Bessie Gerhardt v. Fresno Medical Group

217 Cal. App. 2d 353, 31 Cal. Rptr. 633, 1963 Cal. App. LEXIS 1918
CourtCalifornia Court of Appeal
DecidedJune 19, 1963
DocketCiv. 159
StatusPublished
Cited by23 cases

This text of 217 Cal. App. 2d 353 (Bessie Gerhardt v. Fresno Medical Group) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bessie Gerhardt v. Fresno Medical Group, 217 Cal. App. 2d 353, 31 Cal. Rptr. 633, 1963 Cal. App. LEXIS 1918 (Cal. Ct. App. 1963).

Opinion

STONE, Acting P. J.

This is an appeal from a judgment entered pursuant to a jury verdict for defendants, in a malpractice action. Plaintiffs-appellants are husband and wife, their interests are identical insofar as this appeal is concerned, and for convenience Bessie Gerhardt, the patient, is hereinafter referred to as “plaintiff.” The thirteen defendants-respondents are doctors and members of the Fresno Medical Group, an unincorporated association.

A general check-up of plaintiff by defendant Tillotson revealed a cancerous cervix, and a hysterectomy was recommended. As early as 1944 plaintiff had been aware of a lymph node located in the posterior triangle of the right side of her neck. Although it had caused her no difficulty, it was recom *355 mended that at the time of the hysterectomy the node he removed to determine whether the cancer had spread into this area. In a Fresno hospital, defendant Tieehe performed the hysterectomy, assisted by defendant Tusehka. While plaintiff was still under the anesthetic, Dr. Tusehka, a general surgeon, unassisted removed the lymph node.

The hysterectomy was successful, and the lymph node was benign. However, while plaintiff was still hospitalized she had difficulty in moving her right arm and shoulder, and movement was accompanied by pain. The shoulder operation was performed December 5, 1960. On January 20, 1961, plaintiff was examined by defendants Tieehe and Tillotson, who diagnosed her difficulty as possible bursitis and referred her to defendant Reiner, an orthopedic surgeon. Dr. Reiner discovered that plaintiff had a paralyzed trapezius muscle, and concluded the cause was damage to the spinal accessory nerve which innervates the trapezius muscle. This nerve originates in the brain, courses down the spinal column, across the jugular vein, and then branches. We are concerned with the branch that leads to the trapezius muscle. In the area of the operation the nerve travels through fatty tissue beneath the lymph node.

Defendant Tusehka told plaintiff that he believed he had injured the spinal accessory nerve during surgery, and referred her to a neurosurgeon, Dr. Pace, who, though not a member of defendant Fresno Medical Group, handled eases for them ■within his special field. After an examination, Dr. Pace concluded that plaintiff’s condition was the result of an injury to the spinal accessory nerve. He recommended an exploratory operation to determine the nature and the extent of damage.

Plaintiff decided to have an examination by a doctor in no way connected with the Fresno Medical Group. She consulted a Dr. Washburn of San Francisco, who also recommended an exploratory operation.

Plaintiff elected to have Dr. Washburn perform the operation. He made an incision above the site of the prior operation and traced the nerve to the trapezius muscle. The following observations by Dr. Washburn are not disputed: The nerve was located in its normal position approximately 1% to 2 centimeters from the outside of the skin; it was lying below the scar tissue from the previous operation and was not involved in excessive scar tissue, that is, no scar tissue was *356 pinching the nerve and causing the malfunction; the nerve had not been severed; a section of the nerve had been crushed.

Defendant Tuschka testified that in his opinion the nerve had been crushed during the surgery which he performed, and that the crushing had been done by a hemostat, a clamping device, which he had used.

In describing the operation Dr. Tuschka testified that he made a 1% to 2-inch incision to expose the node, that he grasped it with tweezers, pulled it up, and dissected the node from the floor of the wound by use of a blunt dissecting instrument. The floor of the wound was not visible until the node was separated, whereupon the underlying mass of fatty tissue became visible. The doctor also testified that he knew the nerve was in the fatty tissue, but that he did not see it. He said that he was operating in a bloodless field, that his procedure was to cut, sponge the area, catch the bleeders with a hemostat and tie the bleeding vessel, then cut again, repeating the procedure. He testified, also, that during the operation the vessels themselves are frequently unseen, since they bleed from points within the tissue, and under such circumstances clamps are applied at the points of bleeding. He emphasized that blood vessels in fatty tissue don’t stick up in the open so they can be seen and clamped.

Although plaintiff appeals on the sole ground of insufficiency óf the evidence to support the verdict, the question has three facets. As delineated by defendants they are: One, is the doctrine of res ipsa loquitur applicable in the light of Siverson v. Weber, 57 Cal.2d 834 [22 Cal.Rptr. 337, 372 P.2d 97], which was decided subsequent to the trial of this action? Two, aside from the rule of Siverson, is the doctrine of res ipsa loquitur applicable ? Three, did defendants present evidence of a substantial nature to meet the inference of defendant Tuschka’s negligence raised by the doctrine of res ipsa loquitur?

One. Is the doctrine of res ipsa loquitur applicable under the rule of Siverson v. Weber, supra ? Defendants argue that the evidence proved only that the unfortunate result of the operation here suffered by plaintiff rarely occurs, and therefore the rule of Siverson precludes application of the res ipsa loquitur doctrine. It is true that in Siverson the Supreme Court said, at page 839, “To permit an inference of negligence under the doctrine of res ipsa loquitur solely because an uncommon complication develops would place too great a bur *357 den upon the medical profession and might result in an undesirable limitation on the use of operations or new procedures involving an inherent risk of injury even when due care is used.”

However, this conclusion must be construed in the light of the facts related in the opinion. The Supreme Court observed in Siverson that the medical witnesses agreed that the exact cause of a fistula’s appearing several days after a hysterectomy cannot ordinarily be ascertained, and that the cause of the particular fistula there involved could not be determined from the evidence. A number of possible causes were cited, but there was nothing to indicate that the fistula was caused by any of them, or a combination of them. As Chief Justice Gibson, speaking for the court, said in Davis v. Memorial Hospital, 58 Cal.2d 815 [26 Cal.Rptr. 633, 376 P.2d 561], at pages 817-818: “The ease of Siverson v. Weber, supra, 57 Cal.2d 834, 836-838, is readily distinguishable since it involved a medical matter of far greater complexity than an enema, namely, a hysterectomy, one of the inherent risks of which, according to all the expert testimony, was the occurrence of a fistula.”

In contrast to the Siverson

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Bluebook (online)
217 Cal. App. 2d 353, 31 Cal. Rptr. 633, 1963 Cal. App. LEXIS 1918, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bessie-gerhardt-v-fresno-medical-group-calctapp-1963.