Steele v. Woods

Decision Date14 September 1959
Docket NumberNo. 46881,No. 2,46881,2
Citation327 S.W.2d 187
PartiesIrene STEELE, Plaintiff-Appellant, v. Harold V. WOODS, Defendant-Respondent
CourtMissouri Supreme Court

Galen Knowlton, Thomas M. Howell, Donald E. Raymond, Kansas City, for appellant.

Paul C. Sprinkle, Richard P. Sprinkle, Kansas City, for respondent, Sprinkle, Carter, Sprinkle & Larson, Kansas City, of counsel.

JUSTIN RUARK, Special Judge.

This is a malpractice case. Plaintiff sought and obtained damages because of gangrene and resulting crippling by the loss of her toes and part of her feet following a varicose vein operation. The petition contained numerous charges of negligent and unskillful treatment before, during, and after an operation, including failure to exercise reasonable skill and care such as skillful and careful surgeons are accustomed to use in like operations under like circumstances, negligent failure to employ a method approved and practiced by the members of his profession of like skill, carelessness in performing the operation and in his attendance upon her after the operation, and careless and negligent treatment of plaintiff following an unsuccessful operation.

At the trial the plaintiff expended a great deal of energy and evidence in attempting to prove negligence in failure to make certain proper and necessary preoperative (Trendelenburg) tests in order to determine the sufficiency of plaintiff's inner circulation before operating, and the defendant offered considerable evidence in rebuttal of this accusation. Defendant contended that plaintiff's gangrene and subsequent disability resulted from her refusal to submit to certain postoperative treatment which is referred to as a paravertebral block. At the close of the evidence the defendant was permitted to amend his answer by charging contributory negligence on the part of the plaintiff (among other things) in failing or refusing to have such paravertebral block when it became apparently necessary following the operation. Plaintiff abandoned her theory of negligence in failure to give preoperative tests and submitted her case to the jury upon the theory that, following the operation, plaintiff suffered an impairment of circulation, that a paravertebral nerve block was necessary, that defendant negligently failed to advise the plaintiff of the need for such paravertebral block and that it was not performed. The defendant caused the jury to be instructed on the theory that plaintiff refused to have the nerve block suggested by the defendant and thereby contributed to her own disability. Thus the sole issue which went to the jury was (a) whether the defendant advised a paravertebral nerve block and (b) whether the plaintiff refused to permit it. The plaintiff received a jury verdict for $40,000. Thereafter the court sustained the defendant's motion for judgment after verdict and also sustained defendant's motion for new trial because of deemed error in the giving of plaintiff's instructions 1 and 2. Plaintiff has appealed.

The first and principal question is whether or not the plaintiff made a submissible case. In making such determination we recognize that we are not the judges of the truth or falsity of the testimony. Such determination was the prerogative of the jury. On this appeal we are required to take as true and give the plaintiff the benefit of all favorable evidence and reasonable inferences which may be drawn therefrom, including any evidence introduced by the defendant which is not contrary to her own fundamental theory, and, in general, disregard all evidence which is unfavorable to plaintiff's cause of action. 1 Hence in reciting the facts we take from this voluminous record only those which are favorable to the plaintiff's verdict.

Plaintiff, thirty-three years of age and mother of four children, suffered from a prolapsed uterus. For relief of this condition she was referred to and consulted the defendant, who is a doctor of medicine and a surgeon with his practice 'pretty much limited * * * to general surgery.' An operation was performed on July 24, and plaintiff was discharged from the hospital on August 1. Plaintiff had also been suffering from varicose veins for some ten years, and when the defendant doctor examined her prior to the pelvic operation this venous condition was discussed. After the operation plaintiff's feet and legs began to swell, and she went back to the doctor. It was decided between them that the varicose veins should be 'taken care of,' and as a consequence plaintiff went back to the hospital and (on August 24) the defendant performed the operation which was the beginning of the troubles we are now concerned with. This second operation, which was done under general anesthetic, consisted of bilateral high ligations. The great saphenous veins were tied off and the distal ends opened and injected with a drug solution called sodium morrhuate, which is a sclerosing agent. There seems to be little or no contention that the operation itself was not of the character recommended by medical science or that it was not competently done.

When plaintiff was admitted to the hospital for the first (uterus) operation, both she and her husband signed a 'consent to treatment and operation' whereby the defendant was authorized to perform all treatments and operations which in the judgment of the physician might be considered to be advisable or necessary. Upon the second entry, however (for the varicose vein operation) the same form of consent was signed by the husband only. There is no explanation in the record as to way the plaintiff did not sign this second authorization.

Almost immediately after recovery from anesthetic given for the venous surgery, the plaintiff began to suffer great pain, which the evidence indicates came at least partially from a lack or impairment of inner circulation in the legs and feet. That portion of the hospital records which is entitled 'Nurses' Notes' shows that on the morning following the operation 'patient's feet continue to be blue, especially the middle toe of the right foot. Complains of numbness and does not feel any pressure when toes are moved. Dr. Woods notified 6:00 a. m. States he possibly could do nothing more.'

Plaintiff's legs and feet were 'burning up.' She said the defendant told her this was because she was allergic to the material injected into her veins. She was given 'shots and--[they] started giving me pills along all the time too.' She said her legs were unwrapped after three or four days, and when she saw them 'they were all blue and purple, platted.' Ulcers formed on her legs and later the flesh about her feet began to decay and the bones in one foot became exposed. The nurses' notes from operation date to September 13 mention that plaintiff was frequently crying and in great pain, and this was true occasionally after that time. Various lay witnesses testified to plaintiff's apparent condition during her 69-day stay in the hospital. A sister-in-law who visited plaintiff in the hospital during the week following the operation described plaintiff's feet as black and swollen and one of her legs swollen and with an angry looking sore. She said plaintiff was in misery and wanted her to do something for her. One witness (a patient in the same room August 30 to September 7) described her as 'in pain constantly,' 'she was rolling around in bed.' 'her feet were black in spots and her toes was all black. They looked like dried up shriveled prunes at the time I first noticed them.' By both lay evidence and hospital records, the plaintiff was suffering pain and (eventually) gangrene in both feet and one leg. The defendant advised or left instructions for her to dangle her feet off the bed and to get on her feet. The evidence shows that on one occasion the nurses attempted to get her to walk, that 'she would scream with every step,' and after three or four steps she fainted. The defendant in his testimony describes the plaintiff as 'pretty near hysterical at times, in her distress.' During this period she was given various drugs. Papaverine, a drug to relieve spasms of the blood vessels, was ordered by the defendant 'as needed for pain.' The progress record, initialed by the doctor, shows that on September 21 the plaintiff was 'still very highly nervous and wants papaverine oftener then scheduled.' Other drugs administered were demerol, a pain reliever and anti-spasmodic; empirin compound No. 3, a compound of codein, aspirin, phenacetin, and caffeine; sodium bromide, a sedative; seconal, a barbiturate; and chloral hydrate, a sedative and hypnotic.

On September 25 the 'Nurses' Notes' show 'debridement of right instep by Dr. Woods.' On October 16 the doctor performed a skin graft to the right lower leg and foot and to the left lower leg. Part of the graft 'took' and part of it did not. On October 30 the patient was dismissed from the hospital.

Plaintiff testified that 'so many things were hazy to me while I was in the hospital that I don't remember a lot that----.' Various occurrences she did not recall; some she did. In regard to asking for more narcotics than the doctor ordered, she said, 'All I can remember I was in so much pain I asked for it every time I could think of it.' She testified she had no recollection of people coming to see her in the hospital. Other witnesses testified to the effect that plaintiff did not realize or recall that she had visitors. The husband testified that she did not remember his being there from day to day; that this condition started shortly after (the operation); that she 'got to where she didn't know who I was'; that 'there was part of the time she didn't even know I was in the hospital and we didn't discuss nothing'; that part of the time she would know him and part of the time she did not. He placed the period, however, 'the biggest part of the time she didn't even know I was there,' after the first three weeks she was in the hospital, 'about three...

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