*1 KASTLER, Appellant, Betty Colleen HOSPITAL, Appellee. METHODIST
IOWA
No. 53668.
Supreme of Iowa. Court
Dec.
Mrs. Kastler entered on the afternoon of psy- October The chiatrist directed standing that his orders followed, should be but he did not examine her until after the incident. His orders contained no reference to baths. The hospital regulations hospital per- for sonnel contained directions for showers of p. at 9:00 daily. m. Reynoldson, Werden, Brown & Van Os- ceola, appellant. for Upon admission, Mrs. Kastler’s her hus- reported band the nurse on Patterson, Lorentzen, Duffield, Timmons Mrs. Kastler suffered from nerve trouble Irish, Moines, appellee. & Des and fainting spells. The evidence reveals that Mrs. Kastler UHLENHOPP, cooperative is a and well-meaning individu- Justice. al and in ward she was question principal The to be decided here obedient and tried to follow rules. hospital patient generated is whether a jury question on the in issue spent Mrs. Kastler 24th in October against personal this action morning ward. of Octobеr 25th On injuries. well, dizzy, she did not feel at all and general felt “in sick all over.” She tried Betty Kastler, at the Plaintiff Colleen personal laundry to do but not her could question, in time the events married it; complete another did for her. lives on a farm to Howard Kastler and testified, As to her condition she “I had Wert, Viewing evi- near Iowa. Van tried tell the nurse that was in the light dence in the most favorable to Mrs. station, but all tried to talk to her I nurse’s Kastler, could find that from done, way atten- only get I could her spells of head- childhood she suffered I peck tion was the window and what heartbeat, aches, rapid breathing, difficult ignored, get to say would so I didn’t by fainting. dizziness, followed The talk to her.” spells grew after an worse she became spell, she either At the onset of attempted adult. to eat Kastler That noon Mrs. to, to, cot, and got carried a bed or or was but unable to do so. lunch was side the other. her head rolled from one change shifts nurses and aides she was regained After she consciousness reported m., outgoing shift and the 3:00 depressed wept. fami- Someone incoming Kastler one Mrs. to the ly stayed during spells. near her her well. feeling not received treatment Kastler Mrs. 25th, in the afternoon of October Later Des Moines form medication from both she but play bingo, Kastler tried Mrs. but she obtained physicians, Leon aide on asked the ill to do so. too She difficulty was of 1964 her relief. In October lie down because duty if she could family аnd her that she became so severe do so. allowed “so sick.” She hospitalized. Her be decided she should how in and asked the aide came Later psychia- a Des Moines physician contacted testified, ex- “I Mrs. Kastler she was. trist, psychiat- to the who had her admitted got dizzy that I had—I plained to her Methodist defendant Iowa ric ward of . .” rapidly. . my heart beat sick and history was taken Hospital. A excite- might be the cause suggested aide on her psychiatrist or entered admitting responded ment, Kastler but Mrs. question. the incident until after chart covered her with a bath In a spells, mat. “I these had negative and that regained time Kastler con- short Mrs. spells.” I had these sciousness, in due she received course evening meal Mrs. for the About time injuries. treatment for her take unable to up. got She psychiatrist later examined Mrs. inquiry Mrs. food, the aide made and when *3 opinion of that she Kastler. He was the just so sick she was responded Kastler in a epilepsy that she had seizure has and testified, “I was eat. could not She she the shower. felt just time. I feeling at that terrible before, dizzy light-headed, and I like had left later Mrs. Kastler defend- Sometime just surely I that my and to stomach sick Leon, hospital hospital entered a at ant rest.” get laid down wanted to voluntary pa- she a Still later was Iowa. Mental Health Institute tient at the Iowa patients’ showers came The time for at Clarinda. for female The area m. 9:00 containing rectangular room a consists of an action commenced Mrs. Kastler adjoining an toilets, with lavatories and her Hospital for Methodist against Iowa containing the rectangular shower room fall. case was tried injuries the The entry space an shower stall itself and of the evi- jury. At the conclusion ato indi- patients are the The female shower. dence, hospital the directed moved vidually by the room called the shower verdict, proof of mainly the grounds on case, aide duty the aide on same this—in The negligence proximate cause. of or of had been convers- with Mrs. Kastler whom Court, stated, however, is “The court trial the ing just outside earlier. The aide sits testimony view the that’s constrained to gave The Mrs. Kastler shower room. aide light in introduced in this the been case early At the an shower. number for her plaintiff in the determin- most favorable to the trial aide was asked: question has ing jury or not a whether testimony in generatеd. Viewing the been Q. any particular there Was reason light in the of the decisions light, this why she would that have been number? in re- Supreme two the Court of Iowa before, of you A. Because as I told have cases, namely, cent the Bradshaw reported feeling she was not well. cases, Court is constrained the Shover The aide sent the Mrs. Kastler into di- motion for overrule the defendant’s shower jury room alone. The could find rected verdict.” Kastler Mrs. ten feet from about the аide when she clothing off her Mrs. took a verdict for returned According Kastler, shower. to Mrs. hospital moved Kastler. stepped court,
next into the shower and started trial notwithstanding verdict. The washing point her face. At good, she lost concluding sus- that the motion fell, consciousness and striking of appealed the side Kastler the case tained it. Mrs. her face on shower wall. then fell She to us. face down floor. aide contends sub- Two whether issues before us:
she tried
clutсh
Kastler,
Mrs.
but of
(1)
evidence was introduced as to
stantial
course the truth
testimony
of the aide’s
(2)
fall,
was for the
As a result of the
proximate cause.
lacerated,
lip
severely
Mrs. Kastler’s
jaw
broken,
her
and two of her teeth
The first issue
Negligence.
I.
contains
were knocked
upper
out—all of her
teeth
duty
parts:
three
whether
(a)
had to
in
be removed later
consequence of
care
to exercise “reasonable
injury from the fall.
light
in
patient’s
knоwn condi-
Mrs.
mouth,
Kastler bled
by hospitals
from the
and tion” or “the care exercised
aide placed
in
generally,”
washcloth
mouth
(b)
whether evidence of
(6th
hospitals generally was neces-
practice
Cir.).
case the court was not
case,
required
whether Mrs.
sary
problem.
in
to resolve the
(c)
this
proof that de-
adduced substantial
courts, however,
Several
by
confronted
fendant
breached its
toward
problem,
have held that the two rules
her.
are not
they
identical but
apply
to two
different
situations.
If
the conduct
care of
hos
(a) As
the standard of
question
professional
nature,
patient,
rules are fre
then
pital
two
toward
applicable standard is the care exercised
quently
A host of decisions
enunciated.
hospitals generally
by hospitals in
(or
use the care
hold that a
must
community). But if
generally
the conduct
hospitals
which
involves
is exercised
nonmedical,
ministerial,
administrative,
(or by hospitals
сommunity).
routine
then
applicable
involving profes
recently so held
a case
rule is
*4
such reasonable
by
patient’s
care
as
the
hospital.
Dickinson
sional services
v.
known
may
588,
require.
condition
Mailliard,
Perhaps
(Iowa)
N.W.2d
596-597
the
175
clearly
earliest case
(“The
drawing
care
the
correct standard of
to which
distinction
is Hayhurst
Boyd
661,
v.
hospitals
Hosp., 43
be held
that which
Idaho
should
is
ob
254 P.
also,
528. Other
hospitals
making
tains in
decisions
generally”);
see
the
distinction
Hosp.
are Gold
Hosp. Marshall,
v. Sinai
of De
Garfield Memorial
v.
92
troit, Mich.App. 368,
234,
5
723;
146
U.S.App.D.C.
(D.C.
N.W.2d
physical condition, known, may if re two classes of services is a ; quire”) Hospitals 41 8(3) at 349 § C.J.S. comports valid with negligence one which (“such patient reasonable care toward a law, generally. law Under that the stand require” his may known condition ard ordinarily of conduct which applies is skill, degree care, “that of diligence the care “of reasonablе man under like used hospitals generally in that commu Restatement, circumstances.” 2d Torts nity”). § practice profession
283. But in the
aof
or
trade,
By
possibly
an
the standard is
sophistry,
exercise
“the skill and knowl
edge normally
possessed
two rules can be made to mean the same
members of
thing,
profession
good
or
stand
pointed
but one court has
out that
trade
they
actually
ing
Id.,
rules.
different
White
similar communities.”
299A.
§
professional
Baptist
respect
With
Hosp.,
v.
Memorial
hоspitals, we adhere to 40 A.L.R.3d 542-45, “which obtains in hos standard is the care 547-52. pitals generally under similar circum sufficiency As (c) Mailliard, N. stances.” Dickinson v. which negli evidence was introduced on (Iowa). accordance with W.2d recited, gence, given previously the facts cited, however,
the authorities we have
we believe
made a case for
Mrs. Kastler
administrative,
nonmedical,
respect
with
cited,
jury.
Under the decisions
one of
ministerial,
adopt
routine
we
important
patient’s
circumstances
is such
rule that
the standard
reasonable
known
the patient
Here
suf
condition.
patients
known
care for
as their
mental
fainting
spells,
fered
and the
may require.
physical
condition
We
very day
informed.
of the inci
so
On
attempt
will
at this time
to formulate
ill;
dent the
precise distinction
the two kinds
between
too,
through
its
informed
em
think
activities.
the cited authori
ployees.
say all
We cannot
reasonable
activity
ties make
cleаr
issue;
agree
minds would
on the
present
case—showers
—was
hence it
In addition to
was for
routine care. We believe too that such
cited,
previously
cases
see Crawford
showers did not
their character as
lose
Hardeman,
Long
Hosp.
W.
Memorial
they
employed
routine care
because
were
63; Elliott v.
Ga.App.
66 S.E.2d
psychiatric patients
feel
make
better.
*5
531,
Tempkin,
App.Div.2d
32
299 N.Y.S.2d
particular activity
The character of a
of a
also, Annot.,
no and indeed fainting more about the personnel knew (b) adoption of the reasonable Our up the time the spells psychiatrist, than present rule the means that care case hospitаl days the of the fall. For two over required Mrs. Kastler was not to adduce day in its All of had care. proof practice generally hospitals of the patient was ill injury of the respecting expert showers or to introduce personnel her trouble. told about testimony. jury could use its own knowledge good respect sense with not insulate hospital’s question. as Doctors’ orders do hos conduct in This subsequent if circum
pect pitals liability in case was discussed from Cramer action, in change Hosp., v. Theda 45 stances show need Clark Memorial Wis.2d 150, 427, That 147, care. (“the jury 172 N.W.2d 428 the exercise of reasonable Alta in Mundt v. competent experience problem its de own involved 413, Cal.App.2d 35 Cal. apply Hosp., termine and Bates 223 such reasonable-care pa also, Rptr. physician left the standard”). Hosp. See Gold v. Sinai 848. There leg Detroit, into her in Mich.App. 368, flowing 5 146 tient with fluid N.W.2d 275, 723; Robinson, travenously, orders to continue the Stallman v. 364 Mo. with 743; changеs in During subsequent 260 process. S.W.2d Bennett v. Punton Sani Ass’n, 363, Mo.App. nurses, tarium 213 observed 249 S.W. shifts of the nurses
1Q3 swelling notify the in leg did not manner which has re- but his any physician in patient’s physician or other sulted the harm. nor- leg to twice its
until
was swollen
Viewing Mrs. Kastler’s evidence in
court
size, resulting
injury.
mal
its most
light,
favorable
think the
we
simply rest
could not
held
could find that the
action of the
directions, saying:
physician’s
having her take a shower without an aide
clearly
sufficient
This evidence
attendance,
in immediate
in her knоwn ill
hospital nurses
finding
that the
support
fainting spells,
condition and proclivity to
observe the
in their
derelict
were
bringing
substantial factor in
about
leg and
respondent’s
condition
least,
say
the fall. At
we cannot
that all
symp
report all unfavorable
promptly
reasonable minds
agree that the fall
would
223 Cal.
charge.
to the doctor in
toms
proximate consequence
was not a
of the
423, Cal.Rptr.
35
at 854.
App.2d at
too,
negligence.
issue,
Hence
this
propеrly submitted to
Hosp. of
also,
Goff Doctors General
See
P.2d
Jose,
Cal.App.2d
San
right
hold the trial
court was
when
physician insuffi-
(nurses believed
ruled
conclusion
evidence
had
patient—“Both nurses
ciently sutured
plaintiff’s
jury,
case was for the
but
the facts
enough
reported
to have
time
that it fell into error when it sustained the
to a su-
peril
of Mrs. Goff’s
circumstances
motion notwithstanding
verdict.
ver-
corporation with
perior
dict must be reinstated and
must
adequate mea-
prompt
purpose
be entered thereon.
life of
safeguard the
taken to
sures be
Reversed.
Argonaut Ins.
Goff.”);
Mrs.
Norton v.
or-
Co.,
(La.App.) (doctor’s
They encouraged to take showers day, Saturday, plaintiff next social- their own. There is not a bath available. TV, patients, ized with other watched took They sponge could take a There bath. her scheduled meals and a shower that eve- history given by me either ning. any or the husband or the doctor of n grand any plaintiff seizures mal seizures of sort. Sunday morning, When arose my obligation try keep date, It things dizzy gener- accident she felt nearly possible ally normal in the help ward as as sick all over. With of another society. patient plaintiff and to mix in have them laundry did her and then wrote a letter to her husband. testi- She longhand “All writing page of the attempted fied she to talk to the nurse records is mine. I am the ignored. nurses’ station but was That reading page follows, from that ‘white played bingо afternoon she but became sick year old hair and female with brown and did not finish game. gave A nurse eyes. ambulatory Admitted toward South permission to lie down and advised *7 accompanied by 6 her husband. Entered plaintiff perhaps her illness was due to ex- cooperatively ward but was tearful. Gait citement. Speech normal. vibrant and coherent. Sunday Plaintiff evening at Insight judg- Sensorium seems intact. and usual shower time went to the shower adequate. ment seem Attention and rеten- room and waited her turn. Plaintiff testi- good. memory tion and Recent remote ad- fied she understood a required. shower was equate. patient has Husband states been sick, In the shower she became fell and depressed years off and for four and injured. complaint She had made no saw Dr. Haines in 1959. She has had to the shower attendant who was a few fainting spells many years. The last feet from her. Later she stated she had years appears three or four havе an never before had such a sudden black out up. waking aura and cries a lot after Re- opined seizure. Dr. Cash grand she had a cently spells changed in have that she epileptic mal seizure. pass does not clear out. The last one was ago. two or three weeks then she The trial court Since submitted these two pleaded specifications has had almost a headache and of constant to the days it the last two or three has been mоre leaving plaintiff In
“a. unattended and The record before us discloses no such in plaintiff’s physical unobserved and men- ruling evidence and therefore the of the tal condition and under the circumstances sustaining trial court defendant’s motion existing. then notwithstanding the verdict majority should be affirmed. But plaintiff “b. In requiring to take a ignore would abandon or the well estab- shower bath when defendant knew or in adopt applying lished rule and a rule the exercise of reasonаble care should have against duty a under the fic- known, danger plaintiff to the under ordinary prudent tional man-reasonable existing.” conditions then concept. care under the circumstances permit In instruction 9 This under the facts here would the trial court told the jury: require speculate and en- gage guess work.
“You are instructed that duty it was the ap- of the Iowa Hospital Under the doctor’s orders Methodist give Betty pears psychiatric Colleen life in the ward has suсh reasonable care knew, admitted, pa- therapeutic and attention design. as it Once or in the exercis- ing of tients allowed no visitors for least known, reasonable care should have required. expected up condition Each is to be five weeks. This is mea- mingle patients during day- sured degree with other skill and dili- gence except nap period from two to three customarily time by hospitals. exercised placed upon m. Great stress “A failure of thе Iowa Hospi- Methodist scheduling patients’ and activities. lives tal to render ordinary such care and atten- pa- Betty encourage mingling tion to To with other Colleen Kastler would be negligence. many are scheduled. tients activities stay plaintiff exposed to bin- her short “However, the Iowa Hospital Methodist pong danc- go, bowling game, ping was not an insurer Betty Colleen Kas- ing. for television and Time was set aside safety, tler’s and it required was not a shower made rеading. Plaintiff testified guard against or take measures to avert her feel better. that which person a reasonable under the anticipate circumstances would procedure not as Thus the and routine like- ly happen.” (Emphasis added). psychiatric ward can be seen as treat- therapy process of ment or resocialization. This statement applicable of rule is objective. It dif- Easing of is the tensions almost verbatim with the form of instruc vastly procedure from the and routine fers tion used in Bradshaw v. Iowa Methodist ordinary medical ward. Hospital, 375, 390, 251 Iowa 101 N.W.2d 167, 176; evidentiary help majority Shover v. Iowa Without Hospi Lutheran tal, 706, 252 Iowa would cast aside our established rule 107 N.W.2d speculate hos- Mailliard, permit jury to Iowa, Dickinson 175 N. pital’s duty any breach thereof. I can- W.2d 595. See also Baker v. United States, Cir., layman does a 222, 225; agree. knowledge 343 F.2d What 40 A.L. *8 515; psychiatric proper R.3d care of a Am.Jur.2d, Hospitals have of the Asylums, section ward ? which state the same general rule. majority opinion states: “We will pre- attempt each of to formulate a the above cited not at this time Iowa cases plaintiff kinds of introduced between the two evidence cise distinction of the cus- tomary practice administrative).” (professional activities care exercised given bench and bar does that leave the circumstances and its Where change failure not to meet the in future cases? I would stated standard of care. applied recognized general rule
Bradshaw, and Dickinson. Shover opinion to be majority
II. If the certainly
adopted should this plaintiff At under
be re-entered. most only a new be entitled to
record would
trial.
I would affirm.
LeGRAND, J., joins in this dissent. Iowa, Appellee,
STATE CUNHA, Appellant.
Louis
No. 54619.
Supreme Court of Iowa.
Dec. 1971.
Rehearing Denied Jan.