Court Opinion

ID: 9467516
Source: CourtListenerOpinion
Date Created: 2023-08-05 01:50:42.769987+00
Date Added: 2024-06-11T17:40:23.203507
License: Public Domain

FAY, Circuit Judge,
dissenting:
The case presents an extremely difficult question for resolution. Mrs. Marek’s medical emergency was both massive and complicated. As pointed out by the majority, however, the crucial question before us involves the trial court’s rulings as to the “four-minute standard for establishing an airway.” All now agree that the district court misunderstood the “four-minute standard” and that such a period was not the minimum lifesaving time from unconsciousness but rather the standard of care applicable to the establishment of an airway after arrival in the emergency room. The majority holds this misunderstanding to be harmless because the district court found an airway was established within four minutes of her arrival at the hospital and that there is evidence to support this finding.
My review of the record convinces me that such a finding, if made, is not only unsupported by but contrary to the overwhelming evidence negating such a possibility. As the majority concedes, there is no question about the activity of Dr. Faber and his attempt to perform a tracheostomy. His conduct fell below all standards and could have only caused a bad situation to become worse. The judgment then rests solely on the activity of Major Least who is a nurse-anesthetist.1
When Mrs. Marek arrived in the emergency room it was located in the North wing of the hospital on the first floor. Three employees of the hospital fixed her arrival at 10:30 a. m. Some time elapsed between Mrs. Marek’s arrival and the sounding of the “Core Zero”. Major Least was taking a patient from the operating room to the recovery room when he heard this signal. The operating room was located in the South Wing of the hospital on the second floor. Major Least had to complete his handling of the patient going to the recovery room, go from one end of the hospital to the other, use either an elevator or stairs to go down one floor, and then into the emergency room. Upon arrival, Major Least surveyed the scene and asked what he could do by way of assistance. Dr. Faber requested help in establishing an airway. Major Least says he then checked Mrs. Marek’s mouth, was unable to open it, took an endotracheal tube and began the process of blind nasal intubation. Major Least, in describing this procedure, stated that it took from one-half a minute to one and one-half minutes. The trial court found that Mrs. Marek was intubated within a minute or two of her arrival (R. 294). Such a finding is contrary to the undisputed testimony, physical facts and distances involved and a critical mistake. Major Least continued, and the trial court so found, that it took another minute or two to suction Mrs. Marek to establish ventilation (airway). To suggest that all of this activity occurred within four minutes of Mrs. Marek’s arrival in the emergency room is simply wrong. To conclude such as a finding of fact is wrong as a matter of law.2
*1168The hospital records confirm the fallacy of any such reasoning. Knowing that time was of the essence and each minute precious, it was noted that the endotracheal tube was inserted at 10:45 a. m. This hardly satisfies the “four-minute standard” since all agree arrival was very close to 10:30 a. m.
Mrs. Marek was in medical distress. Her husband, a member of the United States Air Force, took her to a government hospital. A government doctor, Dr. Faber, performed below the standard of care required. The other personnel did their best but were not able to overcome or regain the opportunity lost by Dr. Faber’s mistake. This conduct contributed to Mrs. Marek’s death. The United States is responsible and should respond in compensatory damages. Any other conclusion is clearly erroneous.
I respectfully dissent.

. A nurse-anesthetist is a nurse specializing in the giving and administering of an anesthesia (R. 169). An anesthesiologist is a medical doctor specializing in this area (R. 170).

. In footnote number 2 of the majority opinion it is suggested that the trial court had before it conclusory expert testimony that the standard of proper medical care for establishing an airway was met, even though the four-minute standard might not have been met. My brother’s logic has me befuddled. The central issue is whether the “four-minute standard” was met. The government’s expert did not comment on that question. He was not asked. The basis of his very general conclusionary answer was a review of the hospital records, which do not start with any time notation until 10:45 a. m., and some additional hypothetical facts totally unrelated to any specific time. The only expert testimony in the record suggests that the proper standard of care required the establishment of an airway within four minutes of Mrs. Marek’s arrival in the emergency room. The trial judge did not understand this test, no factual findings were made on this specific question and the uncontradicted testimony of Major Least coupled with known physical distances, makes it manifestly improbable. How one could fail to establish an airway within four minutes of arrival and yet meet some general standard of medical care escapes me?