Opinion ID: 1968425
Heading Depth: 1
Heading Rank: 2

Heading: Alleged Malpractice of Dr. Dollard.

Text: Plaintiffs contend that there was evidence adduced which would establish that Dr. Dollard was negligent in the following respects: (1) He failed to use proper surgical techniques  in the skin-grafting operations upon Jimmy; (2) he failed to use proper postoperative care to prevent infection to the patient; and (3) he discharged the patient at a time when the latter's condition required that he be kept under care. The ground for plaintiffs' claim that Dr. Dollard failed to use proper surgical techniques in skin-grafting is stated in their brief as follows: In this regard it is plaintiff's contention that the defendant, James E. Dollard, in removing skin from the donor sites and placing it upon the area to be grafted cut too deep removing an excessive amount of skin from the donor sites of the injured boy. Plaintiffs concede that there is no direct evidence that Dr. Dollard did cut too deeply in removing the skin from the donor sites. The claim of cutting too deeply is predicated entirely upon unusual result. Plaintiffs especially rely upon an admission made by Dr. Dollard that the scars at the donor sites are unusual and much thicker and more hypertrophied than normal scars. Dr. Bernard, on the other hand, testified without contradiction that the scars were due to infection, and while infection of donor sites is not common, it does occur. There is no expert medical testimony that Dr. Dollard's skin-grafting operations on Jimmy did not meet accepted standards of care. This court in Fehrman v. Smirl, supra, at page 25, refused to adopt the rarity test, or unusual result, as a basis for an inference of negligence in medical malpractice cases, and we adhere to that determination in the present case. The claimed failure of Dr. Dollard to use proper postoperative care to prevent infection is based on the fact that while he had a culture taken from the leg to determine infection on May 9th he did not take another until June 26th, although the second skin-grafting was done on June 16th. At the time the second skin-grafting was accomplished the prior grafts had taken and the burned area appeared clean. Dr. Bernard testified that, if the first graft takes and the  wound remains clean, it is good practice to attempt another graft. He further testified that we do not necessarily wait for a negative culture to put a graft on a burn. The record is not clear whether the we was used by Dr. Bernard as referring to himself and his associate plastic surgeon, or whether it encompassed plastic surgeons generally. In any case, there was no expert testimony given that would afford a basis for an inference that failure to take a culture at the time of making the second set of grafts on June 16th constituted negligence on the part of Dr. Dollard. We turn now to plaintiffs' claim that Dr. Dollard negligently discharged Jimmy when the latter's condition required that he be kept under care. This requires a consideration of the circumstances under which Jimmy left St. Mary's Hospital on July 1st, after which Dr. Dollard no longer treated him. Jimmy's father testified that some three to five days prior to July 1st Dr. Dollard told him about the June 16th grafts coming off as a result of the infection; that Jimmy was run down and would have to be built up before any more grafting could be done; and that the father should take him home and feed him up. The father admitted that Dr. Dollard issued instructions to him as to how the dressings should be changed and that, after the boy had been taken home, he changed the dressing two or three times, and that afterwards the county nurse came and changed the dressings. The father, however, did not testify that he expected or understood that Dr. Dollard would continue to treat Jimmy after the latter's leaving the hospital on July 1st. At the time the motion for nonsuit was made, the trial court summarized the evidence in a pronouncement from the bench. In that part of this summarization which dealt with the instant phase of the case the trial court stated, . . . there was a mutual understanding that the boy would be discharged from the hospital and that Dr. Dollard would no longer be treating him.  Five days after Jimmy was discharged from St. Mary's Hospital he was admitted to University Hospitals and placed under the care of Dr. Bernard. There is no medical testimony that during this five-day interval anything occurred to the detriment of Jimmy or which made it more difficult for Dr. Bernard to treat him. The applicable rule of law with respect to withdrawal from a case by a physician is well stated in Ricks v. Budge (1937), 91 Utah 307, 314, 64 Pac. (2d) 208, as follows: We believe the law is well settled that a physician or surgeon, upon undertaking an operation or other case, is under the duty, in the absence of an agreement limiting the service, of continuing his attention, after the first operation or first treatment, so long as the case requires attention. The obligation of continuing attention can be terminated only by the cessation of the necessity which gave rise to the relationship, or by the discharge of the physician by the patient, or by the withdrawal from the case by the physician after giving the patient reasonable notice so as to enable the patient to secure other medical attention. A physician has the right to withdraw from a case, but if the case is such as to still require further medical or surgical attention, he must, before withdrawing from the case, give the patient sufficient notice so the patient can procure other medical attention if he desires. See also 41 Am. Jur., Physicians and Surgeons, p. 194, sec. 72; 70 C. J. S., Physicians and Surgeons, p. 965, sec. 48 f (1); Anno. 57 A. L. R. (2d) 432, 439. We conclude that there is no evidence which would support a finding that Dr. Dollard wrongfully withdrew from the case. Furthermore, even if he had done so, there is a complete lack of any evidence that this was causal. Our review of the evidence bearing on possible malpractice by Dr. Dollard has demonstrated to our satisfaction that the trial court also properly granted a nonsuit with respect to this defendant.