MADSEN, C.J.
¶ 1 The primary issue in this medical malpractice case is whether the trial court properly granted the defendant hospital's postverdict motion for judgment as a matter of law. Here, the plaintiff patient presented expert testimony establishing that following the patient's lengthy heart surgery, the surgeons in charge of the patient's postoperative recovery failed to meet their standard of care, which required appropriately monitoring the patient for compartment syndrome, a known possible complication following such surgery, and also failed to direct members of the hospital's care team treating the patient during his recovery to so monitor. In light of this evidence, we reverse the trial court and remand for reinstatement of the jury verdict.
¶ 2 On December 21, 2006, Raymond Grove underwent a complex six hour cardiac surgery performed by Dr. Richard Leone, who remained Grove's primary physician until December 25, when Dr. Leone traveled for Christmas vacation. In Dr. Leone's absence, other surgeons at PeaceHealth St. Joseph Medical Center (PeaceHealth or hospital) assumed the role of primary physician for Grove. Dr. Edward Zech took over on December 25 and Dr. James Douglas on December 29. Dr. Leone remained Grove's physician of record until Grove was ultimately released from the hospital.
¶ 3 Although Grove's heart surgery went well, he had a difficult recovery. He developed various complications, including pneumonia and a blood infection. His condition required intubation from December 23 through December 26 and the hospital brought in an infectious disease specialist, Dr. Sara Mostad,
¶ 4 By December 29, Grove's progress chart noted that Grove's left calf was swollen, red, and painful to the touch. Grove's ability to bend his joints in both ankles was weak, particularly on his left leg. Based on these symptoms, Drs. Mostad and Douglas
¶ 5 By December 31, Grove could not fully flex his left foot and dragged his left toe when he walked during physical therapy sessions.
¶ 6 Compartment syndrome can result in irreversible damage but is curable if detected early. Grove underwent surgery to relieve his compartment syndrome, but it was too late. He suffered necrosis, muscle and other cell death within the compartment, resulting in permanent injury to his left leg.
¶ 7 Grove sued PeaceHealth for medical malpractice, asserting that the hospital was vicariously liable for the negligence of its managers, supervisors, agents, and employees who treated him.
¶ 8 Two experts testified for Grove: orthopedic surgeon Dr. Sean Ghidella and cardiovascular surgeon Dr. Carl Adams. Dr. Ghidella testified that the medical care provided to Grove fell below the standard of care because of inadequate monitoring and failure to rule out a known possible postoperation complication. Dr. Ghidella opined that Dr. Leone was ultimately responsible as team leader at the outset of Grove's treatment. He testified that with proper monitoring Grove's compartment syndrome should have been detected earlier. According to Dr. Ghidella, Grove's leg should have been examined on every round. He opined that Grove would not have suffered permanent injuries or would have had a better outcome if the standard of care had been met. He thought it likely that the compartment syndrome began to develop while Grove was intubated, but he could not determine precisely when Grove developed the syndrome, stating that had the standard of care been met, with record entries regarding proper monitoring and testing, he could have determined when the syndrome developed.
¶ 9 Dr. Adams opined that the cardiovascular surgeon in charge of Grove's care failed to meet the standard of care of such practitioners. He identified the three surgeons in charge of Grove's care as Drs. Leone, Zech, and Douglas.
¶ 10 The trial court instructed the jury on the standard of care applicable to a "physician, surgeon or health care provider." Clerk's Papers (CP) at 329. The court instructed the jury that a "health care provider" included "an entity" including a hospital or an employee or agent of same acting within the course and scope of his or her employment. CP at 330. And the court instructed the jury that any act or omission of a PeaceHealth employee was an act or omission of the hospital. The jury returned a special verdict for Grove, finding that PeaceHealth was negligent and that its negligence was a proximate cause of Grove's injury, and awarding Grove $583,000 in damages.
¶ 11 The trial court granted PeaceHealth's postverdict motion for judgment as a matter of law,
¶ 12 When reviewing an order granting or denying a motion for judgment as a matter of law, this court applies the same standard as the trial court, determining whether, after viewing the evidence in the light most favorable to the nonmoving party, substantial evidence exists to support the verdict for the nonmoving party. Schmidt v. Coogan, 162 Wn.2d 488, 491, 173 P.3d 273 (2007); see also Kemalyan v. Henderson, 45 Wn.2d 693, 277 P.2d 372 (1954) (in ruling upon a motion for judgment notwithstanding the verdict, no element of discretion is involved, and the trial court can grant such motions only when it can be held as a matter of law that there is no evidence or reasonable inference from evidence to sustain the verdict); see also Douglas v. Freeman, 117 Wn.2d 242, 247, 814 P.2d 1160 (1991) (same).
¶ 13 Tort actions based on injuries resulting from health care are generally governed by statute. RCW 7.70.010. A plaintiff seeking damages for medical malpractice must prove that his or her "injury resulted from the failure of a health care provider to follow the accepted standard of care." RCW 7.70.030(1). The statutory definition of "health care provider" includes physicians, physician assistants, nurses, and any "entity" employing such persons, including hospitals or an employee or agent thereof acting in the course and scope of his or her employment. RCW 7.70.020(1), (3). The plaintiff must prove that the health care provider "failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he or she belongs." RCW 7.70.040(1). The plaintiff also must prove proximate cause. RCW 7.70.040(2). The applicable standard of care and proximate causation generally must be established by expert testimony. Berger v. Sonneland, 144 Wn.2d 91, 111, 26 P.3d 257 (2001).
¶ 14 Grove's complaint alleged that the hospital and its operating foundation were "responsible and liable for the negligent acts and negligent failures to act of their agents and employees and for the corporate negligence of the hospital under the Doctrine of Respondeat Superior." CP at 10. Grove's list of the responsible "agents and employees" included Drs. Leone and Douglas and physician's assistant Shane Spears. Id. The jury was instructed that the hospital was the defendant and that it was to treat corporations
¶ 15 As noted, the jury found for Grove but the trial court overturned the verdict, reasoning that Grove failed to prove that the standard of care had been breached by any one individual member of the hospital's team. The trial court ruled, "A hospital which operates with team treatment provided only by hospital employees ... will always be liable under respondeat superior where an employee is negligent within the scope of their employment. But a plaintiff is still required to prove negligence on the part of the particular employee."
¶ 16 But Grove's experts identified Dr. Leone, as individually negligent. Dr. Adams testified that the negligent failure to properly monitor Grove started with Dr. Leone and continued thereafter.
¶ 18 The Court of Appeals opined:
Grove, 177 Wash.App. at 384, 312 P.3d 66. But that is not so. As discussed, based on Adams's and Ghidella's testimony the jury could have concluded that any one or all three of the surgeons breached the standard of care in that they failed to adequately monitor Grove for the known possible complication of compartment syndrome, resulting in the late diagnosis of the onset of compartment syndrome, which resulted in injury to Grove. There is no dispute that the negligence of a single employee of PeaceHealth rendered the hospital liable for such negligence, and the jury was so instructed without objection. Accordingly, based on the evidence concerning the surgeons' omissions, reversal of the trial court and reinstatement of the jury verdict is warranted.
¶ 19 Additionally, we note that the Court of Appeals view that chapter 7.70 RCW "does not contemplate liability for groups of providers" appears to be overly restrictive. Grove, 177 Wash.App. at 383, 312 P.3d 66. The statutory definition of "health care provider" is nonexclusive, extending to "[a]n entity" "employing one or more" individual health care providers. RCW 7.70.020(3). The hospital is specifically identified as one such entity, and it would logically seem that a hospital medical team collaborating in providing treatment to an individual patient in accordance with hospital policies could constitute yet another type of "entity." The jury instructions comport with this reading of the statute and the instructions were not challenged. See CP at 330 (defining "health care
¶ 20 Further, the Court of Appeals published decision declined to apply this court's decision in Hansch v. Hackett, 190 Wn. 97, 66 P.2d 1129 (1937). There, the estate of a deceased patient sued a hospital and one of its physicians for negligence after the patient died following childbirth. The jury returned a verdict in favor of the plaintiff as to the hospital but also returned a verdict in favor of the physician. On the hospital's appeal this court affirmed, holding that while there was evidence that would have supported the jury's determination that the defendant physician was not negligent, there was also evidence indicating that another doctor and one or more nurses may have been negligent in treating the patient in the absence of the defendant physician, and thus the jury could validly find the hospital liable under the rule of respondeat superior. Id. at 101-02, 66 P.2d 1129.
¶ 21 The Court of Appeals acknowledged that this case is similar to Hansch. Indeed, that is so, as both cases involved negligent care received during treatment delivered by multiple employee health care providers at a hospital, but the Court of Appeals held that Hansch was not controlling because it was decided before chapter 7.70 RCW became effective in 1976. See Grove, 177 Wash.App. at 386, 312 P.3d 66. Division One opined that when Hansch was decided, "medical malpractice was a common law claim and no statutory requirement existed necessitating expert testimony in order to establish the standard of care applicable to `a health care provider' as a member of a particular `profession or class.' Hansch no longer properly states the law." Id. But while Hansch preceded chapter 7.70 RCW, it has not been overruled or held by this court to be abrogated by the statute. Moreover, the statute does not appear to necessarily abrogate Hansch. Division One is correct that expert testimony must now establish the applicable standard of care in a medical malpractice case. Nevertheless, the statute seems to leave room for the notion that where evidence of such standard is presented, a jury may still determine that a particular physician did not breach the standard of care but that other physicians and health care providers did, allowing hospital liability under respondeat superior principles. The broad definition of "health care provider" in RCW 7.70.020 attests to such flexibility.
¶ 22 Considering the inferences and the evidence presented in Grove's favor, Grove met his burden under chapter 7.70 RCW to show that identified health care providers employed by PeaceHealth failed to meet the applicable standard of care in monitoring his postoperation recovery for compartment syndrome, resulting in the untimely diagnosis of that syndrome and proximately causing injury to Grove by failure to timely treat that complication. Accordingly, we reverse the Court of Appeals and remand to the trial court with direction to reinstate the jury verdict in favor of Grove.
WE CONCUR: C. JOHNSON, OWENS, FAIRHURST, STEPHENS, WIGGINS, GONZÁLES, GORDON McCLOUD, and YU, JJ.
Test. of Adams at 36.