may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1998).
STATE OF MINNESOTA
IN COURT OF APPEALS
Oscar R. Quast,
Bethesda University Family Practice Clinic,
Americo Fraboni, M.D.,
St. Joseph's Hospital,
University of Minnesota, et al.,
Filed July 20, 1999
Toussaint, Chief Judge
Ramsey County District Court
File No. C5972721
Thomas D. McCormick, McCormick Law Office, P.A., 701 Fourth Avenue South, Suite 500, Minneapolis, MN 55415 and
William N. Majerus, Majerus Law Office, 701 Fourth Avenue South, Suite 500, Minneapolis, MN 55415 (for respondent Oscar R. Quast)
Kay Nord Hunt, John R. McBride, Lommen, Nelson, Cole & Stageberg, P.A., 1800 IDS Center, 80 South Eighth Street, Minneapolis MN 55402 (for appellant St. Joseph's Hospital)
David C. Hutchinson, Kyle M. Thomas, Geraghty, O'Loughlin & Kenney, 1400 Ecolabs University Center, 386 North Wabasha Street, St. Paul, MN 55102-1308 (for respondent Americo Fraboni)
Bruce P. Candlin, Candlin & Wright, 3800 West 80th Street, Suite 1500, Bloomington, MN 55431-4429 (for respondent Bethesda University Family Practice Clinic)
Considered and decided by Toussaint, Chief Judge, Short, Judge, and Schultz, Judge.[*]
TOUSSAINT, Chief Judge
In this medical malpractice action, appellant St. Joseph's Hospital challenges the trial court's denial of its motions for directed verdict and judgment notwithstanding the verdict or, in the alternative, a new trial. Because respondent Oscar R. Quast failed to establish a prima facie case of medical malpractice against St. Joseph's Hospital, we reverse.
From July 1993 to May 1995, appellant St. Joseph's Hospital administered 22 intravenous iron infusions to respondent Oscar Quast at the direction of Dr. Fraboni, a second-year resident at Bethesda University Family Practice Clinic ("Bethesda Clinic"). As a Bethesda Clinic resident physician, Dr. Fraboni had hospital privileges at St. Joseph's for the care of Bethesda Clinic patients. Quast was a Bethesda Clinic patient diagnosed with marked iron deficiency anemia in 1993. St. Joseph's oncology nursing staff administered Quast's iron infusions, which were provided by the hospital pharmacy.
In May 1995, Dr. Fraboni became concerned that Quast's complaints of achiness in his joints was due to iron deposits in his joints. He arranged for a bone marrow biopsy, which revealed increased iron storage. Dr. Fraboni then referred Quast to Dr. Bartsch, a hematologist. Before he could see Dr. Bartsch, Quast was admitted to the hospital for a small bowel obstruction and acute hemorraghic pancreatitis. After his surgery, Quast began seeing Dr. Lewis, a hematologist who ordered phlebotomies to decrease the iron load in Quast's body.
In December 1996, Quast filed a medical malpractice suit against Dr. Fraboni, Bethesda Clinic and St. Joseph's. St. Joseph's made a pre-trial motion in limine to preclude Dr. Lewis's testimony regarding the applicable standards of care for pharmacists and oncological nurses and breach of those standards. Quast responded by stating:
Dr. Lewis is not expected to offer opinions regarding the standard of care applicable to pharmacists or nurses. However, he may offer testimony relating to his working experience with pharmacists and nurses, and his expectations. Dr. Lewis will appear at trial and the hospital can note it's [sic] objections, if any, for ruling by the Court.
Quast moved to preclude any reference to Quast's status as a Medicaid recipient. The trial court denied St. Joseph's Hospital's motion and granted Quast's motion.
At trial, Dr. Fraboni testified, consistent with hospital records in evidence, that he gave St. Joseph's either a written or oral order to administer an iron infusion to Quast on 18 different occasions. Dr. Lewis testified that the iron infusions administered to Quast caused an iron overload, which necessitated numerous phlebotomies to reduce the iron in Quast's body. Dr. Lewis also testified about his experiences with his clinic's oncology nurses and stated that the pharmacy acted inappropriately in dispensing the iron infusions. Quast also called David Robarge, a clinical pharmacist at St. Joseph's, who testified that he was unsuccessful in pulling up a complete history of Quast's iron infusions on the hospital computer system.
After Quast rested, St. Joseph's moved for a directed verdict. The trial court denied the motion. At the end of trial, the jury found St. Joseph's and Bethesda Clinic negligent, but not Dr. Fraboni. It attributed 60 percent of the negligence to St. Joseph's and 40 percent to Bethesda Clinic. St. Joseph's Hospital moved for judgment notwithstanding the verdict (JNOV) or, in the alternative, a new trial. The trial court denied the motion. St. Joseph's now appeals from the judgment, contending the trial court erred in denying its motions for directed verdict and JNOV or a new trial.
In order to create a jury question, a plaintiff must first establish a prima facie case of medical malpractice. Plutshack v. University of Minnesota Hosps., 316 N.W.2d 1, 5 (Minn. 1982) (directed verdict proper when plaintiff failed to establish standard of care or causation); Lhotka v. Larson, 307 Minn. 121, 130, 238 N.W.2d 870, 876 (1976) (general rule in medical malpractice cases is that plaintiff must introduce expert testimony on the standard of care and defendant's departure from it to create a jury question). To establish a prima facie case, a plaintiff must introduce expert testimony demonstrating (1) the standard of care recognized by the medical community as applicable to the particular defendant's conduct; (2) that defendant in fact departed from the standard of care; and (3) that the defendant's departure from the standard was a direct cause of plaintiff's injuries. Plutshack, 316 N.W.2d at 5.
St. Joseph's Hospital contends that Quast failed to introduce expert testimony establishing the standard of care applicable to the hospital pharmacy, which dispensed the iron infusions, and the oncology nursing staff, which administered the infusions. Quast argues expert testimony was not required to establish the standard of care. Although a medical malpractice case is not ordinarily submitted to the jury without expert testimony on the standard of care and departure from that standard, expert testimony is not required when the matter is within a lay person's common knowledge and comprehension. Hestbeck v. Hennepin County, 297 Minn. 419, 424, 212 N.W.2d 361, 364 (1973) (holding that jury could infer negligence in res ipsa loquitur situation involving a surgeon who left a sponge in patient's body); Schulz v. Feigal, 273 Minn. 470, 475 142 N.W.2d 84, 88-89 (1966) (concluding that jury could infer, without expert testimony, that mistaken injection of adrenalin to a heart patient by a doctor's medical technician did not conform to usual degree of skill required of doctor). Contrary to Quast's contention, the present claim of negligence does not fall squarely within a lay jury's comprehension. A lay person is unaware of the standard of care a hospital's oncology nursing staff must exercise when administering intravenous iron infusions at the direction of a physician. Likewise, hospital pharmaceutical standards or the measures that conform to such standards are not within the common knowledge of the average juror. This case does not present an exception to the general rule that expert testimony is required to establish the applicable standard of care and departure from that standard in a medical malpractice suit.
In the alternative, Quast argues that the testimony of Dr. Lewis established the standard of care for hospital oncology nurses. Dr. Lewis admitted that he did not have expertise on what standards of care apply to nurses. His testimony regarding oncology nurses' conduct is a recitation of personal experience and expectation rather than expert testimony establishing a standard of care. Specifically, the testimony failed to address whether St. Joseph's Hospital oncology nursing staff's conduct conformed to the recognized standard of care applicable to hospital nursing staff in the particular circumstances. See Cornfeldt v. Tongen, 262 N.W.2d 684, 697 (Minn. 1977) (issue is whether defendant's actions conformed to accepted medical practice, not whether conduct was appropriate). Dr. Lewis merely stated, on the basis of his experience with clinic oncology nurses, that "it would have been appropriate [for St. Joseph's Hospital's oncology nurses] to question [Dr. Fraboni]."
Quast similarly failed to establish, through expert testimony, a standard of care applicable to hospital pharmacy and St. Joseph's departure from that standard. Quast argues that Minn. R. 6800.3110, a Minnesota Board of Pharmacy regulation, establishes the applicable standard of care. Minn. R. 6800.3110 provides for the maintenance of patient medication profiles. Without expert testimony, Quast cannot establish St. Joseph's breach of this particular regulation or standard of care. The only expert to testify about St. Joseph's compliance with Minnesota pharmacy regulations definitively stated that the pharmacy's record-keeping system was in full compliance. Robarge, who acknowledged he was not proficient in the use of the computer system, did not offer any testimony regarding the hospital's compliance with the Board of Pharmacy rule.
We conclude that Quast failed to establish a prima facie case of medical malpractice against St. Joseph's. Accordingly, the trial court erred in denying St. Joseph's motions for a directed verdict and JNOV. Our decision obviates review of the trial court's denial of the motion for a new trial; the standard for review of a denial of a motion for a new trial is not as rigorous as the JNOV standard. Lamb v. Jordan, 333 N.W.2d 852, 855-56 (Minn. 1983). Our decision does not relieve the final judgment against other parties in this action. See Loram Maintenance of Way, Inc. v. Consolidated Rail Corp., 354 N.W.2d 111, 113 (judgment final and binding on party who did not join appeal or file separate notice of appeal).
[*] Retired judge of the district court, serving as judge of the Minnesota Court of Appeals by appointment pursuant to Minn. Const. art. VI, § 10.