Opinion ID: 1484870
Heading Depth: 1
Heading Rank: 1

Heading: the negligence standard

Text: It should be noted at the outset that Hood does not assert that the surgical removal of the carotid body was unskillfully or negligently performed. Nor does Hood contend that Dr. Phillips' diagnosis of emphysema was incorrect. Instead, the patient-plaintiff maintains that it was negligence to utilize this particular surgical procedure as a method of treating emphysema. Both Hood and Dr. Phillips assert the court of civil appeals erred in adopting the respectable minority negligence standard. There are at least four standards that may be applied to a medical malpractice suit based on the assertion that the mode or form of treatment was not a remedy for the diagnosed condition. RESPECTABLE MINORITY: The respectable minority standard approved in the instant case by the court of civil appeals was adopted in Leech v. Bralliar, 275 F.Supp. 897 (D.Ariz. 1967); Baldor v. Rogers, 81 So.2d 658 (Fla. 1954); Walkenhorst v. Kesler, 92 Utah 312, 67 P.2d 654 (1937); Gruginski v. Lane, 177 Wash. 121, 30 P.2d 970 (1934); Swanson v. Hood, 99 Wash. 506, 170 P. 135 (1918); Dahl v. Wagner, 87 Wash. 492, 151 P. 1079 (1915); and Smith v. Beard, 56 Wyo. 375, 110 P.2d 260 (1941). In McHugh v. Audet, 72 F.Supp. 394, 400 (M.D.Pa.1947), the court adopted a slightly different standard: Where competent medical authority is divided a physician or surgeon will not be held responsible if in the exercise of his judgment he followed the course of treatment advocated by a considerable number of his professional brethren in good standing in his community. [Emphasis added.] Accord, Fritz v. Parke Davis and Company, 277 Minn. 210, 152 N.W.2d 129 (1967); Scheuler v. Strelinger, 43 N.J. 330, 204 A.2d 577 (1964); Duckworth v. Bennett, 320 Pa. 47, 181 A. 558 (1935); Gresham v. Ford, 192 Tenn. 310, 241 S.W.2d 408 (1951); McPeak v. Vanderbilt University Hospital, 33 Tenn.App. 76, 229 S.W.2d 150 (1950). REASONABLE SURGEONS WOULD DISAGREE: Dr. Phillips maintains it was error for the court of civil appeals to adopt the respectable minority standard. He proposes the following test: When reasonable surgeons would disagree as to either the need for an operation or the procedure employed, the decision is a matter of surgical judgment, and the surgeon will not be liable even if it subsequently appears that the organ removed was healthy or the operation itself was not needed or was unsuccessful. [Emphasis added.] See Graham v. Alcoa S. S. Co., 201 F.2d 423 (3d Cir.), cert. denied, 346 U.S. 832, 74 S.Ct. 32, 98 L.Ed. 335 (1953); Snyder v. St. Louis Southwestern Ry. Co., 228 Mo.App. 626, 72 S.W.2d 504 (1934). ANY VARIANCE: Some courts have held any variance from the accepted mode of treatment renders the physician liable. In Jackson v. Burnham, 20 Colo. 532, 39 P. 577, 580 (1895), it was stated that when a particular mode of treatment is upheld by a consensus of opinion among the members of the profession, it should be followed by the ordinary practitioner; and if a physician sees fit to experiment with some other mode, he should do so at his peril. Accord, Allen v. Voje, 114 Wis. 1, 89 N.W. 924 (1902). REASONABLE AND PRUDENT DOCTOR: The following standard has been applied in Texas in other medical malpractice suits... what a reasonable and prudent doctor would have done under the same or similar circumstances. Snow v. Bond, 438 S.W.2d 549, 550 (Tex.1969). This review of the various standards reveals most courts have not attempted to articulate a distinction among experimental, outmoded, rejected, and accepted surgical procedures. Instead, the majority of courts have attempted to draw a line between the reasonable and prudent physician who, as a last resort, turns to an experimental or a rejected treatment in the hope of assisting the patient and the individual practitioner who attempts to beguile his patient with false or distorted promises. These courts have recognized, as we do, that physicians should be allowed to exercise their professional judgment in selecting a mode or form of treatment. Further, physicians should be allowed to experiment in order that medical science can provide greater benefits for humankind. Consequently, we reject the any variance standard. The respectable minority standard adopted by the court of civil appeals and considerable number test could convey to a jury the incorrect notion that the standard for malpractice is to be determined by a poll of the medical profession. Accordingly, these standards are rejected. Dr. Phillips' proposed reasonable surgeons would disagree standard and the what a reasonable and prudent doctor would have done standard, which has been applied in other medical malpractice suits, appear to be simply different ways of reaching the same objectivepreclude the imposition of liability on the reasonable and prudent physician and permit liability on the one who is not. We are of the opinion that the statement of the law most serviceable to this jurisdiction is as follows: A physician who undertakes a mode or form of treatment which a reasonable and prudent member of the medical profession would undertake under the same or similar circumstances shall not be subject to liability for harm caused thereby to the patient. The question which conveys to the jury the standard which should be applicable is as follows: Did the physician undertake a mode or form of treatment which a reasonable and prudent member of the medical profession would not undertake under the same or similar circumstances? See Snow v. Bond, supra ; McCoid, Some Particular Duties of Medical Practitioners, in Clinical Investigation in Medicine: Legal, Ethical, and Moral Aspects 216 (1963). Generally this standard should be applied whether the mode or form of treatment is experimental, outmoded, or rejected. The burden of proof is on the patient-plaintiff to establish that the physician-defendant has undertaken a mode or form of treatment which a reasonable and prudent member of the medical profession would not have undertaken under the same or similar circumstances. The circumstances to be considered include, but are not limited to, the expertise of and means available to the physician-defendant, the health of the patient, and the state of medical knowledge. Unless the mode or form of treatment is a matter of common knowledge or is within the experience of the layman, expert testimony will be required to meet this burden of proof. In the instant case there was expert medical testimony characterizing carotid surgery as an unaccepted mode of treatment for emphysema, as a controversial procedure, as a treatment not supported by medical evidence, and as a surgical procedure which had been tried by a number of physicians, found ineffectual, and abandoned. Although the trial court refused to submit an issue regarding ordinary negligence, this evidence would raise a question of fact for the jury on the issue of ordinary negligence and such issue should have been submitted.