Van Hook v. Anderson
1992 Wash. App. LEXIS 62, 64 Wash. App. 353, 824 P.2d 509 (1992)
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Rule of Law:
A surgeon is not directly negligent for leaving a foreign object in a patient if they complied with the accepted medical standard of care by reasonably relying on the surgical team's procedures, such as a nurse's sponge count. Furthermore, a surgeon is not vicariously liable for the negligence of hospital-employed nurses under the 'captain of the ship' doctrine unless the surgeon exercised direct control over the specific negligent act.
Facts:
- Dr. Anderson, a surgeon, performed a hernia operation on Van Hook at Tacoma General Hospital.
- Hospital-employed nurses assisted Dr. Anderson during the operation.
- The hospital had a written procedure requiring two nurses to count surgical sponges before use and after removal from the patient.
- Near the end of the operation, the nurses informed Dr. Anderson that the sponge count was correct, and they recorded this in the nursing report.
- Relying on the nurses' correct count, Dr. Anderson completed the surgery and closed the incision.
- After the operation, Dr. Anderson became concerned he had not removed one sponge and, upon questioning the nurses, learned it had been counted while still inside Van Hook.
- An X-ray confirmed a sponge remained in Van Hook's body.
- Dr. Anderson immediately informed Van Hook and performed a second surgery to remove the sponge.
Procedural Posture:
- Van Hook sued Dr. Anderson for medical negligence in the trial court.
- Dr. Anderson and Van Hook filed cross motions for summary judgment.
- The trial court denied Dr. Anderson's motion for summary judgment.
- The trial court granted Van Hook's motion for summary judgment as to liability only.
- Dr. Anderson (appellant) was granted discretionary review of the trial court's order by the intermediate court of appeals.
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Issue:
Is a surgeon liable, either directly or vicariously, for leaving a surgical sponge in a patient when the surgeon relied upon an incorrect sponge count provided by the hospital's nursing staff in accordance with the established medical standard of care?
Opinions:
Majority - Morgan, A.C.J.
No. A surgeon is not liable in this situation. The court analyzed direct and vicarious liability separately. For direct liability, while leaving a foreign object in a patient creates an inference of negligence, that inference can be overcome by strong, uncontradicted evidence. Here, undisputed expert testimony, including from the plaintiff's own expert, established that the medical standard of care permits a surgeon to rely on the nurses' sponge count. Because Dr. Anderson complied with this standard, he was not directly negligent. For vicarious liability under the 'captain of the ship' doctrine, liability hinges on the surgeon's control over the negligent act. The nurses were following a routine counting procedure established by the hospital, not by Dr. Anderson's direct orders. As Dr. Anderson did not exercise control over the manner in which the nurses performed the count, he cannot be held vicariously liable for their error.
Analysis:
This case significantly clarifies the limits of a surgeon's liability within the modern operating room team. It establishes that the inference of negligence from a retained foreign object (res ipsa loquitur) is rebuttable with clear evidence that the surgeon adhered to the professional standard of care, such as relying on other specialized personnel. The decision also narrows the application of the 'captain of the ship' doctrine, moving away from automatic liability for the head surgeon and toward a more nuanced analysis based on actual control over the specific negligent conduct. This precedent protects surgeons from liability for errors made by other hospital staff performing routine, delegated tasks according to hospital protocol.
