On appeal from the Superior Court of New Jersey, Law Division, Camden County.
Approved for Publication November 13, 1996. As Amended November 25, 1996.
Before Judges Muir, Jr., Kleiner, and Bilder. The opinion of the court was delivered by Muir, Jr., J.A.D.
The opinion of the court was delivered by: Muir
The opinion of the court was delivered by
In this nursing malpractice action, the jury awarded Edward Adams (plaintiff) $1,500,000 and his wife, Barbara Adams, $160,000 on her per quod claim. Defendants appeal the ensuing judgment. They argue the trial court committed reversible error when it refused to instruct the jury on the right of a nurse to exercise her medical judgment in the treatment of a patient. They also contend, because the plaintiff's Personal Injury Protection (PIP) insurer paid the stipulated $154,380 in medical malpractice expenses, N.J.S.A. 39:6A-12 barred the admissibility of all medical expenses. Thus, they argue the trial court committed reversible error when it instructed the jury pursuant to the collateral source rule. Finally, they contend the damage awards were so excessive as to require a new trial on both liability and damages. We affirm.
The trial court instructed the jury on the general standard of care required of a medical provider as defined in Schueler v. Strelinger, 43 N.J. 330, 344-45, 204 A.2d 577 (1964). However, the court refused defendants' request to instruct that a medical provider "must be allowed a wide range in the reasonable exercise of judgment" as to the course of treatment taken. Ibid. Defendants find error in the refusal to charge the medical judgment rule. We disagree.
The medical judgment rule does not apply to all medical malpractice actions. Schueler set its parameters. "When a surgeon selects one of two courses, . . . either one of which has substantial support as proper practice by the medical profession, a claim of malpractice cannot be predicated solely on the course pursued." Id. at 346. The Schueler Court emphasized that, when a matter exists "about which there are differing schools of medical opinion . . . the plain inference is that the matter must be left to the good faith judgment of the experienced attending surgeon." Ibid. The Court relied on this principle to absolve the defendant doctor of liability because he chose between two medically confirmed alternatives. Those alternatives were to operate quickly and risk the patient's bleeding to death because of a blood-clotting problem or to take additional time to improve the blood's clotting and risk the spread of her possible cancer. These Hobson's choice circumstances induced the Court's reversal of a judgment against the doctor.
Here, no such choicelessness existed. The issue before the jury was whether Kim Holcomb, R.N., (defendant) had the duty to constantly monitor her patient, the plaintiff, during the time she was in charge of his care.
Plaintiff sustained serious injuries in an automobile accident. The hospital diagnosed his injuries as several broken ribs, a punctured lung, and a suspected heart injury. Hospital personnel placed him in the Trauma Intensive Care Unit. Approximately fifteen days after admission, plaintiff's condition stabilized. He was then transferred to a private room in a medical surgical ward where he came under the defendant's care.
On May 15, 1990, shortly after admission to the surgical ward, plaintiff, who had a trache tube inserted in his throat, was having difficulty breathing and was coughing up thick yellow mucous. He was unable to speak. His temperature went up to 101.4 degrees, and his vital signs also deteriorated. His blood pressure went to 210 over 100. A trauma physician ordered a blood gas test, medicine, and application of nitro paste to open up blood vessels. The nurse's hospital notes, recorded after her conversation with the trauma physician, indicated she would monitor the plaintiff.
Defendant claimed she complied with the trauma doctor's directions. She ordered the test and administered the paste and medicine. She also suctioned mucous from plaintiff's throat. Thereafter, she left plaintiff alone for thirty minutes or more. During that time, plaintiff began to choke on mucous accumulated at the trache tube. Unable to speak, he attempted to use a bedside call button designed to summon a nurse. His effort to do so led to his falling out of bed. The defendant and the trauma doctor found plaintiff lying on the floor surrounded by his urine and fecal matter. Subsequent suctioning of plaintiff's throat, according to the trauma doctor, brought out a "copious" amount of mucous. Plaintiff sustained a comminuted fracture of his left hip and a head trauma as the result of the fall. The hospital immediately transferred plaintiff back to the trauma unit and placed him on mechanical ventilation.
Plaintiff's nursing expert and defendant's nursing expert differed over the need to constantly monitor plaintiff. Emphasizing plaintiff's dangerously increased vital statistics and his inability to communicate, plaintiff's expert testified defendant deviated from the required standard of care when she left plaintiff alone for thirty minutes or more. The expert stated plaintiff needed someone to be with him constantly until he became stabilized. The expert did state that nurses "have the ability to make judgments," but defense counsel conceded she did not use the word judgment in rendering her opinion. We conclude the expert used the word ...