IN THE SUPREME COURT OF THE STATE OF KANSAS
No. 84,292
AUDRA NICHOLE NOLD, a minor,
by and through her Parents, Natural
Guardians, and Next Friends,
Joseph C. Nold and Bonnie B. Nold.
Plaintiff/appellee,
v.
KERNIE W. BINYON, M.D.;
ERIC PEKARSKI, D.O.;
PHILIP C. JAMES, M.D.;
Defendants,
and
MICHAEL P. BROWN, M.D.;
JAMES M. DONNELL, M.D.;
SCOTT E. MOSER, M.D.;
Defendants/appellants,
and
HCA HEALTH SERVICES OF KANSAS, INC.,
a Kansas Corporation, d/b/a WESLEY MEDICAL CENTER,
Defendant/appellee.
SYLLABUS BY THE COURT
1. An appellant bears the burden to compile a record on appeal sufficient to support its arguments, not those of its opponents.
2. Where reasonable minds might differ on the existence or extent of a defendant's liability, judgment as a matter of law under K.S.A. 2000 Supp. 60-250 is unavailable.
3. As a matter of law, a physician who has a doctor-patient relationship with a pregnant woman who intends to carry her fetus to term and deliver a healthy baby also has a doctor-patient relationship with the fetus.
4. As a matter of law, a pregnant woman is entitled to be informed if medical test results reveal that she has a communicable disease that can be transmitted to her baby during labor and delivery.
5. In order to recover damages in a medical malpractice case, a plaintiff is required to prove the following elements: (1) The defendant owed plaintiff a duty of care and was required to meet or exceed a certain standard of care to protect plaintiff from injury; (2) the defendant breached this duty or deviated from the applicable standard of care; and (3) plaintiff was injured and that injury proximately resulted from the defendant's breach of the standard of care.
6. The question of whether a duty exists is a question of law.
7. Negligence is never presumed and may not be inferred merely from a lack of success or an adverse result from treatment. The plaintiff in a medical malpractice case bears the burden of showing not only the defendant's negligence, but that the negligence caused the plaintiff's injury. The standard of medical or hospital care that is to be applied in any given case is not a rule of law, but a matter to be established by the testimony of competent medical experts.
8. The expert testimony requirement in medical malpractice cases is particularly apt in the current managed care environment, populated as it is by family practice "gatekeepers" and the specialists to whom they refer patients for care and from whom they receive referrals for more routine tests and procedures. This arena is not static. A common-law court needs to turn a receptive ear to societal changes while safeguarding traditional tort concepts that exist to protect injured persons.
9. In a first impression medical malpractice case arising in a managed health care environment from the pregnancy of a hepatitis B positive patient and delivery of a hepatitis B positive daughter, brought by the parents on behalf of their daughter, alleging that defendant physicians and a hospital were negligent in the care and treatment of the mother and daughter, the record is examined and it is held:
(1) The district court erred in: (a) excluding proffered testimony of plaintiff's expert medical witness on the breach of the standard of care of defendant hospital's nurses; (b) sustaining the defendant hospital's K.S.A. 2000 Supp. 60-250 motion for judgment as a matter of law; and (c) instructing the jury as a matter of law on certain duties owing from defendant physicians to plaintiff.
(2) On retrial, expert standard of medical care testimony may be introduced on plaintiff's claims concerning: (a) the defendant physicians' failure to report to plaintiff's mother her hepatitis B test result; (b) the adequacy of the reporting of her test result to other physicians, the hospital, and the local health department; (c) the failure of plaintiff to receive the post-delivery hepatitis B inoculation and vaccination; and (d) the hospital's duties under the existing circumstances.
(3) The case is reversed and remanded for further proceedings consistent with this opinion.
Appeal from Sedgwick district court; D. KEITH ANDERSON, judge. Opinion filed September 21, 2001. Reversed and remanded.
Christopher A. McElgunn, of Klenda, Mitchell, Austerman & Zuercher, L.L.C., of Wichita, argued the cause, and Gary M. Austerman and Mary T. Malicoat, of the same firm, were with him on the briefs for appellant Scott E. Moser, M.D.
Stephen L. Brave, of Turner & Boisseau, Chtd., of Wichita, argued the cause, and Eldon L. Boisseau, and Bobby J. Heibert, Jr., of the same firm, were with him on the brief for appellant Michael P. Brown, M.D.
Harold S. Youngentob, of Goodell, Stratton, Edmonds & Palmer, L.L.P., of Topeka, argued the cause, and Laura B. Lawson, of the same firm, was with him on the briefs for appellant James M. Donnell, M.D.
John H. Gibson, of Boyer, Donaldson & Stewart, L.L.P., of Wichita, argued the cause, and Michelle M. Watson, of the same firm, was with him on the brief for appellee Wesley Medical Center.
Arden J. Bradshaw, of Bradshaw, Johnson & Hund, of Wichita, argued the cause, and James R. Howell, of the same firm, was with him on the brief for appellee Audra Nold.
The opinion of the court was delivered by
SIX, J.: This first impression medical malpractice action arises from the pregnancy of Bonnie Nold and the later birth of her daughter Audra Nold. Joseph and Bonnie Nold, Audra's parents, on her behalf, alleged that certain physicians and a hospital were negligent in their care and treatment of Bonnie and Audra. We consider, in a managed care environment, the duty owed by the mother's physicians and the delivery hospital to the baby of a mother who intends to carry the fetus to term. We also consider the reporting responsibilities of physicians whose pregnant patient tests positive for hepatitis B.
Bonnie is not asserting a personal claim for damages. The jury returned a verdict for Audra and awarded damages totaling $800,000, apportioning negligence as follows: Dr. Scott Moser, 90 percent; Dr. James Donnell, 6 percent; Dr. Michael Brown, 2 percent; and Dr. Kernie Binyon, 2 percent. Three of the physician defendants, Drs. Moser, Donnell, and Brown, appeal. At the close of Audra's case, defendant HCA Health Services of Kansas, Inc., d/b/a Wesley Medical Center (Wesley), was dismissed on its motion for judgment as a matter of law. See K.S.A. 2000 Supp. 60-250 (formerly motion for directed verdict). The jury assessed zero fault to Eric Pekarski, D.O.; Katie Mroz, M.D.; Philip C. James, M.D.; and "unknown physician." Mroz and the "unknown physician" were not defendants; James' motion for summary judgment was granted before trial.
Our jurisdiction is under K.S.A. 20-3017 (the defendants' motion to transfer was granted).
We reverse, set aside the jury's verdict, and remand for a new trial. The district court erred in excluding certain expert testimony regarding the comparative fault of Wesley and in sustaining Wesley's K.S.A. 2000 Supp. 60-250 motion for judgment as a matter of law. We also disapprove the submission of an overly broad jury instruction setting forth a physician's reporting duty to: (1) other physicians and the hospital, (2) public agencies, and (3) the pregnant patient, as well as the length of time that duty would continue.
Because of our reversal and remand we need not reach the following additional issues raised on appeal by the physician defendants: Did the district court err: (1) in allowing certain claims for future medical care and treatment to be submitted to the jury; (2) in allowing a claim for future lost wages, loss of earning capacity, loss of career opportunity, and employment disability to be submitted to the jury; and (3) by precluding the doctors from comparing the fault of Bonnie? The evidence underlying the district court's decision on these issues may be subject to change. Defendant Moser also asks us to evaluate this case as if it were a "loss of chance" case. The case had neither been framed nor tried as a loss of chance case; thus, this issue is not properly before us. See, Jarboe v. Board of Sedgwick County Comm'rs, 262 Kan. 615, 622, 938 P.2d 1293 (1997).
INTRODUCTION
The focus of all of Audra's claims is on the failure to notify Bonnie of her hepatitis B status and to administer gamma globulin and vaccine treatment to Audra at the time of her birth. While pregnant, Bonnie was treated by numerous physicians. Laboratory test results obtained early in her pregnancy showed she was a carrier of hepatitis B, although she was asymptomatic and experienced no related health problems. A carrier, during pregnancy and delivery, can pass hepatitis B to her child. That happened here. Audra did not receive the necessary preventive treatment and has tested positive for the presence of hepatitis B surface antigens and is a chronic carrier. As of trial, she had none of the identifiable risk factors for more severe stages of hepatitis B and had remained asymptomatic and without physical problems related to her status as a carrier.
FACTS
In order to better understand the parties' contentions, and because Audra's claims arise within the current environment of managed care, we set out the facts in detail. We understand there is no universally accepted definition of "managed care." See Stephen M. Fatum, Managed Care, in Health Care Law Desk Reference § 501, p. 59 (Alison Barnes et al. eds., 2001). We use the term here to reflect Bonnie's referrals by her primary care physicians to specialists under her Equicor Health Plan, Inc., and to the specialists' referrals to and/or use of the primary care physicians for specific tests and lab work.
In February 1990, Bonnie was under the care of Dr. Kernie Binyon, a family practice physician. She became pregnant and was referred by Dr. Binyon to Dr. Michael Brown, a board-certified obstetrician and gynecologist. On February 12, 1990, during Bonnie's first visit, Dr. Brown ordered laboratory tests, including one for hepatitis B. Those orders were given to Bonnie, who took them to Dr. Binyon's office. Dr. Binyon's staff drew blood samples and transmitted them to a laboratory for testing. The laboratory sent the results to Dr. Binyon's office, which then sent them to Dr. Brown. Included in the test results was a report dated February 20, 1990, which showed that Bonnie tested positive for hepatitis B. Neither Dr. Brown nor Dr. Binyon informed Bonnie of the results of this test.
During Bonnie's second visit to Dr. Brown, he requested a sonogram because he believed her growth was a bit abnormal. Due to managed care insurance constraints, Dr. Brown had to have a referral from Dr. Binyon. Dr. Binyon refused to provide the sonogram referral. Dr. Brown elected to terminate his doctor-patient relationship with Bonnie, still in her first trimester of pregnancy, because he said he could not properly treat her without conducting tests he believed necessary to protect her health and the health of the developing fetus.
Bonnie then sought the care of another physician. She first terminated her doctor-patient relationship with Dr. Binyon and requested that he forward her medical records to Dr. James Donnell. On March 30, 1990, Dr. Donnell became Bonnie's primary care physician under her Equicor Health Plan. Sometime between March 30, 1990, and May 22, 1990, Dr. Binyon's office delivered Bonnie's medical records to Dr. Donnell. Included within those records was the laboratory test result on Bonnie's positive hepatitis B status. Shortly after March 30, 1990, Dr. Donnell, a family practice physician who had chosen to limit his practice to nonobstetrical cases, referred Bonnie to Dr. Scott Moser for obstetrical care.
Despite the referral to Dr. Moser, Bonnie visited Dr. Donnell's office five times before giving birth to Audra: (1) March 30, 1990; (2) May 22, 1990, for lab work requested by Wesley Family Practice/ Dr. Moser; (3) July 2, 1990, for additional lab work; (4) July 17, 1990, for RhoGAM shots ordered by Wesley Family Practice/Dr. Moser; and (5) August 21, 1990, for more lab work ordered by Wesley Family Practice/ Dr. Moser. Dr. Donnell never reviewed the hepatitis B test result nor advised Bonnie or later health care providers of her hepatitis B status.
Dr. Moser, a physician certified in family practice, made obstetrics an active part of his practice. He first saw Bonnie on April 11, 1990, when she was 18 weeks pregnant. On that visit Dr. Moser decided that a sonogram would be helpful and requested her medical records from Dr. Brown. After Dr. Moser received the medical records, he noted and entered the hepatitis B information in Bonnie's chart. Dr. Moser's standard practice in the care of hepatitis B positive pregnant women is to enter the information at a prominent place in the medical record. He does this so that at the time of delivery anyone involved in the mother's care will be aware of her hepatitis B status and ensure that the child receives appropriate treatment. He testified that he believed he entered the information sometime after the initial visit on April 11, 1990, and before Bonnie's May 16, 1990, visit. Dr. Moser testified that he recalled telling Bonnie about her hepatitis B status and advising her of the implications it would have for her fetus, but he was not sure when the conversation took place. Bonnie testified Dr. Moser did not tell her about her positive hepatitis B test or its implications for the fetus.
Dr. Moser testified that a patient's prenatal records are customarily sent to the delivering hospital at about 34 to 36 weeks' gestation. In 1990, the labor, delivery, and recovery unit (LDR) at Wesley had an established policy and procedure. Once prenatal records were received from a patient's physician, they were sent directly to the LDR and placed in alphabetical order in a filing cabinet. The records were filed by the unit clerks as the records came into the unit. When the patient was later admitted to the hospital, the unit clerk would retrieve the patient's prenatal history from the filing cabinet, put it with the chart that was being assembled upon admission, and deliver the chart to the physician who was handling the labor and delivery.
Wesley would stamp all records within a chart with "address-o-graph" information. The address-o-graph stamp included the patient's hospital stay number, name, birthday, date of admission, and the date Wesley received the record. This procedure ensured that such information was on every piece of permanent record within the hospital and that the information would follow the patient through the course of her care and treatment at Wesley.
Bonnie's prenatal records from Dr. Moser were stamped with an address-o-graph, showing that Wesley received the records. However, the only date that appeared in the address-o-graph information was Bonnie's September 14, 1990, admission date. At trial, Wesley personnel testified that, despite the professed practice of stamping records with the date they are received, the information concerning the receipt of the records is inaccurate and unreliable.
The last entry on the copy of Dr. Moser's prenatal records from the hospital file was made on August 30, 1990. The original prenatal records maintained by Dr. Moser in his office contain a later entry made on September 11, 1990. It is therefore likely that the prenatal records from Dr. Moser were sent to Wesley sometime before September 11, 1990.
After a baby is born, Wesley's standard practice is to place information in the mother's chart in the medical chart for the baby. Dr. Moser expected the standard practice to occur in Bonnie and Audra's case. He assumed that the hepatitis B information would find its way in a timely manner to the appropriate caregivers for Audra, including her designated pediatrician. The pediatrician could then provide Audra with appropriate care and treatment to prevent hepatitis B transmission.
In 1990, Dr. Eric Pekarski was a resident physician at Wesley training to become a specialist in family medicine. He is now board certified in Family Practice. During his residency, he practiced under the supervision of residency program faculty members. On the night of September 14, 1990, between 9:40 and 10 p.m., Dr. Pekarski was called to the LDR. Dr. Pekarski examined Bonnie, determined she was in active labor, contacted his attending physician, Dr. Katie Mroz, and agreed with Dr. Mroz that Bonnie should be admitted.
In admitting a patient, as part of his duties as a resident, Dr. Pekarski completed a Resident Admission Note consisting of the patient's history. Included within the Resident Admission Note is a section for major medical illnesses. The resident doctor obtains the information to complete that section by asking the patient. Dr. Pekarski followed his general practice of completing the Resident Admission Note and then delivering it to the unit clerk to be placed in Bonnie's chart. Dr. Pekarski did not review Dr. Moser's prenatal records when filling out the Resident Admission Note.
It was Dr. Pekarski's practice to check in with his attending physician when he was providing care to a patient. Dr. Mroz, a physician in Dr. Moser's office, was on weekend call for Dr. Moser on that particular Friday night. Dr. Pekarski's practice of consulting with the attending physician was intended at least in part to find out any information about risk factors, including any information in the prenatal records. Thus, Dr. Mroz played a role in the process of putting together the chart for Bonnie.
Dr. Moser arrived at the hospital at 11:06 p.m. By the time Dr. Moser arrived, Bonnie was already in the delivery room, the baby was having distress, and delivery was imminent. The fetal heart tones were dangerously slow, suggesting that the baby's health might be compromised and that the baby's condition was not improving. Because of the emergency situation, Dr. Moser immediately focused on the distressed baby and did not review Bonnie's prenatal records. Forty-four minutes after Dr. Moser's arrival, Audra was delivered by Cesarean section, and Dr. Moser helped with the efforts to resuscitate her.
In emergencies such as Bonnie's, Dr. Moser and other physicians rely on the records system to make sure that the transfer of information from the mother's prenatal records to the baby's chart takes place. As part of this record transfer system, Dr. Moser relied primarily on Dr. Mroz and Dr. Pekarski. Dr. Mroz remained at the hospital through the delivery despite Dr. Moser's arrival and was actively involved in the delivery.
Dr. Moser testified that typically he is both the mother's doctor and the baby's doctor. As the baby's doctor, he would order the hepatitis B inoculation and vaccination needed by the baby of a hepatitis B positive mother. However, in this instance, Dr. Pekarski was covering for the baby's designated pediatrician, Dr. Phillip James. Thus, Dr. Moser did not order postdelivery treatment for Audra.
Dr. Pekarski handled Bonnie's discharge from the hospital on September 7, 1990. On October 9, 1990, he dictated a discharge summary, reviewing her medical chart in its entirety. Dr. Pekarski's discharge summary did not contain information either that Bonnie is hepatitis B positive, or that Audra was born to a hepatitis B positive mother. At trial, Dr. Pekarski testified that Dr. Moser's prenatal records were not in Bonnie's hospital medical chart at the time she presented to the LDR, when he reviewed it while providing her care, or at the time he dictated her discharge summary.
It is recommended that a gamma globulin injection be given to an infant exposed to hepatitis B within the first 12 hours after birth. However, the gamma globulin treatment is still effective if administered up to and perhaps beyond 2 days after birth. The hepatitis B vaccine is also given to such a baby within the first week of life. When this treatment is administered, there remains a 10 percent chance that the newborn will contract hepatitis B.
In 1992, Bonnie underwent a hysterectomy. During the procedure, a nurse was stuck with a needle that had been used on Bonnie. As a result, Bonnie's blood was tested again. She was advised that she had tested positive for hepatitis B, that it was an infectious disease obtained through intimate contact, and that she should have her family tested. Afterward, Audra was tested and found to be hepatitis B antigen positive.
DISCUSSION
The Comparative Fault of Wesley Medical Center
The physician defendants contend the district court erred by excluding the testimony of Audra's expert, John Bundren, M.D., on the breach of the standard of care by Wesley's nurses. See K.S.A. 60-258a (comparative negligence). The district court found Dr. Bundren was not qualified to testify on the nursing standard and granted Wesley's motion for judgment as a matter of law at the close of Audra's case because of the lack of expert testimony. We agree with defendants.
The admission of expert testimony lies within the discretion of the district court, and its decision will not be reversed on appeal absent a showing of abuse of discretion. Olathe Mfg., Inc. v. Browning Mfg., 259 Kan. 735, 762, 915 P.2d 86 (1996).
Wesley filed a motion in limine, requesting that the district court exclude the testimony of Dr. Bundren concerning nursing standards. Wesley points out that the limine motion, the supporting trial brief, and its motion to strike Dr. Bundren as an expert on nursing standards are not included in the record on appeal. According to Wesley, these submissions are "vital" to our review, and the appellants carry the burden to include them in the record on appeal. The appellants bear the burden to compile a record sufficient to support their arguments, not those of their opponents. Wesley had the opportunity to request additions to the record to support its arguments. See Supreme Court Rule 3.02(c) (2000 Kan. Ct. R. Annot. 21). It also had the ability to address arguments it advanced below in its appellate briefs. We conclude the question is properly before us on the record as it stands.
The defendants argue that Dr. Bundren's more than 20 years of experience as an obstetrician/gynecologist in labor and delivery qualified him to testify on the standards applicable to nurses in labor and delivery units, particularly with respect to the review and maintenance of chart information on patients' infectious diseases. Dr. Bundren testified he had "[w]orked with . . . nurses on a daily or weekly basis in multiple sites across the country." He answered "yes" to the following question from Audra's counsel: "Before I ask your opinions are you knowledgeable concerning the general standard for how nurses in a labor and delivery unit would handle prenatal records coming in from a doctor from the point of being received and getting into the chart?"
K.S.A. 60-419 says in part:
"As a prerequisite for the testimony of a witness on a relevant or material matter, there must be evidence that he or she has personal knowledge thereof, or experience, training or education if such be required. Such evidence may be by the testimony of the witness himself or herself."
K.S.A. 60-456(b) says:
"If the witness is testifying as an expert, testimony of the witness in the form of opinions or inferences is limited to such opinions as the judge finds are (1) based on facts or data perceived by or personally known or made known to the witness at the hearing and (2) within the scope of the special knowledge, skill, experience or training possessed by the witness."
A further review of Dr. Bundren's qualifications is appropriate. He is on the faculty of the University of Oklahoma College of Medicine, in the Department of Gynecology and Obstetrics. He is a board certified OB-GYN specialist and a tenured associate professor. He does a substantial amount of private practice. His focus currently is on the hospital's infertility patients. He is actively involved in teaching the 16 OB-GYN residents who work with him in the operating room and in his private practice office in the hospital. It is not uncommon for him to spend weekends in the hospital with residents delivering babies and managing obstetrical complications and problems. He sees private patients in his office and probably delivers the babies of 20 private patients a year. He is involved in about 200 deliveries a year as a resident supervisor or helper, and it has been that way for many years. He is familiar with high-risk obstetrical situations. He teaches residents about how to handle obstetrical situations and problem patients on a weekly basis in the clinic with patients. He has published and does research. He attends meetings of the American College of Obstetrics and Gynecology, which promotes national standards to make obstetrical care safe across the country. In his dealings with pregnant women over the years, he has considered the hepatitis B problem.
Dr. Bundren also has been involved with teaching nurses. He has given numerous lectures to nurses and worked with them on various aspects of patient care in hospitals. He is on the staff of various medical centers in Tulsa and is familiar with labor and delivery unit standards for handling patient records as they come in and are put into patients' charts.
The critical passage in the proffer of Dr. Bundren's testimony reads:
"Q. . . . [D]id you form an opinion as to whether the labor or any of the labor and delivery nurses at Wesley were negligent in any respect and fell below the standard acceptable nursing practice?
"A. I did form an opinion.
"Q. And what is that opinion?
"A. My opinion is that the nurses failed to follow their own policies and procedures. They failed to adequately assess the patient and document on their nurses assessment that the patient was hepatitis B surface antigen positive and failed to transmit that information on to the nursery nurses which is the usual means by which that information is moved around.
"Q. You're referring to that nursing admission assessment?
"A. I'm referring to the nursing admission assessment and the documents and testimony that I became aware of.
"Q. Can you tell us whether the nurses doing that function, that is adding the hepatitis B information from the prenatal record to the nursing assessment records, would be a standard thing for nurses to do?
"A. That would be a very standard thing for nurses to do.
"Q. You hold those opinions to a degree of medical probability?
"A. Yes, sir."
Dr. Brown joined in the proffer, and this preserved the issues of Dr. Bundren's testimony and Wesley's dismissal for our review. The district judge excluded Dr. Bundren's testimony because he viewed Dr. Bundren as a physician who merely worked around nurses and not as one who possessed actual nursing expertise. We hold the district court erred as a matter of law in excluding Dr. Bundren's testimony on the general standard of care commonly applicable to nurses in labor and delivery units, particularly with respect to the review and maintenance of prenatal chart information.
We visited the medical expert nursing standard of care question in Avey v. St. Francis Hospital & School of Nursing, 201 Kan. 687, 422 P.2d 1013 (1968). Avey supports defendants' contention that the district court abused its discretion in excluding Dr. Bundren's testimony. In Avey, we considered whether a physician was qualified to testify to nursing standards and hospital procedures. Avey's expert, Dr. Robert Stein, testified that he was a licensed physician practicing medicine in Kansas, Massachusetts, and California and that he was familiar with the nursing care standards and practices at issue in the case. Although he had not practiced in Wichita, Dr. Stein testified that he was familiar with the practices of St. Francis Hospital and with nursing care in general in the community. We reversed the district court's exclusion of Dr. Stein's testimony. 201 Kan. at 692-93. Wesley argues that Avey is distinguishable on the facts because the challenge to Dr. Stein's testimony was based on the "locality rule." See 201 Kan. at 690-91. Dr. Bundren's testimony was challenged on the basis of his qualifications. We acknowledge the factual distinction; however, we extend the discussion in Avey surrounding a physician testifying as an expert on nursing standards to the situation here. See Chandler v. Neosho Memorial Hospital, 223 Kan. 1, 574 P.2d 136 (1977) (following Avey); Moore v. Francisco, 2 Kan. App. 2d 526, 583 P.2d 391 (1978) (in a malpractice action against an orthopedic surgeon, it was error to exclude an anesthesiologist from testifying on the standard of care in taking a patient's personal history, a matter common to all areas of medicine).
Wesley cites Hall v. Sacred Heart Med. Ctr., 100 Wash. App. 53, 995 P.2d 621 rev. denied 141 Wash. 2d 1022 (2000), and Haney v. Alexander, 71 N.C. App. 731, 323 S.E.2d 430, cert. denied 313 N.C. 329 (1985), to support its contention that Dr. Bundren was not qualified to testify regarding nursing standards. These citations are puzzling, as the cases seem to support the defendants' contention that Dr. Bundren's testimony should have been admitted.
In Hall, the defendant hospital sought to have a doctor, who was codirector of the hospital, testify regarding the standard of care for critical care nurses. Hall objected on competency grounds. The hospital elicited testimony showing that the doctor worked with ICU nurses on a daily basis, was involved in the education and training of nurses, and was involved with the supervision of critical care nurses. On appeal, Hall asked the appellate court to establish a bright line rule stating that only a nurse could testify as to the standard of care of another nurse. The Hall court refused and found the district court had properly admitted the doctor's testimony. See 100 Wash. App. at 59-60.
The Haney court approved the testimony of two physicians who te