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Weekly UpdatesCASE ON POINT: Natoli v. Massilon Community, Hosp., 2008 Ohio-6258--OH
ISSUE: Do some ERs present unacceptable risks to patients?
CASE FACTS: On July 14, 2003, at approximately 6:30 p.m., Paul Fortney, age 76, presented to the Emergency Room of Massion Community Hospital. He was accompanied by his Daughter, Virginia Natoli, and his grandson, Paul Marchette. He previously had his lower right leg amputated due to vascular disease and was in a wheelchair. According to Ms. Natoli, her father complained of extreme pain in his right side, including the right hip and stump area. He had previously suffered a stroke and had some expressive aphasia, but was able to communicate his condition to his daughter, who relayed the information to the emergency room receptionist. They were instructed to have a seat in the waiting area due to the volume of patients. Over the next forty-five minutes, while in the waiting room, he began to groan, hyperventilate, and vomit. The emergency room nurses allegedly did not attend to him despite his family's insistence. He went into cardiac arrest and finally was taken back to the emergency treatment room at 7:22 p.m., where he was seen by Dr. Jeffrey Yosten, an emergency room physician employed by EME The record reflected that there was a contractual agreement between EMP and the hospital for management of the emergency room. Resuscitation efforts were unsuccessful and Mr. Fortney was pronounced dead at 8:27 p.m. An autopsy was performed and the cause of death was determined to be a massive "ruptured abdominal aortic aneurysm," a fatal condition if not surgically treated. On June 13, 2005, Virginia Natoli, as administratrix of her father's estate, filed a wrongful death and survivorship suit against the hospital, EMP and Dr. Yosten. The plaintiff alleged that the defendants negligently failed to timely diagnose and treat the decedent's medical condition, resulting in his death! She further alleged that the defendants were negligent in their operation, staffing, training and/or regulation of the hospital's ER. The case went to trial. The plaintiff voluntarily dismissed Dr. Yosten from the suit. EMP filed a motion for summary judgment claiming it was entitled to judgment as a matter of law. The trial court issued a decision granting EMP's motion for summary judgment on the basis that the plaintiff failed to prove that EMP was contractually liable to create the triage unit for the ER. The trial court also excluded the testimony of the plaintiff's expert medical witness. The trial court granted the hospital's motion for summary judgment because of the exclusion of the testimony of one of the plaintiff's expert medical witnesses. The plaintiff appealed.
COURT'S OPINION: The Court of Appeals of Ohio found that the trial court erred in granting summary judgment for the hospital and also erred in granting summary judgment for EMP. The court held, inter alia, that the trial court erred in refusing to allow the proffered testimony of the plaintiff's expert medical witnesses into evidence. Accordingly, the court ordered the that the trial court be reversed and the case remanded to the trial court for a trial of the suit against the defendants.
LEGAL COMMENTARY: The plaintiff identified two expert medical witnesses, Dr. Samuel Kiehl and Dr. David Feldbaum. Dr. Kiehl, a board-certified emergency medicine physician, opined in his report, that both the hospital and EMP failed to meet the standard of care because no appropriate triage was performed. For example, there was no evidence of Mr. Fortney's vital signsor a satisfactory history having been taken, or appropriate observation of the patient's deteriorating condition. Dr. Kiehl also reviewed the contract between EMP and the hospital in formulating his opinion. In his report, he further stated EMP provided the medical director of the emergency room to the hospital pursuant to the contract. The medical director was contractually obligated to direct and operate the emergency department, which would include a mechanism whereby patients are appropriately triaged, and those with potentially serious illnesses or injury are treated in an appropriate and timely manner. Dr. Kiehl's report revealed that the hospital did not have a written triage protocol in 2003. He opined that both the hospital and EMP fell below the standard of care by failing to ensure that a written triage policy was developed and properly implemented. Dr. Feldbaum, a board-certified vascular surgeon testified in his deposition the patient's chance of survival from the ruptured abdominal aortic aneurysm was less than fifty percent. He further stated that the patient was walking and conversed while in the waiting room. He opined that the failure to adequately evaluate the patient in a reasonable timely manner delayed the eventual ability of the patient to have a potential operation that had a small chance, at most 10 percent, of saving his life if a surgeon and surgical team were available. He also stated that a patient's past medical history would also affect a patient's survivability. It is almost inconceivable that any hospital emergency room would be so poorly mismanaged as to not have written protocols and, in fact, tail to have even the semblance of triage. The hospital's policy was tantamount to: "Be quiet and wait your turn," unless you go into cardiac arrest. Then, it was a case of too little too late! Shame on the hospital! Shame on EMP!
Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island 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 Regan 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, Marquis Who's Who in American Law. Who's Who in America and Who's Who in the World.
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