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Groover v. Johnston11/10/2005
e address Groover's contention that Johnston is guilty of negligence per se because he violated the statute, which sets forth the standard of care. The nurses in Redmond's PACU did not have advanced skills or training, and Redmond is not a public health or indigent care facility within the meaning of the statute. Groover argues that Johnston violated the statute in two ways: by delegating his authority to order and dispense drugs to PACU nurses who were registered nurses without advanced training or certification; and by delegating that authority without a written protocol being in place. Groover asserts that the custom and usual practice in the PACU at Redmond was to use "standing verbal orders." The nurses in the PACU were permitted to select which of a number of possible pain medications to give, what dosage to administer, and when and how to administer the chosen medication.
The record supports these factual contentions, and Johnston does not dispute them. Indeed, both Johnston and the two PACU nurses caring for Mrs. Groover admitted under oath that the "standing verbal orders" in existence at the time of Mrs. Groover's surgery allowed the PACU nurses "to administer narcotics to patients without requiring them to consult with a physician prior to administration." Johnston testified that he knew of "no written protocol," and that his "standing verbal orders" gave the nurses discretion to administer narcotics to patients in the PACU without asking him "as necessary to get the pain under control." According to Johnston, when patients were discharged from the PACU and sent to a floor, his customary practice was to sign the chart, indicating that he was approving the medications already administered. He believed that his signature converted his verbal standing order into a written order, albeit after the fact. It was his impression that this satisfied the provision in the hospital by-laws requiring such orders to be in writing.
OCGA § 54-34-26.1 (b) creates a duty recognized by the law to protect patients against unreasonable risk. That duty requires a physician to conform to a certain standard when delegating authority to a nurse. See Central Anesthesia Assoc. v. Worthy, 254 Ga. 728, 733 (2) (333 SE2d 829) (1985). It is clear from the evidence presented that nurses in Redmond's PACU routinely functioned without a written protocol and that they ordered controlled substances and administered them to patients. This practice violates the statute and offends the statute's purpose of ensuring good patient care.
Having determined that the purpose of the statute was undermined, we turn to the remaining factors to be considered when deciding whether violation of the statute constituted negligence per se. Brown v. Belinfante, supra, 252 Ga. App. at 861 (1). Because Katheryn Groover was a patient, she falls within the class of persons OCGA § 43-34-26.1 (b) (1) (B) was intended to protect, and the harm she suffered is one the statute was intended to guard against. Lastly, common sense dictates that if an unqualified person selects an improper drug or administers an improper type or amount of medication, especially to a patient emerging from anesthesia, disastrous consequences such as those that befell Katheryn Groover are possible. Because all the elements were present, the trial court erred in concluding that Groover had not shown negligence per se. See Brown, supra.
2. The conclusion that Groover showed negligence per se, however, does not conclude our analysis. Groover also contends that the trial court's order denying partial summary judgment appears to eliminate negligence per se considerations and evidence from trial and to implicitly grant partial summary judgment to Johnston
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