Thus, if liability is to be imposed upon defendant, it would stem not from the conduct of the medical personnel defendant employed, but from defendant's policy of having patients treated on their first visit by paramedically trained personnel without requiring a licensed physician to review at least the patient's chart prior to discharge of the patient.
In determining whether such a practice constituted a departure from the required standard of care, we must look to Pennsylvania law. See 28 U.S.C. § 2674. The Pennsylvania courts, however, apparently have yet to articulate in a published decision the standard of care governing hospitals in the development of policies for the care and treatment of their patients. In other jurisdictions, courts have variously stated the rule to be that a hospital has a duty to exercise that degree of care, skill and diligence employed by hospitals generally in the community, or that a hospital must exercise such reasonable care as the patient's known physical and mental condition may require. See Kastler v. Iowa Methodist Hospital, 193 N.W.2d 98 (Iowa 1971) and the authorities cited therein. We need not scrutinize this issue more closely, however, for under either formulation of the rule, defendant's policy and conduct were negligent.
Plaintiff's expert witness was clearly familiar with the practice of emergency rooms in several Philadelphia hospitals at about the time involved. He testified that even interns-medical school graduates-were customarily required to have at least the patient's chart reviewed by a physician at some time before or soon after the patient's discharge. What is more important, he testified that a practice of permitting a patient to be discharged from an emergency room without ensuring some review of the patient's record by a physician would not constitute reasonable medical care. Thus, there is qualified medical expert testimony that defendant's practice failed to conform to the standard of care, whether that standard is measured by the practice of other hospitals in the community or by a general standard of reasonableness.
Defendant's expert witness, an expert in the field of emergency medical care, might well have been expected to contradict the opinion of plaintiff's expert on this point. The testimony elicited from defendant's expert, however, was often non-responsive, vague and imprecise, and thus less than helpful. When asked on direct examination whether in 1978 it would have been proper to discharge a patient from an emergency room without ever involving a licensed physician in the diagnosis, he answered that he was "not sure (he could) answer" the question, that it might depend on the skills of the particular individual. The point was not pursued. Thus, the opinion of plaintiff's expert, which was expressed without hesitation, went virtually unchallenged.
Plaintiff's contention is supported not only by the weight of expert opinion but also by reason alone. A person with only two years of general medical training cannot hope to have the same ability to recognize medical disorders as that possessed by a licensed physician having four years of formal medical training. The present case is only one example of the dangers involved in failing to recognize the difference. Accordingly, the Court must hold that defendant failed to conform to the applicable standard of care in permitting emergency room patients to be treated and discharged by paramedical personnel without requiring that either the patient or the patient's chart be reviewed by a licensed physician.
CONCLUSIONS OF LAW
1. In failing to have a licensed physician personally examine plaintiff's decedent or review her chart prior to her discharge at the time of her first visit to the NRMC on Wednesday, October 25, 1978, defendant acted negligently by failing to exercise the degree of care, skill and diligence employed by hospitals generally in the community, or such reasonable care as the plaintiff's decedent's known physical and mental condition required.
2. Defendant's failure to have decedent examined or her chart reviewed prior to her discharge on Wednesday, October 25, 1978, was a proximate cause of her death.
3. To compensate plaintiff for the losses he has sustained by reason of decedent's wrongful death, plaintiff is entitled to an award of damages in the amount of $ 245,178.94.
4. To compensate decedent's estate for the losses suffered by reason of decedent's death, decedent's estate is entitled to an award of damages in the survival action in the amount of $ 74,360.91.