Title: Skaggs v. Johnson

State: arkansas

Issuer: Arkansas Supreme Court

Document:

Mary SKAGGS and James Skaggs v. Philip
JOHNSON, M.D., and Richard Nix, M.D.,
Individuals, and Little Rock Orthopedic &
Sports Medical Center

95-982                                             ___ S.W.2d ___

                    Supreme Court of Arkansas
               Opinion delivered February 12, 1996


1.   Appeal & error -- summary judgment -- standard of review. -- 
     When reviewing summary judgment, the appellate court need only 
     decide if the granting of summary judgment was appropriate   
     based on whether the evidentiary items presented by the moving 
     party in support of the motion left a material question of
     fact unanswered.

2.   Judgment -- summary judgment -- burden of sustaining motion on
     moving party -- proof viewed in light most favorable to party
     resisting motion. -- The burden of sustaining a motion
     for summary judgment is always the responsibility of the
     moving party; all proof submitted must be viewed in a light
     most favorable to the party resisting the motion, and any
     doubts and inferences must be resolved against the moving
     party.

3.   Judgment -- summary judgment -- when proper. -- Summary
     judgment is proper when a claiming party fails to show that
     there is a genuine issue as to a material fact and when the
     moving party is entitled to summary judgment as a matter of
     law. 

4.   Negligence -- medical malpractice -- elements necessary to
     sustain claim. -- To sustain a claim for medical malpractice
     a plaintiff must prove, among other elements, the applicable
     standard of care and the defendant's breach of it; the
     standard of care applicable to a case is defined by Ark. Code
     Ann.  16-114-206(a)(1) (1987) as "the degree of skill and
     learning ordinarily possessed and used by members of the
     profession of the medical care provider in good standing,
     engaged in the same type of practice or specialty in the
     locality in which he practices or in a similar locality." 

5.   Negligence -- when expert testimony is required. -- A
     plaintiff must present expert testimony when the asserted
     negligence does not lie within the jury's comprehension as a
     matter of common knowledge, when the applicable standard of
     care is not a matter of common knowledge, and when the jury
     must have the assistance of experts to decide the issue of
     negligence.  

6.   Negligence -- medical malpractice -- doctors made conscious
     medical decision to leave foreign object in appellant's leg. -
     - expert testimony required. -- The supreme court determined
     that appellee doctors made a conscious medical decision to
     leave a piece of penrose-drain tube in appellant's leg; thus,
     the present case was distinguishable from typical foreign-
     object cases that involve the inadvertent leaving of objects
     in a patient's body and do not involve a physician's judgment;
     the supreme court therefore concluded that this case presented
     an issue outside the jury's common knowledge that required
     expert testimony.

7.   Negligence -- medical malpractice -- appellees met burden of
     proving prima facie case for summary judgment -- appellants
     failed to show disputed issue of fact existed -- order of
     dismissal affirmed. -- The supreme court agreed with the trial
     court's finding that the opinion expressed in a deposition by
     a physician who stated that the piece of penrose-drain tube
     left in appellant's leg probably caused her infection and
     should have been removed was general and based on his
     experience as an infectious-disease expert and did not address
     a surgical decision by an orthopedist; the physician did not
     offer testimony that the conduct of appellee doctors fell
     below the standard of care for orthopedic surgeons in Little
     Rock; to the contrary, the physician stated in his deposition
     that it was a surgical decision whether to remove the piece of
     tubing; the supreme court held that appellees met their burden
     of proving a prima facie case for summary judgment by showing
     that appellants had no expert to testify as to the breach of
     the applicable standard of care; the burden shifted to
     appellants to show that a disputed issue of fact existed, and
     their failure to do so excused the need for appellee
     physicians to show a lack of proof on the element of proximate
     causation; accordingly, the appellate court affirmed the trial
     court's order of dismissal.


     Appeal from Pulaski Circuit Court, Sixth Division; David
Bogard, Judge; affirmed.
     Satterfield Law Firm, by: G. Randolph Satterfield and Diana
Hamilton Turner, for appellants.
     Friday, Eldredge & Clark, by: Guy Alton Wade and Clifford W.
Plunkett, for appellees.

     Bradley D. Jesson, Chief Justice. 02/12/96 *ADVREP1*







MARY SKAGGS and JAMES SKAGGS,
                    APPELLANTS,

V.

PHILIP JOHNSON, M.D., and
RICHARD NIX, M.D., Individuals
and LITTLE ROCK ORTHOPEDIC &
SPORTS MEDICAL CENTER,
                    APPELLEES,





95-982


APPEAL FROM THE PULASKI COUNTY
CIRCUIT COURT, SIXTH DIVISION
(94-2327)


HONORABLE DAVID BOGARD
CIRCUIT JUDGE




AFFIRMED.

                Bradley D. Jesson, Chief Justice




     This is a medical malpractice case.  Appellants Mary and James
Skaggs appeal from a trial court's order granting summary judgment
in favor of appellees, Drs. Philip Johnson and Richard Nix and the
Little Rock Orthopedic & Sports Medical Clinic.  On appeal, the
Skaggses argue that the trial court erred in granting summary
judgment and in ruling that expert testimony was necessary to meet
their burden of proof.  We affirm.
     Mary Skaggs was in an automobile accident and suffered a
compound fracture of her right leg on September 21, 1992. 
Approximately one inch of bone was exposed, and the wound was
extremely dirty from the accident.  Dr. Philip Johnson, an
orthopedic surgeon at Little Rock Orthopedic & Sports Medical
Clinic ("the Clinic"), performed surgery on Mary's leg to repair
the fracture.  A penrose drain tube was placed in her leg to drain
any infectious materials from the wound.  Three days after the
surgery, appellee Dr. Richard Nix, another orthopedic surgeon at
the Clinic, was making rounds and pulled the penrose drain tube out
of Mary's leg.  He experienced difficulty in removing the drain and
believed that a portion of it could have been left inside.  Both
surgeons decided to leave the piece of tube inside Mary's leg, as
they believed that irrigating and probing the wound further could
cause greater potential for infection.  Mary was discharged.
     Dr. Johnson continued to treat Mary during subsequent visits. 
On December 22, 1992, early union of the bones in her leg became
apparent.  One month later, redness and swelling were noted, and
Mary was treated with oral antibiotics.  On March 15, 1993, Mary
underwent surgery, during which a five millimeter piece of penrose
drain tube was removed from her leg.  Dr. John Schultz, a lung and
infectious disease specialist, was consulted to administer
antibiotics. 
     On March 7, 1994, Mary Skaggs and her husband, John Skaggs,
filed a complaint against Drs. Johnson and Nix and the Clinic,
alleging medical malpractice.  They claimed that the doctrine of
res ipsa loquitur applied on the basis that the portion of the
penrose drain tube left in Mary's leg was a foreign object within
the exclusive control of the defendants.  The Skaggses claimed that
Mary suffered osteomyelitis, an infection of the bone.        
     The physicians and the Clinic filed a motion for summary
judgment on April 28, 1995.  Attached to the motion along with
pleadings and medical records were the affidavits of Drs. Johnson,
Nix, and Michael Weber, an expert orthopedic surgeon, all of whom
refuted the Skaggses' allegations of negligence and proximate
cause.  Particularly, Dr. Weber averred that he was aware of the
degree of skill and learning ordinarily possessed and used by
members in the medical profession in good standing engaged in the
practice of orthopedic surgery in Little Rock.  Based on his review
of the case, it was Dr. Weber's opinion that Drs. Johnson and Nix
used and applied their best judgment with reasonable care.  Dr.
Weber found no evidence of negligence or proximate causation.  
     In response, the Skaggses maintained that no expert testimony
was necessary.  The Skaggses also pointed to the deposition of Dr.
Schultz, in which he averred that the piece of penrose drain left
in Mary's leg probably caused her infection and should have been
removed.  Following a hearing, the trial court granted the
appellees' motion for summary judgment.  In making its ruling, the
trial court acknowledged Dr. Schultz's opinion; however, it
concluded that, while his opinion was general and based on his
opinion as an infectious disease expert, it did not address the
surgical decision by an orthopedist.  The trial court entered an
order dismissing the case, from which the Skaggses now appeal.   
     Our standards for summary judgment review can be summarized as
follows: 
    In these cases, we need only decide if the granting of 
    summary judgment was appropriate based on whether the 
    evidentiary items presented by the moving party in 
    support of the motion left a material question of fact 
    unanswered.  Nixon v. H & C Elec. Co., 307 Ark. 154,