Gage v. St. Paul Fire & Marine Insurance Company

282 So. 2d 147
CourtLouisiana Court of Appeal
DecidedNovember 9, 1973
Docket4241
StatusPublished
Cited by10 cases

This text of 282 So. 2d 147 (Gage v. St. Paul Fire & Marine Insurance Company) 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
Gage v. St. Paul Fire & Marine Insurance Company, 282 So. 2d 147 (La. Ct. App. 1973).

Opinion

282 So.2d 147 (1973)

Horace Alexander GAGE, Plaintiff and Appellee,
v.
ST. PAUL FIRE & MARINE INSURANCE COMPANY, Defendant and Appellant.

No. 4241.

Court of Appeal of Louisiana, Third Circuit.

August 20, 1973.
Dissenting Opinion August 22, 1973.
Rehearings Denied September 14, 1973.
Writs Refused November 9, 1973.

*148 Pugh, Boudreaux & Gachassin by Nicholls Pugh, Jr., Lafayette, for defendant-appellant.

Edwards, Stefanski & Barousse by Homer E. Barousse, Jr., Crowley, for plaintiff-appellee.

Before HOOD, CULPEPPER and MILLER, JJ.

CULPEPPER, Judge.

This is a medical malpractice case. The radial nerve of plaintiff's right arm was inadvertently severed during surgery by the defendant, Dr. Guy J. Dunning. A jury awarded plaintiff $150,000. The doctor and his insurer appealed.

The substantial issues are: (1) Was the defendant physician negligent? (2) Was the plaintiff contributorily negligent in failing to follow the instructions of his doctors? (3) Did the trial judge commit reversible error in certain evidentiary rulings and/or in a charge to the jury on res ipsa loquitur? (4) Is the award excessive?

GENERAL FACTS

Plaintiff has no education. He has worked most of his life as a laborer on farms and in the oil fields. On March 18, 1969, while working as a roughneck on a drilling rig, he was thrown against some stairs. He sustained a simple fracture of the right humerus at about midshaft. Initially, he was treated by Dr. Tom Curtis, a general practitioner of Rayne, who did a closed reduction and applied a cast. However, the bone did not knit. Five months post-injury, Dr. Curtis referred plaintiff to the defendant, Dr. Guy J. Dunning, an orthopedic surgeon of Lafayette.

On August 24, 1969, Dr. Dunning performed the surgery in question, the general purpose of which was to secure a proper union of the bone by plating and bone grafting. First, an incision was made in the upper arm, and the muscles were spread apart to give access to the bone. A five months' accumulation of scar tissue and callus, between one-quarter and onehalf inch thick, was attached to the bone at the fracture site. This hard callus had to be removed to give a flat surface on the bone to which a metal plate could be attached *149 with screws. Bone chips, taken from the hip, were later placed around the fracture site to aid the bone in healing.

The radial nerve comes out of the body just under the arm pit, and wraps around the front of the humerus near the fracture site. In innervates the muscles that raise the hand and lift the fingers. In this case, the radial nerve was imbedded in the scar tissue and callus. Using an osteotome (an instrument similar to a chisel), Dr. Dunning pushed the sharp edge along the surface of the bone to cut and pry off the callus. He could not see the radial nerve, but knew it was in or under the callus. During this procedure, he noted a jerk of the right arm, which indicated the osteotome had come in contact with the radial nerve. After the callus was removed and turned over, he discovered the nerve had been severed. Following the completion of the plating and bone grafting procedure, the ends of the sheath of the radial nerve were sutured together and the surgery was closed. The expert medical testimony shows that normally nerve fibers will grow back down inside the sheath of the nerve to the muscles which they innervate at the rate of about one inch per month. In this case, complete reinnervation was anticipated in about seven months.

NEGLIGENCE OF DR. DUNNING

Our jurisprudence is established that physicians are not insurers of the results of their treatment. They are not required to exercise the highest degree of skill and care possible. Their duty is to exercise the degree of skill ordinarily employed, under similar circumstances, by the members of their profession in good standing in the same community or locality, and to use reasonable care and diligence, along with their best judgment, in the application of this skill to the case, Meyer v. St. Paul Mercury Indemnity Company, 225 La. 618, 73 So.2d 781 (1953); Uter v. Bone & Joint Clinic, 249 La. 851, 192 So. 100 (1966); Thibodeaux v. Aetna Casualty & Surety Company, 216 So.2d 314 (La.App. 3rd Cir. 1968); and Sims v. Silvey, 246 So.2d 394 (La.App. 1st Cir. 1971).

We will briefly summarize the expert medical testimony. The defendant, Dr. Dunning, described the surgery, as stated above. He emphasized that since five months had elapsed after the fracture, a large amount of callus had formed, and the nerve was encased in this hard substance, which increased the hazard. Dr. Dunning takes the position that the callus had to be removed, that the risk of injury to the radial nerve had to be taken, that he followed the usual and customary surgical procedures, but inadvertently severed the nerve. He concedes that this had never happened to him before or to any other orthopedic surgeon to his knowledge, but maintains that the occurrence was unavoidable under the circumstances.

Dr. William Louis Meuleman, an orthopedic surgeon of Lafayette, was called by the plaintiff. He agreed the surgical procedure used by Dr. Dunning was proper and that in this operation there is always a risk of injury to the radial nerve. In picturesque language he stated that the radial nerve "is there no matter what time of the day or night and it is one of the things that can get you into trouble whether you want to get into trouble or not." Nevertheless, Dr. Meuleman would not state, despite being pressed to do so by counsel for defendant, that the severance of the nerve was "unavoidable". Furthermore, Dr. Meuleman said he had performed substantially the same surgery several times and had never severed the nerve, and had never heard of any other surgeon doing so.

Dr. Hugh Larriviere, also an orthopedic surgeon of Lafayette, is Dr. Dunning's associate and assisted him during the surgery in question here. His testimony is substantially the same as that of Dr. Dunning, particularly in that he considered injury to the radial nerve to be a normal risk of such surgery, and that in this case the severance of the nerve was unavoidable. However, Dr. Larriviere also testified that *150 he had performed similar surgery several times but had never severed the nerve, and had never heard of any other surgeon doing so.

Dr. Luke Bordelon is also an orthopedic surgeon from the Lafayette area. He stated that Dr. Dunning had used the customary and proper procedure, and that there is always a great risk of injury to the radial nerve. However, like the other physicians who testified, he had never damaged the nerve or heard of any surgeon who had. When asked whether the occurrence was "unavoidable", he compared it to an automobile accident, stating that there is always a chance of a wreck.

Dr. Joseph W. Robertson, a neurological surgeon of Houston, Texas, testified by deposition. Since he is not an orthopedic surgeon, he would express no opinion as to the correctness of the surgical procedure used by Dr. Dunning. But he did say that severance of a radial nerve during the repair of a fractured humerus should not occur, although it is possible. His testimony concerns principally the extent of plaintiff's residual disability, which he estimated to be about 25% of the arm as a whole, based on the weakness of the wrist and fingers.

Summarizing the expert medical testimony, it shows the general procedure used by Dr. Dunning was proper.

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Bluebook (online)
282 So. 2d 147, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gage-v-st-paul-fire-marine-insurance-company-lactapp-1973.