Case Title: MONT DEACONESS HOSP v GRATTON

Citation: 

Docket Number: 

State: montana

Court: Montana Supreme Court

Date: 1976-01-22T00:00:00Z

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No. !.3U27 IN 'CHE iUPKh=ME ZOUKT OF THE STAlE 3F 3ONTANA 19 75 MUN'MNA MACONESS HOSPlTAL, a Non-Prof it Corporation, P l a i n t i f f and Respondent, GEORGE 3, SKATTON, Defendant and Counterclaimant and Appellant, GEK'IRUDE G R A T T O N , P l a i n t i f f and Counterclaimant and Appellant, J U D I T H GRAHAM, M.D., and J . C . W O L G A M O T , M.D., Additonal Defendants on Counterclaim and Respondent. AppeaL f r o m ; D i s t r i c t Court of t h e Eighth J u d i c i a l D i s t r i c t , Honorable Truman G . Bradford, Judge presiding. Counsel of Record: For Appellants : McKittrick and Duffy, Great F a l l s , Montana Joseph W. Duffy argued and P a t r i c k McKittrick, appeared, Great F a l l s , Montana For Respondents : Jardine, Stephenson, B l e w e t t and Weaver, Great F a l l s , Montana John D. Stephenson, Jr. argued, Great F a l l s , Montana Smith, Emmons and B a i l l i e , Great F a l l s , Montana William L. B a i l l i e argued, Great F a l l s , Montana Church, Harris, Johnson and W i l l i a n ~ s , Great F a l l s , Montana Submitted: December 10, 1975 M r . J u s t i c e Frank I. Haswell delivered t h e Opinion of t h e Court. A p a t i e n t and h i s wife appeal from a summary judgment a g a i n s t them i n t h e i r medical malpractice claim a g a i n s t two doctors and a h o s p i t a l . The summary judgment was entered i n t h e d i s t r i c t c o u r t of Cascade County by Hon. Truman G. Bradford, d i s t r i c t judge. Appellants a r e George B. Gratton, t h e p a t i e n t , and Gertrude Gratton, h i s wife. Respondents a r e two Great F a l l s doctors, J u d i t h Graham, M.D. and J. C. Wolgamot, M.D., and t h e Montana Deaconess Hospital, a nonprofit corporation. O n June 1 4 , 1970, Gratton f e l l and f r a c t u r e d h i s r i g h t shoulder. H e was h o s p i t a l i z e d a t t h e Montana Deaconess Hospital i n Great F a l l s from June 1 4 t o June 30 during which t i m e D r . Wolgamot, an orthopedic surgeon, performed an open reduction of t h e f r a c t u r e . During t h i s h o s p i t a l i z a t i o n D r . Graham a l s o t r e a t e d Gratton f o r a pre-existing s e i z u r e d i s o r d e r . A t t h e t i m e Gratton was discharged from t h e h o s p i t a l on June 30 h i s s u r g i c a l wound appeared t o be healed. During t h e next two months, Gratton was seen p e r i o d i c a l l y by both D r . Graham and D r . Wolgamot. Gratton was r e h o s p i t a l i z e d on September 1 0 following t h e breaking and draining of what appeared t o be a b o i l i n t h e a r e a of t h e s u r g i c a l i n c i s i o n . Cul- t u r e s taken from t h e drainage revealed a staph i n f e c t i o n and l a t e r showed t h e presence of a pseudomonas organism. Gratton remained h o s p i t a l i z e d u n t i l October 16 during which time he was t r e a t e d by D r . Wolgamot and was a l s o seen from time t o time by D r . Graham. Following h i s discharge from t h e h o s p i t a l t h e second time, G r a t t o n ' s i n f e c t i o n p e r s i s t e d . Gratton was h o s p i t a l i z e d a t h i r d time from November 18 t o November 2 4 . Later Gratton was t r e a t e d a t t h e Mayo C l i n i c i n Rochester, Minnesota, but he claims h i s r i g h t arm i s s t i l l disabled. I n June, 1971, t h e h o s p i t a l sued Gratton f o r t h e balance of $546.40 a l l e g e d l y owing from G r a t t o n ' s t h i r d h o s p i t a l i z a t i o n . Gratton answered claiming t h e h o s p i t a l overcharged f o r its f a c i l i t i e s and s e r v i c e s and t h a t t h e s o l e reason f o r h i s second and t h i r d periods of h o s p i t a l i z a t i o n was t h e i n f e c t i o n caused by t h e h o s p i t a l ' s negligence during h i s f i r s t h o s p i t a l i z a t i o n . Gratton a l s o counterclaimed f o r damages a g a i n s t t h e h o s p i t a l and doctors based on medical malpractice i n an amount exceeding $100,000. Gertrude Gratton a l l e g e s a claim a g a i n s t t h e d o c t o r s and t h e h o s p i t a l based on medical malpractice i n an amount i n excess of $75,000. Extensive discovery was undertaken by a l l p a r t i e s con- s i s t i n g of depositions, i n t e r r o g a t o r i e s and answers, r e q u e s t s f o r admissions, and production of medical records f o r i n s p e c t i o n and copying f o r a period of approximately 3-1/2 years. On March 5, 1975, t h e d i s t r i c t c o u r t granted summary judgment t o t h e two doctors and t h e h o s p i t a l on a p p e l l a n t ' s claim of medical m a l - p r a c t i c e , leaving t h e h o s p i t a l ' s o r i g i n a l a c t i o n f o r c o l l e c t i o n of t h e balance of t h e h o s p i t a l b i l l undisturbed. The Grattons appeal from t h i s summary judgment. The i s s u e on appeal i s whether t h i s summary judgment i s c o r r e c t . Summary judgment is proper: " * * * i f t h e pleadings, depositions, answers t o i n t e r r o g a t o r i e s , and admissions on f i l e show t h a t t h e r e is no genuine i s s u e a s t o any m a t e r i a l f a c t and t h a t t h e moving p a r t y i s e n t i t l e d t o judgment a s a matter of l a w . * * *" Rule 5 6 ( c ) , M.R.Civ.P. Here a review of t h e record before t h e d i s t r i c t c o u r t d i s c l o s e s no genuine i s s u e of m a t e r i a l f a c t . The Grattons have pointed o u t numerous f a c t u a l i s s u e s p r i n c i p a l l y r e l a t i n g t o t h e t i m e of t h e i n f e c t i o n , its source, t h e diagnosis of G r a t t o n ' s condition, and t h e treatment given him. I f a l l t h e s e questions were u l t i m a t e l y resolved i n favor of t h e Grattons, they s t i l l could n o t p r e v a i l . Hence, they a r e n o t m a t e r i a l f a c t s i n t h e context of t h e case before us. What i s missing here i s evidence of any standard of c a r e a g a i n s t which t h e acts o r omissions of t h e doctors o r t h e h o s p i t a l s t a f f can be measured t o e s t a b l i s h negligence on t h e p a r t of e i t h e r . When t h e record d i s c l o s e s no genuine i s s u e of m a t e r i a l f a c t , t h e p a r t y opposing summary judgment has t h e burden of pre- s e n t i n g evidence of a m a t e r i a l and s u b s t a n t i a l n a t u r e r a i s i n g a genuine i s s u e of material f a c t . Rickard v . Paradis, Mont . , 539 P.2d 718, 32 St.Rep. 834; Roope v. The Anaconda Co., 159 Mont. 28, 494 P.2d 922. The Grattons have f a i l e d t o c a r r y t h i s burden and have not met t h e i r i n i t i a l e v i d e n t i a r y o b l i g a t i o n s . I n Evans v. Bernhard, 23 Ariz.App. 413, 533 P.2d 721, t h e c o u r t granted summary judgment i n favor of a general p r a c t i - t i o n e r on t h e b a s i s of absence of any proof of a standard of medical care, observing t h a t i n a malpractice case t h e p l a i n t i f f ' s threshhold o b l i g a t i o n involves two e v i d e n t i a r y s t e p s : " F i r s t , evidence must be presented t o e s t a b l i s h t h e a p p l i c a b l e standard of medical p r a c t i c e i n t h e p a r t i c u l a r type of case involved and second, it must a l s o be shown t h a t t h e doctor n e g l i g e n t l y departed from t h i s recognized standard i n h i s treatment of t h e p l a i n t i f f . I n o r d e r t o make t h i s threshhold breach of duty a c t i o n a b l e , it must then be shown t h a t t h e breach of duty w a s t h e l e g a l cause of t h e p l a i n t i f f ' s i n j u r i e s . S t a l l c u p v. Coscarart, 79 Ariz. 4 2 , 46, 282 P.2d 791, 793 (1955). The medical standard of c a r e must be established by expert medical testi- mony u n l e s s t h e conduct complained of i s r e a d i l y a s c e r t a i n a b l e by a layman. Kalar v. MacCollum, 17 Ariz.App. 176, 496 P.2d 602 (1972). However, t h i r d p a r t y e x p e r t testimony i s n o t always neces- s a r y a s t h i s standard can be e s t a b l i s h e d by t h e defendant d o c t o r ' s own testimony. V i r g i l v. H e r - man, 102 Ariz. 31, 424 P.2d 159 (1967)." The cause of an i n f e c t i o n is not r e a d i l y a s c e r t a i n a b l e by a layman and t h e Grattons have not presented expert medical proof es- t a b l i s h i n g t h e required standard of medical care. The testi- mony e l i c i t e d from D r s . Wolgamot and Graham a s t o t h e i r treat- ment of Gratton as w e l l a s t h e i r p a s t experience with i n f e c t i o n s has not e s t a b l i s h e d a standard of medical care o r a d e v i a t i o n therefrom. A defendant d o c t o r ' s testimony a s t o h i s u s u a l personal p r a c t i c e is n o t s u f f i c i e n t t o e s t a b l i s h a general medi- c a l standard of c a r e . Also, t h e personal and i n d i v i d u a l method of p r a c t i c e of t h e defendant doctor i s n o t s u f f i c i e n t t o estab- l i s h a b a s i s f o r an inference t h a t he has n e g l i g e n t l y departed from t h e general medical custom and p r a c t i c e of h i s community. Bernhard, supra. Also, s e e C o l l i n s v. I t o h , 160 Mont. 461, 469, 503 P.2d 36; Karrigan v. Nazareth Convent & Academy, Inc., 212 Kan. 4 4 , 50, 510 P.2d 190; Downer v. Veilleux, ( M e . 1974),322 A.2d 82, 88; Davis v. Virginian R. Co., 361 U.S. 354, 80 S.Ct. 387, 4 L ed 2d 366. A s t h e Grattons have f a i l e d t o p r e s e n t any evidence t h a t would e s t a b l i s h t h e a p p l i c a b l e standard of medical care; t h a t such a standard was departed from; and t h a t a breach of d u t y w a s t h e proximate cause of G r a t t o n ' s i n j u r y ; t h e h o s p i t a l and d o c t o r s a r e e n t i t l e d t o summary judgment as a matter of law. The Grattons seek t o e s t a b l i s h a presumption of negligence through a p p l i c a t i o n of t h e d o c t r i n e of res i p s a l o q u i t u r . This d o c t r i n e i s i n a p p l i c a b l e i n t h e ordinary malpractice a c t i o n . See Negaard v. Feda, 152 Mont. 4 7 , 446 P.2d 436; Vonault v. O'Rourke, 97 Mont. 92, 33 P.2d 535. The elements necessary f o r t h e a p p l i c a t i o n of r e s i p s a l o q u i t u r a r e a s follows: (1) The i n s t r u m e n t a l i t y which caused t h e i n j u r y must be within t h e exclusive c o n t r o l of t h e defendant; ( 2 ) t h e i n j u r y must be one t h a t does n o t o r d i n a r i l y occur i f t h e p a r t y i n c o n t r o l uses proper c a r e ; (3) t h e i n j u r y must n o t be due t o any f a u l t on t h e p a r t of t h e i n j u r e d person. Jackson v. W i l l i a m Dingwall Co., 145 Mont. 127, 399 P.2d 236; Krohrner v. Dahl, 145 Mont. 491, 402 P.2d 979; Stocking v. Johnson Flying Service, 143 Mont. 61, 387 P.2d 312; Prosser, Law of T o r t s , 4 t h ed., p. 214. I n t h e i n s t a n t c a s e t h e r e is no evidence t o e s t a b l i s h t h a t t h e i n s t r u m e n t a l i t y causing t h e i n f e c t i o n was within t h e exclusive c o n t r o l of t h e defendants. D r s . Wolgamot and Graham t e s t i f i e d t h a t t h e i n f e c t i o n could have o r i g i n a t e d from any number of d i f f e r e n t sources, e.g. blood borne i n f e c t i o n , d i r e c t contamination from t h e patient's skin, o r a s a r e s u l t of a trau- matic i n j u r y . Therefore, t h e i n s t r u m e n t a l i t y causing t h e in- f e c t i o n was not n e c e s s a r i l y within t h e exclusive c o n t r o l of t h e h o s p i t a l and doctors. I n Chase v. Haber, 221 C.A.2d 569, 34 Cal.Rptr. 605, it w a s held t h a t severely i n f e c t e d abscesses appearing a t t h e site of i n j e c t i o n s f o r t h e treatment of pneumonia were n o t caused by an agency o r i n s t r u m e n t a l i t y within t h e ex- c l u s i v e c o n t r o l of t h e defendant a s t h e abscesses could e a s i l y have o r i g i n a t e d from another source. A bad r e s u l t alone does n o t c o n s t i t u t e evidence o r r a i s e a presumption o r inference of negligence. The d o c t r i n e of r e s i p s a l o q u i t u r i s not a p p l i c a b l e i n a malpractice a c t i o n from t h e m e r e f a c t t h a t an i n f e c t i o n developed i n t h e a r e a of treatment. 162 A.L.R. 1265, 1284, 82 ALR2d 1262, 1298. The presence of an i n f e c t i o n following an operation o r open reduction of a f r a c t u r e does n o t e s t a b l i s h negligence. ~ a r m a v. Rust, 420 S.W.2d 563, (Ky. 1967); P f e i f e r v. Konat, 181 Neb. 30,146 N.W.2d 743; Starnes v. Taylor, 272 N.C. 386, 158 S.E.2d 339; Smith v. Curran, 28 Colo.App. 358, 472 P.2d 769; Steinmetz v. Humphrey, 289 Ky. 709, 160 S.W.2d 6; Haliburton v. General Hosp. Soc. of Connecticut, 133 Conn. 61, 48 A.2d 261, 20 N.C.C.A., N.S. 505; Lorenz v. Booth, 84 Wash. 550, 147 P. 31. Gertrude Gratton a d d i t i o n a l l y a s s e r t s t h a t she is en- t i t l e d t o summary judgment a g a i n s t D r s . Wolgamot and Graham a s a matter of law based on an admission of negligence contained i n t h e i r answer. W e do n o t so construe t h e pleadings. W e have examined t h e counterclaim and answer and f i n d t h a t such a con- s t r u c t i o n of t h e answer i s s t r a i n e d and a t odds with t h e i r en- t i r e defense as appearing i n t h e record. F i n a l l y t h e Grattons seek t o e s t a b l i s h noncompliance by t h e doctors and t h e h o s p i t a l with o r d e r s of t h e c o u r t covering answers t o i n t e r r o g a t o r i e s and production of records. S u f f i c e it t o say t h a t t h i s i s n o t a bona f i d e i s s u e on appeal i n t h e i n s t a n t case. I n any event a l l discovery must come t o an end sometime and 3-1/2 years seems an adequate allowance of time. The d i s t r i c t c o u r t ordered a l l discovery completed by December 1, 1974. The Grattons simply w e r e unable t o produce any evidence of malpractice i n 3-1/2 y e a r s and t h e i r claim must f a i l . The summary judgment of t h e d i s t r i c t c o u r t i s affirmed. This cause is remanded t o t h e d i s t r i c t c o u r t f o r f u r t h e r proceed- i n g s on t h e claim of t h e h o s p i t a l a g a i n s t t h e Grattons f o r pay- ment of t h e balance of t h e h o s p i t a l b i l l . J u s t i c e concur : Chief J u s t i c e