Opinion ID: 1976643
Heading Depth: 1
Heading Rank: 3

Heading: CORBETT vs. DeMOURA

Text: Ms. Corbett has appealed from the judgment entered by the trial court in favor of Dr. DeMoura. All of the events which are the subject of this appeal occurred between July and October, 1978. Ms. Corbett argues that the trial court erred in granting Dr. DeMoura's motion for a compulsory non-suit which was made at the conclusion of plaintiff's liability case against Dr. DeMoura. Dr. DeMoura contends that the testimony of Ms. Corbett's expert, Dr. Starks, contained irreconcilable conflicts, and thus was not sufficient to present an issue to the jury. Ms. Corbett responds that the testimony of her expert, Dr. Starks, was not contradictory, but rather was sufficient to create a question for the jury concerning Dr. DeMoura's alleged negligence. Therefore, she argues that she is entitled to a new trial. We agree. A non-suit may not be granted unless the jury, viewing all the evidence and all reasonable inferences arising from it, in the light most favorable to the plaintiff, could not reasonably conclude that the elements of the cause of action have been established. Mazza v. Mattiace, 284 Pa.Super. 273, 277, 425 A.2d 809, 811-12 (1981). To establish a prima facie case of professional medical negligence, Ms. Corbett must prove by competent evidence that the conduct of Dr. DeMoura fell below the standards of reasonable medical practice, and that her injuries [were] caused by [his] failure to provide such medical care. Reichman v. Wallach, 306 Pa.Super. 177, 183, 452 A.2d 501, 504 (1982). Before addressing the legal arguments on this issue, we must expand our summary of the facts listed above. Ms. Corbett was admitted to the hospital on July 11, 1978. Dr. DeMoura operated on her knee the following day, July 12, 1978. She was discharged on July 19th. Ms. Corbett was readmitted to the hospital on July 25, 1978, where she remained until August 26, 1978, due to a post-operative infection. She remained under Dr. DeMoura's care until October 10, 1978. Her expert witness, Dr. Starks, was critical of Dr. DeMoura's treatment on two counts: (1) that a different antibiotic should have been utilized; and (2) that debridement of the left knee should have been performed in the operating room under general anesthesia. Dr. Starks was the only expert to testify against Dr. DeMoura. He took the witness stand and was duly qualified as an expert in orthopedic surgery. The gravamen of Dr. Starks' theory was that an enterobacter organism, existing dormant in the wound from Ms. Corbett's prior difficulties, caused her later infection. After outlining the course of treatment which Ms. Corbett received while under the care of Dr. DeMoura, Dr. Starks specifically testified that in his opinion, based upon a reasonable degree of medical certainty, the wound should have been debrided in the operating room and gentamicin should have been administered with close monitoring. This opinion was offered during the following exchange: BY MR. FINNEY [Ms. Corbett's counsel]: Q. Doctor, based upon all the facts in the record that we have reviewed this morning, and that appear in the chart for the St. Joseph's Hospital, do you have an opinion, based upon a reasonable degree of medical certainty, as to whether the medical treatment for this patient met the standard of reasonable care as it existed in 1978? A. My opinion is that it did not. Q. Would you please explain your opinion, sir? A. I feel that according to the standards of good and reasonable care, the wound should have been debrided more widely in the operating room under an anesthetic so that all of the necrotic tissue could have been removed to normal, healthy tissue. And I believe that the gentamicin should have been administered with the blood urea nitrogen level being monitored very closely. Trial transcript, December 9, 1985 at 39-40 (emphasis added). Further, Dr. Starks opined that the keflex prescribed by Dr. DeMoura failed to kill the enterobacter organism. He explained his position, stating: It's my opinion that the infection that was originally treated subsided, but was not cured or eliminated and that it did lie dormant or quiescent in the tissues and was then  then again became active at the time of the Metropolitan Hospital admission, producing a recurrence of infection. T.T., December 9, 1985 at 52. Thus, there can be no doubt that on direct examination Ms. Corbett's expert witness unequivocally stated that in his opinion, Dr. DeMoura's treatment fell below the standard of good and reasonable care. On cross-examination, defense counsel attempted to get Dr. Starks to recant his testimony. With regard to the debridement issue, the following testimony was elicited: [BY MR. DuBOIS, attorney for Dr. DeMoura:] Q. Would you agree with me that it is important to debride away or to cut away all of the dead or necrosed tissue? A. Yes, sir. Q. And if in the judgment of the treating physician that could be done at a hospital bedside, you would have to agree with that type of treatment; would you not? A. Yes, sir. Q. And by the way, . . . you have talked in your testimony about going to the operating room and going through a debridement under general anesthesia; is that right? A. Yes, sir. Q. Is it correct that there are risks associated with general anesthesia? A. Yes, sir. Q. Is it correct that patients can die as a result of general anesthesia? A. Yes, sir. Q. If you can avoid using general anesthesia in a case, Dr. Starks, will you avoid it? A. Yes, sir.       Q. All right. Would you agree with me that you would try to avoid general anesthesia in cases because it is risky and dangerous? A. Yes, sir. T.T., December 9, 1985 at 72-73 (emphasis added). Although Dr. Starks testified generally concerning dangers which possibly can occur in the use of general anesthesia, defense counsel did not elicit from the witness testimony that under the facts of the case at bar, the dangers of anesthesia outweighed the danger posed by not being able to fully debride the wound such that in this instance the treatment fell below the standards of good and reasonable care. In other words, cross-examination focused on generalities, rather than on the specifics of this case. It was not contradictory, therefore, that on redirect testimony, Dr. Starks reiterated his position by stating that, in his opinion, the infection that was present in 1978 never went away: [By Mr. Finney:] Q. [D]o you have an opinion, doctor, whether the infection which is seen in December of '78 at Metropolitan, whether or not that is the same infection that we were talking about back in July and August?       A. It's my opinion that it is the same infection. THE COURT: Well, that means enterobacter? THE WITNESS: Yes, sir. T.T., December 8, 1985 at 88-89. Further, Dr. Starks explained, I feel that the infection that we saw in the summer of 1978 subsided, but it was not cured, and that the organisms that caused the infection remained dormant in the tissues and then were reactivated by the fall and reinjury, and therefore, you would have to say that it was the same infection that had recurred as a result of the reinjury. T.T., December 9, 1985 at 91. Dr. Starks fully explained the reasons why the organism never went away: the wound was not fully debrided and a strong enough antibiotic was not used. Upon thoroughly reviewing this testimony, we do not agree with Dr. DeMoura's contention that Dr. Starks waivered from his opinion to such an extent that it could not be relied upon to support a verdict for Ms. Corbett. However, even had he waivered, in the case of Brannan v. Lankenau Hospital, 490 Pa. 588, 417 A.2d 196 (1980), the Supreme Court held that a relatively minor divergence in only a part of appellant's expert testimony, when viewed against the testimony as a whole does not sufficiently compromise the witness' testimony on direct so as to justify the removal of the issue from jury consideration. Id., 490 Pa. at 597, 417 A.2d at 200. Therefore, the trial court erred in granting the non-suit and we remand the case for a new trial against Dr. DeMoura. [6]