Opinion ID: 1653218
Heading Depth: 1
Heading Rank: 6

Heading: other grounds argued on appeal

Text: TMC also appealed on other grounds. We draw freely from the opinion written by the Honorable Gary A. Fenner of the Missouri Court of Appeals, Western District. First, TMC argues that the public duty doctrine bars plaintiffs' claims. Pursuant to this doctrine, Missouri cases have consistently held that public officers are not liable for injuries or damages sustained by particular individuals resulting from a breach by the officers of a duty owed to the general public. Berger v. City of University City, 676 S.W.2d 39, 41 (Mo.App.1984). These holdings are based on the absence of a duty to the particular individual as contrasted to the duty owed to the general public. Id. This rule applies equally to the governmental body for whom the public officers work. Id. We have already held that TMC is not a public entity and its employees are not public officers. Furthermore, unlike the instant case, the cases that have utilized the public duty doctrine involve situations where there is clearly no duty owed to a particular individual. In Lawhon v. City of Smithville, 715 S.W.2d 300, 302 (Mo.App.1986), the court held that the creation of a municipal fire department is for the benefit of the public, and the duty is owed to the entire community. Likewise, the enforcement of a municipality's ordinances by the police is a public duty and no liability arises from the breach of that public duty. Christine H. v. Derby Liquor Store, 703 S.W.2d 87, 89 (Mo.App.1985). In arguing that the public duty doctrine should apply in this case, TMC focuses on the fact that although the fire originated in plaintiffs' room, patients outside the room of fire origin were also in danger and TMC employees had to act out of concern for their safety. TMC goes on to argue that the creation of a special duty towards occupants of the room of fire origin, would jeopardize the safety of persons outside the room of fire origin. If TMC is arguing that hospitals owe only a duty to the general public, not to the individual patients, then no malpractice case could ever be brought against any hospital. However, it appears that TMC is arguing that it owed a duty only to the general public in this particular case because of the nature of the claim. TMC appears to be arguing that, in this particular situation, its role was similar to that of the fire department, and TMC is also comparing the other patients in the hospital to the general public. The fact is that TMC owes a duty of reasonable care to all of its patients. In Stallman v. Robinson, 364 Mo. 275, 260 S.W.2d 743, 745 (1953), this Court stated that even though the case may not be strictly a medical malpractice case, once the hospital accepts a patient, it owes the patient a specific duty of reasonable care proportionate to the patient's needs as the patient's known condition requires. See also Robbins v. Jewish Hosp. of St. Louis, 663 S.W.2d 341, 346 (Mo.App.1983) (a hospital's duty is proportionate to the needs of the patient, meaning that the hospital must exercise such care and attention as the patient's condition requires); Goodenough v. Deaconess Hosp., 637 S.W.2d 123, 126 (Mo.App.1982) (the known mental and physical condition of the patient must be considered in determining whether the hospital's agent exercised due care; the duty to safeguard is proportionate to the patients' needs). The public duty doctrine is inapplicable to this cause. TMC's first point is denied. Second point, TMC argues that there was no evidence to prove a causal connection between various alleged acts of negligence submitted in the verdict director and patient Wheeler's death. Plaintiffs may establish causation by circumstantial evidence, which includes favorable inferences drawn from all the evidence. Brickner v. Normandy Osteopathic Hosp., Inc., 746 S.W.2d 108, 116 (Mo.App.1988) (citation omitted). Initially, TMC argues that there was no evidence to causally link the alleged negligence in allowing smoking without an approved ashtray to the death of patient Wheeler. On the date of the fire, Cheryl Stacy was smoking in room 327 and was using a juice container and soup container for her ashes. Nurse Cominos knew Cheryl was smoking and that she did not have an ashtray. The hospital's policy concerning ashtrays states that the ashtrays must be of noncombustible material, safe design and the only type approved by the hospital. When Nurse Cominos made rounds on that date, she did not see any ashtray in the room. There was evidence that the fire started in the trash can from discarded smoking materials. The jury was free to believe, from the evidence presented, that had Cheryl Stacy been given a hospital-approved ashtray, she would have discarded her cigarette in a proper ashtray and that the fire would not have occurred. Next, in support of this point, TMC argues that there was no evidence to causally link the absence of a smoke detector in room 327 to patient Wheeler's death. It is undisputed that there was no smoke detector in room 327. Liberty's Fire Chief, Richard Lehman, testified that a smoke detector would have given an earlier warning in this fire and that the fire was burning one to three minutes before Nurse Schreiner initially discovered it. He further testified that smoke detectors were sensitive enough in 1986 that they would go off even before the eye would notice smoke in a room. The evidence was sufficient to submit the issue to the jury. Finally, TMC argues that there was no evidence to causally link the death of patient Wheeler to the alleged inadequate fire training of TMC's staff. The man in charge of fire safety training at TMC, Lieutenant Walter Campbell, testified that he did not even use Exhibit 57, TMC's fire safety manual in his orientation and training of the nurses. He testified that the hospital policy was to first remove a patient from the room and out of immediate danger in case of fire. Chief Lehman testified that the particular training received by the TMC nurses was below the standard of care and that attempting to put the fire out with linens would also be indicative of a lack of training. TMC's expert, Fire Captain James Gibson, testified that throwing dry sheets on the fire would have added to the problem by fueling the fire. The jury could have found that if TMC's nurses would have been properly trained, they would have followed their training and prevented patient Wheeler's death by removing him from the room, in accordance with their training acronym RACE. The record reflects that plaintiffs presented sufficient evidence of causation between the alleged acts of negligence and decedent's death to submit the issue to the jury. Third, TMC argues that the jury's verdict in favor of defendant Michelle Taylor mandates the exoneration of TMC. TMC argues that it cannot be liable absent actionable negligence on the part of Michelle Taylor, its employee. TMC cites Moran v. North County Neurosurgery, Inc., 714 S.W.2d 231 (Mo.App.1986), in support of its argument that there can be no judgment against the master where there is a finding of no negligence by a servant. Moran does stand for the proposition that where the right to recover is dependent entirely on the doctrine of respondeat superior and there is a finding of no negligence by the servant there should be no judgement against the master. Id. at 232-33 (emphasis added). However, the Moran court goes on to state that [t]his doctrine is not applicable if the liability of the employer may be predicated upon some basis other than the negligence of the exonerated servant. Id. at 233. TMC's liability was not predicated solely upon the conduct of Michelle Taylor. The verdict directing instructions submitted disjunctive assignments of negligence, including negligent acts by other employees and by TMC. As its fourth and fifth points, TMC argues that the disjunctive nature of the verdict directors rendered them invalid. TMC argues that the multiple disjunctive nature of the verdict directors (Instructions No. 14 for the Wheeler plaintiffs and No. 9 for the Stacy plaintiffs), in combination with the verdict form, unconstitutionally diluted the Article I, Section 22(a) of the Missouri Constitution requirement that nine or more jurors concur in the verdict. Article I, Section 22(a) of the Missouri Constitution provides that in all civil courts of record three-fourths of the members of the jury concurring may render a verdict. In Instruction No. 14, the trial court submitted five disjunctive theories of negligence against TMC as follows: Your verdict must be for plaintiffs Thelma Allen and Amanda Wheeler against Defendant Truman Medical Center, if you believe: First, either: Defendant Truman Medical Center violated its Smoking Policy, either: by allowing smoking without an approved ashtray in Room 327; or by allowing smoking in a no smoking area; or Defendant Truman Medical Center failed to give adequate fire safety training to its employees concerning removal of patients from the danger of fire; or Defendant Truman Medical Center's employees failed to remove patient Wheeler from the danger of fire at the first opportunity; or Defendant Truman Medical Center failed to have a smoke detector in Room 327; and Second, defendant Truman Medical Center, in any one or more of the respects submitted in Paragraph First was thereby negligent; and Third, as a direct result of such negligence, Dale Wheeler died. [2] The verdict directors are instructions for wrongful death with multiple negligent acts submitted, as set out in MAI 20.02. Plaintiffs were bound to follow MAI. See Hudson v. Carr, 668 S.W.2d 68, 71 (Mo. banc 1984) (failure to follow MAI, including the notes on use, is error). According to TMC's argument, submitting cases in multiple negligent acts would always result in unconstitutional error. However, disjunctive submissions are provided for in MAI 20.02 and 17.02. As long as each submission of negligence is supported by the evidence, the submission is proper. See Yust v. Link, 569 S.W.2d 236, 240 (Mo.App.1978); Bunch v. McMillian, 568 S.W.2d 809, 811 (Mo.App.1978). The jury was properly instructed in accordance with MAI 2.04 that nine or more of the jurors had to agree in the verdict. This means that the same nine jurors must agree upon all of the elements necessary for a verdict for or against any particular party claiming damages. Thus, under the verdict director set forth above, the same nine jurors must agree upon at least one particular disjunctive element of the five disjunctive elements submitted under Paragraph First, the same nine jurors must agree that act was negligence as submitted in Paragraph Second and those same nine jurors must agree upon causation as submitted in Paragraph Third. If these jurors return a verdict in favor of the plaintiff, then those same nine jurors must also agree upon the amount of the damages. The direction in MAI 2.04 that nine or more of you must agree in order to return any verdict advises the jury of this fact as does the Form of Verdict that provides for one set of signatures (the nine or more who agree to all the elements) with the return of any particular verdict. If a jury is called upon to return more than one verdict in a particular case because different parties make different claims, such as was the case in Powell v. Norman Lines, Inc., 674 S.W.2d 191 (Mo.App.1984), where one group of nine jurors returned a verdict in favor of the plaintiff and against both defendants, and another set of nine jurors apportioned fault between the two defendants. This result was proper in that case because the apportionment of fault claim was asserted by cross claims filed by the defendants pursuant to Missouri Pac. R. Co. v. Whitehead & Kales Co., 566 S.W.2d 466 (Mo. banc 1978), and this was a separate claim from the plaintiff's main claim. The Form of Verdicts provided in MAI for the submission of such a case properly provide for this result by providing for separate sets of signatures by jurors for the return of the verdict on the plaintiff's claim and the return of the verdict on the apportionment of fault claim. See MAI, Verdict A and Verdict B, Illustration 35.05 [1983 Revision Committee Illustration] (4th ed. 1991). The trial court did not err in submitting multiple acts under MAI 20.02. TMC's fourth point is denied. TMC also argues that the Verdict B form, which was given pursuant to MAI 36.21, operates to restrict those jurors deliberating on the damage issue to the same nine jurors who concurred as to liability by providing only one set of spaces for the jurors to sign their names. TMC's contention is without merit. See our discussion of TMC's fourth point immediately above and of Powell v. Norman Lines Inc., 674 S.W.2d 191. Moreover, TMC did not object to the verdict form, and specific objections must be made at the time the verdict forms are given to the jury. Johnston v. Lerwick, 738 S.W.2d 868, 869 (Mo.App.1986). TMC's fifth point is denied. As its sixth point on appeal, TMC argues that Instruction No. 14 (set out above) is improper for several reasons. First, TMC argues that Instruction No. 14, which directed the jury to find TMC negligent if patient Wheeler had not been removed from danger at the first opportunity, was vague and ambiguous and in irreconcilable conflict with Instruction No. 9 (the verdict director for the Stacy plaintiffs). TMC argues that the term first opportunity was open to interpretation by the jury to mean many different time frames in the rescue scenario, depending upon the point of view taken. TMC then goes on to argue that the alleged inconsistency in the verdict directors for each plaintiff allows the jury to use its roving commission to look at each patient's situation in a vacuum and without regard to the safety of anyone else. However, by defining the reasonable time for removal of a patient as the first opportunity, instead of as a specific point in time, the instruction does just what TMC argues it fails to do. It allows the jurors to determine when a patient should be removed by finding, in light of all the circumstances, when the first opportunity existed. The cases were consolidated because they arose out of the same set of facts, and there is no reason to believe the jury was given a roving commission to look at each patient's situation in a vacuum. Next, TMC argues that one of the disjunctive theories in Instruction No. 14, the one allowing a verdict for plaintiffs if TMC violated its smoking policy by allowing smoking without an approved ashtray, was unsupported by the evidence. It is true that a verdict director that submits disjunctive theories of negligence is erroneous unless the evidence is sufficient to support all of the theories. Bushong v. Marathon Elec. Mfg. Corp., 719 S.W.2d 828, 831 (Mo.App.1986). In support of its argument, TMC notes that there was evidence that there was an ashtray in room 327. However, Instruction No. 14 submits that TMC violated its smoking policy by allowing smoking without an approved ashtray in Room 327. There was evidence indicating that Cheryl Stacy was not using a hospital-approved ashtray and that TMC personnel knew that fact but did nothing about it. Nurse Cominos admitted violating the hospital's smoking policy on the date of the fire by observing smoking and the use of a grape juice cup for an ashtray in room 327. The instruction does not focus on whether TMC supplied an ashtray to the room. There was sufficient evidence to show that smoking was allowed without an approved ashtray. Finally, TMC argues that Instruction No. 14 improperly equated a violation of TMC's smoking policy with negligence. TMC cites Robinson v. St. John's Medical Center, 508 S.W.2d 7, 13 (Mo.App.1974), for the proposition that under Missouri law, an internal policy or procedure manual does not necessarily parallel the proper standard of care for the circumstances. The court in Robinson states: Nevertheless, the manual itself would not serve to absolutely establish the existence of a joint enterprise or adventure as a matter of law or conclusively as a matter of fact; neither would it constitute absolute or conclusive evidence of the proper standard of care in the circumstances... and violation thereof could not constitute actionable negligence unless it was a proximate cause of the casualty.... Id. at 13 (emphasis added). TMC argues that the instruction improperly equates a violation of the smoking policy with negligence because the policy is not evidence of the standard of care. Chief Lehman testified that the failure to enforce hospital smoking policies concerning ashtrays and smoking in patient rooms where people were incapacitated such as room 327, was below the standard of care. In this case, there was evidence that a failure to enforce the policy was below the standard of care. TMC's sixth point is denied. As its final point, TMC challenges various evidentiary rulings as prejudicial. TMC argues that the proffered testimony of Nurse Aletta Fields, as to fire training she received from other Kansas City area hospitals, should have been admitted as evidence of due care. Plaintiffs' counsel objected to the proffered evidence on the basis that it asked for an opinion without laying a proper foundation. TMC's counsel made no effort to rephrase the question and counsel's offer of proof also failed to address foundational matters. The trial court acted within its discretion in sustaining plaintiffs' objection. Next, TMC argues that plaintiffs cross-examined TMC's expert with NFPA (National Fire Protection Agency) report without first admitting expert testimony that the publication was authoritative. However, TMC's counsel made no objection to the cross-examination concerning the report. As this issue was not properly presented to or expressly decided by the trial court, it is not considered on appeal. Rule 84.13(a). TMC also argues that evidence of excerpts of the 1982 Uniform Building Code (UBC) was irrelevant because the provisions did not apply to TMC, and any relevancy was overwhelmed by unfair prejudice caused to TMC. The court limited the use of the UBC to help establish the standard of care but would not allow testimony concerning whether TMC was governed by the UBC. TMC argues that the prejudice resulted from the impression left on the jury that the 1982 UBC provisions concerning sprinklers and smoke detectors defined the standard of care applicable to TMC. Plaintiffs' expert testified that it was below the standard of care to have hospital rooms without smoke detectors. The fact that the UBC requires smoke detectors was merely further evidence of the standard of care. Admission of the excerpts did not constitute reversible error. TMC further argues that evidence of a December 18, 1986, smoking incident was irrelevant. TMC argues that the prior smoking incident was not substantially similar. The incident involved a fire that occurred in a room without a smoke detector, on the same floor of the hospital, as a result of a patient smoking in his room. It occurred less than two weeks prior to the fatal fire out of which these two lawsuits arose. This incident was admissible to show the notice that defendant had of a potential smoking/fire problem. Corley v. Kroger Grocery & Baking Co., 193 S.W.2d 897 (Mo.1946) (evidence that plaintiff was the third person to fall in defendant's store that day admitted on the specific issue of notice on the part of defendant); Dewey v. Kline's, Inc., 229 Mo.App. 1079, 86 S.W.2d 622, 626 (1935) (maid allowed to testify that she had seen persons stumble and fall when going into the toilet room where defendant fell, and that she had reported such occurrences); Mick v. John R. Thompson Co., 77 S.W.2d 470, 475 (Mo.App.1935) (evidence admitted of prior accidents where persons had stumbled over scales located in the same place in restaurant where plaintiff stumbled over them). Where the theory of recovery is negligence, any knowledge or warning that defendant had of the type of accident in which plaintiff was injured clearly aids the jury in determining whether a reasonably careful defendant would have taken further precautions under all the facts and circumstances, which include the knowledge of defendant of prior accidents. Moreover, the degree of similarity required for evidence that constitutes notice to defendant of prior similar accidents is less demanding than the similarity required for a series of prior accidents offered to show that the same accident occurred on the occasion in issue. In discussing this lower requirement of similarity, McCormick states: The proponent probably will want to show directly that the defendant had knowledge of the prior accidents, but the nature, frequency or notoriety of the incidents may well reveal that defendant knew of them or should have discovered the danger by due inspection. Since all that is required is that the previous injury or injuries be such as to call defendant's attention to the dangerous situation that resulted in the litigated accident, the similarity in the circumstances of the accidents can be considerably less than that which is demanded when the same evidence is used for one of the other valid purposes. McCormick on Evidence, § 200 at 848 (4th ed. 1992) (footnotes omitted). We reject TMC's contention that this notice was meaningless and therefore inadmissible because no public hospital could, within the twelve-day period between the two fires, have designed and installed a smoke detector system. TMC's contention goes to weight and not to the admissibility of this evidence. The issue of what precautions, if any, TMC could have taken in the twelve days was for the jury. We affirm the trial court's admission of the evidence of the prior smoking occurrence. Finally, TMC argues that evidence of an uncorrected portion of Michelle Taylor's deposition testimony injected post-accident remedial measures into evidence. TMC's counsel did not object to this testimony at trial. Because this issue was not properly presented to or expressly decided by the trial court, it is not considered on appeal. Rule 84.13(a). Plaintiffs' point is denied.