In its opinion rendered on October 13, 2017, the Commonwealth of Kentucky Court of Appeals (“Kentucky Appellate Court”) had to decide if the res ipsa loquitor doctrine applied, which would eliminate the need for an expert witness, in a case filed by the wife of a hospital patient in which she alleged that the defendant hospital negligently allowed her husband to fall from a bed on which she says all rails were not up as required by the care plan, or whether expert testimony was needed to establish the defendant hospital’s expected standard of care, breach thereof and resulting injury.
The Underlying Facts
On December 12, 2012, the plaintiff’s 78-year-old husband was admitted to the defendant hospital for extreme weakness and fatigue. The defendant hospital deemed him to be at high risk for falling and placed a red band on his arm to alert its staff to his status. As a further precaution, the patient’s care plan required all four bed rails to be in the up position and he was to ambulate only with the assistance of two persons.
Sometime between 7:00 p.m. on December 14, 2012 and 2:00 a.m. on December 15, 2012, the plaintiff’s husband fell from his hospital bed, causing a wound to his forehead and an abrasion to his knee. A nurse discovered him on the floor beside the bed with a bleeding head wound.
On June 20, 2013, the plaintiff’s husband filed a complaint against the defendant hospital alleging negligence and failing to provide the minimum standard of professional care during his stay in December 2012 when he, assessed by the hospital to be a patient with a high risk of falling, fell and sustained permanent and debilitating injuries. After her husband’s death, the case was revived with the wife substituted as the plaintiff in her capacity as Executrix of her late husband’s Estate.
One of the defendant hospital’s experts testified during his deposition that the decedent “maybe grabbed the rail and just pulled … Could he move himself? Absolutely. Could he have pulled himself out of the bed? Absolutely. Would he have had a great chance of falling if he did so? Absolutely.” This same expert testified that he found no deviation in the standard of care in the hospital staff’s handling of the decedent’s high risk of falling.
The defendant hospital moved for summary judgment, arguing this was not a slip and fall case but rather a medical malpractice case due to the nature of the claims, i.e., negligence and failure to provide the minimum standard of care. The defendant argued that expert testimony was required to establish the degree of care and skill expected and that the decedent fell because hospital staff deviated from the expected standard of care.
The plaintiff argued in response that no expert witness was required because this was a res ipsa loquitor case in which the plaintiff testified that her husband had limited mobility and could not get over the bed rails had they been in the up position. The trial court granted the defendant hospital’s motion for summary judgment, and the plaintiff appealed.
Kentucky Appellate Court Decision
The Kentucky Appellate Court stated that in some medical malpractice scenarios, expert testimony is not needed because the res ipsa loquitor doctrine allows negligence to be inferred from medical evidence in the record showing the risk of injury was extraordinary, its occurrence was within the defendant’s exclusive control, and the plaintiff did not contribute to his own injury.
The Kentucky Appellate Court stated that whether expert testimony is required in a hospital fall case depends on whether hospital personnel were exercising professional judgment as opposed to rendering nonmedical, administrative, ministerial or routine care, or simply carrying out doctor’s orders: if measures beyond standard or ordered care were obviously needed, an expert witness is unnecessary to establish staff members were negligent in not taking reasonable actions to protect the patient.
The Kentucky Appellate Court stated that determining whether the decedent was at a high risk of falling required an exercise in professional judgment; whether the four bed rails should have been in the up position and the decedent should have ambulated only with the assistance of two persons required an exercise in professional judgment; and, whether even more precautions were needed, even though the decedent could speak and call for help, required an exercise in professional judgment. The Kentucky Appellate Court stated that jurors would not automatically know of other options and whether they were advisable.
The Kentucky Appellate Court held that whether more measures, other than those routinely applied to all patients, should have been used to protect the decedent required professional judgment and therefore, expert testimony was necessary: “This was not an ordinary negligence case resolved by res ipsa loquitor.”
A dissenting opinion argued that to the extent the plaintiff contended that the defendant hospital’s failure to follow its own care plan was the proximate cause of the decedent’s fall, her claim sounded in ordinary negligence and therefore no expert medical testimony was necessary to establish the standard of care. Nonetheless, the plaintiff would still need to provide some proof that the rails were not in use. The dissenting opinion further argued that based on the conflicting testimony, it was up to the jury to determine whether the decedent had the ability to get himself over the rails had they been up.
Source Chamis v. Ashland Hospital Corporation, No. 2015-CA-001071-MR
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