Opinion ID: 2357967
Heading Depth: 1
Heading Rank: 2

Heading: failure to charge on two schools of thought

Text: We additionally find prejudicial error in the trial court's failure to give a submitted point for charge on the two schools of thought doctrine. [8] This doctrine is called into play in medical malpractice cases where there is more than one method of accepted treatment for the patient's disease or injury. The rule is that, where competent medical authority is divided, a physician will not be liable if in the exercise of his judgment he followed a course of treatment supported by reputable, respectable, and reasonable medical experts. Brannan v. Lankenau Hospital, 490 Pa. 588, 417 A.2d 196 (1980); Tobash v. Jones, 419 Pa. 205, 213 A.2d 588 (1965). Here, the medical authority on the treatment of a severe bacterial infection was diametrically opposed. Dr. Bass testified that treatment should absolutely be limited to antibiotic therapy. The defense experts stated that surgical intervention was imperative, and that it would have constituted malpractice to have failed to operate at once. Appellant asserts that on the basis of this testimony, the jury, if it found that appellee had a severe bacterial infection, should have been afforded the opportunity to conclude that both methods of treatment were medically accepted and that appellant was not liable for following one accepted method even though the jury might decide that the treatment advocated by Dr. Bass was preferred. One of the seminal cases in Pennsylvania on the two schools of thought doctrine is instructive. In Remley v. Plummer, 79 Pa.Super. 117 (1922), this court was confronted with a situation where plaintiff's and defendants' medical experts presented conflicting views as to the proper course of treatment. The court held: The question actually passed upon by the jury was not whether the defendants, in their handling of the case, had been guilty of negligence in not following a well-recognized and established mode of treatment, but rather, which of two methods, both having their respective advocates and followers of respectable authority, was the safer and better from a surgical standpoint. In other words, in the face of conflicting reliable expert evidence as to what was the proper course to be pursued by the surgeon in charge of the case, twelve laymen, with no knowledge of medicine and surgery were called upon to decide a disputed scientific medical and surgical question upon which eleven physicians and surgeons of standing and experience could not agree, and as to which there is a wide divergence of competent authority, and were permitted to mulct the defendants in damages for following a course of conduct which by far the greater number of the expert witnesses testifying said was in accordance with that indicated by the best modern surgical practice. . . . . Thus practitioners of a reputable school of medicine are not to be harassed by litigation and mulcted in damages because the course of treatment prescribed by that school differs from that adopted by another school: Force v. Gregory, 63 Conn. 167, 27 Atl. 1116; Grainger v. Still, 187 Mo. 197, 85 S.W. 1114; 21 R.C.L. 383; 5 Thompson on Negligence, section 6715. As was said in Patten v. Wiggin [51 Me. 594], supra, `The jury are not to judge by determining which school, in their judgment, is the best.' `If the treatment is in accordance with a recognized system of surgery, it is not for the court or jury to undertake to determine whether that system is best, nor to decide questions of surgical science on which surgeons differ among themselves.': 30 Cyc. 1588, section 8. . . . . The testimony clearly showed a difference of medical opinion, expressed by physicians and surgeons of unquestioned standing and reputation, and the defendants were not negligent for having adopted the view held by the majority of their brethren who testified. Id., 79 Pa.Superior Ct. at 121-23. In Remley, the standing and ability of each of the experts was not questioned and so the court reversed a judgment for the plaintiff and entered judgment for the defendants. A jury may not decide which of two respected methods of treatment is the better one. Brannan, supra . In Tobash, supra, the court noted that although the instructions complained of permitted an inquiry by the jury unwarranted by the applicable law . . . Id., 419 Pa. at 217, 213 A.2d at 593, the appellant was favored by the instructions rather than harmed. It is evident, therefore, that where the evidence establishes two schools of thought, the court as a matter of law must find a physician not liable for choosing treatment advocated by either school. Here, however, an initial jury question was presented as to whether or not there were two competent medical viewpoints on the treatment of severe bacterial infections. The defense strenuously attacked the credentials and expertise of Dr. Bass [9] and both sides claimed that it would be malpractice to follow the treatment advocated by the other side. Faced with this testimony and unaided by the proffered instruction on two schools of thought, the question actually passed upon by the jury was not whether the appellant had been negligent in not following a well-recognized and established mode of treatment, but rather, which method was the correct one. Remley, supra . Absent the proposed instruction, the jury was not advised that it could find that both methods of treatment were proper courses of treatment, and that appellant would not be liable if he had followed either one. Thus, the requested charge was both accurate and applicable. The failure to give a requested point for charge, which is accurate and applicable, is reversible error if the appellant has been prejudiced. Gombar v. Schaeffer, 202 Pa.Super. 282, 195 A.2d 527 (1963). An omission to charge which leaves the jury without discretion on an important question, or which plainly tends to mislead them, is cause for reversal. 2 P.L.E. Appeals § 491. We find that the failure to give a two schools of thought charge was prejudicial error. While the appellee's case de-emphasized the importance of the bacterial infection and stressed an alleged failure to diagnose pancreatitis, from the perspective of appellant's case, the issue of treatment of the bacterial infection was crucial. There was testimony by the defense that even if appellee had had pancreatitis, which they felt he didn't have, surgery should still have been performed because of the life-threatening bacterial infection. Since the undisputed evidence on the extent of the bacterial infection clearly indicated that appellee's bacterial infection was serious (i.e., E. Coli bacteria in the blood stream), the jury inevitably had to decide if surgery was a proper course of treatment for the bacterial infection, regardless of whether they found initially that appellant had failed to diagnose pancreatitis. Without being charged that they could find both surgical and non-surgical methods to be proper, the jury engaged in an impermissible weighing of the two alternatives. Thus, the jury was not advised of the allowable latitude of choice in reaching its decision. The appellant, who might have been absolved of liability if a two schools of thought charge had been given, was thereby prejudiced. Accordingly, we reverse and remand for a new trial. This court does not retain jurisdiction.