Pederson v. Dumouchel

Citations: 431 P.2d 973; 72 Wash. 2d 73; 31 A.L.R. 3d 1100; 1967 Wash. LEXIS 784Docket: 38184

Court: Washington Supreme Court; September 21, 1967; Washington; State Supreme Court

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

Dorothy H. Pederson, as guardian for Larry C. Neal, appeals a judgment dismissing a medical malpractice case against Dr. M.L. Dumouchel, dentist Walter D. Heikel, and St. Joseph Hospital. The case stems from events following an automobile accident on June 6, 1961, after which Neal underwent surgery for a fractured jaw at St. Joseph Hospital. Dr. Dumouchel examined Neal before surgery and concluded there was no brain injury. The surgery, which involved general anesthesia administered by a nurse, commenced on June 7, 1961, without the presence of any medical doctor. Following the procedure, Neal experienced convulsive seizures in the recovery room, and Dr. Dumouchel was unavailable. Dr. John D. Fletcher, who was eventually located, found Neal unconscious and conducted a spinal tap that indicated potential brain injury. Neal was subsequently transferred to Seattle for further treatment, where he remained unconscious for nearly a month. Testimony revealed that the nurse anesthetist had a history of narcotic use and had recently started drinking alcohol. She had limited memory of the surgical events and relied on the anesthesia chart for her account. The hospital was responsible for hiring and compensating the nurse anesthetist.

Competent expert medical testimony indicates that the plaintiff sustained severe and permanent brain damage due to cerebral anoxia or hypoxia, linked to inadequate ventilation during anesthesia or the postoperative period. The plaintiff has raised 14 errors, focusing on four main legal issues: the trial court's instructions regarding the standard of care for medical professionals, the omission of a requested instruction on the doctrine of res ipsa loquitur, the appropriateness of hypothetical questions posed during the trial, and alleged improper arguments by defense counsel.

The initial seven assignments pertain to the standard of care instructions applicable to doctors, dentists, and hospitals. Assignment eight challenges the trial court's refusal to provide a specific instruction that articulated the plaintiff's proposed standard of care. The crux of this issue is captured in a questioned instruction emphasizing that the standard is defined by the knowledge, skill, care, and diligence typically found among practitioners in the same profession, locality, or under similar circumstances. Conflicting Washington case law exists regarding the locality rule's application; some cases reference the standard within the same community, while others consider similar communities. Historical context reveals that the locality rule aimed to account for differences in resources and opportunities between small and large communities, particularly in medicine. However, the law does not differentiate between the professional competency of lawyers based on community size.

Challenges to the locality rule include the difficulty of finding qualified local experts to testify about the standard of care and the risk of establishing a subpar local standard due to the practices of negligent practitioners. The law maintains that negligence cannot be justified by the prevailing practices in a locality, asserting that patients deserve a consistent standard of care irrespective of community size.

Expanding the 'locality rule' to include 'similar localities' offers some relief from its initial limitations, particularly by allowing for additional witnesses. However, it does not fully address the shortcomings associated with the second difficulty. In *Teig v. St. John's Hosp.*, the court admitted expert testimony from a doctor in Portland, Oregon, regarding a malpractice case in Longview, Washington, despite the two locations being approximately 50 miles apart and not classified as 'similar localities.' The court acknowledged that the doctor was knowledgeable about the standards in both areas, emphasizing that modern communication and educational resources enable physicians to stay informed about national practices. Consequently, the 'locality rule' has diminished relevance, serving primarily as one of several factors in determining the standard of care expected from practitioners. The required standard is that of an average, competent practitioner under similar circumstances, rather than being confined to local practices. Unlike in England, where a uniform standard applies nationwide, the vast geographic diversity in the U.S. complicates the establishment of a definitive standard of care. A medical professional may be liable for negligence if they fail to meet the expected standard of care based on the broader medical practices accessible in their area. In this case, the plaintiff was transported from Aberdeen to Seattle, illustrating the need for a broader standard. The court granted the plaintiff a new trial against Dr. Dumouchel and Dr. Heikel but rejected the plaintiff's proposed jury instruction that would allow jurors to ignore medical testimony. The principles discussed also apply to hospital standards, which are influenced by both administrative oversight and physical facilities necessary for accreditation.

Negligence is established as a matter of law for a hospital that allows surgery under general anesthesia without a medical doctor's presence and supervision, barring extraordinary circumstances. The hospital violated its own regulations, specifically allowing dental procedures to be performed under the oversight of a qualified dentist and medical staff member, who must conduct a medical examination and take responsibility for the patient’s care. The dismissal of the lawsuit against the hospital is reversed, and the case is remanded for a new trial to assess whether the hospital's negligence caused the plaintiff's injury and to determine damages.

The doctrine of res ipsa loquitur is applicable, allowing the jury to infer negligence if an injury occurs under circumstances that typically do not happen without negligence, provided that the instrumentality causing the injury was under the defendants' control. The jury has the discretion to make this inference. The case meets the criteria for res ipsa loquitur, as the prolonged unresponsiveness to anesthesia, resulting in apparent brain damage, is an extraordinary outcome. Expert testimony supports the inference of negligence, despite the defense's argument regarding the plaintiff's prior serious automobile accident, which ultimately presents a jury question since the surgery occurred significantly later.

Prior to surgery, the plaintiff's doctor, a defendant, testified that the plaintiff had no significant brain injury. The jury could reasonably support the plaintiff's case based on the evidence presented. The court determined that the plaintiff's requested instruction No. 13, which allowed the jury to infer negligence without a complete explanation, should have been granted. Defense arguments requiring the plaintiff to prove surgical error were deemed inappropriate.

The plaintiff also challenged the trial court's acceptance of broad hypothetical questions regarding the standard of care for dental surgeries under general anesthesia. The court agreed these questions should have been more focused. However, a complex hypothetical question about the plaintiff's brain function was upheld, as it was supported by expert testimony.

Concerns were raised about the defense counsel's conduct, suggesting that they improperly appealed to local sentiments, which could bias the jury. Specific examples indicated that defense arguments strayed from factual presentation to emotional appeals tied to local pride. The court concluded that the trial was unfairly influenced by these tactics, leading to a decision for a retrial. The judgment of dismissal was reversed, and the case was remanded for a new trial, with costs pending the final outcome.