Title: Murdoch v. Thomas
Citation: 404 So. 2d 580
Docket Number: N/A
State: Alabama
Issuer: Alabama Supreme Court
Date: August 28, 1981

404 So. 2d 580 (1981)
Donald MURDOCH, et al.
v.
Theresa B. THOMAS, etc.
79-687.

Supreme Court of Alabama.
August 28, 1981.
Rehearing Denied September 25, 1981.
*581 Richard A. Ball, Jr., Montgomery, and Horace Williams, Eufaula, for appellants.
Jimmy S. Calton, Eufaula, for appellee.
FAULKNER, Justice.
This is an appeal from a judgment in a wrongful death action in the Circuit Court of Barbour County for plaintiff, Theresa Thomas.
On October 15, 1978, Mr. Copeland Thomas, deceased, was injured in a two-car accident. He was taken by ambulance to the Barbour County Hospital emergency room complaining of pain in his chest, side and lower back. Defendant, Dr. Donald Murdoch, a licensed physician, examined Mr. Thomas upon arrival. Dr. Murdoch had worked exclusively in emergency room medicine for two and one-half years and was, at the time, an employee of Emergency Room Professional Association of Enterprise, Alabama, working on assignment in the Barbour County Hospital emergency room. Through the use of X-rays, Dr. Murdoch ruled out the possibility of broken bones, heart concussion, collapsed lungs, contused lungs or bleeding around the lungs, and ruptured abdomen. Dr. Murdoch further considered the possibility of a ruptured spleen but subsequently, after a physical examination, ruled it out. Dr. Murdoch prescribed Dolene-AP for the pain and advised Mrs. Thomas to take her husband home. When Mrs. Thomas expressed her desire to have Mr. Thomas admitted to the hospital, Dr. Murdoch purportedly responded: "[T]here is nothing the matter with this man but he's got arthritis in his left knee." No follow-up instructions were given to the Thomases advising what to do if complications later developed. That night, Mr. Thomas took one of the pain pills, continued to complain of chest pains, and later vomited. Around 9:30 P.M., Mrs. Thomas contacted Dr. Woodbury, her husband's doctor, who informed her that vomiting was often a side effect of the particular drug that Mr. Thomas had taken and advised her to discontinue the medication. He also told Mrs. Thomas to call back if she needed him.
The following morning, Mr. Thomas was taken back to the emergency room and diagnosed by Dr. Woodbury and another examining physician as suffering from internal bleeding and shock. Shortly after being admitted, he lost consciousness and subsequent cardiopulmonary resuscitation (CPR) efforts failed to revive him. The autopsy report indicated that although Mr. Thomas had a severely diseased heart, death most likely resulted from a chain of events precipitated by an initial loss of blood from a ruptured spleen which culminated in respiratory arrest.
On November 21, 1978, Theresa B. Thomas, the personal representative and administratrix of her husband's estate, filed suit against Dr. Donald Murdoch and the Barbour County Hospital seeking one million *582 dollars for the wrongful death of her husband due to the alleged malpractice of the defendants. She later amended her complaint to add Emergency Room Professional Association as a defendant and to dismiss Barbour County Hospital. The defendants pleaded the general issue and assumption of the risk. The jury returned a verdict of $100,000.00 in favor of Mrs. Thomas. Defendants' motions for directed verdict and for JNOV or, in the alternative, for a new trial were denied. Dr. Murdoch and Emergency Room Professional Association appeal.
Appellants, Dr. Murdoch and Emergency Room Professional Association, raise the following issues:
1. Whether the trial court erred in denying defendants' motions for directed verdict and for JNOV or, in the alternative, for a new trial on the grounds that the evidence was insufficient to support findings that: (1) the alleged negligence was the proximate cause of death; (2) the death was the proximate result of any injury that Dr. Murdoch could have reasonably discovered on the afternoon of the accident; and (3) the alleged failure to provide follow-up instructions played any part in the events leading to the death.
2. Whether the trial court committed reversible error in admitting into evidenceover defendants' objectionsnine separate incidents of testimony.
In Pappa v. Bonner, 268 Ala. 185, 105 So. 2d 87 (1958), this Court addressed the issue of proximate cause of medical malpractice cases:
Appellants further contend that Ohio's "probability of survival" test is, or should be interpreted to be, synonymous with this state's requirement that there be "some evidence... that such negligence probably caused the injury." Pappa v. Bonner. We disagree. Probability of survival and probability of cause are not the same.
Moreover, under our "scintilla" rule, "[i]f the evidence presents a mere gleam, glimmer, spark, smallest trace or scintilla to support the theory or to sustain the issue, the trial court must submit the question to the jury." Baker v. Chastain, 389 So. 2d 932 (Ala.1980) (emphasis added). In Waddell v. Jordan, 293 Ala. 256, 302 So. 2d 74 (1974), a wrongful death action in which expert testimony indicated that the deceased suffered a massive cardiovascular infarction, we alluded to the "probability of survival" test and then indirectly rejected it in holding:
We now hold, therefore, on the authority of Waddell, that our standard for determining the propriety of the submission of proximate cause to the jury does not encompass the "probability of survival" standard urged by appellants.
We turn now to the evidence in order to ascertain whether there was, in fact, a scintilla of evidence of proximate cause to warrant submission of that issue to the jury. After careful review and consideration of the record, we conclude that a scintilla existed and that proximate cause was properly before the jury. While time and *583 space preclude an exhaustive recitation of the evidence supporting our conclusion, we necessarily include the following testimony which we believe suppliesat the very leasta basis from which "reasonable inferences" of a scintilla can be drawn. See Pappa v. Bonner.
Interrogatories answered by Dr. Murdoch revealed the following:
108. At any time did you consider the possibility that the said Copeland Thomas might have a ruptured spleen?
109. At any time did you consider the possibility that the said Copeland Thomas could have a subcapsular hemorrhage[1] of the spleen?
110. If your answer to either of the two preceding interrogatories is in the affirmative, please state at what point during your examination you considered the possibility and please state at what point of your examination you ruled out this possibility.
. . . .
When read into evidence, excerpts from the deposition of Dr. Willis Crawford, a pathologist, disclosed the following conflicting testimony:
Q...."Now, Doctor, is there anything on the October 15th, 1978, Emergency Room sheet, the one signed by Dr. Murdoch, which would rule out the possibility of a subcapsular hematoma?"[2] Please read his answer.
A. "Because the only way you can rule out a subcapsular hematoma is to open the belly and look at the spleen." [emphasis added]
Dr. Murdoch further contended that the spleen was ruptured as a result of the CPR efforts; therefore, he could not have reasonably discovered the rupture on the afternoon of the accident. Dr. Murdoch introduced evidence from Harrison's Principles of Internal Medicine consistent with his theory of rupture, i.e., that "[e]xternal cardiac massage [CPR] is not free from significant complications, including ... ruptured spleen with late, occult blood loss." Both the pathologist who performed the autopsy and Thomas's family physician testified that they had never encountered a ruptured spleen resulting from CPR. The pathologist further testified that he had performed between 1500 to 2000 autopsies during his career. One of the medical experts also pointed out that the treatise introduced by Dr. Murdoch failed to state whether the referenced splenic rupture was a potential complication of a normal spleen, an abnormal spleen, or both. Moreover, multiple lacerations were found on Mr. Thomas's spleenseveral small, irregular, superficial lacerations and two deeper more extensive cuts. Expert testimony confirmed that the more extensive lacerations were consistent with blunt trauma, such as the impact of the steering wheel on the deceased.
When questioned specifically about which, if any, splenic rupture symptoms Mr. Thomas exhibited on presentation, Dr. Murdoch responded:
A. The symptoms of a ruptured spleen indicate pain in the left upper quadrant of the abdomen, tenderness of any or varying degrees to palpation in the abdomen, especially its left upper quadrant, and rarely as pain referred to the left shoulder blade. However, early impending or advanced shock from blood loss is a presentation due to internal bleeding into the abdomen. Here the symptoms would be weakness or dizziness aggravated by standing, rapid pulse, falling blood pressure are part of shock in whatever degree it is when seen [sic]. Mr. Thomas was fully conscious and reported no pain. His abdomen was soft with no tenderness to palpation. His pulse was normal at 86 and his blood pressure was normal at 140/80.
The record is replete with testimony that Mr. Thomas was in pain. There is also evidence indicating that Mr. Thomas had difficulty standing when leaving the hospital and that he had to be helped to a wheelchair. While the emergency room record does not specify which side of Mr. Thomas's chest was tender, the evidence is undisputed that Mr. Thomas did, in fact, suffer a chest injury. The following excerpt from an article entitled "Surgical Management of Splenic Injuries" published in American Journal of Surgery, Volume 108, November 1964, clearly shows that abdominal injury is not the only "red flag" indicator for splenic injury:
Moreover, there was no evidence that Dr. Murdoch provided any follow-up instructions to the patient. In response to questions seeking what, if any, instructions or warnings were given, Dr. Murdoch answered:
Once again, the record abounds with expert testimony to the effect that proper follow-up instructions were crucial. Numerous medical experts also testified that, under the circumstances, Mr. Thomas should have been hospitalized. Although the experts agreed that Mr. Thomas was a poor candidate for surgery, Dr. Weinheimer, a teacher and practitioner of emergency room medicine, testified: "Obviously, he was too sick not to operate on."
In Torrance v. Wells, 219 Ala. 384, 122 So. 322 (1929), a case involving a doctor's negligent treatment of a wound, this Court stated:
Under the circumstances of the instant caseand based upon the foregoing rationalethere was sufficient evidence from which the jury could infer that the alleged negligence was the proximate cause of death.
Appellants, Dr. Murdoch and Emergency Room Professional Association, next contend that the trial court committed reversible error in nine separate instances for admitting allegedly illegal evidence over objection from counsel. After a thorough review of these nine instances, we are of the opinion that only one merits our attention. Appellants objected to the admission of a statement from Emergency Department Organization and Management (2d ed. 1978), that incorrectly expressed the standard of care owed a patient by a physician under Alabama law. No proof was made that the text or treatise was recognized as an authoritative one. Appellants are correct in their contention that the standard stated in the book or manual is not the law of this jurisdiction. We opine, however, that the admission of the complained of quote was harmless error on the authority of Rule 45, ARAP, and Knighten v. Davis, 358 So. 2d 1022 (Ala.1978), wherein we stated:
As in Knighten, we find the error did not probably injuriously affect the substantial rights of appellants.
Finally, we reemphasize the rule of Cobb v. Malone, 92 Ala. 630, 9 So. 738 *586 (1891), that the trial judge's refusal to grant a new trial strengthens the presumption in favor of the correctness of the verdict. The judgment of the trial court is due to be affirmed.
AFFIRMED.
ALMON, EMBRY and ADAMS, JJ., concur.
TORBERT, C. J., concurs in the result.
[1]  Dr. Thompson, the pathologist who performed the autopsy, explained the distinction between a ruptured spleen and a subcapsular hemorrhage as follows:

A. Well, in the one the bleeding gets beneath the capsule of the spleen [subcapsular hemorrhage] and distends it, and then eventually this will, in turn, rupture into the cavity. And, of course, your out-and-out rupture is when the spleen is fragmented or has big tears in it.
Q. Now, when you say a rupture of a capsule around the spleen, would that be something similar to a balloon filling up with water until it finally got as big andand then popping?
. . . .
A. I think that is a fair description.
[2]  Subcapsular hematoma is the same as subcapsular hemorrhage, supra.