DARLENE FLOWERS, Plаintiff and Appellant, v. TORRANCE MEMORIAL HOSPITAL MEDICAL CENTER et al., Defendants and Respondents.
No. S033331
Supreme Court of California
Dec. 5, 1994
8 Cal. 4th 992
Gittler & Wexler, Gittler, Wexler & Bradford, Harlan L. Bransky, Robert M. Moss and Ronald P. Kaplan for Plaintiff and Appellant.
Robert R. Huskinson, Horvitz & Levy, David M. Axelrad, S. Thomas Todd and David S. Ettinger for Defendants and Respondents.
Catherine I. Hanson and Gregory M. Abrams as Amici Curiae on behalf of Defendants and Respondents.
ARABIAN, J.—In this case, we consider the distinction between “ordinary” and “professional” negligence and conclude that with respect to questions of substantive law they comprise essentially one form of action. Apart from statutory considerations, characterizing misfeasance as one type of negligence or the other generally only serves to define the standard of care applicable to the defendant‘s conduct. Accordingly, we reverse the decision of the Court of Appeal holding that the same alleged breach of duty can give rise to distinct causes of action for “ordinary” as well as “professional” negligence.
FACTUAL AND PROCEDURAL HISTORY
This case began Christmаs Eve 1986 when plaintiff Darlene Flowers (plaintiff) was admitted to the emergency room of defendant Torrance Memorial Hospital Medical Center (the hospital) complaining of bladder pain. She was assisted onto a gurney by defendant Nurse Mary Elizabeth Osborne (Osborne) to await further medical attention, at which time Osborne raised only the far side railing. While awaiting treatment, plaintiff apparently fell asleep. When she awoke, she attempted to roll over but instead fell off the gurney and sustained injury to her back and arm.
Plaintiff subsequently filed suit against the hospital and Osborne (collectively, defendants) alleging causes of action for “general negligence” and
The trial court granted summary judgment in favor of defendants after finding that the declaration of plaintiff‘s expert witness was defective in several respects. Hence, defendants’ evidenсe as to the applicable standard as well as their exercise of due care stood unrebutted, and no triable issue of material fact remained as to their negligence. The court denied plaintiff‘s motion for reconsideration.
In a divided opinion, the Court of Appeal reversed. Although the majority agreed that defendants had negated any “professional negligence,” they found the pleadings “broad enough to encompass a theory of liability for ordinary as well as professional negligence” because the manner of her injury did not involve a breach of duty to provide professional skill or care.1 (See Gopaul v. Herrick Memorial Hosp. (1974) 38 Cal.App.3d 1002, 1007 [113 Cal.Rptr. 811]; see also Neel v. Magana, Olney, Levy, Cathcart & Gelfand (1971) 6 Cal.3d 176, 188 [98 Cal.Rptr. 837, 491 P.2d 421]; but see Murillo v. Good Samaritan Hospital (1979) 99 Cal.App.3d 50, 56-57 [160 Cal.Rptr. 33].) Relying in part on Gopaul v. Herrick Memorial Hosp., supra, 38 Cal.App.3d 1002, the court concluded that summary judgment was not proper in light of defendants’ failure to address this alternative theory of liability. The dissenting justice disagreed that the pleadings or the facts raised any claim other than one for professional negligence.
DISCUSSION
The Court of Appeal majority erroneously premised their result on a perceived conceptual distinction between “ordinary” and “professional”
“[N]egligence is conduct which falls below the standard established by law for the protection of others against unreasonable risk of harm.” (Rest.2d Torts, § 282.) Thus, as a general proposition one “is required to exercise the care that a person of ordinary prudence would exercise under the circumstances.”2 (Polk v. City of Los Angeles (1945) 26 Cal.2d 519, 525 [159 P.2d 931]; Rowland v. Christian (1968) 69 Cal.2d 108 [70 Cal.Rptr. 97, 443 P.2d 561, 32 A.L.R.3d 496]; see
With respect to professionals, their specialized education and training do not serve to impose an increased duty of care but rather are considered additional “circumstances” relevant to an overall assessment of what
Since the standard of care remains constant in terms of “ordinary prudence,” it is clear that denominating a cause of action as one for “professional negligence” does not transmute its underlying character. For substantive purposes, it merely serves to establish the basis by which “ordinary prudence” will be calculated and the defendant‘s conduct evaluated. Nor does it distinguish a claim separate and independent from some other form of negligence. As to any given defendant, only one standard of care obtains under a particular set of facts, even if the plaintiff attempts to articulate multiple or alternate theories of liability. (Cf. Central Pathology Service Medical Clinic, Inc. v. Superior Court, supra, 3 Cal.4th at p. 192; Rowland v. Christian, supra, 69 Cal.2d at pp. 119-120.)
Any distinction between “ordinary” and “professional” negligence has relevance primarily when the Legislature has statutorily modified, restricted, or otherwise conditioned some aspect of an action for malpractice not directly related to the elements of negligence itself. For example, the statute
Two decisions by Courts of Appeal have addressed the question of whether a patient‘s fall from a hospital bed or gurney constituted “ordinary” or “professional” negligеnce. In Gopaul v. Herrick Memorial Hosp., supra, the court determined that “‘professional malpractice’ was not involved” because “[t]he situation required no professional ‘skill, prudence and diligence‘” and “[t]he need to strap plaintiff to the gurney while she was ill and unattended would have been obvious to all.” (38 Cal.App.3d at p. 1007.) In Murillo v. Good Samaritan Hospital, supra, the court reached a contrary conclusion, finding that the decision whether or not to raise the bedrails on the plaintiff‘s bed came within the defendant hospital‘s “duty ‘to use reasonable care and diligence in safeguarding a patient committed to its charge [citations] and such care and diligence are measured by the capacity of the patient to care for himself.’ [Citation.]” (99 Cal.App.3d at p. 55.)
In resolving this case, the Court of Appeal formulated the same dichotomy. However, the analysis in neither Murillo nor Gopaul is relevant here because both concerned the question of whether the defendant could raise a statute of limitations defense. Since the limitations period differed depending upon the characterization of the alleged negligence, the statutory distinction controlled the ultimate procedural viability of the plaintiff‘s cause of action. Nonetheless, having been imposed by the Legislature for reasons of policy, it could in no way alter the nature of the claim itself.
On a motion for summary judgment involving substantive law, the court does not confront a procedural differentiation but a more fundamental
The Court of Appeal thus erred in finding plaintiff‘s pleadings “broad enough” to state a cause of action for ordinary negligence as well as professional negligence. This analysis necessarily implies that the same factual predicate can give rise to two independent obligatiоns to exercise due care according to two different standards. But this is a legal impossibility: a defendant has only one duty, measured by one standard of care, under any given circumstances.
An additional analytical flaw, derived from the rationale of Gopaul v. Herrick Memorial Hosp., supra, underlies the decision below. In drawing the distinction between ordinary and professional negligence, the court in Gopaul observed that “[t]he need to strap plaintiff to the gurney while she was ill and unattended would have been obvious to all.” (38 Cal.App.3d at p. 1007.) In other words, it found that the circumstances did not require expert testimony to establish the appropriate standard of care. (Ibid.) This reasoning confuses the manner of proof by which negligence can or must be established and the character of the negligence itself, which does not depend upon any related evidentiary requirements.
In this case, the trial court granted summary judgment in favor of defendants based on their expert‘s testimony that prevailing standards did not require emergency room personnel to raise gurney side rails for patients like plaintiff whose condition did not appear tо warrant this precaution. The Court of Appeal affirmed the ruling with respect to “professional” negligence but found the evidence insufficient to negate “ordinary” negligence. As we have explained, bifurcation of plaintiff‘s pleadings in this manner was erroneous. However, we are unable to determine whether this error may have affected the court‘s determination of the requisite standard of care and its analysis of the materiality of disputed facts.5 Accordingly, we remand the
DISPOSITION
The judgment of the Court of Appeal is reversed and the case is remanded for additional proceedings consistent with this opinion.
Lucas, C. J., Kennard, J., Baxter, J., George, J., and Werdegar, J., concurred.
MOSK, J., Concurring and Dissenting.—I agree with the majority that there is no distinct cause of action for professional as opposed to ordinary negligence. I also agree with the majority inasmuch as the holding today does not alter the “common knowledge” exception to the usual rule that a plaintiff‘s medical malpractice action must be supported by some expert evidence as to the proper community standard of care. (See Meier v. Ross General Hospital (1968) 69 Cal.2d 420, 429-431 [71 Cal.Rptr. 903, 445 P.2d 519].) Nor do I take issue with the majority‘s deferral of the issue of whether or not the common knowledge exception applies in this case. (Maj. opn., ante, at p. 1001, fn. 5.)
I disagree, however, with the disposition of this case, because I believe the Court of Appeаl was right in reversing the trial court‘s grant of summary judgment, albeit not for all the right reasons. Summary judgment should only be granted “if all the papers submitted show that there is no triable issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” (
Plaintiff was in defendant‘s care, allegedly with bladder pain, when she fell from a gurney and injured herself. The question is whether defendant hospital‘s failure to рut up both side rails on plaintiff‘s gurney falls below the proper standard of care. It is evident that this question is not one of great technical complexity. As with other standard of care issues, a trier of fact must ultimately weigh the evidence to determine the proper standard, and whether the hospital departed from it.
One piece of evidence highly relevant to the foregoing determination is the hospital‘s own policy statements on the appropriate medical prоcedures to be followed. Although such policy statements are not necessarily the definitive word on the community standard of care, they can be more reliable reflections of that standard than, for example, the declarations of expert witnesses: the former are forward-looking prescriptions of proper medical practice designed for the guidance of employees and staff, while the latter can be viewed as post hoc justifications of past behavior designed for use in litigation. Thus, even if this case does not fall within the “common knowledge” exception to the expert evidence rule, a hospital policy statement that contradicts the declarations of the hospital‘s own expert witnesses as to the proper standard of care may raise a triable issue of fact that cannot be resolved on summary judgment.
The record in this case reveals that, in opposition to the motion for summary judgment, plaintiff produced a document authored by defendant hospital entitled “Orientation to the Emergency Department” for its new emergency employees. The document stated as follows: “Both side rails are to be up on a patient lying on a gurney; both side rails are up on a child lying on a gurney.” Defendant countered that the policy reflected in the above quoted passage applies only to children, but the plain language of the document belies that contention. Moreover, defendant contends that this “Orientation Packet” did not establish hospital policy; rather, a document called an “Emergency Policy and Procedures Manual” (Manual) was the hospital‘s official word on when side rails should be put upright. That Manual sets forth the various conditions under which side rails are to be raised, and plaintiff in her situation arguably did not meet those conditions. But the precedence of the Manual over the Orientation Packet in this case is
Defendant also produced two declarations to the effect that the community standard of care at the time did not necessarily include putting up both side rails on gurneys. One declaration was given by a nurse who was an employee of the hospital, the other by a doсtor whose relationship to the hospital was unclear. Both statements are somewhat conclusory. In light of the hospital‘s own Orientation Packet, a reasonable trier of fact could legitimately view these declarations with skepticism.
Thus, in this case, there was at the very least a factual ambiguity as to the official hospital policy regarding side rails on gurneys. In fact, plaintiff‘s case was arguably stronger than that of defendant, for the document relied on by plaintiff was the only one to explicitly mention gurneys rather than beds, and therefore was the document that came the closest to governing plaintiff‘s situation. Although the trial court is required to strictly construe the moving party‘s documents, and liberally construe those of the opponent, here it did precisely the reverse.
Because there was a question of material fact regarding care pursuant to hospital safety policy, and therefore regarding the proper standard of care in plаintiff‘s situation, I would forego the needless exercise of remanding the case and uphold the Court of Appeal‘s reversal of the summary judgment.