Court Opinion

ID: 9607476
Source: CourtListenerOpinion
Date Created: 2023-08-22 02:59:06.302911+00
Date Added: 2024-06-11T13:27:36.028597
License: Public Domain

McQUADE, Justice
(dissenting) :
I dissent from the decision of the majority that the record in this case establishes as a matter of law that respondent’s conduct proximately caused the injury of which appellant complains.
On May 29, 1961, while appellant and his wife were visiting friends in Nyssa, Oregon, appellant fell from a truck onto ground strewn with manure and other debris, suffering a compound comminuted fracture of the tibia and fibula of his right leg, six inches above the ankle joint. Bones protruded through his clothing and boot into the filthy earth, which, the trial court found, probably contained infectious organisms.
*301Appellant was promptly taken to a hospital in Nyssa, where Dr. Kenneth E. Kerby debrided nonviable tissue, otherwise cleansed the wound and manipulated and reduced the fracture. Dr. Kerby then sutured the wound and applied a plaster cast which extended from the middle third of the right femur to just above the toes of the right foot. While cleansing the wound, the trial court found, Dr. Kerby discovered that the soft tissue and circulatory system of the lower right leg had been damaged.
On the next day, the court found, “the circulation was so impeded by reason of the swelling and tightness of the cast that the right foot became discolored, cold and numb and it was necessary for Dr. Kerby to split the cast up to the ankle.” On the following day, the court found, it was again necessary to split the cast, this time to the knee, since “because of the tightness of the cast and the swelling in the leg and foot, the circulation was so impeded that the foot and toes continued to remain discolored and cold.” The court also found “that the swelling and further imped[i]ment of the circulation may have increased the damage already done to the soft tissue and circulatory system” of appellant’s right foot and leg. A combiotic was administered twice each day to combat the possibility of infection. When appellant left the hospital, declomycin was substituted for the combiotic, though it later proved to be ineffectual.
On June 3, the sixth day after the fracture, appellant left the hospital at Nyssa and returned with his wife to their home in Paul, Idaho. Late that afternoon appellant’s wife first contacted respondent. The trial court found that she then advised him of the injury, read a note written by Dr. Kerby, and told respondent that she had a supply of medication prescribed by Dr. Kerby. In its opinion, the court noted that from June 3 to June 19 appellant had a supply of declomycin which had been prescribed by Dr. Kerby. At the request of Mrs. Formont, respondent prescribed a drug to relieve appellant’s pain and made an apointment to see him on June 9. The trial court stated in its opinion that from June 3 to June 9 there was no evidence of increasing infection.
On June 9, the twelfth day after the fracture, appellant and his wife kept their appointment at respondent’s office in Burley, Idaho, and respondent first saw the broken leg. At that time, the court found, appellant’s temperature was normal, the toes of his right foot were warm and had good color, the cast was dry (although spotted near the wound), and there was no odor. The fractured leg was X-rayed and the bone alignment found to be good. At the end of this examination, an appointment was scheduled for June 17. The trial court found that on June 9 respondent should have known that appellant’s supply of antibiotics was exhausted and should have prescribed or supplied antibiotics for his use, and that failure to do so was a departure from the standard of medical practice in the community. Respondent’s failure to prescribe or supply antibiotics on June 9 was the only negligent act or omission with which the court charged respondent as of that day.
The trial court stated in its opinion that from June 9 to June IS there was no evidence of odor and drainage requiring the opening of the cast and a change of treatment procedure from that commenced by Dr. Kerby. On June IS, the eighteenth day after the fracture, Mrs. Formont again phoned respondent and told him that the cast was moistening around the fracture and that there was an odor connected with it. The court found that upon receiving this phone call, the standard of medical practice in the community required respondent to then see appellant, window the cast or otherwise subject the wound to observation, take an antibiotic sensitivity test, and administer a broad spectrum antibiotic different from declomycin until tests indicated the proper antibiotic to use.
*302Respondent saw appellant on June 17, pursuant to the appointment made on June 9. The trial court found that on this day there was a foul odor connected with the wound, and the cast around it was damp. Respondent strengthened the cast and set appellant’s next appointment for June 19. On June 19, the twenty-second day after the fracture, respondent windowed the wound and found infection existing with necrotic flesh and purulent matter and the bone partly exposed. Respondent immediately told appellant that he should be placed in a specialist’s care, the trial court found, and made arrangements for appellant’s further treatment with Dr. David J. Nelson, an orthopedic surgeon in Pocatello. That same day, appellant was admitted to Bannock Memorial Hospital in Pocatello under the care of Dr. Nelson and examined by him. Treatment with Chloromycetin, an antibiotic, was then begun and the infectious organisms were tested to determine their sensitivity to different antibiotics. The tests showed that appellant’s infection appeared sensitive to eight separate antibiotics but not to declomycin. Although the tests indicated the infection sensitive to Chloromycetin, clinically this drug failed to control the infection and Dr. Nelson withdrew its administration on June 24.
In a letter to respondent, noted in this court’s original opinion (December 31, 1965), Dr. Nelson stated that his examination on June 19 showed that:
“ * * * the skin was very reddened; a great deal of drainage was coming from the wound and the tibia was exposed, after trimming away a lot of dead skin. * * *
“ * * * antibiotics did not show any sign of cutting down the amount of infection and most of the infection was of a resistant strain. The bone was dead for quite an area * *
This court in its original opinion states:
“The evidence is convincing that at the time plaintiff [appellant] was transferred to the care of Dr. Nelson the infection had developed to the uncontrollable stage thereby necessitating the amputation.”
The trial court found that the care or lack of care by respondent was not established to be the proximate cause of the loss of appellant’s leg. In his opinion the trial judge found the test of proximate cause in this case to be:
“ * * * whether the proper course of conduct would have ‘fairly probably’ changed the result. In other words, there must be testimony that * * * the proper conduct * * * ordinarily produces different results.”
The trial judge states in his opinion that to have carried his burden of proof on the issue of proximate cause, appellant:
“ * * * must have presented, or had presented through the defendant or his witnesses, testimony that had the defendant [respondent] in period (4) [between June 9 and June 15] continued the declo-mycin therapy and/or during period (5) [between June 15 and June 19] takeii the steps previously spoken of [observed the wound and administered a broad spectrum antibiotic different from dec-lomycin and tested for antibiotic sensitivity] there is a fair probability that different results would have been produced. To do this he needed to show that in similar medical histories such actions ordinarily produced different results. I cannot say that he has done this.”
Further discussing the issue of proximate cause, the trial judge noted in his opinion on a motion after judgment that between June 9 and June 15 respondent should have continued the administration of “declamyecin [sic], a drug to which-the organism was not shown to be sensitive to.” He also notes in this opinion:
“The fact that the organism apparently wasn’t controlled by declamyecin [sic] during some six or seven days of its use would indicate a lack .of sensitivity.
*303“ * * * This period’s inactivity does not establish causation.
“On June 15th the Defendant [respond-dent] should have taken a sensitivity test, administered a broad spectrum anti-biotic until the test results were available and then administered the proper drug. These things he didn’t do but the total time is short; the time for administration of a tested drug is presumeably even shorter.”
(There was expert testimony that 36 to 48 hours were required to complete the antibiotic sensitivity tests.)
The. trial court concluded in its opinion:
“There is'evidence that proper care over the- entire period of treatment could have been expected to produce different results, but there' was none that proper care during the times of defendant’s culpability would have.”
The original opinion in this case stresses the statement in the trial court’s opinion that “while infections of this sort aresome-times uncontrollable, they can ordinarily be controlled if treated properly.” This statement must be construed in light of the trial court’s findings that the full plaster cast which Dr. Kerby applied to appellant’s injured leg on the day of the fracture had to be split to the ankle the next day and to the knee the succeeding day due to the impediment to circulation caused by the tightness of the cast and the swelling of the leg and foot and its further findings this “swelling and further .impediment of the circulation may have increased the damage already done to the soft tissue and circulatory system of the right -foot and leg of’the Plaintiff [appellant].”
Also relevant on the issue of proximate cause is the following testimony of Dr. Nelson, Dr. Kelly and Dr. Terhune:
Dr. Nelson testified that the “golden opportunity” to save the leg was in the 12 hours immediately after the accident, and Drs. Kelly and Terhune both agreed with this statement. Dr. Terhune testified that the danger of losing the leg depended on “your initial treatment and your follow-up care in the next several days.” Dr. Kelly testified that the “initial treatment * * is really the important thing.”
Dr. Terhune testified that the practice “in this vicinity” was not to suture and cast this fracture, but rather to “put a posterior molded splint on it so the plaster-cast is [at] the back of the leg and down the foot, placing your dressings on first- so you could change the dressing on this leg at daily intervals or every other day as necessary; have good actual visibility of your wound.” Dr. Nelson testified regarding the wound,. “obviously it shouldn’t have been closed.” Dr. Kelly testified, “It was a compound comminuted fracture; it was contaminated and I don’t think any . contaminated wound should be closed; it is not. the practice to close that. type of wound.” His. testimony also . contains fhe following, colloquy: ..,
“Q-, Would it .have been the practice.in this community to have sutured -.that wound?
“A Well, ,I.wouldn’t.have sutured it. ,
“Q Sir? - -
“A I-, would not have sutured it.-
“Q And what do you say about the cast being applied from’the basé of the toes to up above the knee, midThigh ?
“A I don’t think it should have been, had a cast put on.
“Q It should not?
“A (Witness shakes head.)”
Respondent testified , as follows :
“Q Now’ Doctor,' we all know that down at Nyssa this leg was sutured and cast. Now do you know the standard of practice in this vicinity with reference to that procedure ?
“A Yes, sir.
“Q Would it have been proper and within the standards of medical practice in *304this vicinity to have not sutured that wound ?
“A Yes, sir, that would have been within the standard.
"Q And under the standard of practice in this vicinity, would you have applied that cast?
“A No, sir.”
In support of its decision that the record establishes proximate cause as a matter of law, the majority, in both this opinion on rehearing and its original opinion, cites Reinhold v. Spencer, 53 Idaho 688, 26 P.2d 796 (1933).
In that case this court merely upheld a jury’s finding that a hypodermic needle left in the plaintiff’s chest after an operation by the defendant doctor was the proximate cause of pain in and about the region where the needle was located. The opinion in Reinhold v. Spencer, supra, states:
“The expert testimony would seem to establish beyond serious controversy that the pain suffered by respondent was due directly to the presence of the needle and not to some other cause or causes.” 53 Idaho at 692, 26 P.2d at 798.
In Dimock v. Miller, 202 Cal. 668, 262 P. 311 (1927), cited in Reinhold v. Spencer, supra, and quoted in the original majority opinion herein, the Supreme Court of California merely upheld a jury’s determination that defendant doctor’s injection of infectious matter into plaintiff’s arm was the proximate cause of an infection in the arm which developed almost immediately. Two doctors testified in Dimock that their opinion was that the infection was probably due to the injection.
Appellant had the burden of proof on the issue of proximate cause, and “the mere showing of a possibility or a suspicion that the negligence or unskillful treatment received at the hands of a physician or surgeon hastened or accelerated the * * [injury complained of] is not sufficient” to support that burden. Willis v. Western Hospital Association, 67 Idaho 435, 447, 182 P.2d 950, 957 (1947). See Matheson v. Idaho Hardware & Plumbing Co., 75 Idaho 171, 270 P.2d 841 (1954); Swanson v. Wasson, 45 Idaho 309, 262 P. 147 (1927). Cf. Hale v. Heninger, 87 Idaho 414, 393 P.2d 718 (1964); Evans v. Bannock County, 59 Idaho 442, 83 P.2d 427 (1938).
In Hancock v. Halliday, 70 Idaho 446, 220 P.2d 384 (1950), an action against four physicians and surgeons for alleged malpractice proximately causing the amputation of plaintiff’s leg at the knee, plaintiff contended that if the preponderance of the evidence was against the finding of the trial court, its judgment should be reversed. This court said:
“Whatever may be the holdings in other jurisdictions, such is not the rule in this state. This court has frequently and consistently held that findings of fact, sustained by competent, substantial, though conflicting, evidence, will not be disturbed on ap’peal.” 70 Idaho at 448-449, 220 P.2d at 385.
The record supports the trial court’s finding that the care or lack of care by respondent was not established to be the proximate cause of the loss of appellant’s leg. See Reinhold v. Spencer, supra; Dimock v. Miller, supra; and McAlinden v. St. Maries Hospital Ass’n., 28 Idaho 657, 156 P. 115 (1916).
RASMUSSEN, District Judge, concurs in the dissent.