Opinion ID: 1773140
Heading Depth: 1
Heading Rank: 13

Heading: Coup de grace

Text: Even if we conceded there were splinters of bone which were not noted by Dr. Clayton, what effect would it have made in Dr. Boyd's, or any doctor's, treatment had he been informed of them? Returning to what happens to the anatomy when there has been a sprain severe enough to dislocate the joint, such dislocation is and of itself points to the strong likelihood the joint capsule had to be ruptured, and ligaments of the joint thereby torn. The ligaments are attached to and enmeshed in the bone. Any tearing of the ligament from the bone is going to remove some of the bone. Dr. Carter said it was like tearing wallpaper from the wall. The splinters might be so small they could only be detected by microscope. The fragment might be large enough where the observer could see not only the chip, but the broken off place in the bone where it came from. Whatever Dr. Robertson saw was quite small. Therefore, Dr. Robertson knew when he was looking at x-rays of a sprain so severe that the joint was dislocated, that in all likelihood some bone splinters were somewhere. What he saw may have been bone splinters, there may have been more he did not see. This information of a subluxation, however, would also incline him to believe what might otherwise be deemed an artifact was a bone fragment: in other words, make a false positive diagnosis. [6] The only significance of these minute bone splinters, however, was to indicate a ligament had been pulled loose from the bone there. The damage to the bone would have been insignificant, requiring no bone repair. Dr. Boyd already knew in all likelihood one or more ligaments had been torn loose from the bone. Any doctor who observes a sprain severe enough to have knocked bones out of joint knows he has a substantial sprain. Of what benefit would it have been to him for Dr. Clayton to have reported he saw evidence of three bone splinters? It would only have been an indication of the severity of the sprain. He already knew this. Indeed, Dr. Boyd was never asked, Doctor, if Dr. Clayton had reported to you he saw three bone splinters, would that have made any difference in your treatment? [7] Thompson had a severe sprain, he had one damaged ligament, which was surgically repaired. There can be no dispute he needed adequate medical treatment and advice. A sprained joint which is not properly treated can cause serious, disabling problems. A sprained joint is weaker, less stable, and more prone to re-injury and worse damage than a healthy one. Dr. Meyer testified if he had seen Thompson in July with the history he gave, and based on the x-rays of Dr. Clayton, he would have performed some clinical tests to further evaluate the damage to his thumb, and he would have probably splintered him and immobilized the thumb and checked him further. Another point he said he would have possibly made more x-rays at the time. [8] It is also quite significant to note Dr. Meyer, Thompson's own witness, was never asked, Doctor, if you had received a report of three bone splinters, or `cortical evulsions' of minute size, would this in and of itself have made any difference in your treatment if you had seen Thompson in July? Dr. Caden, the other orthopedist, testified it would have made no difference to him in the treatment of Thompson, whether or not he had seen bone splinters on an x-ray. Had he seen Thompson initially, he would have clinically examined the thumb by routine tests of movement. He also testified he would have either put the thumb in a cast or operated on it to repair the damaged ligament. He was asked whether such small fractures would have made a difference in his treatment, even if they had been noted. He replied: I can't really associate it because it doesn't matter. [Vol. IV, p. 486] Then, he testified: I don't know how more clearly I can say that an x-ray with a joint in normal alignment does not tell you whether you have a major ligament injury with or without a chip fracture. [Vol.IV, p. 487] What would have been significant to both Dr. Meyer and Dr. Caden was the fact the thumb joint was dislocated. [9] That was an indication of the severity of the sprain. Dr. Clayton was not privy to this information in July, 1979. Thompson's thumb was not immobilized. It was not splinted or even taped. He was sent home and told to soak it in hot water. He was also told if it did not get better to return to his doctor. Instead, he continued his sports activities and to work with a completely unprotected hand until November, 1979, over four months later. This time his joint was back out of place again. With this scenario it would have been miraculous if he had not re-injured that thumb hundreds of times, exacerbating its condition. It is not the purpose of this special concurring opinion to blame anybody. But I certainly have an obligation to remove blame from what I can only conclude was a competent physician who did nothing negligent. Despite the contentions of Dr. Robertson, we would have to abandon common knowledge and basic wisdom to accept plaintiff's thesis of liability. While the record indicates Dr. Robertson is a technically competent radiologist, not markedly less obvious is a hypercritical stance frequently demonstrated when citizens of the British Commonwealth (of English descent) evaluate others. The whole thrust of Thompson's case against Clayton is his alleged failure to note three bone fragments and tell Boyd that his patient had a sprain in which some ligaments had been torn loose. Knowing his patient had suffered a lick so severe it knocked the joint out of place, if Boyd did not already know this, a 2 X 4 would not have made it any plainer.