Opinion ID: 2368220
Heading Depth: 1
Heading Rank: 8

Heading: proof of the standard of care

Text: In order to prevail in a malpractice case the plaintiff must establish through expert testimony not only the standard of care but also that the defendant's conduct did not measure up to that standard. Fitzmaurice v. Flynn, 167 Conn. 609, 616, 356 A.2d 887 (1975). With regard to the qualifications of the expert witness the crucial question is not whether he practiced in the locale where the accident occurred but rather whether he knows what the standard of care is in the locale. Ardoline v. Keegan, 140 Conn. 552, 557, 102 A.2d 352 (1954). For purposes of determining the standard of care applicable to an accident occurring in Stamford, the pertinent area includes at least the entire state of Connecticut. Katsetos v. Nolan, 170 Conn. 637, 646, 368 A.2d 172 (1976). Before we examine the evidence itself a resume of the qualifications of the several expert witnesses called by the plaintiff is in order. Dr. Stephen Fleck is a board certified psychiatrist and is deputy chairman and professor of psychiatry at the Yale Medical School. He is psychiatrist in chief of the Yale Psychiatric Institute and the Connecticut Mental Health Center. He is on the consultant staff of the Stamford Hospital, the West Haven Veterans Administration Hospital and the Connecticut Valley Hospital. He established the general inpatient psychiatric ward at the Yale-New Haven Hospital, a general hospital, and is active in clinical care on that ward. He also is in charge of the entire clinical operations of the Yale Psychiatric Institute inpatient facility treating seriously ill mental patients. Fleck testified that he was familiar with the standard of psychiatric care practiced at general hospitals in the state of Connecticut in January, 1976. Dr. Gerald Flamm is chairman of the department of psychiatry at St. Raphael's Hospital in New Haven and has held this position since 1971. During this same time he has been clinical professor of psychiatry at the Yale Medical School. He is also a consultant at Connecticut Valley Hospital. He has been board certified in psychiatry since 1964, and is an examiner for the American Board of Psychiatry. Flamm is president of the American Association of General Hospital Psychiatrists, the purpose of which is to develop standards of care and education. He was president of the Connecticut Psychiatric Society, and for a number of years has been chairman of the society's peer review committee, which monitors quality and standard of care. He testified that he was familiar with the standards of psychiatric care practiced at general hospitals in the state of Connecticut in January, 1976. Dr. Myer M. Shimelman is director of inpatient psychiatric services at St. Raphael's Hospital in New Haven and an assistant professor of psychiatry at Yale Medical School. He is on the staff of the Yale-New Haven Hospital and has been on the staff of the Griffin Hospital in Derby. Commencing in June of 1972, he became assistant director of psychiatry at the West Haven Veterans Administration Hospital, a general hospital. While in that position he assisted in the design of the psychiatric security unit at the West Haven Veterans Hospital, which contained a seclusion room. He was director of the psychiatric emergency room and established the psychiatric crisis intervention unit for the Bronx Municipal Jacobi Hospital, which at that time was a general hospital with a psychiatric unit. He was responsible for the administration of the psychiatric emergency room and also responsible for approximately fifty psychiatric emergency evaluations per day. He has a private psychiatric practice in addition to his clinical responsibilities at St. Raphael's Hospital. He testified that he was familiar with the standard of psychiatric care practiced at general hospitals in the state of Connecticut in January, 1976. Doris Banchik, Registered Nurse, is chairman of the Psychiatric Mental Health Nursing Program at the Yale School of Nursing. From 1974 through 1977, she held the position of clinical specialist and assistant supervisor of the department of psychiatric nursing at Yale-New Haven Hospital, together with being an instructor of psychiatric nursing at the Yale University School of Nursing. In January of 1977, she had the responsibility for making sure that the psychiatric standard of care was being adhered to at the Yale-New Haven Hospital, and was responsible for the in-service education of the psychiatric nursing staff and the direct supervision of the nursing staff at the psychiatric unit. Since July of 1978, she has been assistant professor in psychiatric nursing at the Yale School of Nursing, which has trained the present directors of psychiatric nursing at Waterbury Hospital, Griffin Hospital, Middlesex Memorial Hospital and Park City Hospital, in what is known as the Yale Model. She testified that she was familiar with the Yale Model in January of 1976. Previous testimony in the case indicated that the defendant relied on the Yale Model for its standard of care for nurses. Susan Faris, Registered Nurse, is the supervisor of nursing for the department of psychiatry at St. Raphael's Hospital. She is the chairman of the General Hospital Psychiatric Nurse Managers Group, which is a group of nursing supervisors throughout the state of Connecticut who are concerned with the proper standard of care for psychiatric nursing in the state. She testified that she had personal knowledge of the care, skill and diligence ordinarily possessed and exercised by registered nurses, licensed practical nurses, and psychiatric technicians in the care of psychiatric patients in psychiatric units at general hospitals in the state of Connecticut as of January of 1976. Vivian Romoff, Registered Nurse, is a licensed nurse in the state of Connecticut. She completed her nursing program at the City University of New York and obtained her master's degree in psychiatric nursing from Yale University School of Nursing in 1972. She later became supervisor of psychiatric nursing at the Yale-New Haven Hospital and was on the faculty of the Yale School of Nursing and the Yale School of Medicine. She established the general psychiatric nursing procedures and policies for the opening of the psychiatric unit at Yale-New Haven Hospital, which policies are still in effect. She is presently the director of nursing and assistant director of the hospital for clinical services at the Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania, a 120-bed hospital affiliated with the University of Pittsburgh School of Medicine, department of psychiatry. She testified that she was aware of the standard of care, skill and diligence ordinarily possessed and exercised by nurses, licensed practical nurses, and psychiatric technicians in Connecticut as of January of 1976, and by general hospital psychiatric units. She gained this familiarity because she spent six years in Connecticut working in psychiatric nursing and has maintained professional contact with psychiatric nurses still working in Connecticut in various capacities, as well as an awareness of the national standard of care in reference to nurses in general hospitals. There was evidence from the plaintiff's expert witnesses that if a psychotic person is placed in a seclusion room the standard of care requires that no objects or furniture should be left there that could cause the patient harm. This requirement applies specifically to the steel bed frame; that if a bed is left in the room with a patient who has a history of attempting to climb over bed rails, the rails should be in the down position; that a mattress used on the bed should not be so small as to leave substantial space between the mattress and the side rails; that a patient in the plaintiff's acute psychotic state should be kept under constant observation; that seclusion should be broken at regular short intervals and the patient's condition assessed; and finally, that when a patient's condition deteriorates to the point where she hears voices telling her to hurt herself, her physician or at least a hospital physician should be notified immediately so that the patient's situation and condition may be evaluated. Although the defendant's evidence disputed most if not all of the plaintiff's evidence, the defendant's bald assertion that the plaintiff introduced no evidence to establish the existence of any psychiatric standard of care does not comport with the facts.