Dent v. Memorial Hospital of Adel

Benham, Chief Justice,

dissenting.

I respectfully dissent to the majority’s reversal of the judgment *319entered on the jury’s verdict in favor of the defendant hospital. Appellants and the majority believe that another jury trial is necessitated by the trial court’s instruction that the jury could not return a lawful verdict for the plaintiffs if the jury found that the hospital employees did not commit any acts of professional negligence or malpractice. The majority bases its conclusion on the belief that certain of the alleged acts of nursing negligence constitute ordinary negligence because the acts purportedly amount to a failure to operate equipment correctly or are administrative acts not involving professional knowledge. It appears from the majority opinion’s succinct summation of the nursing activities at issue that the majority’s position stems from a misapprehension of the vital role nurses play in medical care-giving, and a failure to understand the significance of the General Assembly’s recognition of nursing as a licensed and regulated profession. From reading the transcript of the four-day trial, I have concluded that each of the plaintiffs’ criticisms of the nursing staff’s actions was an assertion of professional negligence since each involved the exercise of professional nursing skill and judgment. There being no ordinary negligence for which the hospital could be held liable,1 the trial court’s charge was not error.2

Through legislative enactment, nursing has been recognized statutorily as a profession. OCGA § 43-26-1 et seq. When a negligence action creates an issue in which professional skill and judgment are involved, professional negligence is at issue. Lamb v. Candler Gen. Hosp., 262 Ga. 70 (1) (413 SE2d 720) (1992). Where, as here, the negligence is an alleged failure to perform nursing duties and responsibilities with the requisite degree of care and skill required of the nursing profession,3 the negligence action is one for *320professional negligence since it “calls into question the conduct of a professional in [the professional’s] area of expertise” and the allegations of negligence involve the questioning of expert nursing judgments. Candler Gen. Hosp. v. McNorrill, 182 Ga. App. 107 (2) (354 SE2d 872) (1987). See also Chafin v. Wesley Homes, 186 Ga. App. 403 (1) (367 SE2d 236) (1988); Gen. Hosp. of Humana v. Bentley, 184 Ga. App. 489, 490 (361 SE2d 718) (1987).4 In Chafin, the allegations found to aver professional negligence included the use of a catheter, the allegedly wrongful administration of drugs, and the decision to feed a patient intravenously. In Bentley, the Court of Appeals ruled that hospital employees exercised expert professional judgment when the medical condition of the patient was the determinative factor in deciding on the amount of supervision to be given a patient. In Robinson v. Medical Ctr. of Central Ga., 217 Ga. App. 8 (456 SE2d 254) (1995), because the decision to employ bed side rails was a matter of nursing judgment predicated on an overall assessment of the patient, it was a question of professional negligence whether the rails on the plaintiff’s bed should have been raised. The assertion that professional hospital personnel having the duty to take a patient’s vital signs did not do so promptly and at appropriate intervals, was an allegation of professional negligence. See Dozier v. Clayton County Hosp. Auth., 206 Ga. App. 62, 65 (424 SE2d 632) (1992).

Ordinary negligence, on the other hand, is at issue where the allegedly negligent conduct involves the execution of issued instructions which execution requires no exercise of professional judgment or skill (Robinson v. Medical Center of Central Ga., supra, 217 Ga. App. at 10 (emphasis supplied)), or the performance of mere administrative or clerical tasks, again involving no professional judgment or skill. See, e.g., Candler Gen. Hosp. v. McNorrill, supra, 182 Ga. App. at 110, where moving a patient from a stretcher to a wheelchair, “an act of relative physical strength and dexterity rather than an act requiring the exercise of expert medical judgment,” did not constitute an act of professional negligence.

The majority opinion points to two allegations of nursing conduct as alleging ordinary negligence. In Porter v. Patterson, 107 Ga. App. 64 (129 SE2d 70) (1962), cited by the majority as involving an act of ordinary negligence indistinguishable from one act of negligence involved herein, the issue was not whether the nurse’s allegedly neg*321ligent act was one of professional or ordinary negligence, but whether the hospital employer or the patient’s physician was responsible under respondeat superior for the nurse’s negligence.5 The majority also concludes that the nurses’ alleged failure to ensure that the “crash cart” was equipped for a pediatric patient constituted ordinary negligence. A hospital may be negligent under the “locality rule” if the facilities and services are not comparable to those “in general use under the same, or similar, circumstances in hospitals in the area. . . .” Candler Gen. Hosp. v. McNorrill, supra, 182 Ga. App. 107 (1). However, where the plaintiffs question the professional judgment of the hospital’s nurses rather than the adequacy of the services or the facilities, the “locality rule” standard of care is not applicable and the exercise of professional judgment is governed by the standard of care ordinarily employed by that profession generally. Wade v. John D. Archhold Mem. Hosp., 252 Ga. 118, 119 (311 SE2d 836) (1984); Candler Gen. Hosp. v Joiner, 180 Ga. App. 455 (1) (349 SE2d 756) (1986). In the case at bar, plaintiffs’ attorney repeatedly assured the trial court and defense counsel that plaintiffs were not attempting to prove “locality rule” negligence and, in lieu of evidence of what similarly situated hospitals provide on their crash cart, plaintiffs went on to present expert testimony that the nurses fell below the professional standard of care by failing to have available on the crash cart the instruments the nurses knew a physician preferred, and the proper-sized equipment.6 Thus, with regard to the assertions that the crash cart was not properly equipped, the plaintiffs chose to forego proving ordinary “locality rule” negligence on the part of the hospital and set about to establish that the allegedly ill-equipped crash cart was the product of the nursing staff’s flawed exercise of professional judgment. The majority, by asserting that the allegation of negligence was one of ordinary negligence, disregards the statements of plaintiffs’ counsel as to what he was alleging and improperly substitutes its judgment as to how the case should have been tried for that of plaintiffs’ counsel.

Because I believe that the alleged acts of negligence on the part of the hospital nursing staff involved matters in which the nurses exercised their professional judgment and skill based upon an overall assessment of their young patient, I must respectfully dissent to the majority’s conclusion that this tragic case contained aspects of ordi*322nary negligence.

Decided December 4, 1998 — Reconsideration denied December 17,1998. Gray & Hedrick, William E. Gray II, L. Bruce Hedrick, for appellants. Hall, Booth, Smith & Slover, John E. Hall, Jr., for appellee.

I am authorized to state that Presiding Justice Fletcher and Justice Sears join this dissent.

The only allegation of ordinary negligence related to the hospital’s purported failure to train the nursing staff. If, however, none of the nurses’ alleged shortcomings constituted professional negligence, then whatever negligence there may have been in the hospital’s training of the nurses could not have been proximately related to the child’s death since the hospital’s alleged shortcoming did not result in the failure of the nursing staff to meet the appropriate standard of care.

While I would affirm the judgment of the Court of Appeals, I do not endorse the rationale employed by that court in reaching its judgment.

There was expert testimony that the nurses had violated the appropriate standard of care by failing to follow the admitting physician’s orders to take the child’s temperature every hour, to place a vaporizer in the child’s room, and to obtain a chest x-ray of the child. Other expert testimony found fault with the nursing personnel for failing to adjust the “gain knob” to record respiration on the apnea monitor; failing to connect both the respiratory and cardiac monitoring functions of the apnea monitor; failing to set both the cardiac and respiratory alarms on the monitor; failing to turn on the respiratory alarm; failing to make written comments about the child after connecting him to the apnea monitor; taking a lengthy period of time to connect the child to the monitor; failing to place a board under the child during resuscitation attempts; failing to establish an IV portal and to intubate the child before the treating physician arrived; failing to fill out a pediatric resuscitation medical chart before the child’s apneic event; failing to have the “crash cart” equipped with pediatric *320bicarbonate, pediatric-size defribillating pads, and a curved pediatric laryngoscope blade; failing to have the appropriately-sized mask for use with the ambu bag; and by not writing up a “code sheet” during the efforts to revive the child. .

The hospital may be held liable under a theory of respondeat superior for the professional negligence of its employee nurses. Holloway v. Northside Hosp., 230 Ga. App. 371 (496 SE2d 510) (1998); Minster v. Pohl, 206 Ga. App. 617, 621 (fn. 1) (426 SE2d 204) (1992).

Porter v. Patterson is also known for being an early statement of the “locality rule,” the standard by which is measured a hospital’s purported negligence in providing equipment and facilities. See Wade v. John D. Archbold Mem. Hosp., 252 Ga. 118 (311 SE2d 836) (1984).

In response, the hospital presented expert testimony that nurses do not fall below the professional standard of care in not having the “preferred” instruments and “size-appropriate” equipment on the crash cart.