Opinion ID: 1295414
Heading Depth: 3
Heading Rank: 5

Heading: Duty to inspect nursing standard of care

Text: I next consider the duty to inspect for skin integrity. Given that patients recovering from surgery are entrusted to the care of nurses who have the responsibilities of attending to the immediate needs of patients and of monitoring their recovery, the duty to inspect for skin integrity would arise from a nursing standard of care. At this point, I must note my concern about the district court's reasoning with respect to the duty to inspect for skin integrity. The court stated that it would have been against Dr. Pairolero's instructions for nurses to disturb the restraint. The court then asserted that the head restraint was not a dressing or bandage which would have made a nursing standard of care applicable, but rather a device designed to prevent possible death. The court concluded that Wick, as a nurse practitioner, was not qualified to recommend post-operative care for this type of surgery. In reaching this conclusion, the court disregarded Wick's opinion that the restraint had the essential characteristics of a `dressing,' so as to require adherence to the skin integrity and dressing inspection protocols. Again, the district court's reasoning appears to flow from Mayo's theory of the case. By using this approach, the court erred in how it evaluated Wick's qualification to give an expert opinion on a duty to inspect for skin integrity. More particularly, this error resulted in the court's adopting Mayo's theory that this case is strictly one of thoracic surgeon malpractice as opposed to Broehm's nursing malpractice theory. The burden on Broehm was simply to make out a prima facie case of medical malpractice. In particular, Broehm had the burden to produce an expert whose opinion supported her claim. See Sorenson, 457 N.W.2d at 191 (stating the purpose of section 145.682's dismissal provision was to deal with cases completely unsupported by expert testimony.). The essence of a prima facie showing is that the plaintiff has presented facts and opinions that, if uncontested, would allow a decision in her favor. Tousignant v. St. Louis County, 615 N.W.2d 53, 59 (Minn.2000). In Tousignant, we concluded that it was inappropriate for a court to focus on the defendant's rebuttal argument rather than on whether the plaintiff had established a prima facie case of medical malpractice. Id. at 60. Here, the court's adoption of Mayo's theory amounted to a consideration and weighing of the defendant's rebuttal argument. Doing so is contrary to the nature of the burden required of the plaintiff in a section 145.682 dismissal motion and therefore I conclude that the court abused its discretion in dismissing Broehm's claim on this basis. Cf. Northern States Power Co. v. Franklin, 265 Minn. 391, 395, 122 N.W.2d 26, 29 (1963) (holding that A claim is sufficient against a motion to dismiss    if it is possible on any evidence which might be produced, consistent with the pleader's theory, to grant the relief demanded. (emphasis added)). I also conclude that the district court abused its discretion when it explicitly rejected Wick's opinion that the restraint had the essential characteristics of a `dressing.' In Ruether, our court held that a finder of fact is not free to disregard unopposed medical testimony because such testimony concerns issues not within the realm of knowledge of the fact finder. 455 N.W.2d at 478 (citing Olson v. Midwest Printing Co., 347 N.W.2d 43, 46 (Minn.1984)). There was no medical opinion other than Wick's concerning whether the restraint should have been construed to be a dressing. Whether the restraint had the characteristics of a dressing in terms of nursing or hospital protocol is outside of common knowledge and the court improperly discounted Wick's opinion. The opinion that the restraint was essentially a dressing is an important premise of Wick's overall opinion. Unless Wick's opinion was contradicted by other evidence or was completely unreasonable, the court had to accept it and its implications for purposes of the motion to dismiss and, therefore, the court abused its discretion in summarily rejecting it. Here, it is important to place in the correct context the district court's statement that checking the restraint would be in direct disobedience of Dr. Pairolero's orders. At this stage in the litigation, the issue of Dr. Pairolero's instructing nursing staff not to disturb the restraint, in the context of Broehm's theory, may not eliminate a duty to inspect for skin integrity. Rather, it might only shift that inspection duty from nurses to Dr. Pairolero and therefore is an insufficient reason for finding that Wick was not qualified to testify regarding the appropriate standard of care. Therefore, for the foregoing reasons, I conclude that the district court abused its discretion when it found Wick not qualified to give an expert opinion to support a claim based on a nursing standard of care.