Britt, J.*fn* Grosse, C.j., and Webster, J., concur.
Helen and Joseph Ketchum (referred to collectively as Ketchum), plaintiffs below, appeal from a judgment in favor of respondent Overlake Hospital Medical Center (Overlake) in a medical malpractice action. Among other things, Ketchum challenges an instruction informing the jury that a disagreement among health care providers regarding appropriate treatment does not establish negligence. We agree that the giving of the instruction was prejudicial error and reverse.
On September 28, 1980, appellant Helen Ketchum was admitted to respondent Overlake Hospital Medical Center. Ketchum's physician, Dr. John Maxwell, a neurosurgeon, had diagnosed a subarachnoid hemorrhage. An angiogram revealed that Ketchum was suffering from an aneurysm at the tip of her basilar artery, the primary artery supplying blood to the brain stem.
Ketchum suffered a second hemorrhage on October 6, 1980, which left her in a coma for several hours. Following this hemorrhage, Dr. Maxwell diagnosed vasospasm, a condition in which blood vessels constrict, reducing the blood
supply to the brain. Such constriction may be severe enough to destroy brain tissue supplied by the blood vessels.
On November 13, 1980, Dr. Maxwell operated on Ketchum. Utilizing a microscope, Dr. Maxwell placed a silver "clip" on the aneurysm to prevent future hemorrhage. The operation lasted from about 11 a.m. to 6 p.m. Ketchum was placed in the intensive care unit (ICU) for recovery.
When examined in 1989, Mrs. Ketchum was found to be suffering from severe mental retardation. The primary basis for this lawsuit is Ketchum's contention that her present condition is the result of negligent nursing care that she received in the ICU of Overlake during the night shift -- 11 p.m. to 7 a.m. -- following the operation.
The testimony at trial focused on the degree to which Ketchum's condition may have deteriorated during the night shift, whether the Overlake nurse adequately assessed and documented Ketchum's condition during this period, whether the nurse properly informed Dr. Maxwell of Ketchum's condition during the night, and whether Ketchum's present condition was the result of the allegedly negligent care that she received during this shift or whether the damage had occurred prior to the operation.
Patricia Tobis, a registered nurse, testified that the Overlake nurse had inadequately assessed and documented Ketchum's neurological condition during the night shift. According to Tobis, Ketchum's night shift chart indicated that the nurse had failed to document adequate responses to a series of warning signs, including respiratory distress, elevated pulse, and reduced pupilar response, all signs of Ketchum's possible deteriorating condition. Tobis was concerned that Ketchum's chart did not indicate that Dr. Maxwell had been adequately informed of the warning signs.
Dr. Robert Rand, a professor of neurosurgery, also testified for the plaintiff. Rand, who examined Ketchum in 1989, stated that a reasonably prudent ICU nurse would
have reported the warning signs to Dr. Maxwell. In Rand's opinion, the warning signs indicated that Ketchum was experiencing brain stem compression during the night shift. According to Dr. Rand, if Dr. Maxwell had been informed of these warning signs, he could have prescribed a diuretic, which would have relieved the pressure on Ketchum's brain, and the damage causing Ketchum's current condition would probably not have occurred. Dr. Rand ...