Washington v. Washington Hospital Center
1990 WL 112542, 579 A.2d 177, 1990 D.C. App. LEXIS 189 (1990)
Rule of Law:
In medical malpractice negligence actions, a national standard of care may be established by expert testimony supported by evidence of emerging practices and internal hospital requirements. Furthermore, a non-settling defendant is entitled only to a pro tanto (dollar-for-dollar) credit, rather than a pro rata (proportional) credit, regarding a co-defendant's settlement unless the non-settling defendant has preserved a claim for contribution and the settling defendant's liability has been judicially determined.
Facts:
- On November 7, 1987, LaVerne Alice Thompson underwent elective surgery (abortion and tubal ligation) at Washington Hospital Center (WHC).
- Nurse-anesthetist Elizabeth Adland, supervised by Dr. Sheryl Walker, inserted an endotracheal tube intended for Thompson's trachea but allegedly placed it in her esophagus.
- During the surgery, the surgeon noticed Thompson's blood was abnormally dark, indicating oxygen deprivation.
- Thompson suffered cardiac arrest and was resuscitated, but the lack of oxygen caused catastrophic, permanent brain injury, leaving her in a persistent vegetative state.
- WHC had not provided a carbon dioxide monitor (capnograph) in the operating room, a device that could have detected the esophageal intubation early.
- At the time of the surgery, WHC's own Department of Anesthesiology had submitted a requisition for monitors stating that failure to provide them would result in failing to meet the national standard of care.
- During the subsequent trial, a juror had a brief, five-minute conversation with the plaintiff's expert witness regarding the weather and the witness's background.
Procedural Posture:
- Thompson's mother (Washington) filed a medical malpractice suit in the trial court against the nurse, anesthesiologist, and Washington Hospital Center (WHC), with family asserting loss of consortium claims.
- The trial court granted summary judgment for WHC on the family's loss of consortium claims.
- Mid-trial, the nurse and anesthesiologist settled with the plaintiffs.
- The jury returned a verdict in favor of Thompson against WHC for $4.586 million.
- WHC moved for Judgment Notwithstanding the Verdict (JNOV) regarding the standard of care and a mistrial regarding juror misconduct.
- The trial court denied the JNOV and mistrial motions.
- The trial court reduced the verdict pro tanto (dollar-for-dollar) by the settlement amount, rather than pro rata (proportionally) as requested by WHC.
- Washington appealed the dismissal of consortium claims; WHC cross-appealed the denial of JNOV, the denial of mistrial, and the calculation of the settlement credit.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
1) Is expert testimony relying on 'emerging' standards sufficient to establish a national standard of care? 2) Does a non-settling defendant forfeit the right to a pro rata reduction of a verdict if they fail to cross-claim for contribution or establish the settling defendant's liability?
Opinions:
Majority - Judge Farrell
Yes, regarding the standard of care, and No, regarding the pro rata credit. The court affirmed the judgment against WHC. Regarding the standard of care, the court held that the plaintiff provided sufficient evidence to reach the jury. While the expert's reliance on his own hospital's practices was insufficient alone, it was bolstered by evidence that other teaching hospitals used the monitors and, most damningly, WHC's own internal requisition forms admitted that monitors were necessary to meet the national standard of care. Regarding the settlement credit, the court rejected WHC's request for a pro rata (50%) reduction. The court reasoned that a pro rata credit is a substitute for a contribution claim. Because WHC failed to file a cross-claim for contribution or request a special jury verdict to establish the liability of the settling defendants (the doctor and nurse), the court could not assume they were joint tortfeasors. Therefore, to prevent double recovery without penalizing the plaintiff, the correct application was a pro tanto credit (deducting the specific dollar amount of the settlement).
Analysis:
This case is significant for two primary reasons in tort law. First, it clarifies how a 'national standard of care' can be proven in medical malpractice, specifically allowing internal hospital documents (like requisition forms) to serve as powerful evidence against the hospital regarding what the standard requires. It demonstrates that a standard can be binding even if it is 'emerging' rather than universally adopted. Second, it provides a bright-line rule for calculating damages when some defendants settle: if a remaining defendant wants a proportional (pro rata) reduction in damages based on the settlers' share of fault, they must actively litigate and prove the settlers' liability. Passive reliance on the plaintiff's initial allegations is insufficient. This forces defendants to strategically decide whether to attack settling co-defendants to reduce their own payout.
