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Torts Click here for the full text of this decision FACTS:Jess William Reed, Maureen Reed, Lynn Baugh, Donna Reed and Jennifer Reed appeal from a summary judgment for Granbury Hospital Corp. d/b/a Lake Granbury Medical Center on the Reeds’ medical negligence claims. In March 1998, Jess Reed suffered stroke-like symptoms and was taken to the hospital. Maureen Reed, a registered nurse, had recently heard on a television documentary program that the drug t-PA could be used as a “clot-busting” treatment for stroke if administered within three hours after a stroke. Therefore, she chose to have her husband taken to the hospital, which was only about 10 minutes from the Reeds’ Granbury home, rather than to a more distant Fort Worth hospital that the Reeds’ health care plan used. At the hospital, Maureen told Dr. Don Davis, the emergency-room physician, that she had heard about t-PA and, “if possible, [she] wanted Jess to get this.” Dr. Davis said nothing, turned around, and walked back into the emergency room. After Jess was admitted to the hospital, he was diagnosed as having had a stroke and given a CT scan. The evidence at trial regarding whether Jess was eligible to receive t-PA is conflicting. Although the radiologist who reviewed the CT scan initially concluded that it was negative for a brain hemorrhage, one of the hospital’s experts testified by affidavit that the CT scan revealed early signs of brain damage, which would have disqualified Jess as a t-PA candidate. After waiting for about 45 minutes and learning that Davis “hadn’t done anything” to treat her husband, Maureen asked to have Jess transferred to Plaza Medical Center in Fort Worth while there was still time to administer t-PA. Although Jess was eventually transferred by ambulance to Plaza Medical Center, he arrived there outside the three-hour window for receiving t-PA. The Reeds contend that, because he was not administered t-PA, Jess is significantly and permanently disabled from the stroke. On the date of Jess’s stroke, the hospital had t-PA available and also had a written policy allowing its administration to cardiac patients. The hospital did not, however, have a protocol for administering t-PA to stroke victims, and it had no written standard of care for stroke patients. Davis testified that, although he did not rely on the hospital to advise him regarding what medical treatments were appropriate for a patient, including Jess, he did not consider administering t-PA to Jess without a hospital protocol. Davis believed that the hospital lacked the medical staff (a neurologist or neurosurgeon) and equipment necessary to safely administer t-PA to stroke patients. He testified that a neurological group from Fort Worth had made a presentation to the hospital’s emergency room staff and offered to make arrangements to administer t-PA in Fort Worth to the hospital’s stroke patients should the need arise. Davis had consulted with the neurological group on several occasions, but the patients involved had never met the criteria, “time-wise or other contraindications,” to be transferred to a Fort Worth hospital for t-PA administration. The record does not indicate whether Davis consulted with the neurological group concerning Jess. HOLDING:Affirmed. A hospital may be liable for injuries arising from the negligent performance of a duty that the hospital owes directly to a patient. Denton Reg’l Med. Ctr. v. LaCroix, 947 S.W.2d 941 (Tex. App. � Fort Worth 1997, pet. denied). One such duty is the duty to use reasonable care in formulating the policies and procedures that govern the hospital’s medical staff and nonphysician personnel. Before a fact-finder can consider whether a hospital’s deviation from the standard of care is negligent, however, the plaintiff must first establish what the standard of care is. The test used to determine the standard of care a hospital is required to use in formulating its policies and procedures is what a hospital of ordinary prudence would have done under the same or similar circumstances. Circumstances to be considered include, but are not limited to, the expertise of and means available to the hospital and the state of medical knowledge. Hood v. Phillips, 554 S.W.2d 160 (Tex. 1977). Expert testimony is generally required to establish the governing standard of care and to determine whether the standard has been breached. While the standard of administrative care at a hospital may be established by lay testimony, medical expert testimony is required where, as here, the underlying issue involves the performance of medical procedures. There are certain standards universally regarded as ordinary medical standards beneath which no common or community standards may fall. Webb v. Jorns, 488 S.W.2d 407 (Tex. 1972). This is because universality of education, training, testing, and travel in the realm of medical treatment have produced a correspondent right to expect the same basic quality of care from region to region. Hall v. Huff, 957 S.W.2d 90 (Tex. App. � Texarkana 1997, pet. denied). These universal standards apply to multiple schools of practice and to any medical doctor. Blan v. Ali, 7 S.W.3d 741 (Tex. App. Houston [14th Dist.] 1999, no pet.). The trial court did not abuse its discretion by striking Drs. Bronston’s and Adornato’s testimony on the standard of care. Neither Dr. Paul K. Bronston nor Dr. Bruce Adornato demonstrated having knowledge or experience that would have qualified them to opine concerning whether a hospital of ordinary prudence with the hospital’s capabilities would have had a t-PA protocol for stroke in March 1998. In addition, there has been no showing that a common or universal standard of care for administering t-PA to stroke patients applied to physicians and hospitals or even to all hospitals. The Reeds contend that Bronston and Adornato demonstrated their familiarity with the standard of care under the “same or similar circumstances” as those at the hospital because they opined that any hospital equipped with a CT scanner, as the hospital was, should have had a t-PA protocol in place for stroke patients. This court disagrees. Drs. Bronston’s and Adornato’s testimony demonstrated that they were not familiar with what a hospital of ordinary prudence so equipped would have done; instead they had simply formed opinions, despite their limited knowledge of hospital protocols, policies, procedures, about what they thought the standard of care should be. OPINION:Cayce, C.J.; Cayce, C.J.; Day and Livingston, JJ. DISSENT:Livingston, J. “In the LaCroix case, medical expert testimony of the very type excluded by this trial court was admitted. There, however, it was the hospital’s failure to follow its own policies and procedures as opposed to failing to even have a policy or procedure, as is the case here. Maj. Op. at 19. This distinction is of no significance. Testimony was clear that there were only two requirements for providing t-PA as a potential treatment: a functioning CT scanner and the medicine itself. This hospital had both. The appellants’ two experts, who were sufficiently qualified to testify as to causation, were, by definition, then qualified to testify to appropriate hospital policy: if there is no hospital policy in place to accommodate (or even prevent) a medical doctor from acting in conformity with the current medical standard of care, surely the patient has presented enough evidence to show that the hospital standard of care has not been met. Interestingly, the majority accuses the appellants of failing to provide hospital expert testimony regarding the medical standard of care, and failing to provide medical expert testimony for opinions on hospital policies. Maj. Op. at 16, 18-19. Therefore, I would conclude and hold that the appellants’ experts should not have been struck as to standard of care, and the trial court should not have granted the no-evidence motion for summary judgment and resulting final summary judgment.”

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