Opinion ID: 331435
Heading Depth: 1
Heading Rank: 3

Heading: The Case Against Dr. Trinidad, Nurse Johnson, and St. Joseph's Hospital.

Text: 22 The case against nurse Johnson and her hospital employer rests on the Trinidad testimony which supports the theory that nurse Johnson administered Penthrane, a halogenated anesthesia to the patient contrary to a medical decision which Dr. Trinidad communicated to her. As noted, nurse Johnson disputes receiving any such order from Dr. Trinidad. 23 Fundamentally, this conflict in evidence requires an analysis of the duties of a physician to communicate his medical decision to a nurse and the obligations of a nurse to follow a physician's orders or directions 6 against the backdrop of jury instructions which appellant alleges were erroneous. 24 With respect to Dr. Trinidad, the court instructed the jury as follows: 25 You are instructed that whether or not the injury complained of by plaintiff was the result of the defendant doctors' negligence in failing to use reasonable skill and care in the treatment which they utilized in this case is a question which can only be determined by witnesses qualified to speak, and that requirement is fulfilled only by physicians qualified and acquainted with the method and standard of treatment ordinarily used for the relief of the same or similar conditions. In this case, the defendant doctors' negligence cannot be based upon the testimony of lay witnesses. 26 Therefore, in determining whether or not in this case defendants doctors and the treatment given by them is chargeable with failure to possess and use reasonable skill and care in accordance with the standards given to you in these instructions, you are not to be governed by opinions of your own as laymen, and disregard the preponderance of expert evidence in the case. (Emphasis added). 27 With respect to the nurse-anesthetist, the court instructed: 28 You are instructed that in a medical malpractice case, the negligence of a nurse-anesthetist must be established by testimony of medical experts, and this requirement is fulfilled only by expert witnesses qualified and acquainted with the anesthetics which are acceptable for use under the same or similar conditions or to accomplish the desired result. Thus, in this case, negligence on the part of the defendant, Carol Johnson, cannot be established upon the testimony of persons who are not medical experts in the field of anesthetics. (Emphasis added). 29 Thus, under these instructions, any negligence on the part of Dr. Trinidad in failing to convey any medical decision he made to the nurse-anesthetist could be established only by physician-expert witnesses. Any negligence on the part of nurse Johnson in not following a physician's order could only be established by experts in the field of anesthetics. 30 Ordinarily, of course, negligence in medical malpractice cases must be established by the testimony of medical experts. See Haven v. Randolph, 161 U.S.App.D.C. 150, 494 F.2d 1069, 1070--71 (1974); Bryant v. Rankin, 468 F.2d 510, 513 (8th Cir. 1972); O'Brien v. Stover, 443 F.2d 1013, 1017 (8th Cir. 1971); Thompson v. Lillehei, 273 F.2d 376, 383 (8th Cir. 1959). South Dakota follows this general rule. See Block v. McVay, 80 S.D. 469, 126 N.W.2d 808, 810 (1964); Lohr v. Watson, 68 S.D. 298, 2 N.W.2d 6, 7 (1942). However, where a physician's lack of skill or care is of a nature that is within the 'comprehension of laymen and requires only common knowledge and experience to judge it, expert evidence is not required.' Block v. McVay, supra, 126 N.W.2d at 810; see Lohr v. Watson, supra, 2 N.W.2d at 7; Haven v. Randolph, supra, 494 F.2d at 1070; Bryant v. Rankin, supra, 468 F.2d at 513. 31 It would seem fundamental in the practice of medicine that if a surgeon arrives at a medical decision relating to the administration of drugs, including an anesthetic to his patient, he must communicate that decision to the nurse who will administer the medication. See Warwick v. Bliss, 46 S.D. 622, 195 N.W. 501, 502 (1923). 32 Moreover, it likewise appears fundamental that a nurse, including a nurseanesthetist, is obligated to follow a surgeon's order, or at a minimum, advise the surgeon of her disagreement. As we have noted, nurse Johnson acknowledged her obligation to follow such an order. Defendants' expert, Dr. Weingarten, suggesting that a nurse-anesthetist might violate those orders, indicated that a discussion between the surgeon and nurse who necessary and without agreement the operation should be cancelled. Finally, South Dakota statutory law authorizes a professional nurse to administer medications 'as prescribed by a licensed physician.' See S.C. Compiled Laws Ann. 36--9--3. 7 33 The questions raised by this conflicting evidence did not partake of any scientific or technical nature. Did Dr. Trinidad arrive at a medical judgment not to use Penthrane? Did he communicate his decision to nurse Johnson? Did nurse Johnson disobey or disregard Dr. Trinidad's directions? While expert testimony on these questions might help in explaining the obligations of surgeon and nurse, the lay-jury is perfectly capable of deciding these fact questions. The trial court, however, instructed that the jury could consider only evidence of physicians qualified to speak and, with respect to a nurse's duty, only the evidence of medical experts in the field of anesthetics. These instructions served to exclude Dr. Trinidad's crucial testimony as the court rejected his expertise in the field of anesthetics and served to exclude nurse Johnson's testimony as bearing on Dr. Trinidad's conduct in failing to communicate his medical decision to her. 34 The court instructed on the issue of the skill and learning of the surgeons as follows: 35 By undertaking professional service to a patient a physician and surgeon represents that he has the necessary degree of skill and learning to do so. That degree of skill and learning is generally measured by the skill and learning possessed by other physicians and surgeons in good standing practicing in similar localities under similar circumstances, and in view of the absence of testimony to the contrary you are instructed that the defendants possessed such skill and learning. (Emphasis added). 36 The court similarly instructed concerning the skill and learning of the nurseanesthetist: 37 By undertaking professional service to a patient a nurse-anesthetist represents that she has the necessary degree of skill and learning to do so. That degree of skill and learning is generally measured by the skill and learning possessed by other nurseanesthetists in good standing practicing in similar localities under similar circumstances, and in view of the absence of testimony to the contrary you are instructed that the defendant possessed such skill and learning. (Emphasis added). 38 In view of the marked conflict in testimony outlined above--whether Dr. Trinidad made a determinative medical decision on which anesthetic to use; whether he communicated such a decision to nurse Johnson; and whether she violated an express order in administering Penthrane--these instructions in substance could be taken as directing a verdict for nurse Johnson and Dr. Trinidad on the issues of negligence in this case. 8 39 The appellant takes issue with the court's instruction on proximate cause since during the course of the instructions the court periodically advised the jury that the plaintiff had the burden of proving as to each defendant that the negligence of that defendant was 'the' proximate cause of Mrs. Carlsen's death rather than merely 'a' proximate cause. Although the trial court did properly instruct on proximate cause, 9 the court otherwise erred in repeatedly advising the jury that the plaintiff was required to show that the negligence of each defendant was 'the' proximate cause of death. 40