Opinion ID: 163699
Heading Depth: 4
Heading Rank: 1

Heading: Evidence of a Single Ligature

Text: -11- The Hartnetts first argue that there is evidence in the record directly indicating that Dr. O’Rourke applied only one ligature to Mrs. Hartnett’s splenic artery. In advancing this argument, the Hartnetts rely primarily on Dr. O’Rourke’s notes regarding the initial surgery, which state that the splenic artery “was ligated.” Aplts’ App. at 119. The Hartnetts contrast that description with Dr. O’Rourke’s notes regarding the second surgery, which refer to his having applied “suture ligatures.” Id. at 120 (emphasis added). The Harnetts contend that from the specific use of the plural in the second set of notes, a factfinder could conclude that, when Dr. O’Rourke stated in the first set of notes that the artery “was ligated,” he meant that he applied only one ligature. The Hartnetts also rely on the testimony of their expert, Dr. Gordon. As we have noted, Dr. Gordon explained in deposition testimony that his opinion that Dr. O’Rourke had applied only one ligature to the splenic artery during the first surgery was based on a review of Dr. O’Rourke’s notes. Dr. Gordon also explained that his conclusion was based in part on his knowledge of how surgical notes are typically written. He stated that “[b]ecause of the nature of a suture ligature, one usually places a second ligature proximal to the suture ligature and in the course of the dictation, one usually dictates it was doubly ligated.” Id. at 86. When asked whether “the specificity of operative dictations can vary from report to report with the same surgeon,” Dr. Gordon responded: -12- That I don’t know. I know in my own case and I have to go from personal experience and from other operative notes that I’ve read that in general, surgeons use the same type of language most of the time for the report. As I said, in terms of ligature, ligated or doubly ligated are pretty standard terminology for most surgeons. Id. at 87. Finally, the Hartnetts point to the following deposition testimony of Dr. Chambers, the surgeon who assisted Dr. O’Rourke in the initial operation: I recall he [Dr. O’Rourke] used a silk suture ligature on the splenic artery. He ligated the smaller pancreatic veins with, I believe, a 5-0 or 4-0 Prolene, and then he used a free tie on the –to follow that on the splenic artery of silk. Id. at 34. According to the Hartnetts this testimony indicates that Dr. O’Rourke applied only one ligature. See Aplts’ Reply Br. at 3 (contending that “with both references to the silk suture, [Dr. Chambers] [is] referring to one and the same suture”). In response, Dr. O’Rourke invokes his own deposition testimony and that of Dr. Chambers. As to the latter, Dr. O’Rourke contends that the Hartnetts’ interpretation is not plausible. He maintains that because a “suture ligature” and “free tie” are two different kinds of ligatures, Dr. Chambers’ account cannot be reasonably read to support the Hartnetts’ one-ligature theory. We agree that the deposition testimony of Dr. O’Rourke indicates that he applied two ligatures to Mrs. Hartnetts’ splenic artery. In particular, Dr. -13- O’Rourke testified that, although his notes of the first surgery do not describe the number of ligatures, he remembers that he did doubly ligate Mrs. Hartnett’s splenic artery. He added, “With major arteries, I always doubly ligate.” Aplts’ App. at 30. As to Dr. Chambers’ testimony, we note that, in describing the first surgery, he referred to two different kinds of ligatures—a “suture ligature” and a “free tie.” See Aplts’ App. at 34; see also Alton v. Kitt, 431 N.E.2d 417, 421 (Ill. App. 1982) (noting the distinction between suture ligatures and free ties). The Hartnetts’ contention that Dr. Chambers’ testimony supports their theory is thus not plausible: his testimony does indicate that Dr. O’Rourke used two ligatures. Nevertheless, the testimony of Dr. O’Rourke and Dr. Chambers is not the only evidence in the record regarding the number of ligatures. As noted above, Dr. O’Rourke’s written account of the first surgery undermines his own testimony. Not only did he use a phrase— “was ligated”—that is consistent with only one ligature having been applied, but he also used the plural “sutures” in the description of other phases of the first surgery. See Aplts’ App. at 119 (stating that “subcutaneous tissue [was] irrigated with Betadine and closed with interrupted sutures of 3-0 Vicryl”) (emphasis added). Moreover, as the Hartnetts have observed, Dr. O’Rourke used the plural in describing his repair of the splenic artery during the second surgery. See id. at 120 (stating that “bleeding -14- from the splenic artery . . . was controlled with a clamp and suture ligatures”) (emphasis added). The notes of the second surgery also use the plural in describing other ligatures. See id. (stating that “subcutaneous tissue was irrigated with Betadine and closed with interrupted sutures of 3-0 Vicryl”) (emphasis added). This specific use of the plural to describe other ligatures provides support for the Hartnetts’ contention that the phrase “was ligated” was used by Dr. O’Rourke to refer to one ligature. Dr. Gordon’s testimony also undermines the testimony of Drs. O’Rourke and Chambers regarding the number of ligatures. Dr. Gordon stated that when a surgeon applies two ligatures to an artery, “one usually dictates [that the artery] was doubly ligated” and that “ligated or doubly ligated are pretty standard terminology for most surgeons.” Id. at 86-87. Thus, according to Dr. Gordon, the use of the phrase “was ligated” in the notes of the first surgery, when contrasted with the reference to the application of “sutures” to the splenic artery in the notes of the second surgery, supports the conclusion that Dr. O’Rourke used only one ligature. In granting summary judgment to the defendants, the district court characterized Dr. O’Rourke’s notes as “ambiguous,” but the court added that “Dr. Gordon’s assumptions based on [the notes] are not sufficient to create a genuine issue of material fact.” See id. at 165 (District Court Order filed Aug. 2, 2000). -15- According to the district court, “[t]he Hartnetts have presented no credible evidence that the artery was not doubly ligated.” Id. The court cited cases in which experts’ conclusory opinions, based on evidence not in the record, were held insufficient to defeat summary judgment. See id. (citing Evers v. General Motors Corp., 770 F.2d 984, 986 (11th Cir. 1985); American Key Corp v. Cole Nat’l Corp., 762 F.2d 1569, 1580 (11th Cir. 1985), and Merit Motors Inc. v. Chrysler Corp., 569 F.2d 666, 672-74 (D.C. Cir. 1974)). In so concluding, the district court misread the record evidence and did not properly apply the governing principles regarding summary judgment motions. As to the record, we note that, unlike the expert opinions in the cases cited by the district court, Dr. Gordon’s opinion was based upon evidence presented to the district court—Dr. O’Rourke’s own notes—as well as Dr. Gordon’s view that “one usually dictates [that the artery] was doubly ligated” and that “‘ligated’ or ‘doubly ligated’ are pretty standard terminology for most surgeons.” Aplts’ App. at 86-87 That evidence from Dr. Gordon and Dr. O’Rourke’s own notes is arguably inconsistent with the deposition testimony of Drs. O’Rourke and Chambers regarding the number of ligatures and raises a question of whether the latter testimony is credible. Cf. Sealock v. Colorado, 218 F.3d 1205, 1212 (10th Cir. 2000) (reversing the grant of summary judgment in light of inconsistency between medical records and defendant’s testimony). -16- In light of the Hartnetts’ evidence, the district court’s reliance on the deposition testimony of Drs. O’Rourke and Chambers constituted a “[c]redibility determination[], [a] weighing of evidence, and [a] drawing of . . .inferences from the facts,” functions properly performed by the jury rather than “[the] judge [when] he is ruling on a motion for summary judgment.” Anderson, 477 U.S. at 255; see also Starr, 54 F.3d at 1557 (stating that, at the summary judgment stage, the court may not “assess the credibility of . . . conflicting testimony”). When viewed in the light most favorable to the Hartnetts (the non-moving parties), see Tool Box, 316 F.3d at 1173, Dr. O’Rourke’s notes and Dr. Gordon’s testimony provide evidence from which a reasonable juror could conclude by a preponderance of the evidence that Dr. O’Rourke applied only one ligature to the splenic artery during the first surgery and that, as a result, he failed to exercise a duty of care commensurate with that of a reasonable physician practicing in the field. See Kaiser Foundation, 741 P.2d at 718. To be sure, a reasonable juror could also find Dr. O’Rourke’s and Dr. Chambers’ account of the first surgery entirely credible, concluding that Dr. O’Rourke applied two ligatures and that the use of the phrase “was ligated” in the notes of the first surgery was merely an abbreviated way in which to describe the application of more than one ligature. However, such matters should be resolved by the factfinder at trial rather than on summary judgment. See Anderson, 477 -17- U.S. at 255. Accordingly, we conclude that the district court erred in granting summary judgment to Dr. O’Rourke on the Hartnetts’ negligence claim.