McBride v. United States, 26771.
Decision Date | 14 June 1972 |
Docket Number | No. 26771.,26771. |
Citation | 462 F.2d 72 |
Parties | Peggy W. McBRIDE, individually and as next friend of Susan Kay McBride, et al., Plaintiffs-Appellants, v. UNITED STATES of America, a body politic and sovereign, Defendant-Appellee. |
Court | U.S. Court of Appeals — Ninth Circuit |
Daral G. Conklin (argued), of Conklin & Kimura, Honolulu, Hawaii, for plaintiffs-appellants.
William J. Eggers, Asst. U. S. Atty. (argued), Michael R. Sherwood, Asst. U. S. Atty., Robert K. Fukuda, U. S. Atty., Honolulu, Hawaii, for defendant-appellee.
Before BROWNING, WRIGHT and CHOY, Circuit Judges.
After Commander Robert McBride, a retired naval officer, suffered a fatal heart attack, his widow and minor children commenced this wrongful death action against the United States under 28 U.S.C. § 1346(b). They claim the death was proximately caused by negligent failure of the duty doctor at Tripler Army Hospital, Hawaii, to admit McBride to a coronary care unit.
The parties agreed to bifurcate the trial and to litigate first the issue of liability, with the court as trier of fact. At the close of the plaintiff's evidence, the trial judge granted the government's motion to dismiss under Rule 41(b), F. R.Civ.P., on the alternate grounds that the government doctor had not been negligent and that the plaintiffs had not established the requisite causal proximity between lack of hospital treatment and McBride's death.
We reverse and remand because we believe the trial judge may have applied an incorrect standard of care on the negligence issue, and because the finding on proximate causation is clearly erroneous.
In January 1968 McBride spent five days in the Tripler Hospital heart ward, undergoing testing to diagnose the source of pain in his lower chest. The tests revealed no evidence of heart disease, but the staff did not rule it out. McBride was released and requested to return in a few weeks for further testing.
Three nights later McBride again experienced severe chest pains. He went to the Tripler emergency room in the early morning hours of January 28. The physician on duty, a young resident, examined him, read the report of the earlier testing, and took an electrocardiogram, a tracing showing the changes in electric potential produced by heart contractions. McBride's pain had subsided quickly, and throughout the examination his vital signs appeared normal.
The physician told McBride his pain probably resulted from a gastrointestinal disturbance, but that heart disease could not be eliminated as a possibility. He advised admission to the coronary care unit. McBride expressed a preference to return home, saying he felt fine and the previous hospitalization had disclosed no problems with his heart. The doctor allowed McBride to leave, on condition that he return at once should the pain recur. McBride died shortly after reaching home.
The plaintiffs sought to prove that the duty doctor had been negligent in his diagnosis and should have insisted that McBride be hospitalized. The trial judge correctly stated the appropriate standard of conduct against which the doctor's acts must be measured. See Restatement (Second) of Torts § 299A:1
Unless he represents that he has greater or less skill or knowledge, one who undertakes to render services in the practice of a profession or trade is required to exercise the skill and knowledge normally possessed by members of that profession or trade in good standing in similar communities.
We are unable to determine from the record whether the court actually applied this standard in making its finding. The judge's comments and questions suggest strongly that he was judging the doctor on the basis of what one could reasonably expect from a young resident, instead of measuring his acts against a community standard.2
The duty doctor acknowledged at trial that he had erroneously interpreted McBride's electrocardiogram as normal, although in truth it revealed an abnormal pattern. The plaintiffs produced experts who said the general practitioner with ordinary skill would have read the electrocardiogram accurately. The Chief of Cardiology at Tripler testified that many interns and residents would not have recognized the abnormal tracings. The court relied heavily upon this last bit of testimony, saying that the duty doctor's misinterpretation did not demonstrate negligence if one viewed it against the backdrop of his lack of special training and experience.
The appellants contend that the court erred in holding the duty doctor to a standard of conduct founded upon his personal experience. We agree. Under the American Law Institute formula, the duty of care owed to the patient does not vary according to the doctor's individual knowledge or education. The wording of the Restatement section indicates that the normal standard will be altered only if the doctor represents to his patients that he possesses special skill. The change depends upon the nature of the representation to the patient, not upon an after-the-fact assessment of what one could expect from a doctor with comparable training and practice.
Commander McBride had the right to expect the quality of care usually found in the medical community and the hospital was obliged to provide physicians who could meet that standard. If the hospital staff had reason to believe that its interns and residents could not reasonably be expected to discern subtle abnormalities in electrocardiogram tracings, then it should not have permitted them to make unaided electrocardiogram analyses.
We do not mean to imply that we believe the duty doctor acted negligently. Indeed, had the trial court made its finding after applying the correct standard, we could not say on this record that the finding would be clearly erroneous. But we do not know whether the judge would have...
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