Choma v. Iyer

871 A.2d 238, 2005 Pa. Super. 96, 2005 Pa. Super. LEXIS 379
CourtSuperior Court of Pennsylvania
DecidedMarch 16, 2005
StatusPublished
Cited by8 cases

This text of 871 A.2d 238 (Choma v. Iyer) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Choma v. Iyer, 871 A.2d 238, 2005 Pa. Super. 96, 2005 Pa. Super. LEXIS 379 (Pa. Ct. App. 2005).

Opinions

OPINION BY

DEL SOLE, P.J.:

¶ 1 Appellants, husband and wife,1 appeal a judgment entered in favor of Appel-lee, Manny Iyer, M.D., following a jury trial in a medical malpractice action. We are asked to review two questions: whether the trial court erred in charging the jury on the “two schools of thought doctrine” and whether the jury’s verdict on the informed consent claim was contrary to the weight of the evidence. We find no reason to disturb the trial court’s dismissal of Appellant’s challenge to the weight of the evidence, but we find an award of a new trial is required because the jury was improperly instructed on a doctrine which did not apply to the facts of the case.

¶ 2 Dr. Iyer performed a type of breast reconstruction, known as a TRAM flap procedure, on Appellant following a mastectomy for breast cancer. The procedure done on her left breast used muscle and other tissue from her abdomen. Significant complications later arose resulting in scarring and deformity at the abdominal site and requiring skin grafting from Appellant’s thigh area. The complications necessitated four additional surgical procedures.

¶ 3 Appellants later brought an action against Dr. Iyer claiming that he was negligent in his decision to perform a TRAM flap procedure where it was contra-indicated by Appellant’s medical history, and that he failed to obtain her informed consent to the procedure. The jury returned a verdict in favor of Dr. Iyer, specifically finding that he was not negligent and that he did not fail to obtain Appellant’s informed consent. Post-trial motions were later filed and denied. This appeal followed.

¶ 4 Appellants’ initial claim concerns the appropriateness of the court’s charge to the jury on the “two schools of thought” doctrine. Appellants contend the instruction was not warranted based upon the facts and expert opinion produced at trial.

[241]*241¶ 5 The “two schools of thought” doctrine provides a complete defense to a malpractice claim. Levine v. Rosen, 532 Pa. 512, 616 A.2d 623, 627 (1992). It directs that where “competent medical authority is divided, a physician will not be held responsible if in the exercise of his judgment he followed a course of treatment advocated by a considerable number of recognized and respected professionals in his given area of expertise.” Jones v. Chidester, 531 Pa. 31, 610 A.2d 964, 969 (1992). The doctrine is applicable only where there is more than one accepted method of treatment or procedure. See Levine v. Rosen (finding the “two schools of thought” instruction appropriate where the evidence established that there were a considerable number of respected physicians who subscribed to each school of thought—regular vs. yearly mammograms).

¶ 6 The question presented at trial was whether the TRAM flap procedure performed on Appellant was an appropriate form of reconstructive surgery given Appellant’s body weight and medical history. The trial court found that the diagnosis of breast cancer was agreed upon and the only question concerned the method of treatment between a TRAM flap procedure and other forms of reconstruction surgery. It found that one school of thought was presented by Appellants who offered the testimony of experts indicating that because Appellant was obese the TRAM flap procedure was counterindicat-ed. It further found that a second school of thought was offered by Dr. Iyer through the testimony of his expert who testified that the TRAM flap procedure was an appropriate procedure to perform on Appellant. Given this testimony, the trial court ruled that Dr. Iyer met his burden of proving the application of the “two schools of thought” doctrine.

¶ 7 Our review of the evidence offered at trial does not support the trial court’s assessment of the evidence and the application of the doctrine. The evidence in this case does not reflect that there were two approaches to treatment. Nor did the experts agree on the diagnosis. The underlying cancer condition was not at issue in this procedure for breast reconstruction. At issue was whether Appellant was extremely obese. Both sides recognized that obesity significantly increases the risks of failure of a TRAM flap procedure, yet they disagreed as to whether Appellant was extremely obese. Appellants’ expert Dr. Grayson stated that Appellant was not a candidate for TRAM flap reconstruction because of her obesity, history of smoking and previous gall bladder and appendectomy surgeries. N.T., 2/13/03, at 51. Dr. Iyer’s expert, Dr. Murphy, opined that the procedure was not contra-indicated for Appellant. During his own testimony Dr. Iyer stated that he would not do this procedure on morbidly obese people. N.T., 2/12/03, at 22. However, he opined that Appellant was “moderately” but not “overly” obese and that in his assessment, her weight did not present a high risk. N.T., 2/13/03 at 204, 215; N.T., 2/14/03, at 19. Thus both sides agreed that the TRAM flap procedure is an appropriate form of reconstructive surgery, and that it is contra-indicated where the patient is extremely obese. The disputed question was whether Appellant was extremely obese.

¶ 8 Where as here, the dispute is not to the course of treatment, but rather to a question of fact regarding plaintiff’s condition, the “two schools of thought” doctrine is inapplicable. The courts, when presented with similar factual questions, have consistently held that a jury instruction on the “two schools of thought” is in error.

[242]*242¶ 9 In Morganstein v. House, 377 Pa.Super. 512, 547 A.2d 1180 (1988), the appellant’s decedent died as a result of undiagnosed unstable angina. The decedent had presented to his physician with complaints of pain, and an EKG was administered and nitroglycerine was prescribed. Several days later he collapsed and died. At trial the experts did not dispute the propriety of the specific treatment ordered, as .they both agreed on the usefulness of nitroglycerine under certain circumstances. However, the jury was to determine if Dr. House should have diagnosed the decedent’s condition as an unstable angina. It held that this was an issue of fact for the jury, and to instruct the jury regarding two schools of medical thought was inappropriate and warranted a new trial. It cited to a Supreme Court decision which found: “where medical experts in a case agree as to the recognized and established proper treatment for a particular type injury but there is a dispute as to whether the plaintiff had that type of injury, the latter question is one of fact for the jury.” Id. at 1183, citing Hodgson v. Bigelow, 335 Pa. 497, 7 A.2d 338 (1939).

¶ 10 Both Morganstein and Hodgson were cited in D’Angelis v. Zakuto, 383 Pa.Super. 65, 556 A.2d 431 (1989), where a new trial was ordered after the jury was instructed on the “two schools of thought” doctrine. Therein a young child went into cardiopulmonary arrest and died after twice seeking treatment from the defendant doctor, who prescribed an antibiotic and cough suppressant based upon the child’s symptoms. A post mortem exam revealed that the child had suffered from acute and chronic pneumonia of the left lung.

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Bluebook (online)
871 A.2d 238, 2005 Pa. Super. 96, 2005 Pa. Super. LEXIS 379, Counsel Stack Legal Research, https://law.counselstack.com/opinion/choma-v-iyer-pasuperct-2005.