South Carolina Court of Appeals affirms admission of nursing expert witness testimony 

On October 25, 2014, a five-week-old child, Robert Lee M., Jr. (Minor), was admitted to Regional Medical Center (“Regional”) for a high fever. Jamie Downing worked at Regional as a nurse and treated Minor during his hospital stay. Medical personnel at Regional did not initially know the cause of Minor’s fever but on the day of his admission, they started him on IV antibiotic therapy in case he had an infection.

On the morning of October 28, 2014, Downing administered an antibiotic, Ampicillin, into Minor’s IV. Shortly thereafter, Minor’s hand became swollen with a dark spot and his mother, Tekayah Hamilton, called the nurses’ station because Minor was “really crying.” The antibiotic Downing gave Minor through the IV caused a third-degree burn to his hand because it infiltrated outside of his vein. On October 30, 2014, Minor was discharged from Regional. 

On October 7, 2015, Hamilton, individually and as parent and guardian ad litem for Minor, sued Regional on charges of negligence and malpractice. Regional denied any liability and wrongdoing on its part and asserted numerous affirmative defenses. Minor was awarded damages worth $300,000 at trial and Regional appealed. 

Monica Stobbs, a nursing expert witness for the Plaintiff, testified at trial that before administering medication through an IV, a nurse must flush the IV with saline to ensure the IV is actually going into the vein and not instead into the skin. She explained saline would not harm the area and cause a burn type of injury if it went into the surrounding tissue of the vein, unlike an antibiotic which could if it did not go directly into the vein.

Stobbs further noted that Regional’s policies and procedures for IV therapy require a saline flush to be given. Stobbs testified that Minor’s medical chart indicated his IV was flushed on several occasions before the medication was administered but that on the occasion when the injury occurred, the chart did not indicate the IV was flushed. Stobbs noted Regional’s policies and procedures state that the flush should be documented on the medication record and opined that the IV was not flushed if it was not documented concluding that Regional’s conduct constituted breach of care by not documenting the saline flush and by not staying with Minor for at least five minutes after starting medication. 

In her defense, Downing testified that at the time she treated Minor, she had worked as a nurse at Regional for less than three months and had been allowed to work on her own for about two weeks. Downing stated Regional’s policies and procedures “are direct instructions” and there is “not room for interpretation” of them. Downing testified that Regional’s policies require a saline flush before putting medication into an IV.

She believed the policies required flushing to be documented on the electronic medical record only when not associated with giving a medication. Downing testified she could not specifically remember administering a saline flush prior to ampicillin that morning but testified her practice was to flush prior to giving medication. Downing stated Minor’s medical records indicated a saline flush was given every four hours but Regional’s system provided no way to document giving a saline flush before an antibiotic. 

Discussion by the court 

Regional challenged Stobbs’ testimony contending she was lacked expertise since she had not administered IV therapy to a pediatric patient and did not review literature specifically about IV therapy for pediatric patients. Hamilton replied the administration and monitoring of an IV is the same for a pediatric patient as it is for an adult patient and that Regional’s argument went to the credibility of Monica Stobbs rather than her expertise, citing McMillan v. Durant, 312 S.C. 200 . The Court declined the Defendant, Regional Medical Center’s request to exclude the testimony of Monica Stobbs and held that Monica Stobbs was qualified to testify as a nursing care expert at trial. The Appellate Court affirmed the Trial Court’s qualification of her as an expert witness. 

Regional alleged that the Trial Court erred by not admitting the testimony of Regional’s nursing expert Cindy Hurley but the Trial Court held and the Appellate Court affirmed that considering Hurley was retained to determine whether the conduct of Regional amounted to negligence or gross negligence, her testimony would have only amounted to a legal conclusion and since expert testimony on issues of law is inadmissible, it would most likely confuse the jury, citing Dawkins v. Fields, 354 S.C. 58. 

Held 

The Appellate Court held that it did not constitute abuse of discretion when the Trial Court admitted the testimony of Monica Stobbs regarding the standard of care, prohibited the testimony of Cindy Hurley as to whether Regional’s conduct constituted gross negligence or negligence, or admitted the photographs of the Minor’s hand. The Appellate Court affirmed the determinations of the Trial Court. 

Key Takeaway 

1. General vs. Specialized Expertise – The court found that Stobbs had extensive overall expertise in nursing care, even though she lacked specialized experience in pediatric IV therapy specifically. The rules for expert testimony do not require a witness to be a specialist in the exact area at issue. General expertise can be sufficient if it is relevant to the facts of the case 

2. Credibility vs. Admissibility – The court determined that Stobbs’ lack of pediatric specialization went to the credibility and weight of her testimony, not its admissibility. She could not be completely excluded on this basis, though the defense was permitted to highlight the issue. 

3. Relevance of Testimony – Stobbs’ testimony about proper nursing care for IV line flushes and documentation was relevant to the alleged negligence in this case, despite involving a pediatric patient. The standards did not necessarily differ between adult and pediatric IV administration. 

4. Discretion of Trial Court – The decision to qualify an expert witness is within the trial court’s discretion. Appellate courts give this significant deference if the trial court has applied the proper legal standards.

Experts generally cannot offer legal opinions or conclusions, as this usurps the role of the judge and jury. The terms “negligence” and “gross negligence” have specific legal definitions that witnesses should not testify to. As a nurse, Hurley was not qualified to offer legal opinions. Her expertise was in nursing care, not application of legal standards. Asking her legal questions went beyond her area of expertise. Whether negligence occurred was an ultimate issue of fact for the jury to decide, not an expert witness. Hurley could not tell the jury what outcome to reach on this key issue.