Riewe v. Arnesen, C8-85-671
| Decision Date | 04 February 1986 |
| Docket Number | No. C8-85-671,C8-85-671 |
| Citation | 381 N.W.2d 448 |
| Parties | Roger D. W. RIEWE, et al., Respondents, v. Paul M. ARNESEN, M.D., Paul M. Arnesen, M.D., P.A., Marvin W. Dobson, M.D., et al., Immanual-St. Joseph's Hospital of Mankato, Inc., Mankato Clinic, Ltd., et al., David A. Pope, M.D., et al., Defendants and Third Party Plaintiffs, Respondents, v. Peter MUCHA, Jr., M.D., third party defendant, Appellant. |
| Court | Minnesota Court of Appeals |
Syllabus by the Court
1. The trial court properly determined that respondents were the real parties in interest to a third-party action when settlement of the original claim was accomplished through loan receipt agreements with their insurers.
2. Although respondents were the real parties in interest, the trial court's total prohibition against disclosure of insurance was reversible error when appellant was prevented from establishing bias or prejudice through meaningful cross-examination.
3. The trial court erred in preventing a pathologist from testifying on the length of time peritonitis existed in a patient's abdomen when it was a crucial issue in the case and when no showing was made that a continuance would clearly prejudice respondents.
4. The trial court did not err in allowing an internist and non-surgeon who specialized in diseases of the abdomen and frequently functioned as a diagnostician during surgery to testify as an expert on the surgery performed by appellant.
Robert J. Sheran, Lynn M. Anderson, Minneapolis, for Roger D.W. Riewe, et al.
James F. Roegge, Minneapolis, for Paul M. Arnesen, M.D., Paul M. Arnesen, M.D., P.A.
Kay N. Hunt, Minneapolis, for Marvin W. Dobson, M.D., et al.
Robert G. Johnson, Mankato, for Immanual-St. Joseph's Hosp. of Mankato, Inc.
C. Allen Dosland, New Ulm, for Mankato Clinic, Ltd., et al.
Jerome C. Briggs, Minneapolis, for David A. Pope, M.D., et al.
L. Joseph Genereux, Minneapolis, for Peter Mucha, Jr., M.D.
Heard, considered and decided by SEDGWICK, P.J., and LANSING and RANDALL, JJ.
Dr. Peter Mucha appeals from a judgment and denial of his motion for a new trial. Roger and Juliane Riewe sued a group of Mankato physicians, their respective clinics and Immanuel-St. Joseph's Hospital for negligent treatment of an abdominal injury Roger Riewe received in a farming accident. The Mankato group sued Dr. Mucha for contribution and indemnity alleging that Riewe was negligently treated by Mucha after being transferred to Mayo Clinic.
Riewes settled with the Mankato group the day before trial and were not involved with any claim against Mucha. The trial was solely on the Mankato group's claim against Mucha.
The jury determined that Dr. Mucha and two of the Mankato doctors were negligent in treating Riewe and that each was the direct cause of the injuries. The jury found Dr. Mucha 40% at fault and each of the Mankato doctors 30% at fault and that the settlement amount of $1,600,000 was reasonable. We affirm in part, reverse in part and remand for a new trial.
Roger Riewe was injured on March 20, 1981 when a cement wall fell against him and pinned him against a piece of farming machinery. He was transported to Immanuel-St. Joseph's Hospital in Mankato. At the time of the accident, Riewe was 32 years old.
At the hospital, Riewe was examined by Dr. Paul Arnesen, an orthopedic surgeon. Riewe's chief complaint was severe pain in the abdomen and pelvic area, particularly on the left side where X-rays revealed a fractured pelvis. Riewe also experienced pain on the right side, opposite the fracture site.
When the X-rays ruled out spinal damage, Arnesen concentrated on the possibility of abdominal complications. Arnesen was mainly concerned about on-going hemorrhage since urine tests had ruled out possible bladder damage. He agreed that the type of injury Riewe sustained could produce serious conditions, including peritonitis, an inflamation of the lining of the abdominal cavity. Since Arnesen did not feel qualified to diagnose intra-abdominal complications, he asked Dr. Mervin Dobson, a general surgeon, to examine Riewe.
Dobson examined Riewe on March 21st. As part of his examination of the abdominal area, Dobson tested for "rebound tenderness," an indicator of peritonitis, and bowel sounds, which are present if the bowel is functioning normally. Both tests were also conducted by Arnesen. Both doctors testified that a positive "rebound tenderness" test was a necessary symptom of peritonitis, a fact that was disputed at trial. Both tests performed by the doctors were negative. They agreed on an initial diagnosis of an adynamic ileus--a non-functioning or temporarily paralyzed bowel stemming from trauma to the area, although neither ruled out the possibility of further injury to the abdominal area. Both doctors admitted that they did not perform a peritoneal lavage, a test used to detect on-going infection in the abdomen. Dr. John Perry, a general surgeon who developed the technique, testified at trial that the procedure was rather simplistic. Dobson concluded on March 21st that Riewe had a bruising of the abdominal wall but no serious internal injury.
Arnesen and Dobson continued to care for Riewe until March 24, 1981. Riewe's vital signs fluctuated during this period although his temperature gradually decreased. Arnesen testified that this cycle coincided with hemorrhaging muscles. A raspiness also developed in Riewe's breathing. According to the expert testimony, this symptom indicated a respiratory deterioration. Riewe's hospital records noted that his abdomen was increasingly "distended" and "firm."
Dobson contacted Dr. David Pope, a family practitioner, to take over Riewe's care while he was out of town. Pope examined Riewe on March 24, 1981 and concurred in the previous finding of no rebound tenderness. He was concerned that Riewe's respiratory condition indicated further abdominal problems. Pope consulted Dr. Rheinhardt Riessen, an internist, because Riewe's condition was deteriorating.
Riessen examined Riewe on March 26, 1981 and immediately placed him in intensive care. Riewe experienced episodes of confusion and complained of severe burning on his right side.
Riessen consulted Dr. J. Scott Sanders, a specialist in pulmonary diseases. Sanders examined Riewe on March 26th. After a number of tests, he made a tentative diagnosis of ARDS (adult respiratory distress syndrome), a finding common in cases of severe abdominal infection. Sanders utilized a cooling blanket to keep Riewe's temperature down.
Dr. Richard Meyer, a general surgeon, was also consulted on March 26th. Meyer testified that he found no "rebound tenderness" and only limited bowel sounds. He concluded that Riewe was not suffering from peritonitis since the rebound test was negative. Meyer believed a peritoneal lavage was unnecessary in light of these findings. A special blood test subsequently revealed intra-abdominal infection. A radiologist's report further indicated a thickened bowel wall, suggesting the presence of peritonitis. As a result of Riewe's rapidly deteriorating condition and the limited testing devices available, the doctors unanimously agreed to transfer Riewe to Mayo Clinic.
Riewe was critically ill when transferred to Mayo Clinic on March 28th. Dr. Peter Mucha, a general surgeon, was on duty in the emergency room and took over Riewe's treatment. Mucha testified that he concentrated initially on Riewe's respiratory problem, since that was the primary basis of the Mankato referral. His immediate diagnosis was that the difficulty breathing was due to peritonitis. This caused severe distention of the abdomen and resulting pressure on the diaphragm. Mucha started a peritoneal lavage and immediately discovered "foul smelling" infected discharge in Riewe's abdomen. On the basis of these findings, urine tests, and x-rays, Mucha concluded that Riewe's condition was attributable to peritonitis and scheduled him for emergency surgery.
During surgery, Mucha discovered that 15-20 centimeters of the right portion of the small intestine were necrotic. His operative notes indicated that this was due to a torn sheath of blood vessels "obviously injured in the original accident." Mucha noted that the right side of Riewe's large intestine (colon) was also infected. This portion of the colon and the necrotic small bowel were removed.
Mucha performed a "primary anastomosis" in which the small and large intestines are joined at the point of healthy tissue. A second option, an "ileostomy", was also available to Mucha. In this procedure, the necrotic portion of the intestines is cut out, the end is brought to the surface of the abdomen and the fecal material drains outside the body. In the opinions of Dr. John Bond, a non-surgeon, Dobson, Meyer and Dr. Frederick Owens, a retired surgeon, an ileostomy was a proper and safer procedure under the circumstances because it better avoided the risk of ineffective stitching and spread of bacteria throughout the abdomen.
Mucha testified he performed a primary anastomosis based on a number of factors: the viability and health of the two ends of the bowels to be joined; the risks and difficulty of pulling the small bowel through Riewe's thick abdomen; the fact that the juncture was on the right side of the large intestine rather than on the left side; the desire to maintain maximum nutritional content in the intestinal tract; his training and experience with primary anastomosis rather than ileostomy; and the fact that he had experienced fewer complications in the former procedure.
Two other Mayo Clinic physicians corroborated Mucha's choice of a primary anastomosis. Dr. Oliver Beahres, a retired surgeon, and Dr. Michael Farnell, a colleague of Mucha's, agreed that this procedure had generally resulted in fewer complications at Mayo Clinic and was preferable in view of...
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