Yunker v. Kaiser Foundation Health Plan

611 P.2d 314, 46 Or. App. 165, 1980 Ore. App. LEXIS 2670
CourtCourt of Appeals of Oregon
DecidedMay 19, 1980
DocketNo. A77 11 16099, CA 12870
StatusPublished
Cited by1 cases

This text of 611 P.2d 314 (Yunker v. Kaiser Foundation Health Plan) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Yunker v. Kaiser Foundation Health Plan, 611 P.2d 314, 46 Or. App. 165, 1980 Ore. App. LEXIS 2670 (Or. Ct. App. 1980).

Opinion

BUTTLER, J.

This is an action for damages for breach of contract and for medical malpractice arising out of an alleged failure to diagnose plaintiff’s gallbladder condition. The complaint alleges two causes of action, and at the close of plaintiff’s case the circuit court granted defendants’ motions for a nonsuit on both causes. Plaintiff appeals from the ensuing judgment entered in favor of both defendants. On review, we conclude that there was sufficient evidence to present a jury question as to the Clinic’s negligence, and therefore reverse as to that cause of action. In all other respects we affirm.

Plaintiff sued both the Kaiser Foundation Health Plan (Kaiser), which operates a health insurance program, and the Permanente Clinic, which is a partnership operating a health service. In her contract cause of action, plaintiff alleged that during the relevant time period she was a member of the Kaiser plan, that Kaiser contracted to furnish "all medical or hospital services required for [her] health care,” and that Kaiser breached its contract by failing to provide and pay for gallbladder treatment and surgery which plaintiff needed while covered by the plan.

For the purpose of analysis it is convenient to discuss plaintiff’s negligence cause of action against the Permanente Clinic first. Her theory was that when she visited two Permanente facilities in December, 1976, she was suffering from gallstones, that the physicians who treated her failed to diagnose that condition, and that the physicians were negligent in not arranging for diagnostic tests which would have revealed the problem. She further alleged that if her gallbladder condition had been discovered in December, 1976, she would have undergone surgery at that time while her Kaiser coverage was in force; it expired in March, 1977. As a result of the negligent failure to diagnose, she alleged she had to pay for her own medical and surgical costs when her gallbladder was [168]*168removed in August, 1977, and that the delay subjected her to continued pain and suffering, to her damage.

We review the evidence "in the light most favorable to plaintiff,” Thompson v. Industrial Lumber Co., 41 Or App 519, 521, 599 P2d 468, rev den (1979), to determine whether there is sufficient evidence from which, if believed, a jury could find for her. James v. Carnation Co., 278 Or 65, 70, 562 P2d 1192 (1977).

"* * * It is * * * fundamental * * * that in determining whether to withdraw an allegation from consideration by the jury it is not the function of the court to weigh conflicting evidence and if an allegation is supported by any substantial evidence, including the testimony of a single witness, it is the exclusive function of the jury to decide whether or not to believe that testimony, despite the fact that all other witnesses may have testified to the contrary.” Hansen v. Bussman, 274 Or 757, 763, 549 P2d 1265 (1976) (footnote omitted).

Viewed in that light, the evidence may be summarized as follows: On December 13, 1976, while covered by the Kaiser Foundation Health Plan, plaintiff made emergency visits to two Permanente facilities. On both visits plaintiff complained of acute abdominal pain.

The first doctor who saw plaintiff advised her that she probably had "heartburn.” He prescribed an antacid, and arranged for plaintiff to have upper G. I. x-rays. Plaintiff had a second attack of acute abdominal pain later that same day and made another emergency visit to a second Permanente facility. The second doctor told her that she had stomach flu, and prescribed medication for that problem.

Neither physician took a medical history from the plaintiff. Thus, neither doctor learned that a few years earlier plaintiff had seen a physician in Chile who took a gallbladder x-ray and diagnosed a possible gallstone.

[169]*169A few days after the December 13 visits, plaintiff had the upper G. I. x-rays taken. They were normal. During the remaining term of her Kaiser coverage, plaintiff did not seek any further treatment for abdominal pain. The first physician who saw plaintiff on December 13 suggested, according to plaintiff, that she "follow up” on the problem only if she had further pain.

Plaintiff had no further problems while covered by Kaiser and did not experience any abdominal pain between December, 1976, and June, 1977. In June, she suffered some slight abdominal discomfort; during that summer, her pain increased in both severity and frequency. In August, 1977, plaintiff returned to a Permanente clinic where she saw an internist.

That doctor took a medical history whereby he learned of the Chilean doctor’s diagnosis. The internist scheduled a variety of tests for the plaintiff, including a gallbladder x-ray. However, at this point, no longer being under Kaiser coverage, plaintiff decided to contact another physician. She then saw Dr. Goldman, a gastroenterologist, who ordered a gallbladder x-ray, which revealed gallstones. Several days later plaintiff had another attack of severe pain. She called Dr. Goldman and her gallbladder was removed that day.

Dr. Goldman testified that the need for a gallbladder x-ray "would have been indicated” by plaintiff’s symptoms on December 13, 1976. He believed "that someone presenting with this kind of story should have further x- rays * * * and the x-rays should include a gallbladder x- ray.” Dr. Goldman expressed the opinion that the "ordinary diligent doctor” would have concluded that a gallbladder x-ray was necessary.

It is undisputed that plaintiff had the condition on December 13, 1976, that the Permanente physicians did not diagnose the problem, and that a gallbladder x-ray would have revealed plaintiff’s gallstones.

[170]*170The foregoing evidence, if believed, is sufficient to present a jury question as to whether the Clinic was negligent in failing to diagnose plaintiffs gallstones prior to the expiration of her coverage by the Kaiser plan.

The trial judge granted defendants’ motion for non-suit, in part, because he concluded that plaintiff had failed to show the need for 'immediate' surgery, or for surgery before the expiration of plaintiff’s Kaiser coverage in March, 1977.1 Again, however, there is evidence, although meager, from which the jury could conclude that the need for surgery was sufficiently immediate that plaintiff would have undergone surgery prior to the expiration of her Kaiser coverage had it been recommended.

Dr. Goldman testified that when gallstones are diagnosed, "surgical therapy is indicated” that while the precise timing of surgery may vary with the patient and the particular symptoms, removing the gallbladder will prevent further attacks of pain and complications, such as a gallstone entering the common bile duct, which was determined to be the case when Dr. Goldman operated in August, 1977.

A jury could have reasonably inferred from Dr. Goldman’s testimony that when gallstones are diagnosed, the patient should be told that surgery is indicated and given some choice over the timing of [171]*171surgery. Since the physicians did not diagnose plaintiff’s gallstones in December, 1976, she was not given that choice. Plaintiff’s Kaiser coverage did not end until March, 1977, and she testified that she would have consented to surgery had she been advised of the situation.

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Bluebook (online)
611 P.2d 314, 46 Or. App. 165, 1980 Ore. App. LEXIS 2670, Counsel Stack Legal Research, https://law.counselstack.com/opinion/yunker-v-kaiser-foundation-health-plan-orctapp-1980.