Title: GAINES v. COMANCHE COUNTY MEDICAL HOSPITAL

State: oklahoma

Issuer: Oklahoma Supreme Court

Document:

GAINES v. COMANCHE COUNTY MEDICAL HOSPITAL  GAINES v. COMANCHE COUNTY MEDICAL HOSPITAL 2006 OK 39 143 P.3d 203 Case Number: 100598 Decided: 06/13/2006 As Corrected: June 20, 2006 THE SUPREME COURT OF THE STATE OF OKLAHOMA STEPHEN GAINES, Appellant, v. COMANCHE COUNTY MEDICAL HOSPITAL and NURSEFINDERS, INC., Appellees. CERTIORARI TO THE COURT OF CIVIL APPEALS, DIVISION IV ¶0 While hospitalized for multiple gunshot wounds, the appellant, Stephen Gaines (Gaines/patient), developed decubitus ulcers (bedsores). The patient filed a medical malpractice suit against his doctor and the appellees, Comanche County Medical Hospital (hospital) and Nursefinders, Inc. (Nursefinders). After the doctor was dismissed from the cause, the hospital and Nursefinders moved for summary judgment on grounds that Gaines had not presented expert physician testimony to support his claims. The trial court sustained the motion and the Court of Civil Appeals reversed. Under the facts presented, we hold that: 1) as a matter of first impression in Oklahoma law, a registered nurse -- with eighteen years of experience, who is familiar with the standards of nursing care for the elderly and critically ill and who has a certification for wound care -- may offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, care and cause of bedsores; and 2) the existence of genuine issues of material fact concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable requires the reversal of summary judgment. CERTIORARI GRANTED; COURT OF CIVIL APPEALS OPINION VACATED; REVERSED AND REMANDED. Mike Markey, Wichita Falls, Texas, for appellant, Stephen Gaines, Inona Jane Harness, Leslie D. Guajardo, Pierce Couch Hendrickson Baysinger & Green, L.L.P., Oklahoma City, Oklahoma, for appellee, Comanche County Memorial Hospital, Monty B. Bottom, Jason T. Rogers, Foliart, Huff, Ottoway & Bottom, Oklahoma City, Oklahoma, for appellee, Nursefinders, Inc., Stephen Peterson, Michael McMillin, FENTON, FENTON, SMITH, RENEAU & MOON, Oklahoma City, Oklahoma, for amici curiae, Oklahoma State Medical Association & Oklahoma Hospital Association. WATT, C.J.: ¶1 The cause presents a question of first impression in Oklahoma law: whether a registered nurse -- with eighteen years of experience, who is familiar with the standards of nursing care for the elderly and critically ill and who has a certification for wound care -- may offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, treatment and cause of bedsores. Under the facts presented, we determine that the registered nurse's expertise makes her qualified to give such expert testimony and express her opinion. ¶2 In allowing the nurse-expert's testimony as to the practices of other nurses, we align Oklahoma jurisprudence with all other jurisdictions considering whether a nurse may offer expert opinion testimony concerning decubitus ulcers. ¶3 The second question requires that we consider whether a material issue of fact exists militating against the entrance of summary judgment. Here, the only physician testimony contained in the record indicates that the doctor does not consider himself an expert on decubitus ulcers. ¶4 When presented with the review of summary judgment, all inferences and conclusions to be drawn from the underlying facts contained in the record are considered in the light most favorable to the patient.5 Summary judgment is improper if, under the evidentiary materials, reasonable individuals could reach different factual conclusions.6 We are constrained to reverse summary judgment when it appears there are disputed facts.7 ¶5 Here, genuine issues of material fact exist concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable. Therefore, we determine that the judgment should be reversed and the cause remanded for a resolution of these issues by the trier of fact. RELEVANT FACTS ¶6 On December 1, 2000, following injuries from multiple gunshot wounds, the appellant, Stephen Gaines (Gaines/patient), was admitted to Comanche County Memorial Hospital (hospital), an appellee herein. Gaines was a large man, approximately six feet four inches tall and weighing three hundred and eighty pounds. Following his initial surgery, Gaines suffered two abdominal eviscerations requiring surgical repair. The repairing physician, Kelly Means, M.D. (Means), instructed that Gaines not be moved for forty-eight hours following the second procedure. ¶7 Gaines left the Hospital on January 17, 2001, when he was transferred to another facility. Before his transfer and while in the hospital, Gaines developed bedsores on his sacral area, feet, heels and head. ¶8 The doctor who was originally a defendant in the cause testified that he did not consider himself any kind of an expert on bedsores and that he would find it difficult to identify the stage of the ulcers.8 The nurse's affidavit offered as plaintiff's evidentiary material provides that: 1) the standard of care for the critically ill patient was not carried out by the hospital's nurses; 2) the failure to reposition the patient was a direct contributor to the development of severe decubitus ulcers; 3) the nurses failed to meet the standard of care when they did not place heel protectors on Gaines' heels or feet and that this negligence was a direct and foreseeable cause of the development of decubitus ulcers; and 4) the decubitus ulcers could have been avoided if the standard of care had been followed.9 ¶9 The patient filed a malpractice suit against Means, the hospital and the appellee, Nursefinders, Inc. (Nursefinders), in October of 2002. Subsequently, the doctor was dismissed from the malpractice cause leaving only the hospital and Nursefinders as defendants. The hospital and Nursefinders filed a motion for summary judgment on February 17, 2004, on grounds that Gaines had not come forward with any expert physician testimony to support his malpractice claims. Gaines opposed the motion and requested additional time to provide a more detailed vitae on the nurse's qualifications. Nevertheless, on April 1, 2004, the trial court sustained the motion. Recognizing the management of pressure sores is the responsibility of nurses, the Court of Civil Appeals reversed. DISCUSSION ¶10 a. The registered nurse's expertise makes her an appropriate professional to offer expert testimony concerning the practices of other nurses and the standard of care in the avoidance, treatment and cause of bedsores. ¶11 The patient argues that a registered nurse with the experience of his nurse-expert should be allowed to offer an expert opinion as to the practices of other nurses and the standards of care in the avoidance, treatment and cause of bedsores. The hospital and Nursefinders assert that the nurse is not qualified to give an expert opinion in a medical malpractice action. Their assertion is supported by the amici curiae, Oklahoma State Medical Association and the Oklahoma Hospital Association (collectively, Associations), who submitted their statement in support of granting certiorari. We disagree with the hospital, Nursefinders and the Associations. ¶12 It is a rarity when all courts addressing any particular question are in agreement. Nevertheless, our research reveals that, in all causes in which the issue of a nurse's expert testimony arose in response to inquiries concerning a patient's development of and the treatment for bedsores, all jurisdictions having addressed the issue allow the testimony.10 ¶13 The Kansas Court did so in Mellies v. National Heritage, 6 Kan.App.2d 910, 636 P.2d 215 (1981). Mellies shares two important and persuasive factors with this cause. In Mellies, the testimony was offered by nurses who had special training in wound care. Here, the nurse had eighteen years of experience, worked in an area where she treated the elderly and critically ill and was certified for wound care practice. In Mellies, the testimony was offered to demonstrate the negligence of the nursing staff. Here, after the physician had been dismissed from the cause, the nurse's testimony was offered as evidence of substandard care administered by the hospital's staff. ¶14 The Mellies Court concluded that the trial judge abused his discretion in disallowing the nurse's testimony as expert on decubitus ulcers. It concluded that, with the proper foundation, nurses should be qualified as experts as to causation and as to treatment and cure of bedsores. In doing so, it recognized that such skin eruptions are "primarily a nursing problem . . . nurses are experts . . .". ¶15 Mellies represents the position taken by all deciding tribunals concerning nurse-expert testimony in relation to bedsores.11 Research reveals no decision, turning on the issue of whether a nurse may offer expert testimony relating to bedsores, which has disallowed such evidence. ¶16 The Kansas Court's stance is consistent with 12 O.S. 2001 §2702's12 legislative directive providing that witnesses may qualify as experts "by knowledge, skill, experience, training or education." Also instructive on the impact of the statute on nurse-expert testimony is Grover v. Isom, 137 Idaho 770, 53 P.3d 821, rehearing denied (2002). ¶17 In Grover, the Idaho Supreme Court considered the impact a statute similar to §270213 had on recognition of an individual as an "expert." The Grover Court determined that a certified registered nurse anesthesiologist with twenty years of experience was qualified to give expert testimony in a patient's action against an oral surgeon. The Idaho Court found it immaterial that the nurse had never administered anesthesia in an oral surgeon's office. ¶18 Here, the registered nurse has almost twenty years of experience. She is a specialist in wound care nursing and she has practiced with patients who are prone to develop decubitus ulcers -- the elderly and critically ill. She is qualified as an expert witness under 12 O.S. 2001 §270214 by her knowledge, her skill, her experience, her training and her education.15 ¶20 b. The existence of material fact issues concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable requires that the cause be reversed and remanded for a resolution of these issues by the trier of fact. ¶21 Summary judgment is proper only when the pleadings, affidavits, depositions, admissions or other evidentiary material establish that there is no genuine issue as to any material fact, and that the moving party is entitled to judgment as a matter of law. ¶23 In contrast, the nurse outlined her qualifications arising from eighteen years of nursing practice, her certification for wound care and her knowledge of the standard of care for nurses to critically ill and/or bedridden patients. Based on her training and experience, the nurse stated in an affidavit signed on February 24, 2004, that: 1) the standard of care for a critically ill patient was not carried out by the Hospital's nurses - Gaines' chart revealed that the nurses did not turn him every two hours as is standard practice to avoid bedsores either before the time his doctor ordered him not to be moved for forty-eight hours or following the rescission of that order; 2) the failure to reposition the patient in required intervals was a direct contributor to the development of severe decubitus ulcers on Gaines' coccyx, heels and head region; 3) the nurses failed to meet the standards of care when they did not place heel protectors on Gaines' heels or feet and that this negligence was a direct and foreseeable cause of the development of decubitus ulcers; and 4) Gaines' development of decubitus ulcers could have been avoided if the standards of care had been followed despite his weight, any nutritional deficits, and/or immobility due to trauma and surgical complications. ¶24 The evidentiary materials reveal material questions of fact as to whether Gaines received appropriate care for the prevention and treatment of bedsores. The registered nurse's testimony regarding the patient's handling by the hospital and Nursefinders might be sufficient for a trier of fact to determine that the care, or lack thereof, that Gaines received caused his decubitus ulcers. The trier of fact might be even more inclined to rule in the patient's favor if, as here, there were no evidence to contradict the nurse-expert's opinion. ¶25 Although we express no opinion on whether Gaines will or should prevail, all inferences and conclusions to be drawn from the underlying facts favor the patient. CONCLUSION ¶26 This case does not involve a situation where a nurse is giving expert testimony against a physician. The doctor has been dismissed from the cause and the only remaining defendants are the hospital and Nursefinders. The nurse's affidavit attached to the motion for summary judgment gave expert testimony based on her training and experience while the doctor stated that he would have difficulty identifying what stage a bedsore was in and that he would not consider himself any kind of expert on such wounds. ¶27 Under the facts presented, we determine that the registered nurse's expertise qualifies her for expert testimony on the issue of bedsores, their cause, treatment and avoidance. In so holding, we align Oklahoma jurisprudence with all other jurisdictions that have considered whether a nurse may offer expert opinion testimony concerning development or prevention of decubitus ulcers. ¶28 The cause presents disputed issues of material fact concerning whether the patient received appropriate treatment and, if not, whether the patient's bedsores were avoidable. Considering all the available evidentiary material in favor of the patient submitted in summary process, we determine that summary judgment should be reversed and the cause remanded for a resolution of these issues by the trier of fact. CERTIORARI GRANTED; COURT OF CIVIL APPEALS OPINION VACATED; REVERSED AND REMANDED. WATT, C.J., LAVENDER, OPALA, EDMONDSON, COLBERT, JJ. - concur. HARGRAVE, J. - concurs in result. WINCHESTER, V.C.J., TAYLOR, J., JOHNSON, S.J. - dissent. KAUGER, J. - recused. FOOT