Locke v. Pachtman
| Decision Date | 01 March 1994 |
| Docket Number | No. 5,Docket No. 96046,5 |
| Citation | 446 Mich. 216,521 N.W.2d 786 |
| Parties | Danny LOCKE and Shirley M. Locke, Plaintiffs-Appellants, v. Judith A. PACHTMAN, M.D. and James A. Roberts, M.D., Defendants-Appellees. Calendar, |
| Court | Michigan Supreme Court |
In this medical malpractice action, the trial judge granted defendants' motion for a directed verdict at the close of the plaintiff's proofs. The Court of Appeals affirmed, finding that plaintiff had failed to make a prima facie showing of the standard of care related to defendants' allegedly negligent conduct.
We affirm.
On August 5, 1981, plaintiff Shirley Locke underwent a vaginal hysterectomy with entocele and rectocele repair at the University of Michigan Hospital. 1 The procedure was performed by defendant, Dr. Judith Pachtman, then a fourth-year resident in gynecology. Codefendant, Dr. James Roberts, was the attending physician and was present for most of the surgery. 2
Dr. Pachtman testified that she performed the first two procedures, the hysterectomy and entocele repair, without complication, although the entocele repair took longer than expected. Following the entocele repair, Dr. Roberts left the room to attend another operation that had been previously scheduled.
Dr. Pachtman then began the rectocele repair. Upon Dr. Pachtman's initial insertion into the levator ani muscle, the needle she was using broke. One-half to two-thirds of the needle, a length of about 1.5 cm, broke off and lodged somewhere within that muscle. Dr. Pachtman searched unsuccessfully for the broken portion of the needle for fifteen to twenty minutes. At that time, Dr. Roberts returned and joined Dr. Pachtman in searching for the needle fragment.
Drs. Pachtman and Roberts utilized a silver probe to x-ray the affected area, in an attempt to locate the broken portion of the needle. After ascertaining the approximate location of the fragment, they decided to close the old incision and to continue their search through a new incision. 3 After unsuccessfully searching for the needle for another forty-five minutes to one hour, they abandoned the search and closed the second incision. Both doctors indicated that they felt it was in the plaintiff's best interest to terminate the surgery at that point, even though they had failed to locate the needle fragment.
Plaintiff testified that after the surgery Dr. Pachtman informed her of the needle breakage and stated that the needle was entrenched in the muscle and therefore could remain there without causing her any problems. However, after experiencing considerable pain and discomfort, plaintiff consulted with another physician, Dr. Frances Couch. Dr. Couch advised removing the needle fragment, and, subsequently, she performed the surgical procedure, successfully locating and removing the broken portion of the needle.
Plaintiff filed suit against Drs. Pachtman and Roberts, alleging negligence on various grounds, including the use of a needle that they knew or should have known was too small and failing to locate and remove the needle fragment. Plaintiff claimed that she suffers from severe pain, disfigurement, and limitation of body movement and functions, as well as experiencing mental and emotional distress. Plaintiff's husband, Danny Locke, filed a derivative claim.
In testimony presented at trial, plaintiff's expert witness, Dr. Couch, was unable to identify any negligent conduct on the part of either Dr. Pachtman or Dr. Roberts. 4 Dr. Couch also stated that she could not give an opinion regarding the adequacy of the needle size, because she had never viewed the needle intact. She explained that she could not identify the size of the needle without viewing the needle in its entirety.
When questioned generally regarding the cause of needle breakage and its relation to the standard of care, Dr. Couch made two separate statements. At one point Dr. Couch stated that the standard of care did not relate to needle breakage at all, but rather to how one dealt with it, suggesting that needle breakage was simply one of the risks of surgery. Later, without relating this point to a standard of care, she noted that a surgeon's "incorrect technique" often causes a needle to break. When asked to describe what she meant by incorrect technique, Dr. Couch described instances in which a surgeon fails to manipulate the needle correctly, such as by inserting it at the wrong angle or applying too much force. Dr. Couch also testified that she had previously had a needle break while performing surgery.
In addition to Dr. Couch's expert testimony, plaintiff introduced evidence regarding a number of statements allegedly made by Dr. Pachtman following the surgery.
Plaintiff's brother, Reverend Gary Heniser, testified that, while he was at the hospital visiting his sister, Dr. Pachtman told him, " 'I knew the needle was too small when I used it.' "
Coplaintiff Danny Locke testified that Dr. Pachtman had also spoken to him about the surgery: "[S]he told me that it was her fault, that she used the wrong needle, and she was sorry."
Finally, Shirley Locke testified that Dr. Pachtman had told her:
5
Both Dr. Pachtman and Dr. Roberts testified at trial. Neither acknowledged any negligent behavior in the choice of needle, the needle breakage, or their subsequent search for the needle fragment.
At the close of plaintiff's proofs, the trial court granted defendants' motion for directed verdict on the ground that plaintiff had failed to make a prima facie showing regarding the standard of care. Plaintiff's motion for a new trial was denied, and, in a divided opinion, the Court of Appeals affirmed. This Court granted leave to appeal. 444 Mich. 885, 511 N.W.2d 687 (1993).
Proof of a medical malpractice claim requires the demonstration of the following four factors: (1) the applicable standard of care, (2) breach of that standard of care by the defendant, (3) injury, and (4) proximate causation between the alleged breach and the injury. M.C.L. § 600.2912a; M.S.A. § 27A.2912(1). 6 To survive a motion for directed verdict, the plaintiff must make a prima facie showing regarding each of the above elements.
Plaintiff argues that the lower courts erred in finding that she had failed to demonstrate the standard of care applicable to defendants' conduct. Plaintiff contends that expert testimony was sufficient to establish this point, and, further, that the standard of care and breach of that standard were inferable under the doctrine of res ipsa loquitur and because the alleged negligence was within the common understanding of the jury.
We agree with the lower courts' determination that no prima facie showing was made, and therefore we affirm the directed verdict entered for the defendants.
When evaluating a motion for directed verdict, the court must consider the evidence in the light most favorable to the nonmoving party, making all reasonable inferences in the nonmoving party's favor. Beals v. Walker, 416 Mich. 469, 480, 331 N.W.2d 700 (1982).
Because different theories of recovery are involved, we will address the claims against each defendant individually.
Plaintiff argues first that the standard of care attributable to Dr. Pachtman was established by way of expert testimony. This Court has long recognized the importance of expert testimony in establishing a medical malpractice claim, and the need to educate the jury and the court regarding matters not within their common purview. As we have previously explained:
In a case involving professional service the ordinary layman is not equipped by common knowledge and experience to judge of the skill and competence of that service and determine whether it squares with the standard of such professional practice in the community. For that, the aid of expert testimony from those learned in the profession involved is required. [Lince v. Monson, 363 Mich. 135, 140, 108 N.W.2d 845 (1961).]
While we have recognized exceptions to this requirement, the benefit of expert testimony, particularly in demonstrating the applicable standard of care, cannot be overstated.
In this case, plaintiff contends that the standard of care applicable to Dr. Pachtman was established by Dr. Couch's expert testimony. For this point, plaintiff relies on Dr. Couch's statement that needle breakage often occurs because of the surgeon's "incorrect technique." Plaintiff asserts that this testimony, coupled with Dr. Pachtman's admissions regarding use of a needle she knew to be too small, were sufficient to establish the standard of care and breach of that standard.
Dr. Couch's testimony with regard to the standard of care associated with needle breakage was rather confused. At one point she suggested that needle breakage was merely one of the risks of surgery, and that needle breakage did not ordinarily signal a violation of the standard of care:
Q. Do you feel that when a needle breaks off during a hysterectomy procedure as in this case that it is not a standard of care question but rather is just one of the contemplated risks of such surgery?
A. Yes, that is correct. It's not a standard of care. You always know that there will be something, maybe some equipment failure but standard of care is how you deal with the situation.
Dr. Couch later testified that needle breakage may be attributable to a surgeon's "incorrect...
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