Holmes v. Gamble
| Decision Date | 20 December 1982 |
| Docket Number | No. 80SC361,80SC361 |
| Citation | 655 P.2d 405 |
| Parties | G. Dudley HOLMES, Petitioner, v. William E. GAMBLE, M.D. and Carl F. Heaton, M.D., Respondents. |
| Court | Colorado Supreme Court |
Dufty, Schoenwald & Hultin, Lawrence J. Schoenwald, Denver, for petitioner.
Johnson, Mahoney & Scott, P.C., Paul E. Scott, Brian J. Lampert, Denver, for respondent Gamble.
Hall & Evans, Eugene O. Daniels, Denver, for respondent Heaton.
We granted certiorari to review the judgment of the Colorado Court of Appeals in Holmes v. Gamble, 624 P.2d 905 (Colo.App.1980), affirming a Denver District Court order directing verdicts for both defendants in a medical malpractice action. We affirm the judgment, but determine that the Court of Appeals applied the wrong standard in upholding the district court's ruling that the plaintiff failed to establish a prima facie case of res ipsa loquitur.
Holmes was a Vail building contractor who suffered severe injury to his knee when a ditch in which he was working collapsed. Rescuers dug Holmes out of the ditch where he was buried waist-deep. A doctor in Vail referred Holmes to the defendant William E. Gamble, a Denver orthopedic surgeon, for immediate knee surgery. After a sedative was administered to Holmes, his brother transported him from Vail to Denver in the back of a station wagon. Dr. Gamble, assisted by the defendant anesthesiologist, Dr. Carl F. Heaton, operated on Holmes' knee the following day. 1 Holmes was anesthetized and unconscious during the entire operation.
Awakening from anesthesia the morning after the operation, Holmes experienced numbness and tingling in the last three fingers of both hands. Holmes testified that he noticed these sensations immediately after regaining consciousness. His mother and brother, who were present in his hospital room when he awakened, corroborated his testimony. Holmes also testified that he described the numbness and tingling to Dr. Gamble later that day and that Gamble told him that the sensations could have been caused by pressure on his elbows during the operation. Dr. Gamble testified that he was not sure whether Holmes told him of this condition the day after the operation but believed that Holmes first mentioned it almost two weeks later. A medical history taken by a neurologist whom Holmes consulted three weeks after the operation recited that Holmes had not become aware of the sensations until several days after the operation. The neurologist diagnosed the sensations as symptoms of bilateral ulnar neuropathy--a condition which can be caused by traumatic injury to nerves in the elbows. Holmes' use of his hands became increasingly impaired by a loss of strength and by curling of the fingers. Neurosurgery was performed on one elbow, and by the time of the trial, Holmes had recovered some but not full use of both hands.
Holmes sued Doctors Gamble and Heaton for malpractice, alleging that the ulnar neuropathy affecting his hands was triggered by traumatic injuries to the nerves in his elbows caused by the doctors' negligent failure to properly position him on the operating table during his knee operation. Because he possessed no direct evidence of the events which had transpired during the operation, Holmes attempted to invoke the doctrine of res ipsa loquitur to create a presumption that his neural disorder was a proximate result of the defendants' negligence. His prima facie case consisted of the following circumstantial evidence: never before had he exhibited any symptoms of ulnar neuropathy; the cave-in injured only his lower body; undue force was not exerted on his upper body or extremities during the rescue; medical examinations conducted preoperatively in Vail and at the Denver hospital disclosed no evidence of trauma to the elbow nerves; he was transported from Vail to Denver in a careful manner; he experienced no numbness or tingling in his fingers between the time he was injured in the cave-in and the time he was anesthetized by Dr. Heaton; and he experienced those sensations for the first time immediately upon regaining full consciousness following the operation. Holmes also presented medical testimony that: trauma to the elbow nerve often causes ulnar neuropathy; improper positioning on an operating table can cause trauma to a patient's elbow nerves; a doctor who improperly positions a patient on an operating table fails to use the reasonable degree of knowledge, skill and training possessed by other physicians practicing the same specialty; and, if a surgical patient has never experienced symptoms of ulnar neuropathy before being anesthetized, the onset of those symptoms immediately after the patient regains consciousness justifies an inference, to a reasonable degree of medical certainty, that the neuropathy was triggered between the time anesthesia was administered and the time the patient awoke.
The district court directed a verdict for the defendant Heaton at the close of the plaintiff's evidence but did not rule on whether the plaintiff had established the elements of res ipsa loquitur. Defendant Gamble then presented evidence that: ulnar neuropathy can arise spontaneously, but bilateral ulnar neuropathy is virtually unheard-of in the medical world; Holmes' symptoms, involving sensations in three fingers, indicate an injury to the brachial plexus which cannot be caused by positioning during surgery 2; the structure of Holmes' elbows exposed his ulnar nerves to an exaggerated risk of trauma; the trauma may have occurred during the cave-in but the sedative administered to Holmes could have precluded his pre-operative sensitivity to the nerve injury; Gamble properly positioned Holmes on the operating table; Holmes may not have experienced the first symptoms of neuropathy until several days after the operation; the failure of those symptoms to appear immediately after a patient awakens from anesthesia demonstrates the absence of a continuous heavy pressure on the ulnar nerve which would indicate a causal connection between operating room procedures and the patient's neuropathy; and that lesser trauma, such as the partial...
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