Donaldson v. Maffucci

• Decision Date: 24 November 1959
• Parties: Merrill DONALDSON and Dorothy Donaldson, his wife, Appellants, v. Victor MAFFUCCI, Jr.
• Court: Pennsylvania Supreme Court

156 A.2d 835

397 Pa. 548

Merrill DONALDSON and Dorothy Donaldson, his wife, Appellants, v. Victor MAFFUCCI, Jr.

Supreme Court of Pennsylvania.

November 24, 1959.

Michael Hahalyak, Pittsburgh, for appellant.

Samuel H. Jubelirer, Altoona, E. W. Van Horn, Jr., Bedford, for appellee.

Before CHARLES ALVIN JONES, C. J., and BELL, BENJAMIN R. JONES COHEN, BOK, and McBRIDE, JJ.

BENJAMIN R JONES, Justice.

Dorothy Donaldson, the wife-appellant, was injured in an automobile accident in the late evening of July 17, 1954 and admitted to the Bedford County Memorial Hospital in the early morning of July 18, 1954. The appellee, Dr. Maffucci her private physician, was summoned and upon his arrival at the hospital an X-ray examination, at his direction, was made of Mrs. Donaldson's left wrist and jaw. This examination indicated a 'Colles fracture' of the left wrist consisting of a 'fracture of the distal radial metaphysis with marked posterior and lateral displacement of the distal fragment which is rotated posteriorly and over-rides the proximal fragment for about 1 cm' and a 'fracture of the ulnar styloid'. Mrs. Donaldson's upper lip had a 2"'-2 1/2"' laceration.

Dr. Maffucci then performed a 'closed reduction' ^[1] of the fractured wrist, under anesthesia, sutured the lip, directed another X-ray examination and applied a cast to the left arm from the elbow down to the tips of the fingers. Later on the same morning Dr. Maffucci removed the cast and manipulated the fracture, without anesthesia. An X-ray examination then made indicated that the overriding of the bones had been corrected, that there was 'about 5 mm posterior displacement of the distal fragment * * * now rotated posteriorly for only 15 degrees' and that the posion was improved over that shown in the previous film. The cast was then reapplied. Dr. Sipes, the senior surgeon of the hospital was called into consultation by Dr. Maffucci; on July 22nd Dr. Sipes recommended an 'open reduction' ^[2] which never took place. Another X-ray examination was made on July 23rd which indicated that the improvement of position obtained by the second 'closed reduction' had been lost. This examination was not interpreted for Dr. Maffucci until after Mrs. Donaldson had left the hospital on July 24th. At the time Mrs. Donaldson left the hospital her left arm from the elbow to the tips of her fingers was enclosed in a cast. Dr. Maffucci did not treat Mrs. Donaldson subsequent to July 24th.

On July 28th Mrs. Donaldson consulted a Dr. Palin, who, upon examination, found some deformity in the wrist and some stiffness in the finger joints. Mrs. Donaldson was readmitted on July 28th to the hospital where a further examination by X-ray and fluoroscope revealed the existence of the same conditions as noted in the X-ray examination of July 23rd. Dr. Palin then attempted another 'closed reduction' on July 29th. Mrs. Donaldson left the hospital on July 31st and remained thereafter under Dr. Palin's care. She was readmitted to the hospital on September 20th, it having been discovered that, despite Dr. Palin's sttempt at a 'closed reduction', a non-union of the bones existed. While at the hospital two 'open reductions' were performed by Dr. Palin which included the insertion first of wires, then later of a bone plate. At a subsequent time, at Dr. Palin's suggestion, Mrs. Donaldson consulted a Dr. White in Pittsburgh who performed further operations on the wrist.

On June 30, 1956 in the Court of Common Pleas of Bedford County Mr. and Mrs. Donaldson instituted a trespass action against Dr. Maffucci alleging that he had been guilty of malpractice. The matter came on for trial and, at the close of appellants' testimony, the court below entered a compulsory nonsuit. From the refusal to take off this nonsuit this appeal was taken.

The reason assigned for the entry of the nonsuit by the court below was: '* * * plaintiffs had clearly failed to meet the burden of proof required in malpractice cases * * *' in that they 'were bound to produce expert witnesses whose testimony would support their claim and who would conclude that, in their professional opinion, [appellants] injury resulted from [appellee's] negligence.

Appellants urge four reasons why the nonsuit should be lifted: first, under the instant factual situation expert testimony was unnecessary; second, even if such expert testimony were necessary, it was supplied by appellants' medical evidence; third, evidence that appellee was in a state of intoxication when he attempted the 'closed reduction' of the wrist was improperly excluded; fourth, assuming, arguendo, the insufficiency of appellants' medical evidence to establish the requisite negligence as the cause of the injury, the court below erroneously excluded certain testimony through the medium of which megligence would have been stablished.

In our disposition of this appeal 'plaintiffs must be given the benefit of all the favorable testimony and every reasonable inference of fact arising therefrom; and all conflicts therein must be resolved in their favor. [citing cases]:' Finnin v. Neubert, 378 Pa. 40, 41, 42, 105 A.2d 77; Seburn v. Luzerne & Carbon County Motor Transit Company, 394 Pa. 577, 579, 148 A.2d 534.

The standard of care required of a physician or surgeon is well-settled. In the absence of a special contract, a physician or surgeon is neither a warrantor of a cure nor a guarantor of the result of his treatment: McCandless v. McWha, 22 Pa. 261, 267; ^[3] Tyson v. Baizley, 35 Pa.Super. 320, 322. A physician who is not a specialist is required to possess and employ in the treatment of a patient the skill and knowledge usually possessed by physicians in the same or a similar locality, giving due regard to the advanced state of the profession at the time of the treatment; and in employing the required skill and knowledge he is also required to exercise the care and judgment of a reasonable man. However, a physician or surgeon is not bound to employ any particular mode of treatment of a patient, and, where among physicians or surgeons of ordinary skill and learning more than one method of treatment is recognized as proper, it is not negligence for the physician or the surgeon to adopt either of such methods: Duckworth v. Bennett, 320 Pa. 47, 181 A. 558; Moscicki v. Shor, 107 Pa.Super. 192, 163 A. 341; Barnard v. Schell, 85 Pa.Super. 329; Remlly v. Plummer, 79 Pa.Super. 117.

The burden of proof in a malpractice action is upon the plaintiff to prove either (1) that the physician or surgeon did not possess and employ the required skill and knowledge or (2) that he did not exercise the care and judgment of a reasonable man in like circumstances; and that the injury complained of either (1) resulted from the failure on the part of the physician or surgeon to possess and employ the required amount of skill and knowledge or (2) resulted from his failure to exercise the care and judgment of a reasonable man in like circumstances. Furthermore, a plaintiff is bound by the expert testimony rule so well expressed by Chief Justice Stern in Robinson v. Wirts, 387 Pa. 291, 294, 295, 127 A.2d 706, 709; '* * * no presumption or inference of negligence arises merely because the medical care or surgical operation terminated in an unfortunate result which might have occurred even though proper care and skill had been exercised, and where the common knowledge or experience of laymen is not sufficient to warrant their passing of judgment. In such cases the doctrine of res ipsa loquitur or of exclusive control may not be invoked, and expert testimony in support of the plaintiff's claim is an indispensable requisite to establish a right of action' (Emphasis supplied). ^[4]

Appellants initially argue that the expert testimony rule has no present application because of the factual situation. They urge that 'a layman is equally competent [equally to an expert] in determining whether a steady hand had been used in approximating the bone fragments and whether the bones in this very common type of fracture were properly approximated'. In short, the appellants argue: we have proven a poor result from the treatment for a very common wrist fracture and, since a steady hand on the part of the doctor was all that was required to make a proper 'closed reduction' and secure a good result, a jury, particularly with evidence of intoxication before it, would be equally as competent as any expert to find whether the...