State v. Joint Comm'n on Accreditation of Hosps., Inc.

470 So. 2d 169
CourtLouisiana Court of Appeal
DecidedMay 8, 1985
Docket16900-CA
StatusPublished
Cited by10 cases

This text of 470 So. 2d 169 (State v. Joint Comm'n on Accreditation of Hosps., Inc.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Joint Comm'n on Accreditation of Hosps., Inc., 470 So. 2d 169 (La. Ct. App. 1985).

Opinion

470 So.2d 169 (1985)

The STATE of Louisiana, Plaintiff-Appellant,
v.
JOINT COMMISSION ON ACCREDITATION OF HOSPITALS, INC., Aetna Casualty & Surety Co., Inc., and St. Paul Fire & Marine Insurance Company, Defendants-Appellees.

No. 16900-CA.

Court of Appeal of Louisiana, Second Circuit.

May 8, 1985.

*170 Hudson, Potts & Bernstein by Jesse D. McDonald, Monroe, for plaintiff-appellant.

Provosty, Sadler & Delaunay, Alexandria, for defendant-appellee, St. Paul Fire & Marine Ins. Co.

Theus, Grisham, Davis & Leigh by Ronald L. Davis, Jr., P.C., Monroe, for Joint Com'n on Accreditation of Hospitals, Inc. and Aetna Cas. & Sur. Co.

Before MARVIN, SEXTON and LINDSAY, JJ.

SEXTON, Judge.

This litigation arises as the result of the illness and/or death of certain renal patients at E.A. Conway Memorial Hospital. The harm to these patients was caused by the presence of excessive quantities of aluminum in the water used for their dialysis. The State of Louisiana subsequently settled with the injured patients or their survivors, obtained releases and became subrogated to the rights of those patients. The state then brought suit for contribution as a joint tortfeasor from the Joint Commission on Accreditation of Hospitals, Inc. (JCAH), who surveyed and accredited the hospital on March 27 and 28, 1980; its liability insurer, Aetna Insurance Company; and its excess liability insurer, St. Paul Fire & Marine. JCAH and its insurers in turn filed a third party demand against Culligan, Inc., the manufacturer of the water purification system and Livingston Water Conditioner, Inc. (Livingston), installer and servicer of the system. Prior to trial, the third party demands of JCAH against Culligan and Livingston were severed from the main demand. After a trial, judgment was rendered dismissing the State's claims. This appeal followed. We affirm.

*171 Factual Background

One morning in early March, 1981, five of the eight patients receiving dialysis at E.A. Conway Memorial Hospital began having speech disturbances, seizures and difficulty walking, symptoms of a potentially fatal condition called dialysis encephalopathy or dialysis dementia. The dialysis unit was closed on March 18, 1981, and the patients transferred to another local dialysis facility. Investigators from the Center for Disease Control (CDC) in Phoenix, Arizona were then summoned by the doctors. In order to fully understand the findings of the investigators, some explanation of the dialysis process and the water purification system is required.

When being dialyzed, the patient's blood is exposed to a semi-permeable membrane. On the other side of this membrane is a substance called dialysate solution. This solution is composed of water and dialysate concentrate, which is a fluid composed of electrolytes such as sodium, potassium and chloride. As the blood and dialysate solution oppose each other through the membrane, harmful substances present in high quantities in the blood are transported to the dialysate solution, and conversely, the elements from the electrolyte solution lacking in the patient's blood pass through the membrane to replete and enrich the blood. In this process, then, the substances desirable for repletion of the blood are contained in the dialysate, as the substances will travel from the fluid where they exist in the highest concentration to the fluid containing the lowest concentration of these substances. Therefore, if a harmful or undesirable substance exists in a large concentration in either the dialysate concentrate or the water with which the concentrate is diluted, the harmful substance will be conducted across the membrane and into the patient's blood serum.

The purity of the water used in this process is supposedly insured by a water purification system. In the system existing at E.A. Conway, water entered the unit and passed through a charcoal filter bed, through a water softener, then went to a reverse osmosis (RO) unit which removed impurities. From the RO unit, the pure water was conducted to outside storage tanks and pumped as needed back into the system through deionization (DI) tanks, which acted as a polisher. From this point, the water traveled through a heater, and then proceeded to the individual dialysis machines.

The water purification system contained an alarm system called a resistivity or conductivity meter designed to indicate when the water contained certain impurities. The presence in the water of certain chemicals, electrolytes, would cause the water to conduct electricity and activate a red light on the discharge side of the DI tanks. Normally, when the water was pure, a green light was illumined. This warning device could be calibrated as dictated by the system.

At E.A. Conway, it was the duty of the nurses at the renal unit to monitor this red/green light, and notify either the maintenance personnel or the unit directors when the red light was activated so that appropriate action by way of changing the DI tanks could be instituted to restore the purity of the water used for dialyzing patients.

The investigation of the renal unit water purification system by personnel from the CDC revealed that: (1) The resistivity meter was malfunctioning as it was constantly illumined green; (2) The DI tanks were totally exhausted. The tanks normally should have been exhausted in three days when the RO unit was not functioning properly. These DI tanks had been changed only two times since the unit's opening in 1976; (3) The RO unit, when it functioned, was only working at a 63% efficiency rate in regard to removing chemical contaminants from the water. The investigators were told by hospital personnel that because of water pressure problems, the RO tanks burned out frequently; (4) From mid-1979 through March 16, 1981, the RO unit had been by-passed by maintenance personnel. The RO unit was reconnected to the system on March 16, 1981. *172 Consequently, during the time period in question, the RO unit had only been in functional operational condition for two days before the dialysis unit was closed; and (5) the charcoal filter in the treatment equipment was totally nonfunctional and exhausted.

A further environmental complication was discovered by the CDC investigators. On February 4, 1981, the city of Monroe decided to do routine and preventive maintenance on its new water treatment facility. To facilitate this maintenance work, all of the water in Monroe was sent to an old treatment plant. At this point, the city water contained aluminum in the ratio of 1,000 to 1,500 parts per billion, a figure 100 to 150 times higher than the normal level of aluminum allowed in water used for dialysis purposes. Under normal circumstances, the tap water of the city of Monroe contained 400 parts per billion aluminum, 40 times greater than normal allowable limits.

After consideration of the environmental data, and the medical records of the patients dialyzed at E.A. Conway, Dr. Jeral Ahtone of the CDC opined that these patients were suffering from dialysis encephalopathy arising from aluminum intoxication of their bodies. He found that sufficient levels of aluminum, introduced into their systems by the dialysis process, had been deposited in their brains to cause these neurological symptoms. Dr. Ahtone specifically concluded that the cause of the aluminum getting into the patients' bodies was the malfunction of the water purification equipment, including the by-passing of the RO unit; the failure to change the DI tanks when exhausted; and the malfunctioning of the resistivity meter.

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