Court Opinion

ID: 9625773
Source: CourtListenerOpinion
Date Created: 2023-08-22 07:50:56.289119+00
Date Added: 2024-06-11T18:06:15.096002
License: Public Domain

HENDLEY, Judge (concurring in part and dissenting in part). I dissent from that part of the majority opinion relating to Dr. Klebanoff and his acts during the surgery. I will not restate the applicable law. That has been correctly stated by the majority. I disagree with the application of that law to the existing facts. I believe a factual issue was raised by Dr. Davis’ affidavit, the depositions of Dr. Whitcomb and Dr. Klebanoff and the Article of Dr. Holscher. When read as a whole, a satisfactory explanation is made as to how Dr. Davis arrived at his opinion of failure to meet the recognized standards of medical practice in the community. The pertinent parts of Dr. Davis’ affidavit are as follows: “Richard Allen Davis, M.D., being first duly sworn on oath, deposes and says as follows: “That he is a resident of Philadelphia, Pennsylvania. That he is a doctor of medicine duly licensed in the State of Pennsylvania. That he is a board certified neurosurgeon, and is an Associate Professor of Neurosurgery at the University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania. “That at the request of counsel for Shirlee Smith of Albuquerque, New Mexico, he has examined the voluminous hospital records of Shirlee Smith from the Presbyterian Hospital and the Bataan Memorial Hospital covering the periods from her first admission into Presbyterian Hospital in Albuquerque, New Mexico, on January 21st, 1968, through her discharge from the Bataan Hospital on March 1st, 1968, the report of Dr. Robert M. Klebanoff dated January 31st, 1968, the medical report of Dr. John G. Whitcomb dated February 2nd, 1968, and all of the records submitted to him concerning her hospitalization, and concerning the removal of the herniated disc between the 4th and 5th lumbar vertebra on January 31st, 1968 by Dr. Robert M. Klebanoff, and the repair surgery performed by Dr. John G. Whitcomb for the repair of the right common iliac arterial venous fistula. “That he additionally examined and read the deposition of Dr. Franklin Coffey given in the case of Ron Smith and Shirlee Smith vs. Gordon Winter, which case was at that time pending in the District Court of Bernalillo County, New Mexico, and denominated A 26466. “That additionally he has examined the report of counsel relative to the claim of Shirlee Smith against Dr. Robert M. Klebanoff, and after this examination of the records, statements of fact and findings, it is his opinion that at the time of the surgical procedure performed by the said Dr. Robert M. Klebanoff on January 31st, 1968, the said Dr. Robert M. Klebanoff was using a pituitary rongeur in the performance of the surgery, and that the instrument penetrated the anterior wall of the annulus fibrosis, and that the penetration resulted in a severance of the right common iliac artery and vein. “That this act in the performance of the surgical operation constituted, in the opinion of this affiant, less than the usual caution and care, in this instance, and the medical skill displayed by Dr. Robert M. Klebanoff at this time, was less than that required by the standards of medical practice under the circumstances in Albuquerque, Bernalillo County, New Mexico, on January 31st, 1968, and that the conduct of the said Dr. Robert M. Klebanoff in the performance of this surgery, and the care required of him did not meet the usual standards of practice in this type of surgical procedure when performed in the United States. “That the damage sustained by Shirlee Smith on the 31st day of January, 1968, was brought about as result of surgical complications arising from the disc surgery, which complications have been emphasized in medical journals, texts, and in surgical conventions since the time of the perfecting of the procedure for performing this type of surgical procedure. “That this affiant, if called to testify, would under oath, testify that based upon the facts before him, and the examination which he has made of records, that the conduct of Dr. Robert M. Klebanoff in the performance of the surgery on January 31st, 1968, fell below the usual standards of surgical practice and that his competence in this instance, did not meet the recognized and accepted level of neurosurgical practice in Albuquerque, Bernalillo County, New Mexico, or the United States, on January 31st, 1968.” Dr. John Whitcomb who performed the corrective surgery stated in his deposition that the vein was punctured and the two ends of the almost severed artery were inserted into the anterior punctured hole of the vein. (The ronguer had gone through the vein). He described the vein as “its as big as your thumb” and the artery as being smaller, “approximately five-eighths of an inch.” The part of the artery which was inserted in the vein was described by the doctor as having a piece of the circumference missing. “I speak of the almost complete severance so, apparently, one portion of the wall artery was intact and a circular but not completely circumferential portion was missing.” The doctor further stated there was nothing abnormal in the location of the artery or vein. As a part of the record is an Article written by Dr. Edward C. Holscher on “Vascular and Visceral Injuries During Lumbar-Disc Surgery” which describes the problems in Lumbar-Disc Surgery. Under the heading of “Prevention” Dr. ITolscher states: “ * * * It is, indeed, true that an absolute method of prevention is not available at this time, but experience has given the surgeon doing disc surgery safer guidelines to follow than he had in the past. “Prevention should embrace the following desiderata: “1. Adherence to strict indications for disc surgery, which at least would lower the numerical incidence. “2. Awareness of the striking ease with which such an accident occurs. “3. Dependable anesthesia with the patient fully asleep and the anesthetist fully alert. “4. Adequate lighting in the depths of the wound so that the surgeon can see what he is doing and not have to delineate the depths of the wound instrumentally and blindly. “5. Adequate hemostasis and effective root retraction, prerequisites to any safe interbody procedure. “6. Safe-depth-or-death markings on all interbody instruments. Approximately one and one-fourth inches forward from the posterior margin of the vertebral bodies at the third and fourth lumbar levels and approximately one and one-eighth inches at the fifth lumbar level in the adult patient are safe distances; penetration beyond these depths is perilous. * * * Instruments can be marked to show the critical depth in various ways, such as circular scoring of the metal, collaring it at fabrication, or simply by applying a one-half inch wide circle of colored plastic tape. * * * “7. Avoidance of depth sounding with an instrument.” (Emphasis added). Dr. Klebanoff testified upon deposition that there was no unusual narrowing of the disc space; that when he observed the body cavity of Mrs. Smith during the corrective surgery there was nothing unusual about her and that the vein was located about one-half inch or less anteriorally to the anterior annulus. From the record one can fairly read that between the 4th and 5th lumbar levels a penetration beyond one and one-eighth inches is perilous; that the vein was about one-half inch or less anterior to the anterior annulus; that the vein was larger than the artery; that the artery was approximately five-eighths of an inch. Even assuming the vein was the same size as the artery, a reasonable inference would be that the rongeur would necessarily have to be inserted more than twice the recommended safe distance. Dr. Davis having the benefit of the foregoing information at the time of making his affidavit necessarily concluded that “this act” (going far beyond the safe distance) was what constituted less than the required standards of medical practice. Factual issues involving the operation, although disputed, are raised. Where the slightest doubt exists as to the material facts summary judgment should not be-granted. Binns v. Schoenbrun, 81 N.M. 489, 468 P.2d 890 (Ct.App.1970). I dissent.