STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
10-458
JEANNIE HEITMAN, ET AL.
VERSUS
CHRISTUS HEALTH CENTRAL D/B/A CHRISTUS ST. FRANCES CABRINI HOSPITAL, ET AL.
**********
APPEAL FROM THE NINTH JUDICIAL DISTRICT COURT PARISH OF RAPIDES, NO. 228,728 HONORABLE DONALD THADDEUS JOHNSON, DISTRICT JUDGE
JOHN D. SAUNDERS JUDGE
Court composed of John D. Saunders, Jimmie C. Peters, and James T. Genovese, Judges.
AFFIRMED.
Eugene A. Ledet, Jr. Joseph Texada Dalrymple Dalrymple & Ledet 1450 Dorchester Drive Alexandria, LA 71301 (318) 442-1818 Counsel for Plaintiffs/Appellants: Jeannie Heitman Daniel Heitman, O. D. David Richard Sobel Jeremy C. Cedars Provosty, Sadler, deLaunay, Fiorenza & Sobel P. O. Drawer 1791 Alexandria, LA 71309-1791 (318) 445-3631 Counsel for Defendant/Appellee: Christus Health Central Christus St. Frances Cabrini Hospital SAUNDERS, Judge.
Herein, we address whether the trial court erred in allowing Courtney
Robinson, an out-of-state pediatric nurse practitioner, to testify as an expert witness
at trial in this medical malpractice case. For the following reasons, we find that it did
not err.
FACTS AND PROCEDURAL HISTORY:
On December 25, 2004, Callie Heitman (Callie), an infant, was admitted to
Christus St. Francis Cabrini Hospital (Cabrini) after experiencing a syncopal episode
(fainting) at home. She was diagnosed as suffering from a severe case of anemia
(iron deficiency).
Callie was initially treated in the Cabrini emergency room, where the staff
attempted to initiate an IV to the patient. After several unsuccessful attempts at
placing the IV, Curt Fuqua, RN, was able to establish the IV in the patient’s foot at
6:05 p.m. Thereafter, the Cabrini staff started Callie on a drip and drew blood
through the IV. No immobilization device was used by Fuqua on the patient’s foot
in order to secure the IV.
Unfortunately, IV access was lost at 11:14 p.m. due to kinking in the tubing.
The Cabrini staff was unable to reestablish an IV at any peripheral site, and Dr. Stuart
Head was called in to establish a central line in the patient’s right femoral vein.
Callie’s parents (the Appellants) filed the instant suit against Cabrini, alleging
that it was negligent in failing to secure the IV access site with an armboard. The
matter was initially submitted to a medical review panel, which unanimously held that
Cabrini did not deviate from the standard of care.
The case was then presented before Judge Donald T. Johnson of the Ninth
Judicial District Court in Rapides Parish. The trial court ultimately dismissed the Appellants’ action against Cabrini. However, in making its decision, the trial court
took into consideration testimony offered by nurse Courtney Robinson—accepting
Robinson as an expert witness in pediatric nursing. It is on this issue that the
Appellants bring their appeal.
APPELLANTS’ ASSIGNMENT OF ERROR:
The trial court committed legal error in failing to exclude the testimony of
nurse Courtney Robinson, pursuant to [La.R.S.] 40:1299.41(A)(7).
LAW AND DISCUSSION ON THE MERITS:
The sole issue before this court is the propriety of the trial court allowing
Courtney Robinson to testify as an expert witness in this case.
It is well-settled law that trial courts are given great discretion in determining
if a potential expert witness is adequately qualified.
Trial Courts are vested with great discretion in determining the competence of expert witnesses, and rulings on the qualifications of an expert witness will not be disturbed unless there was an abuse of that discretion. A combination of specialized training, work experience, and practical application of the expert’s knowledge can combine to demonstrate that the person is an expert; a person may qualify as an expert based upon experience alone.
State v. Jarrell, 07-1720, p. 16 (La.App. 1 Cir. 9/12/08), 994 So.2d 620, 633 (quoting
State v. Berry, 95-1610, p. 20 (La.App. 1 Cir. 11/8/96), 648 So.2d 439, 456, writ
denied, 97-278 (La. 10/10/97), 703 So.2d 603).
Moreover, “[t]he trial court is allowed much discretion in determining whether to
allow a witness to testify as an expert under La.Code Evid. art. 702, and its judgment
will remain undisturbed unless that discretion was abused.” Benton Specialties, Inc.
v. Cajun Well Serv., Inc., 09-506, p. 10 (La.App. 3 Cir. 2/10/10), 31 So.3d 1155,
1162, writ denied, 10-951 (La. 6/25/10), 38 So.3d 343 (citing Cheairs v. State ex rel.
-2- Dep’t of Transp. & Dev., 03-680 (La. 12/2/03), 861 So.2d 536).
In the present matter, the Appellants do not dispute Robinson’s impressive
credentials in the field of pediatric nursing. Robinson holds a Master’s degree from
the University of Texas and a Post Master’s certificate from Rush University in
Chicago. She has held nursing licences in five different states and Washington D.C.,
and is certified by the Pediatric Nurse Credentialing Board. She is also a professor
at Rush University in the field of clinical nursing, and she has been employed as a
nurse practitioner at Texas Children’s Hospital Emergency Room.
The Appellants’ lone objection to the admission of Robinson’s testimony is
that it violates the locality rule as contemplated by La.R.S. 40:1299.41(A)(22). In a
malpractice suit against a health care provider, the plaintiff must prove the applicable
standard of care and the breach of that standard.
The standard of care required of every health care provider, except a hospital, in rendering professional services or health care to a patient, shall be to exercise that degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his best judgment, in the application of his skill.
Id.
Our state’s jurisprudence has dictated that an expert witness testifying as to a
health care professional’s performance in relation to the applicable standard of care
is constrained by the need to have practiced in a similar community or locale and
under similar circumstances. Leyva v. Iberia Gen. Hosp., 94-795 (La. 10/17/94), 643
So.2d 1236; Piazza v. Behrman Chiropractic Clinic, Inc., 601 So.2d 1378 (La.1992);
and Donaldson v. Sanders, 94-1366 (La.App. 3 Cir. 7/19/95), 661 So.2d 1010.
However, “[w]here there is a uniform nationwide method for performing a particular
-3- medical procedure, an expert having knowledge of such method is qualified to testify,
and . . . the testifying expert in this circumstance is not constrained by the need to
have practiced in a similar community or locale and under similar circumstances.”
Roberts v. Warren, 01-1342, pp. 1-2 (La. 6/29/01), 791 So.2d 1278, 1279 (quoting
Leyva, 643 So.2d at 1239)(second alteration added).
Here, the Appellants urge that Robinson, despite her list of credentials, is unfit
to testify as to the standard of care required of pediatric nurses in Alexandria,
Louisiana, because her relevant experience was obtained in cities such as Houston,
San Diego, Indianapolis, Chicago, and Omaha. They argue that because she has only
worked in pediatric hospitals in large cities, Robinson is “clueless” as to the standards
exercised in smaller community hospitals such as Cabrini.
Cabrini counters by arguing that the locality rule should not apply. It contends
that, as a result of her teaching position, Robinson has taught numerous students who
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STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
10-458
JEANNIE HEITMAN, ET AL.
VERSUS
CHRISTUS HEALTH CENTRAL D/B/A CHRISTUS ST. FRANCES CABRINI HOSPITAL, ET AL.
**********
APPEAL FROM THE NINTH JUDICIAL DISTRICT COURT PARISH OF RAPIDES, NO. 228,728 HONORABLE DONALD THADDEUS JOHNSON, DISTRICT JUDGE
JOHN D. SAUNDERS JUDGE
Court composed of John D. Saunders, Jimmie C. Peters, and James T. Genovese, Judges.
AFFIRMED.
Eugene A. Ledet, Jr. Joseph Texada Dalrymple Dalrymple & Ledet 1450 Dorchester Drive Alexandria, LA 71301 (318) 442-1818 Counsel for Plaintiffs/Appellants: Jeannie Heitman Daniel Heitman, O. D. David Richard Sobel Jeremy C. Cedars Provosty, Sadler, deLaunay, Fiorenza & Sobel P. O. Drawer 1791 Alexandria, LA 71309-1791 (318) 445-3631 Counsel for Defendant/Appellee: Christus Health Central Christus St. Frances Cabrini Hospital SAUNDERS, Judge.
Herein, we address whether the trial court erred in allowing Courtney
Robinson, an out-of-state pediatric nurse practitioner, to testify as an expert witness
at trial in this medical malpractice case. For the following reasons, we find that it did
not err.
FACTS AND PROCEDURAL HISTORY:
On December 25, 2004, Callie Heitman (Callie), an infant, was admitted to
Christus St. Francis Cabrini Hospital (Cabrini) after experiencing a syncopal episode
(fainting) at home. She was diagnosed as suffering from a severe case of anemia
(iron deficiency).
Callie was initially treated in the Cabrini emergency room, where the staff
attempted to initiate an IV to the patient. After several unsuccessful attempts at
placing the IV, Curt Fuqua, RN, was able to establish the IV in the patient’s foot at
6:05 p.m. Thereafter, the Cabrini staff started Callie on a drip and drew blood
through the IV. No immobilization device was used by Fuqua on the patient’s foot
in order to secure the IV.
Unfortunately, IV access was lost at 11:14 p.m. due to kinking in the tubing.
The Cabrini staff was unable to reestablish an IV at any peripheral site, and Dr. Stuart
Head was called in to establish a central line in the patient’s right femoral vein.
Callie’s parents (the Appellants) filed the instant suit against Cabrini, alleging
that it was negligent in failing to secure the IV access site with an armboard. The
matter was initially submitted to a medical review panel, which unanimously held that
Cabrini did not deviate from the standard of care.
The case was then presented before Judge Donald T. Johnson of the Ninth
Judicial District Court in Rapides Parish. The trial court ultimately dismissed the Appellants’ action against Cabrini. However, in making its decision, the trial court
took into consideration testimony offered by nurse Courtney Robinson—accepting
Robinson as an expert witness in pediatric nursing. It is on this issue that the
Appellants bring their appeal.
APPELLANTS’ ASSIGNMENT OF ERROR:
The trial court committed legal error in failing to exclude the testimony of
nurse Courtney Robinson, pursuant to [La.R.S.] 40:1299.41(A)(7).
LAW AND DISCUSSION ON THE MERITS:
The sole issue before this court is the propriety of the trial court allowing
Courtney Robinson to testify as an expert witness in this case.
It is well-settled law that trial courts are given great discretion in determining
if a potential expert witness is adequately qualified.
Trial Courts are vested with great discretion in determining the competence of expert witnesses, and rulings on the qualifications of an expert witness will not be disturbed unless there was an abuse of that discretion. A combination of specialized training, work experience, and practical application of the expert’s knowledge can combine to demonstrate that the person is an expert; a person may qualify as an expert based upon experience alone.
State v. Jarrell, 07-1720, p. 16 (La.App. 1 Cir. 9/12/08), 994 So.2d 620, 633 (quoting
State v. Berry, 95-1610, p. 20 (La.App. 1 Cir. 11/8/96), 648 So.2d 439, 456, writ
denied, 97-278 (La. 10/10/97), 703 So.2d 603).
Moreover, “[t]he trial court is allowed much discretion in determining whether to
allow a witness to testify as an expert under La.Code Evid. art. 702, and its judgment
will remain undisturbed unless that discretion was abused.” Benton Specialties, Inc.
v. Cajun Well Serv., Inc., 09-506, p. 10 (La.App. 3 Cir. 2/10/10), 31 So.3d 1155,
1162, writ denied, 10-951 (La. 6/25/10), 38 So.3d 343 (citing Cheairs v. State ex rel.
-2- Dep’t of Transp. & Dev., 03-680 (La. 12/2/03), 861 So.2d 536).
In the present matter, the Appellants do not dispute Robinson’s impressive
credentials in the field of pediatric nursing. Robinson holds a Master’s degree from
the University of Texas and a Post Master’s certificate from Rush University in
Chicago. She has held nursing licences in five different states and Washington D.C.,
and is certified by the Pediatric Nurse Credentialing Board. She is also a professor
at Rush University in the field of clinical nursing, and she has been employed as a
nurse practitioner at Texas Children’s Hospital Emergency Room.
The Appellants’ lone objection to the admission of Robinson’s testimony is
that it violates the locality rule as contemplated by La.R.S. 40:1299.41(A)(22). In a
malpractice suit against a health care provider, the plaintiff must prove the applicable
standard of care and the breach of that standard.
The standard of care required of every health care provider, except a hospital, in rendering professional services or health care to a patient, shall be to exercise that degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his best judgment, in the application of his skill.
Id.
Our state’s jurisprudence has dictated that an expert witness testifying as to a
health care professional’s performance in relation to the applicable standard of care
is constrained by the need to have practiced in a similar community or locale and
under similar circumstances. Leyva v. Iberia Gen. Hosp., 94-795 (La. 10/17/94), 643
So.2d 1236; Piazza v. Behrman Chiropractic Clinic, Inc., 601 So.2d 1378 (La.1992);
and Donaldson v. Sanders, 94-1366 (La.App. 3 Cir. 7/19/95), 661 So.2d 1010.
However, “[w]here there is a uniform nationwide method for performing a particular
-3- medical procedure, an expert having knowledge of such method is qualified to testify,
and . . . the testifying expert in this circumstance is not constrained by the need to
have practiced in a similar community or locale and under similar circumstances.”
Roberts v. Warren, 01-1342, pp. 1-2 (La. 6/29/01), 791 So.2d 1278, 1279 (quoting
Leyva, 643 So.2d at 1239)(second alteration added).
Here, the Appellants urge that Robinson, despite her list of credentials, is unfit
to testify as to the standard of care required of pediatric nurses in Alexandria,
Louisiana, because her relevant experience was obtained in cities such as Houston,
San Diego, Indianapolis, Chicago, and Omaha. They argue that because she has only
worked in pediatric hospitals in large cities, Robinson is “clueless” as to the standards
exercised in smaller community hospitals such as Cabrini.
Cabrini counters by arguing that the locality rule should not apply. It contends
that, as a result of her teaching position, Robinson has taught numerous students who
went on to work in communities similar to Alexandria. It also argues that the record
is devoid of evidence suggesting that the local standard of care differs in any respect
from the national standard and that the Appellants bear the burden of establishing the
relevant standard.
If, indeed, it is determined that Robinson had no experience practicing in a
similar community or locale, or under similar circumstances, then the appropriate
question would be whether her testimony was given on a “uniform nationwide
method for performing a particular medical procedure.” Roberts, 791 So.2d at 1279.
Inasmuch as we find the answer to be clear and compelling on the national standard
issue, we will advance our discussion to the uniform nature of the procedure on which
Robinson was called to testify. We note that the two issues are largely intertwined.
-4- The Appellants’ claim against Cabrini is that the nursing staff failed to
adequately place and secure an IV in the foot of the infant patient. Nurse Robinson
was brought in to testify as to the standard of care in placing and securing an IV in
a small child. Virtually all of Robinson’s testimony addressed IV placement and
whether there is a need to further secure an IV that has been placed in the foot of a
pediatric patient. She testified that these are universal issues that are tested on the
National Certification Exam for nurses and that this is an exam that all nurses must
pass, regardless of location, in order to obtain a nursing licence. Furthermore,
Frances Trahant, the nurse called as an expert witness on behalf of the Appellants,
testified that “[t]he basic principles of IV therapy are the same across the population.”
When questioned on whether the use of an armboard would have been appropriate on
a patient in Callie’s condition, Robinson responded that it was dependant on the
judgment of the nurse. This testimony was consistent with the testimony of the local
medical experts that were called to testify in this case.
Upon our examination of the record before us, it is clear to this court that IV
placement and the subsequent securing of the IV are uniform procedures, the practice
of which would vary little at hospitals across the nation. For this reason, we find that
Robinson’s testimony was addressed toward a “uniform nationwide method for
performing a particular medical procedure,” such that it would amount to an
exception to the locality rule as contemplated in Roberts, 791 So.2d at 1279.
Accordingly, we find that the trial court did not abuse its considerable discretion, and
its ruling is affirmed.
This court also notes that there was sufficient evidence in the record to support
the trial court’s judgment even without the use of Nurse Robinson’s testimony.
-5- CONCLUSION:
For the foregoing reasons, we find that the trial court did not abuse its
considerable discretion in allowing Courtney Robinson to testify as an expert witness
at trial. The judgment of the trial court is affirmed, and all costs of this appeal are
assessed to the Appellants.
-6-