When a patient alleges negligence, the outcome often hinges on the strength and precision of expert witness testimony. A recent Texas case highlights how critical it is for these expert reports, especially from nurses, to meet strict legal standards.
In the past, I’ve written about the requirements and importance of nurse expert witness opinions in professional negligence cases involving nurses.
This topic stresses the precision a court uses in determining if an expert witness statement presented to the court in a particular case is acceptable based on the court rules governing expert witness statements.
Expert witness statements are required when there is an allegation that a healthcare professional, including nurses, caused an injury. Their importance cannot be overstated. For the injured plaintiff (the patient), an acceptable expert witness’s opinion is essential to possibly winning their case.
For the defense, an opinion that isn’t consistent with the established court rules for such an opinion can mean a possible dismissal of the case or winning at trial. In the following Texas case, this precision is demonstrated again.
Happenings prior to the case being filed
It started when the female patient was admitted to the hospital through the emergency department (ED). She arrived complaining of a headache, chest pain, neck pain, and numbness in her left arm.
The patient was considered “morbidly obese.” Her blood pressure in the ED was 200/166. She was admitted to the hospital and was immediately placed on medication.
The patient was also classified as a fall risk and given a yellow bracelet that the hospital used to indicate that status.
The day after her admission, the patient complained of dizziness, and her blood pressure was quite low. She wanted to use the bathroom, but her nurse told her she couldn’t walk to the bathroom because she could fall. The nurse offered her a bedpan, but she refused.
Two days later, while walking to the bathroom, the patient fell, resulting in “fractures in her left tibia and left distal fibula,” which required surgery to repair. The fall and surgery resulted in the patient’s need to use a walker.
Patient files lawsuit
The patient filed a case alleging that the nurse caring for her on the day of her fall failed to “implement interventions to prevent falls,” and after the fall, the nurse didn’t assess her injury before moving her from the floor.
Because the nurse was an employee of the hospital, the patient also named the hospital as a defendant under the doctrine of respondeat superior.
Trial court proceedings
The injured plaintiff (patient) filed an expert witness opinion from a nurse, and the hospital objected to the report because of the following:
- The nurse's failure to establish her qualifications as an expert witness.
- She didn’t affirm the standard of care and its breach in her report.
- She wasn’t a physician and therefore couldn’t establish the cause of the patient’s injuries based on the breach of the standard of care.
The hospital’s objections to the nurse's qualifications were overruled by the court, but the court allowed the objections to the other two points and granted the plaintiff time to amend the report.
The injured patient filed a new expert witness report from a physician and a second, supplemental report by the nurse expert. The defendants objected to these reports, but the court allowed them.
The hospital appealed that decision to the appellate court.
Appellate court analysis and decision
After citing applicable state law, the court held:
- The nurse’s report identified “specific fall preventions” that weren’t taken (e.g., using a bedside commode, having two staff members help the patient to the bathroom), thus establishing the standard of care.
- The physician’s clinical experience and report supported her ability to provide an opinion on the causation of the patient’s fall.
- The patient was identified as a fall risk with a yellow bracelet to alert staff about this risk.
- The doctor’s report indicated how a fall would cause broken bones in this patient, including the fall descent, the fall impact, and bone strength.
Based on these and other factors, the appellate court found no abuse of discretion in the trial court’s denial of the hospital’s motion to dismiss the case and affirmed the trial court’s order.
It also ordered that the injured patient be reimbursed for the costs of the appeal from the hospital.
How does this decision apply to professional negligence cases?
The appellate court minced no words in holding that when a nurse expert and any additional expert reports (in this case, a physician’s report to prove causation) are presented to a court, vagueness can lead the court to grant a motion to dismiss the case.
In contrast, the more specific the nurse expert witnesses’ report, the better it supports a court’s decision to deny such a motion.
Similarly, the court pointed out that although a nurse expert may be qualified through experience and education to render an expert opinion, those qualifications alone cannot support a report or testimony that is vague or lacking the legal requirements to support a breach of the standard of care and causation.
The case also illustrates the harmony between the nurse expert’s report on the breach of the standard of care and the physician’s report as to causation. Each ratified the other.
The case also illuminates the importance of a nurse expert witness establishing what the standard of care in nursing is.
The American Association of Nurse Attorneys (TAANA) has published two position statements on the need to use nurses as experts in professional negligence cases involving nurses.
Final thoughts
This case focuses on expert witness testimony. Although you may never be in the role of a nurse expert witness, you may be involved in a case as an occurrence witness; that is, testifying to what you heard or saw when a patient was injured by the care of another nursing staff member.
Such testimony is important as it supports “in real time” what happened and what a nurse expert testifies to concerning the legal rules to support a breach of the standard of care.
