TX: Forceps Delivery - `Ping-Pong' Depression: Alleged Failure to Train & Supervise Nurses.

CASE FACTS: On April 15, 1996, at approximately 9:30 p.m. Lisa Gonzales presented herself to the labor and delivery unit at Sid Peterson Memorial Hospital. The patient was having contractions. An initial examination revealed that the patient was slightly dilated, 50% effaced, with the fetus at -2 station. The patient was admitted for observation of labor and external fetal monitoring. Dr. Paul H. Kocay, one of the patient's treating obstetricians, was notified by telephone of the patient's admittance to the hospital and informed of the progress of her labor. Thereafter, attending nurses implemented Dr. Kocay's orders. On April 16, Dr. Kocay examined the patient twice. The patient continued to have contractions, but labor failed to progress. Later that day, Dr. Melissa Wampler, an obstetrician/gynecologist, took over the care of the patient. Dr. Wampler examined the patient twice and, on four separate occasions, issued orders to attending nurses who implemented her orders. At approximately 10:45 p.m. that evening, the patient went into active labor. After several hours of active labor, the patient experienced both maternal exhaustion with an inability to effectively push and non-reassuring fetal heart rate patterns of decelerations and tachycardia. Due to these complications, Dr. Wampler decided to proceed with a low forceps delivery. Upon delivery, the patient's baby sustained a "ping-pong" depression skull fracture and required resuscitation. The patient brought suit for medical malpractice against her treating physician and the hospital. She alleged that the hospital was negligent in failing to appropriately train and supervise the nurses responsible for her care. The 198th Judicial District Court, Kerr County, granted the hospital's motion for summary judgment. The patient appealed.

COURT'S OPINION: The Court of Appeals of Texas reversed the judgment of the lower court and remanded the case for trial. The court found, inter alia, that the affidavit of Terry Napper, R.N., the Director of Nursing Services at the hospital, was "conclusory" regarding the standard of care required of nurses in the same or similar circumstances. Importantly, the expert neither articulated the standard of care required of nurses in the same or similar circumstances nor stated that the expert was familiar with the applicable standard. Although the expert concluded that the nurses complied with all of the orders issued by the treating physicians, the expert failed to attempt to demonstrate that such actions complied with the applicable standard of care. Gonzales v. Sial Peterson Memorial Hospital, 2000 TX 0047441 S.W.3d - TX (2000)

Meet the Editor & Publisher: A David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Providence, R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American Law.