Court Opinion

ID: 9578091
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:41:24.470183+00
Date Added: 2024-06-11T13:22:36.872109
License: Public Domain

SUTIN, Judge (dissenting). I dissent. The Hennings appealed from a summary judgment granted Dr. Livingston Parsons, Jr., arising out of a claim of medical malpractice. Pending the appeal, Mrs. Henning died of cancer of the breast. We should reverse. This is a second case in which summary judgment was heard and granted the morning of trial before selection of the jury. See, Goffe v. Pharmaseal Laboratories, Inc., 90 N.M. 764, 568 P.2d 600 (Ct.App.1976), Sutin, J., dissenting, reversed 90 N.M. 753, 568 P.2d 589 (1977). I shall not repeat the admonition that a summary judgment of this nature granted the morning of trial does not hasten the administration of justice. The complaint alleged four acts of negligence. Dr. Parsons (1) failed to use care and skill in his examination and evaluation of the breast lump referred to him for diagnosis; (2) withheld and misrepresented the reasonable and recognized risk of malignancy to be expected from the lump in Mrs. Henning’s breast; (3) failed to inform Mrs. Henning of that which a reasonably prudent person would need to know in order to decide whether to undergo a biopsy; and (4) failed to proceed in a timely manner to biopsy the breast lump. The trial court found “that there is no genuine issue of material fact, and that there is no evidence that the defendant Livingston Parsons, Jr. deviated from the standards of medical practice required in this and similar communities * * * * ” In Goodman v. Brock, 83 N.M. 789, 498 P.2d 676 (1972), the Supreme Court ruled out the use of phrases such as “slight doubt” or the “slightest doubt” in determining the existence of a genuine issue of material fact. The Court held that the party opposing a motion for summary judgment shall be given the benefit of all “reasonable doubts.” The “reasonable doubt” rule continued unabated until 1979. In Fischer v. Mascarenas, 93 N.M. 199, 598 P.2d 1159 (1979), the trial court dismissed defendant’s counterclaim on plaintiff’s motion for summary judgment. In reversing, the Supreme Court said: * * * The remedy should not be employed where there is the slightest doubt as to the existence of an issue of material fact. Spears v. Canon de Carnue Land Grant, 80 N.M. 766, 461 P.2d 415 (1969). [Emphasis added.] [Id., 93 N.M. 199, 598 P.2d at 1161.] Fischer did not expressly overrule Goodman v. Brock. Neither was it overruled sub-silentio. It is apparent that the cited language in Fischer was inadvertent. Under Goodman v. Brock, the burden was on defendants to show an absence of a genuine issue of material fact. Once defendants made a prima facie showing that they were entitled to summary judgment, the burden shifted to plaintiff to show that there was a genuine issue of fact and that defendants were not entitled to summary judgment as a matter of law. On review, this Court must view the facts and inferences arising therefrom in the light most favorable to the party against whom the motion was granted. Evans v. Bernhard, 23 Ariz.App. 413, 533 P.2d 721 (1975). To make a prima facie showing of summary judgment, Dr. Parsons presented the affidavit of Dr. P. G. Cornish III, a qualified and licensed physician who specialized in surgery. He was familiar with the recognized knowledge, skill and care used by reasonably well-qualified surgeons engaged in performing breast examinations and performing biopsies in Albuquerque or similar communities. It was his professional opinion that Dr. Parsons, in his care and treatment of Mrs. Henning, did possess and apply the knowledge and use the care and skill which would be used by reasonably well-qualified surgeons practicing in Albuquerque and similar communities in 1978; that Dr. Parsons was not in any way negligent in any aspect of his treatment of Mrs. Henning. His opinion was based upon a host of facts and conclusions set forth in narrative form. To summarize the facts: On March 28, 1978, Dr. Parsons first examined Mrs. Henning with reference to a lump in her left breast, and again on May 8, 1978. Dr. Cornish believed that a reasonable and acceptable medical course of action would be to watch the breast area and reexamine it within a month or so or earlier if there were any significant changes. On May 8, 1978, according to Mrs. Henning, there had been no change, but Dr. Parsons thought the lump seemed to be a little more distinct. He noted a faint inflammation of the skin and an area of pig skin edema below the nipple of the left breast. Despite the negative mammography, he decided a biopsy would be appropriate. On June 13,1978, a skin biopsy was taken and it revealed a single small focus of small malignant cells within the lower portion of the skin. Dr. Cornish believed that a reasonable diagnosis would be inflammatory carcinoma of the breast. Dr. Parsons did not treat the malignant breast. Dr. Cornish’s first conclusion was: A. There is a variation in the medical community with respect to the rapidity with which a biopsy should be performed following the discovery of a lump. However, assuming Mrs. Henning’s description of the lump is correct, affiant does not believe that there was an unreasonable delay before the breast was biopsied. Assuming Dr. Parsons’ description of the lump is correct, affiant reaches the same conclusion. Dr. Cornish stated that Dr. Parsons complied with the standard of knowledge, skill and care owed by a physician to a patient, the standard ordinarily used by reasonably well-qualified doctors in the same field of medicine. Pharmaseal Laboratories, Inc. v. Goffe, 90 N.M. 753, 568 P.2d 589 (1977). Dr. Cornish could not apply the standard as a matter of law “with respect to the rapidity with which a biopsy should be performed following the discovery of a lump.” None could be stated because the matter of rapidity varied in the opinion of surgeons. The delay in the instant case was 28 days. Dr. Cornish established a time period standard of “No unreasonable delay.” This standard is a factual issue per se. What time period is or is not “unreasonable” is a variable. It changes from surgeon to surgeon. This time factor is unknown. The reason for this unknown factor flows from the fact that a variety of opinions of surgeons would differ from an immediate biopsy forward in time sequence to 28 days. This is the equivalent of saying that other surgeons would testify that Dr. Parsons’ delay was unreasonable. Given an opportunity to cross-examine Dr. Cornish, a disclosure of such surgeons would probably appear. At oral argument on the motion for summary judgment the morning of trial, Hennings’ lawyer stated that he had interviewed a highly respected general surgeon; that “I have not been able to persuade this doctor to testify, because he is satisfied I have got it in the record, and he does not want to become personally involved with a legal matter in court, face to face with Dr. Parsons.” This conduct has been dubbed a “conspiracy of silence.” This “conspiracy of silence” was explicitly set forth in Goffe, supra (Sutin J., dissenting). Such a conspiracy should not be fostered as a means of obtaining summary judgment. Where a variation of medical opinion exists with respect to rapidity with which a biopsy should be performed, common sense writes a rule that the patient need not secure a surgeon to dispute the testimony of defendant’s surgeon to create an issue of fact. The admission of a variation of opinion in the medical community is sufficient to establish its existence. It is equivalent to testimony that Doctors Joe Doe and John Roe who are well-qualified surgeons will disagree. It naturally follows that one of these surgeons will testify that Dr. Parsons exercised “unreasonable delay” in performing the biopsy, thus creating a genuine issue of material fact. Dr. Parsons’ testimony affirms this conclusion. Hypothetical questions were asked with reference to whether it was proper to delay the biopsy for a month as opposed to proceeding immediately, malignancy being ruled out. The questions and answers are as follows: Q. * * * The family physician * * * has been following the patient’s complaint of a mass in the left breast* * * * This mass has not changed in size or configuration to any appreciable degree over the three-week period. This mass or lump may be described as a definite and actual mass with well-defined dimensions* * * * The patient has had a mammogram within the three-week period * * * * ****** * * * the same as the one * * * brought to you on * * * March 28, 1978. Do you believe, under those facts, if those had been the facts, that it would be proper to delay biopsy? A. I think that under that set of limited facts given to me, that I would feel that it would be proper to proceed with a biopsy. But I would again say that that might not be a decision that would invariably be made by all surgeons dealing with this problem and receiving that set of facts. Q. If you were personally presented with those hypothetical facts * * * you would deem it proper to proceed with biopsyI A.' Yes. It’s not a real-life situation, but in my thinking, I would find it hard not to proceed with a biopsy. [Emphasis added.] The negligence of a doctor can be established by his own testimony. Mascarenas v. Gonzales, 83 N.M. 749, 497 P.2d 751 (Ct. App.1972). If the facts stated in the hypothetical question are proven, Dr. Parsons admits that the biopsy should have taken place on March 28, 1978, the date of the first examination, even though a variable exists among “all surgeons dealing with this problem.” I do not declare that Dr. Parsons is negligent in this respect. What I do say is that a genuine issue of material fact exists. The Hennings established by medical testimony that on March 7, 1978, 21 days before her examination by Dr. Parsons, Mrs. Henning had a well-defined actual mass in her left breast with well-defined dimensions. A mass is something solid, not filled with air like a bowel or not filled with fluid like a cyst, something that should not be there. It was constantly referred to as a lump. On March 18, this mass persisted with no appreciable change in configuration or size. These facts were confirmed by Mrs. Henning and her daughter. The hypothetical question was based on facts supported by competent evidence and proved. This method of examination of an expert witness is a well-established rule of evidence, 32 C.J.S. Evidence § 551(1) (1964), but never defined in New Mexico. It has simply been accepted as a matter of course during trial. It was not challenged in this appeal. In his office chart, at the time of his first examination of Mrs. Henning, Dr. Parsons wrote “Vague area of thickening. No actual mass.” He testified, “there was no tumor.” Nevertheless, on April 1, 4 days later, Dr. Parsons telephoned the Henning family physician, who had previously examined Mrs. Henning and had recommended Dr. Parsons, to state that he did not believe the mass to be malignant. Mrs. Henning asked Dr. Parsons for a biopsy and he said it wasn’t necessary because the lump was benign and not malignant. In her mind the lump was not malignant, until Dr. Parsons called a month later, after the biopsy, to give her the bad news. Dr. Parsons failed to show an absence of a genuine issue of material fact in two respects: (1) whether Dr. Parsons failed to use care and skill in his examination and evaluation of the breast lump referred to him for diagnosis and (2) whether he failed to proceed in a timely manner to biopsy the breast lump. By way of testimony presented by the Hennings, a genuine issue of material fact also exists: (1) whether Dr. Parsons failed to inform Mrs. Henning of that which a reasonably prudent person would need to know in order to decide whether to undergo a biopsy. Dr. Parsons only said it was not necessary; and (2) whether Dr. Parsons withheld or misrepresented the reasonable and recognized risk of malignancy to be expected from the lump in Mrs. Henning’s breast. Dr. Parsons did not suggest the risk of cancer, a matter of grave concern to women generally in recent years. The Hennings did contend in this appeal that Dr. Parsons’ answers to the hypothetical questions established a deviation from the required standards of medical practice. Dr. Parsons’ countered with Montana Deaconess Hospital v. Gratton, 169 Mont. 185, 545 P.2d 670, 673 (1976) in which the court said: [T]he personal and individual method of practice of the defendant doctor is not sufficient to establish a basis for an inference that he has negligently departed from the general medical custom and practice of his community. [Emphasis added.] This rule was taken from Evans v. Bern-hard, supra. See also, Downer v. Veilleux, 322 A.2d 82 (Me.1974); Karrigan v. Nazareth Convent & Academy, Inc., 212 Kan. 44, 510 P.2d 190 (1973). An “inference” is a logical deduction from facts proved, Bolt v. Davis, 70 N.M. 449, 374 P.2d 648 (1962); and an “inference” and “presumption” are used interchangeably, Tuso v. Markey, 61 N.M. 77, 294 P.2d 1102 (1956). The “personal method of practice” rule means that we cannot presume from the individual practice of a doctor that he negligently departed from the standard. In other words, Dr. Parsons’ method of practice may not be “a basis for an inference” of negligent departure, but when he admits that a contrariety of medical opinion exists on his method of practice, an inference can be drawn that he departed from the standard of the medical community. Dr. Parsons’ answers to hypothetical questions did express his personal, usual practice with reference to the delay taken in performing the biopsy. Dr. Parsons testified that his individual practice would be to perform a biopsy immediately. I agree that this practice does not violate the standard. The fact, however, that he waited 28 days, is sufficient to establish “a basis for an inference” that he did negligently depart from the standard. We may presume that, he negligently violated the standard. Dr. Parsons’ answers to the hypothetical questions did not directly establish a deviation as the Hennings argue, but where a presumption of a deviation exists, I do not hesitate to say that it creates a genuine issue of material fact. It is well established that the standard of knowledge, skill and care can be proven by a defendant doctor’s own testimony. Evans, supra; Montana Deaconess Hospital, supra. I note, however, that Dr. Parsons’ testimony did not differ from that of Dr. Cornish; that a variation of opinion exists in the medical community. I also note in passing that Dr. Cornish believed delay did not appreciably affect the prospects for survival, and that Dr. Parsons’ care did not cause or contribute to Mrs. Henning’s condition. I interpret these opinions to mean that if the biopsy had been performed on March 28, 1978, following Dr. Parsons’ first examination, the discovery of cancer cells on that date, a month earlier, would not have caused, contributed to, or prevented her death. This issue was not raised in this appeal. It is important to comment that the Hennings’ complaint does not seek damages for the death of Mrs. Henning. The Hennings are entitled to damages only for such alleged injuries or loss sustained that occurred between March 28, 1978 to June 13, 1978, when Mrs. Henning was notified that a malignancy existed. I do not indicate in the slightest that Dr. Parsons is liable for medical malpractice. I only hold that a genuine issue of material fact exists.