Bourgeois v. Ochsner Foundation Hospital & Clinic

550 So. 2d 1229, 1989 La. App. LEXIS 1602, 1989 WL 108231
CourtLouisiana Court of Appeal
DecidedSeptember 14, 1989
DocketNo. 89-CA-164
StatusPublished
Cited by3 cases

This text of 550 So. 2d 1229 (Bourgeois v. Ochsner Foundation Hospital & Clinic) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bourgeois v. Ochsner Foundation Hospital & Clinic, 550 So. 2d 1229, 1989 La. App. LEXIS 1602, 1989 WL 108231 (La. Ct. App. 1989).

Opinion

GOTHARD, Judge.

This appeal is from a judgment in favor of the defendant physician in a medical malpractice suit.

Robert A. Bourgeois received a bone graft to his left wrist in surgery performed at Ochsner Foundation Hospital by Dr. Gordon McFarland, an orthopedist specializing in hand surgery, on May 17, 1983. The graft required harvesting bone from the iliac crest of the left hip, in the course of which the lateral femoral cutaneous nerve was injured, causing pain and numbness in Bourgeois’ left lateral thigh. A second surgery was performed on January 11, 1984 by Dr. David Kline, a neurosurgeon, to relieve the pain by severing the previously injured nerve. The numbness is apparently permanent.

While under Dr. Kline’s care Bourgeois began to complain of low back pain. As the back pain continued and limited motion and discomfort in the left wrist had not disappeared, in October, 1984 Bourgeois consulted a new orthopedic surgeon, Dr. Robert Fleming. Dr. Fleming determined that the bone graft had not taken and performed a second graft successfully at West Jefferson Hospital on October 25, 1984.1 Dr. Fleming used conservative treatment on the back until it was apparent that surgery was needed and then, on June 9, 1988, performed a lumbar fusion. Bourgeois had held a responsible job as captain of a crane vessel at Avondale. He returned to work briefly in 1984 after the second surgery but was unable to perform the physical activity the position entailed, and has not been employed since that time.

Bourgeois submitted a claim under the Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq., alleging negligence of Dr. McFarland in allowing a gouge to slip into the soft tissue surrounding the hip, injuring the lateral femoral cutaneous nerve, and negligence in treating him after the surgery. After a medical review panel decided adversely to Bourgeois, on November 27, 1985, he filed suit against McFarland and Ochsner.2 A jury trial was held September 12 through 15, 1988. The court dismissed Ochsner Clinic and Hospital from the suit on a directed verdict at the close of the plaintiff’s case. The jury found in favor of Dr. McFarland and this appeal followed.

The plaintiff raises the following issues: 1) whether Dr. McFarland was negligent, amounting to malpractice, in letting the gouge slip into the soft tissue; and 2) whether the surgeon was negligent in his treatment following the operation.

Bourgeois also assigned seven errors, five of which relate to the conduct of the trial: that the trial court was in error 1) in excluding the entire deposition of Dr. McFarland taken on June 19, 1985; 2) in permitting defendants’ counsel to edit out portions of Dr. J. Ollie Edmunds’ deposition; 3) in permitting the questioning of each member of the Medical Review Panel concerning the panel’s finding, his oath and other matters relating to the medical review; 4) in permitting the introduction of the video deposition of Dr. Frank 0. Petko-vich; and 5) in its charge to the jury. Assignment of error (6) was the judge’s sustaining Ochsner Foundation Hospital and Clinic’s motion for a directed verdict. The seventh is the jury’s returning a verdict in favor of the defendant.

The law regarding medical malpractice claims against a specialist is summarized in Douzart v. Jones, 528 So.2d 602, 603 (La.App. 2nd Cir.1988), as follows:

In a medical malpractice action against a physician-specialist, the plaintiff has the burden of proving the degree of care ordinarily practiced by physicians within the involved medical specialty and is not restricted to proof of the standards of care and skill within the defendant’s com[1231]*1231munity or locality. LRS 9:2794A(1); Ardoin v. Hartford Acc. & Indem. Co., 360 So. 2d 1331 (La.1978).
The plaintiff must also prove that the defendant either lacked the expected degree of knowledge and skill or failed to use reasonable care and diligence and his or her best professional judgment, in the particular application of that skill in the undertaking. Plaintiff must prove, as well, that the injury complained of was the proximate result of the defendant’s breach of the professional duty. LRS 9:2794A(2), (3).
The doctor’s conduct is evaluated in terms of reasonableness under the circumstances existing when the professional judgment is exercised. Neither a general practitioner nor a specialist is held to a standard of perfection or evaluated with the benefit of hindsight. See and compare Matthews v. La. State Univ. Medical Center, 467 So.2d 1238 (La.App. 2d Cir.1985).

See also the Supreme Court’s extensive consideration of the physician’s duty of care in Pitre v. Opelousas General Hosp., 530 So.2d 1151 (La.1988).

NEGLIGENCE IN SURGERY

The harvesting procedure, in brief, entails finding the iliac crest or top of the pelvic bone, then making an incision into the skin and underlying tissue to expose the bone. The muscles and tendons are then peeled away from the iliac crest and held by self-retaining or assistant-held re-tractors. The surgeon then extracts the needed bony material with a gouge, which is a type of bone knife similar to a carpenter’s chisel, which he taps with a mallet.

The plaintiff alleges that Dr. McFarland caused damage to his femoral cutaneous nerve by letting an instrument slip into the soft tissue, partially severing the nerve. Dr. McFarland admitted that the gouge slipped when he was preparing to extract some bone for a plug to be inserted in the wrist. He testified he had made a two-inch incision at the iliac crest. The patient was overweight, and the hole was about two inches deep. Dr. McFarland continued to describe the surgery as follows:

[Y]ou have belly muscles called inferi- or oblique, that generally roll over. Except in very thin people, that has to be pulled out of the way, not necessarily cut out of.the way.
Then you make an incision on the bone, on the surface of the bone, right down on it, and start peeling off the tendons and muscles until you retract it from the side; and you pack it away and put re-tractors in to hold it, stretched out of the way so that it doesn’t keep draping back over the surface you are operating on.

He continued, demonstrating with instruments on a skeleton:

... [W]e had a relatively short incision and a deep hole — he was fat — with self-retaining retractors holding the wound apart and holding the muscle apart, pulled away from the bone. And the problem was, working from a distance, with a soft bed of giggely fat, to hold the gouge very firmly and steadily on the crest of the ilium....
Anyway, the hand is high, resting on the belly fat or the skin and the belly, and pressing very hard on this crest. Now this crest is curved slightly, but definitely curved. So you are pressing hard, and as I hit it with the mallet to start it ... it bounced and went like that. It was my fingers that pushed it into the tissues, not the hammer; so it went like this. And it could not have gone any further than where I was holding it.

He stated further that he was exercising more care than usual because he was holding the gouge firmly on the iliac crest to prevent its shifting.

Dr.

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Related

Ware v. Medical Protective Ins. Co.
621 So. 2d 54 (Louisiana Court of Appeal, 1993)
Maxwell v. Soileau
561 So. 2d 1378 (Louisiana Court of Appeal, 1990)
Bourgeois v. Ochsner Foundation Hospital & Clinic
556 So. 2d 1286 (Supreme Court of Louisiana, 1990)

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Bluebook (online)
550 So. 2d 1229, 1989 La. App. LEXIS 1602, 1989 WL 108231, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bourgeois-v-ochsner-foundation-hospital-clinic-lactapp-1989.