Case Name: Lynn David GALLOWAY, et al. v. BATON ROUGE GENERAL HOSPITAL and ABC Insurance Company
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1991-06-27
Citations: 583 So. 2d 1169
Docket Number: No. 90 CA 0314
Parties: Lynn David GALLOWAY, et al. v. BATON ROUGE GENERAL HOSPITAL and ABC Insurance Company.
Judges: Before COVINGTON, C.J., and LOTTINGER, SHORTESS, CARTER and LeBLANC, JJ.
Reporter: Southern Reporter, Second Series
Volume: 583
Pages: 1169–1181

Head Matter:
Lynn David GALLOWAY, et al. v. BATON ROUGE GENERAL HOSPITAL and ABC Insurance Company.
No. 90 CA 0314.
Court of Appeal of Louisiana, First Circuit.
June 27, 1991.
Rehearing Denied Sept. 4, 1991.
Leslie J. Schiff, Lafayette, for plaintiffs-appellants Lynn David Galloway and Gary Galloway.
Felix R. Weill, Baton Rouge, for defendant-appellee Baton Rouge Gen. Hosp.
Before COVINGTON, C.J., and LOTTINGER, SHORTESS, CARTER and LeBLANC, JJ.

Opinion:
LOTTINGER, Judge.
This is an appeal from a trial court judgment in favor of the defendants and against the plaintiffs dismissing their claim for damages in a medical malpractice suit.
FACTS
Ora Fay Galloway was admitted to Baton Rouge General Hospital on August 20, 1979, for surgery. On August 21, 1979, Dr. Anthony S. Ioppolo, a neurosurgeon, performed a C4-5 discectomy and a C5-6 anterior cervical fusion and decompression. The surgery was completed at 5:00 p.m., and Mrs. Galloway was taken from the operating room to the recovery room, where she remained under observation by the hospital staff and nurses for about two hours.
Thereafter, Mrs. Galloway was discharged from the recovery room and brought to her floor room at about 7:15 p.m. While in her floor room, she experienced breathing problems caused by bleeding at or near the surgical site. Mrs. Galloway went into respiratory arrest at approximately 8:00 p.m. The hospital personnel responded immediately and performed emergency procedures. However, despite all efforts, Mrs. Galloway went into cardiac arrest and subsequently went into a coma, from which she did not recover. She died approximately one week later.
The plaintiffs subsequently instituted proceedings with a medical review panel against Baton Rouge General Hospital, a qualified health care provider, as required by the Louisiana Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq. In due course, based on the documentary evidence presented, the panel rendered its opinion favorable to the plaintiffs on January 19, 1982, as follows: "The evidence supports the conclusion that defendant, Baton Rouge General Hospital failed to comply with appropriate standards of care as charged in the complaint."
On March 8, 1982, the plaintiffs filed suit against the hospital, and the case was tried before Judge Prank Foil on August 23, 1983, ending in a mistrial. The case was then transferred to a different division and was tried before Judge Carl A. Guidry on May 1, 1984. The matter again ended in a mistrial. Finally, the case was tried before Judge William Brown on September 6-6, 1989. Following this trial, the court, for written reasons assigned, rendered judgment in favor of the defendant and against the plaintiffs.
The plaintiffs appealed raising the following issues:
1. Did the trial court err in refusing to admit the prior testimony of Drs. Iop-polo, Poche and Hanchey (both trial and deposition) as substantive proof of plaintiffs' case?
2. Did the trial court err in holding that plaintiffs did not carry their burden of proof to show that the conduct of the hospital and its employees failed to comply with the appropriate standard of care owed its patient, Mrs. Galloway?
EXCLUSION OF PRIOR DEPOSITIONS AND TRIAL TESTIMONY AS SUBSTANTIVE PROOF OF PLAINTIFFS' CASE
Plaintiffs complain that the trial court erred in refusing to admit the prior depositions and trial testimony of Dr. A.S. Ioppolo, Dr. James Poche, and Dr. Robert Hanchey as substantive proof of plaintiffs' case. We find no merit in this complaint.
The record reflects that the testimony of the three doctors was taken in open court before the trial judge as part of the bench trial. After Dr. Ioppolo's testimony on direct, counsel for plaintiffs offered Dr. Iop-polo's prior trial testimony as "substantive proof of its contents." The trial judge refused to allow the introduction of Dr. Ioppolo's prior court testimony for "direct purposes." However, the trial judge indicated that such testimony could be used for "impeachment purposes." Counsel for plaintiffs declined to offer the testimony for such purposes, but proffered such testimony. After examining Drs. Poche and Hanchey, counsel for plaintiffs made similar requests regarding their prior deposition and trial testimony. The same rulings were made as to the prior testimony and deposition of Dr. Hanchey and Dr. Poche.
These rulings of the trial court were governed by LSA-C.C.P. art. 1450, which at the time of trial provided, in pertinent part:
A. At the trial . any part or all of a deposition, so far as admissible under the Louisiana Code of Evidence, applied as though the witnesses were then present and testifying, may be used against any party who was present or represented at the taking of the deposition or who had reasonable notice thereof, in accordance with any of the following provisions:
(1) Any deposition may be used by any party for the purpose of contradicting or impeaching the testimony of deponent as a witness.
(3) The deposition of a witness, whether or not a party, may be used by any party for any purpose if the court finds:
(a) That the witness is unavailable, or
(b) Upon application and notice, that such exceptional circumstances exist as to make it desirable, in the interest of justice and with due regard to the importance of presenting the testimony of witnesses orally in open court, to allow the deposition to be used.
To be admissible at the trial, two tests must be met. First, it must be admissible under the Louisiana Code of Evidence and, second, the use of the deposition must fit one of the specific provisions of LSA-C.C.P. art. 1450.
Since plaintiffs' counsel did not choose to use the depositions for contradictory or impeachment purposes, LSA-C.C.P. art. 1450 A(l) is inapplicable. Since the three witnesses in question were available to testify and did, in fact, testify, LSA-C.C.P. art. 1450 A(3)(a) is inapplicable.
Plaintiffs rely on former LSA-C.C.P. art. 1450 A(3)(b) to support their contention that the trial judge erred in refusing to allow the prior testimony and depositions to be admitted as substantive proof.
This paragraph specifically provides that the party seeking to use the prior testimony must show that "such exceptional circumstances exist as to make it desirable, in the interest of justice and with due regard to the importance of presenting the testimony of witnesses orally in open court, to allow the deposition to be used."
We do not find that the "interest of justice" would be best served by accepting the prior testimony and depositions as substantive proof that the hospital departed from the standard of care in the postoperative care of Mrs. Galloway. This holding is brought into proper focus when we consider the trial judge's reasons for judgment, in pertinent part:
The medical review board comprised of Drs. Lohmann, Hanchey and Poche originally found that the Baton Rouge General failed to comply with appropriate standards of care as charged. Subsequently, each of the physicians retracted their prior finding and at trial suggest that there was not any evidence that would have put any of the nurses on notice that Mrs. Galloway was suffering from internal bleeding that would cause respiratory problems. Dr. Flynn, Dr. Berry and even Dr. Walters agreed that no one can predict when significant symptoms will manifest themselves when there is internal bleeding. All of Mrs. Galloway's critical signs (blood pressure, pulse and breathing) were normal until immediately before . Mrs. Galloway's inability to breathe.
The trial judge was fully aware that each of the three members of the medical review panel had changed their opinions and had retracted their prior findings. The refusal to allow the prior testimony and depositions in evidence for the purpose offered did not defeat the interest of justice. Therefore, we find that the depositions and/or prior trial testimony of Drs. Ioppo-lo, Hanchey, and Poche were properly excluded.
In their original brief, plaintiffs rely on Stewart v. Zurich Insurance Company, 342 So.2d 1273 (La.App. 4th Cir.1977), as authority for considering the proffered evidence and deciding the case as a trial de novo in light of the prior trial testimony and depositions. In Stewart, the appellate court found that certain evidence which was in the record through proffer had been erroneously excluded. The Stewart case is not controlling as to our decision in the case sub judice, since we have ruled that the proffered evidence was properly excluded for the purposes offered.
In addition, plaintiffs supplemented their original brief citing Buckbee v. United Gas Pipe Line Company, Inc., 561 So.2d 76 (La.1990). In Buckbee, the supreme court found that the trial court erred in excluding testimony of a co-employee (to whom the decedent had said he was going to seek permission of his superior to use heat to extract a plug from a coil on a used crude petroleum heater) was admissible as an exception to the hearsay rule tó show the speaker's out-of-court declaration of intent. Buckbee, however, is inapposite to the instant case. Herein, the exclusion of the evidence was not based on hearsay grounds, and the evidence was properly excluded by the trial judge for the reasons stated above.
FAILURE OF PLAINTIFFS TO CARRY THEIR BURDEN OF PROOF
On this issue, the trial judge stated:
This Court does not find that plaintiffs have carried their burden of proof, that the conduct of the employee(s) of the Baton Rouge General constituted a breach of the duty owed.
In a medical malpractice action against a hospital, the plaintiffs must prove, as in any negligence action, that the defendant owed the plaintiff a duty to protect against the risk involved, that the defendant breached that duty, that the plaintiff suffered an injury, and that the defendant's actions were a substantial cause in fact of the injury. Further, a hospital is bound to exercise the requisite amount of care that the particular patient's condition may require and to protect the patient from external circumstances peculiarly within the control of the hospital. The facts and circumstances of each particular case determines whether a hospital has breached its duties. Smith v. State, Department of Health and Human Resources Administration, 523 So.2d 815, 819 (La.1988). The mere fact that an injury occurs or an accident happens raises no presumption or inference of negligence on the part of the hospital. Berry v. Rapides General Hospital, Inc., 527 So.2d 583, 585 (La.App. 3rd Cir.1988).
In the instant case, the evidence shows that Mrs. Galloway was admitted to the hospital on the evening of August 20, 1979, for a C4-5 discectomy, and C5-6 anterior cervical fusion and decompression. Dr. Ioppolo performed the surgery on the following day from 3:00 p.m. to 5:00 p.m. Following surgery, Mrs. Galloway was taken to the recovery room, accompanied by Dr. Lillian Wills, the anesthesiologist. Dr. Wills testified, by prior trial testimony and deposition, that between 5:00 p.m. and 7:00 p.m., Mrs. Galloway was extubated (removal of the endotracheal tube) and given oxygen.
According to Dr. Wills, she saw Mrs. Galloway two or three times while in the recovery room. At those times, Mrs. Galloway appeared to be doing well, her color was good, there was no abnormal swelling, and there was no respiratory difficulty. Mrs. Galloway asked about other patients in the recovery room. Dr. Wills described Mrs. Galloway's stay in the recovery room as "non-eventful."
Nurses Winkler, LaRochelle and Masey cared for Mrs. Galloway in the recovery room, closely monitoring her during her stay in the recovery room. Winkler was assigned the primary care of Mrs. Galloway. Pursuant to Dr. Ioppolo's orders, Winkler checked the patient's blood pressure, pulse, and respiratory rate at fifteen minute intervals. She also checked the dressings on Mrs. Galloway's neck and hip. During the time Mrs. Galloway was in the recovery room, Winkler observed no swelling. The strength in Mrs. Galloway's arms and legs was also checked every fifteen minutes. All of Mrs. Galloway's vital signs remained stable during er recovery room stay. Dr. Ioppolo described Mrs. Galloway's condition in the recovery room as "very well."
After two hours, the charge nurse, Nurse Masey, examined Mrs. Galloway to see if she was ready to be released to her floor room. Masey found Mrs. Galloway to be awake and oriented. Her vital signs were normal. There was no swelling in the neck, and her breathing and color were good. She exhibited good strength in her arms and legs. Masey performed the standard test to determine whether Mrs. Galloway could be discharged from the recovery room and taken to a floor room. The test results revealed that Mrs. Galloway's condition was favorable for transfer to her floor room.
While Masey was preparing the discharge notes, Mrs. Galloway complained of a tickle in her throat and a tightness of the soft collar. Masey again checked for swelling and had the patient take a deep breath and clear her throat. The patient was able to do this without difficulty. There was no hoarseness or raspiness in her voice.
At 7:15 p.m., Mrs. Galloway was taken by Winkler and a surgical assistant to her floor room. There were no problems during the transfer, and Mrs. Galloway talked to members of her family, telling them she was doing fine. The evidence shows that at this time the patient was alert, and her voice was low, but clear and understandable.
Mrs. Galloway was received in her room by the floor nurse, Nurse Tate, who found the patient to be awake and alert. Mrs. Galloway complained of a scratchy throat and a tickle in her throat. In response thereto, Tate gave the patient a sip of water, which Mrs. Galloway swallowed without difficulty. Tate encouraged Mrs. Galloway to take a deep breath and to cough. Mrs. Galloway had no difficulty with these activities. An examination of her functions revealed that she had good grip strength and could move all extremities. Mrs. Galloway's blood pressure and pulse were normal. Tate observed no swelling in the throat. After assuring herself that the patient was doing well, Tate returned to the nurses' station, leaving Mrs. Galloway in her room with Wanda Collins, Mrs. Galloway's sister.
Mrs. Collins' deposition testimony revealed that while in the room alone with her sister, Mrs. Galloway began having difficulty with breathing. Mrs. Collins testified that Mrs. Galloway's breathing got "much worse, fast." Her condition deteriorated rapidly; she began to struggle, choke, and strangle. Mrs. Collins ran to the nurses' station at about 8:00 p.m. and advised the nurse that the patient was choking. Tate got a suction machine and, with Nurse Belue, went immediately to Mrs. Galloway's room. Tate attempted to suction Mrs. Galloway nasally and sent Nurse Belue to get help from the Neuro Intensiye Care Unit.
An emergency call was sounded, and Dr. Berry, a thoracic and cardiovascular surgeon, Dr. Sheely, a thoracic and cardiovascular surgeon, and Dr. Peltier, the emergency room doctor, promptly responded. The physicians encountered difficulty intu-bating Mrs. Galloway, but eventually, Dr. Berry was able to intubate her. However, by this time, Mrs. Galloway had suffered irreversible injury due to lack of oxygen and died a few days later.
Dr. Kermit L. Walters, a pathologist, performed an autopsy on December 6, 1979. He attributed Mrs. Galloway's death to "anoxia secondary to tracheal compression resulting from arterial bleeding in the right anterior cervical region following C4-C5 diskectomy (sic) and C5-C6 anterior cervical fusion and decompression."
Dr. Ioppolo, the neurosurgeon who was the physician who performed the surgery on Mrs. Galloway, testified as a witness for the plaintiffs, both as a fact witness and as an expert in neurosurgery. He explained the surgical procedures he performed on the patient. In response to questions regarding what type of bleeding was experienced during Mrs. Galloway's surgery, Dr. Ioppolo stated:
If I remember correctly from the operative note, it mentions using the cautery current to control some bleeding sites. It does not mention any particular bleeding site out of the ordinary, just the type of cauterization one uses to control bleeding if one incises the skin, goes through muscles.
Dr. Ioppolo testified that he did not cut or nick any major arteries of the neck. Nor was there any unusual bleeding in the operative site. "Everything was routine," according to his testimony.
Later, on cross, Dr. Ioppolo acknowledged that something apparently occurred after Mrs. Galloway left surgery. Bleeding from the area at or near the surgical site began and then developed to a point where Mrs. Galloway had respiratory problems. Dr. Ioppolo read into the record his "progress notes" of August 21, which stated:
Patient in recovery room . patient in R.R., doing very well. Moving all extremities, talking and quite awake. Brought to floor in same condition and then at approximately 7:45 p.m. said that she had to cough, did so and had a respiratory arrest. Intubated after some difficulty and delay. Neuro exam. Pupils dilated and fixed. No response to pain. Apneic without corneáis. After several minutes, pupils responsive to light, no corneáis. Breathing slightly on own. Impression, hypoxic. Brain damage. Prognosis, grave.
Dr. Ioppolo further testified that the hospital records showed that prior to the development of these problems, Mrs. Galloway's vital signs were "all normal," and that there was a normal blood pressure. Dr. Ioppolo confirmed, however, that the symptoms of the bleeding did not evidence themselves until after Mrs. Galloway had been placed in her room.
Dr. James A. Poche, Jr., a neurosurgeon who served as a member of the review panel, testified as an expert witness for the plaintiffs, and stated that, based on the documents presented to the panel, he was, at that time, of the opinion that the hospital had departed from the standard of care. He stated: "I think at this time what concerned me about that, or why I feel like that was that . [Mrs. Galloway] had obviously died from bleeding into the operative site in her neck and tracheal compression. And I found it rather difficult to imagine that that could take place over a period of time without this being noticed."
In his testimony on cross, Dr. Poche said that on reflection and after discussion with Dr. Lohmann, another panel member, he was of the opinion there was no substandard care by the hospital. In the discussion with Dr. Lohmann, Dr. Lohmann had pointed out that he was troubled by the panel's review of the case. Dr. Lohmann mentioned a drop of the systolic blood pressure to 90, the administering of a steroid medicine during the surgery, and the hematocrit readings which showed a substantial blood loss. These observations caused Dr. Poche to reconsider whether a blood vessel "might have been injured at the time of surgery, caused some bleeding, then coagulated, or stopped, and at some point post-operatively the clot or thrombus within the artery gave way and the artery again started to bleed."
Dr. Poche reiterated that Mrs. Galloway "had a major hemorrhage." He explained his prior opinion as a panel member, that there was a slow bleed, reasoning that he "did not appreciate some of the things that were later pointed out to me that may offer some substance to the fact that it bled rapidly."
Dr. Robert Hanchey, a neurosurgeon who served as a member of the review panel, testified as an expert witness for the plaintiffs. Based on the documents presented to the panel, Dr. Hanchey was of the opinion that Baton Rouge General Hospital had departed from the standard of care required of a hospital toward Mrs. Galloway. He stated that the panel "had difficulty at that time understanding how such a massive hemorrhage could occur and have no . [premonitory] signs" or without the presentation of recognizable clinical changes "which could have led to an earlier awareness of it and perhaps a different outcome." He could not say when the bleeding started.
Dr. Hanchey then testified that he had serious questions as to whether the hospital staff or nurses could have recognized the hemorrhage. He continued his testimony: "But I do think that a review of the record, I think, shows that there may not have been a clinical . [symptom] that they [hospital staff and nurses] could have recognized." Dr. Hanchey then read from his prior court testimony (August 23, 1983): "I think that Dr. Wills' testimony would be very important and if indeed there was no perceptible swelling and no significant difficulty in her eyes at the time the patient was seen in recovery, then that shifts the clinical picture to sometime thereafter."
On cross, the following testimony of Dr. Hanchey was elicited:
Q. Dr. Hanchey, let me ask you the bottom line: sitting here today, do you believe that you can say that any of the nurses or a particular nurse at Baton Rouge General Medical Center fell below the standard of care expected of them in this community?
A. I don't. I don't think they fell below the standard of care.
Dr. George Y. Lohmann, Jr., a neurosurgeon who was a member of the review panel, in his second deposition stated that on further review he had concluded that the hospital was not negligent in its care of Mrs. Galloway. His further reconsideration led him to believe that the hemorrhage had come on suddenly, within a few minutes, and caused compression of the esophagus and trachea resulting in the respiratory arrest of the patient and finally death.
Dr. Thomas B. Flynn, a neurosurgeon, testified as an expert for the defendants. Dr. Flynn was asked what his opinion, after having reviewed the records, was "as to what the mechanism was of this respiratory arrest." He answered:
My feeling was from review of the autopsy record and the patient record, as well as my understanding of the general nature of the operative procedure itself, that the patient had acquired a retro-tracheal hemotoma of a progressive nature, which resulted in collapse of the membranous trachea and airway obstruction.
He also expressed the opinion that the symptoms of the event that happened to Mrs. Galloway would come on in a matter of minutes. Dr. Flynn opined that, from his review of the records, there was no indication that the staff or nurses fell below the standard of care in this case.
Lynn David Galloway, one of the sons of Mrs. Galloway, was present at the hospital during the surgery on his mother. He told of talking with his mother as she was brought from the recovery room:
I asked her how she was doing, and she said she was doing fine. I was happy to see that she was so alert.... She knew who I was. She mentioned the fact that I had to catch an airplane. She knew that I was going to Kansas City later in the day. She mentioned the fact — I said, "How are you feeling?" She said, "My collar, this collar thing feels tight. I feel as though there's something in . [my] throat, I wish I could cough it out."
He testified he had no difficulty hearing his mother; her voice was clear. He said he noticed "no drastic change or I would not have left."
As an intermediate court of review, we are not to set aside the trier of fact's factual findings in the absence of "manifest error" or unless such findings are "clearly wrong." Lirette v. State Farm Ins., 563 So.2d 850, 852 (La.1990); Arceneaux v. Domingue, 365 So.2d 1330, 1333 (La.1978); Canter v. Koehring Co., 283 So.2d 716, 724 (La.1973). And, where there is a conflict in the testimony, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed upon review. Rosell v. ESCO, 549 So.2d 840, 844 (La.1989).
In considering the evidence, the trial judge observed particularly the medical evidence and considered that the three physicians who comprised the Medical Review Board had changed their opinions regarding the failure of Baton Rouge General Hospital to comply with appropriate standards of care. The trier of fact found that "[a]ll of Mrs. Galloway's critical signs (blood pressure, pulse and breathing) were normal" until immediately before the respiratory arrest during which Mrs. Galloway was unable to breathe.
Our review of the evidence convinces us that the trial judge was not manifestly erroneous in his factual findings and his conclusion that the evidence fails to support the plaintiffs' contention that the conduct of the hospital's employees fell below the standard of care owed to Mrs. Galloway in this case.
We affirm the judgment of the trial court at plaintiffs' costs.
AFFIRMED.
CARTER, J., dissents for reasons assigned.
SHORTESS, J., dissents with reasons.
. The plaintiffs are Mrs. Galloway's two surviving children; her husband and one of her sons died in the meantime.
. The panel was comprised of Dr. George Y. Lohmann, Jr., Dr. Robert E. Hanchey, and Dr. James A. Poche.
. At that time, Dr. Ioppolo was also a defendant in the suit; however, upon declaring a mistrial, the cases were severed, and the matter proceeded to trial against Dr. Ioppolo. Galloway v. Ioppolo, 464 So.2d 386 (La.App. 1st Cir.1985).
. Dr. George Lohmann, Jr. did not testify at trial, but his prior deposition testimony was offered into evidence by the plaintiffs without objection.
. By Acts 1990, No. 134, § 1, the text of LSA-C.C.P. art. 1450 A(3)(b) was redesignated as LSA-C.C.P. art. 1450 A(3)(c).