Swanson v. Chatterton

• Decision Date: 02 August 1968
• Docket Number: No. 40757,40757
• Citation: 31 A.L.R.3d 1152,281 Minn. 129,160 N.W.2d 662
• Parties: , 31 A.L.R.3d 1152 Richard William SWANSON, a minor by Melvin Swanson, his father and natural guardian, and Melvin Swanson, Appellants, v. Dr. Carl C. CHATTERTON, Dr. Samuel M. Loken and Board of Social Ministry of Minnesota Synod of the Lutheran Church in America, owner and operator of Bethesda Lutheran Hospital, Respondents.
• Court: Minnesota Supreme Court

Page 662

160 N.W.2d 662

281 Minn. 129, 31 A.L.R.3d 1152

Richard William SWANSON, a minor by Melvin Swanson, his father and natural guardian, and Melvin Swanson Appellants, v. Dr. Carl C. CHATTERTON, Dr. Samuel M. Loken and Board of Social Ministry of Minnesota Synod of the Lutheran Church in America, owner and operator of Bethesda Lutheran Hospital Respondents.

No. 40757.

Supreme Court of Minnesota.

Aug. 2, 1968.

Syllabus by the Court.

In 1951 plaintiff, then a young child, sustained a supracondylar arm fracture which was treated by Dr. Chatterton, an orthopedic surgeon; and shortly thereafter plaintiff suffered a Volkmann's ischemic contracture and paralysis. In 1963 plaintiff instituted this medical malpractice action against Dr. Chatterton and two other defendants, contending, by the proffered testimony of his medical expert, that Dr. Chatterton's treatment did not measure up to accepted standards of care and treatment of orthopedic surgeons in the medical community at that time in that, among other particulars, he negligently maintained the cast too tightly, failed to give plaintiff's parents adequate instructions as to the signs and symptoms of an impending Volkmann's contracture, and himself failed to diagnose such impending or established conditions or to take appropriate steps to prevent, arrest, or reduce the severity of the condition once it was diagnosed. The trial court excluded the proffered testimony on the ground that plaintiff's medical expert was not qualified to give answers to the particular questions essential to a finding of negligence; and the court directed a verdict for all three defendants on the ground that no issue of fact existed with respect to malpractice by any of the three defendants. Held:

1. Medical expert testimony was essential to a jury finding of negligence against the defendant orthopedic surgeon; and, irrespective of medical expert testimony, no issue of fact was created as to the defendant family physician, a general practitioner who only assisted defendant orthopedic surgeon, or the defendant hospital at which such initial treatment was undertaken.

2. The trial court was clearly within its discretion in excluding the testimony of the medical expert offered by plaintiff. Notwithstanding his important position as chief of the medical staff of a Veterans Administration hospital or his accreditation in the special field of internal medicine, the medical expert had little or no experience field of treatment of supracondylar fractures fracture and, except for his general learning in medical school, he had no familiarity either with the accepted authorities or the scientific writings in the particular filed of treatment of supracondylar fractures and prevention of a Volkmann's ischemic contracture and paralysis.

Thos. F. Burns, St. Paul, for appellants.

Charles R. Murnane, St. Paul, for Dr. Chatterton.

B. C. Hart, Jonathan H. Morgan and Samuel L. Hanson, St. Paul, for Dr. Loken.

J. H. Geraghty, St. Paul, for Board of Social Ministry of Minn.

OPINION

PETERSON, Justice.

Plaintiff, a minor, by his father and natural guardian, sued three defendants for medical malpractice: Dr. Carl C. Chatterton, an orthopedic surgeon; Dr. Samuel M. Loken, a physician in general practice; and the Board of Social Ministry of Minnesota Synod of the Lutheran Church in America, owner and operator of Bethesda Lutheran Hospital, St. Paul (hereinafter 'Bethesda'). The claim of malpractice arises out of the operative and postoperative treatment of the injured minor who, subsequent to the reduction of a supracondylar fracture of his arm, suffered a serious deformity as the result of a Volkmann's ischemic contracture and paralysis.

The trial court directed verdicts for each of the defendants, and plaintiff appeals from the order denying his subsequent motion for a new trial. We hold, for the reasons stated in this opinion, that the verdict was properly directed for defendant Chatterton; and we hold, without other discussion, that the verdicts were properly directed for defendants Loken and Bethesda. Dr. Chatterton, therefore, will be alone referred to as defendant, and the injured child will, for convenience, be referred to as plaintiff.

The basic issue arises out of the trial court's exclusion of certain testimony of plaintiff's medical witness on the ground that the witness was not qualified as an expert to give answers to those questions essential to a finding that defendant was professionally negligent. It is the basic issue because, as we hold, the jury could not have rendered a finding of negligence without the assistance of qualified medical testimony. The verdict was properly directed against plaintiff, therefore, unless we could hold that the trial court abused its discretion in excluding the crucial testimony of the medical expert proffered by plaintiff.

It is not disputed that plaintiff suffered a Volkmann's ischemic contracture and paralysis (hereinafter referred to as a Volkmann's contracture) sometime subsequent to his treatment by defendant for a supracondylar fracture of the right arm. The method of reducing this common fracture of children and the nature of a Volkmann's contracture as a hazard inherent in its treatment are not, in general terms, disputed either. The fracture was, in this case, typically reduced by flexing the elbow under strong traction to approximately a right angle, after which the arm was immobilized by a splint and bandage.

A Volkmann's contracture is the result of a serious interference with the blood supply to the arm. An occlusion of blood circulation causes the tissues to die, resulting in displacement of muscle tissue by noncontractile fibrous tissue, with a consequent contraction of the muscles, and hence a deformity. The arterial circulation to the arm passes through a small antecubital space in the elbow and may become constricted or occluded as a result of trauma. A serious interference with the blood supply may have serious consequences within as short a time as one hour. The signs and symptoms of a developing Volkmann's contracture and paralysis usually include pallor, cyanosis in the affected area, swelling, lack of sensation and inability to move the fingers, and pain.

Plaintiff, then a 5-year-old child, suffered the supracondylar fracture of his arm on June 20, 1951. This action was not commenced, however, until March 14, 1963, almost 12 years later, when records and recollections were somewhat diminished. On the date of his injury, plaintiff's parents immediately called Dr. Samuel M. Loken, who, after taking X rays of plaintiff's arm at Bethesda the same afternoon, diagnosed the severity of the fracture. Dr. Loken advised plaintiff's parents that he was not fully competent to treat the fracture and recommended no them the special competence of Dr. Chatterton. Defendant, with Dr. Loken assisting, reduced the fracture and applied a splint that same evening in the hospital's operating room. Plaintiff was discharged from the hospital the next day upon the order of defendant, and neither Dr. Loken nor Bethesda had any relationship with plaintiff's treatment thereafter.

The onset of the Volkmann's contracture is not certain. On the morning plaintiff was discharged from the hospital, defendant examined plaintiff as to the critical indications of blood circulation in the arm and was 'very happy about it all the way through.' At that time, defendant testified, he instructed plaintiff's mother that it was essential that her son be seen by a doctor--either himself or Dr. Loken--the next day. He did not specifically instruct her as to the signs and symptoms of a Volkmann's contracture because, according to his testimony, only a person with medical training could recognize the medical significance of such conditions. He testified from his office records that plaintiff was not brought to him, however, until June 29, eight days later. This is disputed by plaintiff, whose mother testified that defendant, without other instructions, told her only to bring plaintiff to his office on Saturday, two days later; that she nevertheless took plaintiff to defendant's office the next day, Friday, because she observed that her son was in pain and that his fingers were swollen and 'possibly bluish'; that after waiting for almost four hours in defendant's reception room she observed that the pain had apparently subsided and decided to return instead at the appointed hour the next morning. She testified that, upon noting plaintiff's condition on that Saturday, defendant exclaimed: 'I don't know what went wrong. If I had it to do over again, I'd do it the same way.' But for the dispute as to the day of this observation, that could well have been defendant's concerned reaction; for although the possibility of this postfracture condition has been theoretically known for about a hundred years, it is nevertheless a relatively rare occurrence.

Defendant, whose eminence as an orthopedic surgeon is not challenged, ¹ was unable to definitely diagnose the existence of a Volkmann's contracture or its cause until about July 13 or even July 27. He had, in several prior examinations of plaintiff, observed that plaintiff was in pain, that there was some pallor, and that there was marked swelling and paralysis; but he observed no sloughing of flesh and thought there had been evidence of improvement, based upon his own observations and the conditions reported to him by plaintiff's mother. He ultimately concluded that a Volkmann's contracture existed and that there had been a traumatic swelling of the muscle itself which caused a change in the muscle structure.

1. The crucial issue of fact is whether defendant failed to measure up to the standards of care, skill, and practice of orthopedic surgeons in this area in 1951, the year in which the alleged malpractice occurred. More specifically, as articulated in plaintiff's amended complaint and offer of proof, the...