Opinion ID: 2447946
Heading Depth: 2
Heading Rank: 2

Heading: On the Wrong Organ?

Text: The gist of Dr. Ryan's second argument is that although one could classify Freeman's liver biopsy as a surgical procedure; it is not a surgical procedure performed on the wrong organ. Specifically, Dr. Ryan contends that the unanticipated outcome of a procedure, including, as here, the recovery of kidney tissue instead of liver tissue, cannot constitute a surgical procedure on the wrong organ. To support his contention, Dr. Ryan relies primarily on Williams v. Dyer. [15] In Williams, the patient underwent a bilateral tubal coagulation. During the operation, the physician inadvertently burned the patient's bowel. The trial judge in Williams reasoned that the term `surgical procedure' inherently envelopes an element of intent and concluded that because the physician did not intentionally burn the patient's bowel, he did not perform a surgical procedure on the wrong organ. [16] Therefore, the trial judge held that 18 Del. C. § 6853(e)(3) did not apply. Applying the reasoning found in Williams to Freeman's biopsy, Dr. Ryan asserts that he intended to recover liver tissue but an inadvertent migration of the needle resulted in the recovery of kidney tissue. Dr. Ryan insists that we should not label the unintended consequences of an involuntary migration as a surgical procedure performed on the wrong organ. Dr. Ryan further asserts that during a kidney biopsy, a needle is placed into the kidney through the patient's back; while, the point of entry for a liver biopsy is through the patient's side. Given the different points of entry and the testimony that Dr. Ryan placed the needle through Freeman's side and not her back, Dr. Ryan claims the procedure could not have been a kidney biopsy by definition. Freeman responds to Dr. Ryan's contentions by asserting that reading an element of intent into the statute implies that to invoke 18 Del. C. § 6853(e)(3) successfully, a surgeon would have to commit an intentional tort by intentionally cutting off the wrong body part or by intentionally operating on the wrong organ. Freeman suggests that this interpretation is illogical and clearly contrary to the legislative intent found in the statute's plain language. We find Freeman's argument more persuasive. What Dr. Ryan categorizes as a clear distinction between a liver biopsy and a kidney biopsy based on where a physician inserts a needle into a patient's body is merely semantics. Whether we call the retrieval of kidney tissue a kidney biopsy or not does not negate what happened here. Dr. Ryan inserted a biopsy gun into Freeman's body in order to retrieve tissue samples from Freeman's liver; therefore, he performed a surgical procedure. Because a pathology report later determined the retrieved samples consisted entirely of kidney tissue, Dr. Ryan accidentally inserted a biopsy gun into Freeman's kidney, unintentionally performing a surgical procedure on the wrong organ. Does the statute contemplate excluding unintended results from the meaning of a surgical procedure? [S]tatutory language, where possible, should be accorded its plain meaning. [17] Moreover, when a statute is clear and unambiguous there is no need for statutory interpretation. [18] Title Eighteen, Section 6853(e)(3) plainly states that a plaintiff need not provide a medical expert's opinion on the standard of care or breach thereof if a physician performs a surgical procedure on the wrong organ or part of the patient's body. There is no qualifying language in the statute that limits its application to intentional acts or precludes its application to inadvertent acts. Moreover, the language of the other exceptions listed in 18 Del. C. § 6853 provides some clarification on what the legislature intended. Subsection (e)(1) states that a medical expert is unnecessary when a foreign object was unintentionally left within the body of the patient following surgery. [19] In this exception, the legislature explicitly addressed whether a patient must show intentor the lack thereofto trigger § 6853(e)(1); therefore, it is reasonable to assume that if § 6853(e)(3) required the same or the opposite intent as subsection (e)(1), the legislature would have used express language to convey that requirement. The statute does not read, as Dr. Ryan would like, that a physician must intentionally perform a surgical procedure on the wrong organ, limb or part of the patient's body or that a physician is excused from liability where he intentionally performs a surgical procedure but unintentionally performs the procedure on the wrong organ. In order to produce an outcome that corresponds with the plain language of 18 Del. C. § 6853(e)(3) and the legislature's intent, we must reject Dr. Ryan's contention. Furthermore, contrary to Dr. Ryan's contentions, Williams does not suggest that a physician must have intended the result of a surgery before a patient may gain the benefit of the 18 Del. C. § 6853(e)(3) presumption. [20] In Williams, the trial judge noted that to trigger the medical expert exception, the surgeon would need to purposefullythough erroneously operate[] on the wrong part of the body. [21] Even if we were to read intent into the statute, the intent appears to refer to the surgery and not the results of the surgery. Here, Dr. Ryan clearly intended to perform a biopsy. He did not, as the court hypothesized in Williams, trip on his shoelace and lodge[] a [biopsy needle] in his patient's [kidney]. [22] Dr. Ryan purposefully placed the biopsy needle into Freeman's body and erroneously retrieved kidney tissue. Accordingly, Dr. Ryan performed a surgical procedure on the wrong part of Freeman's body, which renders a medical expert's opinion on the standard of care and breach thereof unnecessary.