Medical Care or General Negligence?

Recent cases in California and Tennessee illustrate the difficulties these scenarios involve, and offer some guidance, although each, of course, relies on its own state's unique legislative and common law.

California's Flores v. Presbyterian Intercommunity Hospital

Flores v. Presbyterian Intercommunity Hospital, 2016 Cal. LEXIS 2561 (Cal. 5/5/16), is a case involving the malfunction of a hospital bed. The patient's doctor, after assessing her condition, ordered that her bed rail be lifted, to prevent her from falling. When the patient leaned on that rail, it collapsed, causing her to fall to the floor and sustain injuries.

The plaintiff brought suit against the hospital on the theory that it negligently failed to inspect and maintain the hospital bed in a safe condition. The statute of limitations for bringing a general personal injury claim in California is two years (Code Civ. Proc., ' 335.1 (section 335.1)), while a special statute of limitations applies to actions “for injury or death against a health care provider based upon such person's alleged professional negligence” (Code Civ. Proc., ' 340.5 (section 340.5)). In the latter cases, the limitations period is one year after an injury is discovered, not to exceed three years. Here the plaintiff had filed suit more than one year, but less than two years, following the incident complained of.

The trial court dismissed the case after finding that the injury involved a lapse in the provision of medical care, so that the plaintiff should have filed her claim within one year after discovery of the harm ' which “discovery,” all parties agreed, took place when she fell to the floor. California's Court of Appeal reversed after determining the claim “sounds in ordinary negligence because the negligence did not occur in the rendering of professional services.” Instead, the appeals court said the harm to the plaintiff resulted from the hospital's failure to properly maintain its furniture, so the statute of limitations for ordinary negligence applied. The intermediate appeals court, therefore, reinstated the case.

The hospital petitioned for review, which the California Supreme Court granted.

In the CA Supreme Court

The State Supreme Court noted that California's legislature amended section 340.5 to its present version of the medical negligence statute of limitations as part of the Medical Injury Compensation Reform Act (MICRA) (Stats. 1975, 2d Ex. Sess. 1975'1976, chs. 1, 2, pp. 3949'4007), an act intended to reduce the costs of medical malpractice insurance. MICRA contains a definition of the “professional negligence” that falls under the purview of the Act: “[1] a negligent act or omission to act by a health care provider in the rendering of professional services, [2] which act or omission is the proximate cause of a personal injury or wrongful death, [3] provided that such services are within the scope of services for which the provider is licensed and [4] which are not within any restriction imposed by the licensing agency or licensed hospital.” ' 340.5, subd. (2). All parties in Flores agreed that only the first element of this four-part definition ' considering whether the negligent act or omission that caused the injuries was one perpetrated by a health care provider in the rendering of professional services ' was at issue.

The plaintiff asked the court to interpret the phrase “professional services” to mean “services involving a job requiring a particularized degree of medical skill.” In her view, because the maintenance of hospital equipment and premises required no “specialized education, training or skill” it could not qualify as negligence “in the rendering of professional services (' 340.5).” The Supreme Court was not convinced by this argument, however, noting that not all types of professional negligence involve advanced medical skills, and offered as an example failure to follow a doctor's order to provide a specialized diet to a patient. In such a case ' say, where the food service staff gave a patient a chicken and rice dinner when he had been prescribed a liquid diet ' the hospital would have inflicted injury to the patient in the rendering of professional services, despite the fact that the provision of those services would not have required any advanced medical training or knowledge.

For its part, the hospital cited to Murillo v. Good Samaritan Hospital (1979) 99 Cal. App. 3D 50, which held that, when analyzing a negligent act to determine if it involved the rendering of professional services under section 340.5, “the test is not whether the situation calls for a high or a low level of skill, or whether a high or low level of skill was actually employed, but rather the test is whether the negligent act occurred in the rendering of services for which the health care provider is licensed.”

In the end, the court rejected both the plaintiff's and defendants' interpretations and formulated its own. Stated the court, “The text and purposes underlying section 340.5 instead require us to draw a distinction between the professional obligations of hospitals in the rendering of medical care to their patients and the obligations hospitals have, simply by virtue of operating facilities open to the public, to maintain their premises in a manner that preserves the well-being and safety of all users.” The court concluded that the question whether equipment failure leading to injury amounted to negligence in the provision of medical care must be answered by looking at the way the subject equipment related to the provision of the medical care.

“A hospital's negligent failure to maintain equipment that is necessary or otherwise integrally related to the medical treatment and diagnosis of the patient implicates a duty that the hospital owes to a patient by virtue of being a health care provider,” stated the court. “Thus, if the act or omission that led to the plaintiff's injuries was negligence in the maintenance of equipment that, under the prevailing standard of care, was reasonably required to treat or accommodate a physical or mental condition of the patient, the plaintiff's claim is one of professional negligence under section 340.5. But section 340.5 does not extend to negligence in the maintenance of equipment and premises [such as toilets, office chairs or televisions] that are merely convenient for, or incidental to, the provision of medical care to a patient.” These latter claims would fall under the umbrella of general negligence: the obligation that all Californians owe one another to act with care, explained the court. So, for example, a an injury that occurs when a hospital waiting room chair collapses would be treated the same as an injury that occurs when a homeowner's living room chair collapses and causes injury to a guest: Both would be subject to the two-year general negligence statute of limitations.

This case was different, the court said. Here, a patient's bed was involved. The patient's doctor had ordered her bed rails raised following a medical assessment of her condition. And plaintiff Flores was injured when, while she was holding the rail and attempting to exit the bed, the rail collapsed and caused her to fall to the floor. “Flores thus alleges, in essence, that [the hospital] failed to properly implement the doctor's order, which was based on a medical assessment of her condition, that the rails on her bed be raised.” Taking all of this into account, the court concluded: “Flores's injuries therefore resulted from [the hospital's] alleged negligence in the use or maintenance of equipment integrally related to her medical diagnosis and treatment. When a doctor or other health care professional makes a judgment to order that a hospital bed's rails be raised in order to accommodate a patient's physical condition and the patient is injured as a result of the negligent use or maintenance of the rails, the negligence occurs 'in the rendering of professional services' and therefore is professional negligence for purposes of section 340.5, subdivision (2).”

Thus, California's Supreme Court ultimately found that, because the patient's doctor ordered the raising of the patient's bed rails for medical reasons, the injuries complained of were the consequence of faulty medical care and the trial court was correct in determining that the one-year statute of limitations for medical professional negligence found in section 340.5 was the appropriate one to apply. So, having failed to file the claim within one year of the accident, the plaintiff lost her chance to seek recovery against the hospital.

Next month, we'll discuss a med-mal versus general negligence question recently decided in the Tennessee Court of Appeal.

Janice G. Inman, Esq., is Editor-in-Chief of this newsletter.