Case Title: LLERA v WISNER

Citation: 

Docket Number: 

State: montana

Court: Montana Supreme Court

Date: 1976-12-20T00:00:00Z

Document:
No. 13404 I N T H E S U P R E M E C O U R T O F T H E STATE O F MONTANA 1976 A L A N LLERA, P l a i n t i f f and Appellant, BYRON R. WISNER, D.D.S. ; JON A. J O U R D O N N ~ S , D . D . s . ; ROBERT R . HYLTON, MID.; J. MCGARITY, c.R.N.A.; M.D. ANESTHESIA SERVICES; M. KEMP,R.N.; D. DRAKE, R.N.; and SAINT VINCENT'S HOSPITAL, Defendants and Respondents. Appeal from: D i s t r i c t Court of t h e Thirteenth J u d i c i a l D i s t r i c t , Honorable C. B. Sande, Judge presiding, Counsel of Record: For Appellant : Lewis Em Brueggemann argued, B i l l i n g s , Montana For Respondents: Anderson, Symmes, Forbes, Peete and Brown, Billings, Montana Richard F. Cebull argued, Billings, Montana Weymouth Symmes argued, Billings, Montana Keef e r and Roybal, Billings, Montana J. Dwaine Roybal argued, Billings, Montana Neil Keefer appeared, Billings, Montana Crowley, Haughey, Hanson,, Ghllagher and Toole, Billings, Montana Jack Ramirez argued, Billings, Montana Submitted: October 19, 1976 Decided: DEC 2 0 1 9 B DEC 2 0 1976 M r . J u s t i c e John Conway Harrison delivered the Opinion of the Court. This i s an appeal from summary judgment entered i n favor of a l l defendants i n a dental malpractice action i n the d i s t r i c t court, Yellowstone County. P l a i n t i f f Alan Llera brought action alleging malpractice resulting from an o r a l surgical procedure known a s a p a r t i a l glossectomy. P l a i n t i f f alleges t h e malpractice occurred i n the diagnosis of h i s problem and i n the r e s u l t a n t operation. He alleges no informed consent was obtained nor were the r i s k s and the a l t e r n a t i v e s t o h i s tongue problem ever explained o r discussed. P l a i n t i f f alleges D r . Joh A. Jourdonnais, the r e f e r r i n g d e n t i s t , gave D r . Byron Wisner no r e f e r r a l information a t the time; t h a t D r . Hurly, the admitting doctor a t S t . Vincent's Hospital found nothing wrong with h i s tongue but did find en- larged t o n s i l s ; t h a t D r . Hylton, the anesthesiologist and h i s agents were negligent i n allowing the operation; t h a t two nurses, D. Drake and M. Kemp, did not provide t h e proper care; and f i n a l l y t h a t St. Vincent's hospital f a i l e d t o exercise the proper degree of care f o r p l a i n t i f f . P l a i n t i f f , a 20 year old man, went t o see D r . Jourdonnais, a Great F a l l s orthodontist, f o r treatment t o reduce the gaps between h i s teeth. D r . Jourdonnais, a f t e r t r e a t i n g p l a i n t i f f through the use of orthodontic appliances suspected t h a t t h e space problem might be caused by what i s known i n the profession a s "tongue thrust" which is an involuntary forward-thrusting movement of the tongue upon swallowing which forces the upper teeth apart. H e discussed h i s conclusions with plaintiff and informed him of an operation that might help the problem. The doctor also informed plaintiff of a doctor i n Billings, Montana who had special board certification a s an o r a l surgeon, one D r . Byron R. Wisner, who might perform the operation necessary t o correct the tongue problem. D r . Jourdonnais did not know D r . Wisner personally, he had heard about him from another dentist. Plaintiff request an appointment with D r . Wisner i n Billings. D r . Jourdonnais denied ever recommending an operation t o p l a i n t i f f , but stated i n h i s deposition that a f t e r discussing h i s diagnosis with plaintiff he merely made the appointment for him with D r . Wisner. H e sent D r . Wisner h i s X-rays and a plastic mold of p l a i n t i f f ' s teeth but did not send h i s written diagnosis. Neither did he t e l l D r . Wisner of h i s diagnosis a s "tongue thrust" . P l a i n t i f f ' s appointment with D r . Wisner was February 23, 1973, i n Billings. D r . Wisner's diagnosis was "congential macroglassia" which i n common terms is an oversized tongue. D r . Wisner recommended surgery known as a p a r t i a l glossectomy, which he performed on June 5, 1973 a t St. inc cent's Hospital i n Billings. This operation consisted of removal of a wedged shaped piece of the tongue t o reduce i t s size. Prior to the surgery and upon entrance into the hospital, p l a i n t i f f was examined by D r . John Hurly, as required by the rules of the hospital for any patient who was t o undergo surgery. During surgery D r . Wisner was assisted by a nurse, M. Kemp, who was trained and employed by D r . Wisner for oral surgery. The anesthesiologist and the anesthetist, D r . Robert R. Hylton and J. McGarity, respectively, members of M.D. Anesthesia Services, a s s i s t e d i n the aperation. One defendant, D . Drake was t h e circulating nurse and was an employee of St. inc cent's. Plain- t i f f remained i n the hospital f i v e days before returning home t o Great F a l l s . Although a schedule was s e t up f o r p l a i n t i f f t o see D r . Wisner a f t e r leaving the h o s p i t a l , he returned only once, on July 20, 1973. I n h i s deposition, D r . Wisner t e s t i f i e d t h a t on t h a t c a l l p l a i n t i f f had no complaints. He a l s o t e s t i - fied he did t e l l p l a i n t i f f there was a chance of some l o s s of tongue mobility, speech impairment, loss of t a s t e , and possibly it might not cure h i s tongue thrust when he was informed by p l a i n t i f f t h a t D r . Jourdonnais had discussed the operation with him and he wanted the operation. However, D r . Wisner did say he t o l d p l a i n t i f f t h a t it was a d i f f i c u l t procedure t h a t should be done i n the hospital. P l a i n t i f f s a i d h i s reason f o r wanting the operation was because of the spacing and f l a r i n g of h i s t e e t h and the operation might help remove the pressure on those teeth. While denied by p l a i n t i f f and h i s mother, D r . Wisner s t a t e d i n h i s deposition t h a t she was i n favor of h e r son having the operation. During the one return v i s i t t o D r . Wisner, no infection was noted i n the tongue. O n examination p l a i n t i f f a l s o showed no t a s t e nor sensory deficiency; the tongue had normal mobility and p l a i n t i f f could l i c k h i s l i p s . The hospital records and depositions indicate t h a t plain- t i f f l o s t from 1100 t o 1500 cc of blood and t h a t two blood transfusions were required. P l a i n t i f f alleges t h a t expert t e s t i - mony would indicate t h a t 200 t o 300 cc i s a normal l o s s i n t h i s type of operation and the l o s s of such a large amount i s an evidentiary fact tending to prove the ultimate fact the operation was not performed properly. Following the operation plaintiff returned t o Great Falls and continued t o have D r . Jourdonnais do orthodontic work for him for some s i x months u n t i l plaintiff moved t o Bozeman. Plaintiff stated i n his deposition that when he went t o see D r . Wisner some s i x weeks a f t e r the operation h i s tongue was inflamed and that D r . Wisner gave him some p i l l s for the inflam- mation. D r . Jourdonnais stated he had difficulty with plaintiff before and a f t e r the operation with plaintiff not keeping appointment dates, which interfered with h i s giving plaintiff constant care. Some s i x months a f t e r the operation i n Billings, plaintiff had h i s tonsils and adenoids removed i n Great Falls by D r . W. J. Roberts. In h i s deposition, D r . Roberts stated that a t the time of h i s removing the tonsils they were enlarged and infected and i n h i s opinion t h i s infection was chronic. However, he stated when he f i r s t examined p l a i n t i f f i n October 1973, he found no acute infection. H e further stated that while he doubted the tonsils would have interfered with the movement of p l a i n t i f f ' s tongue, the recurring inflammation could cause the tongue t o be sore. Five issues are presented a l l directed t o the granting of summary judgment t o defendants. These issues can be summarized thus -- Was summary judgment proper: 1) I f there were genuine issues of fact as t o any one or more of defendants? 2) Where plaintiff moved for a continuance t o locate additional expert testimony? 3) Where there was expert testimony already before the court, or i t s equivalent? 4) A s t o any one o r more, or a l l of defendants, as a matter of law as pertaining t o any one o r more of the three causes of action? 5) When defendants failed t o comply with the notice requirements of Rule 56(c), M.R.Civ.P.? W e note here that p l a i n t i f f ' s complaint against the defendants s e t s forth three causes of action, the f i r s t for lack of informed consent, the second for failure t o use due care, (both sounding i n t o r t ) ; and the third against only defendant Wisner for breach of express warranty t o obtain a specific result. Extensive discovery procedures followed the f i l i n g of the complaint, including seven depositions, several sets of interrogatories, numerous exhibits, and including a r t i c l e s from dental publications that considered the treatment of an "open bite" and " tongue thrust" condition. W e have carefully reviewed the posture of the cause a t the time a l l defendants filed motions for summary judgment and a t the time such motions were heard. W e affirm such summary judgments as t o s i x defendants without further discussion other than t o note w e find the record concerning these s i x t o t a l l y f a i l s t o disclose genuine issues of material fact on any theory of pleading advanced by p l a i n t i f f . These s i x defendants are: Robert R. Hylton, M.D.; J. McGarity, C.R.N.A.; M.D. Anesthesia Services; M. Kemp, R.N.; D. Drake, R.N.; and Saint Vincent's Hospital. See: Montana Deaconess Hospital v. Gratton, - Mont . , 545 P.2d 670, 33 St.Rep. 128; Collins v. Itoh, 160 Mont.461, 503 P.2d 36; Maki v. Murray Hospital, 91 Mont. 251, 7 P.2d 228; Davis v. Trobough, 139 Mont. 322, 363 P.2d 727. The summary judgments granted Dr. Jourdonnais and Dr. Wisner, will be discussed individually. As to Dr. Jourdonnais, the summary judgment resulted after no facts were developed that revealed any deviation from the established standards of treatment by orthodontists and after it was shown that no harm came to plaintiff resulting from the treatment by Dr. Jourdonnais. It is of import to note that the court did not grant this defendant's motion for summary judgment until after plaintiff's attorney told the court he could not produce any additional expert witness testimony against Jourdonnais other than that before the court. The record is bare of any testimony of another orthodontist, dentist, medical doctor, or other expert that the professional service rendered plaintiff by this defendant was in any manner improper or negligent. In truth, plaintiff has no complaint as to the orthodontic work, but directs his complaints as to Jourdonnais' diagnosis and his failure to warn plaintiff of the seriousness of the operation called a "partial glossectomy". Before the district court was the deposition of Dr. Morgan Allison, Ohio State University, an internationally recognized oral surgeon. His testimony shows clearly that there was no error in diagnosis by Dr. Jourdonnais and his treatment of plaintiff is a recognized and acceptable method of treatment. Here we have a referring doctor being faulted on the referral, because plaintiff is dissatisfied. We find no case law cited by plaintiff or by our research of the question, that holds a recommendation of a physician to another will subject the latter to liability for the recommendation, absent a showing of partnership or employment or agency. The recommended physician i s treated as an independent contractor, l i a b l e for h i s own t o r t s . Graddy v. N e w Y ~ r k Medical College, 243 N.Y.S.2d 940; Oldis v. La Societe Francaise de Bienfaisance Mutuelle, 130 C.A.2d 461, 279 P.2d 184; Huber v. Protestant Deaconess Hospital Ass'n, 127 Ind.App. 565, 133 N.E.2d 864; Myers v. Holborn, 58 N.J.L. 193, 33 A. 389; 70 C.J.S. Physicians and Surgeons, $54(d), p. 978. W e do not find p l a i n t i f f ' s allegation that defendant Jourdonnais was negligent due t o the lack of informed consent supported by any evidence. Again we can find no case where l i a b i l i t y for f a i l u r e t o inform is found against one other than the physician who undertakes the operation. Here, de- fendant Jourdonnais did not advise p l a i n t i f f on the surgical procedure because he did not have knowledge of it other than reading. H e stated he explained t o p l a i n t i f f that he knew of the procedure having been performed; he knew nothing about it; he did not recommend it; but i f p l a i n t i f f f e l t h i s situation was serious enough in h i s own mind, and he wanted further in- formation on the procedure, then he would put him i n touch with him D r . Wisner. H e told plaintiff he would put/in touch with D r . Wisner for information only. O n t h i s basis he contacted D r . Wisner, made an appointment for p l a i n t i f f , and sent a l l h i s records t o D r . Wisner, The rule is that the physician who pre- pares t o perform a medical or surgical procedure has the obliga- tion t o explain that procedure t o the patient -- not the r e f e r r a l doctor. Watson v. Clutts, 262 N.C. 153, 136 S.E.2d 617; Mitchell v. Robinson, (Mo. 1960), 334 S.W.2d 11; Harwick v. /I @p Harris, ( E l & ; ! 1964), 166 S. 2d 912. The accepted view is that the sufficiency of the physi- cian's disclosure i s a matter t o be measured against acceptable medical practice. Plaintiff is required to produce expert testimony to establish a standard of medical practice and show defendant's deviation from that standard. Zebarth v. Swedish Hospital Medical Center, 81 Wash.2d 12, 499 P.2d 1. The record presented t o the d i s t r i c t court i n the instant case lacks any evidence of a standard for an orthodontist, or of one that refers patients t o another specialist. The testimony of D r . Schultz, an o r a l surgeon of Great Falls, does not supply the standard necessary t o sustain p l a i n t i f f ' s position here. W e find summary judgment proper as t o defendant Jourdonnais. The general fact situation as it relates to D r . Wisner has been heretofore s e t out. H e is a board certified o r a l surgeon who before practicing i n Billings, served a three year residency under D r . Morgan ~ l l i s o n of Ohio State University. D r . Allison i n h i s deposition stated D r . Wisner was fully quali- fied t o perform the "partial glossectomy" and a f t e r reviewing a l l the depositions i n t h i s case, along with the records of the surgical procedure, he found no indication of any improper pro- cedure on the part of D r . Wisner i n performing the operation. With t h i s background i n mind, we review the background of t h i s complaint. The operation was performed i n June 1973. The complaint was f i l e d March 5, 1975. Extensive discovery followed and the t r i a l date of February 2, 1976 was continued t o M a y 17, 1976 t o complete such discovery. Motion for summary judgment was f i l e d and served by defendant Wisner on M a y 7 , 1976. After reviewing the depositions of D r . Schultz and and Dr.~Jourdonnais, which showed that a f t e r examining p l a i n t i f f a f t e r h i s operation they found no residual damage o r evidence t o sustain the problems he complained of, the court granted the motion for summary judgment on May 17, 1976. W e note here that a t the time of the hearing on summary judgment, the attorney for plaintiff did not object t o notice on the hearing of less than the ten days allowed by statute, and admitted that "he had no qualified expert testimony other than the depositions which t h i s Court has read", a l l of which appears i n the t r i a l court's judgment. A l l parties t o t h i s action agree that four cases control the issues before us. Donathan v. McConnell, 121 Mont. 230, 193 P.2d 819; Negaard v. Feda, 152 Mont. 47, 446 P.2d 436; Montana Deaconess Hospital v. Gratton, Mont . - , 545 P. 2d 670, 33 St.Rep. 128, 130, 132; Collins v. Itoh, 160 Mont. 461, 503 P.2d 36. Donathan - established that i n Montana a dentist,. owes the same duty as a physician to h i s patient. I n Gratton t h i s Court held summary judgment i s proper: " I * * * i f the pleadings, depositions, answers t o interrogatories, and admissions on f i l e show that there i s no genuine issue as t o any material f a c t and that the moving party i s entitled t o judgment a s a matter of law. * * *' Rule 56(c), M.R.Civ.P." Also Gratton held that where no genuine issue of fact has been raised that the opposing party has the burden of presenting evidence of material and substantial nature raising such issue, noting that when plaintiff f a i l s t o do so, summary judgment must issue. The question of the establishment of a standard of care against which the acts o r omissions could be measured t o establish negligence i s quoted from Evans v. Bernhard, 23 Ariz.App. 413, 533 P.2d 721,723: I"* * * F i r s t , evidence must be presented t o estab- l i s h : the applicable standard of medical practice i n the particular type of case involved and second, it must also be shown that the doctor negligently departed from t h i s recognized standard i n h i s treat- ment of the p l a i n t i f f . In order t o make t h i s threshold breach of duty actionable,it must then be shown that the breach of duty was the legal cause of the p l a i n t i f f ' s injuries. * * * The medical standard of care must be established by expert medical testimony unless the con- duct complained of i s readily ascertainable by a lay- man. * * * However, third party expert testimony i s not always necessary as t h i s standard can be established by the defendant doctor's own testimony.'" Plaintiff i n relying upon Donathan acknowledges that the rule established there controls t h i s case. I n a l a t e r case, Negaard the duties owed by a dentist were fully set forth, and those principles apply t o the instant case. A t the time of the hearing on summary judgment, plaintiff here was i n the same position a s were the Grattons, appellants i n Montana Deaconess Hospital i n t h e i r appeal t o t h i s Court. Plaintiff complains of numerous factual issues principally relating t o the diagnosis of h i s condition, the procedure used t o correct it, and the treatment given him. I f a l l the questions were resolved i n h i s favor, he s t i l l , could not prevail for he had no qualified expert testimony five days before t r i a l date t o show that defendant Wisner departed from the recognized standard of care i n h i s treatment of p l a i n t i f f . The doctors he alleged as h i s experts were not "deposed" and several indicated no intent t o travel t o Billings t o t e s t i f y on May 17, 1976. Plaintiff stated he intended t o c a l l , as experts, D r s . Baldwin and Roberts of Great Falls, however he previously admitted that D r . Baldwin would not t e s t i f y a t t r i a l or by deposition. Sa a t the time of the summary judgment ruling, he was down t o one possible witness D r . W. J. Roberts, a physician whose testimony was t o provide the standard of care for an oral surgeon. D r . Roberts, a board certified ear, nose and throat specialist, under the standard s e t by t h i s Court in Collins, could not qualify as an expert against D r . Wisner a s to the standard of care that i s usually exercised by an o r a l surgeon. This i s true too as to h i s testimony about the f a c t the tonsils created an infected area i n the oral cavity that could have caused an infection t o the tongue. This Court i n Gratton noted: "The presence of an infection following an operation or open reduction of a fracture does not establish negligence. [Citing cases] .I1 According to h i s deposition, D r . Roberts knew nothing about a p a r t i a l glossectomy u n t i l a f t e r he examined plaintiff before removing h i s tonsils and the only knowledge he had was gained thereafter a f t e r discussing the procedure with oral surgeons i n Great Falls. Plaintiff claims "lack of informed consent1'. There was nothing before the t r i a l court i n way of deposition o r other documents which s e t forth the standard of dental care required of dentists i n informing their patients with respect t o risks that might result from the performance of an operation such as performed on p l a i n t i f f . N o showing was made with respect t o disclosure required of a dental practitioner prior t o the per- formance of a p a r t i a l glossectomy. In so f a r as could be deter- mined, t h i s may have been the f i r s t such operation i n t h i s area. Plaintiff recognizes that under Negaard expert testimony is required t o establish the "informed consent" doctrine, but argues he has carried that burden of proof i n the depositions of Jourdonnais, Wisner, Schultz, Roberts and Allison. A s previously noted, these depositions do not present the necessary testimony from any qualified expert that establishes such standard. W e next consider the blood loss issue. W e find no t e s t i - mony showing the loss of blood during the operation could result i n p l a i n t i f f ' s alleged residual complications. D r . Morgan Allison, defendant's expert, t e s t i f i e d i n h i s deposition that t h i s was unusual bleeding for the p a r t i a l glossectomy on but wentlto s t a t e that plaintiff did not suffer any complications from t h i s loss because of the transfusions he received. W e find no testimony of any of those deposed alleging p l a i n t i f f suffered an* compensable damage o r complication resulting from an abnormal loss of blood. Next we consider p l a i n t i f f ' s allegations the operation was unnecessary and unwarranted. The record is devoid of any testimony supporting these allegations. Some doctors might have proceeded with a different treatment before resorting t o the surgery, but none t e s t i f i e d that it was unnecessary or unwarranted. The choice was one of medical or dental judgment. Plaintiff argues t h i s Court's holding i n Baylor v. <-.- ', . . . - ,>.b ..A- Jacobson, Mont . , W2P.2d 55, 33 St.Rep. 662, is au- thority to allow -him to go t o the jury. H e alleges there was expert testimony o r i t s equivalent i n the record indicating the operation should be performed only a f t e r "everything e l s e fails" and that the operation should not have been performed a t a l l i n t h i s case. W e do not agree. In Baylor the majority found an offer of proof of the required standard of care and the defendant's breach thereof i n the medical testimony of a D r . Robert Tuby whose identity the plaintiff revealed i n an amended answer, filed a day a f t e r the summary judgment. Here, no expert medical testimony is available t o establish any general issue of material fact concerning the required standard of care D r . Wisner allegedly deviated from. I n p l a i n t i f f ' s complaint, as a third cause of action, he alleged he agreed t o pay defendant D r . Wisner $283.20, a s consideration for h i s promise, warranty and performance of the operation. He alleges defendant breached t h i s warranty, but plaintiff shows no reliance on same. The record indicates the amount plaintiff paid for the surgical procedure (the operation) but shows no warranty, While it is the law of Montana that i f the contract was merely that defendant was t o perform a surgical operation, then the law requires that the defendant possess the s k i l l and learning possessed by the average member of h i s profession i n the community and to use those s k i l l s and learning i n a reasonable and prudent manner. He does not become a guarantor of the results of such operation. W e find summary judgment proper as t o defendant Wisner. Plaintiff raises for the f i r s t t i m e on appeal the failure t o give a t least ten days notice of time fixed for hearing the motions on summary judgments a s required by Rule 56(c), M.R. Civ.P. However, p l a i n t i f f f a i l s t o recognize that he must timely object t o the rule requirement. Failure t o do so waives the defect. 10 Wright & Miller, Federal Practice and Procedure: Civil 3 2719, p. 451; 6 Moore's Federal Practice V56,14[1], p. 56-357. Also, p l a i n t i f f failed t o raise h i s objection before the t r i a l court. A n objection raised for the f i r s t time on appeal i s not timely and w i l l not be considered by t h i s Court. Berdine v. Sanders County, 164 Mont. 206, 520 P.2d 650; Carpenter v. Free, 138 Mont. 552, 357 P.2d 882. See also: Rule 61, M.R.Civ.P. The orders of the d i s t r i c t court granting summary judgments a r e affirmed, J u s t i c e s QdkL IJbn. Jack L. Green, D i s t r i c t Judge, Y s i t t i n g f o r ~ u s t i c e Wesley Castles.