Title: BAYLOR v JACOBSON
Citation: N/A
Docket Number: 13212
State: Montana
Issuer: Montana Supreme Court
Date: July 12, 1976

No. 13212 I N T H E SUPREME C O U R T O F THE STATE O F M O N T A N A 1976 ROBIN B A n O R and S A R A H J. BAYLOR, Husband and Wife, P l a i n t i f f s and Appellants, DR. DAVID P, JACOBSON, Defendant and Respondent. Appeal from: D i s t r i c t Court of t h e Fourth J u d i c i a l D i s t r i c t , Hon. E. Gardner Brownlee, Judge presiding. Counsel of Record: For Appellants : Moore and Lyrnpus, K a l i s p e l l , Montana James D. Moore argued, K a l i s p e l l , Montana For Respondent : Garlington, Lohn and Robinson, Missoula, Montana Larry E, Riley argued, Missoula, Montana Submitted: May 27, 1976 Filed : ,BtjE4 5 . 3 j p t j M r . J u s t i c e Frank I. H a s w e l l d e l i v e r e d t h e Opinion of t h e Court. The d i s t r i c t c o u r t of Missoula County granted summary judgment t o defendant doctor i n a medical malpractice a c t i o n . P l a i n t i f f s appeal. P l a i n t i f f s are Robin Baylor and Sarah J. Baylor, hus- band and wife, of Missoula, Montana. O n December 13, 1970 Sarah Baylor slipped on t h e driveway a t her home while g e t t i n g o u t of her c a r and f r a c t u r e d her leg. She w a s taken by ambu- l a n c e t o S t . P a t r i c k ' s Hospital where her i n j u r i e s w e r e diagnosed a s a s p i r a l f r a c t u r e of t h e t i b i a and a comminuted f r a c t u r e of t h e f i b u l a of her r i g h t l e g . Defendant, D r . David 0. Jacobson, a medical s p e c i a l i s t i n orthopedic surgery, performed a closed reduction and placed t h e l e g i n a c a s t . Sarah Baylor w a s confined t o t h e h o s p i t a l f o r four days and w a s seen d a i l y by D r . Jacobson. Following her r e l e a s e from t h e h o s p i t a l , she was seen by D r . Jacobson a t h i s o f f i c e on f i v e occasions: December 24, 1970, January 21, 1971, February 18, 1971, March 17, 1971, and May 2 1 , 1971. H e r c a s t was completely removed on March 17, 1971. When D r . Jacob- son last s a w Sarah Baylor on May 21, he made t h e following n o t a t i o n i n h i s records: " S t i l l with pain about t h e t i b i a . N o gross movement with manipulation but new x-rays show a remarkable paucity of c a l l u s formation con- s i d e r i n g t h e f i v e months t h a t have elapsed s i n c e her f r a c t u r e . I would have a n t i c i p a t e d f u r t h e r c a l l u s formation o r some attempt a t healing which has n o t occurred. W i l l r e e v a l u a t e i n one month and g e t new f i l m s and a t t h a t t i m e perhaps manipulate under fluoroscope t o d e t e r - mine any motion." According t o t h e deposition of Sarah Baylor, D r . Jacob- son t o l d her a t t h i s t i m e t h a t her l e g w a s completely healed; t h a t f u r t h e r treatment w a s unnecessary; t o q u i t babying h e r s e l f and ignore t h e pain; t h a t she might even jump up and down on her l e g ; and d i d n o t a d v i s e her t h a t t h e bone i n her l e g w a s slow i n healing; t h a t t h e r e was some q u e s t i o n about nonunion; o r anything along t h a t l i n e . Sarah Baylor was scheduled t o see D r . Jacobson a g a i n i n a month b u t she never returned. According t o her d e p o s i t i o n and t h a t of her husband s h e d i d n o t r e t u r n because she d i d n o t f e e l D r . Jacobson could do anything f u r t h e r f o r her and t h a t a l l he would do was send her t o p h y s i c a l therapy. I n s t e a d s h e exercised t h e l e g by walking back and f o r t h a c r o s s t h e f l o o r a t home with t h e help of her husband. I n any event, Sarah Baylor e v e n t u a l l y consulted D r . Clinton Craig, a n orthopedic surgeon i n Missoula, who took X-rays and t o l d h e r t h a t her l e g had never healed and advised h e r t o have surgery. A month o r two l a t e r she consulted D r . Paul Melvin, an orthopedic surgeon i n Great F a l l s who X-rayed her l e g , t o l d her t h e r e was a nonunion and t h a t she needed surgery. She next went t o D r . William J. McDonald, a Missoula orthopedic surgeon t o g e t another opinion. H e X-rayed her l e g , t o l d h e r she needed surgery, and r e f e r r e d her t o D r . Carlo Z . Biscaro, a Missoula orthopedic surgeon. The d a t e s of t h e s e consulta- t i o n s a r e uncertain. D r . Biscaro performed a bone g r a f t i n March, 1973 a t t h e Community Hospital i n Missoula. I n t h e late summer of 1973. D r . Biscaro advised t h a t t h e f r a c t u r e had n o t healed and t h a t f u r t h e r surgery w a s necessary. I n November, 1973 D r . Biscaro performed a bone g r a f t , and i n s e c t e d a metal screw and a Rush rod. By August, 1974 when Sarah Baylor's d e p o s i t i o n w a s taken, t h e healing of t h e l e g looked good although she was s t i l l scheduled f o r p e r i o d i c v i s i t s t o D r . Biscaro and h i s a s s o c i a t e . The Baylors f i l e d s u i t a g a i n s t D r . Jacobson on A p r i l 2 , 1974 a l l e g i n g medical malpractice and seeking damages of $184,000. Defendant f i l e d an answer which was s u b s t a n t i a l l y a general d e n i a l on J u l y 11. This was subsequently amended t o include t h e defense of contributory negligence. I n t e r - r o g a t o r i e s and answers w e r e f i l e d , d e p o s i t i o n s w e r e taken, supplemental answers were f i l e d , and a p r e t r i a l conference was held. When p l a i n t i f f s f a i l e d t o provide t h e name of t h e i r expert witness and answer defendant's i n t e r r o g a t o r i e s concern- ing t h i s expert by April 11, 1975 a s agreed, t h e d i s t r i c t c o u r t granted defendant's motion and dismissed t h e e n t i r e l i t i g a t i o n . This was subsequently vacated and t h e c o u r t granted p l a i n t i f f s u n t i l August 1, 1975 t o name t h e i r e x p e r t and answer defendant's previous i n t e r r o g a t o r i e s concerning him. O n J u l y 29, 1975 p l a i n t i f f s s t a t e d they had an e x p e r t and answered f u r t h e r as follows: "Dr. Biscaro's deposition w i l l be taken on J u l y 31, 1975. H e may be t h e only expert. I f h i s testimony does n o t r e l a t e t h e negli- gence t o p l a i n t i f f ' s condition, an expert w i l l be r e t a i n e d and t h e background infor- mation sought herein immediately furnished." The o t h e r i n t e r r o g a t o r i e s were answered "Not applicable". Defendant moved f o r summary judgment. It w a s b r i e f e d by both defendant and p l a i n t i f f s , and o r a l l y argued. O n Sep- tember 30,1975 t h e d i s t r i c t c o u r t granted defendant a summary judgment. The order granting summary judgment i s s e t f o r t h i n f u l l : "Larry E. Riley, Esq., counsel f o r t h e Defendant i n t h i s a c t i o n , D r . David P. Jacobson, has f i l e d a Motion For Summary Judgment and has based h i s motion upon t h e documents i n t h e c o u r t f i l e , in- cluding depositions and Answers t o I n t e r r o g a t o r i e s . "This a c t i o n i s a malpractice a c t i o n . The f a c t s show t h a t t h e P l a i n t i f f , Sarah J. Baylor, sustained a f r a c t u r e of t h e r i g h t l e g . She was t r e a t e d by t h e Defendant, and a f t e r about f i v e and one-half months refused t o r e t u r n f o r an appointment with D r . Jacobson. The condition of P l a i n t i f f ' s l e g was such t h a t s u r g i c a l treatment w a s required about twenty-six months a f t e r t h e accident. "The P l a i n t i f f s designated Carlo Z . Biscaro, M.D., a s t h e expert medical witness t o be c a l l e d on behalf of t h e P l a i n t i f f s a t t i m e of t r i a l . D r . Biscaro's deposition was taken and he repeatedly s t a t e d t h a t i n h i s opinion t h e r e w a s proper c a r e and treatment of Sarah J. Baylor by D r . Jacobson. "The Court f i n d s t h a t Sarah J. Baylor's r e f u s a l t o continue medical treatment i s a proximate cause of her subsequent problems with her leg. "The Court f u r t h e r f i n d s t h a t t h e P l a i n t i f f s ' expert medical witness has not t e s t i f i e d t o any conduct on t h e p a r t of D r . David P. Jacobson which can be termed medical malpractice. There- f o r e , "IT IS HEREBY ORDERED t h a t t h e Defendant's Motion For Summary Judgment be granted without c o s t s t o any party." O n October 1 p l a i n t i f f s f i l e d amended answers t o de- fendant's i n t e r r o g a t o r i e s , i d e n t i f y i n g a New York doctor, D r . Robert Tuby, a s t h e i r expert witness and answering t h e o t h e r i n t e r r o g a t o r i e s . P l a i n t i f f s ! answer t o interrogatory N o . 12 sets f o r t h t h e substance of D r . Tuby's testimony: "Dr. Tuby w i l l t e s t i f y t h a t it was a deviation from acceptable medical p r a c t i c e t o remove t h e c a s t a t t h e t i m e it was removed and t o prescribe exercise therapy when t h e r e w a s p r a c t i c a l l y no c a l l u s formation about t h e f r a c t u r e site. H e w i l l f u r t h e r s t a t e t h a t it was a deviation from acceptable medical p r a c t i c e t o t e l l t h e p a t i e n t t h a t t h e i n j u r y was healed when it w a s not healed a s shown by t h e X-ray films. D r . Tuby w i l l state t h a t t h e exercise therapy and removal of t h e c a s t caused t h e lack of union, subsequent development of a bone necrosis, t h e subsequent s u r g i c a l pro- cedures, and t h e r e s u l t which has [been] obtained." P l a i n t i f f s f i l e d t h e i r n o t i c e of appeal from t h e summary judgment a g a i n s t them on October 10, 1975. The ultimate i s s u e on appeal i s whether summary judgment f o r defendant was properly granted. This t u r n s on two under- lying issues. (1) Is t h e r e s u f f i c i e n t expert testimony t o r a i s e a genuine i s s u e of malpractice? (2) Is t h e r e a genuine i s s u e of material f a c t concern- ing contributory negligence on t h e p a r t of Sarah Baylor? A s background f o r our a n a l y s i s of t h e i s s u e s , w e note s e v e r a l b a s i c r u l e s of l a w a p p l i c a b l e t o medical malpractice a c t i o n s . The g i s t of a malpractice a c t i o n i s negligence on t h e p a r t of defendant. Negaard v. Feda, 152 Mont. 47, 446 P.2d 436, and c a s e s c i t e d t h e r e i n . The mere f a c t of i n j u r y o r t h e occurrence of a bad r e s u l t , standing alone, is no proof of negligence i n t h e ordinary malpractice a c t i o n . Loudon v. S c o t t , 58 Mont. 645, 194 P. 488, 12 A.L.R. 1487. The law does not re- q u i r e t h a t f o r every i n j u r y t h e r e must be a recovery of damages, but only imposes l i a b i l i t y f o r a breach of l e g a l duty by a doctor proximately causing i n j u r y t o t h e p a t i e n t . Loudon v. S c o t t , supra. The l e g a l duty imposed on a doctor has been described by t h i s Court i n t h e following language: " * * * The l a w r e q u i r e s a physician o r surgeon t o possess t h e s k i l l and l e a r n i n g which i s pos- sessed by t h e average member of t h e medical pro- f e s s i o n i n good standing, and t o apply such s k i l l and learning with ordinary and reasonable care. He is n o t an i n s u r e r , nor i s a good r e s u l t impliedly guaranteed. H i s o b l i g a t i o n i s merely t o e x e r c i s e such reasonable c a r e and s k i l l i n t h e treatment of t h e p a t i e n t as i s u s u a l l y exercised by physicians o r surgeons of good standing, of t h e same school of p r a c t i c e i n t h e community i n which he r e s i d e s , with due regard t o t h e condition t o t h e p a t i e n t and t h e progress of medical o r s u r g i c a l science a t t h e t i m e . * * *" Dunn v. Beck, 80 Mont. 4 1 4 , 4 2 1 ; 260 P. 1047. The l e g a l duty o r standard of care imposed upon a medical s p e c i a l i s t , such a s t h e orthopedic surgeon i n t h i s case, i s set f o r t h i n t h e following passage i n 2 1 ALR3d 953: " * * * t h e general proposition t h a t a physician o r surgeon who holds himself o u t a s having s p e c i a l knowledge and s k i l l i n t h e treatment of some par- t i c u l a r organ o r d i s e a s e must e x e r c i s e , i n h i s treatment of one who employs him as a s p e c i a l i s t , t h a t degree of s k i l l and care o r d i n a r i l y possessed and used by s i m i l a r s p e c i a l i s t s , and t h a t h i s duty t o h i s p a t i e n t i s accordingly measured by a higher standard of s k i l l than t h a t of a general p r a c t i t i o n e r . " Ordinarily t h e standard of c a r e t o which a medical p r a c t i t i o n e r i s held and t h e breach thereof must be e s t a b l i s h e d by expert medical testimony. C o l l i n s v. I t o h , 160 Mont. 461, 503 P.2d 36, 81 ALR2d 597, and c a s e s c i t e d t h e r e i n . With t h e s e p r i n c i p l e s i n mind, w e proceed t o consider- a t i o n of whether summary judgment f o r defendant w a s properly granted. Rule 5 6 ( c ) , M.R.Civ.P., a u t h o r i z e s a summary judg- ment when: " * * * t h e pleadings, d e p o s i t i o n s , 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 as t o any material f a c t and t h a t t h e moving p a r t y is e n t i t l e d t o a judgment a s a matter of law." It i s n o t a s u b s t i t u t e f o r a t r i a l of disputed i s s u e s of f a c t . Dunjo Land Co. v. Hested S t o r e s , 163 Mont. 87, 515 P.2d 961; Dean v. F i r s t National Bank, 152 Mont. 474, 452 P.2d 402. A p a r t y seeking a summary judgment has t h e burden of e s t a b l i s h - i n g t h e absence of any genuine i s s u e of m a t e r i a l f a c t . Meech v. Cure, 165 Mont. 49, 525 P.2d 546; B e i e r l e v. Taylor, 164 Mont. 436, 524 P.2d 783, and cases c i t e d t h e r e i n . Is t h e r e a genuine i s s u e of m a t e r i a l f a c t concerning malpractice i n t h e i n s t a n t case? O r s t a t e d another way, is t h e r e expert medical testimony t h a t e s t a b l i s h e s a genuine i s s u e of m a t e r i a l f a c t concerning t h e required standard of c a r e and D r . Jacobson's deviation therefrom? The d i s t r i c t c o u r t held t h e r e w a s n o t . The d i s t r i c t c o u r t s t a t e d i n its order granting summary judgment t h a t D r . Biscaro, p l a i n t i f f s ! designated expert medical witness, repeated- l y s t a t e d t h a t i n h i s opinion " * * * t h e r e was proper c a r e and treatment of Sarah J. Baylor by D r . Jacobson", and t h a t D r . Biscaro " * * * has not t e s t i f i e d t o any conduct on t h e p a r t of D r . David P. Jacobson which can be termed medical mal- p r a c t i c e . " A t t h e o u t s e t we observe t h a t p l a i n t i f f s ' intended t o c a l l D r . Biscaro t o e s t a b l i s h proximate cause, n o t m a l - p r a c t i c e . P l a i n t i f f s ' answers t o defendant's i n t e r r o g a t o r i e s , f i l e d J u l y 29, 1975,provide i n p e r t i n e n t p a r t : "INTERROGATORY NO. 1 "Have you r e t a i n e d , o r do you intend t o call, an e x p e r t witness, o r e x p e r t witnesses, t o t e s t i f y on behalf of t h e P l a i n t i f f s a t t h e t i m e of t h e t r i a l i n t h e above-captioned case? "ANSWER: Y e s . "INTERROGATORY NO. 2: " I f so, a s t o t h a t e x p e r t , p l e a s e s t a t e : " (a) H i s name; " ( b ) H i s age; " ( c ) H i s r e s i d e n t i a l address; " (d) H i s business address. "ANSWER: "Dr. Biscaro's deposition w i l l be taken on J u l y 31, 1975. H e may be t h e only expert. I f h i s testimony does n o t r e l a t e t h e negligence t o p l a i n t i f f ' s condition, an e x p e r t w i l l be r e t a i n e d and t h e background information sought herein immediately furnished. " ( ~ m ~ h a s i s - added. ) P r i o r t o t h e t i m e D r . B i s c a r o ' s deposition had been taken, s p e c i f i c a l l y on October 4 , 1974, t h e d e p o s i t i o n of t h e defendant D r . Jacobson had been taken. I n our view h i s testi- mony and t h e medical records attached a s d e p o s i t i o n e x h i b i t s were s u f f i c i e n t t o r a i s e t h e i s s u e of medical malpractice. The crux of h i s testimony i s contained i n h i s answer t o a hypothetical question. The assumed f a c t s i n t h e hypo- t h e t i c a l question represented t h e f a c t s of t h e c a s e from plain- t i f f s ' viewpoint and D r . Jacobson w a s asked whether it would be acceptable medical p r a c t i c e t o a d v i s e t h e p a t i e n t t o q u i t babying t h e l e g and jump up and down on it. The doctor, a f t e r considerable r e p a r t e e with defense counsel over whether he w a s t a l k i n g about Sarah Baylor o r not, i n d i c a t e d t h a t under t h e assumed f a c t s it would n o t have been a d v i s a b l e t o have t h e p a t i e n t walk on t h e l e g . This, i n our view, is s u f f i c i e n t t o e s t a b l i s h an i s s u e on medical malpractice precluding summary judgment. I t is n o t t h e f u n c t i o n of summary judg- ment t o decide t h a t i s s u e b u t simply t o e s t a b l i s h whether a n i s s u e e x i s t s t h a t r e q u i r e s determination and r e s o l u t i o n a t t r i a l . Dean v. F i r s t National Bank, supra; Matteucci's Super Save v. Hustad Corp., 158 Mont. 311, 491 P.2d 705. W e note i n passing t h a t subsequent t o summary judgment p l a i n t i f f s f i l e d amended answers t o i n t e r r o g a t o r i e s i n d i c a t i n g t h a t they intended t o c a l l D r . Tuby t o e s t a b l i s h m a l p r a c t i c e and proximate cause. This w a s n o t b e f o r e t h e d i s t r i c t c o u r t a t t h e t i m e it r u l e d on summary judgment, nor w a s any a t t e m p t made t o bring t h i s matter before t h e c o u r t f o r c o n s i d e r a t i o n o r a d j u d i c a t i o n . The d i s t r i c t c o u r t cannot be held i n e r r o r on t h e b a s i s of documents n o t before it a t t h e t i m e it made its r u l i n g . The d i s t r i c t c o u r t granted summary judgment on t h e ad- d i t i o n a l ground t h a t it found t h a t " * * * Sarah J. B a y l o r ' s r e f u s a l t o continue medical treatment i s a proximate cause of her subsequent problems w i t h her l e g . " Here a g a i n t h e d i s t r i c t c o u r t has made a f a c t u a l determination of t h e cause of h e r i n j u r i e s i n g r a n t i n g summary judgment. It ignores h e r deposi- t i o n testimony and t h a t of h e r husband t h a t she continued t o p u t weight upon her l e g and p r a c t i c e d walking on it a s advised by t h e doctor. It e l i m i n a t e s her testimony t h a t she d i d n o t know t h e r e was a nonunion a t t h e site of t h e f r a c t u r e and t h a t D r . Jacobson d i d n o t t e l l h e r t h e r e w a s a nonunion. It rejects t h e reasons and j u s t i f i c a t i o n t h a t Sarah Baylor and h e r husband gave f o r discontinuing c o n s u l t a t i o n s w i t h D r . Jacobson. These c o n s i d e r a t i o n s e s t a b l i s h a n i s s u e on proximate cause t h a t precludes summary judgment. W e pass no judgment on t h e m e r i t s of t h i s case. The ultimate determination of t h e i s s u e s here must be de- cided a t t r i a l . W e simply hold t h a t t h e r e a r e genuine i s s u e s of material f a c t t h a t preclude summary judgment i n advance of t r i a l . The summary judgment of t h e d i s t r i c t c o u r t is reversed. The cause is remanded t o t h e d i s t r i c t c o u r t of Missoula County f o r f u r t h e r proceedings. J u s t i c e ---;-----LL-;-J---------------- Hon. Bernard Thomas, D i s t r i c t Judge, s i t t i n g i n place of M r . Chief J u s t i c e James T. Harrison. M r . Justice Wesley Castles dissenting: I respectfully dissent. In my view the determinative question is whether plaintiffs presented sufficient expert testimony to establish an issue of malpractice. In Collins v. Itoh, 160 Mont. 461, 470, 503 P.2d 36, this Court said: " * * * The well-recognized rule, subject to certain exceptions, is that there must be expert testimony to establish negligence in a malpractice action." Here, plaintiffs rely on defendant's deposition to supply the required expert testimony. They constructed a hypothetical question which they maintain is representative of their view- point of the facts of this case. Plaintiffs then asked defend- ant if it would be acceptable medical practice to advise the patient in the hypothetical question to jump up and down on her leg. Defendant said no. Plaintiffs find a contradiction be- tween this response and the defendant's alleged treatment of plaintiff Sarah Baylor. Upon this premise they contend the issue of malpractice is raised and summary judgment is precluded. I disagree. The deposition shows the defendant em- phatically and persistently refused to accept the hypothetical as an accurate statement of this case. It is clear defendant perceived significant differences between the facts of this case and the assumed facts in the hypothetical. He did not intend his response to apply to the medical history of plaintiff Sarah Baylor and he explicitly said so. There is no other expert testimony as to the required standard of care or its breach by defendant. There comes a time when the district court must be allowed to enter summary judgment. The complaint in this action was filed April 2, 1974. The summary judgment which is the s u b j e c t of t h i s appeal w a s entered September 30, 1975. A t t h a t t i m e p l a i n t i f f s had s t i l l not presented an expert witness t o t h e d i s t r i c t c o u r t who would t e s t i f y t h a t defendant was negligent i n h i s treatment of p l a i n t i f f Sarah Baylor. I n t h e absence of such e x p e r t testimony I would a f f i r m t h e judgment of t h e d i s t r i c t c o u r t . J u s t i c e M r . J u s t i c e John Conway Harrison d i s s e n t i n g : I concur i n t h e foregoing d i s s e n t . o f M r . J u s t i c e Wesley C a s t l e s . V