TWO DAYS AFTER undergoing bilateral knee replacement surgery, Dorothy Kline* died of respiratory and cardiac arrest. Her family filed a malpractice suit against the hospital alleging that negligence by the anesthesiologist and the nurses caused her death.

The hospital sought summary judgment on the claim regarding the nurses, asserting that no expert testimony had indicated that negligence by the nurses contributed to Mrs. Kline's death. The court denied the motion, and the hospital appealed its decision.

Kline's family opposed the appeal, citing two depositions to the trial court by expert witnesses. Ellen Rothman, RN, had indicated that the nurses had breached the standard of care, and Samuel Vincent, MD, had testified about the cause of death.

The hospital claimed that their expert testimony wasn't enough to show that nursing negligence caused Kline's death. It argued that Rothman had stated she wouldn't offer an opinion on causation and Vincent had stated he didn't have an opinion on whether the nurses had breached the standard of care.

The appellate court agreed that Rothman had indicated she wouldn't testify as to causation but indicated that she "did provide testimony that the nurses breached the standard of care" for a patient receiving epidural analgesia. Specifically, she said that they'd failed to monitor and document Kline's vital signs, to adequately assess and document her response to epidural analgesia, to notify the anesthesia department of a change in her level of sedation, and to discontinue epidural analgesia according to policy when arousing her became difficult.

And although Dr. Vincent's deposition was intended to shed light on the anesthesiologist's practices, it too indicated deficiencies in the nurses' actions. Explaining that the opioids could cause respiratory depression and that deepening sedation could cause the tongue to obstruct the airway, he indicated that closer monitoring would have detected Kline's slowing heart rate and breathing and dropping oxygen saturation levels. "Missing the evidence of hypoventilation or airway obstruction" he testified, led to respiratory and cardiac arrest from which she never recovered.

The appellate court rule found a genuine issue of material fact as to whether the nurses' negligence was the proximate cause of Kline's injuries and death. It concluded that the trial court didn't err in denying the hospital's motion for summary judgment on her husband's claim against the nurses.

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