Court Opinion

ID: 9567411
Source: CourtListenerOpinion
Date Created: 2023-08-21 19:53:36.844685+00
Date Added: 2024-06-11T10:00:35.858564
License: Public Domain

STEWART, Justice
(dissenting):
I respectfully dissent.
I think the conclusion is inescapable that the plaintiffs have been denied a full and fair day in court. The heart of the issue is whether the trial judge’s exclusion of evidence pursuant to a motion in limine was error. A motion in limine, in plain English, is a pretrial motion to exclude certain evidence. The defense contended that what apparently was strong evidence of negligence in the defendants’ treatment of Mrs. Reiser’s pregnancy prior to the date the amniocentesis was performed, could not have been the proximate cause of the injury and, therefore, should have been excluded. Clearly, had the proffered evidence been admitted, there would have been substantial evidence of negligence. Given Mrs. Reiser’s Rh negative blood type and her prior pregnancies when she was under the care of Dr. Francis, Dr. Lohner, a partner of Dr. Francis, should have been aware of potential difficulties from the clinic records of her past pregnancies.
Pretrial motions to exclude evidence in a negligence case should be granted only when there is no question that the evidence will not be relevant. If there is an arguable position as to admissibility, the trial court will always be in a better position to rule on relevancy at trial. The trial judge, at the time he granted the motion in this case, was in a highly disadvantaged position *101to rule in an informed manner on the motion to exclude evidence of Mrs. Reiser’s prior treatment during her pregnancy. The order read: “Plaintiff shall not present, attempt to present, or seek to have admitted, or in any way attempt to bring before the jury, directly or indirectly, any evidence relating to the following facts: (a) that an antibody titer reading was not taken by the defendants ... prior to June 24, 1971; and (b) that an amniocentesis procedure was not performed by the defendants ... prior to June 26, 1971.”
Plaintiff proffered the following proof: Dr. Banner and Dr. Roche, plaintiffs’ experts, would have testified that the failure to perform a titer prior to June 24, 1971, and the performance of a first and single amniocentesis on June 26,1971, were departures from acceptable medical practice and such failure had a causal connection with the injuries sustained by Elizabeth. Dr. Banner would have also testified that, because of the low blood pressure evident on June 24, the failure to monitor the vital signs on June 26 at the time of the performance of the amniocentesis was a departure from medical standards and was causally connected to the injurious results since performing an amniocentesis at that stage in pregnancy with the patient’s blood pressure at a very low level would aggravate the situation. Dr. Banner would have also testified that the benefit to be derived from the single amniocentesis compared with the risk involved was so small that it was surely negligence to perform an amniocentesis under those circumstances.
A physician has a duty to exercise that degree of care and skill considered proper by correct and accepted standards of the profession. Forrest v. Eason, 123 Utah 610, 261 P.2d 178 (1953). If the physician fails to exercise that legal duty of care in any particular, he is liable in tort for all damages and injuries proximately caused by the wrongful act. Harris v. Grizzle, Wyo., 625 P.2d 747 (1981); Belk v. Schweizer, 268 N.C. 50, 149 S.E.2d 565 (1966).
Once a defendant fails to exercise the requisite degree of care, the law of negligence holds that the tortfeasor must take his victim as he finds him and that the tortfeasor be held responsible for proximately caused injuries even though exacerbated by a condition of the victim not known to the tortfeasor. Brittis v. Freemon, 34 Colo.App. 348, 527 P.2d 1175 (1974). The pertinent inquiry is not whether the actual harm sustained was of a particular kind which was expected, but rather whether the harm fell within the general field of danger to plaintiff. Adams v. State, 71 Wash.2d 414, 429 P.2d 109 (1967). Although negligence involves a recognizable danger which is apparent, or should be apparent, to one in defendant’s position, it is not required that a defendant should have foreseen the particular injury, the exact extent of the harm, or the precise manner in which it occurred. Endresen v. Allen, Wyo., 574 P.2d 1219 (1978). A defendant may not justify negligence on the ground that a particular result, although within the general scope of the risk created, has not before occurred.
Plaintiffs allege that the proffered evidence of negligent treatment leads to the conclusion that the placement of Mrs. Reiser in a supine position during an unnecessary and potentially dangerous medical procedure was the proximate cause of the injury. The contention is that putting Mrs. Reiser in that position was dangerous at her stage of pregnancy, and led to a condition known as supine hypotensive syndrome, a condition which women in their late stages of pregnancy may develop. Plaintiffs also claim that this led to Mrs. Reiser’s cardiac arrest which produced the anoxia causing the infant’s brain damage. Whether the injuries suffered and the damages incurred were the proximate result of the negligent treatment was clearly a factual issue for the jury. Jensen v. Mountain States Tel. and Tel. Co., Utah, 611 P.2d 363 (1980). In excluding that evidence, the trial court denied plaintiffs their right to a jury trial.
Defendant argues that the jury’s finding that Dr. Lohner was not negligent in allowing Mrs. Reiser to stay on her back for a long period of time during the amniocentes*102is destroys the critical link in plaintiffs’ alleged chain of causation and renders acts of defendants prior to that point irrelevant. The argument begs the issue. A jury cannot make a proper determination as to negligence unless it is allowed to evaluate the benefits reasonably expected to be gained from a given medical procedure versus the risks to which a patient is subjected as a result of that procedure. Negligence occurs when the gravity and likelihood of danger outweigh the utility of the conduct. Weirum v. RKO General, Inc., 15 Cal.3d 340, 123 Cal.Rptr. 468, 539 P.2d 36 (1975). The jury in the instant case, without the proffered testimony of plaintiffs’ experts, simply could not properly evaluate Dr. Lohner’s actions. Withholding the evidence in question prevented consideration of relevant factors in determining whether defendant was negligent.1
Furthermore, it is of crucial importance that the theories presented by defendants’ experts to explain the causes of Mrs. Reiser’s injuries were inextricably intertwined with the administration of the amniocentesis. Defendants’ experts presented various commonly known reactions to procedures such as the one Mrs. Reiser underwent which could have caused the cardiac arrest.
Although defendants admit that an amniocentesis can lead to supine hypotensive syndrome, they claim that neither amniocentesis nor supine hypotensive syndrome has ever been reported to have resulted in cardiac arrest. But that does not resolve the issue in light of evidence proffered by plaintiffs’ expert that amniocentesis is virtually never administered under circumstances similar to those existing at the time Mrs. Reiser was subjected to the test. In all events, the issue was unquestionably a factual issue for the jury as to which plaintiffs’ expert’s testimony was highly relevant.
Furthermore, the issue of lack of consent was also seriously prejudiced by the exclusion of plaintiffs’ evidence. Uninformed consent to a medical procedure is tantamount to no consent at all. Dale v. State, 44 A.D.2d 384, 355 N.Y.Supp.2d 485 (1974). Plaintiffs’ evidence, had it not been excluded, would have cast great doubt upon the advisability of the procedure and any benefit to be gained therefrom. The nature of the risk was never made apparent to Mrs. Reiser so as to enable her to give an informed consent. See Ficklin v. Macfarlane, Utah, 550 P.2d 1295 (1976). If in fact the procedure is virtually never administered at that stage and under the conditions of Mrs. Reiser’s pregnancy, and the benefits to be gained therefrom were at best minimal, Mrs. Reiser’s lack of this knowledge would have indeed rendered her consent uninformed.
The Court also misapplies Foil v. Ballinger, Utah, 601 P.2d 144 (1979). In that case the Court stated that the two-year statute of limitations “does not commence to run until the injured person knew or should have known that he had sustained an injury and that the injury was caused by negligent action.” Id. at 148 [emphasis added]. In Foil, as in the instant case, the plaintiff knew that she had suffered a physical injury which was apparently related to a medical procedure. In neither Foil nor in this case, however, was there an obvious reason for a layman to suppose that the injury was attributable to negligence on the part of the physician. Yet, in this case, the majority asserts the wholly factual proposition that the “plaintiff should have known” that she “had suffered legal injury at the time of the cardiac arrest.” Why she should have known that the cardiac arrest was a result of negligence is simply not explained nor is it explainable. I think the conclusion inescapable that the issue should have been submitted to a trier of fact and that Foil was misapplied in this case.
*103This Court has previously determined that if a person who exercises reasonable diligence does not know of an injury, the statute of limitations for a malpractice action does not begin to run against him, Christensen v. Rees, 20 Utah 2d 199, 436 P.2d 435 (1968). Similarly, a plaintiff who does not know or have reasonable grounds for knowing that a known injury was caused by unknown negligence, the two-year statute of limitations for a malpractice action does not begin to run, Foil v. Balling-er, supra. Simple awareness of an injury that might have been an unavoidable consequence of the medical treatment, or the result of some other cause, or even a temporary side effect of treatment, is not tantamount to knowledge that the injury was the result of improper treatment. As stated in Foil v. Ballinger, supra, at 147:
Because of the nature of malpractice actions, and based on prior Utah law, we hold that the statute begins to run when an injured person knows or should know that he has suffered a legal injury. We base this holding on several grounds. In the health care field it is typically the case that there often is a great disparity in the knowledge of those who provide health care services and those who receive the services with respect to expected and unexpected side effects of a given procedure, as well as the nature, degree, and extent of expected after effects. While the recipient may be aware of a disability or dysfunction, there may be, to the untutored understanding of the average layman, no apparent connection between the treatment provided by a physician and the injury suffered. Even if there is, it may be passed off as an unavoidable side effect or a side effect that will pass with time. [Emphasis added.]
In Mrs. Reiser’s affidavit in opposition to the summary judgment, an affidavit not referred to in the majority opinion, she stated that she was unaware of the extent of the injury suffered until June, 1972, and that she had been under a physician’s care for the trauma suffered as a consequence of the cardiac arrest; however, she was not advised by the physician of the permanency of the neurological damage until June of 1972. That there was a factual issue as to her knowledge of the nature, extent, severity and permanency of her injury is hardly debatable.
This action is not to recover for temporary side effects discovered shortly after June 26, 1971. Rather, she is seeking damages for a permanent and severe injury, an injury of which she was not aware according to her affidavit until June of 1972. Neither Dupler v. Yates, 10 Utah 2d 251, 351 P.2d 624 (1980) nor the cases cited therein and referred to in the majority opinion justify the conclusion that plaintiff’s affidavit failed to establish an issue of fact. Basic principles of civil procedure provide that the party opposing a motion for summary judgment is entitled to the benefit of all favorable inferences, Durnham v. Margetts, Utah, 571 P.2d 1332 (1977), and that affidavits in opposition to a motion for summary judgment are to be liberally construed against summary judgment. Sutton v. Brown, 85 Idaho 104, 375 P.2d 990 (1962); Chilson v. P. G. Industries, 174 Cal.App.2d 613, 344 P.2d 868 (1959). Considering the contents of Mrs. Reiser’s affidavit in light of the above analysis, I find the conclusion inescapable that plaintiffs were entitled to a trial on the issue of the running of the statute of limitations pursuant to Utah Code Ann., 1953, § 78-12-47.

. In support of the jury’s finding of no negligence, defendants suggested other activities which would have likewise caused Mrs. Reiser to be placed in a similar position: sleeping, undergoing general examination, and giving birth. Plaintiffs, however, are quick to point out that Mrs. Reiser would not necessarily be required to lie completely flat for any of the above-mentioned activities. In any event, the argument underscores the impropriety of excluding plaintiffs’ evidence.