State supreme court affirms $3.2 million verdict in negligence case against hospital
By Damian D. Capozzola, Esq.
Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Tim Laquer, 2015 JD Candidate
Pepperdine University School of Law
News: The patient, a 73-year-old woman, suffered a fall at home in September 2005 and sought an evaluation at an emergency department (ED). The patient told the ED physician that she had a sore throat, and the physician ordered a quick streptococcus test, which turned out negative. Other tests were unremarkable as well, and the patient was discharged. However, after the discharge, the laboratory at the medical center found the presence of methicillin-resistant Staphylococcus aureus (MRSA). This information was not reported to the patient’s family physician. The patient returned to the same ED two months later, complaining of a cough and respiratory problems, and she died five days later. The patient’s estate brought suit against the physician and medical center and claimed that their negligence caused the patient’s death. The physician and medical center denied any wrongdoing. The jury found the medical center liable and awarded the patient’s estate $3.2 million in damages.
Background: In this matter, the patient was an elderly 73-year-old woman who had suffered a fall at her home in September 2005. She visited an ED at a hospital operated by a public entity and sought an evaluation. The patient suffered from several chronic pre-existing medical conditions, including respiratory problems, diabetes, hypertension, chronic pain, gastrointestinal bleed, and stroke-related problems. The ED physician’s initial examination revealed no signs of infection, and other tests and X-rays were unremarkable for injuries caused by the fall. The patient informed the physician that she had a sore throat. The ED physician tested the patient for streptococcus, which turned out negative, and the patient was discharged from the ED to return home.
After the patient was discharged, the laboratory at the medical center grew the culture taken from the streptococcus test that reflected the presence of MRSA. The laboratory recorded the culture results in its own electronic medical records system, but these results were not reported to the patient’s family physician. These test results should have been reported to an appropriate physician, but the evidence showed no record that the test results were reported to the ED physician or the patient’s primary physician by the laboratory. In any event, there was no follow-up from this MRSA finding, and the patient remained unaware of the infection. The patient sought and received various medical treatments for other conditions from different medical providers than this medical center. Over two months, the patient received no treatment for the MRSA. In November 2005, the patient returned to the original medical center. She was admitted to the ED and was complaining of a cough and moderate to severe respiratory distress. Because of the underlying infection, the patient died five days after this admission to the ED.
The patient’s estate brought suit and alleged that the physician and hospital breached the standard of care by not reporting the finding of MRSA directly to the patient’s attending physician. The plaintiff’s expert witness opined that the patient died from MRSA-related pneumonia and that the failure of the laboratory to report the finding caused the patient’s death. The hospital attempted to argue that the patient’s death was not caused by MRSA because MRSA does not cause a sore throat, and the patient was not suffering from a throat infection when the streptococcus culture was taken. The defense’s experts stated that MRSA is present in a large part of the population without any symptoms or consequence, meaning that finding the patient has MRSA was not relevant to this patient, and that if the patient’s physician were notified, it would not have changed the patient’s course of treatment. The defense also attempted to argue that the patient died of congestive heart failure, completely unrelated to the MRSA, rather than MRSA-related pneumonia. The trial court entered judgment for the ED physician on the basis that the physician had no knowledge of the positive test for MRSA. The jury found the hospital liable and awarded the estate $3.2 million in damages.
On appeal, the hospital argued that there was a cap on damages, and that it was immune from liability on the basis that it possessed state immunity, as a public, non-profit entity. The appeal made it to the state’s supreme court, which rejected the argument that the hospital was immune. The state supreme court found that the hospital was a public corporation but was an entity separate from the state and any city or county political subdivision. Under state statutes, the hospital enjoyed certain privileges, including tax-exempt status and the power to exercise eminent domain, but it performed the function of a private entity: providing the same health services as those of any other hospital. The state supreme court thus rejected the hospital’s immunity claim and affirmed the judgment of the trial court.
What this means to you: Two important issues raised in this case relate to record-keeping and communication. Accurate record-keeping is not only critical, but it is mandated by government regulations. For example, recent items of legislation, such as the American Recovery and Reinvestment Act (ARRA) and Patient Protection and Affordable Care Act (PPACA), have established two provisions relating to electronic health records (EHRs): a penalty for failing to use EHR systems and a reimbursement incentive for implementing EHR systems. Both of these provisions require healthcare providers and professionals to adopt and demonstrate "meaningful use." The provisions offer significant monetary incentives for those who comply (institutions may receive incentive payments beginning at $2 million) and penalties that will continue to increase for those who do not comply. For more information, see the Center for Medicare and Medicaid Services website at www.cms.gov/EHrIncentivePrograms.
Record-keeping serves a secondary function of protecting in potential future litigation related to any diagnosis and treatment where there might be a claim of negligence. Complete records can help exonerate a hospital or physician, when inaccurate records or no records almost certainly will hurt any defense attempt to argue against negligence. Keeping accurate records of tests conducted and their results also might be essential to prove that these tests actually occurred.
There was no question that the test was properly performed here, as the laboratory at the medical center grew the culture and found the presence of MRSA. However, more action needs to occur beyond simply running the test. The results do not help the patient receive treatment if the proper individual is not notified of the results, which is where effective communication is required.
Communication between hospitals and other entities is important to keep the physicians informed of a patient’s status and allow for complete and accurate treatment. There are many aspects of healthcare which the physician does not have a direct interaction with, but they still are crucial for the physician to successfully treat the patient. Testing, whether done by a hospital’s own laboratory or sourced to an external facility, occurs with such frequency that there must be proper procedures in place to ensure that the results are communicated to any individual who might need to act on them. The laboratory and the hospital might not be responsible for the patient’s treatment directly, but they are responsible for sending information to the correct individuals who are responsible for treatment.
This link is an important one in the chain. If a hospital or laboratory fails to send information, the physician cannot act and cannot be responsible for the injuries suffered, but the hospital or laboratory might well be found liable. This case serves as an illustration for this danger. The physicians were not found negligent, as there was nothing they could do without the proper information regarding the MRSA finding, but the hospital was liable because it failed to pass on the information. Once a hospital relays test results to the appropriate physician or entity, it has likely met its burden and probably will not be held liable. The responsibility switches to the physician to properly act once the information is received.
To these ends, hospitals should ensure that employees are properly trained regarding reporting procedures to ensure that the correct modes of communication are met. Merely recording information in one’s own database might be insufficient: some oversight which guarantees that results are externally reported will help protect a hospital from liability based on failure to communicate. Allowing for discretion in communication can be a dangerous proposition for hospitals. Here, the defense attempted to argue that the MRSA was not the cause of the patient’s death, so the failure to report was irrelevant. This argument is a much more difficult one for a hospital to make. It is safer to have proper procedures in place, and communicate important information, such as the existence of potentially deadly bacteria, to the correct individuals. A record that the results were processed and delivered to the patient’s physician provides a much stronger defense and is easier to satisfy if employees are properly trained.
The hospital’s appeal here raises interesting issues relating to public entities and a potential for reducing their liability. Public non-profit entities often receive special treatment, which is largely governed by state statutory law, as was the case here. State healthcare authorities are subject to unique rules that vary by state, and public hospitals should review these special treatments to determine if there is an argument for reducing or preventing liability.
Unfortunately for the hospital here, law in the state of Alabama, while offering certain protections to the public authority, does not entitle a public hospital acting in the same way as a private entity to receive immunity from liability simply because of its public nature.
- Supreme Court of Alabama. Case No. 1090084.Feb. 28, 2014.