Hospital not liable for death of burn victim treated in ER. (Hospital Law Case of the Month).

CASE ON POINT: Jackson County Hosp. Corp. v. Aldrich, 2002WL318751 So.2D -FL

ISSUE: Many healthcare professionals working in hospitals are not necessarily hospital employees. Many are employed by independent contractors. Generally, hospitals are not responsible for the negligence of non-employees. However, there are exceptions. Some of them fall into the category of the Apparent or Ostensible Agent. In this unusual Florida case, all bets were off when a hospital's ER department provided emergency treatment to a burn victim who had suffered second and third degrees over 85 percent of his body. The hospital's emergency department was called upon to stabilize the patient until the patient could be transported by a helicopter to a major burn treatment center.

CASE FACTS: William Roddenberry, Jr., was severely burned at his place of employment while using a cutting torch on a barrel containing flammable liquid. He suffered second and third degree burns over 85 percent of his body. Paramedics arrived at the scene of the accident and transported the victim to Jackson County Hospital to be stabilized while waiting for a life-flight to a major burn treatment center. Upon the patient's arrival in the ER, a Foley catheter was immediately inserted into the his bladder, indicating clear urine. However, despite having received 100 percent oxygen for 30 minutes in the ambulance, the patient's arterial blood-gas level was only 66.2. The patient was noted to be breathing 28 times per minute compared to the normal 12 to 14. This indicated that the patient was suffering from severe oxygen deprivation. Dr. Griffin, Jackson Hospital's emergency room physician, decided that the patient required endotracheal intubation. Teresa Cruce, a Certified Registered Nurse Anesthetist (CRNA) employed by Bay Anesthesia Inc. (Bay), an independent third party contractor. Nurse Cruce was called to the emergency room to perform the intubation. The CRNA was working at the hospital pursuant to a contract between the hospital and Bay. Pursuant to the contract, the hospital and Bay agreed that Bay would act at all times as an independent contractor and not as a partner of the hospital. Bay's anesthetists were not permitted to act or hold themselves out to third parties as partners, employees, or agents of the hospital. After the patient's death, the co-representatives of the deceased patient's son Hospital as well as Bay. At trial, it was revealed that CRNA Cruce, after assessing the patient's condition, was unable to see the patient's vocal cords and airway due to the swelling of the upper airway and burns, which were particularly severe around the neck and face. Dr. Griffin ordered Nurse Cruce to perform a rapid sequence oral tracheal intubation. Nurse Cruce administered a paralytic agent that, while preventing aspiration, caused the patient to be entirely dependent upon the intubation tube for his oxygen supply. Since Nurse Cruce questioned whether she had intubated the patient's trachea as opposed to his esophagus she expressed her concern to Dr. Griffin. The team satisfied itself that the intubation tube was in the correct place. However, seven minutes after Nurse Cruce intubated the patient, the color of the patient's urine changed from clear to red. Red urine in a burn victim can indicate either a fatal condition known as hemolysis or a nonfatal condition known as rhabdomyolysis, which is caused by the breakdown of the burn victim's muscle pigment. No expert for either side testified at trial which of the two conditions, if not both, caused the patient's urine to turn red in color. Yet, all experts agreed that if, in fact, the patient had been suffering from hemolysis, such a condition would be fatal. The Circuit Court, Jackson County, denied the hospital's motion for summary judgment. The hospital appealed.

COURT'S OPINION: The District Court of Appeal of Florida affirmed the judgment of the lower court in part and reversed it in part. The court held that as a matter of law, the trial court erred in failing to direct a verdict for the hospital. The court further held that the hospital did not act "with reckless disregard" in treating the patient, nor did it cause the patient's death.

LEGAL COMMENTARY: Surprisingly, the court made no reference to the `Borrowed Servant' doctrine. Nurse Cruce was not working in the ER. She was called to respond by Dr. Griffin, who, in fact, was an employee of the hospital. Dr. Griffin assumed control over Nurse Cruce. He ordered her to proceed according to his directions. She was not free to choose the method of intubation. This appears to be a classic illustration of a `Borrowed Servant' case.