Thomas v. Corso

Citations: 288 A.2d 379; 265 Md. 84; 1972 Md. LEXIS 931Docket: [No. 201, September Term, 1971.]

Court: Court of Appeals of Maryland; March 17, 1972; Maryland; State Supreme Court

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In the case of Thomas et al. v. Corso et al., the Court of Appeals of Maryland reviewed a judgment from the Circuit Court for Montgomery County, which awarded $99,609.24 to Mida Belle Corso and her children following the death of her husband, Faust Q. Corso. Appellants Dr. Robert J. Thomas and Frederick Memorial Hospital contested the decision, raising three primary issues: (1) whether the trial court erred in denying their motions for directed verdicts and judgments n.o.v.; (2) whether the jury instructions regarding the decedent's contributory negligence were erroneous; and (3) whether the case should be remanded for a new trial to allow additional evidence regarding liability.

The court affirmed the lower court's judgment, concluding that there was no error in the trial court's decisions. On January 8, 1969, Corso and a colleague attended a union meeting and later parked along Maryland Route 180, where Corso consumed alcohol at a nearby restaurant. After leaving the restaurant around 10:30 p.m., while preparing to drive home, Corso was struck by an oncoming vehicle driven by Robert Lee Miller. Witness John R. Lyons observed the incident and confirmed that he had warned Corso of the approaching car moments before the accident occurred. The court found that the evidence supported the earlier ruling and did not warrant a new trial.

Miller reported that he did not see anyone on the road during the collision but heard a loud thump while driving at 35 to 40 miles per hour, and subsequently stopped a distance down the road. Both Miller and Trooper Wolfe noted that Corso was found lying in the road approximately 40 feet from his vehicle. The impact caused a significant dent in Miller's car and damaged the aerial. Upon arrival, Lyons discovered Corso unconscious, with blood coming from his nose and mouth, though Corso regained consciousness before the ambulance's arrival. Trooper Wolfe later found Corso conscious, vomiting, and experiencing pain in his right hip.

Corso was transported to the Emergency Room at 11:10 p.m. by Brunswick Ambulance. Nurse Constance M. Halter assessed Corso’s vital signs, noting low blood pressure and complaints of numbness in the right thigh, but observed no deformities and confirmed he could move his right leg. She documented treatment provided, including an intramuscular injection of Demerol and cleaning of abrasions, and communicated with Dr. R.J. Thomas about Corso's condition and vital signs. Dr. Thomas instructed Nurse Halter to admit Corso, but Nurse Halter disputed Dr. Thomas's claims regarding his requests for observation and whether he needed to see Corso. The hospital operates with private practicing physicians on a voluntary, rotating on-call basis, responsible for patient diagnosis and treatment in the Emergency Room.

Nurse Halter stated Corso was covered with blankets and did not retake his pulse after the initial reading of 84, considering it normal. She was primarily focused on his blood pressure, which she monitored every ten minutes. Halter maintained that she did not inform Dr. Thomas of the 100/60 blood pressure reading, as it was taken after her communication with him regarding earlier lower readings of 80/60 and 90/60.

Dr. Thomas testified that a blood pressure reading under 100 is considered low. Due to an influenza epidemic, the hospital was at full capacity, leading to Corso's transfer from the Emergency Room to a hallway outside the nurse's station. Nurse Peggy Lou Strawsburg and Assistant Nurse Supervisor Kathryn Nussbaum attended to Corso, noting vital signs that indicated severe hypotension (70/50), tachycardia (pulse of 120), and rapid respiration (40). Despite complaints of pain, Corso was rational and had received a maximum dose of Demerol, which can depress blood pressure. As time progressed, Corso's condition fluctuated, with blood pressure readings improving slightly to 89/70 and then 94/70, while he continued to exhibit signs of distress. By 2:00 a.m., he was found to be in respiratory failure, and attempts at resuscitation failed. Dr. Thomas was on-call that evening but remained at home until notified of Corso's deteriorating condition. Upon arriving at the hospital at 2:30 a.m., he pronounced Corso dead and observed a potential fractured hip, which he believed was present upon Corso's arrival at the Emergency Room but became clinically apparent later. He acknowledged that Corso had not been seen by a physician until his death and stated it was his responsibility to ensure proper diagnosis and treatment for his patients.

Dr. Thomas ordered an autopsy on Corso, performed by Dr. Robert J. Furie, which revealed severe injuries including a lacerated liver, comminuted fractures of the left femoral neck and pelvic area, and separation of the coccyx from the sacrum, with extensive hemorrhage but no signs of pre-existing disease. Both doctors concluded that Corso's death was caused by traumatic shock due to these fractures. 

Dr. Thomas received initial information from Nurse Halter indicating Corso had been struck by a car, was conscious, and had a blood pressure of 100/90. However, he later reported different blood pressure readings given by Nurse Halter (80/60, 90/60, 100/60) and denied being informed of pain in Corso's thigh, despite admitting to a previous misstatement about this in his deposition. He differentiated between 'pain' and 'numbness,' suggesting that pain could exacerbate shock but ultimately stated this distinction would not have influenced his treatment approach.

Following the call, Dr. Thomas instructed Nurse Halter to admit Corso for observation and ordered Demerol for his agitation. He emphasized his practice of keeping trauma patients for observation to monitor potential changes in their condition. Dr. Thomas acknowledged the possibility of undetected fractures and confirmed that Corso was kept for observation for this reason. He was unaware of Corso's condition between 11:30 p.m. and 2:15 a.m., only learning that Corso had seemingly stabilized before collapsing. He asserted that physicians rely on nurses for clinical observations as they cannot be present for every patient.

Dr. Thomas relied on Nurse Halter's assessment, which she later denied, that patient Corso was stable and did not require his evaluation. He claimed he was as competent as the nurse for observations but better suited to integrate those observations for a diagnosis. However, he never diagnosed Corso, despite hospital rules mandating a provisional diagnosis upon admission, especially in emergencies. When questioned about billing for his services, Dr. Thomas admitted, “I didn’t do anything.” He asserted that he should have been informed at 12:05 a.m. about Corso's deteriorating vital signs, which indicated shock and necessitated his immediate intervention. Dr. Thomas emphasized that trained nurses should communicate significant changes in a patient's condition to the physician without needing a formal order. He indicated that had he been notified in time, he might have been able to save Corso, although he stated that only God could know for sure. Dr. Furie corroborated Dr. Thomas's concerns about the critical nature of Corso’s condition, explaining that shock involves inadequate blood flow to tissues, risking irreversible damage if not treated promptly. He identified key symptoms of shock, including low blood pressure and rapid pulse, and noted that Corso needed immediate medical attention upon arrival at the hospital due to his low blood pressure and the trauma from being struck by a vehicle. Dr. Furie stressed the need for physical examination in such cases to detect potential life-threatening injuries, including internal bleeding, which may not be immediately visible.

Assessment of a patient's serious injuries involves the physician's direct observation and judgment, as relying on others' interpretations can be dangerous. Dr. Furie noted that vital signs recorded at 12:05 a.m. indicated a critical, life-threatening situation requiring immediate action, suggesting that Corso may have been in shock with a concerning blood pressure of 100/60. He emphasized the need for frequent monitoring of vital signs, especially for shock symptoms. Nurses Strawsburg and Nussbaum contested Dr. Thomas's claim regarding standard practice for notifying physicians of significant changes in vital signs but acknowledged they would alert a physician if they suspected shock, recognizing the shock-indicative blood pressure of 70/50 and a pulse of 120 at the same time. Despite Corso's request for water, the nurses did not consider thirst as a shock symptom. Dr. Thomas argued that Corso's drinking did not influence his judgment. Both doctors confirmed Corso's blood alcohol level of .05%, which is below the Maryland intoxication threshold of .15%. Dr. Thomas contended that the trial court erred in denying his motions for a directed verdict and judgment n.o.v. based on three arguments: (i) plaintiffs did not provide expert evidence to establish the local standard of care or its breach; (ii) they failed to demonstrate a causal link between alleged negligence and Corso's injury; and (iii) they did not prove that the alleged negligence was the proximate cause of the injury. The document notes that while expert testimony is often necessary in medical malpractice cases, certain situations may not require it, similar to cases where a dentist performs an obviously negligent act, such as extracting the wrong tooth.

In Butts v. Watts, it was established that expert testimony is not always essential in malpractice cases when laypersons can recognize negligence based on common knowledge. The case contrasted complex medical procedures requiring expert input with simpler cases where negligence, such as carelessly dropping a scalpel, could be assessed by laypersons. 

The standard of care expected from physicians entails a duty to attend to patients after establishing a physician-patient relationship, and such attendance must be reasonable. While expert evidence is often needed to determine how much attention a case requires, a complete failure to attend a patient, particularly when serious consequences are evident, does not require expert input to establish negligence.

In the current case, Dr. Thomas was informed by Nurse Halter that Corso was struck by an automobile and exhibited concerning symptoms. The nature of the incident suggested possible serious injuries that a layperson could recognize. Expert opinion indicated that Dr. Thomas's physical presence was necessary to adequately assess Corso's condition. Nurse Halter noted that it is common practice for on-call doctors to examine patients involved in automobile accidents, highlighting a standard expectation of care. Dr. Thomas acknowledged that a majority of emergency patients are seen by physicians, though he did not clarify the specifics for those injured in automobile accidents.

When evaluating claims of insufficient evidence for jury consideration or errors in denying a judgment n.o.v. after a jury's verdict for the plaintiff, all evidence conflicts must be resolved in favor of the plaintiff, granting them all reasonable inferences. Significant contradictions arose between Dr. Thomas and Nurse Halter's testimonies regarding a phone call at 11:25 p.m. Dr. Thomas asserted he inquired whether he needed to attend to Corso, to which Nurse Halter allegedly replied he did not; she denied both the question and the response. Consequently, Nurse Halter's account is assumed true, indicating Dr. Thomas was not informed that his presence was unnecessary. Nurse Halter also refuted Dr. Thomas’ claim that he instructed Corso to remain in the Emergency Room for observation, and she testified that she only recorded Corso's blood pressure of 100/60 after their call, not during it. The jury could infer that Dr. Thomas was informed of the lower blood pressure readings earlier. Dr. Thomas acknowledged that a blood pressure below 100 is low and knew that Demerol could further decrease blood pressure yet ordered its administration, leading to a critical drop in Corso's blood pressure to 70/50 by 12:05 a.m., when he showed signs of shock. It was foreseeable that such a decline could occur, and Dr. Thomas had the opportunity to examine Corso, being only 10 minutes away and not occupied with other patients. Dr. Thomas argued that the plaintiffs failed to demonstrate a causal link between his negligence and Corso's death, but the court disagreed, citing that if a defendant's negligence eliminates a person's chance of survival, they cannot argue about the extent of the chances lost. If any substantial possibility of survival existed, the defendant is held accountable.

The plaintiff is not required to prove with certainty that the patient, Corso, would have survived had he received prompt hospitalization and treatment. Dr. Thomas acknowledged that he could have potentially revived Corso if called at 12:05 a.m. and admitted that the absence of timely treatment increased Corso's risk of death. Testimony from Dr. Furie indicated that Corso's survival chances were contingent on immediate treatment for shock, which, if not addressed promptly, could lead to irreversible consequences. This evidence supports a jury's finding of a significant possibility of survival lost due to Dr. Thomas's failure to examine and treat Corso after he was accepted as a patient.

Dr. Thomas argued that, assuming negligence, a clear causal link must exist between his actions and Corso's death, without any intervening causes. He claimed that either the nurses' negligence or Corso's critical condition was the proximate cause of his death. However, the court found that Dr. Thomas's failure to act upon being alerted at 11:30 p.m. constituted sufficient negligence that severed the causal chain between his actions and Corso's demise.

The testimony from Dr. Thomas, while binding, could be challenged by circumstances or the testimony of others. The jury could reasonably conclude that if Dr. Thomas had fulfilled his duty and attended to Corso after being notified, he might have saved Corso's life. The court supported the idea that multiple proximate causes could independently justify liability. The trial judge's denial of Dr. Thomas's motions for a verdict and judgment was deemed appropriate.

Regarding the hospital's motion for a directed verdict, the court found no error. At 12:05 a.m., observations indicated Corso was in shock, and when questioned about calling the doctor, Nurse Strawsburg implied that the thought crossed her mind but did not confirm action.

The jury may have dismissed the nurses' justifications for not contacting Dr. Thomas regarding Corso's condition, given his low blood pressure and the administration of Demerol alongside alcohol. Nurse Nussbaum acknowledged concern about Corso's blood pressure of 70/50, and Dr. Thomas emphasized the importance of notifying him of significant changes in vital signs, as standard procedure, particularly at 12:05 a.m. He indicated that timely communication could have allowed him to provide immediate treatment to potentially save Corso's life. Dr. Furie's testimony supported Dr. Thomas, asserting that prompt treatment for shock is critical to prevent irreversible damage. The nurses' failure to contact Dr. Thomas at the appropriate time could lead the jury to find the Hospital liable for their negligence. The findings from both doctors were deemed sufficient to establish a causal link between the nurses’ actions and Corso's death. The trial court appropriately denied the Hospital's motions for a directed verdict, and the jury was instructed regarding the applicability of contributory negligence, which Dr. Thomas contested. The judgment against the Hospital was under $100,000, negating any claims for damage limitations.

Corso's "alcoholic condition" at the time of the accident allegedly contributed to both the accident and the inability of medical personnel to recognize his injuries, as pain perception was diminished compared to a sober individual. However, no evidence indicated that Corso was intoxicated; testimony revealed he consumed only two beers and no other alcoholic beverages were available. Dr. Thomas stated that knowledge of any alcohol consumption would not have impacted his diagnosis or treatment, affirming the trial court's instructions on this matter. 

The case involved a bifurcated trial structure under Maryland Rule 501a, where liability was determined first. The jury found no negligence on the part of Miller, Corso's employer. During the subsequent damages trial, Dr. C.T. Byron Kao, Corso's personal physician, offered to testify after reading about the case. Although he was not listed as a witness, he was allowed to testify about Corso's history of alcoholism and health issues, indicating that Corso's condition was below average for his age due to excessive drinking, which was known to his wife. Dr. Thomas argued that Corso's alcoholic condition was relevant to liability and could support a defense of contributory negligence, suggesting that more evidence should be introduced.

Dr. Kao's testimony could have been utilized to challenge Corso's widow and son, who claimed Corso was generally healthy and did not drink excessively before the accident. However, this challenge was not preserved for appellate review because it was not raised or decided by the lower court, as per Maryland Rule 885. After Dr. Kao's testimony was disclosed on May 11, 1971, Dr. Thomas and the Hospital opted not to reopen the liability case or take action regarding this testimony, choosing instead to include it in the damages phase, likely hoping it would lower the damages awarded. The jury reached its verdict on the same day, and no motions for a new trial were filed by either party until Dr. Thomas filed an appeal on June 2, 1971, followed by the Hospital's appeal on June 14, 1971. Dr. Thomas had previously filed a motion for a new trial on December 11, 1970, which did not cite Dr. Kao's testimony, as it was not known at that time. 

Both Dr. Thomas and the Hospital sought a remand for a new trial based on a revised Death Certificate and Affidavit from Dr. Russell Fisher, the Chief Medical Examiner, dated September 21, 1971, which indicated a change in the cause of death from "Traumatic Shock" to "Fat Embolism." Dr. Fisher's findings suggested that fat embolism, often difficult to clinically diagnose, caused heart failure in Corso due to impaired blood flow. The revised Death Certificate and Affidavit were not formally presented to the trial court but merely included in the record, leading to the conclusion that this issue was also not preserved for appellate review. Ultimately, the court found no errors and affirmed the judgment, with costs assigned to the appellants.