Court Opinion

ID: 9773977
Source: CourtListenerOpinion
Date Created: 2023-08-29 18:05:27.599523+00
Date Added: 2024-06-11T07:32:00.178624
License: Public Domain

ON MOTION FOR REHEARING
SMITH, Justice
(dissenting).
I respectfully dissent. When the Court’s original opinion was written, I assumed that the facts set out in the opinion were controlling and were directly related to the issues involved. However, upon reading the motion for rehearing and upon a closer examination of the record, I find that I cannot agree with the result attained by the Court. This Court, in my opinion, has unwittingly permitted the petitioner the advantage of another trial because of its acceptance of petitioner’s inaccurate presentation of evidence elicited from expert witnesses based upon hypothetical questions which failed to properly embrace facts established or facts reasonably inferable from the evidence. I disagree with the petitioner’s contention that the respondent has overlooked settled principles of law such as the rule that a party in propounding hypothetical questions is entitled to a witness’ opinion upon any combination of facts inferable from the proof.
This record, in my opinion, is completely void of elements of proof which are essential to a recovery by the plaintiff. The defendant contends, and my examination of the record confirms, that there is no evidence that the defendant, at the time of performance of the operation of October 13, 1959, should have explored the L5 SI disc. Evidence of what is usually or customarily done is not expert evidence of what should have been done by the defendant prior to, during, and subsequent to the surgical operation on the plaintiff. The very evidence of what is usual and customary under the circumstances, such as *799confronted the defendant, implies that there are cases when it is proper not to conduct exploration at a different level. The Court after correctly announcing the rule that “[in] determining negligence in a case such as this, which concerns the highly specialized art of treating disease, the court and jury must be dependent on expert testi-timony,” promptly proceeded to ignore the rule in the above particular and in the following respects:
(1) There is no expert evidence that had the defendant explored the L5 SI disc during surgery at the L4 L5 level he would have discovered a disc requiring operative correction or removal. Not once did an expert witness testify that in his opinion a disc requiring surgical correction or removal existed at L5 SI when defendant performed surgery on October 13, 1959. Without expert evidence of that kind it is impossible to reasonably conclude that the failure of defendant to explore at L5 SI at that time caused any of the problems of which plaintiff complains. At best, the presurgical diagnoses were inconclusive. Defendant diagnosed “possible” lumbo sacral, disc and “possible” lumbo sacral instability. The diagnosis made by Dr. O’Bannon before surgery was of a suggestion of a rupture of the disc at L4 L5. Such evidence is a far cry from “expert evidence applied to the facts” that exploration of the L5 SI disc would have revealed it to be in such a condition as to require its removal on October 13, 1959.
(2) There is no expert evidence that, under the particular facts confronting the defendant, the L5 SI disc should have been surgically removed on October 13, 1959. Dr. Hawes testified that even if a pre-surgical diagonsis or rupture of the L5 SI disc is made, nevertheless, “it is not unusual to remove a ruptured disc at L4 and L5 prior to looking at the other area,” and went on to say that he could not give an opinion as to whether or not the doctor should have then looked at the other area unless he knew and took into consideration “the entity that was found at the time of surgery, the condition of the patient and other circumstances which have a great bearing.” The witness was never asked to take those factors into consideration and then give an opinion. Obviously, without evidence that the defendant should have explored the L5 SI area after finishing his work at L4 L5, there is no basis for a conclusion that he then should have performed surgery at L5 SI. I decline to agree to the Court’s holding that there is evidence that the defendant should have performed surgery to remove the L5 SI disc on October 13, 1959. The effect of the holding is to allow the jury to draw its own medical conclusions from the evidence, despite the fact that the only expert testimony is that no acceptable opinion can be expressed on the subject unless all of the circumstances of defendant’s surgery are known and taken into consideration, and even though no expert witness ever expressed an .opinion on the subject after taking the facts and circumstances of this particular case into consideration.
(3)There is no evidence that removal of or any kind of surgical procedure on the L5 SI disc on October 13, 1959, would have corrected or prevented the problems of which plaintiff complains. Without evidence of that kind there is no way that a jury could reasonably conclude that the failure of defendant to explore or perform surgery at L5 SI on October 13, 1959, in any way caused plaintiff’s complaints. True, there is evidence that nerve involvement at L5 SI could cause plaintiff’s symptoms. But the evidence shows that it is equally possible that nerve involvement which in this case was shown to exist at L4 L5 could likewise cause the same symptoms. Under the record in this case, there are any number of possibilities which would explain plaintiff’s symptoms. No one of them is shown by expert evidence to be a probability. Furthermore, even if it is assumed, arguendo that plaintiff’s complaints were caused by L5 SI involvement, standing alone, there is no expert evidence that removal of the L5 SI disc on October 13, 1959, would have corrected the situation. *800For all that appears from the record, the situation may well have been irreversible by October 13, 1959. In that case, failure of the defendant to remove the L5 SI disc at that time could not possibly be the cause of plaintiff’s complaints. Surely the Court does not intend to hold that there is evidence that it was not irreversible at that point in time. To so hold would be saying that expert evidence is not needed on that subject. Is it possible that the Court is holding that no evidence of any kind is needed?
There is no expert evidence that defendant, under the particular circumstances confronting him, should have taken further steps after October 13, 1959, and before June, 1960. There is some testimony in the abstract, and which was not given in answer to questions taking into consideration all of the relevant facts and circumstances confronting the defendant, that a doctor should have performed further evaluation with a myelogram and that “other care” should have been instituted and that “possible exploration” may have been in order. That testimony does not meet the test of “expert evidence applied to the facts” laid down by this Court; and, even if it did, it would be meaningless insofar as defendant’s conduct is concerned, because: (a) the undisputed evidence is that another myelo-gram would not have revealed any information not already known to defendant and which would be diagnostic of a rupture of the L5 SI disc, (b) defendant did take other steps, such as taking X-rays and sending plaintiff to other specialists, and there is no evidence of any “other care” not taken by the defendant which should have been taken, and (c) testimony that “possible exploration” may have been in order is hardly any evidence that a doctor, confronted with the particular facts and circumstances confronting defendant, should have in the exercise of care performed further surgery at the L5 SI level. The mere fact that the witnesses said that re-evaluation by myelo-gram was indicated itself establishes without dispute that a number of things would have to be taken into consideration and determined before deciding if further surgery should be performed; otherwise, why bother with a myelogram?
Assuming that further steps, such as myelogram and/or surgery should have been taken by the defendant after October 13, 1959, and before June, 1960, there is not the slightest expert evidence that any of the problems of which plaintiff complains probably would have been relieved or prevented by such further steps. As to the myelogram, the evidence affirmatively shows that a myelogram test would have revealed nothing new. As to further steps generally, including possible surgery at the L5 SI level, there is no evidence as to a point in time when such steps should have been taken, nor is there any evidence as to a point in time when such further steps could have been taken in such a manner as to prevent the problems of which plaintiff complains.
Furthermore, there is no evidence that the defendant’s failure to do something after October 13, 1959, caused the problems of which the plaintiff complains. As to this, I am afraid the Court’s opinion will allow a jury, without benefit of expert evidence, to arbitrarily select a time or date when the defendant should have taken further steps, and to further decide, without expert evidence, that proper action by the defendant at the arbitrarily selected time would have corrected or prevented plaintiff’s complaints.
The defendant’s motion for instructed verdict was properly granted by the trial court. The evidence only raises a surmise or suspicion of the existence of facts sufficient to support a finding of negligence and proximate cause. The plaintiff’s approach, approved by the Court, is contrary to the sound rule that:
“ * * * if an inference consistent with the existence of a fact in issue is but equally as valid as an inference of its nonexistence, then the jury may not determine the question. * * * There *801must be evidence to support the conclusion that the inference of the particular fact is the more reasonable.” Texas Pacific Fidelity & Surety Co. v. Hall, 101 S.W.2d 1050 (Tex.Civ.App.1937, err. dism.).
In Bowles v. Bourdon, 148 Tex. 1, 219 S.W.2d 779, 785, 13 A.L.R.2d 1, (1949), this Court said that it is not enough to show the injury, together with an expert opinion that an injury might have occurred from negligence and many other causes, because such evidence has no tendency to show that negligence did cause the injury. In Bowles, we went on to say that fact issues in a case such as this are raised only by proof of probability and not by proof of possibility. In so holding we quoted from an Iowa decision wherein it was said:
“Verdicts must rest upon reasonable certainty of proof. Where the proof discloses that a given result may have occurred by reason of more than one proximate cause, and the jury can do no more than guess or speculate as to which was, in fact, the efficient cause, the submission of such choice to the jury has been consistently condemned by this court and by other courts.”
Two or more evidentiary factors suggesting a possibility that a fact exists will not suffice. The statements of facts, consisting of 446 pages, reflects, at most, a possibility that the defendant was negligent, and that negligence of the defendant was a proximate cause of the plaintiff’s injuries and damages.
The trial court correctly granted the defendant’s motion for instructed verdict. I make this assertion without fear of successful contradiction. The plaintiff has so far prevailed because he has convinced the Court that there is expert evidence in this case, and that defendant’s argument is based upon inconsistencies in the testimony of some of the doctors rather than upon an absence of expert evidence. I interpret the defendant’s position to be that none of the evidence when reasonably interpreted in context justifies a conclusion that material fact issues exist. Again, I say that the plaintiff’s basic premise is unsound, and this basic premise has led the Court away from the essential factor necessary to convict the defendant of malpractice. The plaintiff’s so-called expert witnesses have based their testimony on the • premise of what is usually and customarily done, and not upon the facts of this particular case. The entire testimony of each witness must be considered and, if when all of it is taken into consideration, it is apparent that the witness is not saying that under the particular facts of the case, the operating doctor should have done certain things, the testimony of that witness is not expert evidence (applied to the facts) that he should have done those things. Therefore, the testimony of Drs. Hawes and Rehfeldt that exploration customarily or usually is conducted at L5 SI following surgery at L4 L5, cannot possibly have any probative force where the expert evidence must be applied to the facts. This is especially true when such testimony is considered in the light of the doctors’ further testimony that no intelligent opinion can be formulated as to what should have been done in any particular case unless a number of things are taken into consideration. These things were not taken into consideration by the doctors. There appears in this case nothing more than isolated questions and answers completely out of context. This record affords no basis or sound reason for invoking the well recognized rule that in deciding whether a directed verdict is proper, which is, the Court must accept the evidence most favorable to the plaintiff as true. The doctors’ evidence relied upon by the plaintiff, clearly shows that they could formulate and state an intelligent opinion, because they were not requested to take into consideration the factors said by them to be essential to a meaningful answer so far as the issue involved was concerned.
The testimony upon which the plaintiff relies is not in answer to proper hypothetical questions relating to any significant *802combination of facts. The attempt to convict the defendant of malpractice in performing surgery upon the plaintiff is based entirely upon testimony of a general and abstract nature. The following testimony is typical of the evidence relied upon by the plaintiff as evidence that the defendant should have explored the LS SI level following his surgery at L4 LS. It should be readily seen that such testimony does not meet the test. None of the controlling facts of the defendant’s surgery are embraced within the questions, and, of course, such facts are not embraced in the answers. This is true in regard to all attempts by the plaintiff to establish negligence on the part of the defendant.
Dr. Hawes testified:
“Q. Doctor, do you have an opinion as to whether or not the doctor would be exercising the ordinary skill and care employed by others of the medical profession in the Dallas-Fort Worth area by scheduling a man for surgery at the L5-S1 level and then performing an operation on the L4-L5 level, without exploration of the L5-S1 level ?
“A. I can only say this would depend on the entity that was found at the time of surgery, the condition of the patient and other circumstances which have a great bearing. I couldn’t say absolutely.
“Q. I wasn’t asking you to assume any other facts, Doctor. I want you to please assume the facts that you have been given, [which include none of the facts said by the doctor to be essential for him to form an intelligent opinion]. State whether or not you have an opinion as to whether or not a doctor, under these facts, would be exercising the ordinary care and skill employed by others of the medical profession in the Dallas-Fort Worth area by scheduling surgery at L5-S1, and then performing surgery at L4-L5, without any inspection or visualization of the LS-S1 disc?
“A. Yes, I have an opinion..
“Q. What is your opinion?
“A. It’s customary to explore both L4-L5 and L5-S1.”
Dr. Hawes made it clear that unless he took the facts of the defendant’s surgery into consideration he could not arrive at and state an intelligent opinion. Dr. Hawes repeatedly made it clear that he was unable to formulate an intelligent opinion as to what should have been done by the defendant without knowing and taking into consideration the facts of the defendant’s surgery.1 Dr. Hawes could not formulate an intelligent opinion simply because he said that he had not been furnished with enough facts. The hypothetical questions propounded to him did not include facts relevant to the formation of an opinion.
*803In Shuffield v. Taylor, 125 Tex. 601, 83 S.W.2d 955 (1935), this Court announced the rule in regard to the use of hypothetical questions;
“A hypothetical question should be so framed as to recite all the facts in evidence relevant to the formation of an opinion, and then, assuming the facts to be true, the witness should be asked, if able to form an opinion therefrom, to state such opinion.
“A question is not necessarily improper because it includes only a part of the facts in evidence, provided it embraces enough of them to enable the witness to formulate an intelligent opinion.” See Topletz v. Thompson, 342 S.W.2d 151, (Tex.Civ.App.1960, no wr. hist.).
What I have said in regard to the testimony of Dr. Hawes is equally true of the testimony of Dr. Rehfeldt.2
Dr. Rehfeldt, it is seen, testified that his practice is to explore L5 SI after performing surgery at L4 L5, but he also testified that “if we find a very good lesion at 4 and 5, we sometimes will not look at 5 and 1.” Dr. Rehfeldt was never asked to take into consideration the type of lesion found by the defendant at L4 L5 and then state what, in his opinion the defendant should have done. Remember, this burden was upon the plaintiff. In fact the two doctors were never asked to take into consideration any of the other facts of the defendant’s surgery. The doctors were never asked a question which embraced enough facts to enable them to formulate and state an intelligent opinion.
The plaintiff attempts to bolster his case by a comparatively lengthy argument that a jury would be entitled to disregard the testimony of the defendant that he found 90 per cent of the disc material extruded at L4 L5, as good lesion, because Dr. Van Zandt was a party defendant to the suit and an interested party. This is just some more of the mist created to help strengthen the untenable position of the plaintiff. I doubt that a jury would have been warranted in disregarding the defendant’s clear and un-impeached testimony. Nor do I believe a jury would be properly performing its duty by disregarding the defendant’s post, operation report of October 13, 1959, that in making the operation at L4 L5, he found and removed “a large extruded disc * * * under the L-4 — 5 nerve root.”
However, be that as it may, even if the statement were of a kind which could be disregarded by the trier of the facts, the plaintiff is right where he started, because once disregarded there is still no evidence of a vital factor which had to be taken into consideration by Doctors Hawes and Reh-feldt in arriving at an intelligent opinion as to whether or not the defendant should have explored L5 SI after performing surgery at L4 L5. Do not forget that both Hawes and Rehfeldt testified that “it would depend on the entity that was found at the time of surgery.” Surely, the jury would not be entitled to reject the testimony given by the defendant as to the type of entity found and *804then substitute, without any support in the evidence, its own judgment as to the type of lesion which might have been found. Surely, a jury should not be allowed to compound the error by assuming that had the witness taken into consideration whatever type of entity the jury arbitrarily might have found, the witness then would have said that the defendant should have explored LS S1. In Texas & P. Ry. Co. v. Brown, 142 Tex. 385, 181 S.W.2d 68 (1944), this Court said:
“We recognize the rule that a jury may accept or reject portions of the testimony of a witness, Austin Fire Ins. Co. v. Adams-Childers Co., Tex.Com.App., 246 S.W. 365; still, there must be other facts and circumstances, or the testimony of other witnesses in evidence, to supply that which has been rejected * * * **
Thus far my attention has been primarily directed to the question of whether the hypothetical testimony of plaintiffs witnesses constitutes evidence of negligence. I think that clearly it does not; but, assuming that such evidence does establish the fact that the defendant should have explored further, there is still no evidence, beyond a mere possibility, that had the defendant explored L5 SI he would have found anything. Assuming one step further, that he did find a disc requiring surgical removal, there is no evidence that such removal would have prevented plaintiff’s post-operative complaints. It is just as possible that the sacral nerves were injured in a number of ways: by involvement in the extension at L4 L5, or at L5 S1; by traumatic injury of some kind during the myelo-gram procedure; by surgical bruising; by scar tissue; or by a combination of such factors. There is no evidence, expert or otherwise, which shows a probability that the defendant’s failure to explore L5 SI or to remove a hypothetical injured disc at that level resulted in plaintiff’s disabilities. I must conclude, from my examination of the record, that there is no evidence that defendant was negligent in his operative technique or procedure and there is no evidence that assuming negligence, it proximately caused plaintiff’s complaints.
I would affirm the judgments of the Court of Civil Appeals and the trial court.

. At another point Dr. Hawes again made it clear that he was unable to formulate an intelligent opinion as to what should have been done by Dr. Van Zandt without knowing and taking into consideration the facts of Dr. Van Zandt’s surgery, saying:
“Q. You mentioned that it is considered proper in your profession to look at the L4-L5 level and at the L5-S1. Assuming that you found a rather severely ruptured disc in the L4 and L5, and removed that disc to the best of your ability, then you deemed it to the patient’s disadvantage to attempt further exploration in that operation, would you cease your work at the L4-L5 level?
“A. Yes.”
and again:
“Q. Do you regard it in your practice that many times you are called upon with a judgment decision after you have started an operative procedure?
“A. Many times.
“Q. That’s usual in most operations, is it not, Doctor?
“A. Yes.
“Q. Regardless of how clearly you outline your course of procedure prior to the operation, there are many times that you have to change that course of procedure during the actual operation, is there not?
“A. That is correct.”

. Further confirming that Dr. Kehfeldt was of the same mind as Dr. Hawes that the facts of each case must be considered before an intelligent opinion can be formed as to what should have been done is his further testimony, as S.F. 190:
“Q. Yes, sir. Now you testified that it was good practice, when exploring at the L4 and L5, to, also, explore the L5-S1?
“A. Yes.
“Q. Would that depend on the patient, the doctor’s judgment and the length and duration of the operation, as to how far you would go in an operation?
“A. Yes, sir, depending upon what the surgeon’s objective was.
“Q. If the surgeon felt in his mind that he had found the root of the trouble he was looking for, would he necessarily go further or would he stop when he thought he had covered the point that he was searching for?
“A. Usually a surgeon has an objective when he makes a procedure and when he feels he’s reached that objective, he has reason to stop.”