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FRED J. MOEHLENBROCK, AS ADMINISTRATOR OF THE ESTATE OF ALBERT R. MOEHLENBROCK, DECEASED v. PARKE, DAVIS & COMPANY. JOHN B. ROSENWALD AND ANOTHER, APPELLANTS

Minnesota Supreme Court1920-02-06No. No. 21,593
145 Minn. 100

Summary

Holding. The court affirmed the judgment against the surgeons, finding that the surgeons' own testimony, combined with evidence of recognized warning signs and common knowledge of physical laws, provided sufficient evidence for a jury to conclude that the surgeons negligently persisted in administering ether despite clear danger signals.

A patient died following a tonsil removal surgery performed under ether anesthesia administered by two surgeons. The estate brought suit against both the surgeons and the manufacturer of the ether. On a prior appeal, the court had already upheld findings that the ether itself was defective and a proximate cause of death. The surgeons now appealed, contending there was no evidence of malpractice on their part. The surgeons' own testimony, however, established that they observed the patient developing a dangerous bluish discoloration (cyanosis) during the procedure—a recognized warning sign that ether administration should be stopped—yet they continued administering the anesthetic for approximately three-quarters of an hour. Additionally, the surgeons provided inadequate post-operative care when the patient's condition became critical.

The court held that a surgeon may be held liable for negligence when he persists in administering an anesthetic after clear warning signs that would prompt any reasonably prudent person to stop. Expert testimony is not always necessary to establish negligence in such cases; the jury may draw reasonable inferences from the surgeon's own statements and from common knowledge of physical facts and laws. The surgeons' testimony describing their observations of the patient's distress and dangerous symptoms provided sufficient evidence for a jury to find that reasonable care required them to discontinue the ether use.

Summary generated by law.co from the public-domain opinion. The opinion text itself is public domain.

Key issues

  • Whether a surgeon may be held liable for malpractice based on persistence in a dangerous medical procedure despite warning signs
  • Whether expert testimony is required to establish negligence in administering anesthesia
  • Whether post-operative care fell below the standard of reasonable care

Procedural posture

This is the second appeal in the case; the first appeal by the ether manufacturer was already decided, and this appeal was brought by the two surgeons challenging the verdict against them.

Authorities cited

No cited authorities resolved to law.co cases yet.

Opinion

majority opinion

Hallam, J.

Plaintiff’s intestate, a young man in good general health, submitted to an operation, under the influence of ether, for the removal of his tonsils» The ether was administered and-the operation performed by defendants Andrews and Rosenwald. The ether used was manufactured by defendant Parke, Davis & Company. Deceased never recovered from the administration of the ether, and died as á result of it in a few hours. Thatthere was fault somewhere was clear. Plaintiff charged the defendant surgeons with malpractice and defendant Parke, Davis & Company, with negligently putting on sale ether unfit for use. Plaintiff had a verdict against all defendants. A former appeal was. taken by defendant Parke, Davis & Company [141 Minn. 154, 169 N. W. 541], This court held that there was evidence to sustain a finding that the ether was unfit for use; that its use was dangerous to life; that defendant Parke, Davis & Company, was negligent in putting it on sale, and that its use was a proximate cause of decedent’s death-. This appeal was then taken by defendants Andrews and Rosenwald.

Appellants contend that there is no evidence to show malpractice. Respondent makes various contentions. These two appeal to us. It is contended that the doctors early discovered the pernicious effect of the ether, but negligently persisted in its use, and that they neglected to give the patient proper care after the operation. We think there is evidence to sustain both contentions.

As to the first proposition the appellants themselves gave this testimony :

Doctor Andrews said, during the operation: “The -patient came out rather quickly from the ether so I administered a little bit more, but I noticed that it was hard to fully relax the patient * * * he seemed ■ to resist every time the doctor tried to remove the tonsils, and I did not like to push the anaesthetic in this instance, because of what I had observed, that when I did push it a little the patient became blue or a little cyanotic you might say, and I would raise the mask until that condition would pass away, and then repeat the giving of the anaesthetic, so the doctor could go on with his work, but that is the way the patient acted during the whole time of the administration of the anaesthetic.”

Doctor Andrews further testified in substance that, if a patient is on the table, having ether administered, and develops a cyanotic condition and if that cyanotic condition proceeds and increases as the ether is being administered, it is dangerous to continue it. When that condition appears it is a signal of warning to a physician that, if the ether is persisted in, it is dangerous, and if persisted in too much it will cause the death of the patient.

Doctor Eosenwald said: “We had that difficulty during the operation * * * and I think the trouble was of such a nature that if the operation had not been partly completed and it had been a long operation I would not have finished it, I would have waited.” Question: “If it had been an operation that would have taken half or three-quarters of an hour, would you have tried to finish it?” Answer: “No sir.” Doctor Eosenwald further testified that the usual tonsil operation is a short operation — perhaps five or ten minutes. In this case there is evidence that the administration of ether extended over three-quarters of an hour.

The alleged want of care after the operation is in the fact that very soon after the operation, cyanosis appeared and the patient was in a very critical condition until about noon when he died, and that appellants neglected to give him the constant care which the critical nature of his case required.

The skill and diligence which the law requires of a physician or surgeon is such as is usually exercised by others of the same school. Getchell v. Hill, 21 Minn. 464; Martin v. Courtney, 75 Minn. 255, 77 N. W. 813. He is not necessarily liable for malpractice because of a bad result. He must often act promptly, upon his best judgment, and he is not liable for injuries arising, without negligence, from honest errors of judgment. Staloch v. Holm, 100 Minn. 276, 111 N. W. 264, 9 L.R.A. (N.S.) 712; McGray v. Cobb, 130 Minn. 434, 152 N. W. 262, 153 N. W. 736. But this is an exception to general rules of negligence and the exception is not absolute. Every act of his is in a sense an exercise of judgment and usually of honest judgment. Yet it may be negligent. He might be honest in his judgment that he could safely leave certain details to an assistant, and yet be liable for negligence in doing so. Walk er v. Holbrook, 130 Minn. 106, 153 N. W. 305. He is liable if his mistake of judgment is so gross as to constitute negligence. 5 Thompson, Neg. § 6719; West v. Martin, 31 Mo. 375, 80 Am. Dec. 107; Dubois v. Decker, 130 N. Y. 325, 29 N. E. 313, 14 L.R.A. 429, 27 Am. St. 529. He is bound to observe plain physical laws, or, as stated in Staloch v. Holm, 100 Minn. 276, 111 N. W. 264, 9 L.R.A. (N.S.) 712, he may be liable when his wrong concerns physical facts and is governed by ordinary principles of intelligence. If. a surgeon persists in the use of an anaesthetic after warning which would impel one of reasonable prudence to desist, he should be held to answer for the consequences.

Appellants insist that, since no expert witness testified that appellants did or omitted to do anything contrary to good surgery and practice, it was the duty of the court to direct a verdict in their favor. We do not concur in this contention. From the testimony of the defendant surgeons, and from common knowledge of physical facts and laws, the jury might infer that, if appellants had desisted from the use of the ether at the first sign of danger, decedent’s life might have been spared, and that reasonable prudence required them to do so.

It is only in cases where the evidence and the facts to be deduced therefrom, are undisputed, and the case concerns a matter of science or specialized art, or other matters of which a layman can have no knowledge, that the opinion of experts is conclusive. Moratsky v. Wirth, 74 Minn. 146, 76 N. W. 1032. This is not such a case.

For similar reasons the testimony of Doctor Condit exonerating appellants is not conclusive.

Other alleged errors do not seem to us serious.

It was not error to receive testimony of Doctor Liedloff as to the effect of the use of ether from the same container on the following day. This testimony tended to show the character of the ether.

The instructions of the- court to the jury do not contain any reversible error.

Order affirmed.