Copeland v. Robertson

• Decision Date: 18 May 1959
• Docket Number: No. 41153,41153
• Citation: 112 So.2d 236,236 Miss. 95
• Parties: Dr. E. A. COPELAND v. Mrs. Laverne D. ROBERTSON.
• Court: Mississippi Supreme Court

Page 236

112 So.2d 236

236 Miss. 95

Dr. E. A. COPELAND v. Mrs. Laverne D. ROBERTSON.

No. 41153.

Supreme Court of Mississippi.

May 18, 1959.

Watkins & Eager, Harmon W. Broom, Jackson, for appellant.

Pierce & Waller, Jackson, for appellee.

LEE, Justice.

This is the second appearance of this cause here. Robertson v. Copeland, Miss., 97 So.2d 512, 513. Mrs. Laverne D. Robertson had sued Dr. E. A. Copeland to recover damages for his alleged malpractice in performing on her a complete hysterectomy. At the close of the evidence for the plaintiff, the trial court sustained a requested peremptory instruction for the defendant. On appeal here, this Court, in holding that the directed verdict should not have been given, said that there was 'a clear issue for the jury on conflicting testimony as to whether or not the defendant was justified in operating on the plaintiff at all at the time he did or in the manner in which the operation was performed.' The cause was therefore reversed and remanded for a new trial. On the second trial, the issue was submitted to the jury and there was a verdict for the plaintiff in the sum of $17,500. From the judgment entered thereon, Dr. Copeland appealed.

Mrs. Robertson testified that, when she went to Dr. Copeland's hospital on March 7, 1954, she was not concerned with her female organs at all; that she had a terrible cold; that her leg was hurting her; and that she was afraid she had polio. Dr. Copeland told her that she had an ovarian cyst, which it was necessary to remove, but that he said nothing about removing her female organs. She was corroborated in this particular by T. L. Dixon and Mrs. Bobbie Sylvester, her father and sister. Mrs. Sylvester testified that the doctor, after first saying that he would operate, then informed her that he would not do so because the insurance company would not pay for the expense. Later the doctor said that the insurance company informed him that it would pay, and that he was going to operate on her on Tuesday, March 9th. Mrs. Robertson denied that she agreed to an exploratory operation. A day or two after her discharge from the hospital, because of frequent bowel movements, nausea of the stomach, swelling in the lower part of her body, soreness of her female organs, and the appearance of a rash, Mrs. Robertson went back to the hospital. She was treated for several weeks, both in and out of the hospital, and, failing to get any relief, she finally went to Dr. Edward R. North.

Dr. Copeland was called as an adverse witness for the purpose of cross-examination. Both his original hospital record and an amendment thereto were introduced in evidence. The record showed, and he admitted, that he performed a complete hysterectomy on Mrs. Robertson; that he took out the uterus, the Fallopian tubes, and a cystic like abscess on the right ovary; that he punctured a watery cyst on the left ovary; and corrected a defect in a previous operation where the bladder had been stitched down. He had previously examined this patient, and, on August 18, 1953, had addressed a latter to the Dependent's Clinic at Keesler Field, advising that he had found her with an enlarged spleen, considerable tenderness throughout the abdomen, a bad discharge which had partly cleared up, a fractured coccyx, and colitis. He was later apprised of the result of her examination and treatment at that hospital for approximately ten days, when the final diagnosis and conclusion was 'Salpingitis, chronic E. coli, paracolon species, cured.'

In Dr. Copeland's history sheet, among the complaints then registered was 'Stomach swells often with pains going into upper stomach, drawing leg also.' The admittance diagnosis was 'Acute pelvic inflammatory disease.' The physical examination and findings were: 'High state of nervousness. Very rigid in abdomen, suffering severe abdominal pain with shock and weakness. Hard mass in cul-de-sac.' The doctor testified that Mrs. Robertson came into the hospital on Sunday afternoon, March 7, 1954, all drawn over to one side, complaining of severe abdominal pains. She had a greatly 'extended' bladder, a rapid pluse, was perspiring, and showed symptoms of shock. He found a discharge from the cervix, pus in the tubes, and a hard mass in the cul-de-sac. His diagnosis was a recurrent pelvic inflammatory disease with pus in the tubes, endometritis, and a cystic ovary. It was his opinion that this situation constituted an emergency, and that she should have surgery to get rid of the tubes. He further testified that he so informed Mrs. Robertson, and that she replied 'That's what I came in here for.'

Dr. North, who qualified as an expert in obstetrics and gynecology, with a wide experience in the treatment of female diseases and surgery on the female organs, testified that he first saw Mrs. Robertson on April 29, 1954. The pelvic examination at that time disclosed 'at the top of the vagina, all the way up at the dome, a large mass of tissue which was a raw granulating type of proud flesh, which was a bloody rotten sort of mass, about the size of a golf ball, which had a good deal of discharge * * *'. The tenderness and thickening around this mass indicated an inflammatory condition. There was complaint of bloating, swelling, pain, and frequent bowel movements, and she was in a highly emotional state. He treated her intensively for about two and one-half months. He admitted her to the Baptist Hospital on July 15, 1954, for gastro-intestinal tests, and, on July 20th, operated. In the abdomen, massive adhesions stuck the intestines together, and existed throughout the pelvis and the cul-de-sac, and this condition accounted for her pain. The right angle of the vaginal cuff had broken loose and the round ligament was hanging loose in the abdomen. A right overian cyst was plastered down by adhesions, causing the destruction of the ovary and making it necessary to remove the residue. By this operation, the doctor released the adhesions, revised the vaginal cuff and eliminated the inflammation, removed scarred tissue, got the bladder flap up and mollified the difficulty of the acute infection in the neck and bladder wall.

Inasmuch as Dr. Copeland's record showed that he admitted Mrs. Robertson to the hospital for acute pelvic inflammatory disease, it was Dr. North's opinion, from that record, and from what he learned in his operation, that pus leaked out of the tubes into the abdominal cavity, causing a generalized peritonitis, and that such infection and rough handling of the bowel during surgery accounted for the massive adhesions.

Dr. North further testified that, according to the standard of treatment among doctors in the City of Jackson, if pus is running out of a boggy womb and the tubes are full of pus, the patient should be given massive does of antibiotics, sulfa, penicillin, streptomycin, etc., until there is no longer any pus, until the tenderness is gone, and until the infection is sterile, in which event there may then be no need whatever for surgery. A boggy infected uterus, running pus, should not be removed because to remove the womb, clamps have to be put across the infected tissue that supports it; when this tissue is cut, there is contamination of the pelvic cavity; and to cut through the infected tissue around the womb and take it out is one of the cardinal sins of surgery. If there is pus in the cul-de-sac, it should be drained from below. The use of antibiotics is the treatment for salpingitis, and the female organs should never be removed unless absolutely necessary. A surgeon should never operate where the patient has a severe cold or is in shock unless absolutely necessary. To diagnose acute inflammatory pelvic disease, it is necessary to have a blood count, a urinalysis, an examination of the female organs and of the abdomen and the pelvis. The purpose thereof is to determine whether there is fever, shock, blood pressure too high, or infection, and whether acute or chronic.

The witness further said that, according to Dr. Copeland's operative sheet, he provided no drain; that there was nothing on the sheet to indicate shock, as the blood pressure did not appear; that there was nothing to indicate an emergency; and that it did not show temperature, respiration, or pulse.

Dr. Robert B. McLean, who qualified as an expert in general surgery and gynecology, with particular training in necessary operations on female organs, testified that adhesions result in propertion to the amount of trauma and infection; that, if gentle and clean, there are few; but if rough and infectious, there are more. Among doctors in the community of Jackson the standard procedure is to have a complete history and physical examination before doing a hysterectomy. The accepted treatment is to drain until the acute stage subsides, and then operate only if necessary. An abscess on the ovary can be cured by the use of antibiotics; and the common opinion is that a hysterectomy should not be done in the presence of an abscess, for the reason that tissue is cut and infection can be spread to the adjacent area. In the presence of shock, the operation should be delayed. There is no immediate danger because of an abscess in the cul-de-sac and pus running from the uterus. He gave study to Dr. Copeland's history sheet and record, and said he could not find anything about temperature, pulse, respiration, blood count, or blood pressure. He could not understand how there was a diagnosis of shock without a blood pressure reading. He said that an acute pelvic inflammatory disease, such as Dr. Copeland's diagnosis, is rarely operated on during its acute stage. With acute pus tubes, it is not satisfactory, the results are not good, and morbidity is high. He said that, with this disease, the patient is very sick, there is high fever, and the blood count is elevated. But in Dr. Copeland's record, such count was not elevated. There is nothing in his record to indicate such a...