Unit 2 Application Assignment - Domko

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Dec 6, 2023

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Hastings V. Baton Rouge Hospital Keri M. Domko Park University HA517DL: Legal and Ethical Issues in Healthcare Administration Dr. James Baird October 22, 2023 Module 1: Negligence HA517 Case Brief 1

Facts On March 1, 1981, at 11:56 pm, Cedric hastings presented to the emergency room (ER) of Baton Rouge General Hospital with two stab wounds and weak vitals. Dr. Reed (going off shift) and Dr. Gerdes (oncoming shift) both worked to resuscitate Cedric. A chest tube connected to an Emerson pump was installed because one of the stab wounds was in the parasternal area and air and blood needed to be drained from the chest. An IV was started to restore circulation and Cedric’s vital signs had been restored by 12:25 am. Cedric had lost at least 1,000 cubic centimeters of blood. The chest x-ray taken at 12:15 am showed blood, the tube, and a degree of tension that Dr. Gerdes felt was not enough to compromise the circulation or respiration and was not lethal enough to be considered tension hemothorax. Two units of whole blood were started at 1:00 am and Cedric was not close to exsanguination at this time. Dr. Gerdes felt that a thoracotomy was necessary and called the on-call thoracic surgeon, Dr. McCool prior to 12:25am. Dr. Gerdes and described Cedric’s condition and that he’d been stabbed in one of the major blood vessels. Dr. McCool asked if the patient had insurance and when told no, Dr. McCool asked that Cedric be transferred to Earl K. Long hospital. Dr. Gerdes did not feel that Cedric’s condition was stable enough to for transfer and told Dr. McCool that the patient could not be transferred. Dr. McCool reiterated that he would not come in and to transfer the patient and that putting in another chest tube would only increase the bleeding. Dr. Gerdes ended the conversation. Dr. Gerdes contacted Earl K. Long Hospital, who said they would be ready for the patient although they did not have a heart-lung machine. An ambulance answering service received the call at 1:03 am. When the ambulance arrived, driver Tom Crittenden questioned the stability of Cedric as he had never transferred a patient in that condition. The Emerson pump had to be disconnected to transfer the patient. When the pump was removed, Cedric began to fight wildly, his chest tube came out, and the bleeding increased. In five minutes, his pulse dropped to 44 and respiration to 16: his color was ashen, and his pulse weak. There was a dramatic deterioration of Cedric’s condition. When Dr. Gerdes went to the ambulance, Cedric had virtually bled to death. He inserted a larger tube and ordered Cedric back to the ER. Cedric died of cardiac arrest at 2:00 am. Module 1: Negligence HA517 Case Brief 2

Hospital regulations and Bylaws govern emergency service provided by the hospital. These rules include admitting patients regardless of ability to pay or insurance and patients were not to be transferred unless their condition warranted it. The initial trial verdict was in favor of Dr. Gerdes, Dr. McCool, and the hospital, refusing to let the case go to the jury. The court of appeal affirmed, and a writ was granted to consider the judgement. After an initial denial by the appellate court for a rehearing, the Supreme Court of Louisiana determined that the policy of Baton Rouge General Hospital was to furnish emergency service regardless of a patient's insurance or ability to pay and not to transfer an unstable patient. Since Cedric Hastings was medically unfit for transfer, his attempted transfer was a violation of the hospital's policy. Since hospitals act through their staff physicians and regulate those physicians' behavior relative to emergency service, the hospital is responsible for any derelictions by the two physicians, and it was decided that the case would go to a jury trial (Justia Law, n.d.). Issue Were Dr. Gerdes, Dr. McCool, and the hospital negligent in the death of Cedric Hastings? Did the physicians and the hospital act prudently and do everything within their ability and authority to save the life of Cedric Hastings? Did the inaction of Dr. McCool by not coming to the hospital as requested, contribute significantly to the chances of Cedric’s death? Would Cedric’s chances of survival have increased had; 1 – Dr. McCool reported to the hospital to perform the thoracotomy or, 2 – had Dr. Gerdes called the chief of service as required by the hospital bylaws when Dr. McCool refused to report? Is the hospital liable for the actions or inactions that significantly contributed to the death of Cedric Hastings? Rule Both LSA-R.S. 40:2113.4 and the Baton Rouge General Hospital Bylaws were used in making the decision to remand the case to trial. LSA-R.S. 40:2113.4 states “Any general hospital licensed under this part, which is owned or operated, or both by a hospital service district, which benefits from being financed by the sale of bonds that are exempt form taxation as provided by Louisiana law, or which receives any other type of financial assistance from the state of Loiuisiana and which offers emergency room services to the public and is actually offering such services at the time, shall make its emergency services available to all persons residing in the Module 1: Negligence HA517 Case Brief 3

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territorial area of the hospital regardless of whether a person is covered by private, federal Medicare, or other insurance” (Casetext, n.d.). The BRGH bylaws also require the doctor on emergency call to see anyone for whom he is called or arrange for other care and provide that no patient shall be transferred without due consideration for his condition and the facilities existing for his care. The bylaws also require that the emergency room physician on duty is required to notify the chief of the hospital’s service when a doctor refuses the call (Justia Law, n.d.). . Analysis In this case, it took a higher-level court to come to the proper decision. Given that Dr. McCool refused to report to the hospital even though Dr. Gerdes stated he had damage to major vessels and Dr. Gerdes’ inaction in taking it higher to the chief of service as required in the hospital’s bylaws, they both failed Cedric Hastings and his family by significantly contributing to the cause of his death, they both should be held accountable. Dr. McCool was responsible under his contract to the hospital and Dr. Gerdes, although unaware of his responsibility, failed to call the service chief in order that another surgeon could treat Cedric Hastings was a contributing factor in his death. The hospital is liable for this breach of duty by Dr. Gerdes, who was performing a service which the hospital was required to make available and who functioned under the control of the hospital’s rules and regulations as well as its medical staff. Since it was in his contract, he should have known, and exercised his responsibility to call the chief. It is my opinion that both Dr.s Gerdes and Dr. McCool should be held liable under negligence. Medical negligence is when a healthcare professional makes a decision or performs and action that accidentally causes harm to their patient, whereas medical malpractice is when a healthcare professional is aware of the potential consequences before making a mistake (Murdoch, 2022). Conclusion The outcome in this case is that it should proceed to trial. It was decreed that the judgment of the court of appeals was reversed, and the matter is remanded to the trial court for trial on the merits. They further determined that the issues of responsibility cannot be made on Module 1: Negligence HA517 Case Brief 4

this appeal based on the record before them, however it should be made only after the case is fully tried and decided by the trier of fact on remand. Module 1: Negligence HA517 Case Brief 5

References Casetext. (n.d.). Statutes, codes, and regulations . Legal research tools from Casetext. https://casetext.com/statute/louisiana-revised-statutes/revised-statutes/title-40-public- health-and-safety/chapter-11-state-department-of-health/part-ii-licensing-of- hospitals/subpart-a-the-hospital-licensing-law/section-4021134-duty-to-provide-services- penalty#:~:text=Any%20general%20hospital%20licensed%20under%20this%20Part%2C %20which,private%2C%20federal%20Medicare%20or%20Medicaid%2C%20or%20other %20insurance. Justia Law. (n.d.). Hastings v. Baton Rouge General Hospital . Justia Law. https://law.justia.com/cases/louisiana/supreme-court/1986/86-c-1034-1.html Murdoch, J. (2022, March 29). The differences between medical malpractice and negligence . GoodRx. https://www.goodrx.com/healthcare-access/patient-advocacy/medical- malpractice-vs-negligence Module 1: Negligence HA517 Case Brief 6

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Unit 2 Application Assignment - Domko

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