Source: https://law.justia.com/cases/california/supreme-court/3d/17/399.html
Timestamp: 2019-04-18 20:37:03+00:00

Document:
Caputo & Liccardo, Caputo, Liccardo & Rossi, Richard P. Caputo and Richard J. Kohlman for Plaintiff and Appellant.
In this medical malpractice action plaintiff Gita Landeros, a minor, appeals from a judgment of dismissal entered upon an order sustaining general demurrers to her amended complaint. As will appear, we have concluded that the complaint states a cause of action and hence that the judgment must be reversed.
The material factual allegations of the amended complaint are as follows. Plaintiff was born on May 14, 1970. On repeated occasions during the first year of her life she was severely beaten by her mother and the latter's common law husband, one Reyes. On April 26, 1971, when plaintiff was 11 months old, her mother took her to the San Jose Hospital for examination, diagnosis, and treatment. The attending physician was defendant Flood, acting on his own behalf and as agent of defendant San Jose Hospital. At the time plaintiff was suffering from a comminuted spiral fracture of the right tibia and fibula, which gave the appearance of having been caused by a twisting force. fn. 2 Plaintiff's mother had no explanation for this injury. Plaintiff also had bruises over her entire back, together with superficial abrasions on other parts of her body. In addition, she had a nondepressed linear fracture of the skull, [17 Cal. 3d 406] which was then in the process of healing. fn. 3 Plaintiff demonstrated fear and apprehension when approached. Inasmuch as all plaintiff's injuries gave the appearance of having been intentionally inflicted by other persons, she exhibited the medical condition known as the battered child syndrome.
It is alleged that proper diagnosis of plaintiff's condition would have included taking X-rays of her entire skeletal structure, and that such procedure would have revealed the fracture of her skull. Defendants negligently failed to take such X-rays, and thereby negligently failed to diagnose her true condition. It is further alleged that proper medical treatment of plaintiff's battered child syndrome would have included reporting her injuries to local law enforcement authorities or juvenile probation department. Such a report would have resulted in an investigation by the concerned agencies, followed by a placement of plaintiff in protective custody until her safety was assured. Defendants negligently failed to make such report.
The complaint avers that as a proximate result of the foregoing negligence plaintiff was released from the San Jose Hospital without proper diagnosis and treatment of her battered child syndrome, and was returned to the custody of her mother and Reyes who resumed physically abusing her until she sustained traumatic blows to her right eye and back, puncture wounds over her left lower leg and across her back, severe bites on her face, and second and third degree burns on her left hand.
With respect to damages the complaint alleges that as a proximate result of defendants' negligence plaintiff suffered painful permanent [17 Cal. 3d 407] physical injuries and great mental distress, including the probable loss of use or amputation of her left hand.
The second and third "causes of action" are predicated on defendants' failure to comply with three related sections of the Penal Code. Section 11160 provides in relevant part that every hospital to which any person is brought who is suffering from any injuries inflicted "in violation of any penal law of this State" fn. 4 must report that fact immediately, by telephone and in writing, to the local law enforcement authorities. Section 11161 imposes the identical duty on every physician who has under his care any person suffering from any such injuries. Section 11161.5 deals specifically with child abuse, and declares in pertinent part that in any case in which a minor is under a physician's care or is brought to him for diagnosis, examination or treatment, and "it appears to the physician" from observation of the minor that the latter has any physical injuries "which appear to have been inflicted upon him by other than accidental means by any person," he must report that fact by telephone and in writing to the local law enforcement authorities and the juvenile probation department. fn. 5 All three sections require the report to state the name of the victim, if known, together with his whereabouts and the character and extent of his injuries; and a violation of any of the sections is a misdemeanor (§ 11162).
By means of allegations phrased largely in the statutory language plaintiff undertakes to charge defendants with a duty to comply with section 11161.5 (second "cause of action") and sections 11160 and 11161 (third "cause of action"), and avers that they failed to make the reports thus required by law. Her allegations of proximate cause and damages on these counts are essentially identical to those of the first count.
[4a] The first question presented, accordingly, is whether the foregoing standard of care includes a requirement that the physician know how to diagnose and treat the battered child syndrome.
[6b] We cannot say categorically that an ordinarily prudent physician who had correctly diagnosed that plaintiff was a victim of the battered child syndrome would not have foreseen the likelihood of further serious injuries to her if she were returned directly to the custody of her caretakers. On the contrary, it appears from the professional literature that one of the distinguishing characteristics of the battered child syndrome is that the assault on the victim is not an isolated, atypical event but part of an environmental mosaic of repeated beatings and abuse that will not only continue but will become more severe unless there is appropriate medicolegal intervention. fn. 9 If the risk of a resumption of physical abuse is thus a principal reason why a doctor's failure to diagnose and treat the battered child syndrome constitutes negligence, under section 449 of the Restatement the fact that the risk eventuates does not relieve him of responsibility.
[9a] There remain for consideration plaintiff's allegations that defendants violated Penal Code sections 11160, 11161, and 11161.5, summarized hereinabove, requiring doctors and hospitals to report certain injuries to the authorities.  As noted at the outset, the complaint separately sets forth these violations as the second and third "causes of action." In fact, plaintiff has only one cause of action because only one of her primary rights has been invaded -- her right to be free from bodily harm: "There was one injury and one cause of action. A single tort can be the foundation for but one claim for damages. [Citations.]" (Panos v. Great Western Packing Co. (1943) 21 Cal. 2d 636, 638-639 [134 P.2d 242].) The charged statutory violations constitute simply an alternative legal theory in support of plaintiff's cause of action for personal injuries. Alternative theories of common law negligence and statutory liability may be pleaded in a single count (Coleman v. City of Oakland (1930) 110 Cal. App. 715, 721 [295 P. 59]) or in separate counts (3 Witkin, Cal. Procedure (2d ed. 1971) Pleading, § 296, p. 1969); or the statutory basis of liability need not be pleaded at all, as the trial court is required to take judicial notice of acts of the Legislature (Evid. Code, § 451, subd. (a)).
 Finally, defendants raise two questions of statutory interpretation. They contend that even if plaintiff may rely on Penal Code section 11161.5 in this case, she cannot invoke sections 11160 and 11161 because the latter are "general" statutes which have assertedly been superseded by the former as a "special" statute on the same topic. But such supersession occurs only when the provisions are "inconsistent" (Code Civ. Proc., § 1859), which is not here the case. Sections 11160 and 11161.5 are directed to different classes of persons, and hence are not inconsistent but complementary. Sections 11161 and 11161.5, on the other hand, are duplicative of each other to the extent that the former deals with physical injuries unlawfully inflicted on minors and the latter deals with the observation of such injuries by a physician. (See generally Note, The California Legislative Approach to Problems of Willful Child Abuse (1966) 54 Cal.L.Rev. 1805, 1814-1815.) But inasmuch as the same penalty is provided for a violation of each section (Pen. Code, § 11162), they do not present an irreconcilable conflict requiring one to give way to the other. (Compare People v. Gilbert (1969) 1 Cal. 3d 475, 479-480 [82 Cal. Rptr. 724, 462 P.2d 580], and cases cited.) There is nothing to prevent the Legislature from imposing a reporting requirement on physicians in two separate statutes, even if their coverage apparently overlaps.
 Defendants next contend that plaintiff can rely on section 11161.5 only if she can prove that Dr. Flood in fact observed her various injuries and in fact formed the opinion they were caused by other than accidental means and by another person -- in other words, that his failure to comply with the reporting requirement of the statute was intentional rather than negligent. We first note that the complaint in effect so alleges, [17 Cal. 3d 415] thereby mooting the issue at this pleading stage. For the guidance of the court at the trial, however, we briefly address the point of proof.
Wright, C. J., McComb, J., Tobriner, J., Sullivan, J., Clark, J., and Richardson, J., concurred.
FN 1. On this appeal plaintiff has expressly abandoned her claim of punitive damages.
FN 3. A nondepressed linear skull fracture is ordinarily detectable only by X-ray examination.
FN 5. The statute imposes the same duty on certain other health care professionals, school officials and teachers, child care supervisors, and social workers.
FN 6. A typical article in the field recites case histories of child abuse, points out the distinguishing signs and symptoms of the battered child syndrome, and advises the practicing physician how to detect and treat the condition. For a detailed survey of the medical literature on the topic from its beginning until 1965, see McCoid, The Battered Child and Other Assaults Upon the Family: Part One (1965) 50 Minn.L.Rev. 1, 3-19. A selection of the later articles is cited in Grumet, The Plaintive Plaintiffs: Victims of the Battered Child Syndrome (1970) 4 Family L.Q. 296, passim.
FN 8. Whether the physician would have followed the procedure of reporting plaintiff's injuries to the authorities, however, is not solely a question of good medical practice. The above-cited reporting statutes (Pen. Code, §§ 11160-11161.5) were in force in 1971. They evidence a determination by the Legislature that in the event a physician does diagnose a battered child syndrome, due care includes a duty to report that fact to the authorities. In other words, since the enactment of these statutes a physician who diagnoses a battered child syndrome will not be heard to say that other members of his profession would not have made such a report. The same is true of each of the persons and entities covered by this legislation. Accordingly, although expert testimony on the issue of a duty to report is admissible, it is not mandatory.
The statute also lays to rest defendant Flood's concern that if he were required to report his findings to the authorities he might be held liable for violation of the physician-patient privilege. (Evid. Code, § 992.) Section 11161.5 specifically exempts the physician from any civil or criminal liability for making a report pursuant to its terms.
Defendants complain that the first "cause of action" is nevertheless fatally defective because it assertedly fails to allege certain specific facts, i.e., that Dr. Flood negligently treated plaintiff's leg fracture, that proper treatment of that fracture or the bruises on plaintiff's back included taking an X-ray of her skull, and that Dr. Flood negligently failed to ask plaintiff's mother for an explanation of the cause of the fracture. None of these allegations is necessary, however, because they are irrelevant to the gist of the complaint. Plaintiff's theory is that in the circumstances of this case the fracture, the bruises, and the lack of an explanation offered by her mother are themselves indicia of the underlying battered child syndrome of which plaintiff was the victim, and it was that condition which defendants negligently failed to diagnose and treat. For the reasons stated, the complaint adequately alleges the facts necessary to support such a theory.
FN 9. See, e.g., Kempe et al., The Battered-Child Syndrome (1962) 181 A.M.A.J. 17, 24, quoted in footnote 7, ante; Boardman, A Project to Rescue Children from Inflicted Injuries (1962) 7 Soc. Work 43, 49 ("Experiences with the repetitive nature of injuries indicate that an adult who has once injured a child is likely to repeat. ... [T]he child must be considered to be in grave danger unless his environment can be proved to be safe"); Fontana et al., The "Maltreatment Syndrome" in Children (1963) 269 New England J. Med. 1389, 1393 ("over 50 per cent of these children are liable to secondary injuries or death if appropriate steps are not taken to remove them from their environment"); Friedman, The Need for Intensive Follow-Up of Abused Children, in Helping the Battered Child and his Family (Kempe & Helfer eds. 1972) chapter 6, page 79 ("it would appear from our investigations that the severe permanent damage associated with the 'battered child syndrome' usually does not occur with the initial incident. [Fns. omitted.] Identification of abuse at this time thus offers an opportunity for intervention with the goal of preventing subsequent trauma and irreversible injury to the child").
"(1) The person violating the statute, ordinance, or regulation did what might reasonably be expected of a person of ordinary prudence, acting under similar circumstances, who desired to comply with the law; ..."
FN 13. By parity of reasoning, the same rule will apply if plaintiff elects to rely at trial on sections 11160 and 11161 as well.
This does not mean, of course, that plaintiff can meet her burden only by extracting damaging admissions from defendant Flood. "The knowledge a person may have when material to an issue in a judicial proceeding is a fact to be proven as any other fact. It differs from physical objects and phenomena in that it is a state of mind like belief or consciousness and cannot be seen, heard or otherwise directly observed by other persons. It may be evidenced by the affirmative statement or admission of the possessor of it. If he is silent or says he did not have such knowledge, it may be evidenced in other ways," i.e., by circumstantial evidence and the inferences which the trier of fact may draw therefrom. (Oil Workers Intl. Union v. Superior Court (1951) 103 Cal. App. 2d 512, 532-533 [230 P.2d 71].) Plaintiff will therefore be entitled to introduce proof of facts alleged in her complaint as circumstantial evidence that defendant Flood possessed the requisite state of mind, and any conflict between such evidence and direct testimony of defendant Flood will be for the trier of fact to resolve.

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