was not negligently inflicted if administered in the upper outer quadrant of the buttock. In the same vein to a requested charge by defendant hospital to the effect that the standard and accepted practice of administering intramuscular injection was that such injection should be made in the upper outer quadrant of the buttock we added the qualification "and away from or not in close proximity to the sciatic nerve." All of the nursing personnel knew of the dangerous consequences of an injection into the sciatic nerve area, either from actually striking the nerve or from the congestion of the injected material in close proximity to the nerve. That the injection was given in the sciatic nerve area is supported by the eye-witness testimony of plaintiff's mother. There is no direct evidence that the injection in question was not given in the sciatic nerve area.
This case did not, therefore, present either a res ipsa loquitur situation, nor an exclusive control situation, but rather a case where the standard of care has been established by competent medical testimony. This is the standard required by Demchuk v. Bralow, 404 Pa. 100, 170 A.2d 868, 88 A.L.R.2d 285 (1961). Eye-witness testimony and supporting circumstantial evidence placed the site of the injection near the sciatic nerve area.
Nor do we find that the jury's verdict was contrary to the weight of the evidence. While the defendant hospital produced a great mass of testimony to establish the upper outer quadrant rule it actually produced little evidence to contradict the eye-witness testimony of the mother as to the site of the injection. A plain issue of credibility of testimony was presented to the jury.
Defendant hospital argues that the verdict is excessive and that prejudicial remarks made by plaintiffs' counsel in his closing address to the jury contributed to the excessiveness of the verdict. The award to the minor plaintiff was $45,000. That this child is permanently crippled is not denied; that one foot is paralyzed, toed-in, subject to further muscle atrophy, and requiring braces and orthopedic appliances is not denied. The necessity for a surgical operation to help alleviate this condition was not denied, and the necessity for further surgical procedure during her teens is not denied. That she will have a permanently paralyzed, deformed left foot for the remainder of her life is not denied. We can by no means call the award to the child excessive. The parents on the other hand were awarded $11,453. They have incurred medical expenses to date of $1,252. and they will be required to expend further sums in the future for surgical operations to alleviate the condition, all of which may total $2,500. for medical expenses. The child will require corrective shoes and other orthopedic devices and will always require shoes of different sizes for the two feet. While the balance of the award to the parents must be allocated to the loss of earnings which they will suffer until this child reaches majority we do not think it beyond a reasonable determination of the jury that the loss of earnings may be more severe because these parents may be deprived of earnings which otherwise might come to them in their effort to continue the education or training of this child for some occupation where her physical disability will not be so great a handicap. Without regard to the alleged prejudicial remarks of counsel we cannot find the award to the parents to be so excessive as to shock the conscience of the Court. That they may be high or higher than the Court would itself have awarded is no criteron. We must rather consider whether the jury might reasonably have determined upon such a figure from this evidence. We cannot find it unreasonable. Therefore, the remarks of counsel which are alleged to have been a plea to the sympathy of the jury in urging it to give a high award did not, in the opinion of the Court, lead the jury to disregard its duty and make an award which was not justified by the evidence presented to it.
Finally, defendant hospital argues that the verdict of the jury in favor of the defendant, Dr. George E. Rogers, was against the weight of the evidence in the case. The jury rather quickly came to a determination that Dr. Rogers was not liable in this case. During the course of the deliberation it requested further instructions of the Court and in connection with these instructions, it stated on its written message to the Court: "We have decided in the sense of agency that the hospital is the sole owner or master of the trainee who gave this injection. How is this written in legal terms?" As we have stated there was no evidence of personal negligent action on the part of defendant, Dr. Rogers, in this case and it was submitted to the jury under an instruction that liability, if any, of the defendant Dr. Rogers must rest upon agency. Defendant hospital argues that the evidence against Dr. Rogers shows that he prescribed the medication and the general manner in which it was to be administered; that he had the right to control the nurse who gave the injection; and that he gave a detailed explanation to a registered nurse as to how the injection of February 17, 1962 was to be given. With reference to the instructions given by the doctor to an unidentified nurse at the time the doctor was signing the discharge order for the patient the evidence shows that he directed that this injection be given with a "Z-track" technique. This technique was fully explained by several of the witnesses in this case consisting of drawing the skin to one side when making the injection so that the skin would slide back over the site of the injection into the subcutaneous tissue and seal the injected material off from direct access to the puncture which the needle made in the skin. This was advisable in the administration of Imferon because if the injected material would leak out of the site into the area of the skin puncture it would permanently stain the skin. This tends further to explain the evidence of some of the medical witnesses that they found such a stain on the buttock of the minor patient which extended down toward or over the sciatic nerve area of the buttock. The "Z-track" technique was known and practiced by the nursing personnel in defendant hospital, and the Imferon injections given the minor plaintiff in the hospital were done by this technique. In any event the order pertaining to the Z-track" technique was in no way connected by the evidence with the selection by the nurse of the site of injection.
Otherwise, the testimony presented by defendant hospital in this case tending to establish that all of the nursing personnel were fully trained and competent to give such injections as a standard and regular part of the hospital services, all served to insulate the treating physician from the action of the hospital staff. The jury was charged that the liability of the defendant Dr. Rogers would depend upon its making a finding that the nurse, the admitted employee and servant of the hospital, also became the servant of the doctor by reason of his right to control the act to be done and the manner of its performance. The law of Pennsylvania imposes liability on the physician in a situation where the negligent act is performed by an employee of the hospital only in those cases where it is shown that the doctor had direct charge of the administration of the treatment, a duty to supervise its administration, and the right to control the act to be done and the manner of its performance. Under this doctrine liability has been imposed in the Pennsylvania cases in what is known as the "operating room" cases, where a surgical procedure has been involved. Because of the necessity of absolute authority of the operating surgeon in the critical surgical situation it has been held that where the authority of the doctor was complete, as with the surgeon in charge of the operating room, responsibility rests upon the surgeon for all acts of all hospital personnel who assist him or who are responsible for the carrying out of the operative and post-operative procedures. This is also called the "captain of the ship" doctrine under the analogy that the surgeon in the operating room
"is in the same complete charge of those who are present and assisting him as is the captain of a ship over all on board, and that such supreme control is indeed essential in view of the high degree of protection to which anaesthetized, unconscious patient is entitled * * *."
McConnell v. Williams, 361 Pa. 355, at p. 362, 65 A.2d 243, at p. 246. This liability has been extended to a surgical patient injured as a result of the negligence of an interne and resident employed by the hospital in the post-surgical treatment of the patient, even though the surgeon was no longer present. Yorston v. Pennell, 397 Pa. 28, 153 A.2d 255, 85 A.L.R.2d 872 (1959). It applies even where the mistake is that of other physicians while the patient is under the direction and control of the surgeon preparatory to surgery. Rockwell v. Kaplan, 404 Pa. 574, 173 A.2d 54 (1961).
There is no question, however, that the "operating room" or "captain of the ship" doctrine has not been extended beyond the surgical situation in Pennsylvania.
Shull v. Schwartz, 364 Pa. 554, 73 A.2d 402, 403 (1950), strictly limited this liability to the operating room situation, quoting from McConnell v. Williams, 361 Pa. 355, 65 A.2d 243 (1949):
"* * * [A] surgeon's liability [does not] apply, after the operation is concluded, to treatment administered by floor nurses and internes in the regular course of the services ordinarily furnished by a hospital; as to all such care and attention they would clearly be acting exclusively on behalf of the hospital and not as assistants to the surgeon." 364 Pa. at p. 556, 65 A.2d at p. 247.