Case Name: Darrell COLEMAN v. CHRISTIAN HOME HEALTH CARE
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 2001-04-11
Citations: 786 So. 2d 819
Docket Number: No. 99-CA-2948
Parties: Darrell COLEMAN v. CHRISTIAN HOME HEALTH CARE.
Judges: Court composed of Judge JOAN BERNARD ARMSTRONG, Judge STEVEN R. PLOTKIN, Judge CHARLES R. JONES, Judge PATRICIA RIVET MURRAY and Judge DENNIS R. BAGNERIS, Sr.
Reporter: Southern Reporter, Second Series
Volume: 786
Pages: 819–827

Head Matter:
Darrell COLEMAN v. CHRISTIAN HOME HEALTH CARE.
No. 99-CA-2948.
Court of Appeal of Louisiana, Fourth Circuit.
April 11, 2001.
Kern Anthony Reese, Kern A. Reese & Associates Inc., New Orleans, Counsel for PlaintiffAppellant.
Frederick H.N. Dwyer, Bailey & Dwyer, Mandeville, James A. Oswald, Shields Mott Lund L.L.P., New Orleans, Counsel for DefendantyAppellee.
Court composed of Judge JOAN BERNARD ARMSTRONG, Judge STEVEN R. PLOTKIN, Judge CHARLES R. JONES, Judge PATRICIA RIVET MURRAY and Judge DENNIS R. BAGNERIS, Sr.

Opinion:
|,ARMSTRONG, Judge.
This is a personal injury case in which the plaintiff alleges that a home health care service failed to adhere to the proper standard of care and, as a result, he suf fered a gangrenous penis. The jury returned a verdict for the defendant and, in particular, determined, in response to a jury interrogatory, that the home health care service did not fall below the applicable standard of care. Based upon a careful review of the record as a whole, we conclude that the jury was clearly wrong/manifestly erroneous and/or that, as a matter of law, the home health care service breached a duty to the plaintiff. Thus, we must reverse the judgment of the trial court. The plaintiff, Darrell Coleman, is a paraplegic. At the relevant time, he lived by himself in his own home. However, he had no means of transporting himself elsewhere and required the assistance of others to go to see a doctor. He required home health care because of very severe ulcers ("bedsores"). He was incontinent and required the use of a Foley catheter which was inserted through the penis into the bladder. His home health care was supplied by the defendant Christian Home Health Care ("CHHC"). Mr. Coleman was cared for by Nurse's Aid Joseph Perkins and Licensed Practical Nurse Larry Hills. They were CHHC employees. On August 31,1990, Mr. Perkins, the nurse's aide, observed blood in | PMr. Coleman's urine. Licensed practical nurse Larry Hills was called to see Mr. Coleman, observed that Mr. Coleman's penis and scrotum were swollen and advised Mr. Coleman to go to the hospital. Mr. Coleman's sister was called and Mr. Coleman's nephew came and took Mr. Coleman to the Veteran's Administration Hospital the next day, September 1,1990.
At the Veterans Administration Hospital on September 1, 1990, Mr. Coleman was given an antibiotic, bactrium, discharged and told to come back in ten days. On September 3, 1990, Mr. Hills made a routine visit to Mr. Coleman and observed that Mr. Coleman had blood in his urine. Mr. Hills testified that the blood in the urine that he observed on September 3, 1990 indicated that there was a problem and that Mr. Coleman was suffering from a trauma somewhere. Mr. Hills testified that he told Mr. Coleman on September 3, 1990 to go to the Veterans Administration Hospital to be evaluated. However, Mr. Hills did not call Mr. Coleman's sister or other family members to inform them that Mr. Coleman needed to go to the hospital and made no other attempt to get Mr. Coleman to the hospital. Mr. Hills did call the CHHC office to report Mr. Coleman's condition to the Director of Nursing, Miss Davis, but she did nothing.
On September 6, 1990, Mr. Hills once more visited Mr. Coleman. On this visit, he observed that the swelling of Mr. Coleman's penis had increased to the point that the penis was twice its normal size. Once again he advised Mr. Coleman to go to the hospital but, once again, Mr. Hills did not call Mr. Coleman's sister or other family members and did nothing to get Mr. Coleman to the hospital. Mr. Hills did call the CHHC office to report Mr. Coleman's condition to the director of Nursing, Miss Davis, but, other than "supposing" at trial that she would have called the hospital, she did not know of anything she did in response to his report.
|sOn September 8, 1990, Mr. Coleman's nephew took him to the Veteran's Administration Hospital. At the hospital, Mr. Coleman was diagnosed as having a "frankly necrotic" (i.e. gangrenous) penis of two days' duration. This meant that there was dead penile tissue. Mr. Coleman was advised that he needed surgery to his penis to remove the dead tissue. He also was advised that it might be necessary to amputate the entire penis. The surgery was performed, and the penis was not amputated, but it was necessary to perform a "debridement", a removal of dead tissue, from almost all of the penis. However, for some time after the surgery, Mr. Coleman believed that his penis had been amputated.
During the surgery, a suprapubic catheter was placed through Mr. Coleman's abdomen directly into his bladder. That catheter was still in place at the time of trial and was expected by Mr. Coleman to be permanent. Later, a second operation was performed to graft skin from Mr. Coleman's leg onto his penis. Mr. Coleman testified that, prior to this injury to his penis, he had sexual function but, after the injury, he did not. He was hospitalized for over two months. There was un-contradicted medical testimony to the effect that necrosis takes 5 or 6 days to develop and that, if Mr. Coleman had been gotten to the hospital at an earlier date, then he would not have suffered the injury of a necrotic penis.
The dispositive issue is whether CHHC should have gotten Mr. Coleman to the hospital at an earlier date.' The plaintiff presented the expert testimony of Maria Trattler, R.N., as an expert in nursing. Nurse Trattler is Assistant Professor of Nursing at LSU Medical Center and was established at trial as very well qualified, both by advanced academic training and by long practical experience, as an expert in the standards of care for nursing. She had several criticisms of CHHC's care of Mr. Coleman. First, she opined that, because of Mr. Coleman's paraplegia and the ^severity of his ulcers (bedsores), a fully-trained Registered Nurse, rather than a Licensed Practical Nurse such as Mr. Hills, should have been assigned to Mr. Coleman. Second, she opined that, when Mr. Hills observed the blood in Mr. Coleman's urine and the swelling of his penis and scrotum, a Registered Nurse should have been sent to assess Mr. Coleman's condition. Third and most importantly, she opined that, on September 3, 5, and 6, Mr. Hills should have done whatever was necessary to get Mr. Coleman to the hospital. She testified that Mr. Hills should have telephoned one of Mr. Coleman's family members to take him to the hospital. In fact, Mr. Hills testified that just a few months before the events in question, in May 1990, he had telephoned Mr. Coleman's sister to tell her that Mr. Coleman needed to go to the hospital, and that there had been no problem with that procedure. There does not appear to be any reason that Mr. Hills could not have repeated that procedure in the September 3-6, 1990 period of the events in question. Nurse Trattler also testified that, in the absence of assistance from Mr. Coleman's family, Mr. Hills (or someone else at CHHC) should have called the Social Worker at the Veterans Administration Hospital who was assigned to Mr. Coleman's case to arrange transportation. As a last resort, Nurse Trattler testified, Mr. Hills or someone else at CHHC should have called an ambulance to take Mr. Coleman to the hospital. Nurse Trattler emphasized that, above all else, Mr. Hills and CHHC had a duty to do more than tell Mr. Coleman that he should go to the hospital and that the duty was to ensure that he did, in fact, get to the hospital.
Nurse Trattler's above discussed expert opinions are unrebutted. CHHC argues that Mr. Hills advised Mr. Coleman to go to the hospital and that Mr. Coleman himself should have called his family members to get him to the hospital. However, on this point, Nurse Trattler testified that a nurse has a duty to act as an | s"advocate" for the patient and that, when Mr. Hills saw that Mr. Coleman had not acted so as to get to the hospital, then Mr. Hills and CHHC had a duty to act so as to get Mr, Coleman to the hospital. She emphasized that this duty was particularly strong because Mr. Coleman was a paraplegic who lived alone. CHHC points out that one of Mr. Coleman's treating physicians, Dr. Salvatore, said in his deposition that a patient has a responsibility to follow through on a nurse's orders. Aside from the fact that Dr. Salvatore was not qualified as an expert in nursing, his testimony was a generalization. He did not contradict Nurse Trattler's expert testimony that when a patient fails (despite the nurse's advice) to get to the hospital when it is necessary, then the nurse has a duty to see to it that the patient does get to the hospital, especially when the patient is a paraplegic living alone. Moreover, common sense dictates that, as between a layperson in Mr. Coleman's position, and a professional health care provider, it is the professional with the ultimate responsibility.
In sum, based upon Nurse Trattler's uncontradicted expert testimony, we conclude that CHHC did breach its duty to Mr. Coleman, and failed to meet the standard of care for nursing, by failing to see to it that Mr. Coleman got to the hospital in a timely manner.
Rlt is apparent, however, that Mr. Coleman also bears responsibility for his injury. There was testimony, which the jury could reasonably credit, that Mr. Coleman eatheterized himself, and did so improperly, so as to initally cause the infection. More importantly, although Mr. Coleman is disabled, he is able to understand nurses' instructions and had a telephone next to his bed that he could use to call relatives for assistance. The fault of Mr. Coleman and CHCC appearing to be about equal, we assessed 50% comparative fault to Mr. Coleman.
The damages suffered by Mr. Coleman are detailed above, in the discussion of his surgeries, hospitalization and their aftermath, and consist of general damages in the form of physical pain and suffering, mental distress and emotional anguish, and disability. These damages are most certainly substantial and we fix the monetary damages at $250,000, to be reduced by 50% due to plaintiffs 50% comparative fault.
For the foregoing reasons, the judgment of the trial court is reversed and we render judgment as aforesaid.
REVERSED AND RENDERED.
MURRAY, J., concurs with reasons.
PLOTKIN, J., dissents with reasons.
BAGNERIS, J., dissents with reasons and concurs with J. PLOTKIN's dissent.
. We do not create any new duty. Rather, we have examined the trial court record with respect to the factual issue of the standard of care for nursing as established by members of the nursing profession. Of course, as the standard of care of a learned profession is a matter of specialized knowledge, outside of the common experience of laypersons, that standard must be evidenced by expert testimony. In the present case, the only such expert testimony is that of Nurse Trattler. In the absence of any contrary expert testimony, there is no basis for rejecting Nurse Trattler's expert testimony as to the standard of care in the nursing profession. Her testimony showed that, as part of the standard of care, a nurse has a duty to get a patient with Mr. Coleman's symptoms to the hospital- — even if the patient does not respond to the nurse's advice to go to the hospital. In other words, the uncontradicled expert testimony shows that noncompliant patients are part of the nurse's job, and that the nurse's duty is to see that such noncompliant patients receive vitally-needed medical care. CHHC's breach of its duty to get Mr. Coleman to the hospital in a timely manner was fully briefed in Mr. Coleman's Supplemental Brief on appeal. The causation on the injury is discussed above where we note the unctradicted medical testimony that necrosis takes 5 or 6 days to develop and that, if Mr. Coleman had gotten to the hospital at on earlier date, then he would not have suffered the injury of a necrotic penis. The basis of the general damages award, i.e., the injuries suffered by Mr. Coleman, is discussed above (surgical removal of dead penile tissue, the possibility of amputation of the penis, the belief for some time that the penis had been amputated, the permanent placement of a catheter through the abdomen into the bladder, a skin graft to the penis, loss of sexual function, and hospitalization for more than two months).