Opinion ID: 2447946
Heading Depth: 2
Heading Rank: 1

Heading: Meaning of a Surgical Procedure

Text: We first consider Freeman's contention that a liver biopsy is a surgical procedure. It is undisputed that Freeman failed to obtain a medical expert to testify about the applicable standard of care and breach thereof; rather, Freeman sought to invoke a statutory exception that would render an expert's opinion unnecessary. The resolution of Freeman's contention presents a matter of first impression for us. The Healthcare Medical Negligence Insurance and Litigation Statute found at 18 Del. C. § 6853(e)(3), provides that in order to maintain a healthcare negligence lawsuit, the plaintiff must demonstrate medical malpractice through expert medical testimony; unless, a medical negligence review panel finds negligence or if one of the below exceptions is present, each of which creates a rebuttable inference of negligence: (1) A foreign object was unintentionally left within the body of the patient following surgery; (2) An explosion or fire originating in a substance used in treatment occurred in the course of treatment; or (3) A surgical procedure was performed on the wrong patient or the wrong organ, limb or part of the patient's body. We must give effect to the legislature's intent by ascertaining the plain meaning of the language used. [2] Where, as in this case, the legislature has not defined the term surgical procedure, we must give the term its commonly accepted meaning. [3] Because dictionaries are routine reference sources that reasonable persons use to determine the ordinary meaning of words, we often rely on them for assistance in determining the plain meaning of undefined terms. [4] In attempts to give the phrase, surgical procedure, its commonly accepted meaning, the parties offer three definitions from two dictionaries. Freeman compares a surgical procedure to a surgery and asks us to adopt the following definition: a surgical operation or procedure, especially one involving the removal or replacement of a diseased organ or tissue. [5] Freeman further contends that because a biopsy involves the removal and examination of a sample of tissue from a living body for diagnostic purposes, it falls squarely within the definition of a surgery. [6] Although surgery and surgical procedure appear to be linguistically similar, Dr. Ryan contends that a surgical procedure is more comparable to an operation, which is [a] surgical procedure for remedying an injury, ailment, defect, or dysfunction, [7] or a procedure performed on a living body usually with instruments for the repair of damage or the restoration of health and especially one that involves incision, excision, or suturing. [8] Dr. Ryan asserts that because there is neither an incision involved, nor any removal of diseased tissue for the purposes of repairing damage or restoring health, the term surgical procedure cannot include a biopsy. Rather, Dr. Ryan claims a biopsy is more analogous to drawing blood: a minimally invasive, non-surgical procedure during which a physician inserts a needle into a part of the body and removes a sample for diagnostic purposes. [9] Considering the three definitions advanced by the parties here, one could reasonably argue that a surgical procedure may broadly encompass any procedure that remedies an injury or ailment; narrowly include procedures that involve incisions, excisions, or suturing; or only covers the removal, or replacement of a diseased organ or tissue. The lack of consistency among the proffered definitions suggests that the dictionary options do not reveal an ordinary meaning that is commonly accepted. [10] We, therefore, may refer to other sources. [11] A common resource used in the healthcare industry is the American Medical Association's Current Procedural Terminology guide, which helps practitioners and insurers determine how to categorize medical procedures. [12] The CPT guide places liver biopsies under the general heading, Surgery Digestive SystemLiverIncision, which belies the classification of a liver biopsy as anything but a surgery. The general rules of statutory interpretation lend further support to our conclusion that a liver biopsy is a surgical procedure. While neither party acknowledged that 18 Del. C. § 6853(e)(1) explicitly uses the term surgery and subsection (e)(3) uses the phrase, surgical procedure, we cannot overlook the legislature's use of different terms. If we were to consider the parties' proffered definitions of surgery and operation alone to determine what surgical procedure means, we would render the use of that phrase, superfluous. A redundant interpretation is at odds with the commonly accepted rule of statutory interpretation that requires us to give each distinctive term an independent meaning. [13] At least one reference defines surgical broadly: relating to, resulting from, or characteristic of a surgery. [14] That broad definition more than sufficiently encompasses the procedure of a liver biopsy and comports with the medical profession's pricing guide, the CPT. Accordingly, we hold that the liver biopsy performed on Freeman to have been a surgical procedure as contemplated by 18 Del. C. § 6853(e)(3).