Court Opinion

ID: 9700673
Source: CourtListenerOpinion
Date Created: 2023-08-25 21:43:19.65659+00
Date Added: 2024-06-11T18:21:13.118034
License: Public Domain

ON MOTION FOR REARGUMENT AND REHEARING EN BANC
Before CHRISTIE, C.J., HORSEY and HOLLAND, JJ„ and HARTNETT, Vice Chancellor.
This 12th day of March, 1990, the Court has before it the Russells’ motion for rear-gument and for rehearing en banc. The Russells have requested that we reconsider our holding in this case, in view of our holding in Strauss v. Biggs, Del.Supr., 525 A.2d 992 (1987). Specifically, the Russells suggest that the “inferences” permitted in Strauss support their position in this appeal.
In Strauss, the patient, Mrs. Biggs, originally consulted the defendant, Dr. Strauss, because of a “pebble-like” pain in her right heel. Strauss v. Biggs, 525 A.2d at 994. Dr. Strauss concluded that Mrs. Biggs was suffering from heel spurs. Id. Dr. Strauss advised Mrs. Biggs that an outpatient surgical procedure, called a fascioto-my, would relieve her pain. Id.
On a later date, Mrs. Biggs returned to Dr. Strauss’ office to have the fasciotomy performed. Id. She was prepared for surgery and a local anesthetic was administered. Id. According to Mrs. Biggs, seconds after Dr. Strauss made an incision, she experienced excruciating pain which caused her to scream. Id. Dr. Strauss immediately withdrew the scalpel. Id. When Dr. Strauss inserted the scalpel into Mrs. Biggs’ foot a second time, she again felt excruciating pain. Id. Dr. Strauss stopped operating on Mrs. Biggs’ foot within seconds of her second scream. .Id.
Following the operative procedure, Mrs. Biggs returned to see Dr. Strauss on several occasions, each time complaining of the continuation of her original pain and a severe “new” pain. Id. Dr. Strauss told Mrs. Biggs that there was nothing else he could do, and suggested that she find another physician. Id. at 995. Thereafter, Mrs. Biggs consulted Dr. Centrella. Id. Dr. Centrella concluded that a fasciotomy had not been performed by Dr. Strauss, that Mrs. Biggs was still suffering from heel spurs, and that she was also suffering from damage to her lateral plantar nerve. Id.
Mrs. Biggs filed a lawsuit against Dr. Strauss alleging medical malpractice. One of the questions raised on appeal in Strauss was whether Dr. Strauss’ negligence in failing to perform a fasciotomy was the cause of the continuation of the original pain in Mrs. Biggs right heel, until the fasciotomy was eventually performed by a different physician. Our opinion reflects that, at trial, Mrs. Biggs presented direct expert medical testimony that Dr. Strauss’ failure to perform a fasciotomy was negligence. Id. Mrs. Strauss also presented direct expert medical testimony, at trial, that once a fasciotomy was performed, by another physician, the original pebble-like pain in her heel was eliminated. Id.
Our opinion in Strauss did suggest that the jury could “infer” a correlation between Dr. Strauss’ negligence and the continuation of the painful symptoms in Mrs. Biggs’ right heel. Strauss v. Biggs, 525 A.2d at 997.17 However, the record reflects the “inference” was in reality a syllogism which was based upon the direct medical testimony of negligence, i.e., 1) Dr. Strauss was negligent in not performing a fasciotomy, 2) the pain in Mrs. Biggs’ heel was eliminated when the fasciotomy was performed by another physician, and 3) therefore, the negligence of Dr. Strauss, in *734not performing the fasciotomy, caused Mrs. Biggs’ pain to continue.
In Strauss, another question presented on appeal was whether Dr. Strauss’ negligence was the cause of the separate and independent new pain experienced by Mrs. Biggs. Strauss v. Biggs, 525 A.2d at 996. In her complaint, Mrs. Biggs alleged that her lateral plantar nerve was injured by Dr. Strauss. It was unnecessary for Mrs. Biggs to present expert medical testimony that Dr. Strauss was negligent in causing the injury to her lateral plantar nerve, because Dr. Strauss admitted that he was negligent in lacerating that nerve with a scalpel.
Our decision in Strauss concluded that Dr. Strauss’ admission that his negligence caused the injury to Mrs. Biggs’ lateral plantar nerve, and the other expert medical testimony presented, supported a finding by the jury that his negligence caused the new continuing pain which began when Mrs. Biggs first screamed. Id. at 998.18 Once again, the direct admission of medical negligence by Dr. Strauss provided the major premise for a second syllogism, i.e., 1) Dr. Strauss negligently lacerated Mrs. Biggs’ lateral plantar nerve, 2) Mrs. Biggs experienced pain at the nerve site immediately following the laceration, which continued until it was “alleviated” by corrective surgery, and 8) therefore, the negligent laceration by Dr. Strauss was the cause of the new pain.
In the Russells’ case, there was neither expert medical testimony nor an admission that anything Dr. Kanaga did was negligent. Nevertheless, Mrs. Russell argues that because she did not have a pain prior to the operative procedure performed by Dr. Kanaga and did have a pain after the procedure, negligence can be inferred from the pain, and once negligence is inferred, it is also possible to infer that negligence was the cause of the pain. Mrs. Russell’s argument is circuitous. Mrs. Russell’s argument fails as a permissible syllogism, in the absence of a major premise which is based upon an establishment of negligence, pursuant to the Delaware Medical Malpractice statute.
In Strauss, this Court recognized that the medical malpractice statute requires expert testimony concerning negligence (deviation from the standard of care) and causation. Id. at 997; 18 Del.C. § 6853. We then stated that “we find the expert medical testimony was sufficient to satisfy § 6853” as to all of the claims for medical malpractice presented by Mrs. Biggs. Strauss v. Biggs, 525 A.2d at 997. Thereafter, our opinion in Strauss held that, with respect to some of the malpractice claims which Mrs. Biggs presented, causation was subsumed within the direct medical expert testimony or admission concerning negligence.
Our decision in the Russells’ case is a reaffirmation of the principle that, as a matter of law, the Delaware Medical Malpractice statute requires direct expert medical testimony to support a jury’s finding of negligence and causation.19 18 Del. C. § 6853. Since the Russells failed to introduce direct expert medical testimony establishing negligence, a directed verdict should have been entered in favor of Dr. Kanaga. The motions for reargument and rehearing en banc are DENIED.

. We stated, in part:
With respect to causation, Dr. Centrella described the discomfort caused by a heel spur. The jury could readily infer that the failure to make a referral for proper treatment prolonged Mrs. Biggs' discomfort. Although direct testimony linking the alleged negligence to the prolonging of discomfort would have been helpful, under the circumstances of this case the expert testimony was sufficient to allow this claim to go to the jury.
Strauss v. Biggs, 525 A.2d at 997 (emphasis added). Later, in our opinion in Strauss, we concluded that "[t]he expert testimony suggested that the failure to perform [the fasciotomy] prolonged Mrs. Biggs’ discomfort." Id. at 997-98.

. In Strauss, we stated, in part:
While there was no expert testimony explicitly stating that the failure to inform Mrs. Biggs of the possibility of nerve injury delayed appropriate treatment and prolonged at least one of her symptoms, that fact could readily be inferred from the expert testimony which was before the jury. Strauss v. Biggs, 525 A.2d at 998 (emphasis added).

. Alternatively, a plaintiff can establish negligence by proving the applicability of an exception to the requirement for expert testimony, which is recognized in the statute.