Wick v. Henderson, 90-1667

• Decision Date: 13 May 1992
• Docket Number: No. 90-1667,90-1667
• Citation: 485 N.W.2d 645
• Parties: Dorothy A. WICK and Richard S. Wick, Appellants, v. Marvin G. HENDERSON, Mercy Hospital, and Medical Anesthesia Associates, P.C., Appellees.
• Court: Iowa Supreme Court

Page 645

485 N.W.2d 645

Dorothy A. WICK and Richard S. Wick, Appellants, v. Marvin G. HENDERSON, Mercy Hospital, and Medical Anesthesia Associates, P.C., Appellees.

No. 90-1667.

Supreme Court of Iowa.

May 13, 1992.

Rehearings Denied June 18, 1992.

James R. Welsh, Omaha, Neb., and Stephen A. Rubes, Council Bluffs, for appellants.

Marvin F. Heidman and John C. Gray of Eidsmoe, Heidman, Redmond, Fredregill, Patterson & Schatz, Sioux City, for appellees Marvin G. Henderson, M.D., and Medical Anesthesia Associates, P.C.

Michael F. Kinney and David A. Blagg, Omaha, Neb., for appellee Mercy Hosp.

Considered en banc.

ANDREASEN, Justice.

The trial court directed a defendants' verdict in this medical malpractice suit against an anesthesiologist, a professional corporation, and the hospital where surgery had been performed. Plaintiffs' appeal presents questions on the sufficiency of the evidence to support claims based both on allegations of specific negligence and on the theory of res ipsa loquitur. We reverse and remand.

Plaintiff Dorothy Wick entered defendant Mercy Hospital as a patient on August 12, 1987, for gallbladder surgery. Defendant Marvin G. Henderson, a medical doctor specializing in anesthesiology, was employed at the time by defendant Medical Anesthesia Associates, P.C. (MAA). There is no claim or showing that Henderson was personally present during Wick's surgery; it was attended by James Byrk, a nurse anesthetist who was also employed by MAA. Henderson was one of three anesthesiologists employed by MAA. He was on duty in a supervisory capacity in the operating area at the hospital at the time. Henderson was listed on hospital documents by Byrk as the anesthesiologist for Wick's surgery.

After Wick was taken to an operating room she was positioned with her back on the operating table and her arms outstretched in what was described as a "crucifix position." The testimony shows that it was necessary to properly position the arm of a patient in this position to avoid damage to the ulnar nerve. Wick's arms rested on padded extensions that jutted from each side of the operating table. She testified the position caused an uncomfortable feeling to her left arm and shoulder, but she did not communicate this discomfort to anyone. Wick was then placed under anesthesia, and the operation proceeded.

The next thing Wick remembered was waking up in her hospital room. She had no recollection of being taken from the operating room nor did she remember being in the recovery room. Wick had been under a general anesthesia for two and one-quarter hours.

Wick had pain in her left arm upon awakening. She complained of pain and testified the pain was severe and continuing while she was in the hospital. When discharged from the hospital on August 17, 1987, she was told by an anesthesiologist in the hospital that her arm was "stressed" during surgery.

According to her evidence, she sustained a permanent injury to the ulnar nerve located in her upper left arm. She claims damages for a disfiguring scar, a result of corrective surgery, for pain, and for medical expenses, past and future. She sought recovery on theories of specific negligence and res ipsa loquitur against Henderson, MAA, and Mercy. For simplicity, we omit discussion of the loss-of-consortium claim made by Wick's husband.

At trial, Wick presented testimony of both defendant Henderson and Dr. Alfredo Socarras. Henderson testified he was a supervisor of nurse anesthetists at Mercy. As to the proper standard of care, it was his opinion that either a nurse anesthetist or anesthesiologist is responsible for the proper positioning of a patient's arm during surgery. In the instant case, Henderson believed that Byrk, the nurse anesthetist, had the responsibility to properly position and pad Wick's arm to protect against ulnar nerve injury.

Socarras completed his medical education in Cuba in 1952. He interned at Mercy Hospital in Des Moines from 1955-57 and at the Mayo Clinic in Rochester, Minnesota, from 1957-60. He is a licensed physician and surgeon in Iowa and for the past thirty years has maintained a practice in neurology in Des Moines.

Socarras testified as to his extensive experience in the field of neurology and to his attendance at seminars, symposiums, and other meetings at which ulnar nerve problems were discussed. He was familiar with medical writings and studies relating to ulnar nerve injuries during surgery. He described the nervous system and offered a detailed description of the ulnar nerve. He stated the damage to the ulnar nerve could result if the patient were not properly positioned and monitored during surgery.

Socarras testified it was the responsibility of the anesthesiologist or anesthetist to position the patient and then monitor the position of the patient during surgery. In his opinion, the main cause of ulnar nerve injury during surgery is the mechanical compression of the nerve by improper positioning of the arm.

Based upon his review of the depositions and records in the case, Socarras offered opinions on how Wick's ulnar nerve was damaged. He concluded that Byrk failed to properly monitor the position of her arm during surgery. On cross-examination Socarras conceded the injury could also have happened if a surgeon leaned against the patient's arm for a period of time.

At the close of Wick's case, all defendants moved to strike the testimony of Socarras. Mercy also moved for a directed verdict. Before considering the motion to strike, the court granted Mercy's motion for a directed verdict and dismissed the case against it. The court then sustained, in part, the motion to strike and thereafter granted Henderson and MAA a directed verdict resulting in the dismissal of Wick's case.

I. Directed Verdict.

The trial court granted defendants' motion for directed verdict at the close of Wick's evidence. On ruling on a motion for directed verdict, the evidence must be viewed in the light most favorable to the party against whom the motion was made, regardless of whether it was contradicted. Iowa R.App.P. 14(f)(2). Where substantial evidence has been presented in support of each element of a claim, a motion for directed verdict should be denied. Reuter v. State Farm Mut. Auto. Ins. Co., 469 N.W.2d 250, 251 (Iowa 1991). The court must draw every legitimate inference in aid of the evidence. Id.

The court's directed verdict rulings were influenced by the court's ruling on the defendants' motion to strike Socarras's testimony. The court found Socarras "is certainly qualified as a neurologist and qualified to give the opinions that he gave with respect to ulnar nerve injuries." However, the court found Socarras did not qualify under Iowa Code section 147.139 (1989) "to give the opinions that he gave with respect to the responsibility of the anesthetist to monitor the position, the location, and pressure against the patient's arm during surgery." This testimony was then stricken by the court with the additional comment that, if the court incorrectly assumed section 147.139 applied, the testimony would be stricken because Socarras was not qualified to express an opinion as to the standard of care of the anesthetist. We believe the trial court abused its discretion in striking the testimony of Socarras.

We are committed to a liberal rule on admissibility of opinion testimony. DeBurkarte v. Louvar, 393 N.W.2d 131, 138 (Iowa 1986). A physician need not be a specialist in a particular field of medicine to give an expert opinion. Id. An expert witness must be not only generally qualified in a field of expertise; but must also be qualified to answer the particular question propounded. Tappe v. Iowa Methodist Medical Ctr., 477 N.W.2d 396, 402 (Iowa 1991). We believe the trial court committed a manifest abuse of discretion by striking Socarras's testimony.

The trial court's reliance on Iowa Code section 147.139 also is misplaced. This statute provides:

If the standard of care given by a physician and surgeon licensed pursuant to chapter 148, or osteopathic physician and surgeon licensed pursuant to chapter 150A, or a dentist licensed pursuant to chapter 153, is at issue, the court shall only allow a person to qualify as an expert witness and testify on the issue of the appropriate standard of care if the person's medical or dental qualifications relate directly to the medical problem or problems at issue and the type of treatment administered in the case.

It obviously applies only to the professions it lists. The hospital and the nurse anesthetist are not protected by its provisions. Socarras, a qualified neurologist, is qualified to testify as to the cause of injury to the ulnar nerve during surgery based upon his medical education and experience, his research and study, his review of medical publications and writings in this field, and his review of the facts and circumstances of this case.

The trial court also failed to recognize that expert testimony as to the standard of care is not required when a layperson is competent to pass judgment and conclude from common experience that the injury to the nerve would not have happened if proper skill and care were provided. Sammons v. Smith, 353 N.W.2d 380, 385 (Iowa 1984). When the foundation facts of res ipsa loquitur are established--whether by expert testimony or, in the proper case, by the common experience of laypersons--then the plaintiff is not required to present expert testimony on the appropriate standard of care. Welte v. Bello, 482 N.W.2d 437, 439 (Iowa 1992).

II. Res Ipsa Loquitur Doctrine.

We were one of the first jurisdictions to hold the doctrine of res ipsa loquitur was applicable in medical and dental malpractice cases. Whetstine v. Moravec, 228 Iowa 352, 291 N.W. 425 (1940). The Whetstine decision was cited in the landmark case of Ybarra v. Spangard, 25 Cal.2d 486, 489, 154 P.2d 687, 689 (1944). We consider the doctrine to be a rule of evidence rather than one of...