Jutzi v. County of Los Angeles

• Decision Date: 24 November 1987
• Docket Number: No. B009799,B009799
• Citation: 242 Cal.Rptr. 74,196 Cal.App.3d 637
• Court: California Court of Appeals Court of Appeals
• Parties: Judy Elaine JUTZI, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Respondent.

Page 74

242 Cal.Rptr. 74

196 Cal.App.3d 637

Judy Elaine JUTZI, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Respondent.

No. B009799.

Court of Appeal, Second District, Division 4, California.

Nov. 24, 1987.

Review Denied Feb. 25, 1988.

Milton Wasserman, for plaintiff and appellant.

Greines, Martin, Stein & Richland, Martin Stein and Barbara W. Ravitz, Beverly Hills, for defendant and respondent.

GEORGE, Associate Justice.

Plaintiff Judy Jutzi sued defendant County of Los Angeles for alleged medical malpractice involving medical services rendered at Los Angeles County USC (University of Southern California) Medical Center. ¹ A jury returned a verdict in favor of defendant, and the trial court denied plaintiff's motions for new trial and for judgment notwithstanding the verdict.

Plaintiff appeals from the judgment and the denial of her motion for judgment notwithstanding the verdict, ² contending that (1) the trial court erred in applying to this case Health and Safety Code section 1799.110 (formerly Health & Saf.Code, § 1768), which requires additional qualifications of expert witnesses who testify regarding emergency medical care; (2) the trial court erred in admitting the testimony of certain medical witnesses; (3) defendant's attorney committed misconduct during argument; and (4) a juror committed misconduct during deliberations. For the reasons discussed below, we affirm the judgment and the order denying judgment notwithstanding the verdict.

FACTS

At about 10 p.m. on Sunday, December 5, 1976, plaintiff, a 30-year old woman, broke her left ankle in a fall down a flight of stairs. A paramedic ambulance brought her to the emergency room of California Hospital. Her leg was in a cardboard splint, which had been applied by the paramedics. X-rays and a physical examination revealed that the fibula and the tibia were fractured in the ankle joint. The fracture was displaced, meaning that instead of being in normal alignment, the bones had come apart and the ankle was deformed.

The emergency room physician at California Hospital determined that plaintiff had good circulation in her left foot and had suffered no other apparent injuries. He gave her a small dose of Demerol, a painkiller, but not considering himself qualified to give orthopedic care, he did not attempt to treat the fracture. Instead, at about 2:30 a.m. (four hours after she had arrived at California Hospital), plaintiff was transferred by ambulance to the Los Angeles County USC Medical Center (County Hospital), both because no orthopedist was available at California Hospital and because County Hospital had agreed to provide emergency care for persons who had been brought to California Hospital but were unable to pay for treatment. The cardboard splint may have been removed at California Hospital when plaintiff's leg was x-rayed, "but it was either put back on or kept on," according to the emergency room physician at California Hospital.

Although he was not an orthopedic specialist, and such specialists were available at the hospital, Dr. John Reynolds, an emergency room physician, treated plaintiff when she arrived at County Hospital. On prior occasions Dr. Reynolds had treated between 50 and 60 broken ankles similar to plaintiff's. He observed upon her arrival that her leg was in a cardboard splint. Dr. Reynolds proceeded to administer an anesthetic block and reduce the fracture, meaning that he brought the broken bones back into proper alignment. Dr. Reynolds then applied a full-leg cast. A subsequent x-ray showed that the alignment was good. Dr. Reynolds testified that he applied casts every day he worked in the emergency room.

Dr. Reynolds prescribed Tylenol with Codeine to relieve plaintiff's pain and Valium to calm her nerves. Plaintiff was issued crutches and was released to go home. She was aware that her cast was not a walking cast and that it could not bear weight. She was given an appointment to return in 24 hours to have the cast checked and a second appointment to return one week later. An instruction sheet given to her explained how to care for her leg, warned of the danger signs of complications, and advised her to return to the hospital in the event such complications occurred. After Dr. Reynolds went over the instruction sheet with plaintiff, he felt that she understood it and also understood the use of crutches.

Plaintiff's mother picked her up at the hospital at about 9 a.m. Monday and drove her home. She told plaintiff to wait in the vehicle while she went to get help from a neighbor, but plaintiff grew impatient and instead dragged herself unassisted from the vehicle into the house by sitting on the ground and pushing herself backwards. On Tuesday morning, plaintiff's mother telephoned the hospital and told the woman who answered that she was unable to bring in plaintiff for the 24-hour cast check. In response, plaintiff's mother was told, " 'Well, bring her in when you can.' " Since plaintiff's leg seemed to be all right, her parents did not consider the 24-hour cast check very important. They planned to bring her in for her second appointment a week later unless her condition changed prior to then.

Plaintiff had "a little pain" on Monday, Tuesday and Wednesday but no other problems. On Thursday morning, plaintiff was alone in the house and went into the kitchen, where she slipped and fell. By Thursday night, plaintiff was "in terrible pain." She went to her father in tears and asked him to cut off the cast because it was too tight. He refused, and plaintiff did not seek medical care from Dr. Reynolds or anyone else, although the hospital emergency room was open 24 hours a day.

On Friday morning, plaintiff was still in great pain. Plaintiff's mother noticed that there were blisters on plaintiff's toes and that one of the toes appeared black. When plaintiff's father came home for lunch a couple of hours later, he and plaintiff's mother took plaintiff to County Hospital.

At the hospital it was determined that the circulation in plaintiff's lower leg had been impaired and that damage to the tissues was irreversible. Gangrene developed and 15 days after plaintiff's return to the hospital her left leg was amputated below the knee.

At trial plaintiff's experts testified that Dr. Reynolds should have consulted an orthopedic specialist because plaintiff had a "significant" fracture, although there was no evidence that the fracture was improperly reduced. Instead plaintiff's experts asserted the cast had been made too tight and that it contained a protruding ridge on the inside. The ensuing swelling, which would be anticipated in this type of injury, restricted the circulation in the leg, leading to gangrene. Plaintiff's experts also criticized the decision of Dr. Reynolds to release plaintiff immediately from the hospital instead of keeping her overnight for observation. Plaintiff's experts believed her fall on Thursday morning was not the cause of the complications because the gangrene observed in the hospital the next day could not have developed to that extent in 24 hours.

Defendant's experts believed that the cast was not too tight when initially applied and that the amputation was necessitated by plaintiff's fall and failure immediately after the fall to return to the hospital for treatment. These experts relied on plaintiff's complaint of only minor pain following application of the cast, this being consistent with the normal healing process for such a fracture. Following the fall, however, her pain increased quickly and dramatically. Defendant's experts concluded that the fall produced additional swelling, which restricted circulation in the leg and led to gangrene. It was the opinion of these experts that, given Dr. Reynolds's training and experience, it was within the standard of care for him to reduce and cast plaintiff's fracture without consulting an orthopedist. They also expressed the opinion that if the cast had been applied improperly at the outset, thus restricting circulation, plaintiff would have been in excruciating pain within hours of leaving the hospital. The defense experts' interpretation of the medical records was that the damage to the leg, although irreversible by Friday, did not yet constitute gangrene and thus could have developed as a result of the Thursday fall.

DISCUSSION

I THE APPLICABILITY OF HEALTH AND SAFETY CODE SECTION 1799.110, REQUIRING ADDITIONAL QUALIFICATIONS OF EXPERT WITNESSES WHO TESTIFY REGARDING EMERGENCY MEDICAL CARE

Pursuant to Health and Safety Code section 1799.110, ³ the trial court precluded two of plaintiff's expert medical witnesses who did not have recent experience working in a hospital emergency room from testifying that Dr. Reynolds fell below the standard of care in treating plaintiff. ⁴ Plaintiff contends that the excluded testimony should have been received because Dr. Reynolds's services did not constitute "emergency medical coverage" under the statute, and because the statute applies only to suits against physicians whereas the instant action was brought against the County of Los Angeles. We disagree. As explained below, there was sufficient evidence to support the trial court's implied finding that the treatment of plaintiff constituted "emergency medical coverage." Furthermore, section 1799.110, subdivision (c) applies to any suit involving a claim of negligent emergency treatment by a hospital emergency room physician whether or not that physician is named as a defendant.

A. The Definition of "Emergency Medical Coverage"

A special requirement, set forth in subdivision (c), must be met before a witness can qualify to testify as a medical expert concerning alleged negligent treatment administered by an emergency room physician. This provision applies only where "emergency medical coverage" is provided. No definition of this term is given, but the apparently synonymous term "emergency medical care" is defined by subdivision...