Grove v. PeaceHealth St. Joseph Hospital

312 P.3d 66, 177 Wash. App. 370
CourtCourt of Appeals of Washington
DecidedOctober 28, 2013
DocketNo. 69556-8-I
StatusPublished
Cited by6 cases

This text of 312 P.3d 66 (Grove v. PeaceHealth St. Joseph Hospital) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Grove v. PeaceHealth St. Joseph Hospital, 312 P.3d 66, 177 Wash. App. 370 (Wash. Ct. App. 2013).

Opinion

Dwyer, J.

¶1 In the state of Washington, medical malpractice is a statutory cause of action, which requires that the plaintiff prove the standard of care to be exercised by a health care provider within the profession or class to [373]*373which he or she belongs. This is no less the case when a hospital opts to provide medical care to its patients by using a “team approach.” Here, Raymond Grove filed a lawsuit against PeaceHealth St. Joseph Medical Center, alleging medical malpractice for failure to timely diagnose compartment syndrome in his left leg. Grove sought damages against PeaceHealth under a theory of vicarious liability for negligence committed by its medical team or, alternatively, by Dr. Richard Leone as the leader of the team. The jury found in Grove’s favor and awarded Grove $583,000 in damages. The trial court overturned the verdict on a motion for judgment as a matter of law, finding that no legal basis existed for holding PeaceHealth vicariously liable, given that Grove had not proved that any specific employee had acted negligently. Because Grove failed to prove the applicable standard of care as required by statute, we affirm.

I

¶2 On December 21, 2006, Grove underwent aortic root and valve replacement surgery at PeaceHealth in Belling-ham. After the surgery was successfully completed, Grove was placed in the intensive care unit, as is standard hospital practice following heart surgery. Dr. Leone, Grove’s attending physician during the surgery, acted as primary physician until December 25. On that date, Dr. Leone traveled to New Jersey for Christmas, and Dr. Edward Zech, the surgeon on call, assumed the role of primary physician. Similarly, Dr. James Douglas assumed the role of primary physician from Dr. Zech on December 29. Dr. Leone remained the surgeon of record until Grove was released from the hospital.

¶3 Grove developed a number of complications after his surgery. Significantly, he was having trouble breathing and was thus intubated from December 23 through December [374]*37426, during which time he was sedated.1 Grove also developed pneumonia and bacteria in his blood, for which Dr. Sara Mostad, an infectious disease specialist, was called in. Dr. Zech was especially concerned about the possibility of infection, because an infection in Grove’s heart would have almost certainly been fatal. On December 29, Shane Spears, a physician assistant (PA), noted that Grove’s left calf was exhibiting “edematous, tenderness to palpitation, warm with erythema on the anterior aspect.2 Two to five centimeters larger than the right.” PA Spears also noted that Grove had “weakness in flexion”3 in both ankles, “but it was worse on the left.” Dr. Douglas and Dr. Mostad suspected, based on these symptoms, that Grove may have had cellulitis, a bacterial infection typically treated with antibiotics. Grove was already on antibiotics at the time these symptoms developed. Grove’s condition appeared to improve on December 30, but by December 31, Grove’s symptoms had spread down to his foot.

¶4 On December 31, Dr. Mostad noticed that Grove was unable to fully dorsiflex4 his foot and that he was dragging his left toe when he walked. Dr. Mostad suspected at that time that Grove had compartment syndrome. Dr. James Miller5 conducted a compartment pressure test and found that the pressure in Grove’s left leg was over three times the normal average, indicating that Grove was suffering from compartment syndrome. Compartment syndrome is a known, albeit rare, complication from a long surgery, such [375]*375as the heart surgery Grove underwent.6 Symptoms of compartment syndrome typically include hardness, swelling, numbness, tingling, pallor, loss of neurological function, lack of pulse, and excruciating pain. As far as the witnesses could recall or as Grove’s medical records indicated, at no time did Grove ever complain of excruciating pain, the most notable symptom of compartment syndrome. If detected early, compartment syndrome is “completely reversible”; if not, the damage is irreversible and can be so severe as to necessitate limb loss. Grove underwent surgery to relieve his compartment syndrome but, by that time, his compartment syndrome had advanced to the point of necrosis,7 resulting in permanent injury to his left leg.8

¶5 A jury trial began on June 13, 2012. Witnesses for both parties testified that Grove was treated and attended to using a “team” approach. Dr. Douglas explained how the “team” approach operated, stating that the “team,” consisting of “the surgeons and the physician assistants,” made rounds together twice per day. He further stated, “In our situation our patients are seen by both surgeons or all three surgeons depending on the circumstance regardless of who is primarily in charge. So at any time a patient needs assistance that physician is well[ ] aware of what’s going on. So we basically assume everybody is our patient.” Dr. Douglas testified that the “team” “evaluate [s] patients in such a way that everybody gets a chance to have input.”

¶6 Dr. Leone testified that the “team” made rounds more than once a day and that the “team” may also include students, nurses, and other “ancillary staff.” Dr. Zech testified that the method of treatment used was “very much a team approach,” designed to keep all staff informed. Dr. Zech further testified that the team consisted of surgeons, PAs, and intensivists. PA Spears testified that the physi[376]*376cians might not do a physical examination of the patient during rounds, instead relying on the PA’s findings, if there was not a concern with the patient. However, PA Spears also testified that he always discussed the plan of care with the surgeons before he implemented it.

¶7 Dr. Sean Ghidella, an orthopedic surgeon and expert witness for Grove, testified that the care of Grove fell below the standard of care because of a lack of proper monitoring and a failure to rule out a known possible complication after surgery.9 When asked who he was criticizing, Dr. Ghidella testified as follows:

A: I identified Dr. Leone.
Q: And why did you identify Dr. Leone as opposed to someone else?
A: I was aware that there were multiple providers involved, that there was a team approach. At the time I was asked, I was not certain entirely as to who was to blame, but I do know that one person that at least shared in the responsibility would be the surgeon of record. He is ultimately responsible for that admission and the patient’s care under that admission.
Q: So based on —
A: So for the lack of anyone else with certainty, I knew that at least I could include him in that discussion, but I don’t know that I committed anyone else for the lack of clarity in terms of what was going on in the complexity of the situation, the type of documentation that I had available to try to define who said what when and who did what when.
Q: Your understanding is that this was a team approach that was dealing with Mr. Grove?
A: Yes.
Q: As far as you’re concerned, who would be responsible for the team at any particular time?
A: I know in my patients, I do.

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Bluebook (online)
312 P.3d 66, 177 Wash. App. 370, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grove-v-peacehealth-st-joseph-hospital-washctapp-2013.