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Does a Hospital’s Violation of Its Own Policies Prove Medical Malpractice Occurred?


In Tennessee medical malpractice cases, the injured patient must prove that their healthcare provider deviated from the accepted “standard of care.” This is normally done through the testimony of an expert witness qualified in the same field as the defendant. Without such testimony, the plaintiff’s case is likely to fail.

A recent decision from the Tennessee Court of Appeals, Surber v. Mountain States Health Alliance, addresses a related issue, namely how to define the standard of care. In this case, a trial court rejected testimony from an expert who relied on the defendant hospital’s internal policies to establish the standard of care. Applying prior rulings from the Tennessee Supreme Court, the Court of Appeals agreed with the trial judge this was inappropriate.

The plaintiff went to Johnson City Medical Center complaining of eye pain. A physician’s assistant (PA) examined the plaintiff and diagnosed him with a “welder’s burn and a scratch on his eye,” according to court records. The PA told the plaintiff to wear an eye patch for 24 hours and return to the hospital if the pain continued.

Although the plaintiff’s pain did continue more than a day later, he did not immediately return to Johnson City, but instead waited three days to go to a different hospital. Later, a doctor determined the real cause of the plaintiff’s eye pain was not a welder’s burn, but rather a foreign object in his eye. A second specialist then diagnosed the plaintiff with a severe eye infection. The plaintiff’s eye ultimately deteriorated to the point where it had to be removed and replaced with a prosthetic eyeball.

The plaintiff subsequently sued the owner of Johnson City Medical Center for malpractice. The crux of the plaintiff’s case was that Johnson City’s employees failed to follow its own emergency room procedures on the night of the plaintiff’s visit. Those policies required every ER patient be examined by a physician. But as noted above, the plaintiff was only seen and treated by a PA, not a staff physician.

As required by Tennessee law, the plaintiff presented an expert witness, a hospital administrator, to establish the defendant’s breach of the standard of care. The administrator planned to testify that the defendant’s failure to follow its ER policy constituted a deviation from the standard of care. The defense objected to this testimony, and the trial court agreed such statements were inadmissible. Absent any further proof regarding the standard of care, the trial court proceeded to grant a directed verdict to the defense.

The Court of Appeals affirmed the directed verdict. The appellate court said the plaintiff’s mistake here was relying “solely” upon a hospital administrator to establish the defendant’s liability. The plaintiff did not, for instance, offer any expert in a “medical field” who could establish the plaintiff “would not have lost his eyesight had he been examined by a doctor at the hospital.” In this context, the defense’s mere failure to follow its own internal policies did not equate to a breach of the standard of care.

Speak with a Tennessee Personal Injury Attorney Today

Medical malpractice and other personal injury cases often require the use of expert witnesses to establish critical facts. An experienced Knoxville personal injury lawyer can advise you on the specific kinds of evidence that may be necessary to prove your case. Contact the offices of Fox, Farley, Willis & Burnette, today to schedule a free consultation with a member of our team.




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