Cozine v. Moore

• Citation: 159 Iowa 472,141 N.W. 424
• Parties: COZINE v. MOORE.
• Decision Date: 08 May 1913
• Court: Iowa Supreme Court

159 Iowa 472

141 N.W. 424

COZINE

v.MOORE.

Supreme Court of Iowa.

May 8, 1913.

Appeal from District Court, Cedar County; W. N. Treichler, Judge.

Action for damages against the defendant for alleged malpractice as a physician and surgeon. There was a trial before a jury and a verdict and judgment for the plaintiff for $800. The defendant appeals. Reversed.Chas. W. Kepler & Son, of Mt. Vernon, for appellant.

Remley & Calkins, of Iowa City, for appellee.

EVANS, J.

In July, 1910, the plaintiff met with a serious accident. He was thrown under the wheels of his loaded wagon. His observable injuries were a wound upon the back of the head, a “mashed” cheek bone, and two compound fractures of his left lower jaw. The defendant was a physician at West Branch four or five miles distant and was sent for. When he came, he found the plaintiff lying upon the ground at the place of the accident. He extended immediate temporary relief and removed the patient to his home. In the treatment of the plaintiff the most difficult problem was presented by the compound fractures of the jaw. The complaint in this case is directed against, and confined to, the methods adopted by the defendant for the treatment of such fractures. It is undisputed that the injury was a very serious one and one with which it was very difficult to deal safely and successfully. By a “compound” fracture is meant a fracture attended with the penetration of the outer skin or mucous membrane, so that the injury is thereby subjected to the dangers of infection from without. In this case the flesh wounds of the compound fractures were in the mouth, and more or less dirt had been forced into the mouth and into contact with the wounds by the circumstances of the accident. The segment of the jaw between the two fractures had been drawn out of position by the contraction of the muscles and had been drawn upward. One of the problems confronting the surgeon was to restore such segment to its place and to secure it in its proper position. In order to do that, sufficient force had to be applied in some way to overcome the tendency of the contracting muscles. An instrumentality was constructed which was known as an interdental splint. It is known in this record as “Exhibit B.” The principal complaint of the plaintiff is directed against the use of this instrumentality. The defendant called to his assistance an experienced dentist. A wax impression was first made of the plaintiff's jaw and teeth. This impression was used as a model for the construction of Exhibit B, which was made from rubber or gutta percha upon the form of the wax impression. It was so placed over the teeth of the patient as to hold the broken segment in place with a view thereby to bring the fractured ends in apposition and to accomplish a union thereof. Provision was made for the cleansing of the patient's mouth several times daily. These provisions were carried out faithfully by plaintiff's wife as his nurse. Exhibit B was kept in the mouth of the patient for a period of five weeks. It was very uncomfortable. It interfered with the closing of the plaintiff's mouth and with expectoration and with swallowing. There was more or less infection present. The plaintiff's breath became offensive. In the course of five weeks he became sick with pleurisy. Another operation was performed by another surgeon for the removal of pus from the pleural cavity. Exhibit B was removed at the expiration of five weeks. A union had not occurred, or at least was not complete. The patient's general condition was very grave and the chances of recovery were against him. No further surgical attention was given to the jaw. In time the union resulted, and at the time of the trial, the place of fracture was not readily discoverable by the expert witnesses. The alignment, however, was more or less imperfect. There was another surgical method known to the profession which might have been adopted by defendant. This consisted in drilling several holes in the jaw and in each end of the broken segment and drawing and holding the parts together with the use of a silver wire. This method also had its perils. In case of infection there was danger of necrosis of the bone. It increased somewhat the danger of infection because it was impossible to wholly eliminate infecting bacteria from the mouth. It was the contention of the plaintiff appellee that the use of Exhibit B was unwarranted and clearly negligent on the part of the defendant and that the other method referred to should have been adopted.

The foregoing is perhaps a sufficient statement of the general facts to enable a comprehension of the questions presented on this appeal and hereafter discussed.

[1] 1. At the close of the evidence the defendant moved for a directed verdict on the ground that the evidence failed to show any negligence or breach of professional duty on his part. The motion having been overruled, the question involved is now presented for our consideration. As to the general duty of the physician to his patient there is no dispute between the parties. Whether the defendant departed from the standards of his profession in his treatment of the plaintiff is a question which from its very nature must be determined in the main upon the expert testimony of other physicians. The plaintiff used two such witnesses. The first was Dr. Whities.

The following is his testimony complete: “I live in Iowa City. Am a physician about 16 years, and in the active practice all that time. I have had cases of fracture of the jaw. The effort of the surgeon is to replace any malposition that may be and to hold it in such position and so far as possible to keep the wound clean. After the bones have been put in position--natural position--usually a splint and wiring and some bandages is necessary; that is a simple bandage to hold the bones of the jaw; ordinarily a splint or wiring the jaw together, then bandaging them so they will be mobilized. Sometimes it is advisable to drill holes in the bones and wire them in such a way that they can't be separated--ordinarily silver wire. It would be difficult to say; you may perhaps wire most any part of the jaw on the side; it might be. I couldn't say that it is the usual practice, but may be by some surgeons; other surgeons would depend on the splint. Q. What are the results with wiring, as a rule? A. If the apposition is good and there is no separation, the result ought to be satisfactory. A healthy person of temperate habits and good health, full of life, of 45 years, the bones ought to knit together in from four to eight weeks. If there is no separation, the bones would be probably firmly united. At the end of eight weeks, he ought to be able to chew solids if the union has been satisfactory. Q. When you speak of splints, what kind of splints receive the approval of the medical profession? A. There are almost as many splints as there are operators. The Kingsley splint is the most common probably. That is a splint made by the dentist and is designed to hold the bones by the use of a bandage; that is, the splint is so arranged that there is a projection outside of the mouth. The bandage goes around the wire, and the dentist makes an impression of the jaw, then vulcanizes the wire in the rubber, and it projects, and the bandage is put on and holds it up in that position. Q. In that case...