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Piro v. Chandler11/1/2000
nd manifest error in this determination.
Even accepting the testimony that BMC's policy allows four hours for the pharmacy to get PRN-ordered medications to the floor and that the Procardia order was faxed to the pharmacy at 4:00 p.m. on July 13, 1995, we cannot find that this sanctioned delay establishes a four hour window for the administration of certain medications to patients. Moreover, we cannot find that this sanctioned delay justifies the failure of BMC's staff to administer the Procardia to Mr. Piro within a reasonable time of finding his blood pressure elevated to 173/100. The hospital policy regarding the time frame within which the pharmacy must get medications to the hospital's floors does not tell us the time frame within which nurses must act to follow doctors' orders regarding the administration of medications to patients. None of the witnesses testified that a delay of nearly four hours before administering the Procardia, once Mr. Piro's blood pressure was found to be elevated, was reasonable. Interestingly, the testimony regarding the faxing of Dr. Morehouse's order to the pharmacy and the pharmacy-related delays was more striking for what was not said than for what was stated by the witnesses. Nothing in the record tells us when the Procardia was received on the floor from the pharmacy. BMC's position is that we should assume it took almost four hours, the time allowed by hospital policy, for the pharmacy to get the Procardia to Mr. Piro's floor and that administration of Procardia to Mr. Piro at 7:45 p.m. was, therefore, reasonable. This assumption is not supported by the record. The fact that Mr. Piro was given Procardia at 7:45 p.m., after his vital signs were monitored and his blood pressure found to be elevated, does not establish that no breach occurred when BMC's nursing staff failed to timely administer Procardia when Mr. Piro's blood pressure was found elevated at 4:00 p.m. in the afternoon. Still unanswered is when the Procardia was delivered from the pharmacy and why it was not administered sooner since Mr. Piro's blood pressure had been elevated since 4:00 p.m. These unanswered questions preclude a finding that BMC did not breach the standard of care.
Our thorough review of the record convinces us that the jury was clearly wrong to find that BMC did not breach the standard of care in its treatment of Mr. Piro. We find that the record establishes that the failure to give Procardia to Mr. Piro until almost four hours after his blood pressure was found to be 173/100 was contrary to Dr. Morehouse's orders and a breach of the standard of care. Because of this finding and reversal of the lower court's decision, we pretermit discussion of the other two assignments of error. An appellate court is permitted to determine facts de novo from the record and render a judgment on the merits, if possible, when it finds either reversible error of law or manifest error of a material fact. La. C.C.P. art. 2164; Rosell v. ESCO, 549 So.2d 840 (La. 1989). However, in this instance, we believe the record is not sufficient to make findings as to the loss of a chance of survival alleged by the plaintiff to have resulted from BMC's breach of the standard of care. Moreover, the parties have not addressed or argued the issues of causation or damages on appeal. Having found a breach of the standard of care, we hereby remand the matter to the trial court for further proceedings on the issues of causation and damages.
CONCLUSION
We hereby reverse, at appellee's costs, the judgment of the trial court and remand for further proceedings on the merits of this claim.
REVERSED AND REMANDED.
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