Opinion ID: 1894244
Heading Depth: 1
Heading Rank: 5

Heading: national standard of care

Text: Dr. Behrens is certified by the American Board of Surgery and is a Fellow of the American College of Surgery. He has been certified since 1954. He graduated from medical school in 1943. After two years in military service, a pathology residency and some general practice in eastern South Dakota, he completed another residency in surgery and then came to the Rapid City area where he has practiced his profession and had contact with Shamburger. Shamburgers' medical expert, Dr. John E. DeLauro, is a surgeon from Denver, Colorado. He was not familiar with the setting in which Behrens worked. He testified that board certified surgeons must meet and comply with national standards in order to maintain their certification. It was his testimony that such surgeons should be evaluated on a national basis regardless of where they might practice. It was his medical opinion that there was a national standard for reducing the risk of infection in pre-operative and post-operative care and that Behrens failed to meet this standard. In settling the instructions, the trial court determined that the applicable legal standard of care for measuring Behrens' actions should be a national standard of care. Over Behrens' objection the following instruction was given: Instruction 6 In determining whether the Defendant was negligent, you are instructed that the Defendant has the duty to have that degree of learning or skill ordinarily possessed by board-certified surgeons of good standing engaged in the same field of specialization in the United States under same or similar circumstances. It is his further duty to use that degree of skill ordinarily exercised in like cases by board-certified members in good standing of his profession who are engaged in the same field of specialization in the United States and to be diligent in an effort to accomplish the purpose of which he is employed. You will judge Defendant's performance in accordance with the standard of care applicable to him as of the time of events complained of which is April 7, 1980 through May 6, 1980. These duties apply to pre-operative care and post-operative care. The failure to perform these duties is negligence. In analyzing the applicable standard of care in South Dakota, we note that Block v. McVay, 80 S.D. 469, 126 N.W.2d 808 (1964) held that negligence of a physician or surgeon must be established by the testimony of medical experts in those cases where laymen are not qualified by learning or experience to judge the medical aspects of such case. Also, there is no evidence indicating that there was any reasonable doubt as to whether he followed the proper practice prevailing throughout the medical profession. The type of evidence required upon which to base a finding of negligence in this respect must of necessity be furnished by medical experts. 126 N.W.2d at 811-812. Fjerstad v. Knutson, 271 N.W.2d 8, 12 (S.D.1978), involved both hospital and physician negligence and stated that: Decedent had a right to expect that the treatment rendered by a hospital which maintains and staffs an emergency room would be commensurate with that available in the same or similar communities or in hospitals generally. This statement appears to suggest both a national and local standard in the same sentence. [1] As authority for general or national standards, Fjerstad cited Dickinson v. Mailliard, 175 N.W.2d 588 (Iowa 1970). In addressing the standard of care for hospitals and physicians, the Iowa Supreme Court wrote: It is no longer justifiable, if indeed it ever was, to limit a hospital's liability to that degree of care which is customarily practiced in its own community. This is particularly true when we recognizeas we mustthat many communities have only one hospital. Adherence to such a rule, then, means the hospital whose conduct is assailed is to be measured only by standards which it has set for itself. There is no other hospital to which it may be compared. This would permit a hospital to establish a negligent standard of care and later avoid liability by pointing to its own conduct as the norm by which negligence should be tested. We have brushed aside many of these same arguments in connection with the skill to be exercised by a doctor in attending his patient, and we have long compelled him to abide by the rules of good practice followed generally under similar circumstances. (Citations omitted.) (Emphasis added.) 175 N.W.2d at 596. Numerous authorities support the adoption of a national standard of care for specialists in medicine. [2] We now hold that a medical specialist who holds himself out as such should be measured against the national standards of his profession. Based upon the foregoing reasons and authority, we hold that the trial court correctly instructed the jury as to the appropriate standard of care in this case.