Opinion ID: 2175548
Heading Depth: 2
Heading Rank: 3

Heading: The findings in the text.

Text: If the findings in the text of the judge's order are correct, then in July 1985, when Dr. Schultz failed to order hospitalization, Ms. Brown's condition was readily treatable without amputation. If Howard had exercised due care, there would have been no amputation. If R. & G.'s negligence merely caused ulceration, but if amputation could have been avoided, then as between R. & G. and Howard, as a matter of equity, the responsibility of the latter for the amputation substantially outweighs the responsibility of the former, and Howard should be required to indemnify R. & G. with respect to so much of the injury, including the amputation, as is primarily attributable to Howard's malpractice. This is particularly true in light of Howard's responsibility to Ms. Brown over a long period of time both before and after R. & G.'s role, which responsibility included prescribing the very orthopedic shoes which precipitated R. & G.'s liability. Although this court has not previously addressed the question whether a duty to indemnify arises in such a context, the proposition that Howard must indemnify R. & G. is supported by reason and by the overwhelming weight of authority. See generally Annotation: Right of tortfeasor initially causing injury to recover indemnity or contribution from medical attendant aggravating injury or causing new injury in course of treatment, 72 A.L.R. 4th 231, 238-48 (1989) (hereinafter 1989 annotation). A hypothetical example demonstrates why this is so. Suppose that the plaintiff's hand is cut as a result of an initial tortfeasor's negligence. All that is required is to clean and dress his wound. If that were accomplished with due care, the plaintiff's injury would be minimal. Following the injury, however, a physician negligently fails to clean the wound, which becomes infected and gangrenous, so that the plaintiff's arm must be amputated. As between the plaintiff and the original tortfeasor, it arguably may be reasonable to require the latter to compensate the former for his entire injury. If no physician had entered the picture, the plaintiff would have lost his arm. As between the original tortfeasor and the negligent physician, however, there is no equity in requiring the former to pay half of that part of the plaintiff's compensation which is for the harm directly attributable to the physician's malpractice. Where one defendant was responsible for a minor injury and a second defendant's conduct was the effective cause of a major one, the first is unjustly penalized, and the second receives a windfall, if each must pay the same amount to the plaintiff. In Travelers Indemnity Co. v. Trowbridge, 41 Ohio St.2d 11, 321 N.E.2d 787 (1975), a workman had been injured while on the job. The employer's insurer had made payments to the workman to compensate him for the loss. The insurer then sued the physician who had treated the workman, claiming that the physician's malpractice had aggravated the injuries. The insurer contended that the physician should be required to indemnify the insurer for that portion of the damages due directly to the physician's malpractice. The court, reversing the dismissal of the complaint below, held that a tortfeasor who negligently causes an injury has a right to indemnity from a physician who negligently causes a new injury or aggravates the existing injury during the course of his treatment of the injury caused by the tortfeasor. Id. at 16, 321 N.E.2d at 790. Explicating its rationale, the court stated, in pertinent part: In the ordinary joint or concurrent tortfeasor situation, a single indivisible injury is produced, and each of the tortfeasors is charged with liability for the results of the negligence of the other, with no right of contribution or indemnity between them.... The physician and the tortfeasor are not typical concurrent tortfeasors but, rather, are more in the nature of successive tortfeasors. Id. The court recognized that, as between the injured party and the original tortfeasor, the latter was liable for the entire injury, for the physician's intervening negligence had not broken the chain of proximate cause. [19] The court held, however, that as between the tortfeasor and the physician, the latter's responsibility was far more direct and far greater, and that the equities therefore required indemnification. Citing a prior annotation superseded by the 1989 annotation, [20] the court stated that almost all jurisdictions which have considered the issue have concluded that a tortfeasor who caused an initial injury has the right to recover indemnity from a physician who negligently either caused a new injury or aggravated the existing injury during the course of his treatment.... [T]he rationale, that he who actively causes an injury should be responsible to another who is liable for such injury because of his own negligence but who did not actively create such injury, produces a just and equitable result. Id., 321 N.E.2d at 790. In Niles v. City of San Rafael, 42 Cal. App.3d 230, 116 Cal.Rptr. 733 (1st Dist. 1974), Kelly, an eleven-year-old boy, was injured in a fight at the playground of his school. Employees of the City negligently failed to prevent the fight. After complaining of pain, the injured boy was transported to the emergency room of a local hospital, where signs and symptoms of severe head injury were observed by the treating physicians. In spite of this, Kelly was sent home with his father, apparently because a hospital representative erroneously believed that the boy could not be admitted because he was not being treated by a physician with staff privileges at the hospital. After Kelly's pulse rate fell, he was rushed back to the hospital. By the time the doctors were able to perform neurosurgery, however, he had become permanently paralyzed and mute. The public entities which were alleged by Kelly to have negligently failed to prevent his injuries at the playground filed a cross-claim against the hospital for indemnity. The jury found that both the public entities and the hospital were negligent. On the cross-claim for indemnity, however, the jury apportioned the damages in the amount of $25,000 against the City and in the amount of $4,000,000 against the hospital. The appellate court upheld the verdict, reasoning as follows: The jury determined that the negligent acts of appellants and the public entities caused separate and identifiable damages; the evidence supports that determination. There was expert testimony that Kelly had an excellent chance of complete recovery if he had been properly treated when he first arrived at the hospital, and that Kelly's condition did not deteriorate to the point of permanent disability until after Kelly had been sent away and had spent some time at his father's apartment. Id. at 249, 116 Cal.Rptr. at 738. It is noteworthy that in Niles, the hospital did not take any active steps which aggravated Kelly's condition. Rather, its negligence lay in failing to treat Kelly and to stem the tide of events which, without the intervention of a reasonably prudent physician, resulted in catastrophic injuries. Niles therefore cannot be reconciled with any notion that the duty to indemnify arises only if the physician affirmatively inflicts a new injury ( e.g. by administering AIDS-infected blood in treating an abrasion). Aggravation of an injury by negligent failure to treat it, resulting in catastrophe, may also trigger the duty to indemnify, where equity and justice so require. In New Milford Bd. of Educ. v. Juliano, 219 N.J.Super. 182, 530 A.2d 43 (1987), Karen, aged thirteen, was injured when a volleyball stanchion fell on her foot at school. Physicians who subsequently treated her allegedly so aggravated her injury that three of her toes had to be amputated. As in Niles, the Board of Education sought indemnity from the physician. Noting that no New Jersey court had previously decided a claim of indemnity on a comparable state of facts, the court analyzed the issue as follows: A claim for indemnity by initial tortfeasors, such as plaintiffs, against successive tortfeasors, such as defendant doctors, is fundamentally different from a claim for indemnity by one joint tortfeasor against another. Plaintiffs do not seek to escape responsibility for their tortious conduct by holding defendant doctors liable for all damages incurred by Karen. Rather, plaintiffs' claim is limited to the difference between what Karen's damages would have been if defendants had not committed malpractice and the full amount of damages which she suffered as a result of both the original accident and the subsequent malpractice. It is clear that a tortfeasor is responsible for all damages that naturally and proximately flow from the initial tort, including the consequences of medical malpractice in treating the injuries caused by his wrong.... However, in our view, the responsibility of an initial tortfeasor for the additional harm caused by subsequent medical malpractice is less immediate and less direct than the responsibility of the party or parties who have actually committed the malpractice. Indeed, the initial tortfeasor's responsibility for that additional harm can be viewed as a form of constructive or secondary liability.... Consequently, we conclude that justice requires recognition of plaintiffs' right to seek indemnification against defendant doctors. Id. 219 N.J.Super. at 186-87, 530 A.2d at 45. (Emphasis added and citations omitted). The court stated that its conclusion was supported by nearly all the decisions in other jurisdictions, and listed an impressive array of applicable precedents. Id., 530 A.2d at 45. [21] If the trial judge's findings in the text of his order in the present case are accepted as correct, then the reasoning of Niles, as well as Trowbridge, and Juliano, applies with equal force here. The negligence of R. & G. was responsible for Ms. Brown's ulcerations, and R. & G. is entitled to no indemnity or contribution for damages directly flowing from its negligence, up to the point that Howard's malpractice intervened. According to the judge's findings in the text, however, Howard's negligence converted Ms. Brown from someone whose foot did not require amputation into someone for whom such radical surgery was necessary. In that respect, the situation parallels the circumstances in the three cases cited, and the same result must follow. R. & G. therefore has the right to indemnity from Howard for the difference between what [Ms. Brown's] damages would have been if [Howard] had not committed malpractice and the full amount of damages which she suffered as a result of both [R. & G.'s original negligence] and the subsequent malpractice. Juliano, supra, 219 N.J.Super. at 186-87, 530 A.2d at 45. [22] If the question of indemnity is not mooted, and if the judge reiterates the findings in the text of his order, then he will be obliged to calculate and apportion damages as contemplated in Juliano. [23]