Court Opinion

ID: 9722497
Source: CourtListenerOpinion
Date Created: 2023-08-26 09:36:54.757348+00
Date Added: 2024-06-11T18:24:36.353402
License: Public Domain

Spiegel, J.
(with whom 'Spalding, J., and Whittemore, J., concur) dissenting. The reasoning upon which the opinion appears to be based is that “without expert testimony laymen, including the jury, the trial judge, and ourselves, could *143not be, and are not, in a position to determine what the risk and the requirements of professional conduct in the circumstances were in the neighborhood of Boston in 1949.”
The court then rules that as a prerequisite to recovery the plaintiff must prove, by expert medical testimony, a “definable risk” regarded as “sufficiently substantial by practitioners in the locality so that good practice called for discussion of the uncertainty with the patient.”
The plaintiff’s ailment was diagnosed as acute appendicitis. He entered the hospital and was operated on for the removal of his appendix. The defendant, in his own handwritten description and over his signature wrote “ [a]ppen-dix removed to what appeared to be the base, but there were such dense adhesions that it was impossible to be certain.”
After the operation the plaintiff inquired of the defendant why it had taken so long to complete the operation and the defendant in reply stated that it had taken a long time to find the appendix.
That medical science has made extraordinary advances in recent years is common knowledge. It is equally true that the public is far better educated and far better informed about medicine and surgery than ever before. We are not living in the nineteenth century. An operation for the removal of an appendix is quite common and I doubt that it arouses any great apprehension in the mind of the patient. The plaintiff having undergone the operation had every right to believe that his entire appendix had been removed.
As to the extent of the risk it should be borne in mind that it is the patient who is taking the risk, not the surgeon, nor a group of surgeons in the particular locality where the operation takes place. If an appendix requires removal it would seem to be a corollary that the failure to remove the complete organ might result in subsequent difficulties.
This is not a case of a dread illness. There is not the slightest suggestion that the psychological condition of the patient was such that the surgeon was justified in with*144holding the fact that he was uncertain as to whether he had removed the complete appendix. The failure to disclose this fact was not in the interest of the plaintiff. As to information revealed in diagnosis it has been said that “no medical privilege should be recognized to withhold the diagnosis in ordinary cases where the usual patient would feel entitled to have the information as a basis for charting his course and there being no apparent grounds for supposing that a disclosure of the truth would engender in the patient reactions dangerous to his health or life.” Smith, Therapeutic Privilege to Withhold Specific Diagnosis from Patient Sick with Serious or Fatal Illness, 19 Tenn. L. Bev. 349, 350-351. It is readily understandable why a surgeon may withhold information from a patient afflicted with cancer. However, we are not confronted with that type of situation in an operation for the removal of an appendix. Even if the possibility of the need for further medical treatment is quite remote, I can think of no sound reason for not disclosing the information to the patient. This court has held that for an insured to misrepresent the existence of cancer increases the risk of loss as a matter of law. See Lennon v. John Hancock Mut. Life Ins. Co. 339 Mass. 37, 39. Expert medical testimony was not required for the court to reach that conclusion. It should not then, as a matter of logic, require expert medical testimony in order for a jury to decide whether the surgeon should have informed the plaintiff that his appendix might not have been removed.
I am unable to determine from the opinion whether there is imposed upon the plaintiff the additional burden of proving that “the requirements of professional conduct in the circumstances . . . in the neighborhood of Boston in 1949” required the defendant to make a disclosure to his patient.
Under the circumstances of this case, I do not believe that evidence of the prevailing medical practice in the neighborhood was necessary to show that the defendant had a duty to disclose to the plaintiff his doubts as to the complete removal of the appendix. Even if there had been evidence that the practice was to maintain silence under these circumstances, this court should not be foreclosed from impos*145ing a duty to disclose. “Courts must in the end say what is required; there are precautions so imperative that even their universal disregard will not excuse their omission.” L. Hand, J., in The T. J. Hooper, 60 F. 2d 737, 740.
In my opinion the case at bar is among the class of exceptional cases where a breach of the duty owed by the physician to his patient may be ascertained without the assistance of expert medical testimony. See Malone v. Bianchi, 318 Mass. 179, 182, and cases cited.
The remaining question, which the majority opinion did not reach, is whether the plaintiff’s cause of action is barred by the applicable statute of limitations. G. L. c. 260, § 4. The defendant contends that since the operation was performed in May, 1949, and the writ was dated December 9, 1958, the two year statute of limitations is a bar to recovery.
That statute provides that the period within which an action must commence begins when “the cause of action accrues.”
This is not a case where a foreign body had negligently been left in the person of the plaintiff during the course of an operation. In such cases it has been held that a cause of action arises at the time of the operation despite the fact that substantial damage may not occur until after the statutory period has run. See Capucci v. Barone, 266 Mass. 578, 581. It should be noted that, in most cases of that nature, the plaintiff would in all likelihood know of his injury before his remedy is barred by the statute of limitations.
In the case we are here considering, the first intimation that the plaintiff could have had regarding the failure to remove the complete appendix was when he first experienced abdominal pain on or about January 14,1957.
To hold that the statute of limitations begins to run prior to that date is to charge the plaintiff with knowledge of facts well nigh impossible for him to discover until he began to feel pain in the region of the abdomen. The “inherently unknowable” should not bar the plaintiff of his right to compensation. See United States v. Reid, 251 F. 2d 691, 695 (5th Cir.); Urie v. Thompson, 337 U. S. 163,169.
I would sustain the plaintiff’s exceptions.