Source: https://law.justia.com/cases/california/court-of-appeal/3d/12/1062.html
Timestamp: 2019-04-25 02:25:26+00:00

Document:
Cushing, Cullinan, Hancock & Rothert, John Lockley, Bledsoe, Smith, Cathcart, Johnson & Rogers, Robert A. Seligson, Anthony Dougherty, Clark, Heafey & Martin, Chris G. Gasparich and P. Gerhardt Zacher for Defendants and Respondents.
In this action for damages for personal injuries brought by plaintiff against Clay Adams, Incorporated, a corporation (hereinafter referred to as Clay Adams"), H. W. Paley (hereinafter referred to as "Dr. Paley"), and Mount Zion Hospital and Medical Center, a nonprofit corporation (hereinafter referred to as the "Hospital"), plaintiff appeals from a judgment of nonsuit in favor of Clay Adams and a judgment upon a verdict in favor of Dr. Paley and the Hospital in a case tried before a jury.
Plaintiff, with a history of a heart ailment, entered the Hospital for the purpose of undergoing a heart catheterization procedure. This procedure was diagnostic in nature and for the purpose of determining the extent of aortic insufficiency. Plaintiff testified that she underwent such operation without any explanation of what precisely was involved or the attendant risks. However, plaintiff also stated that she told Dr. Paley, who performed the procedure, that she preferred to remain ignorant of the operation. Plaintiff also admitted that she was aware, prior to said operation, of the general nature of a heart catheterization. There was also evidence that plaintiff had talked with a Doctor Bine regarding the advisability of a heart catheterization.
The subject procedure consists of the insertion of tubing through a needle puncture in the right femoral artery and then up through the artery and into the aorta at a point near the heart. The tubing is used to carry radio opaque material into the aorta as part of the diagnostic procedure. When this operation was performed on plaintiff the procedure had proceeded to the point where the tubing was positioned in the aorta when Dr. Paley noted that a "kink" had developed in the tubing. His attempts to straighten the tubing were unsuccessful. Plaintiff was thereupon taken to surgery where the "kinked" tubing was removed from the artery by surgical procedure. This surgical operation was required because the tubing could not be safely removed except by surgery.
The subject tubing was a polyethylene tubing manufactured by Clay Adams and was designated by it as PE-280. This tubing was purchased [12 Cal. App. 3d 1070] by the Hospital in 100-foot rolls. When it was received Dr. Paley examined it to see if it had the right degree of flexibility for its use. In preparing the PE-280 tubing for use as a catheter approximately 4 feet in length was cut from one of the rolls. This length of the PE-280 tubing was then inserted over a tubing of smaller diameter known as PE-160 tubing. The PE-280 tubing was then stretched to narrow its diameter so that it would fit snugly over the PE-160 tubing. This stretching process would stretch the tubing 7, 8 or 9 inches. The leading end of both the PE-280 and PE-160 tubings were then cut and the PE-160 tubing was removed. The end of the PE-280 tubing was then trimmed or beveled with an emery board and the tubing was then soaked for at least 24 hours prior to its use in a detergicide solution. This fabrication procedure was performed under the direction of Dr. Paley. When the PE-280 catheter was completed Dr. Paley examined it in detail by visual and tactile examination. The tactile examination consisted of running his fingers along it and bending it in a wide arc to see if it was flexible. Dr. Paley at no time made any tests as to the strength of the walls of the PE-280 tubing.
In performing the subject diagnostic procedure a PE-160 tubing is inserted into the femoral artery and a wire is put through it. Then the PE-160 tubing is withdrawn from the artery leaving only the wire in the artery. Then a second PE-160 tubing is inserted over the wire, and the deterged PE-280 tubing is inserted over the PE-160 tubing. When the entire ensemble reaches a position close to the descending aorta the wire and PE-160 tubing are withdrawn leaving only the PE-280 tubing in the artery. The PE-280 tubing is then advanced to a few inches below the aortic arch. The PE-280 tubing, operated at the external end by a syringe, is then filled with radio opaque material and then advanced under fluoroscopic vision beyond the aortic arch. It was during this latter procedure in the instant case that Dr. Paley discovered the "kink" in the tubing. Prior to this observation Dr. Paley had experienced difficulty getting the PE-280 tubing beyond the aortic arch. Instead of going around the arch the tubing repeatedly went up into the left common carotid artery.
Dr. Paley further testified that he had performed approximately 100 other heart catheterizations, using PE-280 tubing, all without such a "kinking" mishap. He stated that several other heart catheterization operations had been done prior to the incident one, using PE-280 tubing from the roll used for plaintiff's operation, without such a mishap.
A vice-president of Clay Adams testified that he was aware that PE-280 tubing was being used as a raw material from which heart catheters were fabricated and that Clay Adams never questioned this use. He testified, further, that such use was not suggested by Clay Adams, that it was not Clay Adams' policy to determine or suggest uses, and that the use to which the tubing was put was a matter to be determined by the user. This witness also testified that the walls of the PE-280 tubing varied slightly in thickness and that no specific tests were conducted prior to sale to determine the strength of the walls.
Other facts which may be pertinent to a particular discussion will be stated in conjunction therewith. We proceed to discuss the several contentions made by plaintiff with the observation that the instant action is one for damages for personal injuries alleged to have been suffered as a result of the subject procedure. As against Clay Adams the action, as disclosed by the issues tendered, is one sounding in strict liability in tort, breach of express and/or implied warranty, and negligent manufacture; as against Dr. Paley and the Hospital, it sounds in medical malpractice.
[2a] Plaintiff urges that the doctrine of strict liability in tort was applicable because of the evidence that the tubing kinked easily, that no tests were conducted by Clay Adams to ascertain the tubing's strength and that no warning was given of the failure to make such tests.
Under the circumstances of this case there is a likelihood that the physical integrity of the PE-280 tubing was impaired by the substantial changes it underwent under Dr. Paley's directions. Adverting to the alleged defect, we observe that it is alleged to be a "kink" in the tubing. Although Dr. Paley did not subject the tubing to a test for defects prior to making the changes, he did test it for flexibility. This adaptability test did not reveal any propensity on the part of the tubing to kink prior to the stretching and soaking process. Moreover, the uncontradicted evidence discloses that the PE-280 tubing, while in plaintiff's femoral artery, was subjected to various manipulations in attempting to get it beyond the aortic arch. Accordingly, a question arises whether the defect which caused the tubing to "kink" arose after the [12 Cal. App. 3d 1074] changes and whether the responsibility for the defect shifted to Dr. Paley who undertook to subject the condition of the tubing to these changes.
Here the evidence adduced by plaintiff does not afford a reasonable basis for the conclusion that it is more probable that the "kinking" in the tubing was caused by Clay Adams than that it was not. (See Prosser on Torts (3d ed. 1964) p. 264; Grinnell v. Charles Pfizer & Co., 274 Cal. App. 2d 424, 435 [79 Cal. Rptr. 369].) It is equally as probable under the circumstances of this case that the "kinking" was Dr. Paley's responsibility. Accordingly, Clay Adams may not be held to strict liability merely because the tubing turned out to be unsuitable for the product into which it was made by Dr. Paley. That liability, if any, must depend on other legal doctrines or rules.
[4c] In the present case there is uncontradicted evidence that the condition [12 Cal. App. 3d 1076] of the tubing was changed after it left Clay Adams' possession. After leaving Clay Adams' possession the tubing was soaked in a detergent solution and stretched by Dr. Paley, and then inserted over another tube. This process may well have weakened the tubing's resilient qualities. Accordingly, under the circumstances it cannot be said that it is more probable than not that the injury was the result of Clay Adams' negligence but it is at least equally probable that the accident was caused by some fault for which Clay Adams was not liable. The absence of the second requisite condition precludes, therefore, the application of the doctrine of res ipsa loquitur.
[7a] Plaintiff urges that there was substantial evidence of negligence to support a jury verdict in her favor against Clay Adams under the rule applicable to nonsuits. That evidence is asserted to consist of Clay Adams' failure to conduct tests of the PE-280 tubing to determine its strength and the expert's testimony that the tubing "kinked" easily. With respect to the evidence that the tubing "kinked" easily, plaintiff contends that such is evidence of negligent design and evidence that a duty to warn was breached.
In the instant case there was evidence from which the trier of fact could conclude that the tubing could do harm if it was imperfect. There was evidence that plaintiff's injury resulted from a "kinking" of the tubing. There was also evidence adduced by expert testimony that the tubing "kinked" easily, that it was more apt to "kink" when heated or soaked, and that once it became "kinked" it failed to recover physical integrity. In sum, there was evidence adduced from which the jury could infer that the condition of the tubing made it susceptible to "kinking" and that such a condition was an unreasonably dangerous one.
The jury was entitled to conclude that since the subject tubing was intended for use in body cavities Clay Adams should have recognized that unless the tubing was carefully made there was an unreasonable risk of harm. There was evidence that Clay Adams knew that its PE-280 tubing was being used in heart catheterizations. From this evidence the jury could infer that Clay Adams was aware of the methods used in adapting its tubing for use as a catheter and of the manner in which such catheters were being used in the catheterization procedures. Accordingly, whether Clay Adams took the necessary precautions to prevent dangerous conditions in the subject tubing in the light of these circumstances was a question for the jury, since it cannot be said that the only conclusion which could be reached is that Clay Adams did use reasonable precautions under the circumstances. A reasonable man of average intelligence could come to a different conclusion.
Adverting to the precautions taken by Clay Adams, we note the evidence that it conducted no tests on the tubing to determine its thickness and the uniformity and strength of its walls.  With respect to tests or inspections, it is well settled that where an article is such that it is reasonably certain, if negligently manufactured or designed, to place life and limb in peril, the manufacturer is chargeable with negligence if the defective condition could be disclosed by reasonable inspection and tests, and such inspection and tests are omitted. (Sheward v. Virtue, supra, 20 Cal. 2d 410, 414; Rest.2d Torts, supra, § 395, coms. (e) and (f), pp. 327-328; see Pike v. Frank G. Hough Co., supra, 2 Cal. 3d 465, 470.) [7c] Applying this standard to the case at bench, we perceive that, at the very least, it was a question for the jury whether a reasonable test or inspection would have disclosed that the subject tubing had a propensity to "kink." If it found that such reasonable inspection would have disclosed this propensity, the jury could decide that Clay Adams violated its duty to produce a product reasonably safe for its intended use either on the basis that it could have corrected this deficiency but failed to do so, or, on the basis that if the [12 Cal. App. 3d 1079] deficiency was not susceptible of correction, Clay Adams failed to warn of the dangerous propensity.
[14a] Plaintiff asserts that Clay Adams expressly represented that its PE-280 tubing was fit for use in heart catheterization and that when the tubing "kinked" there was a breach of that warranty. Commercial Code section 2313, in pertinent part, provides: "(1) Express warranties by the seller are created as follows: (a) Any affirmation of fact or promise made by the seller to the buyer which relates to the goods and becomes part of the basis of the bargain creates an express warranty that the goods shall conform to the affirmation or promise. ... (2) It is not necessary to the creation of an express warranty that the seller use formal words such as 'warrant' or 'guarantee' or that he have a specific intention to make a warranty, but ... a statement purporting to be merely the seller's opinion or commendation of the goods does not create a warranty."
[14b] Here there is no evidence that Clay Adams verbally or in writing expressly represented that the tubing was fit for heart catheterization. In its literature it stated that the tubing was useful for moving fluids into and from body cavities. This was clearly a statement relating to the subject tubing. Dr. Paley testified that from this statement he implied that the tubing was suitable for heart catheterization. In the light of these facts it was a question [12 Cal. App. 3d 1080] of fact for the jury whether the statement made by Clay Adams in its literature was intended to include the movement of fluids into the femoral artery; whether the subject statement, if found to include femoral arteries as constituting "body cavities," was merely a statement of Clay Adams' opinion or commendation of the goods; and whether the subject statement became "part of the basis of the bargain" between Clay Adams, as seller, and the Hospital, as the buyer through its agent Dr. Paley. The fact that Dr. Paley also relied on medical journals for the suggestion that the subject tubing was suitable for heart catheterization was a circumstance to be considered in determining whether the subject statement was "part of the basis of the bargain." As pointed out in the Uniform Commercial Code comment to section 2313, comment 3, section 2313 "deals with affirmations of fact by the seller, descriptions of the goods or exhibitions of samples, exactly as any other part of a negotiation which ends in a contract is dealt with. No specific intention to make a warranty is necessary if any of these factors is made part of the basis of the bargain. In actual practice affirmations of fact made by the seller about the goods during a bargain are regarded as part of the description of those goods; hence no particular reliance on such statements need be shown in order to weave them into the fabric of the agreement. Rather, any fact which is to take such affirmation, once made, out of the agreement requires clear affirmative proof. The issue normally is one of fact."
[16a] While under cross-examination by plaintiff's counsel Dr. Paley was asked whether, in his opinion, the catheter was caused to "kink" because of a defect in its walls which could not be detected by him on examination. An objection on the ground that the question called "for clear speculation" was sustained on the ground that Dr. Paley could not testify to "the ultimate facts."
[17b] It is well settled that the exercise of the trial court's discretion as to whether one qualifies as an expert witness will be disturbed only for clear abuse. (People v. Goldsworthy, 130 Cal. 600, 605 [62 P. 1074]; State Comp. Ins. Fund v. Operated Equipment Co., supra, 265 Cal. App. 2d 759, 765; People v. Murray, supra, 247 Cal. App. 2d 730, 735.) [16c] Under the record in this case we cannot say that the trial court abused its discretion.
[18b] In the present case the only objective fact offered in proof of the conduct of the judge alleged to have improperly influenced the verdict is his statement that the jury was not entitled to the information requested by it. As a matter of law it cannot be said that such a statement was of such a character as was likely to have influenced the jury improperly. [19b] As to the remainder of the matters alleged in such affidavits, they consist of the inferences which the jurors making the affidavits drew from the judge's statement, notwithstanding they were advised not to concern themselves with the subject of their inquiry. These matters had the effect of proving the mental or reasoning processes of said jurors and, as such, were not subject to corroboration or disproof. Accordingly, they did not constitute competent evidence to impeach the verdict.
[20a] Plaintiff requested that the jury be instructed that a doctor-patient relationship is one fiduciary in nature and a doctor accordingly must reveal all pertinent information to his patient. Such request was refused. Plaintiff urges such refusal was error since there was evidence that Dr. Paley failed to apprise plaintiff of the risks involved in the heart catheterization.
 It is the duty of a doctor to properly explain a contemplated procedure or operation to his patient in a manner which the patient can reasonably comprehend in order for the patient to give his informed or knowledgeable consent to the procedure or operation. (Berkey v. Anderson, 1 Cal. App. 3d 790, 803-804 [82 Cal. Rptr. 67]; Salgo v. Leland Stanford etc. Bd. Trustees, 154 Cal. App. 2d 560, 578 [317 P.2d 170].) [20b] Here, the evidence does not show that Dr. Paley withheld any information from plaintiff. Although plaintiff testified that Dr. Paley failed to explain the operation and its risks, she also testified that she had specifically requested not to be told about the intricacies of heart catheterization. Moreover, plaintiff, prior to the operation, looked into heart catheterization and stated she was aware of what it involved. In Salgo it was pointed out that a patient's mental and emotional condition is important [12 Cal. App. 3d 1084] in certain cases and that in discussing the element of risk a certain amount of discretion must be employed consistent with the full disclosure of facts necessary to an informed consent. (At p. 578.) Under the circumstances of this case it may not be said that plaintiff's consent to the procedure was not an informed one. Rather, the evidence was such that Dr. Paley's attempts at explanation were prevented by plaintiff's insistence on remaining ignorant of the risks involved and that Dr. Paley acceded to this request in the exercise of his discretion on the basis that an explanation of any risk involved might result in actually increasing the risks by reason of the psychological results of the apprehension itself. (See Salgo v. Leland Stanford etc. Bd. Trustees, supra.) Accordingly, we perceive no error in refusing the requested instruction.
Plaintiff cites us to Meier v. Ross General Hospital, 69 Cal. 2d 420, 433-434 [71 Cal. Rptr. 903, 445 P.2d 519], for the proposition that instructions on malpractice and ordinary negligence may both properly be given in the same case. We apprehend that in a proper case both instructions may be given. Meier, however, is distinguishable from the present case. There, [12 Cal. App. 3d 1085] in addition to a charge of malpractice on the part of a treating doctor, the action was based on ordinary negligence predicated upon the claim that an employee of a hospital left a window open through which the decedent jumped. Here, the case was tried on the theory that Dr. Paley, in performing the subject procedure, did not use the standard of care required of a doctor in the realm of medical treatment as prescribed by medical malpractice decisional rules.
In view of the foregoing we conclude that in the face of a motion for nonsuit, there was sufficient evidence to support a jury verdict in favor of plaintiff as against Clay Adams on the basis of ordinary negligence and breach of express warranty; and we conclude that none of the assignments of error urged against the judgment in favor of Dr. Paley and the Hospital have merit.
The judgment is affirmed as to defendants Dr. Paley and the Hospital. The judgment is reversed as to Clay Adams. Dr. Paley and the Hospital shall recover their costs on appeal from plaintiff. Plaintiff shall recover one-half of her costs on appeal from Clay Adams.
FN 1. The experiments were not performed on the tubing used in the procedure or on any of the tubing from the roll from which the instant tubing was cut as none of these were available at the time of the experiment.
FN 2. In sustaining the objection the court stated: "He may testify as to what he saw, observed, tested, not the ultimate facts."
FN 3. Plaintiff argues that such evidence consisted of Dr. Paley's stretching or handling of the catheter from which the jury could infer that he stretched it too far or otherwise mishandled it.

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