Opinion ID: 1092168
Heading Depth: 1
Heading Rank: 5

Heading: was there competent medical evidence showing causal connection between dr. pittman's treatment and the injuries of hodges?

Text: During the direct examination of Dr. Elgene G. Mainous, chairman of oral maxillofacial surgery at the University of Mississippi Medical Center, who testified as an expert on behalf of Hodges, the following took place: Q Dr. Mainous, do you have an opinion as to the cause of numbness based on a reasonable degree of medical certainty and related to the same hypothetical which I posed to you earlier? Do you have such an opinion? A Well  Q As to the cause of numbness? A There could be three possible causes of numbness. One, the  the nerve could have been damaged during the surgical procedure. Two, the nerve could be damaged from exerting extreme pressure on a material that does not change its intensity when it's in the presence of a solution. And three, the presence of infection secondary to a foreign body that doesn't resorb. Dr. Mainous also testified that in his opinion the use of the xrays in question as a diagnostic tool prior to surgery did not conform to the standard of care in Yazoo City, Mississippi. Based upon this response, Dr. Pittman urges that the peremptory instruction should have been granted because by setting forth three alternative actions the testimony of Dr. Mainous was incompetent to prove proximate cause. The incompetency theory arises because Dr. Mainous expressed his opinion in terms of medical possibilities, and not probabilities. That medical probability is required by our law is supported by our decision in Garrett v. Wade, 259 So.2d 476 (Miss. 1972) to the effect that: This Court has consistently held that medical testimony is not probative unless it is in the terms of probabilities and not possibilities. In Scott County Co-Operative v. Brown, 187 So.2d 321 (Miss. 1966), we held that the doctor's statement that he was of the opinion that the mental condition could have been caused by the accident was insufficient to justify submitting to the jury the question of causal connection between the malady and the accident. This Court has ruled to the same effect in Morrell & Company v. Shultz, 208 So.2d 906 (Miss. 1968); Kramer Service, Inc. v. Wilkins, 184 Miss. 483, 186 So. 625 (1939); Mutual Benefit Health & Accident Association v. Johnson, 186 So. 297 (Miss. 1939); Teche Lines, Inc. v. Bounds, 182 Miss. 638, 179 So. 747 (1938); Berryhill v. Nichols, 171 Miss. 769, 158 So. 470 (1935). In Scott County Co-Op v. Brown , cited in Garrett v. Wade, supra , this Court made a careful reading of all of the expert witness's testimony before evaluating his opinion as to causal connection. The doctor first stated that it was very likely that the accident caused her mental condition, and then stated I am of the opinion that it could have been. Scott County, 187 So.2d at 326. This Court held that the testimony showed only a possibility that her psychotic condition was caused by the accident and it should, therefore, have been excluded. In this case, as in Scott County Co-Op, supra, the inquiry should be whether after a careful reading of all the testimony of Dr. Mainous, his opinion as to causation is expressed in terms of medical probability or possibility. In connection with this inquiry, this Court has noted in Jesco, Inc. v. Shannon, 451 So.2d 694, 700 (Miss. 1984), that absolute certainty is not required for an expert witness and whenever facts are in dispute, or the evidence is such that fairminded men may draw different inferences, a measure of speculation and conjecture is allowed. See also, City of Jackson v. Locklar, 431 So.2d 475 (Miss. 1983). Finally, the scope of appellate review on motion for judgment n.o.v. requires this Court to consider all the evidence, but in the light and with all reasonable inferences most favorable to the party opposed to the motion and to grant such a motion only if the facts and inferences point so strongly and overwhelmingly in favor of the moving party that reasonable men could not have reached a contrary verdict. City of Jackson v. Locklar, 431 So.2d 475, 478; General Tire and Rubber Co. v. Darnell, 221 So.2d 104 (Miss. 1969). Dr. Mainous's opinion as to the proximate cause of Hodges' numbness was expressed in three alternatives. He testified in some detail as to the basis for his opinion on each of these alternatives. The meaning of his answer there could be three possible causes of numbness should be considered in light of his testimony on each of these causes to determine whether he considered the numbness a possible result of one of the three causes mentioned or a probable result of Dr. Pittman's treatment as a whole with three alternative explanations for the numbness. First, Dr. Mainous expressed the opinion that the numbness could have been caused by an injury during the surgical procedure. This sort of injury occurs when the roots of the impacted wisdom tooth impinge upon the mandibular nerve as the tooth is removed. An essential diagnostic tool for preventing such an injury is clear, detailed xrays showing the proximity of the mandibular canal to the roots of the impacted wisdom tooth. Dr. Mainous testified that the panagraphic xray used by Dr. Pittman in this case was inadequate because it lacked the clear detail showing the relation of the mandibular nerve to the wisdom tooth. While Dr. Pittman testified that the xray had faded in time but possessed sufficiently clear detail at the time of the surgery to enable him to make a proper diagnosis, Dr. Mainous contradicted this and stated that in his teaching he used ten-to-fifteen year old xrays which had not faded with time. Dr. Pittman and his expert witness Dr. Hurt admitted that in its present condition the panagraphic xray was not of diagnostic quality. Secondly, Dr. Mainous stated that the nerve could be damaged from exerting extreme pressure on the packing material placed in the tooth socket. Dr. Mainous stated that when there is persistent bleeding an absorbable material may be put in a surgical site to coagulate the blood but his opinion was that the proper practice was to use absorbable materials which become flimsy and disintegrate into the body when saturated. He stated that a danger exists with the use of Iodoform gauze because it does not change consistency when moistened so that considerable pressure can be applied to the gauze. He also stated that Dr. Pittman deviated from the normal standard of care in leaving some of the non-absorbable gauze in the wound for thirty-one days. Dr. Pittman stated that he removed 99% of the gauze on October 23rd, and that only a small silver in a hole in the jawbone was overlooked. Finally, Dr. Mainous stated that the numbness could have resulted from an infection secondary to the portion of gauze left in Hodges' mouth for thirty-one days. Pittman denied that there was any infection at any time in Hodges' mouth and initially did not recall writing Hodges an antibiotic prescription. When confronted with a copy, Pittman stated that he wrote it as a psychological boost and as a precautionary measure since Hodges was preparing to go on a deer hunt. Dr. Mainous stated that the body's response to leaving the gauze in the wound for thirty-one days would be inflammation and infection. In his opinion, leaving the gauze in the wound for that period of time would produce an infection that would affect the nerve tissue. Expert witnesses need not testify with absolute certainty. There is no merit to the slightly ironic argument that more than one breach of the standard of care casts doubt upon Dr. Pittman's liability and entitles him to an exemption from the scrutiny of the jury. Taken as a whole, Dr. Mainous's testimony and his answer to the hypothetical question expressed an opinion based upon a reasonable degree of medical certainty in terms of medical probability that the numbness of Hodges was caused by the actions of Dr. Pittman and Dr. Pittman's breach of the applicable standard of care. There is no merit to appellant's second assignment of error.