Opinion ID: 1168687
Heading Depth: 1
Heading Rank: 2

Heading: admissibility of expert testimony of medical doctor against podiatrist

Text: Since 1930, this court has considered many appeals involving malpractice claims against medical practitioners other than medical doctors. Over the protestations of the plaintiffs (the patients), we have consistently adhered to the rule that practitioners such as osteopaths, chiropractors and podiatrists are entitled to have their conduct in the treatment of patients tested by standards applicable to the system to which they belong. [1] The rule has otherwise been stated as holding the defendant to the standard of skill and care required of an ordinary practitioner of that discipline in the community or a similar community. [2] The resolution of this issue turned upon the determination of the appropriate rule of law to be adopted in framing the appropriate standard of care. Many of the medical malpractice cases we have considered were cases involving practitioners such as medical doctors, osteopaths or chiropractors who have been held liable to their patients on the basis of the testimony of witnesses from another school of medicine. In most of these cases, the practitioner, after losing in the trial court, was asserting (as the podiatrist defendant asserts in the case at bar) that the trial court erred in permitting medical practitioners from another discipline to express expert opinions that the defendant, in treating the patient, was negligent. [3] The resolution of this issue turned upon the statement of the appropriate rule of evidence to be applied in determining the admissibility of evidence. The following oft-quoted paragraph from Wemett v. Mount, 134 Or. 305, 313, 292 P. 93 (1930), states both the rule of law and the rule of evidence: It is the general rule that in a malpractice action a physician or surgeon is entitled to have his treatment of his patient tested by the rules and principles of the school of medicine to which he belongs, and not by those of some other school, because a person professing to follow one system or school of medicine cannot be expected by his employer to practice any other, and if he performs a treatment with ordinary skill and care in accordance with his system, he is not answerable for bad results. However, the rule, which confines the inquiry as to a practitioner's skill and care to the rules and principles of the school of medicine to which he belongs, does not exclude the testimony of physicians of other schools or experts in other lines when such testimony bears on a point as to which the principles of the schools do or should concur, such as the dangers incident to the use of X-rays, or the existence of a condition that should be recognized by any physician   . 134 Or. at 313, 292 P. 93. The first sentence of the quoted material defines the rule of law as to the practitioner's duty of care (ordinary skill and care in accordance with his system). The second sentence states the rule of evidence governing the admissibility of expert opinion testimony from a practitioner of a different school of medicine whether the defendant's treatment was proper (Testimony is permitted when such testimony bears on a point as to which the principles of the schools do or should concur.). Later cases have refined and restated, but have not changed, the rules. In Sheppard v. Firth, 215 Or. 268, 271, 334 P.2d 190 (1959), a case in which the trial court permitted a medical doctor to testify that a chiropractor's treatment of a patient was not proper, we listed a second exception to the rule of evidence set forth in Wemett v. Mount, supra : There is, of course, an exception to this general rule which arises whenever the methods of treating a particular ailment are generally the same in either school, Wemett v. Mount, supra; or where a physician, although trained in one school, steps out of the practice of his own school and attempts to treat a patient in the manner practiced by another school.    215 Or. at 271, 334 P.2d 190. Concerning the Wemett v. Mount quotation set forth above, the court went on to say: The thought contained in the quotation from Wemett v. Mount, supra, is that a person seeking treatment from a practitioner of a given school agrees to accept the curative practices and belief of that particular school, and if the practitioner treats the patient reasonably skillfully in accordance with the teachings of his school he incurs no liability. Therefore, it is apparent the courts are not concerned with the merits of the various systems that seek to relieve human ailments. It is sufficient to state that many of our citizens believe in the efficacy of drugless treatments and secure the services of those practicing them. The unfairness of permitting a practitioner of one school, who uses one method to cure an ailment, to measure the treatment and skill of a practitioner of another school, who uses a different method, must be equally apparent. 215 Or. at 271-272, 334 P.2d 190. Since Wemett and Sheppard we have consistently adhered to the rules they set forth. But the language used in some of our opinions may have created confusion in failing to distinguish between the rule of law pertaining to the defendant's duty of care and the rule of evidence concerning the admissibility of expert testimony from practitioners of another medical discipline. These quotations from later cases are illustrative. Dowell v. Mossberg, 226 Or. 173, 186, 355 P.2d 624, 359 P.2d 541 (1961) (a claim against a chiropractor for negligence in failing to diagnose diabetes in which medical doctors were permitted to testify that the chiropractor's treatment was not proper): In the case at bar, the defendant chiropractor claimed competence in the diagnosis of diabetes. He testified that whenever he detected the malady in a patient he referred the patient to a medical doctor. He testified that he had two or three such cases a year. He also described in detail the procedures used by chiropractors in testing for diabetes. The procedures were generally similar to those described by medical doctors. So long as a chiropractor claims competence to diagnose diabetes, there is no reason in law or logic why he should not be held to the same degree of skill and care as medical doctors in the diagnostic procedure.    (Emphasis added.) [4] James v. Falk, 226 Or. 535, 360 P.2d 546 (1961) (claim against osteopath for negligence in treating a fracture, expert testimony by medical doctor):    There was evidence from which the jury could have concluded that both schools of practice followed the same precepts in treating a fracture of the kind in question. On the other hand, if there was any difference, which we cannot find from the record, the evidence would also establish that defendant relied on standards followed by the medical doctors to justify the course of treatment he adopted in this case. The evidence submitted by defendant's witnesses would lead one to believe that the basic difference between the two schools was that of philosophy. There was no showing that philosophy had any value in treating a severe fracture of the femur. 226 Or. at 539, 360 P.2d 546. In the opinions referred to above we stated the test for admissibility of expert medical testimony from other disciplines or schools in various but not inconsistent ways. In James v. Falk, supra , the evidence was allowed because both schools of practice followed the same precepts.  226 Or. at 539, 360 P.2d 546. Dowell v. Mossberg, supra , approved the reception of evidence because the procedures were generally similar,  226 Or. at 186, 355 P.2d 624, or because the methods of treatment for a particular ailment are generally the same,  226 Or. at 185, 355 P.2d 624. Sheppard v. Firth, supra , allowed the evidence if the methods of treating a particular ailment are generally the same.  215 Or. at 271, 334 P.2d 190. And Wemett approved such testimony if it bears on a point as to which the principles of the schools do or should concur.  134 Or. at 313, 292 P. 3. Our most recent opinion, Sutton v. Cook, 254 Or. 116, 123, 458 P.2d 402 (1969), states that evidence from a practitioner of another school is admissible when the procedures of both schools are substantially the same.  Some of the opinions cited above have discussed the admissibility of such testimony in terms of the duty of care. In Dowell v. Mossberg, supra , we stated that [s]o long as a chiropractor claims competence to diagnose diabetes, there is no reason in law or logic why he should not be held to the same degree of skill and care as medical doctors   . 226 Or. at 186, 355 P.2d 624. The admissibility of testimony from practitioners from other disciplines turns not on whether the duty of skill and care is the same, but upon whether the procedures, practices, precepts, methods, treatments or techniques which are at issue are identical or generally similar. [5] Therefore, in laying the foundation for such testimony, if it is shown that there exists an appropriate similarity in procedures or techniques, that in and of itself is a sufficient foundation for the expression of expert opinion that the defendant's conduct was or was not proper.