Crawford v. Sacramento County

• Decision Date: 01 February 1966
• Citation: 49 Cal.Rptr. 115,239 Cal.App.2d 791
• Court: California Court of Appeals Court of Appeals
• Parties: Emma Ruth CRAWFORD, a Minor, etc., Plaintiff and Appellant, v. COUNTY OF SACRAMENTO, Defendant and Respondent. Civ. 11059.

Page 115

49 Cal.Rptr. 115

239 Cal.App.2d 791

Emma Ruth CRAWFORD, a Minor, etc., Plaintiff and Appellant, v. COUNTY OF SACRAMENTO, Defendant and Respondent.

Civ. 11059.

District Court of Appeal, Third District, California.

Feb. 1, 1966.

Rehearing Denied Feb. 28, 1966.

Hearing Denied March 30, 1966.

Nathaniel S. Colley, Sacramento, for appellant.

McLaughlin & Russell, by Clifford A. Russell, Sacramento, for respondent.

PIERCE, Presiding Justice.

In this plaintiff's appeal in an action for wrongful death (medical malpractice) we hold that the trial court was justified in granting a nonsuit in favor of defendant county.

The principal contention that a 'conditional' res ipsa loquitur situation existed, viz., that death was the probable result of the negligence of defendant's anesthetist, fails because medical testimony neither established nor furnished evidence from which a lay jury could reasonably infer the probability of such negligence. A second contention that there was evidence other than the res ipsa inference sufficient to take the case to the jury and a third contention that evidence of an asserted admission by an intern (not present in surgery) was improperly excluded are also untenable.

Re: The Contention that Res Ipsa Loquitur Applied.

On October 12, 1962, plaintiff's decedent, Fayrene Crawford, suffered an ankle fracture. She was taken to the defendant county hospital where a closed reduction was performed under a general anesthetic--sodium pentothal with nitrous oxide. The anesthesia was administered and the other functions pertaining thereto were performed by an anesthetist, a registered nurse, employed by the hospital. A Dr. Ryan was the surgeon who performed the reduction with a Dr. Bassinger assisting. The reduction was completed and a cast was applied to the leg. X-rays were taken and the films were read. The 'operation record' (taken from the hospital records in evidence) over the doctor's signature reads: 'At this time, the patient had a cardiac arrest. His [sic] BP could not be obtained in the extremities or directly over the heart. A cc of adrenalin was injected directly into the heart and external cardiac massage was immediately instituted. This was started approximately 4-5 seconds after it was known that the heart was not beating. After approximately 4-5 minutes, the pulse became palpable and the patient was taken to the RR [recovery room] with a Bennett respirator in action. Prognosis: Poor.' The condition of the patient remained critical, and she died three days later despite admittedly proper efforts to save her life.

The hospital records and the testimony of the autopsy surgeon were the only medical evidence produced by plaintiff. Neither the anesthetist, the surgeon nor his assistant was called, and none of them was a party defendant at the time of the trial. The autopsy surgeon was Dr. Arthur Wallace, and it is upon the basis of his testimony that plaintiff contends a 'conditional' case of res ipsa loquitur was made out. Both Dr. Wallace's report, the coroner's report and Dr. Wallace's testimony show as the cause of death: 'Infarction left internal capsule brain.' Dr. Wallace stated that in layman's language this meant a stroke; that 'infarction' meant death of tissue. He had found the condition described by gross examination, and it had been confirmed by microscopic examination made by a pathologist. Speaking hypothetically, he explained that this condition can either be the cause or the result of a cardiac arrest during or following an operation. ¹

Summarized, the doctor's testimony was that the infarction was caused by a blocking of a cell or cells of the brain in a vital area. In laymen's terms the patient had suffered a stroke. This infarction was possibly the result of a blood clot. These blood clots are called emboli when traveling, thrombi when stationary. The brain cell infarction could have occurred while the patient was in surgery and could have been the product of an embolus or emboli breaking off from the clotted blood produced by the ankle fracture, thereafter traveling through the body. In this connection, the thrombus found at autopsy in the lungs was, according to the doctor, significant. If the brain cell infarction was thus caused, the cardiac arrest would have resulted and nothing connected with the process of giving anesthesia would have had any connection therewith.

On the other hand, the cardiac arrest could have been the cause rather than the result of the infarcted brain cells, since if the heart stops beating oxygen starvation of the brain would occur within three to five minutes thereafter.

The doctor stated a number of possible causes of cardiac arrest. One, the breaking off of an emboli from the fracture reaching the brain, has already been described. The doctor testified to other possible causes: 'improper administration of drugs, excessive drugs. There possibly could be allergic factors entering this. The other factors primarily would be heart disease per se, coronary artery disease, valvular heart disease, previously damaged hearts.'

Plaintiff's counsel in his examination of Dr. Wallace brought out that in the postmortem examination the heart appeared to be normal, without any valvular disease; there was an insignificant amount of sclerosis and no disease of coronary vessels; the pancreas, spleen, kidneys and uterus were normal.

The incidence of cardiac arrest during anesthesia is a rarity. Dr. Wallace agreed with an article cited by plaintiff's counsel that the statistics varied from one cause in 8,600 to one per 24,000.

From this medical testimony it is argued that there was sufficient evidence from which a lay jury could have inferred that more probably than not an improper or excessive administration of anesthesia was administered. We disagree. No testimony of Dr. Wallace could justify such an inference. He had found no evidence of either an overdose of drugs ² or the improper administration thereof. In short, not a single finding of the doctor pointed to a cardiac arrest as a result of anything the anesthetist did or failed to do. On the contrary, such meager facts ascertained relevant to the unsolved problem of this woman's death pointed away from any fault of the anesthetist.

As stated above, the surgeon's report shows that this cardiac arrest had occurred after the reduction of the ankle had been completed and a cast applied. Dr. Wallace testified: '* * * After the operation is over the anesthesia is terminated. There is no need of it.' The following also appears in the record: 'Q. If a cardiac arrest occurs after the operation is over and after the anesthetizing agency has been shut off, would you say, Doctor, that it is more likely it was a stroke than anything else that brought about the cardiac arrest? A. That would be, I think also a fair statement. These cases like manipulating and ankle like was done in this case do not require too much anesthesia and if the anesthesia had been closed off, shut off and the patient was receiving oxygen and maybe was sent to the recovery room or something I wouldn't think there would be any influence on a cardiac arrest from the anesthetizing agent.' The most that plaintiff proved in this case was that a cardiac arrest during surgery is rare and can be caused by an improper administration or excessive use of the anesthetizing drugs--that among a half dozen other causes at least one, a stroke from a fracture produced emboli, could have occurred here (the latter cause, according to Dr. Wallace, being the more likely). Upon such a record there was no evidence of a res ipsa loquitur inference to put before a jury.

Recently this court in Inouye v. Black (Nov. 1965) 238 A.C.A. 36, 47 Cal.Rptr. 313 (speaking through Justice Friedman) had occasion to state the fundamental rules of res ipsa loquitur in relation to the granting or denial of a motion for nonsuit. We quote excerpts applicable here (pp. 38-39, 47 Cal.Rptr. p. 315): '* * * Briefly stated, the res ipsa loquitur doctrine creates an inference of engligence where, in the light of past experience, (a) the accident was probably the result of someone's negligence and (b) the defendant is probably the responsible person. (Fowler v. Seaton, 61 Cal.2d 681, 686, 39 Cal.Rptr. 881, 394 P.2d 697; Zentz v. Coca Cola Bottling Co., 39 Cal.2d 436, 446-447, 247 P.2d 344.) The plaintiff need not produce evidence excluding all possible causes other than the defendant's negligence. When the defendant's negligence is one of several possible causes reasonably inferable from the evidence, the choice or rejection of that particular inference must be left to the jury and cannot be assumed by the trial judge. [Citations.] Such a choice of inferences may be called 'conditional res ipsa loquitur.' (See Quintal v. Laurel Grove Hospital, 62 Cal.2d 154, 166, 41 Cal.Rptr. 577, 397 P.2d 161.)

'In considering a nonsuit motion the trial judge must view the evidence in the light most favorable to the plaintiff. Thus, where there is any evidence to support the application of res ipsa loquitur, the trial court must deny a nonsuit motion. (Greening v. General Air-Conditioning Corp., 233 Cal.App.2d 545, 553, 43 Cal.Rptr. 662; Reynolds v. Natural Gas Equipment, Inc., 184 Cal.App.2d 724, 735-736, 7 Cal.Rptr. 879.)

'To determine whether there is a reasonable probability of negligence causation, the courts rely on 'the light of past experience,' which in turn may be drawn from expert testimony or common knowledge. The more esoteric kinds of medical causation demand expert testimony; others are within the reach of lay experience. (Compare Davis v. Memorial Hospital, supra, 58 Cal.2d at pp. 817-818 [26 Cal.Rptr. 633, 376 P.2d 561], and Siverson v. Weber, 57 Cal.2d 834, 837, 22 Cal.Rptr. 337, 372 P.2d 97.)'

The type of accident which occurred in the instant case was clearly not one within the reach of lay experience. In some cases, however, medical testimony may...