Court Opinion

ID: 9671661
Source: CourtListenerOpinion
Date Created: 2023-08-24 03:41:27.679611+00
Date Added: 2024-06-11T18:16:11.370269
License: Public Domain

John A. Fogleman, Justice, dissenting. The majority equates the evidence in this case with that in Lanier v. Trammell, 207 Ark. 372, 180 S.W. 2d 818. The distinction seems so clear to me that it should leave no room for argument. Of course, expert testimony was not required to show that failure of a surgeon to wash, his hands or to sterilize his surgical instruments before an operation or to remove a sponge from the surgical incision constituted negligence as these are matters of common knowledge. If the matters set out in the majority opinion are of common knowledge, however, I am astounded to learn of the extent of the acquaintance of the ordinary person with the human anatomy and its functions. The distinction between cases as to the necessity for expert testimony was clearly pointed out in Lanier, where we said: If there could, under the testimony, be any dispute as to the method used in the operation or in the treatment of the patient it would be necessary to establish the correct method by expert witnesses, but we do not have that situation here. There was no dispute whatever as to what was the proper course to be pursued by appellant in preparing for and performing the operation. It was not denied that it was necessary and proper for appellant to cleanse his hands thoroughly and to sterilize his instruments. The dispute in this case was as to whether or not appellant followed the course which is conceded to be necessary and proper. Appellant says that he did and appellee and one of his witnesses testified that he did not follow this course. No amount of expert testimony could have thrown any light whatever on the real question in this case. We also recognized in Lanier the efficacy of Gray v. McDermott, 188 Ark. 1, 64 S.W. 2d 94, saying: Our conclusion that we are not required to set aside the verdict of the jury in this case because of lack of medical or expert testimony to support it is not in conflict with anything said in our opinion in the case of Gray v. McDermott, 188 Ark. 1, 64 S.W. 2d 94, 96. In that case it was insisted by the complaining party that the surgeon in operating had failed to do certain things that he should have done. The surgeon and the expert witnesses testified in that case that the surgeon operated in an approved and skilful manner, and that it would not have been proper for the surgeon to have done the things, the omission of which was claimed to amount to negligence. It was held in that case that a jury should not be permitted to “speculate whether or not the experts in the practice of their profession have pursued the proper course of procedure.” We have no such situation in the case at bar. The question here is not whether appellant in operating followed the approved and skilful method in doing so, but whether or not, prior to the operation, he sterilized his instruments and cleansed his hands. The jury found that he did not do so. No amount of expert or medical testimony as to the proper or improper method of operating would have thrown any light on this question, which was the sole question in litigation. In Gray v. McDermott, the allegations of negligence were that the surgeon was negligent in failing to open up a wound to ascertain that an axillary vein was severed by a bullet and in failing, when the vein began to bleed profusely during subsequent surgery, to ligate both ends of the vein. The patient died and his widow instituted suit. She introduced no evidence on the first allegation of negligence. There we said: The question as to whether or not it was proper or improper for the physicians in charge to open up the wound or probe into it on August 24 or some subsequent time thereto to determine whether or not a vein had been severed by the bullet; and also the question as to whether the physicians were negligent in failing to ligate both ends of the vein on September 3, when the operation was performed, were questions requiring scientific knowledge to determine. It cannot and should not be left to a jury to speculate whether or not the experts in the practice of their profession have pursued the proper course of procedure. So far as I am able to ascertain, we have never departed from these principles. I submit that every question involved here requires scientific knowledge to determine. The alleged negligence was in severing appellant’s left ureter, and in failing to perform preoperative studies, to demonstrate the ureter, to take safety measures by isolation- of the ureter and to associate a urologist in performing the operation. I can conceive of no argument that could be advanced that the question of preoperative studies and association of a urologist were not matters purely within the realm of medical expertise alone. It seems to me that the majority find evidence of negligence in a lack of urgency which would necessitate fast or unusual procedures for the removal of appellant’s left ovary, and in the surgeon’s proceeding to remove this ovary without first identifying the left ovary after his failure to find appellant’s left ureter in its proper place, and in concluding that Dr. Jones was bound to know that the left ureter lay somewhere in the immediate area of surgical invasion. The issue in the case was thus stated by appellant: Was the defendant negligent in severing plaintiff’s ureter while removing plaintiff’s ovaries? We are not concerned with the standards the defendant observed in surgically removing the ovaries — in performing an oophorectomy. Had plaintiff challenged defendant’s professional actions in performing the oophorectomy it would have been necessary to establish plaintiff’s theory by means of expert medical testimony. We are only concerned with defendant’s act in cutting the ureter. On the subject of the ureter, Dr. Jones’ testimony may be summarized as follows: Neither he nor a pathologist had examined the patient’s ureter microscopically before the surgery. As far as he could tell it was a perfectly healthy organ, except for scarring he found on the outside, where it was adhered to the ovary. He found no abnormality other than its abnormal location. This doctor’s reports are reproduced in the majority opinion. It seems to me that expert testimony was lacking at least in the following essential particulars: 1. The normal position of a normal healthy ureter. 2. The probability or improbability of its being in a normal position. 3. The probability of its being found in the middle of the left ovarian pedicle surrounded by the ovarian vessels. 4. The procedures available and used in the community to detect such an abnormal location of the ureter. 5. The effect of the fact the ovary was densely adherent to the side walls of the pelvis in preventing the detection of the location of the ureter before the ovary was removed. 6. The degree of skill and learning possessed and used by physicians engaged in his type of practice in the community and the procedures followed in these circumstances in the exercise of that skill and learning. I confess that my knowledge of these pertinent facts may be more limited than “common knowledge,” but I doubt that many judges or jurors are possessed of adequate knowledge to pass judgment upon the question whether this physician was negligent. I also feel that evidence of proximate cause is inadequate. The uncontradicted testimony offered showed that a proper repair of the ureter was made by a competent urologist, that tests on November 11, 1970, and February 16, 1971, reflected that this ureter was normal, that appellant’s principal complaint was urinary incontinence, that this condition would not follow from the surgery performed, and that appellant had a previous history of urogenital problems. I do not see how the severing of this ureter can be said to have been the proximate cause of appellant’s condition in the absence of medical testimony based upon scientific knowledge of the subject. I would affirm the judgment.