Sandhofer v. Abbott-Northwestern Hospital
| Decision Date | 13 July 1979 |
| Docket Number | 48548.,No. 48526,48526 |
| Citation | 283 NW 2d 362 |
| Parties | Joseph SANDHOFER, Respondent, v. The ABBOTT-NORTHWESTERN HOSPITAL, Appellant, Respondent, Keith D. Millett, M.D., et al., Respondents, Appellants. |
| Court | Minnesota Supreme Court |
Mahoney, Dougherty & Mahoney and Thomas E. Dougherty, Minneapolis, for Abbott-Northwestern Hospital.
Meagher, Geer, Markham, Anderson, Adamson, Flaskamp & Brennan and O. C. Adamson II and M. J. Coyne, Minneapolis, for Millett & Schaffhausen.
Fitzgerald & Crandall and William A. Crandall, Minneapolis, for respondent.
Heard before TODD, WAHL and KENNEDY, JJ., and considered and decided by the court en banc.
This is a medical malpractice action arising from the treatment of plaintiff's fractured right wrist, which allegedly resulted in the eventual loss and amputation of the forearm and hand. By special verdict, the jury sitting in Hennepin County District Court found plaintiff 10 percent negligent, defendant Abbott-Northwestern Hospital 60 percent negligent, and defendants Drs. Millett and Schaffhausen each 15 percent negligent, and assessed $325,000 in damages. All defendants unsuccessfully moved the trial court for judgment notwithstanding the verdict or for a new trial. This appeal was taken only on the issue of liability. We affirm.
Late in the afternoon of June 22, 1974, plaintiff accidentally fell from a ladder on which he was standing while installing a gutter and landed on the ground, injuring his right wrist. After wrapping his wrist and applying ice, plaintiff's wife, a registered nurse, drove plaintiff to defendant Abbott-Northwestern Hospital (Hospital), where they had arranged to meet defendant Dr. Millett. Dr. Millett's examination revealed a comminuted, or shattered, fracture of the wrist. Dr. Millett surgically reduced the fracture, removed most of the bluish gutter seal covering plaintiff's hand, and applied a circular plaster cast from above plaintiff's elbow to his knuckles. According to plaintiff, defendants' negligence in treating his injury occurred in the period between the application of the cast and the splitting of the cast 5 days later. During this period circulation in the hand and arm allegedly was impaired, causing a necrotic condition that necessitated amputation of the arm several months later.
When the cast was applied, Dr. Millett observed good circulation in the hand. After the cast was in place, plaintiff experienced considerable discomfort and pain. Dr. Millett ordered the staff to apply ice packs and to monitor plaintiff's pulse, temperature, respiration, blood pressure, and circulation in the fingers. To check circulation, the doctors and nurses "blanched" the fingernails of plaintiff's injured hand, which means that pressure was first applied to the nail, forcing blood out of the area so that the return of blood could then be observed. Although Dr. Millett ordered and assembled an overhead sling to provide elevation for the arm, the arm was supported instead on pillows much of the time because of the pain.
During his hospitalization, plaintiff was treated by both Drs. Millett and Schaffhausen. The condition of his arm was periodically observed by the nurses and aides and was recorded in their notes over the 5-day period. On the night of admission, the notes described plaintiff's right fingers as bluish and slightly cool. The next evening, June 23, the fingers were described as very blue, cool, and swollen. This condition persisted until the afternoon of the next day, June 24, when the color and sensation in the right hand were described as good. That evening, however, the fingers were again edematous (swollen) and cyanotic (bluish). By June 25, some of the nurses had become concerned over the condition of plaintiff's fingers. That afternoon, a nurses' aide observed the hand and fingers to be swollen and dark blue. Although the charge nurse and doctors expected to be notified of significant changes, they were not notified. The entries for the next day describe the hands and fingers as swollen and bluish. That night the fingers were bluish and cool, a condition that continued until the next noon when the cast was split. After the cast was split the color improved and the fingers were warmer.
The cast was split after Dr. Millett was summoned to the hospital by a nurse who was concerned about the appearance of plaintiff's hand. Dr. Millett, who opened the cast, testified that the arm was normally pink and circulation was good at that time. His notes, however, indicate ischemia (impaired circulation) of the hand. Plaintiff testified that the arm was as hard as a baseball bat and that chunks of his arm were taken out as the cast was spread. According to the medical testimony, such hardness could indicate ischemia. A nurse and nurses' aide testified that they observed sores on the arm, which the nurse stated was unusual. The top half of the cast was replaced and reattached to the arm by Ace bandages. Plaintiff was then issued a sling to be worn around the neck.
Plaintiff remained in the hospital until July 14, when he discharged himself against Dr. Millett's advice. His arm was in a short-arm cast, below the elbow, which had been applied on July 11. Between July 15 and July 24, plaintiff was engaged in activities involving manual labor, such as sweeping, lifting, and driving a van to and from the building where he was working. On July 24, plaintiff returned to the hospital complaining of considerable pain. Dr. Millett's examination revealed a displacement of the fracture and an open ulcer on the forearm. After surgery, plaintiff was diagnosed as suffering ischemic necrosis. On September 24, plaintiff consulted Dr. James House at the University of Minnesota Hospital, who advised and performed amputation of the arm just below the elbow.
Defendants argue on several grounds that the trial court erred in refusing to enter judgment notwithstanding the verdict in their favor or to grant a new trial on the question of liability. On an appeal such as this we review the entire evidence before the trial court to determine whether there is any competent evidence reasonably tending to sustain the verdict. Unless the evidence is practically conclusive against the verdict, we will not set the verdict aside. See, Parkside Mobile Estates v. Lee, 270 N.W.2d 758, 761 (Minn.1978).
1. Defendants initially argue that the testimony of plaintiff's expert witness rested upon an inadequate and unreliable factual foundation and should not have been permitted to form the basis of the jury verdict. Plaintiff was required to offer expert testimony establishing the applicable standard of care recognized by the medical community and the departure from that standard by defendants. See, Todd v. Eitel Hospital, 306 Minn. 254, 257, 237 N.W.2d 357, 359 (1975). Plaintiff presented the testimony of Dr. James House, an orthopedic surgeon at the University of Minnesota Hospital, who diagnosed the necrotic condition of plaintiff's arm and performed the amputation. Preliminary to giving his opinion, Dr. House testified that in connection with his examination of plaintiff in September 1974, he obtained direct information regarding the treatment administered by defendants from plaintiff, from Dr. Schaffhausen, and from the hospital records. Based on these facts, the trial court properly found that the foundation requirements for the opinion testimony were satisfied.1
Dr. House's opinion was then presented within the context of a hypothetical question. When this method is used, the hypothetical must include substantially all of the undisputed material facts relating to the subject and disputed facts which have some clear support in the record. Grapentin v. Harvey, 262 Minn. 222, 114 N.W.2d 578 (1962). The hypothetical question submitted to Dr. House met this standard. Assumptions were stated as to the nature of the accident, satisfactory reduction of the fracture, application of a particular type of cast, all of the information contained in the nurses' notes for the period of June 22 to June 27, the fact that plaintiff periodically removed his arm from the sling prescribed by Dr. Millett but kept it elevated on pillows, and the fact that no doctor's notes existed for June 24, 25, and 26.
We find no indication that any significant incorrect or incomplete data was supplied to Dr. House. If minor inaccuracies were demonstrated to be present in the hypothetical question, the trial court had the discretion to rule on the validity of the question as a whole. Grapentin v. Harvey, supra. In the instant case the trial court found the question to be valid, overruling defendant's objections to foundation. We find no abuse of discretion in that ruling. Moreover, we note that defendants took ample care in cross-examination and in final argument to discredit and qualify Dr. House's testimony.
2. The next issue raised by defendants is whether it was error for the trial court to refuse to give certain jury instructions that were requested by defendants. The trial court refused to give the following instruction, requested by defendants Millett and Schaffhausen:
On the ground that a general charge on the burden of proof was sufficient, the trial court also refused to give the following instruction requested by defendants:
"The plaintiff, in a malpractice action has the burden of proving that there was negligence by defendant doctor and that such negligence was the cause of the injury complained of, in this regard proof of causation in a medical malpractice case cannot rest on conjecture and the mere possibility of such...
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