Court Opinion

ID: 9454025
Source: CourtListenerOpinion
Date Created: 2023-08-04 18:32:50.909398+00
Date Added: 2024-06-11T17:33:55.844505
License: Public Domain

BOREMAN, Circuit Judge
(dissenting).
After concluding, properly so, I think, that the district court misconceived and misinterpreted the effect of this court’s decision in Hicks v. United States, 368 F.2d 626 (4 Cir. 1966), my brethren detect findings of fact and conclusions of law with respect to negligence and proximate cause in the district court’s opinion sufficient to support the judgment for the plaintiff. They even go so far as to say in the very first paragraph of the majority opinion: “And, the judgment itself may be treated as a conclusion that there was actionable negligence.” (Emphasis added.) I disagree and. my disagreement is based upon my analysis of the district court’s disavowal,’ in view of Hicks, of his right to make findings, more particularly as to causation, even though there were direct conflicts in the evidence.
It is agreed that there was no negligence involved in the inadvertent suturing of the ureter as that was not an uncommon occurrence in such cases. The plaintiffs proceeded on the theory that it was negligence to wait until the sixth post-operative day to call in the urologist, that this delay did not conform to the standards of the medical profession in that community and that such delay was the proximate cause of the subsequent loss of the kidney.
The court below noted that the plaintiff was neurotic, that she was a difficult patient with continuous and varied complaints and two days after the operation she complained of numerous pains, including a severe pain in the area of her right kidney. Dr. Moore, the urologist who had performed the post-operative IVP, was called as a witness for the defense. He testified that the actions of the government doctors, Kernan and Wayman, in treating plaintiff for kidney infection on the second post-operative day rather than immediately ordering an IVP was consistent with reasonable standard medical practice. He did not feel that there had been any need for them to obtain a urological consultation and in the circumstances he felt that he would have treated plaintiff in the same fashion as had Doctors Kernan and Way-man.1
Plainly, there was, at the very least, considerable expert testimony as to the proper standard of care here and, unlike Hicks, the evidence as to whether the course followed by Doctors Kernan and Wayman was in accord with that standard was in contradiction. Hicks does not stand for the principle that a district court must hold the defendant liable in such circumstances. Instead, the trial court should make findings resolving the issue where the evidence is conflicting. If the district court should accept the one line of expert testimony and take into account the fact that the plaintiff was a chronic complainer and difficult to diagnose and treat, a permissible conclusion of nonliability might follow.
While the district court made certain observations in its opinion and which *955have been taken out of context by the majority, I think the district judge would be amazed to learn that his comments might be accepted as findings upon consideration of his prepared opinion as a whole.
Paraphrasing, the district judge stated that the crux of plaintiff’s cause of action lies in the alleged failure to subject her to relatively safe tests for the purposes of obtaining a definite diagnosis as to her symptoms of July 27, 1958, at a time when an earlier laparotomy may have resulted in saving the kidney; that under the rule of the Hicks decision the ultimate conclusion to be drawn from the basic facts becomes a question of law; that he was barred of the freedom to express personal views as to the right of a physician to use his independent judgment in making a diagnosis which may definitely be ascertained by a recognized and relatively safe test, and also as to any causal relationship between the alleged negligent post-operative treatment and the ultimate loss of the kidney; that there is no alternative as to the final decision. The judge interpreted Hicks as teaching that “every recognized test must be resorted to by the treating physician if he hopes to avoid liability for malpractice.” He further stated that “While the writer of this opinion expresses the view that Hicks imposes an undue burden on the medical profession as a whole, and tends to deprive the physician of his right to use his own judgment in individual cases, the Hicks opinion is binding and must be followed by district courts throughout the Fourth Circuit.” He further observed that Hicks resolves the troublesome question of causation by relying upon Gardner v. National Bulk Carriers, Inc., 310 F.2d 284 (4 Cir. 1962), and by relating causation in a malpractice case to the “failure to rescue” doctrine in admiralty where it is said that “causation is proved if the (negligence) destroys the reasonable possibility of rescue.” These conclusions were stated after specifically pointing to certain conflicts in the testimony of the experts, not only on the issue of negligence but also on the issue of proximate cause. He stated positively that no expert urologist was willing to state with any probable degree of certainty that earlier surgical repair would have saved the kidney, but he found it “unnecessary to weigh the valued testimony of the experts” and followed with this comment: “Many of these questions now resolve themselves by reason of the recent case of Hicks * * *. Agreement or disagreement with the principles therein stated is not of importance.”
As to the issue of proximate cause there was violent conflict in the testimony. There is no need to review this evidence in detail but it decisively supports the district judge in his statement that no expert urologist was willing to state with any probable degree of certainty that earlier surgical repair of the ureter would have saved the kidney. In fact, it would appear to one who was not present at the trial that the weight of this testimony pointed to the fact that the delay charged as negligence had no substantial effect on the outcome.
I do not construe Hicks as altering the traditional tort concepts of causation as applied by state and federal courts. In Hicks this court found that the doctor involved had failed to make a test which was demanded by the indicated standard of care and which would have shown that the decedent was suffering from a condition “lethal if not attended to promptly.” 368 F.2d at 629. On the question of causation it was noted that “Both of plaintiff’s experts testified categorically that if operated on promptly, Mrs. Greittens would have survived, and this is nowhere contradicted by the government expert.” (Emphasis supplied.) 368 F.2d at 632. The facts in Hicks demonstrate that causation in the usual sense had been shown without contradiction, i. e., that it was more probable than not that the negligence substantially caused or added to the fatal injury. As I interpret Hicks the reference in the opinion to the admiralty law of causation in a “failure to rescue” sit*956uation was used as an analogy but that it was not intended to lay down a principle of tort law supplanting long-established and approved state rules.
If the district judge had not felt bound by Hicks under the circumstances of this ease and with respect to the evidence bearing upon the issues of negligence and causation I think it is clearly evident from the judge’s opinion that he would have made explicit findings with respect to both issues. With all due respect to the opinion of the majority to the contrary, I think it is the duty of the district judge to resolve these conflicts in the evidence and to state his findings and conclusions. To that end I would remand this case for that purpose.

. One of the reasons Dr. Moore gave for his opinion was that plaintiff was a chronic psychosomatic complainer, so that it was difficult to tell whether her complaints were real or imaginary and that one could not rely upon her complaints. This was confirmed by the other doctors who had treated plaintiff. Dr. Wayman characterized her as a “chronic complainer” and noted that “The more complaints, the less obvious a condition is,” Dr. Morgan, plaintiff’s own witness, agreed that an accurate diagnosis would be rendered more difficult by many diverse complaints and indicated that the period of time the plaintiff had under his care had been a “rather trying experience” because of her difficult attitudes. He noted that “I can purely by memory recall that there were many complaints with no organic reason.” Dr. Strode, who saw plaintiff both before and after the events here in question, felt that she was an extremely difficult patient to diagnose and treat.