Opinion ID: 1604756
Heading Depth: 1
Heading Rank: 6

Heading: The second assignment of error relative to the hospital deals with Instruction 14 defining standard of care. It told the jury as follows:

Text: The care which the law requires of a hospital is that in undertaking to care for a patient, the hospital is bound to give such care to the patient as the hospital knew or in the exercise of reasonable care should have known was required, and this duty is measured by the degree of care, skill and diligence customarily exercised by hospitals generally in the community, and a failure to meet such standards would constitute negligence on the part of the defendant, Buena Vista County Hospital. (Emphasis added.) Plaintiff objected to this instruction as follows:    The instruction advising the jury as to the standard of care required of Buena Vista County Hospital and particularly that part    wherein the jury is instructed that the hospital is held to the degree of care, skill and diligence customarily exercised by hospitals generally in the community, [is objected to] in that    the standard is not restricted to the community but rather to similar locations under similar circumstances. We find the instruction given is proper under this record, but we deem it advisable to express our present views on the question of a hospital's duty toward its patients. The instruction states the general rule which is adhered to by many courts. It is also the rule stated in 40 Am.Jur.2d, Hospitals, section 26, page 869, and 41 C.J.S. Hospitals 8c(3), pages 349-350. Several of our decisions have affirmed judgments in which that form of instruction was used. Bradshaw v. Iowa Methodist Hospital, 251 Iowa 375, 390, 101 N.W.2d 167, 176; Shover v. Iowa Lutheran Hospital, 252 Iowa 706, 712, 107 N.W.2d 85, 88. See also Baker v. United States, 8 Cir., 343 F. 2d 222, 225. No case has been called to our attention in which we have squarely decided its propriety under a specific objection. Our language in the Shover opinion (page 712 of 252 Iowa Reports 107 N.W.2d 85) suggests we have some reservations concerning its use. However, this standard of care has come under increasing criticism in recent years, and the reason for its early adoption no longer appears to exist. It is doubtful today if there is any substantial difference from one locality to another in the type of hospital services rendered. Hospitals must now be licensed and accredited. They are subject to statutory regulation. In order to obtain approval they must meet certain standard requirements. See chapter 135B, Code of Iowa. It is no longer justifiable, if indeed it ever was, to limit a hospital's liability to that degree of care which is customarily practiced in its own community. This is particularly true when we recognizeas we mustthat many communities have only one hospital. Adherence to such a rule, then, means the hospital whose conduct is assailed is to be measured only by standards which it has set for itself. There is no other hospital to which it may be compared. This would permit a hospital to establish a negligent standard of care and later avoid liability by pointing to its own conduct as the norm by which negligence should be tested. We have brushed aside many of these same arguments in connection with the skill to be exercised by a doctor in attending his patient, and we have long compelled him to abide by the rules of good practice followed generally under similar circumstances. McGulpin v. Bessmer, 241 Iowa 1119, 1131, 43 N.W.2d 121, 128; Grosjean v. Spencer, 258 Iowa 685, 691, 140 N.W.2d 139, 143, and citations. Among the jurisdictions which have recently receded from the old rule concerning a hospital's negligence are Carrigan v. Sacred Heart Hospital, 104 N.H. 73, 178 A.2d 502, 503; Avey v. St. Francis Hospital and School of Nursing, 201 Kan. 687, 442 P.2d 1013, 1019-1022; Pederson v. Dumouchel, 72 Wash.2d 73, 431 P.2d 973, 978; Darling v. Charleston Community Memorial Hospital, 33 Ill.2d 326, 211 N.E.2d 253, 14 A.L.R.3d 860. All these authorities hold it is competent to show the standards and practices generally in hospitals, not only in the community itself, but in like communities under like circumstances. In Avey v. St. Francis Hospital, supra, the court discounted the importance of the locality rule, pointing out that Massachusetts, where the rule originated, has now discarded it. Brune v. Belinkoff, 354 Mass. 102, 235 N.E.2d 793, 795-798. Although there the court was dealing with a doctor's duty, much of the language is equally applicable to hospitals. At pages 1019 to 1022 of 442 P.2d, the court emphasizes the fact that uniform standards and regulations are usually required for the licensing of hospitals; that these in many instances recognize the differences with respect to services and equipment, depending upon the size and location of the hospital; and that where proper foundation of similarity of conditions is established, the testimony concerning services rendered in like communities or like hospitals is admissible. The recent Illinois case of Darling v. Charleston Community Memorial Hospital, supra, also holds the duty of the hospital is not to be determined by the care customarily offered by hospitals generally in the particular community. It holds such custom relevant but not conclusive. That decision, too, relied on the fact there is now some basic uniformity in standards among hospitals for licensing purposes. We are convinced the correct standard of care to which hospitals should be held is that which obtains in hospitals generally under similar circumstances. In deciding what are similar circumstances, the jury may consider the customs and practices followed in the particular community and like communities as one element, but these are not conclusive. Having said this much, however, we hold the instruction given in the present case was not reversible error. As pointed out in many of the foregoing authorities, there must be competent evidence upon which to find that a hospital has failed to meet the standard of care required of it. Here plaintiff made no effort to show the standard of care practiced in the Buena Vista County Hospital was different from, or inferior to, that practiced in other like communities. He produced no evidence to establish any standard of care. Under such circumstances it would have been error to let the jury determine that the practices of the defendant hospital did not meet those of hospitals in like communities. There was a total absence of evidence upon which such a finding could be made. VIII. In this assignment of errors, plaintiff raises one other matter which he apparently abandoned. He assigns as error the failure of the court to instruct the jury on the issue of indivisible damages, including both those caused by the accident itself and those resulting from delay in diagnosis and treatment. No authorities are cited to support this contention. It was not argued in plaintiff's written brief nor was it taken up in oral presentation. Under rule 344, Rules of Civil Procedure, we deem this to have been waived and give it no consideration. Allerton-Clio-Lineville Community School District v. County Board of Education, 258 Iowa 846, 848, 140 N.W.2d 722, 723; Quint-Cities Petroleum Co. v. Maas, 259 Iowa 122, 126, 143 N.W.2d 345, 347, and citations. IX. Finally, we find no error either in the court's refusal to instruct on the failure of the hospital to call Mrs. Bayliss as a witness. Mrs. Bayliss is a nurse employed by the hospital when plaintiff was a patient and who was still in its employ at the time of the trial. Four nurses testified. The hospital records were introduced in evidence. There is no showing Mrs. Bayliss had information bearing on the sole question whether the doctor had been properly notified of plaintiff's complaints concerning pain and numbness in his left hand and arm. The only evidence about Mrs. Bayliss occurred on questionable rebuttal testimony when one of the other nurses said many of the entries in the hospital records were in her handwriting. There is nothing in the record to suggest the entries important to this appeal were made by her nor that she had information other than that already testified to by the other nurses. Under these circumstances plaintiff was not entitled to an instruction that failure to produce Mrs. Bayliss as a witness permitted an inference her testimony would have been unfavorable to the hospital. State v. Parker, Iowa, 151 N.W.2d 505, 512, 513; State v. Williams, Iowa, 155 N.W.2d 526, 530, and State v. Thomas, Iowa, 162 N.W. 2d 724, 728. See also Quint-Cities Petroleum Company v. Maas, 259 Iowa 122, 127, 143 N.W.2d 345, 348, and Annotations at 5 A.L.R.2d 896. X. For the reasons stated in Division III hereof we reverse and remand for a new trial as to the defendant, R. E. Mailliard, Sr. We affirm as to the defendants, Buena Vista County and Buena Vista County Hospital. Affirmed as to defendants, Buena Vista County and Buena Vista County Hospital; reversed and remanded for new trial as to defendant, R. E. Mailliard, Sr. All Justices concur, except RAWLINGS and UHLENHOPP, JJ., who take no part.