Cherokee County Hosp. Authority v. Beaver

• Decision Date: 23 May 1986
• Docket Number: Nos. 71618,71619,s. 71618
• Citation: 179 Ga.App. 200,345 S.E.2d 904
• Parties: CHEROKEE COUNTY HOSPITAL AUTHORITY v. BEAVER et al. (Two Cases).
• Court: Georgia Court of Appeals

Page 904

345 S.E.2d 904

179 Ga.App. 200

CHEROKEE COUNTY HOSPITAL AUTHORITY v. BEAVER et al. (Two Cases).

Nos. 71618, 71619.

Court of Appeals of Georgia.

May 23, 1986.

Judson Graves, Paul J. Quiner, Atlanta, for appellant.

Michael J. Kramer, Marietta, for appellees.

CARLEY, Judge.

Experiencing pain in her "lower back, around beside [her] kidney" and in her side, appellee Mrs. Beaver telephoned her physician. She was instructed to go to appellant R.T. Jones Memorial Hospital (Hospital). Upon her arrival, Mrs. Beaver received an injection of pain medicine that had been prescribed by her physician. A nurse employed by the Hospital administered the injection in Mrs. Beaver's right buttock. Immediately upon receiving the injection, Mrs. Beaver experienced intense pain radiating down her right leg. The pain was followed by limpness.

In Case No. 71618, Mrs. Beaver sued the Hospital for unspecified personal injuries allegedly resulting from the negligent administration of the injection. In Case No. 71619, Mr. Beaver sued the Hospital for loss of consortium due to his wife's unspecified injury. In each lawsuit it was alleged that "in the administration of said injection ... the [Hospital], its employees and agents failed to exercise the proper and required standard of care and said failure constitutes negligence." Neither complaint contained specific averments as to how the injection had been negligently administered. After discovery, the Hospital moved for summary judgment in both cases. The trial court denied the motion, relying in part on Killingsworth v. Poon, 167 Ga.App. 653, 307 S.E.2d 123 (1983). However, the trial court certified the order for immediate review. The Hospital's application for an interlocutory appeal from the denial of its motion for summary judgment was granted. The Hospital's two appeals are consolidated for purposes of resolution in this single opinion.

1. In a medical malpractice action, "there are three essential elements imposing liability upon which recovery is bottomed: (1) the duty inherent in the [medical professional]-patient relationship; (2) the breach of that duty by failing to exercise the requisite degree of skill and care; and (3) that this failure to be the proximate cause of the injury sustained." Hawkins v. Greenberg, 166 Ga.App. 574, 575, 304 S.E.2d 922 (1983). With regard to the second essential element, a plaintiff in medical malpractice cases is generally required to produce expert testimony in order to show that the defendant deviated from the requisite standard of care. The "pronounced results" exception to this general evidentiary rule requiring the plaintiff to produce expert testimony was recognized in Caldwell v. Knight, 92 Ga.App. 747, 89 S.E.2d 900 (1955) and was applied in the context of summary judgment in Killingsworth v. Poon, supra. The "pronounced results" exception is a very narrow one. It encompasses only "those exceedingly rare cases wherein the medical questions presented concern matters which a jury can be credited with knowing by reason of common knowledge or [wherein] the possibility of actionable medical negligence appears so clearly from the record that the plaintiff-patient need not produce expert medical testimony concerning the applicable standard of care to avoid summary judgment for a defendant [in a medical malpractice action who has produced expert medical testimony] as to his own lack of negligence." Killingsworth v. Poon, supra, 167 Ga.App. at 656, 307 S.E.2d 123. See McClure v. Clayton County Hosp. Auth., 176 Ga.App. 414, 416, 336 S.E.2d 268 (1985); Landers v. Ga. Baptist Medical Center, 175 Ga.App. 500, 333 S.E.2d 884 (1985). The Hospital enumerates as error the trial court's holding that this limited "pronounced results" exception would be applicable in the instant case.

Application of the "pronounced results" exception must be based upon evidence of "such 'pronounced results' [as are] indicative of possibly negligent medical treatment [, examples of which] include those evinced when a doctor, while stitching a wound on his patient's cheek, by an awkward move, thrusts his needle into the patient's left eye, or where a leg or limb which has been broken is shorter than the other after treatment. [Cits.]" Killingsworth v. Poon, supra, 167 Ga.App. at 655, 307 S.E.2d 123. In addition to evidence of such "pronounced results" of medical treatment as a pierced eye or a shortened limb, "[i]t is widely known and generally understood by laymen that subcutaneous injections ostensibly given only for the relief of muscular pain should not, if administered correctly, result in the puncture of internal organs. [Cit.]" (Emphasis supplied.) Killingsworth v. Poon, supra at 657, 307 S.E.2d 123. In the instant case, however, there is no probative evidence whatsoever which would authorize a finding that Mrs. Beaver suffered any "result," pronounced or otherwise, attributable to her injection. The evidence is only that the injection was closely followed in time by the occurrence of pain and weakness in Mrs. Beaver's leg, which weakness continues. This evidence, standing alone, would not only be insufficient to authorize a finding that the injection was negligently administered, it would not even be sufficient to authorize an inference that the injection is a proximate cause of the weakness in Mrs. Beaver's leg. See generally Akins v. Fed. Mut., etc., Ins. Co., 108 Ga.App. 872, 134 S.E.2d 854 (1964). In Killingsworth v. Poon, supra, there was additional uncontroverted evidence that the patient, who had initially experienced pain upon injection, had in fact suffered a punctured lung and that the injection had caused that condition. In contrast, there is in the instant case no probative evidence as to the medical cause of the continuing weakness in Mrs. Beaver's leg and no evidence that the injection was a contributing factor therein. Under the record before us, the unexplained weakness in Mrs. Beaver's leg is merely a physical symptom which may in fact be a manifestation of the pre-existing condition which forced her to seek emergency treatment in the first instance, rather than an indication of an unexpected result of the medical treatment that she received at the Hospital. Compare also Caldwell v. Knight, supra (medical evidence that plaintiff suffered trauma to his back attributable to an injury rather than to disease).

"Generally, ... the doctrine of res ipsa loquitur does not apply to medical professional cases. [Cits.]" Hill v. Hosp. Auth. of Clarke County, 137 Ga.App. 633, 641, 224 S.E.2d 739 (1976). If the "pronounced results" exception were applicable under such facts as exist in the instant case, the consequence would be that, notwithstanding an uncontroverted medical opinion as to the absence of negligence, every malpractice case could go to the jury merely by the plaintiff showing that he sought medical treatment and that his physical condition thereafter worsened rather than improved. This would be contrary to the "well settled principle of negligence law that the occurrence of an unfortunate event is not sufficient to authorize an inference of negligence. [Cit.]" Franklin v. Elmer, 174 Ga.App. 839, 842, 332 S.E.2d 314 (1985). The trial court erred in ruling that evidence merely that Mrs. Beaver experienced pain and an unexplained weakness in her leg at the time she received an injection is sufficient to warrant application of the narrow "pronounced results" exception. The law recognizes that "the fact that the treatment has resulted unfavorably does not raise even a presumption of want of proper care, skill or diligence. [Cits.]" Sullivan v. Henry, 160 Ga.App. 791, 800, 287 S.E.2d 652 (1982).

2. Our holding in Division 1 does not necessarily mandate reversal of the trial court's order. The inapplicability of the "pronounced results" exception means only that the instant case is governed by the rules that are otherwise generally applicable in the context of a malpractice case on summary judgment. See generally Nelson v. Parrott, 175 Ga.App. 307 (1), 333 S.E.2d 101 (1985).

The Hospital submitted the affidavits of two experts, both of whom based their statements on personal knowledge. One affiant was the nurse who had actually administered the injection. The other affiant was the emergency room physician who had examined Mrs. Beaver at the Hospital after the injection. Both affiants expressed the opinion that the injection had been administered in compliance with the applicable standard of care. Neither affiant limited his or her averments merely to that conclusory expert opinion. Each affiant also stated the factual basis upon which the opinion of non-negligence was based: Both opinions were premised upon additional factual averments that the injection had been administered at a "proper" location on Mrs. Beaver's body. One affiant stated that "proper" location to be the "upper outer quadrant" of the right buttock. The other affiant also stated that the "proper" location of the injection had been the "upper ... quadrant" of the right buttock.

In opposition, Mr. and Mrs. Beaver submitted the affidavit of a registered nurse who was qualified as an expert in the "giving [of] intramuscular injections in the buttock." This expert specifically stated what had been implicitly recognized in the affidavits of the Hospital's affiants, to wit: That "a failure to so place an intramuscular injection [in the upper outer quadrant of one of the buttocks] is a deviation from the proper standards of nursing care." The Beavers' affiant did not, however, express a further expert opinion that it would be a deviation from this standard to give an injection at the location on the buttock indicated by Mrs. Beaver as the specific site where she had been injected. With regard to this question of the actual site of the injection, Mrs. Beaver submitted her own affidavit. In that affidavit, she stated: "That the intramuscular injection was administered to...