Court Opinion

ID: 9629493
Source: CourtListenerOpinion
Date Created: 2023-08-22 09:43:38.835387+00
Date Added: 2024-06-11T18:07:20.172046
License: Public Domain

Andersen, J.
(dissenting) — As one court has expressed it, " [t]he hardship of the particular case is no reason for melting down the law." Southern Star Lightning Rod Co. v. Duvall, 64 Ga. 262, 268 (1879).
I dissent from the majority opinion on three grounds:
1. The facts upon which that opinion is based are not necessarily the facts of this case at all.
2. The plaintiff patient did not establish, as he is required by statute to do, that the defendant dentist failed to exercise the standard of care required of members of the dental profession.
3. Where the patient had assured the dentist that he was in good health, and where neither the patient nor the dentist was aware that the patient had high blood pressure (as *892it was later theorized that he had), the dentist did not violate the informed consent doctrine by failing to inform the patient that there was an element of risk in administering the local anesthetic to persons with high blood pressure.
Ground 1
Since this is a review of a summary judgment in the dentist's favor in the trial court, the following rule enunciated by the State Supreme Court is applicable:
In an appellate review of a summary judgment entered pursuant to Rule of Pleading, Practice and Procedure 56, RCW Vol. 0, this court can review only those matters that have been presented to the trial court for its consideration before entry of the summary judgment. The matters considered may be certified to this court by either of two methods, or a combination of them. First, they may be incorporated in a statement of facts certified by the trial court; second, they may be identified with particularity in the summary judgment signed by the trial court and then furnished to this court by transcript certified by the clerk of court. The reason is obvious: it would be unfair to consider, on appellate review, matters not presented to the trial court for its consideration. We must have before us the precise record — no more and no less— considered by the trial court. The court may consider, of course, those matters which it may notice judicially.
American Universal Ins. Co. v. Ranson, 59 Wn.2d 811, 815-16, 370 P.2d 867 (1962). Both this court and the State Supreme Court have followed that rule and have dismissed cases wfyere, as here, the party seeking to reverse the trial court's decision by appeal has failed to provide the appellate court with the precise record considered by the trial court.1
Nothing in the record before us informs us what matters the trial court considered in granting the summary judgment. The "facts" on which the majority bases its decision, other than the affidavits it quotes, consist of statements in *893the briefs of counsel. The numerous depositions of the parties and witnesses are not a part of the record before us. Missing, too, are the exhibits, such as the dentist's records, the patient's hospital records and even the critically important medical questionnaire completed by the patient just prior to the events here in question. For this reason, the appeal should be dismissed or, at the very least, the case should be remanded to the trial court with directions to certify the entire record which was presented to the trial court to this court for review.2
Ground 2
Going past that procedural ground to the merits, however, as the majority has done, based on what facts can be ascertained from such record as we do have before us, I would still reach the same end result and would affirm the trial court's dismissal of the case.
Here we' have a situation where, prior to pulling a tooth, the dentist gave his patient a standard injection of a common local anesthetic for the purpose of deadening the nerve in the tooth. The local anesthetic used was xylocaine with epinephrine, a drug with a low incidence of side effects. The dentist did this only after the patient had filled out a medical questionnaire indicating that he was in good health and after the patient had also personally told him that he was in good health. Neither the patient nor his regular family physician knew that the patient had high blood pressure and there was no previous history of high blood pressure.3 *894As the patient admitted in response to written interrogatories, he had previously had local anesthesia of one kind or another for dental work and suffered no ill effects from it.
In the briefs and argument before this court, the patient's counsel relied heavily on the 1974 decision of the State Supreme Court in Helling v. Carey, 83 Wn.2d 514, 519 P.2d 981, 67 A.L.R.3d 175 (1974). As the patient notes in his brief, the. issue in Helling "was identical in form to the issue here, ..." Brief of appellant at 18. It is true that in that case the court disregarded testimony of the parties' medical experts that medical standards did not require routine eye pressure tests for glaucoma upon patients under 40 years of age. The court in that case then went on to hold that as a matter of law a doctor's failure to administer an eye pressure test to patients under 40 years of age constituted negligence. As I read the majority opinion in the present case, it comes very close to holding that a dentist's failure to give a blood pressure test to a patient before administering a local anesthetic constitutes negligence, as was the Helling approach. The reason we cannot so hold here, of course, is that after the 1974 Helling decision, the state legislature in 1975 promptly enacted a statute abolishing the Helling rule and requiring that a departure from the standard of a profession must be shown in order to sustain recovery for malpractice.4
At the present time, by statute, in a malpractice case,
the plaintiff in order to prevail shall be required to prove by a preponderance of the evidence that the defendant or defendants failed to exercise that degree of skill, care and learning possessed by other persons in the same profession and that as a proximate result of such failure the plaintiff suffered damages, but in no event shall the provisions of this section apply to an action based on the failure to obtain the informed consent of a patient.
*895RCW 4.24.290 (part). It was thus the plaintiff patient's obligation to establish the standard of professional practice at the time of the injury and a violation of that standard through the testimony of professional equals of the defendant dentist.5 According to the briefs in this case, several dentists testified by deposition that at the time of the tooth extraction in question, it was not customary for oral surgeons to take a patient's blood pressure before injecting xylocaine with epinephrine. Therefore, for a dentist to not take a patient's blood pressure in that situation breached no standard of care of the dental profession. I find no contrary professional testimony in the record we have.
The majority, however, reads one of the affidavits before us (that of Dr. Moline) as stating that the defendant dentist "had a definitive duty to determine whether the patient had hypertension or high blood pressure and his failure to do this was not consistent with the accepted standard of care among the dental profession in western Washington in 1972." The majority opinion bases that determination on the portion of that affidavit which reads as follows:
That, he has reviewed Dr. Atkins's record of the procedure and the questionnaire Mr. LeBeuf was asked to fill out.
That, it is his opinion that the pre-anesthetic history obtained by Dr. Atkins was not adequate in that he omitted to determine whether the patient had hypertension or high blood pressure and the failure to do this was not consistent with the accepted standard of care among the dental profession in western Washington in 1972.
(Italics mine.) I do not read that affidavit as saying what the majority holds that it says. As explained in Frace v. Long Beach City High School Dist., 58 Cal. App. 2d 566, 137 P.2d 60, 62 (1943), the phrase "in that" (which I have italicized in the above quotation) means "because, for the *896reason that. . ."6 So read, what the dentist's affidavit says is that the history was inadequate, and the further explanation following the term "in that" gives the reason why. the history was in his opinion inadequate. In dismissing this lawsuit against the dentist, the trial court in its oral decision said:
what we end up with here, after some delays to give the plaintiff further opportunity, is a conclusion by a doctor that the history wasn't adequate but a record which shows that had an adequate history been taken it wouldn't have changed the picture, the history would have been that he had no high blood pressure.
I agree. The causal connection between the dentist's claimed negligence and the patient's present physical problems, required by statute to be shown, was not shown; therefore, the patient's malpractice claim was properly dismissed.7
What the majority appears to me to be holding here is that a dentist has an affirmative duty to diagnose high blood pressure in a patient, which condition is unknown to the patient, before deadening the nerve in a patient's tooth. No judicial decision has ever held that and I would not do so. Furthermore, hypertension or high blood pressure is a medical condition and dentists are not physicians.
As to the patient's claim of negligent post-surgical care, the testimony noted in the briefs is also in conflict. What is determinative to my view, however, is that again there is no expert testimony of any kind that the dentist's conduct in this regard breached any standard of care of the dental profession. That is not something which can be inferred from lay testimony on the subject, as the majority opinion *897seems to do.8 In my opinion that claim, too, was properly dismissed by the trial court.9
Ground 3
Neither did the patient make out a case under the informed consent (or uninformed consent) doctrine.
A dentist's duty to advise his or her patient concerning perils of treatment and alternative treatments available presupposes that the dentist knew or should have known about the patient's physical infirmity which makes the treatment perilous.10 If the rule is to be otherwise then a dentist or doctor will have to give every patient a virtually unlimited number of "ifs" before ever administering to the patient. Here the patient assured the dentist that he was in good health and neither the patient nor the dentist was aware that the patient had high blood pressure, as is now theorized by one doctor. The dentist was thus unaware of any material risk to the patient by administering the local anesthetic; therefore, the dentist did not have any duty to inform.11
It is a universal principle of law that in any case involving a claim of professional malpractice, an unfortunate result is not in and of itself evidence of negligence.12 That is as true in this case as in any other.
*898To then put this case into perspective as I see it. The law applicable to this case is no different than the law applicable to any other malpractice case. If a dentist had testified that under the circumstances presented, the failure of the dentist to take the patient's blood pressure violated the standards of dental practice then existent, then the patient would have made out a malpractice case requiring jury determination. The same would also be true if there was such testimony that the post-surgical standard of dental practice was violated by the dentist. Similarly, if the dentist had presented any testimony or other evidence that the dentist failed to advise of any material risk to the patient that was known, then a legally submissible cause under the informed consent doctrine would exist. None of these was present in this case. Nor was any evidence presented to make out a case under any of the numerous other legal theories mentioned, but not argued on this appeal and therefore not before us.13
In my view, when the trial court dismissed the case against the dentist, it acted properly and in accordance with the established law of this state. I therefore dissent from the majority opinion.
Reconsideration denied June 26, 1979.
Appealed to Supreme Court July 31, 1979.

Harris v. Kuhn, 80 Wn.2d 630, 631, 497 P.2d 164 (1972); Clark v. Tacoma Housing Authority, 11 Wn. App. 518, 519, 523 P.2d 1200 (1974).

RAP 9.10. Cf. Heilman v. Wentworth, 18 Wn. App. 751, 754, 571 P.2d 963 (1977).

Plaintiffs attending physician, Robert P. Crabill, M.D., is quoted in one of the briefs filed in the trial court as having been asked and answered at his deposition as follows:
Q You stated that you had not determined what caused the stroke, you said it may have been hypertension, you also said that you have had patients who have had [a] stroke without any hypertension at all. At this point, would you be speculating as to what caused the stroke?
A I would. I don't know what caused it.

RCW 4.24.290, Laws of 1975, 1st Ex. Sess., ch. 35, § 1, p. 252; Meeks v. Marx, 15 Wn. App. 571, 577, 550 P.2d 1158 (1976); Gates v. Jensen, 20 Wn. App. 81, 84-85, 579 P.2d 374 (1978).

Shoberg v. Kelly, 1 Wn. App. 673, 677, 463 P.2d 280 (1969); Swanson v. Brigham, 18 Wn. App. 647, 651, 571 P.2d 217 (1977).

See also Local 204, Textile Workers v. Richardson, 245 Ala. 37, 15 So. 2d 578, 580 (1943).

RCW 4.24.290; Versteeg v. Mowery, 72 Wn.2d 754, 755, 435 P.2d 540 (1967).

Shoberg v. Kelly, 1 Wn. App. 673, 677, 463 P.2d 280 (1969); Swanson v. Brigham, 18 Wn. App. 647, 651, 571 P.2d 217 (1977).

RCW 4.24.290.

Miller v. Kennedy, 11 Wn. App. 272, 282, 522 P.2d 852 (1974), affd, 85 Wn.2d 151, 530 P.2d 334 (1975); Archer v. Galbraith, 18 Wn. App. 369, 377, 567 P.2d 1155 (1977).

See Miller v. Kennedy, 11 Wn. App. 272, 289, 522 P.2d 852 (1974), aff'd, 85 Wn.2d 151, 530 P.2d 334 (1975); Holt v. Nelson, 11 Wn. App. 230, 235, 523 P.2d 211, 69 A.L.R.3d 1235 (1974).

Teig v. St. John's Hosp., 63 Wn.2d 369, 375, 387 P.2d 527 (1963); Miller v. Kennedy, 11 Wn. App. 272, 279, 522 P.2d 852 (1974), aff'd, 85 Wn.2d 151, 530 P.2d 334 (1975).

DeHeer v. Seattle Post-Intelligencer, 60 Wn.2d 122, 126, 372 P.2d 193 (1962); Krause v. McIntosh, 17 Wn. App. 297, 304, 562 P.2d 662 (1977).