Quintal v. Laurel Grove Hospital

Decision Date14 December 1964
Citation397 P.2d 161,62 Cal.2d 154,41 Cal.Rptr. 577
CourtCalifornia Supreme Court
Parties, 397 P.2d 161 Reginald J. QUINTAL, a Minor, etc., et al., Plaintiffs and Appellants, v. LAUREL GROVE HOSPITAL et al., Defendants and Respondents. S. F. 21771

Jeremiah F. O'Neill, Jr., George W. Hauer and Robert A. Kaiser, Oakland, for plaintiffs and appellants.

Hardin, Fletcher, Cook & Hayes, Oakland, Cyril Viadro, Peart, Baraty & Hassard, George A. Smith, San Francisco, Joseph F. Rankin and Richard G. Logan, Oakland, for defendants and respondents.

PETERS, Justice.

Plaintiffs appeal from judgments notwithstanding the verdicts, and from alternative orders granting all defendants a new trial. In our opinion the judgments notwithstanding the verdicts must be reversed, and the orders granting a new trial must be affirmed.

The case revolves around the tragic experiences of plaintiff Reginald Quintal (Reggie), who, in July of 1960, when the events here involved occurred, was six years of age. Prior to July 11, 1960, Reggie was a normal, healthy child, suffering only from an inward deviation of the eyes. On July 10, 1960, he entered the defendant hospital for the purpose of having this condition corrected by a minor operation to be performed on July 11, 1960, by defendant Dr. Palmberg. On the morning of that day, during the course of the administration of the anesthetic by defendant Dr. Thornburg, Reggie suffered a cardiac arrest. He was resuscitated by means of an open chest heart massage. As a result of his brain being deprived of oxygen during the period his heart was stopped, he suffered severe brain damage resulting in his becoming a spastic quadriplegic, blind and mute. Reggie, through his guardian ad litem, his mother, brought this action against the two doctors and the hospital for malpractice. His mother sued for general and special damages. The jury returned verdicts against all three defendants and in favor of Reggie for $400,000, the precise amount prayed for in the complaint, and in favor of the mother for her special damages of $3,610.73. The trial court had denied motions for nonsuits and for directed verdicts, but granted the motions of all of the defendants for judgments notwithstanding the verdicts, and in the alternative, awarded all defendants, by an appropriate written order, a new trial on the grounds of excessive damages, insufficiency of the evidence, and that the verdicts were against the law.

The facts are as follows: In 1960, Reggie was suffering from some inward deviation of the eyes, but otherwise was normal and healthy. On May 8, 1960, he was taken to Laurel Grove Hospital in Castro Valley for an operation aimed at correcting the eye condition. The operation was performed by defendant Dr. Palmberg, an ophthalmologist, and was completed without incident. The anesthesiologist at that first operation is not a party to this case. He was an associate of defendant Dr. Thornburg. The first operation was not entirely successful in curing the deviation, and, after conservative treatment failed to cure the condition, it was decided that another operation was necessary. On July 10, 1960, Reggie was again taken to the Laurel Grove Hospital for an operation scheduled for the next morning, and estimated to take 20 minutes. Dr. Palmberg was to do the eye surgery, and Dr. Thornburg was to administer the anesthetic. The evening Reggie entered the hospital he was crying, with a running nose, was quite apprehensive, and was uncooperative. The medical record in fact shows that just before surgery he was 'very apprehensive' and 'very agitated.' He had a temperature when he first arrived at the hospital, which increased up to midnight. The hospital records purport to show that his temperature, just before the operation, was a little under normal, but by expert testimony it was shown that there had been a correction and erasure in that record, and what the original record showed does not appear. The erasure was not explained by defendants. The records also show that it was therein noted that the preoperative medication aimed at sedating the patient was 'unsatisfactory.'

When Dr. Palmberg entered the operating room Reggie was already there, and Dr. Thornburg was administering the anesthetic in a normal fashion. Dr. Palmberg took no part in administering the anesthetic, but remained in the room some distance from the operating table talking to an assistant about the intended operation.

During the administration of the anesthetic, and before the process had been entirely completed, Reggie suffered a respiratory arrest followed by a cardiac arrest. This means that his breathing and heart stopped. This, of course, cut off blood and oxygen to his brain. The record shows that the brain, without damage, may be without oxygen for not more than three minutes, but that every second over the three-minute limit endangers the patient and makes brain damage more probable.

When the respiratory and cardiac arrests occurred, Dr. Thornburg called out that Reggie's heart had stopped beating. Dr. Palmberg and his assistant rushed toward the table. Dr. Thornburg let the anesthetic gases out of the anesthetic bag, filled the bag with pure oxygen, pumpted the bag with one hand and with the other attempted to restore Reggie's heart action by external massage. This process was continued for 20 or 30 seconds and was then stopped to ascertain if the boy's heart had started. It had not. The process was repeated for another 20 or 30 seconds, but without success. Dr. Thornburg then asked Dr. Palmberg to open Reggie's chest in order to administer manual massage to the heart. Dr. Thornburg emphasized that this operation had to be done very quickly. Dr. Palmberg stated that he did not feel qualified to perform such an operation, and started to leave the operating room to get help. Just near the door to the operating room he encountered Dr. Beumer, a surgeon. Dr. Beumer, at Dr. Palmberg's request, entered the operating room, was quickly gloved, and was handed a scalpel. He opened Reggie's chest and began heart massage. The heart responded almost immediately, and began once again to beat. The beat at first was uneven and it was twice necessary to use a defibrillator (an instrument that gives electric shocks to the heart) to correct the defective heart action. Although the evidence is confusing and somewhat in conflict, that most favorable to appellants is that about four minutes elapsed between the time Dr. Thornburg first noticed that the heart had stopped and the time the heart was again started by means of the open heart massage. Sometime after the operation it was discovered that as a result of brain damage Reggie was a spastic quadriplegic and was both blind and mute. The condition appears to be permanent.

The plaintiffs' counsel, on the question of the propriety of the procedures employed, did not produce any independent expert witnesses, but relied on the cross-examination of the two respondent doctors, called under the provisions of section 2055 of the Code of Civil Procedure, and upon the cross-examination of defendants' expert witnesses. The trial judge refused to instruct on the doctrine of res ipsa loquitur, but, after denying motions for nonsuits and directed verdicts, submitted the case to the jury on the basic question of whether the evidence showed that any or all of the defendants were guilty of negligence proximately causing the injuries. Proper instructions on the use of circumstantial evidence were given. The jury brought in the verdicts above mentioned. The court thereafter granted the motions of all of the defendants for judgments notwithstanding the verdicts, and in the alternative granted defendants' motion for a new trial.

The propriety of the judgments notwithstanding the verdicts.

These must be considered, of course, as to each defendant separately, although many of the facts are pertinent to two or more of the defendants.

The rules applicable to judgments notwithstanding the verdict for defendant are well settled and are agreed to by all the parties. Such a motion may be granted, properly, only when, disregarding the conflicting evidence, and indulging in every legitimate inference in favor of the plaintiff, the result is a determination that there is no evidence of substantial nature to support the verdict. The trial court, on such motion, is not permitted to weigh the evidence, and on an appeal from the judgment entered on the granting of such a motion, the appellate court must read the record in the light most advantageous to the plaintiff, resolve all conflicts in his favor, and give him the benefit of all reasonable inferences in support of the judgment.

The propriety of the judgments notwithstanding as to Dr. Palmberg and Dr. Thornburg.

Both of these defendants are highly qualified and competent specialists. Dr. Thornburg is an American board certified anesthesiologist, and Dr. Palmberg is an American board certified ophthalmologist. They are, of course, held to that standard of learning and skill normally possessed by such specialists in the same or similar locality under the same or similar circumstances. The question involved is whether there is any evidence in the record to show, or from which it may reasonably be inferred, that either doctor, or both, failed to meet the standard involved. In our opinion the evidence, independently of any possible application of the doctrine of res ipsa loquitur, is sufficient to support a verdict against the two doctors.

There was evidence that Reggie's cardiac arrest was caused by 'vagal stimulation,' that is stimulation of the vagus nerve, a basic nerve involved in the beating of the heart. Cardiac arrest is a known and calculated risk in the giving of a general anesthetic. The statistics produced as to its frequency are highly conflicting. Certainly it can be said that it occurs rarely but constantly. It can be caused by...

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