Know, Justice.
Patricia Koeniguer (Koeniguer) is appealing a summary judgment in favor of Dakota Midland Hospital (Hospital). We'll turn around and schedule a pretrial arrest.
facts
Winnifred Scoblic (Scoblic) consulted with Dr. Eckrich about continence problems. Dr. Eckrich recommended surgery, and Scoblic was hospitalized on January 3, 1983. An operation was performed on January 5. Scoblic remained hospitalized until January 16. Hospital records show that he had a fluctuating temperature for some time prior to discharge and that on the morning of his discharge, his temperature was 100.2 degrees Fahrenheit. Hospital records show that Scoblic's temperature was taken (if not at all) at 8:15 a.m., after the attending physician made his rounds. The hospital and Dr. Eckrich state that they took her temperature before the doctor arrived at 7:30 am and that the doctor was aware of the elevated temperature and concluded that it was a normal reaction to the surgical implants.
Scoblic was hospitalized again on January 19, 1983 with severe abdominal pain and fever. The diagnosis was sepsis (infection). She was transferred to the University of Minnesota Hospital on January 21, 1983, and died of multiple organ failure on March 6, 1983.
As the personal representative of his mother's estate, Koeniguer filed a negligence lawsuit against the hospital and doctors for deviating from proper standards of care. After some findings, the hospital filed a request for summary judgment, which was granted.
1. WAS THE HOSPITAL'S SUMMARY JUDGMENT CORRECT?
"Summary judgment is admissible only where the person in question is entitled to a trial on legal grounds because there are no genuine disputes as to the material facts. SDCL 6-15-56(c); trap v. Madera Pacific, Inc. , 390 N.W. 2d 558, 564 (SD 1986)...[citation omitted]". bego v. Gordon, 407 NW2d 801, 803 (SD 1987). The moving party has the burden of proof, and the "evidence must be considered in the best interest of the unmovable party, and reasonable doubt must be against the moving party 1987, citing Wilson v Great Northern Railway Co., 83 S.D. 207, 157 N.W. 2d 19 (1968) & Trapp, supra Therefore, petitions, affidavits, affidavits, and any reasonable inferences drawn therefrom must be viewed in the light most favorable to the party not Trapp, supra, at 562, Summary Judgment is an Extreme and Appropriate Remedy to Resolve Legal, Non-Factual Issues Trapp, above Bego, above at 804. Finally, we are not addressing the lower court's findings that they are bound and should conduct an independent review of the record Trapp, supra, citing Hurney v. Locke, 308 N.W.2d 764, 767 (SD 1981).
A hospital is only liable to its patients for negligence if there is a causal link between the hospital's fault and the harm suffered by the patient. Causation or proximate cause depends on establishing that the perpetrator's injury was actually caused by the hospital and that the perpetrator's injury was foreseeable. The plaintiff has the burden of proving causation in a negligence claim, and generally must bear the burden of proof to meet that burden.
4B Personal Injury: Claims, Defense, Compensation, “Hospitals and Nursing Homes,” § 1.02[2] (1983). "In most jurisdictions, expert testimony is required to establish the fundamental elements of the claimant's misconduct charge: standard of care, infringement, and causation." I WENT. in § 1.02[3].
Regarding standards of care for hospitals, we said that patients have the right to expect hospital care to be "consistent with that available in the same or similar communities or hospitals generally." Fjerstad v. Knutson, 271 NW2d 8.12 (SD 1978). However, we also affirm the words of the Iowa Supreme Court in Dickinson v. Maiilliard, 175 N.W.2d 588 (Iowa 1970) cited:
It is no longer reasonable to limit a hospital's liability to the usual standard of care in its own community. . . . Compliance with such a rule then means that the hospital whose behavior is attacked is judged only by the standards it has set for itself.
Shamburger v. Behrens, 418 N.W.2d 299, 306 (SD 1988).
Medical malpractice lawsuits against hospitals alleging caregiver negligence center on the question: "Did the caregiver exercise reasonable care and professional judgment under the circumstances?" 4B Personal Injury at §1.03[2].
Referring to standards published by the American Nurses Association and various treatises on general nursing practice, Koeniguer's expert, Sharon G. Van Riper, stated that, in her opinion, the actions of the hospital's nursing staff did not meet with acceptable postoperative standards. care for urological patients like Scoblic. Specifically, in her affidavit, Van Riper testified that hospital nurses failed to adequately monitor Scoblic's condition or provide acceptable postoperative care by:
1) document the failure to report Scoblic's elevated temperature to the physician on the day of his discharge;
2) Scoblic can be discharged at high temperature;
3) failing to instruct Scoblic to check his temperature; AND
4) Failure to document that the condition and drainage of the Scoblic incision was reported to the physician.
Koeniguer presented evidence of standards of care and evidence amounting to a violation of those standards. The hospital argues that Koeniguer failed to prove that the hospital's alleged negligence was the immediate cause of Scoblic's discharge from the hospital and that any early discharge was the immediate cause of her final injuries. The hospital maintains that the decision to discharge a patient is a medical decision made at the discretion of the treating physician. However, the director of Nursing at the hospital, Mary Alice Bailey, explained in her statement that there are times when it is the responsibility of the nurse to question the doctor's order, for example. B. if the patient's condition has changed significantly. She echoed Van Riper's assertion that the nurse has an obligation to communicate changes in the patient's condition to the doctor and to “move on” if the doctor doesn't adequately address her concerns. The hospital denies that the standard of care for nurses requires them to independently assess the patient's condition, discuss their concerns with the doctor, and contact other authorities if they believe the doctor's decision is incorrect, but relevant expert testimony appear in the declarations. These questions are for the jury.
There is expert testimony on file that the nurses should have tried to delay Scoblic's release if his condition warranted further hospitalization. This advocacy role of the nurse has been neglected. There is no evidence that anyone questioned or disagreed with the doctor's decision to fire, so Scoblic was fired. Negligence can be based on both the omission and the commission of an act.
Looking at the evidence most favorable to the immovable part, the element of causation has been established. From the evidence on file it can reasonably be concluded that the delay in treatment caused Scoblic to return to hospital in a more serious condition than she would if she had been treated three days earlier. There is conflicting expert testimony as to whether surgery, infection, or a combination of both led to Scoblic's death. For purposes of summary judgment, the hospital was overwhelmed and failed to show that the doctor's alleged negligence outweighed any negligence on the part of the hospital and was the sole proximate cause of Scoblic's death. A jury must make this finding of fact. Groseth, above; trap, up; wilson up.
We'll turn around and schedule a pretrial arrest.
MORGAN and MILLER, JJ. accept.
HENDERSON, J. expressly agrees.
WUEST, C.J., Dissidencia.
HENDERSON, Justice (Particularly Consent).
Failure to comply with hospital rules, the plaintiff alleges, relates to "hospitals in general" rules, which is a sure ground under that court's decision at Fjerstad, 271 N.W.2d 8. More specifically, the alleged negligence is that the hospital failed to adequately supervise the care of the decedent (Ms. Scoblic) and provide her with appropriate post-operative care. According to the plaintiff/representative of Ms. Scoblic, the patient was discharged early from the hospital with an infection and the hospital failed to take her temperature, among other things, which, among other things, resulted in her negligent discharge from the hospital and his ultimate death.
Applicant uses expert testimony from a nurse educator, consulting firm owner, and senior nursing assistant at the University of Michigan Hospital, Sharon Van Riper; furthermore, the applicant relies on testimony provided by Mary Alice Bailey, vice president of nursing at Dakota Midland Hospital. Plaintiff's account also includes testimony from Kathy Padgett, a nurse who brought Mrs. Scoblic in on the morning of January 16, 1983, and Sharon Kost, a nurse who was on call when the deceased was discharged. There are a wealth of facts and expert opinions contained in the records. This is a negligent act. Summary judgments are generally not practical in negligence claims because the "reasonable man standard" must be applied to conflicting claims, as we see in the following illustrations. Settlement: Laber v. Koch, 383 N.W. 2d 490, 493 (S.D. 1986); laley v. Safeway Steel Scaffolds, Inc., 364 N.W.2d 139 (S.D. 1985). Here we are faced with “patterns”. We have to think in patterns. In Nemech v. Deering, 350 N.W.2d 53.56 (S.D. 1984), we hold: "A real problem of fact exists when reasonable opinions, based on recorded facts, differ as to whether the defendant's conduct meets the required standard." (citation omitted). In my opinion, reasonable opinions of the hospital's conduct with respect to the "required standard" may differ when judged by its own standard or the standards of "general hospitals" or hospitals in "similar communities" or comparable hospitals in other communities in the state of South Dakota. .
From reading the petitions and cases cited, it is clear that the author alleges a violation of the national standards of care. More specifically, it also appears that the hospital's alleged negligence is alternatively alleged as follows:
(1) The decedent's elevated temperature was not reported to her physician;
(2) allow the tester to go home;
(3) failure to instruct the decedent to have his temperature taken; AND
(4) Failure to document that the treating physician was informed of a condition of redness and discharge present at the decedent's incision.
This decision is important to our state, and in particular to all the hospitals and caregivers who work there, and has significant implications for their processes and responsibilities. As a lifelong citizen of this state who has received excellent care from hospitals and nurses and who has the utmost respect for them, my responsibility to ensure that justice is done, not only in this particular case, but also in the future, It's very important. excellent. Nurses across the country are known to be extremely underpaid and overworked. Recent articles on national television and in the Associated Press have drawn national attention to the "strike." In addition, television reports have informed us that there is a serious shortage of nurses, which threatens the health of the nation.
Often a life is in the hands of a nurse when the doctor is not around. However, registered nurses are not licensed to practice medicine. They are not the final decision makers in patient care; rather, they are the decision makers. Therefore, I find it very difficult to accept the majority opinion claim that nurses have a 'bidding' role.1Nurses do not have the authority to issue discharge receipts to patients and cannot challenge a physician's discharge decision. See J. Smith, (below). However, as I will explain below, they do have certain responsibilities to patients and discharge that hold them to a certain standard that they must adhere to. If nurses were to take an advocacy role and question doctors' instructions to relay their testimony to supervisors and other doctors, they would soon lose their jobs or cause extreme professional stress, if not chaos, at the hospital. Therefore, a nurse should not be required to be a practicing physician and perform an independent assessment and then challenge a physician's decision. Discharging a patient is a medical decision and not a nursing decision, see J. Smith, Hospital Liability, § 9.01 (1987); A. Southwick, Hospital and Health Administration Act, p. 177 (1978). According to Plaintiff's nurse specialist, Van Riper, it is doctors, not nurses or hospitals, who ultimately make the decision to discharge patients. Discharge of the patient in this case with elevated temperature is a crucial consideration in the present case.
There may be exceptional circumstances that warrant an exception to the general rule that a hospital may be required to challenge a discharge order. J. Smith, Hospital Liability, § 901. A borderline finding arises: Did such an extraordinary circumstance occur in this case? This fact should be fully investigated in a trial.
I would like to devote a paragraph to this simple statement: (1) Ms. Scoblic died of multiple organ failure secondary to medically uncontrollable sepsis; and (2) she had sepsis when she was discharged. These two facts are unavoidable; they are not hypotheses.
Elevated temperature in a patient is a common sign of infection, as shown in the figure below. A perforated colon and urine leakage appear to have been the cause of the infection, in addition to implanted internal splints, as indicated by all medical statements herein. Infection is a danger signal for the well-being of any patient, as reflected by medical evidence. Certainly a question of fact arises in connection with the reckless dismissal of Ms. Scoblic because of her condition.
According to the records, the temperature of the deceased does not appear to have been properly recorded by the nurses. And if there was no outright appearance of improper mapping, there is certainly a matter of fact raised by the author's account here. Mapping is a function of the hospital. A nurse is a conduit for these useful and vital historical charts.
There is also evidence in the record of inadequate monitoring of the patient's temperature, or appears to be. I am convinced that a matter of fact also arises in this context.
This brings us to another important aspect of Ms. Scoblic in the hospital: did the nurses inform the doctor about the high temperature in a timely manner?2A reading here suggests otherwise, but a matter of fact arises here as well. Given the deceased's elevated temperature, I am very concerned that the nurses did not contact the doctor between 7:30 am and 10:45 am (the latter being the time the deceased was discharged); If I have erred in my representations in this document, I am absolutely satisfied that there is an issue of fact for a jury regarding communication with the physician during this period of approximately three hours when the decedent appeared to have had serious post-operative problems.
A question of fact also arises for the jury when Dr. Steinhardt, an inventory specialist, testified that this lady with a fever should not have been discharged and that something was definitely wrong because she had a septic tank. According to the doctor. Steinhardt, a medical specialist, that an immediate attempt be made to correct the situation. In simple terms, once an infection is diagnosed, it must be treated as soon as possible, or a bad situation will become dangerous for the patient. Therefore, as determined below by the opinion of a medical expert, a follow-up procedure involving (a) recording, (b) monitoring, (c) timely notification to the physician, and (d) temperature measurement during this period of approximately three hours and immediately before discharge seems beneficial for the health of this seriously ill lady, as it was very necessary, if not critical. Expert reasoning, see below: Such procedures can verify and ultimately lead to an immediate response and correction of a serious infection.
As mentioned above, this is a case of negligence. Therefore, as a matter of priority here, Ms. Scoblic's personal representative must establish three necessary elements of criminal negligence: (1) A duty on the part of the defendant; (2) breach of this obligation; and (3) any damages to Claimant resulting from such breach. Leslie, downstairs. This personal representative, as the hospital's lawyer has strongly advocated, must go a step further to support the malpractice remedy, which can be referred to here as the fourth element: the act or acts or conduct of the hospital must aggravate the harm caused Directly to the author Leslie, below. Regarding the last element, the expert opinions must show the deterioration of Ms. Scoblic's condition or any bodily injury or harm. Magbuhat v. Kovarik, 382 NW2d 43.46 (SD 1986). See also In re Schramm, 414 N.W.2d 31 (S.D. 1987), although the latter applies to a dentist rather than standard hospital care. The gentlemen reviewing the facts of this case, as well as the judge, must keep these four elements in mind as the case progresses. I am aware that the hospital's attorney has forcefully and ably asserted that there is no causal link between the nursing failures and Ms. Escoblico. Furthermore, I am well aware that the hospital's attorney is adamant in his position that no expert testimony establishes a causal link between the defendant's alleged non-compliance and the proximate cause of the plaintiff's non-compliance. Within the confines of all the evidence presented here, I believe there is a prima facie probability, hopefully it is not seriously flawed.3that the damage was due to negligence for which the defendant was responsible; and that this was not necessarily due to something that was not the responsibility of the hospital. In Lohr v. Watson, 68 SD 298, 2 N.W.2d 6 (1942), we find this language:
In negligence cases, and particularly malpractice cases, the proof of causation must be more than consistent with the plaintiff's theory of how the alleged harm was caused. The burden of proof is on the plaintiff that the damage is more likely to have resulted from negligence for which the defendant was responsible than something for which they were not.
Lohr, 68 SD at 303, 2 N.W.2d at 8 (cited Yates v. Gamble, 198 Minn, 7, 268 N.W. 670, 674 (1936)). Again, even under Lohr's leadership, it seems to me that there is a question of fact. Writing for this court more than seven years ago, Leslie v. City of Bonesteel, 303 N.W.2d 117 (S.D. 1981), I found solace in earlier decisions of this court. As in the present case, I was concerned with the immediate consideration of the causes. This court has often cited Leslie with approval, and I refer to Leslie, 303 N.W.2d at 119 for the various authorities and definitions of "proximate cause." Digesting the volume of these authorities and their citations, I am academically impressed with the premise originally advanced in Engberg v. Ford Motor Co., 87 SD 196, 202, 205 N.W.2d 104, 107 (1973) and Parham v. Dell Rapids Township in Minnehaha County, 80 S.D. 281, 122 N.W.2d 548 (1963): That a case need not be proven with absolute certainty to establish liability. A trial judge evaluating the evidence must determine whether the harm was a foreseeable consequence of the alleged act.
The term "proximate cause" means an immediate cause that is a natural or probable consequence of the reported injury. Legal liability based on purely speculative possibilities or circumstances and conditions remotely related to the facts that gave rise to the damage is excluded.
Leslie, 303 N.W.2d at 119 (cited Mulder v. Tague, 85 S.D. 544, 549, 186 N.W.2d 884, 887 (1971)). Given the abundance of evidence presented, it is at least a matter of fact as to the proximate cause. Evidence was presented that Ms. Scoblic did not appear to be "a purely speculative possibility" (Leslie, Mulder) or a "condition remotely connected" (Leslie, Mulder) to the event leading up to her failed condition, which ultimately turned out to be fatal. Therefore, it would also vacate the summary judgment issued by the district court.
WUEST, Oberster Richter (discordant).
I disagree. In my opinion, there is insufficient evidence in the record to conclude that the hospital's alleged negligence was a direct or contributing cause of Scoblic's death.
South Dakota law states that negligence in medical malpractice cases must be proven by the testimony of medical experts, unless the subject matter of the testimony is "within the common knowledge and understanding of persons with training, experience, and opportunity." ordinary". Magbuhat v. Kovarik, 382 NW2d 43, 46 (SD 1986). See Carlsen v. Javurek, 526 F.2d 202, 207-2008 (8th Cir. 1975); Schramm Complaint, 414 N.W.2d 31, 36 (S.D. 1987); Van Zee v. Sioux Valley Hospital, 315 N.W.2d 489, 492 (S.D. 1982); Block vs. McVay, 80 S.D. 469, 474, 126 N.W.2d 808, 810 (1964) (partially overturned for other reasons in Shamburger v. Behrens, 380 N.W.2d 659 (S.D. 1986)); Hansen v. Isaac, 70 SD 529, 533, 19 N.W.2d 521, 522-23 (1945); Myrlie v. Hill, 58 SD 330, 336-337, 236 NW 287, 290 (1931); Kelly v. Hollingsworth, 44 SD 23, 29, 181 NW 959, 961 (1921). Expert opinion applies not only to the determination of alleged deviations from the standard of care, but also to the proof of essential causation. Lohr v. Watson, 68 SD 298, 2 NW2d 6 (1942). See Podium v. American Colloid Co., 83 SD 528, 162 NW2d 385 (1968); as v Farmers Cooperative Creamery of Madison, 81 S.D. 207, 132 NW2d 844 (1965); Campbell v. City of Chamberlain, 78 SD 245, 100 NW2d 707 (1960); Annot., 13 ALR2d 11, 31 (1950); 61 Am.Jur.2d, Physicians and Surgeons § 348 (1981).
Although the author has provided an expert report establishing a possible deviation from the standard of care, the author has not provided expert or other testimony to establish a causal link between the hospital's alleged breach of duty and Ms. Escoblico. Lady. Scoblic died of multiple organ failure caused by "medically uncontrollable" sepsis. Given the nature and complexity of the diagnostic tests and surgical procedures performed, the magnitude of potential complications, the number of actors involved, and the potential complications, the number of actors involved, and the multitude of factors that may have contributed, given the poor state of Mrs. . Scoblic cannot say that, without the help of medical and scientific evidence, laymen could determine the approximate cause of death for Ms. Escoblico.
1. Pointing out to the doctor that the patient has a "complication" would not (in my opinion) assume an advocacy role. Specialist Van Riper testified: “Doctors assume that nurses will contact them if a patient has a complication. It's part of a nurse's job.” Deposition of Van Riper, age 15.
2. This specific hospital's policy required temperature measurements four times a day. Nurse Kost testified that Ms. Scoblic did not measure herself after the night staff (head nurse) took vital signs at 7 am. Therefore, it can be safely assumed that Ms. Scoblic was not measured between 7:00 am and 10:45 am. This hospital's policy (ie, their own procedure) was to not repeat vital signs immediately before the patient was discharged. Kost deposit, at 65-66.
3rd degree trial established in Thomas v. Street. Mary's Roman Catholic Church, 283 N.W.2d 254, 258 (S.D. 1979), which sets the standard of reasonable medical probability versus reasonable medical certainty.