Court Opinion

ID: 9548268
Source: CourtListenerOpinion
Date Created: 2023-08-07 18:00:49.267783+00
Date Added: 2024-06-11T15:18:44.181530
License: Public Domain

HUNTLEY, Justice,
dissenting.
I must respectfully dissent because the summary judgment was not properly granted in view of facts and inferences which require resolution by a jury. My restatement of the facts and the appellate ruling which should flow therefrom follows. We should more carefully resist the temptation to invade the province of Idaho juries.
Sparks brought suit alleging medical malpractice in the treatment rendered to Sparks at St. Luke’s. Two areas of medical care provided by St. Luke’s form the basis for this action. The first allegation of negligent care concerns whether the nurses properly performed their duties and informed the surgeons of low or non-existent urine output during an operation on Thomas Sparks on January 21, 1983. The second allegation of negligence against the hospital concerns the treatment given by the hospital on January 30, 1983. The respiratory therapists and nurses employed by St. Luke’s allegedly failed to perform their duties in the evaluation and care given to Sparks during the morning and afternoon hours of January 30, 1983, prior to his cardiac arrest.
St. Luke’s brought a motion requesting summary judgment on all Sparks’ claims against the hospital. The district court granted summary judgment in favor of St. Luke’s on all claims, concluding that, as to the first allegation of negligence, Sparks “failed to put in the record their burden of responsibility showing controverted materi*519al facts.” The district court stated that its ruling was warranted as to the second allegation of negligence “simply because there is no credible evidence in the record which supports allegations of negligence against the hospital.” Sparks appeals contending that genuine issues of material fact were raised on both claims and that, therefore, the district court’s ruling was in error.
In reviewing the motion for summary judgment, the district court correctly acknowledged that it was bound to follow the guidelines issued by this Court in Doe v. Durtschi, 110 Idaho 466, 716 P.2d 1238 (1986). In Doe v. Durtschi, this Court stated:
A motion for summary judgment is proper only when ‘there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.’ I.R.C.P. 56(c). When the motion is supported by depositions or affidavits, the adverse party ‘may not rest upon the mere allegations or denials of his pleadings, but his response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial’ I.R.C.P. 56(e). The latter requirement, however, does not change the standards applicable to the summary judgment motion. Central Idaho Agency, Inc. v. Turner, 92 Idaho 306, 310, 442 P.2d 442, 446 (1968). Those standards require the district court, and this Court upon review, to liberally construe the facts in the existing record in favor of the nonmoving party, and to draw all reasonable inferences from the record in favor of the nonmoving party. Anderson v. Ethington, 103 Idaho 658, 660, 651 P.2d 923, 925 (1982). In this process the Court must look to the ‘totality of the motions, affidavits, depositions, pleadings, and attached exhibits,’ not merely to portions of the record in isolation.
Doe v. Durtschi, supra, pages 469-470, 716 P.2d 1238.
With regard to a motion for summary judgment in a medical malpractice case, in Maxwell v. Women’s Clinic, P.A., 102 Idaho 53, 56, 625 P.2d 407 (1981) this Court stated:
Therefore, in order to preclude summary judgment in medical malpractice cases, plaintiffs must show that expert testimony has been offered by either the plaintiff or defendant which when viewed in a light most favorable to plaintiffs indicates that the defendant has negligently failed to meet the applicable standard of health care practice of the community.
(Quoted with approval in Pearson v. Parsons, 114 Idaho 334, 757 P.2d 197 (1988) and Dekker v. Magic Valley Regional Medical Center, 115 Idaho 332, 766 P.2d 1213 (1988). See also, sections 6-1012 and 6-1013, Idaho Code, (setting forth the proof of community standard of health care practice in a malpractice case and the requisite testimony of an expert witness on community standard).
Both sides submitted depositions and affidavits in support of their position on the motion for summary judgment. Although the district court correctly identified the Doe v. Durtschi, supra, standard as controlling its ruling on the motion for summary judgment, it failed to correctly apply that standard and, as a result, its ruling was in error on both claims of negligent medical care. I first address the treatment rendered Sparks by St. Luke’s during the surgery of January 21, 1983 and then discuss the treatment rendered Sparks by St. Luke’s during the morning and afternoon hours of January 30,1983 prior to his cardiac arrest.

Surgery of January 21, 1983

As a result of the accident, Sparks had multiple internal injuries, including a torn thoracic aorta. The surgical repair of the torn aorta was undertaken by Doctors S. Kirby Orme and Robert P. Barnes, both being board certified general and thoracic surgeons. In order to repair the torn aorta, it was necessary to cross-clamp it both upstream and downstream from the tear. During the cross-claiming, all blood flow to the lower part of the body is interrupted, potentially causing serious damage.
*520Dr. Orme attempted to negate this problem and provide adequate profusion of blood by proper placement of a Gott shunt. The Gott shunt is simply a 9 millimeter diameter hose. If the shunt operates properly, blood flows adequately to protect the lower part of the body, primarily the spinal cord.
One of the ways to monitor the Gott shunt’s performance is to watch urinary output. The absence of urine indicates inadequate blood and blood pressure. It was the acknowledged responsibility of Christine Gilliam, the St. Luke’s operating room circulating nurse, to periodically report and post urine output on a board in the surgery suite. Sparks’ urinary output registered essentially zero throughout the entire surgical procedure. Nurse Gilliam submitted an affidavit to the district court in which she claimed that she audibly announced the urine output every 15 minutes and, in addition, wrote it on the surgery suite board.
According to the depositions Doctors Orme and Barnes submitted to the district court, neither recalled being told that Sparks’ urinary output was essentially zero. Dr. Orme testified in his deposition that even “[i]f they had [so informed me] I wouldn’t have changed what I was doing.” Sparks suffered paralysis immediately after the surgery.
Sparks opposed St. Luke’s motion with the affidavit of David J. Cullen, M.D., a board certified anesthetist and intensivist at Massachusetts General Hospital and professor of anesthesia at Harvard Medical School. Dr. Cullen’s expert medical opinion regarding the case was that “St. Luke’s Operating Room, Intensive Care Unit, and Respiratory Therapy Department negligently failed to meet the applicable standards of health care practice in the Boise, Idaho medical community in January 1983.”
Viewed in conjunction, the affidavit of Dr. Cullen and the depositions of Doctors Orme and Barnes constitute sufficient evidence supporting the claim of negligent care in the surgery of January 21, 1983 to meet the standards applicable to a summary judgment motion. As stated in Doe v. Durtschi, supra, those standards require the district court, and the Supreme Court upon review, to liberally construe the facts in favor of the non-moving party, to accept as true fact allegations contained in the non-moving party’s affidavit, and to draw all reasonable inferences from the record in favor of the non-moving party.
The record before the district court contained the testimony of each of the surgeons, Doctors Orme and Barnes, that they did not remember having been informed of the urinary output. This Court considers it reasonable to infer that the surgeons were not so informed since they testified they did not remember being informed. Such inference would be in conflict with Nurse Gilliam’s affidavit stating that she did audibly announce the output every 15 minutes and, thus, raises a genuine issue as to a question of fact.
Whether the doctors were informed is a material question. Sparks suffered paralysis after the surgery. During the surgery he exhibited indicia of inadequate blood and blood pressure which may not have been made known to his surgeons. The materiality of the fact placed in issue by the inference reasonably drawn from the surgeon’s deposition testimony is demonstrated by the testimony of Dr. Cullen. In his affidavit, Cullen states that “[i]f Nurse Gilliam did not follow St. Luke’s policies and procedures regarding the measuring and reporting and/or posting of urinary output in cardiovascular surgery, such conduct negligently failed to meet the applicable standards of health care practice for operating room personnel as they existed in Boise, Idaho in January 1983.” Notwithstanding Dr. Orme’s cavalier statement that he would not have changed his procedures even if he had been aware of the absence of urinary output, there is no evidence in the record showing that Dr. Barnes, the assistant surgeon, had he been adequately informed, would not have taken corrective action so as to ensure adequate blood flow.
Viewing all facts in the record in favor of Sparks, as dictated by the standards for summary judgment, we should conclude that an order granting summary judgment to St. Luke’s on this issue was in error.

*521
Evaluation and care prior to Sparks’ cardiac arrest on January 30, 1983

Following the surgery, and while still in the ICU, Sparks was intubated and breathed with the help of a respirator. During the morning of January 29, the respirator setting was changed from “intermittent mandatory ventilation” (IMV), which requires the machine to breathe a set number of breaths but also lets the patient breathe on his own, to a setting known as “continuous positive airway pressure” (CPAP), which requires the patient to breathe on his own exhaling against a pressure present in the airway at all times with the respirator’s airway remaining in place. After Sparks breathed with the respirator on CPAP mode for a time, Dr. Orme ordered Sparks extubated (removed) at 12:10 p.m. on January 30, 1983.
Prior to the January 30th extubation Sparks was tried off the respirator and put on a T-tube. Studies were performed, including arterial blood gasses (ABG) tests, and Enloe was responsible to return Sparks to the respirator if he did not tolerate his trial off the respirator. The results of the studies were delivered to Dr. Orme and he found them to be acceptable. The findings, however, indicated respiratory fatigue and, therefore, should have created concern given the circumstances of this case. According to Dr. Cullen’s affidavit, given Sparks’ size and general medical condition, the fact of respiratory fatigue should have been recognized as a problem since he had been removed from respiratory support. Additionally, the measurements should have been serially observed, but were not until 4:00 p.m. that day.
After Sparks was extubated, Enloe provided respiratory therapy pursuant to Dr. Orme’s orders, requiring intermittent positive pressure breathing (IPPB) or incentive spirometry every three hours. Since Sparks’ efforts during the 1:30 p.m. incentive spirometry were “inadequate,” Enloe decided to also give him a nonordered IPPB treatment. Enloe went off shift at 2:30 p.m. She was replaced by Diane Darnell, who offered no evidence for the record.
Gary Newhall was the ICU nurse who came on shift at approximately 3:00 p.m. Newhall stated that he noticed that sometime between 3:00 and 3:30 p.m. Dr. Orme was in the ICU observing Sparks. Newhall further stated that he spoke briefly with Dr. Orme concerning Sparks. Dr. Orme informed Newhall that Dr. Tim Sullivan, an anesthesiologist, was on call in the event that Sparks would need to be reintubated and that there was a flexible bronchoscope at the bedside.
At 4:00 p.m. Sparks complained of being hot and was found to have a temperature of 102.6 degrees and a respiration rate of 36 breaths per minute (BPM). Repeat ABG tests still showed unacceptable results. Dr. Orme was advised of the ABG and chose not to reintubate Sparks. Instead he ordered a repeat ABG in one hour, a chest film at 6:00 p.m., and a modified IPPB treatment. Dr. Orme explained his decision not to re-intubate:
Because I felt that he was having mucus and thought that they could give him an IPPB treatment with a bronchodilator and Mucomyst, and that it would be reasonable to do that and see if it didn’t improve. And he was stable at the time.
At 4:30 p.m. Sparks received the IPPB. Ten minutes later Sparks’ skin was cool, clammy and pale colored and he complained of shortness of breath. Sparks arrested at approximately 4:57 p.m. and a Code Blue was called. As a result of the cardiac arrest, Sparks sustained severe and permanent brain damage.
Despite Sparks’ acknowledged abnormal ABG, and rapidly deteriorating respiratory condition, Newhall did not contact Dr. Tim Sullivan, the anesthesiologist who had been designated by Dr. Orme as being on call in the event that Sparks would need to be re-intubated. Newhall did not undertake any measures to ventilate or re-intubate Sparks even though there was a flexible bronchoscope at Sparks’ bedside. Rather, Newhall simply stood by and watched Sparks go into cardiac arrest without any active medical intervention.
In his affidavit, Dr. Cullen opined that “[o]n January 30, 1983, St. Luke’s nursing and respiratory therapy personnel assigned to care for Thomas Sparks either knew that Dr. Orme’s respiratory orders for Thomas *522Sparks were inadequate and/or failed to recognize Thomas Sparks’ desperate respiratory distress.” According to the policies and procedures of St. Luke’s concerning the Respiratory Therapy Department and Department of Nursing in effect in January 1983, representatives from both these departments had the responsibility of checking Sparks’ tolerance to being removed from the respirator. In his affidavit, Dr. Cullen concludes that:
[B]y not adequately monitoring Thomas Sparks postoperatively and recognizing his respiratory distress and/or procuring a qualified staff physician to attend to Thomas Sparks when the respiratory orders were known to be inadequate on January 30, 1983, St. Luke’s Operating Room, Intensive Care Unit, and Respiratory Therapy Department negligently failed to meet the applicable standards of health care practice in the Boise, Idaho medical community in January 1983.
Enloe’s deposition, Newhall’s affidavit and Cullen’s affidavit together constitute sufficient material in the record to give rise to serious questions regarding the evaluation and care given Sparks prior to his cardiac arrest on January 30, 1983. Thus, the record before the district court upon ruling on St. Luke’s motion for summary judgment should have indicated the presence of a genuine issue of material fact. That issue is whether St. Luke’s personnel adequately monitored and reported Sparks’ medical condition postoperatively and recognized Sparks’ respiratory distress and/or procured a designated anesthesiologist to attend to Sparks, when respiratory orders were known (or in the exercise of reasonable care conceivably should have been known) to be inadequate due to the rapidly failing condition which ultimately resulted in Sparks’ cardiac arrest.
Therefore, we should hold that the district court’s ruling as to the second claim of negligent care was also in error.
JOHNSON, J., concurs.