital gurney after surgery caused intense pain during the period that followed, since the issue was not a “complex” one and “ordinary human knowledge” would permit jury to find that plaintiff would not have suffered pain except for the negligent transfer).

¶ 23. Accordingly, I would reverse the judgment and remand for further proceedings.

¶ 24. I am authorized to state that Justice Robinson joins this concurrence and dissent.

Plaintiff neither identified nor relied on any medical experts, apart from the two brief statements in her opposition to the motion for summary judgment that purported to be excerpts from nursing manuals. Accordingly, the trial court would be fully entitled to exclude such evidence in the event that it was offered at trial.