Toth v. Community Hospital at Glen Cove

In Toth v. Community Hospital at Glen Cove (22 NY2d 255 [1968]) the Court of Appeals recognized a two-tiered standard for measuring a doctor's conduct. There, the Court held that the community or locality test establishes a minimum standard, but that a physician also is required to utilize his or her best judgment and any special skill, knowledge or intelligence that the doctor possess (id.) This second tier imposes a higher duty on doctors with knowledge or skills that might exceed local standards. The Court, in Toth, reasoned that "there is no policy reason why a physician who knows or believes there are unnecessary dangers in the community standard, should not be required to take whatever precautionary measure he or she deems appropriate . . . as this is nothing more than an application of the rule that a physician should at all times use his or her best judgment and care" (22 NY2d at 263). Thus, a medical specialist is held to a standard of care at least equal to that of similar specialists in the community, and expert testimony of a board certified specialist is appropriate to establish the superior knowledge and skill that such a specialist should possess (Toth, 22 NY2d at 262.) In Toth v. Community Hospital at Glen Cove, 22 NY2d 255 (1979) the Court of Appeals ruled that the primary responsibility of a hospital's nursing staff is to follow physician's orders. On that basis, the Toth court held that since the plaintiffs made out a prima facie case that the nurses had not conformed to the pediatrician's orders, the trial court erred in not submitting the case against the hospital to the jury. 22 NY2d 255, 264-265, 239 N.E.2d 368, 292 N.Y.S.2d 440. In Toth, the court found that plaintiffs had introduced substantial evidence that the nurses had not conformed to the pediatrician's order. Introduced at that trial were "written orders that the infants should receive oxygen at the rate of 6 liters per minute for the first 12 hours, and thereafter at the rate of 4 liters per minute" (Toth v. Community Hospital, 22 NY2d 255, 258, 239 N.E.2d 368, 292 N.Y.S.2d 440, supra).