Columbia N. Hills Hosp. Subsidiary, L.P. v. Bowen (Summary)

NEGLIGENT CREDENTIALING AND SUPERVISION

Columbia N. Hills Hosp. Subsidiary, L.P. v. Bowen, No. 02-13-00286-CV (Tex. App. Jan. 30, 2014)

The Court of Appeals of Texas affirmed a lower court decision denying a hospital’s request to dismiss health care liability claims brought by a patient. A hand surgeon severed a patient’s ulnar nerve in a procedure he performed on the patient’s elbow in a surgical hospital although it was not known at the time of the procedure.  When the patient reported in a follow-up visit several weeks later that numbness and weakness persisted in that hand, the surgeon recommended that the patient be admitted to another hospital, that same afternoon, so that he could perform an ulnar decompression procedure. The procedure took five hours, resulted in allegedly deficient documentation of the certain aspects of the operation in the medical record, and did not improve the symptoms.  The patient sued both the hand surgeon and the hospital alleging, among other things, that the hospital was negligent in its supervision of the surgeon.

The hospital objected to the patient’s expert report from a hand and upper extremity specialist, who claimed that there is a better chance of repair to a nerve injury when it is treated sooner rather than later. The hospital argued that the report did not specify any standard of care that applied to the hospital, and did not clarify what kind of surgeon supervision should have been provided. In overruling the hospital’s objections, the appellate court concluded that the report fairly established the hospital’s standard of care by explaining its responsibilities to follow correct monitoring and reporting procedures. According to the court, the report adequately summarized the hospital’s failure to meet the standard of care by detailing the fact that the surgeon did not appear to have adequate or updated training to perform endoscopic cubital tunnel procedures, that the hospital should have questioned the emergent scheduling of the case, as well as the dismissal of proper protocol and documentation in the record.

The hospital also argued that the expert report failed to show a causal connection between a breach in the standard of care and the patient’s resulting injuries. The expert asserted his belief that the hospital was a contributing cause to the patient’s injury, stating that the patient would have learned of the severed ulnar nerve much earlier had the hospital followed proper protocol. Additionally, the expert stated that the hospital should have questioned the need of the second, and ultimately unnecessary, emergency surgery. The court ruled that this report adequately addressed the issue of causation to provide a basis for the patient’s claims.