Caseflicks

District of Columbia Court of Appeals • 1979

Morrison v. MacNamara

407 A.2d 555 | 1979 D.C. App. LEXIS 476

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Takeaway

In short, this case rejects the locality rule for nationally qualified health-care providers in the District and confirms that a patient's uninformed agreement to treatment ordinarily is not assumption of the risk of negligent care.

Background

Morrison went to Hunter Memorial Laboratories, a nationally certified clinical laboratory in the District of Columbia, for a urethral-smear test ordered by his physician. Technician Tom MacNamara administered the first test while Morrison was standing. Morrison then said that he felt faint. MacNamara told him to sit and rest but did not examine him, check his condition, or obtain medical help.

Two or three minutes later, MacNamara asked whether it was all right to perform a second test. Morrison said yes, and MacNamara again performed the test while Morrison stood. Morrison fainted during the procedure, struck his head on a metal stand and tile floor, and sustained serious injuries, including permanent loss of smell and partial loss of taste.

Morrison sued the laboratory and technician for professional malpractice. His expert testified that national medical standards required the test to be performed with the patient sitting or prone and required objective medical evaluation before repeating the test after a patient reported faintness. The defense experts testified that standing was accepted in the Washington metropolitan area. The trial court instructed the jury to judge defendants by the care used by laboratories and employees in the same community, and it also submitted assumption of risk based on Morrison's consent to the second test. The jury found for defendants. Morrison appealed, and defendants cross-appealed the denial of their directed-verdict motions.

Issues

Issue #1

Whether a nationally certified medical laboratory and its personnel should be measured by a national standard of professional care rather than a local-community standard.

Holding

Yes. Board-certified physicians, hospitals, medical laboratories, and comparable health-care providers in the District of Columbia are governed by a national standard of care, not an exclusively local standard.

Reasoning

Professional malpractice is a form of negligence. The relevant duty is reasonable care under the circumstances, informed by the special knowledge, training, and skill that a professional possesses. Health-care providers therefore must exercise the degree of care and skill reasonably expected of professionals with similar qualifications acting in similar circumstances.

The traditional locality rule developed to protect rural doctors at a time when medical education was uneven, professional communication was limited, and rural practitioners lacked the experience and resources available in urban centers. Those premises do not fit modern medical practice, and they have no meaningful application to the District of Columbia, a major metropolitan medical center with advanced facilities, medical schools, and access to national medical information.

National accreditation and board-certification systems have substantially standardized medical training and proficiency. Modern transportation, professional journals, continuing education, and other channels of communication likewise make medical knowledge broadly available. Patients reasonably rely on a provider's training, certification, and competence, not on an expectation that the provider will meet only a potentially lower local practice.

A local standard can also perpetuate substandard care by allowing a professional to defend negligent conduct merely because others in the same area do it too. The court rejected that result: conduct does not become nonnegligent simply because it is customary in a locality. Medical laboratories perform services closely connected to those of physicians and hospitals and have comparable opportunities to stay current with professional advances, so the same national standard applies to them.

The laboratory conceded that it was nationally certified and held itself out as such. Morrison's expert gave evidence of a national standard requiring a sitting or prone position and medical evaluation after faintness, while defense experts offered a different account based on local practice. That conflict was for the jury to resolve. By instructing the jury to compare defendants only with Washington-area practice, the trial court effectively excluded Morrison's national-standard evidence and committed reversible error. A new trial was required.

Issue #2

Whether the evidence supported submitting assumption of risk to the jury because Morrison agreed to undergo a second urethral-smear test after reporting that he felt faint.

Holding

No. Morrison's agreement to the second test did not establish that he knowingly and voluntarily assumed the risk of negligent medical treatment.

Reasoning

Assumption of risk requires proof that the plaintiff actually knew and fully appreciated the particular danger and then voluntarily chose to encounter it. It differs from contributory negligence because it turns on what the plaintiff in fact knew, rather than what a reasonable person should have known.

The defense rarely succeeds in professional-malpractice cases because of the information gap between health-care professionals and their patients. A patient ordinarily cannot know whether the provider's conduct is medically negligent and is entitled to rely on the provider's superior training and judgment. Thus, a patient generally cannot be said to assume a risk of negligent treatment without evidence of specific knowledge and comprehension of that risk.

The record contained no evidence that Morrison knew of the danger associated with repeating the invasive test while standing after he had felt faint. Even if he understood that the first test was connected to his faintness, the evidence did not show that he knew the faintness created a danger of falling or that repeating the test without medical evaluation was improper.

Morrison's brief assurance that it was all right to continue could reasonably reflect reliance on the technician's expertise, not an informed and voluntary decision to accept a known medical danger. Because no reasonable jury could find the essential elements of actual knowledge, full appreciation, and voluntary exposure, the trial court erred by giving an assumption-of-risk instruction.