Carl J. Battaglia, M.D., P.A. v. Alexander

93 S.W.3d 132, 2002 WL 730530
Court of Appeals of Texas·Decided September 19, 2002·No. 14-00-00428-CV·Published·Cited by 17 cases

Opinion

OPINION

KEM THOMPSON FROST, Justice.

In this wrongful death case arising from anesthesia malpractice, appellants Carl J. Battaglia, M.D., P.A. and Tommy A. Polk, M.D., P.A. (collectively, the “Professional Associations”) assert that they owed decedent Mark G. Alexander no duty, that there was no evidence of their negligence, and that there was no evidence and no adequate legal basis to support the vicarious-liability theories against them based on the acts of Dr. Laverta Crowder and Nurse Anesthetist Constance Cernosek. The Professional Associations also argue the trial court erred in calculating prejudgment interest and in holding them jointly and severally liable. We affirm the trial court’s judgment.

Factual and Procedural Background

The Professional Associations were formed as corporate vehicles for the medical practices of two anesthesiologists, Drs. Carl J. Battaglia and Tommy A. Polk. The Professional Associations entered into an exclusive contract with TOPS Surgical Specialty Hospital (“TOPS”). Under this contract, the Professional Associations agreed to provide anesthesia services at the surgical hospital located at 17080 Red Oak Drive, Houston, Texas (“Hospital”). The contract obligated the Professional Associations to “operate and staff’ the Hospital’s Department of Anesthesia. In the contract, the Professional Associations agreed “to provide all medical, technical, education, research, quality control and other customary services necessary or appropriate for the operation of a full service anesthesia program in the [Hospital].” The Professional Associations also promised that the anesthesia services they provided under their contract with TOPS would comply with applicable governmental, legal, and professional standards.

Doctors perform approximately 7,000 surgeries each year in the Hospital’s seven operating rooms. To fulfill their obligations under their contract with TOPS, the Professional Associations use certified registered nurse anesthetists (“Nurse Anesthetists”) to perform anesthesia services. The evidence at trial showed that the Professional Associations selected, trained, assigned, and supervised the Nurse Anesthetists. The evidence also showed that the Professional Associations were responsible for assuring that the Nurse Anesthetists complied with the policies and procedures promulgated by the Hospital, the Anesthesia Department, and the American Society of Anesthesiologists.

TOPS collected all professional fees associated with the Hospital’s Anesthesia Department. TOPS maintained a separate account for these fees and paid each of the Professional Associations $360,000 annually — an aggregate of $720,000 per year — for the services provided by the anesthesiologists under the contract. In addition, TOPS also paid each of the Professional Associations one-third of the “Anesthesia Profits,” which is the amount, if any, by which the gross revenues from *136 all anesthesia services, with a few adjustments set forth in the contract, exceeds the sum of the following: (1) the $720,000 mentioned above and (2) the salaries, benefits, and other direct costs of the Nurse Anesthetists and all supplies, promotional expenses, and other costs directly attributable to the operation of the Hospital’s Anesthesia Department (but not including any of TOPS’s general overhead expense) for the year in question. TOPS retained the other one-third of the “Anesthesia Profits.”

On September 19, 1997, Mark Alexander, a forty-year-old man, reported to the Hospital for routine arthroscopic shoulder surgery, to be performed as an outpatient procedure. Dr. Laverta Jane Crowder, an anesthesiologist, introduced herself to Mark and told him that she was with the Anesthesia Department. Dr. Crowder worked at the Hospital under an agreement that she had with Drs. Battaglia and Polk. Mark asked Dr. Crowder questions about the anesthesia to be used in his surgery. Dr. Crowder answered Mark’s questions; however, she did not tell Mark that his anesthesia would be administered by a Nurse Anesthetist without a supervising anesthesiologist in the room. After the surgical procedure began, Dr. Crowder left the operating room. Consequently, Nurse Anesthetist Constance Cernosek was the only person from the Anesthesiology Department present in the operating room during Mark’s surgery. Dr. Crow-der testified she could not recall having any other duties or responsibilities at that time, and she could have remained in the operating room.

An expert anesthesiologist, Dr. Robert Kirby, testified that Nurse Cernosek made several grave errors during and in preparation for Mark’s surgery. First, she inserted the endotracheal tube to an excessive depth. She also inserted the esophageal stethoscope — used to monitor the patient’s breathing and heart sounds — into Mark’s left lung rather than into his esophagus. Dr. Kirby testified that this would cause inadequate ventilation to Mark’s lungs. Another expert anesthesiologist, Dr. Roy Sheinbaum, also testified that the placement of the esophageal stethoscope into Mark’s right lung could cause inadequate ventilation.

An expert cardiologist, Dr. Robert Fromm, testified that, dining surgery, Mark had progressive bradycardia, an abnormally slow beating of the heart, which is a condition that is consistent with inadequate ventilation. This condition can lead to cardiac arrest. According to Dr. Fromm, if Mark was in good health before the operation and if he had been well-ventilated during surgery, he would have survived a sudden cardiac arrest during the surgery.

To record the time during Mark’s surgery, Nurse Cernosek used the operating room clock. The last documented heart rate for Mark on his anesthesia record was at 10:25 a.m. However, based on the operating room clock, at 10:42 a-m. 1 , the medical team first became aware that Mark had no pulse and was in cardiac arrest. Nurse Cernosek failed to record Mark’s heart rate during this seventeen-minute period.

In order to alert the anesthetist to potential problems, the vital-sign monitors have alarms that are supposed to sound when the recorded vital signs are outside of safe parameters. Nurse Cernosek testified that the alarms on Mark’s vital-sign monitors never went off. No one else *137 present could remember hearing any monitor alarms sound. Dr. Lewis Coveler, an expert anesthesiologist called by appellants, and Dr. Kirby testified that these alarms should have sounded on several occasions. Drs. Coveler and Kirby both testified that the failure of these alarms to go off indicated that either the parameters for these alarms had been set too broadly or the alarms had never been activated.

During Mark’s surgery, the surgeon, Dr. Mark Stuart, noticed Nurse Cernosek fiddling under the drape separating the surgical field from Mark’s head. When Dr. Stuart asked what she was doing, Nurse Cernosek indicated the patient was having ventilation problems. Dr. Stuart immediately withdrew his instruments and turned Mark over. Mark’s upper body and thighs already had turned blue from oxygen deprivation.

Dr. Crowder was summoned to the operating room, and Dr. Battaglia came along as well. These doctors, along with the nurses, began emergency resuscitation efforts. By that time, however, Mark already had been deprived of adequate blood flow to the brain for at least ten minutes and possibly as long as fourteen minutes. Dr.

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Carl J. Battaglia, M.D., P.A. v. Alexander, 93 S.W.3d 132, 2002 WL 730530 (Tex. Ct. App. 2002).

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