Does your hospital have protocols for new treatments?

DOES YOUR HOSPITAL HAVE PROTOCOLS FOR IMPLEMENTING THE LATEST ACCEPTED MODES OF TREATMENT? If not, it may be exposing itself to suits for failing to have protocols in place to guide physicians as to whether the latest accepted forms of treatment should have been employed in a particular case. This

IN MARCH 1999, JESS REED SUFFERED STROKE-LIKE SYMPTOMS AND WAS TAKEN TO GRANBURY HOSPITAL FOR EMERGENCY TREATMENT. The patient's wife Maureen Reed, a Registered Nurse, was aware that the drug T-PA could be used as a "clot-busting" treatment for stroke, if administered within three-hours after a stroke. Therefore, she chose to have her husband taken to Granbury Hospital, which was only about ten minutes from the Reeds' Granbury home. At the hospital, Nurse Reed told Dr. Don Davis, the emergency room physician, that she was aware of the effectiveness of T-PA on stroke patients and, "if possible wanted Jess to get this." Dr. Davis said nothing, turned around, and walked back into the emergency room. After Reed was admitted to the hospital, he was given a CT scan and diagnosed as having had a stroke. There was conflicting opinion as to whether Reed was eligible to receive T-PA. Although the radiologist who reviewed Reed's CT scan initially concluded that the patient was negative for a brain hemorrhage, one of the hospital's experts maintained that the CT scan revealed early signs of brain damage, which would have disqualified Reed as a T-PA candidate. After waiting for approximately forty-five minutes and learning that Dr. Davis "hadn't done anything" to treat her husband, Nurse Reed requested that her husband be transferred to Plaza Medical Center in Forth Worth, while there was still time to administer T-PA within the three hour window. Although Reed was eventually transferred to Plaza Medical Center, he arrived there outside the three-hour window for receiving T-PA. Reed was left with severe disabilities as a result of the stroke. The Reeds sued Granbury Hospital for negligent treatment alleging, inter alia, that the hospital failed to have any protocols for administering T-PA. The Reeds did not sue Dr. Davis .The trial court refused to admit the testimony of the Reeds' medical experts into evidence and granted the hospital's motion for summary judgment. The Reeds appealed.

THE COURT OF APPEALS OF TEXAS AFFIRMED THE TRIAL COURT'S JUDGEMENT. The court affirmed the trial court's refusal to admit the evidence of the testimony of the Reeds' expert medical witnesses who were of the opinion that the Granbury Hospital's failure to have a protocol for the administration of T-PA to stroke patients was negligence since it prevented the administration of T-PA to stroke patients.

THERE WERE TWO DISSENTING OPINIONS FILED IN WHICH THE DISSENTING JUDGES OPINED THAT A HOSPITAL HAS A DUTY TO USE REASONABLE CARE IN FORMULATING THE POLICIES AND PROCEDURES THAT GOVERN A HOSPITAL'S MEDICAL STAFF. One of the dissenting judges opined that the amount of evidence presented by the Reeds showed that Granbury Hospital failed to meet the applicable standard of care. Further, the dissent concluded that the trial judge erred in refusing to admit into evidence the testimony of the Reeds' expert witnesses that the failure of the defendant hospital to have protocols in place for administering T-PA to stroke patients within the critical three-hour window was reversible error. The dissent cited a leading Texas case, Denton Reg'l. Med. Ctr. v. LaCroix, 947 S.W.2d 941, 950, in which Texas held that a hospital has a duty to use reasonable care in formulating the policies and procedures that govern a hospital's medical staff and nonphysician personnel. To determine whether a hospital has deviated from its duty a court must determine whether a hospital deviated from the standard of care to a degree that constitutes negligence. The dissent observed that "While the standard of administrative care at a hospital may be established by lay testimony, expert testimony is required when the underlying issue involves the performance of medical procedures." Further, the dissent observed that in the LaCroix case, medical expert testimony of the type excluded by the trial court in this case was admitted. There, however, was the hospital's failure to follow its own policies and procedures as opposed to failing to even have a policy or procedure. The dissent observed that this distinction was of no significance. The dissent concluded that the testimony was clear that there were only two requirements for providing T-PA as a potential treatment: a functioning CT scanner and the medicine itself. The hospital had both! Reed v. Granbury Hosp. Corp., 117 S.W.3d 404--TX

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.