Larsen v. Yelle

• Decision Date: 22 October 1976
• Docket Number: No. 46095,46095
• Parties: Irl G. LARSEN, Appellant, v. Dr. Matthew D. YELLE, Respondent.
• Court: Minnesota Supreme Court

Page 841

246 N.W.2d 841

310 Minn. 521

Irl G. LARSEN, Appellant, v. Dr. Matthew D. YELLE, Respondent.

No. 46095.

Supreme Court of Minnesota.

Oct. 22, 1976.

Syllabus by the Court

A directed verdict for defendant physician in plaintiff's medical malpractice action was improper when the evidence of record would have been sufficient to sustain a jury verdict for plaintiff. Rule 50.01, Rules of Civil Procedure.

Rischmiller & Wasche and Robert Wm. Rischmiller, Minneapolis, for appellant.

Altman Geraghty Mulally & Weiss and Terence J. O'Loughlin, St. Paul, for respondent.

Considered and decided by the court en banc.

PETERSON, Justice.

Plaintiff, Irl G. Larsen, sued defendant, Dr. Matthew D. Yelle, alleging that defendant was negligent in his medical treatment of a fracture of plaintiff's right wrist. At the close of plaintiff's case in chief before a jury, the district court directed a verdict for Dr. Yelle, and Larsen appealed to this court. We reverse and remand for a new trial.

Larsen fell from a stack stool at his home in Anoka on Saturday, April 22, 1972, and sustained a severely comminuted Colles fracture of the right wrist (a fracture in which the bone was splintered). He was treated by Dr. Yelle, a physician engaged in the general practice of medicine, who after viewing X rays reduced the fracture and applied a conventional circular cast of plaster. Because of severe swelling of Larsen's wrist area, Dr. Yelle within 3 days split the cast open, first on one side then on the other side, as well. There was some slippage or shortening or settling of the bone because it was not held firmly in place, and Larsen's wrist healed in a deformed manner.

Dr. David W. Florence, an orthopedic specialist, testified that because the treatment of a severely comminuted Colles fracture is totally different from the treatment of other types of Colles fractures, it is the ordinary custom and practice of a general practitioner to refer the patient to an orthopedic surgeon for treatment. He explained that this type of fracture is usually treated by a special technique called pins and plaster, in which pins are placed for traction purposes through the hand and through the elbow, then incorporated into a plaster cast. Dr. Florence testified that the purpose of the pins and plaster technique is to prevent residual deformity, and that if pins are not used the bone fragments in the comminuted area will settle back causing it to 'clam up like an egg shell.' In Dr. Florence's opinion, if the pins and plaster technique had been used in this case, deformity would have been minimized or eliminated.

Dr. Florence implied that some general practitioners might competently treat the type of fracture which Larsen sustained, even though most refer such cases to specialists. (Dr. Yelle had already testified that he himself would not be competent to employ a pinning technique without 2 weeks of special training for that purpose.) Dr. Florence agreed that some orthopedists might not have used the pins and plaster technique but might have used some other accepted orthopedic technique instead, such as hanging the arm in pin traction for a number of days to get swelling out before even reducing the fracture or applying a cast. Dr. Florence did testify, however, that orthopedic surgeons do not apply a circular cast in the initial treatment of this type of injury because tremendous swelling is to be expected, and this swelling cannot be handled with a circular cast.

Although, according to Dr. Florence's testimony, tremendous swelling should have been anticipated, some of the swelling of Larsen's wrist area might have been associated with Sudeck's atrophy. Dr. Yelle testified that Sudeck's atrophy is a rarely encountered complication which, when it occurs, usually occurs in fractures of the wrist and ankle and is characterized by the very small blood vessels in the extremity going into spasm, causing poor circulation and consequent swelling from blood still being pumped to the area. The treatment for Sudeck's atrophy is to encourage mobilization of the affected area.

Dr. Yelle agreed that if pins had been employed prior to the onset of Sudeck's atrophy the shortening of the bone would have been prevented. Dr. Florence testified that Sudeck's atrophy can occur anywhere from 8 to 16 weeks after an injury, but admitted that it might in an extremely rare case occur as early as 2 weeks following injury. In the case at bar Dr. Yelle reduced the fracture and applied the circular cast on the date of injury. The swelling that did occur came early, and the cast was loosened 1 day after injury and split completely in two on the third day after injury. It will be for the jury to resolve the factual question to what extent the swelling resulted from normally anticipated causes or from Sudeck's atrophy. From the evidence admitted, however, the jury could have concluded that on the date of injury Dr. Yelle should have anticipated the entire extent of the swelling which occurred shortly thereafter and necessitated the loosening of the cast.

A motion for a directed verdict should not be granted if the evidence is sufficient to sustain a verdict for the opponent. Rule 50.01, Rules of Civil Procedure. In order to sustain a verdict for the plaintiff, the evidence must be sufficient for the jury to ascertain what is the requisite standard of care and to determine that defendant's conduct was a deviation from that standard.

In a negligence action the defendant is held to that standard of care which a reasonably prudent man would have exercised under the same circumstances, although in a medical malpractice case the learning and experience of a physician in good standing in his profession must be incorporated into the definition of a reasonably prudent man. Miller v. Raaen, 273 Minn. 109, 113, 139 N.W.2d 877, 879 (1966). That is to say, the defendant is required at a minimum to exercise that degree of skill, care, knowledge, and attention ordinarily possessed and exercised by other physicians under like...