Clark v. Miller

378 N.W.2d 838, 1986 Minn. App. LEXIS 3865
CourtCourt of Appeals of Minnesota
DecidedJanuary 7, 1986
DocketC6-85-670
StatusPublished
Cited by6 cases

This text of 378 N.W.2d 838 (Clark v. Miller) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clark v. Miller, 378 N.W.2d 838, 1986 Minn. App. LEXIS 3865 (Mich. Ct. App. 1986).

Opinion

OPINION

FOLEY, Judge.

Susan K. Clark appeals from a March 6, 1985 judgment for Dr. Donald B. Miller following a medical malpractice trial and from a February 12, 1985 order denying her alternate motions for judgment notwithstanding the verdict and for a new trial. Clark’s malpractice claim was based on knee surgery performed by Miller on March 27, 1980.

The case was submitted to the jury on alternate theories of negligent treatment and negligent disclosure of risks. Miller claimed that Clark was contributorily negligent in failing to follow post-operative instructions. By special verdict, the jury determined that Miller was negligent in his treatment of Clark, that he negligently failed to disclose significant risks of surgery and that Clark would have refused the surgery had the risk been disclosed. The jury also found Clark negligent but concluded that neither Clark nor Miller were the direct cause of the injury.

Clark claims that the jury’s finding that Miller was negligent but not the direct cause of Clark’s injury is irreconcilable, perverse and manifestly contrary to the evidence. She further alleges that the trial court committed prejudicial error when it (1) denied her requested instruction on a patient’s right to limit surgical consent; (2) refused to include a claim for battery on the special verdict; and (3) submitted an emergency instruction to the jury despite uncontroverted evidence that the surgery was not life-threatening. We reverse and remand for a new trial on the issue of liability only.

FACTS

Appellant initially contacted respondent, an orthopedic surgeon, in August 1977 complaining of stiffness and locking in her left knee. She told him that similar problems with her right knee required surgery in 1975. Appellant’s medical record indicated that the surgery, a “Hauser transposition,” was relatively successful in realigning appellant’s right kneecap. The surgery did leave a scar on the inner side of her right knee.

Based on the similarity in symptoms, respondent made an initial diagnosis of chon-dromalacia, a degeneration in the cartilage underlining the kneecap. In December 1977, an arthrogram disclosed torn cartilage. In January 1978, respondent performed an Insall realignment, a procedure designed to strengthen the kneecap. He also removed cartilage, a procedure appellant had verbally authorized if medically necessary. The surgery left a scar on inner side and over appellant’s left knee.

Throughout 1978, appellant’s left knee developed an increased “crunching” sound. Respondent examined the knee and found evidence of articular damage, although alignment of the knee appeared normal. *841 In August 1979, appellant fell on her left knee and twisted it. She consulted respondent who drained the knee and injected cortisone to reduce inflamation of the joint. On March 7, 1980, appellant returned to respondent complaining that her left knee had “gone out” on several occasions and that pain around the kneecap had increased. Respondent’s examination disclosed increased grating of the knee joint but no objective evidence of instability.

Respondent then discussed alternative treatments with appellant: arthroscopic shaving of the left knee and a lateral release, which would provide only temporary relief of pain; removal of the kneecap, an alternative appellant immediately dismissed; and a modified Maquet or “Hau-ser-Maquet” procedure, which respondent believed “might be of help to” appellant.

At trial, respondent admitted that he had not performed any modification of the Ma-quet procedure prior to appellant’s surgery. A video-taped deposition of Dr. James Murray, an orthopedic surgeon from New York, was shown to the jury. Dr. Murray had studied with Dr. Maquet in Europe and had authored several articles on the Maquet procedure. Respondent had telephoned Dr. Murray prior to appellant’s surgery to discuss results of the Maquet procedure.

According to Dr. Murray, in the traditional Maquet procedure the tibia is split lengthwise and used to elevate the tendon attached to the kneecap. The Hauser procedure is basically an alignment device. Both respondent and Dr. Murray identified infection and skin slough or tissue loss as the major risks of the Maquet procedure. At trial, respondent could not recall whether he specifically discussed the procedures underlying a modified version of the Ma-quet procedure with Dr. Murray.

Appellant testified that she told respondent to proceed with the Hauser-Maquet procedure only if the arthroscopic findings indicated severe arthritis or improper tracking of the kneecap. Respondent denied that appellant placed such strict limitations on the procedure. He testified that he expected to find deep erosion under the kneecap and that appellant had authorized the procedure if he believed it was indicated.

Respondent’s disclosure of surgical risks was also sharply contested by the parties. Respondent testified that he disclosed the risks of the procedure including infection, lack of bone healing, skin or tissue loss and scarring on March 7,1980 and again during a subsequent phone conversation. He further stated that he told appellant he could not guarantee a good result. Appellant acknowledged that success of the procedure could not be guaranteed. On cross-examination, respondent admitted that these notations were not included in his office or surgical notes. Appellant testified that these specific risks were not disclosed although she agreed that her primary concern was potential scarring since she was a professional dancer.

Appellant was admitted to the hospital on March 26, 1980. On March 27, the morning of the surgery, she was asked to sign a consent form that contained the language “arthroscopy lateral release and intraarticular shaving left knee” but that did not mention the Hauser-Maquet procedure. Appellant pointed this out to the nurse but subsequently signed the release. Respondent testified that he spoke with appellant in pre-op about the consent form and told her he could either reschedule the surgery or proceed on the basis of their previous discussions. Appellant denied this conversation took place.

The arthroscopy revealed a marked improvement in appellant’s knee cartilage from the 1978 surgery. The kneecap appeared to be tracking well.

Q You didn’t find [significant disease of the patella] on the arthroscopy, did you, Doctor?
He ⅜ ⅜ ⅜ ⅜
A She had no crab meat at all. She had had crab meat before and that was gone.
Q In fact, I think you reported the overall appearance was quite smooth?
*842 A That’s correct.
Q And that the kneecap was tracking well?
A That’s correct.

Dr. Murray stated that the findings indicated significant healing of the knee cartilage and no objective evidence of instability. Therefore, the arthoscopic results did not indicate that a modified Maquet procedure was necessary. Respondent believed, however, that existing scar tissue and a dipping in the kneecap plus appellant’s subjective complaints necessitated further surgery. Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
378 N.W.2d 838, 1986 Minn. App. LEXIS 3865, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clark-v-miller-minnctapp-1986.