Opinion ID: 297154
Heading Depth: 1
Heading Rank: 3

Heading: the evidence of negligence

Text: 10 The record in this case is voluminous, but the critical testimony with regard to Dr. Stover's conduct is found in the testimony of Dr. Charles Janda. Essentially, plaintiff's case is as follows. Mrs. Cameron's cancer was probably present from the time she went for treatment on May 10, 1967; Dr. Stover suspected something was wrong as early as June 9, 1967, and indeed suspected some systemic ailment, possibly leukemia (cancer) at this time; a tissue biopsy performed June 9 or anytime thereafter would have revealed this cancer; had the cancer been caught at an earlier time, Mrs. Cameron's chances for survival would have been better and in any event she would have lived longer and in more comfort; and Dr. Stover was negligent in failing to diagnose the cancer by performing a tissue biopsy. 11 This theory was supported in all respects by the testimony of Dr. Janda, whose qualifications as a medical expert were not challenged. He testified in substance that if Dr. Stover suspected cancer on June 9 he should have done a tissue biopsy; and even if he didn't suspect cancer on June 9, he should have, as there were sufficient signs and symptoms at that time; and the failure to do the biopsy was negligent. He further testified that the failure to render any treatment to correct the underlying condition between June 9 and August 23, whether for osteomyelitis or cancer, was negligent. (Presumably had treatment of osteomyelitis been undertaken earlier, the patient's failure to respond would have been highly suggestive of the need to re-evaluate the diagnosis.) 12 Dr. Stover asserts two defenses on the issue of negligence. One apparently is that there was no obvious evidence of a gum tumor until until September 26. However, since there were other signs of cancer much earlier, the jury was entitled to rely on the expert testimony that a diagnosis should have been made on the basis of these symptoms. There is no medical testimony in the record that the absence of a visible tumor in and of itself would relieve him of negligence. 13 The second defense offered is that there were two schools of thought with relationship to the treatment of osteomyelitis. One is that surgery is indicated and the infected bone and surrounding tissue should be taken out as soon as possible. The other advocates a more conservative approach initially, because the surgical procedure involves a risk of spreading the infection into other sensitive areas, which could have serious, possibly even fatal, consequences. Therefore, treatment by antibiotics is initially preferred and if this is unsuccessful, then surgery is performed. Dr. Janda agreed that there were these two schools of thought. Dr. Stover testified that he belonged to the more conservative school of thought which disliked surgery initially because of the risk of spreading the infection, and that he did not do the tissue biopsy because of this fear. 14 There are two problems with this defense. First, the two schools of thought as to which procedure is proper treatment for osteomyelitis would appear to come into play only when a definitive diagnosis of osteomyelitis is made. But we are here concerned primarily with proper methods of making the initial diagnosis — i.e., distinguishing the patient's underlying condition so that proper treatment could be pursued. While Dr. Janda agreed that there was a school of thought which advocated the more conservative treatment in dealing with a known case of osteomyelitis, he did not agree that where cancer was suspected as the underlying condition, the fear of spreading infection was an adequate reason for not making a tissue biopsy in order to make a definitive diagnosis. This is because the necessity for early detection and treatment is so imperative with this highly malignant type of cancer. 15 Secondly, even assuming that Dr. Stover did not suspect a tissue cancer on June 9, but suspected only osteomyelitis at this time, he did not begin treatment for this condition, and only began treatment of Mrs. Cameron for osteomyelitis on August 23, at least two and one-half months after he knew there was some underlying cause of her not healing properly. Had he begun treatment for osteomyelitis earlier, her failure to respond to this treatment would probably have led to an earlier discovery of the cancer. Dr. Janda also testified that this failure to accord treatment in this period was negligence. 16 It may also be noted that there is no testimony in the record, apart from Dr. Stover himself, indicating that Dr. Stover was not negligent. 17 The law of Iowa is clear that malpractice may consist in lack of skill or care in diagnosis as well as in treatment. Dickinson v. Mailliard, 175 N.W. 2d 588, 590 (Iowa 1970); Wilson v. Corbin, 241 Iowa 593, 41 N.W.2d 702, 705 (1950). A patient is entitled to as thorough and careful examination as his condition warrants and attending circumstances will permit, with such diligence and methods of diagnosis as are usually approved and practiced by physicians of ordinary skill and learning under like circumstances and in like localities. Grosjean v. Spencer, 258 Iowa 685, 140 N.W.2d 139, 143 (1966); Barnes v. Bovenmyer, 255 Iowa 220, 122 N.W.2d 312, 316 (1963). And a specialist is required to exercise that degree of skill and care ordinarily used by similar specialists under similar circumstances and not merely the average skill and care of a general practitioner. Barnes v. Bovenmyer, supra. Evidence of a doctor's negligence must be given by experts, unless the physician's lack of care is so obvious as to be within the comprehension of the layman's common knowledge. Grosjean v. Spencer, supra. 18 Plaintiff's evidence in this case clearly met the above standards and is sufficient to support the verdict.