Court Faults Hospital’s Attempt to Use Physician’s Orders as Standard of Care

A California appellate court has ruled that an expert’s declaration that a hospital followed a physician’s orders to monitor two troubled young patients was not enough to establish that the facility met its duty to a patient who claimed he was sexually assaulted by his roommate.

In overturning the hospital’s dismissal in John Doe v. Good Samaritan Hospital on a motion for summary judgment, the Central California-based appellate court described a high standard of proof for such pretrial motions. (As in many such discussions on appellate cases, the court relied on facts as alleged and assumed true, though not necessarily proven.)

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The plaintiff, then 12 years old, alleges that he was sexually assaulted while in the adolescent psychiatric unit of the Bakersfield hospital. His suit claims that the hospital was negligent in placing a 10-year-old boy, admitted under a psychiatric hold for violent behavior, in a room with him. The plaintiff claims that the hospital limited its supervision efforts to observing each patient at 15-minute intervals and that the facility should have conducted one-on-one supervision.

The plaintiff, who was admitted for suicidal and homicidal ideations, was discharged after nine days when he showed improvement. He mentioned no problems during his stay but later exhibited signs of post traumatic stress disorder. Some six months after his discharge, the plaintiff told his parents that his hospital roommate had taken him into the room’s bathroom and sodomized him behind a closed door.

The hospital brought a motion for summary judgment, supported by a psychiatric nurse’s expert declaration, on the grounds that it did not breach its duty of professional care in any respect or contribute to the plaintiff’s injury in any way. The nurse’s declaration opined that the hospital met its duties by performing the treating physician’s medical recommendations for both patients, including carrying out the physician’s order that it observe each patient at 15-minute intervals. The declaration also concluded that one-on-one supervision was not warranted under the circumstances.

The plaintiff failed to qualify any of his witnesses as experts, leaving the hospital’s expert declaration unopposed. Based on that lack of opposing expert testimony, the trial court granted judgment in favor of the hospital.

Though the hospital relied on its execution of physician orders for its defense, the treating physician, who testified as a non-expert witness, said he was responsible for medical treatment only, played no role in making room assignments generally, and did not make the room assignments for the two patients.

In overturning the trial court, the Court of Appeal characterized the opinions declared by the hospital’s expert as “conclusory” and therefore insufficient to “establish the absence of material fact issue for trial” — the legal threshold for dismissal via summary judgment.

The appellate court noted that though the defense declaration intended to cover all aspects of the hospital’s provisions of care and all of plaintiff’s theories of liability, “the nurse’s declaration is little more than three pages long, does not differentiate between the issues, and predominantly contains ultimate facts and conclusions without underlying facts supported by evidence.”

“Hospital’s expert did not opine specifically or in any detail as to Hospital’s applicable protocols and procedures regarding the safety and supervision of those there for treatment,” the unanimous three-judge appeals court wrote. “Without any evidence of Hospital’s standards and requirements, there is no basis on which to determine the standard of care, the scope of the duty, or conclude that the Hospital complied in this case.”

In sending the case back to the trial court judge, the appellate court said the lower court will be required to “determine the nature and scope of Hospital’s duties, as well as whether expertise is required to establish applicable standards of care and whether they were breached.”

It is a valid question by a physician involved in medical professional liability suit to ask his or her attorney if the judge can “throw the case out” without the need for a jury trial. The Doe v. Good Samaritan Hospital case shows the high hurdles the courts can apply to such attempts. 

 

Gordon Ownby is CAP’s General Counsel. Questions or comments related to “Case of the Month” should be directed to gownby@CAPphysicians.com.