Court Opinion

ID: 9643211
Source: CourtListenerOpinion
Date Created: 2023-08-22 20:22:13.545294+00
Date Added: 2024-06-11T18:10:58.294775
License: Public Domain

EDGERTON, Associate Justice
(dissenting).
When appellee first consulted appellants, he had a pilonidal cyst, which comprised *841an underlying cyst, a fistula, and also a surface ulcer. For several years it had caused discomfort, intermittently, by erupting. During and after the period in which appellants gave him X-ray treatments, he suffered severe pain. In the course of time the ulcer grew larger, and necrosis and sloughing took place. The question is whether a jury could reasonably find that appellants negligently caused appellee’s sufferings by an overdose of X ray.
The testimony favorable to appellants may be summarized as follows. (1) Shortly before appellee consulted them, his pilonidal cyst had become so bad that a surgeon advised a surgical operation. (2) Surgeons testified, without contradiction, that infection and necrosis usually develop in untreated cases of pilonidal cyst. (3) Surgeons also testified, without contradiction, that surgical operations for pilonidal cysts do not always get rid of the infection, and sometimes present the same “stubbornness in healing” that appellee experienced, or a “later break down.” (4) Appellant Merritt and two other X-ray experts testified, without contradiction, not only that X-ray therapy is proper treatment for a pilonidal cyst, but that the treatments which appellants gave, as recorded on their office chart, were proper treatments and could not cause harm. A disinterested expert called the treatments “very excellent.” The accuracy of appellants’ record was proved, and was not disputed or even questioned. Appellee said: “I cannot dispute Dr. Merritt’s record.” (5) The experts testified, without contradiction, that no X-ray treatments could cause such harm as appellee suffered without at the same time destroying or injuring tissue throughout the whole area which was exposed to the ray. It was not disputed that, although a square area was exposed, necrosis and sloughing were confined to a circular area in its center. (6) The experts testified, without contradiction, that if harm had been caused by the X-ray treatments, it would have reached its maximum within 90 days, or less, after they began. There was substantial, but disputed, evidence that appellee’s ulcer reached its maximum size and virulence several' months after the 90-day period. (7) The experts, and also a surgeon, testified that if the necrosis and sloughing which appellee suffered had been caused by X ray, the resulting sore would never have healed. Undisputed testimony showed that nearly the whole of the diseased area had healed, and the rest was healing. (8) Surgeons not associated with appellants injected Gabriel’s solution into the diseased area. There was substantial, but disputed, evidence that appellee’s ulcer reached its maximum size and virulence after this injection. The X-ray experts testified that such an injection into an area previously treated by X ray is likely to cause harm, and doubtless caused the sloughing in this case.
On the other hand, the experts testified that necrosis often results from excessive use of X ray, and has to be guarded against in giving X-ray treatments. A surgeon, not an X-ray expert, who examined appellee’s condition a year after the X-ray treatments, testified: “My conclusion at that time, from his history, was that it was caused by an X-ray burn.” The trial occurred three years later than the time to which this testimony referred. During this interval, appellee’s sore had practically healed. The surgeon’s opinion at the time of trial was not asked or stated. And he frankly said, “I don’t know anything about the X ray on a pilonidal cyst.” The two surgeons who injected Gabriel’s solution thought at that time, on examination and history, that the possibility of X-ray burn was worth considering, but they disclaimed expertness in the field and never diagnosed the case as X-ray burn. The first surgeon thought that X-ray burn might heal as appellee’s ulcer had healed. The other two testified that the injection did not and could not cause necrosis. Appellee testified that appellant Merritt told him “that he had burned out all that pilonidal cyst, and what he had to do was to heal up the atrophic ulcer caused by that burn.” Appellee’s wife testified that Merritt said to her on the telephone, three and one-half years before the trial, “unfortunately that he had given Mr. Callahan too much bum, but he would be all right.” Appellant testified that he made no such statements.
Causation. A doctor is not liable merely because his patient grows worse. To be entitled to recover, it was necessary for appellee to prove two things: That appellants’ treatment caused his ulcer to grow worse, and that the treatment was negligent. X ray is a technical specialty, and evidence regarding it, to be of value, must be given by experts.1 It appears from the record, and is common knowledge, that sur*842geons do not, in preparation for or in the course of general practice, become X-ray experts; specialized study and experience are required. Apart from the alleged statements of appellant Merritt to appellee and his wife, which appellant denied, the only evidence tending to show that the harm which appellee suffered might be caused by X-ray treatments of any sort came from surgeons who disclaimed special knowledge of the subject, and the only person who ever diagnosed appellee’s condition as actually caused by X ray was the surgeon who said, “I don’t know anything about the X ray on a pilonidal cyst.” No X-ray therapist, no surgeon, and no physician expressed, at the trial, a present belief that appellee’s condition was caused by X ray. Testimony that it was not caused by, and occurred before, the injection of Gabriel’s solution cannot be translated into testimony that it was caused by X ray. On the contrary, the same surgeons who testified that Gabriel’s solution was harmless testified also that they did not know how the harm arose and that infection, ulceration and necrosis such as appellee suffered often occur in pilonidal cysts which have not been treated at all. The fact that appellant himself attributed appellee’s necrosis to the solution does not prove that it was not a spontaneous development of his ulcer but must have been caused either by the solution or by the X ray. Yet this dichotomy is basic in the prevailing opinion. Either it is founded on the erroneous2 assumption that a party is ■concluded by his own testimony, or it has no foundation. Apart from the alleged statements of appellant Merritt, which he denied, there was no testimony from any source that the harm which appellee suffered was or might be caused by the particular X-ray treatments which appellants gave him. The're was much testimony that those treatments could cause no harm, and that no X-ray treatments could cause ■ the particular harm which appellee suffered. It is doubtful, in my opinion, whether a jury could reasonably find that appellants’ treatment caused necrosis and sloughing, or other injury.
Negligence. But we need not determine that question. If appellants did cause injury to appellee, by giving him more “burn” than proved to be good for him, it does not follow that they are liable. Causation is one thing, negligence is another. As we have said in an X-ray case, “It was not enough to show merely that the treatment was injurious, but it was necessary to go further, and to show by competent witnesses that the requisite care and skill was not exercised in giving it” ;3 in other words, that the treatment was negligent. “Generally speaking, no inference of negligence can be drawn from the result of the treatment of a physician or surgeon.” Specifically, no such inference can be drawn from the fact that X-ray treatment results in injury. This court has ruled that the fact of injury by X ray is “no evidence of negligence.” 4 To say that if an X-ray therapist causes harm, he must have been negligent, is as wide of the mark as to say that a surgeon or a lawyer who loses a case must have been negligent. I find no concession, and no testimony, to that effect; to the effect, in other words, that no acts which appellants could properly and reasonably have done in attempting to treat appellee could have produced necrosis and sloughing ; 4a although there was abundant testimony that the treatment actually given him could not produce such consequences.
*843Negligence, technically called absence of due or reasonable care, is unreasonably dangerous conduct. If it was reasonable in the circumstances for appellants to do what they did, their conduct was not negligent, whatever results it may have produced. It is undisputed that appellee’s condition called for treatment; that cysts like his, if they are not treated, are likely to lead to necrosis; that surgical treatment is not a certain cure; and that X-ray therapy is a proper form of treatment. Not only was there abundant evidence that the particular X-ray therapy which appellants administered was in the circumstances correct ; there was no evidence to the contrary. In other words, there was no evidence of negligence. “Here there was no testimony that the instrument used by the defendant was out of repair, that the exposures were of too frequent periods or of too great duration,” or of too great intensity; or that appellants failed to make reasonable inquiry into appellee’s condition before or during treatment. “Neither is there any evidence of lack of skill.”5
The Supreme Court has said that “ ‘When a plaintiff produces evidence that is consistent with an hypothesis that the defendant is not negligent, and also with one that he is, his proof tends to establish neither.’ ”6 It follows from that premise that Merritt’s alleged statement to appellee’s wife, “unfortunately that he had given Mr. Callahan too much burn,” does not tend to establish negligence. Giving “too much burn” is consistent not only with the hypothesis of negligence but with at least three hypotheses which do not involve negligence; (1) that an instrument which was carefully chosen, inspected, and used, gave “too much burn” by failing to function normally on this occasion; (2) that appellee was peculiarly susceptible to X ray, which could not reasonably have been discovered or anticipated, and the treatment he received, while it could not harm a normal person, proved too much for him; and (3) that there was some degree of risk that the treatment might produce “too much burn”, but the risk was so slight, the probability of benefit was so great, and appellee’s prospects without the treatment were so bad, that it was reasonable to take the risk.
Even if the testimony of appellee’s wife to the ambiguous remark attributed to Merritt were interpreted as evidence that he was negligent, it would be no more than a scintilla of evidence. The testimony of an interested person to an alleged, and denied, extra-judicial admission, standing alone, carries little weight. Admission testimony, whoever gives it, “consisting as it does in the mere repetition of oral statements, is subject to much imperfection and mistake; the party himself either being misinformed, or not having clearly expressed his own meaning, or the witness having misunderstood him. It frequently happens, also, that the witness, by unintentionally altering a few of the expressions really used, gives an effect to the statement completely at variance with what the party actually did say.”7 Justice Story, at circuit, said that an alleged admission “ ‘is in all cases most unsatisfactory evidence, on account of the facility with which it may be fabricated, and the impossibility of contradicting it. Besides, the slightest mistake or failure of recollection may totally alter the effect of the declaration.’ ”8 Dean Wigmore says: “The great possibilities of error in trusting to recollection-testimony of oral utterances, supposed to have been heard, have never been ignored.”9 Mrs. Callahan did not even claim to be able to quote the exact words which Dr. Merritt used. “That he had given” is, of course, a paraphrase. “Too much burn” evidently was, also, her attempt to reproduce the substance of what was said; for on cross-examination she changed it to “too much X ray.” With the best will in the world such an attempt is subject, particularly after a long lapse of time, to a large margin of error.
*844A scintilla of evidence of negligence is not enough to sustain a plaintiff’s burden of proof and create a jury question.10 The testimony of appellee’s wife, if interpreted as evidence of negligence, is in conflict with the entire mass of evidence on that subject. The propriety of appellants’ undertaking to treat appellee by X ray is clear. The testimony to the correctness of their treatment is overwhelming. No reasonable jury could regard it as outweighed by the interested and disputed testimony of appellee’s wife to her understanding and recollection of the substance of an ambiguous remark alleged to have been made by Merritt, over the telephone, three and one-half years before the trial. “Where the evidence upon any issue is all on one side or so overwhelmingly on one side as to leave no room to doubt what the fact is, the court should give a peremptory instruction to the jury.”11 It follows that appellants’ motion for a directed verdict should have been granted.

 Sweeney v. Erving, infra.

 Alamo v. Del Rosario, 69 App.D.C. 47, 98 F.2d 328.

 Sweeney v. Erving, 35 App.D.C. 57, 63, 43 L.R.A.,N.S., 734, affirmed on other grounds 228 U.S. 233, 33 S.Ct. 416, 57 L.Ed. 815. The plaintiff appealed to this court, and attacked the trial court’s refusal to charge that the fact of injury by x ray (1) was evidence of negligence and (2) shifted the burden of proof. We sustained the judgment of the trial court, and ruled that both of the plaintiff’s propositions were unsound.

 Id., 35 App.D.C. at pages 61, 62, 43 L.R.A.,N.S., 734. (Italics supplied).

 The prevailing opinion attributes to the X-ray men testimony that necrosis and sloughing could not be caused by .proper X-ray treatment. I find no such testimony. Merritt testified that, while “any X-ray treatment of an intensity necessary to produce destruction of hair follicles will produce a burn * * * it will not destroy tissue if properly administered.” I take this to mean that proper treatment for the destruction of hair follicles, while it will regularly produce a burn, will not, as a general rule, destroy tissue. Merritt did not state that it will never destroy tissue. # Moreover, “proper treatment” is not equivalent to “proper attempts to give treatment.” It is common knowledge that in the practice of medicine or surgery, as of law, faultless acts sometimes produce bad results. Dr. Merritt and the other experts made no claim that this is not true of X-ray treatments.

 Sweeney v. Erving, supra, 35 App.D. C. at page 63, 43 L.R.A.,N.S., 734.

 Gunning v. Cooley, 281 U.S. 90, 94, 50 S.Ct. 231, 233, 74 L.Ed. 720.

 Greenleaf, Evidence, 15th ed., § 200.

 Smith v. Burnham, 22 Eed.Cas. pages 465, 466, No. 13,019.
An alleged admission by the owner of a horse that the horse was “mean” has been held insufficient to support a finding that he knew the horse was dangerous. Webber v. McDonnell, 254 Mass. 387, 150 N.E. 189. A defendant’s alleged statement that “it was my fault” has been held no bar to the direction of a verdict in his favor. Binewicz v. Haglin, 103 Minn. 297, 115 N.W. 271, 272, 273, 15 L.R.A.,N.S., 1096, 14 Ann.Cas. 225. Cf. Jones v. Harris, 122 Wash. 69, 210 P. 22.

 Wigmore, Evidence, 3d ed., Vol. VII p. 468, (§ 2094).

 Jackson v. Capital Transit Co., 69 App.D.C. 147, 99 F.2d 380.

 Gunning v. Cooley, 281 U.S. 90, 94, 50 S.Ct. 231, 233, 74 L.Ed. 720.