Court Opinion

ID: 9728286
Source: CourtListenerOpinion
Date Created: 2023-08-26 14:04:00.762556+00
Date Added: 2024-06-11T18:25:47.432387
License: Public Domain

Clinton, J.,
dissenting.
I respectfully dissent from the majority opinion for the reason that there was no error in the court’s refusal to receive the offer of the opinion of Dr. Robert Brittain. I agree with the dissent of Boslaugh, J., insofar as it pertains to the defendant, David E. Jenny, M.D. There was no evidence presented or offered which made a case submissible to the jury as to the defendant Dr. Jenny. The jury verdict in favor of both defendants should, therefore, be permitted to stand. In addition, the majority, opinion, inadvertently perhaps, casts a shadow upon the validity of Neb. Rev. Stat. § 44-2810 (Reissue 1978), defining malpractice and professional negligence, which section, although not governing this case because it does not apply to causes of action accruing before the effective date of the statute, will apply in other malpractice cases. The three matters mentioned above will be discussed seriatim.
Even if it be accepted that Dr. Brittain was qualified to testify by being familiar with the standard of care required in Alma, Harlan County, Nebraska, and that the local standard is in this instance the same as the national standard, the offer of Dr. Brittain’s testimony in question and answer form was properly refused because the questions and the proffered answers and opinion contained assumptions which were not supported by the evidence.
In Clearwater Corp. v. City of Lincoln, 202 Neb. 796, 277 N.W.2d 236 (1979), we said:
The opinion of an expert witness lacked probative value if the assumptions for it were shown to be not true. [Citation omitted.]
The value of the opinion of an expert witness was dependent on, and was no stronger than, the facts on which it was predicated. Such an opinion had no probative force un*344less the assumptions upon which it was based were shown to be true.
Id. at 802, 277 N.W.2d at 240. In that same case, we also said:
Expert testimony should not be received, or if received should be stricken, if it appears the witness is not in possession of such facts as will enable him to express a reasonably accurate conclusion as distinguished -from a mere guess or conjecture.
Where the opinion testimony of an expert witness does not have a sound and reasonable basis it should be stricken.
Id., syllabus of the court.
We point out in this dissent just three of the assumptions not supported by the evidence in this record. The offer assumes that at the time of the examination by Dr. Stevenson on April 30, 1974, there was a “dominant” mass in the upper, outer quadrant of the patient’s right breast and that it would have been found had the two doctors been in communication at that time. Dr. Stevenson’s testimony was positive that the “large, smooth, freely movable, irregular mass in the upper outer quadrant of the right breast” was no longer there on that examination. It did not exist. There was, therefore, nothing to biopsy. When the patient returned to see Dr. Jenny on June 19, 1974, the mass, which he had detected on April 25, 1974, and which caused him to refer the patient to Dr. Stevenson, no longer existed. There was on these dates, then, nothing to biopsy. The evidence of the plaintiff’s own expert, a general practitioner, is that a “smooth irregular mass would not make one think of a primary diagnosis of carcinoma . . .■.”
The offer, including the questions, assumes that Dr. Jenny and Dr. Stevenson “medically abandoned” the patient for a period of 130 days. A careful examination of the record shows that the 130-day period *345referred to is June 19, 1974, to October 29, 1974. On the latter day the patient returned to see Dr. Jenny. She had detected an enlarged node in her right armpit about 3 weeks earlier. At that time Dr. Jenny again examined the breasts. They were normal. He found the node in the right armpit and on the same day referred her to Dr. Stevenson who examined her the same day. There is no evidence that either of the defendants “medically abandoned” the patient. Under the pleaded allegations, negligent abandonment was not an issue. In any event, the quoted words were a statement of a conclusion not designed to elicit an opinion or fact and was, in the context used, pejorative and had no proper place in the question.
In several instances the offer does not separate the possible liability and claims of negligence as to the two defendants. For example, the offer used such phrases in several places as “did either defendant Dr. Jenny or Stevenson meet the standard of recognized medical care in Harlan County . . . .” It is, of course, elementary that a defendant is liable only for his own negligence and not that of another, absent an agency or some other relationship which makes one vicariously liable. There is no such evidence here.
It seems to be the universal rule that a physician who, being unable to take care of a patient, sends a substitute or who refers a patient to a specialist because the patient’s ailment is or may be outside his field of competence, is not liable for the negligence of the physician to whom referral is made. A lengthy annotation on this and related principles appears at 85 A.L.R.2d 889 (1962). See, §§ 6-10 of that annotation and cases discussed both in the main volume and the 1979 supplement, especially McCay v. Mitchell, 62 Tenn. App. 424, 463 S.W.2d 710 (1970); Nelson v. Sandell, 202 Iowa 109, 209 N.W. 440 (1926); Mayer v. Hipke, 183 Wis. 382, 197 N.W. 333 (1924).
*346The plaintiff’s own expert witness testified that Dr. Jenny satisfied his obligation of care when he referred the patient promptly to Dr. Stevenson. This, the undisputed evidence shows, he did on April 25, 1974, when he first noticed the irregular, freely movable mass, and again on October 29, 1974, when the enlarged node in the armpit was found. The plaintiff’s expert, Dr. Williams, described the relationship as a referral and not as a consultation, and testified that when a physician makes a prompt referral to a specialist, he has then satisfied his obligation of care. There is no claim made in this case that the referral was made to an incompetent specialist.
Many of the proffered questions were vague and confusing. Objections were made to the offers which were inclusive of the deficiencies we have discussed as well as others. Without regard to the question of whether the standard is local or national, or the competency of Dr. Brittain to express an opinion because of his familiarity with the standard, the offer was properly rejected for other good reasons.
As we have already noted in connection with our discussion of the admissibility of the offer of Dr. Brittain’s testimony in its failure to separate the liability of the two defendants, the plaintiff’s own evidence shows that Dr. Jenny, a general practitioner, satisfied his obligations when he, on two occasions, referred the patient to a specialist. It is pure conjecture to argue that, if Dr. Jenny had communicated with Dr. Stevenson, something additional would have been found which would have led to an earlier diagnosis.
This leads us to the discussion of § 44-2810, which became effective July 10, 1976. The majority opinion says:
If practices within a certain specialty do not vary significantly throughout the country, *347there is no policy justification for the locality rule.
“We recognize that medical standards of care and skill are becoming national, rather than local or regional.” [Kortus v. Jensen, 195 Neb. 261, 269, 237 N.W.2d 845, 850 (1976).]
Kortus v. Jensen, 195 Neb. 261, 237 N.W.2d 845 (1976), was released January 22, 1976. I would accept the statement that, in the specialties, especially, it is probably true that in the diagnosis and treatment of certain diseases, national and local standards of care may be the same. However, that is necessarily a question of fact to be determined in each particular case based upon the testimony.
Section 44-2810 provides:
Malpractice or professional negligence shall mean that, in rendering professional services, a health care provider has failed to use the ordinary and reasonable care, skill, and knowledge ordinarily possessed and used under like circumstances by members of his profession engaged in a similar practice in his or in similar localities. In determining what constitutes reasonable and ordinary care, skill, and diligence on the part of a health care provider in a particular community, the test shall be that which health care providers, in the same community or in similar communities and engaged in the same or similar lines of work, would ordinarily exercise and devote to the benefit of their patients under like circumstances.
I do not believe that the statement in the opinion about the lack of “policy justification for the locality rule’ ’ should be construed as limiting the applicability of § 44-2810 when there is, in fact, a difference in standards between localities. This, it seems to me, would also relate to the availability of technological equipment. Every specialist and hospital can-
*348not, e.g., have a body-scanner.
The statement in the majority opinion quoted above seems to saddle Dr. Jenny with the standard of care of a specialist, which he is not.
Dr. Jenny was entitled to have a verdict directed in his favor. There being no error in refusing the proffered opinion of Dr. Brittain, the jury verdict for both defendants should be affirmed.
Boslaugh, J., concurs in this dissent.