Williams v. Chamberlain

Decision Date08 September 1958
Docket NumberNo. 2,No. 46464,46464,2
Citation316 S.W.2d 505
PartiesHelen WILLIAMS, Appellant, v. G. L. CHAMBERLAIN, Respondent
CourtMissouri Supreme Court

Samuel B. Murphy, Cook, Fairfield, Howard & Murphy, St. Louis, Forrest L. Hill, Fayette, Missouri, for appellant.

Schaumburg & Martin, W. H. Martin, Boonville, Wilbur F. Daniels, Fayette, for respondent.

EAGER, Judge.

This is an action for damages, of the type colloquially known as a malpractice case; the amounts prayed were $35,000 actual damages and $25,000 punitive damages. At the close of plaintiff's evidence the court directed a verdict for the defendant, and, after an unavailing motion for new trial, plaintiff has appealed. Since the sufficiency of the evidence is the principal question involved, a detailed statement of the evidence will be necessary.

Plaintiff, a negro woman 42 years of age, worked as a domestic in and about New Franklin, where she lived. The suit arises from the fact that she developed a severe case of tetanus. On April 8, 1954, she was hit on the head with a metal chair by her husband, in the course of an argument about his drinking. This blow raised a hematoma about half the size of a lemon in the right parietal area; in the center of the hematoma was a clean looking cut about an inch long. She was taken very shortly to the office of defendant, who had long been her family physician, and who was a medical doctor in general practice in New Franklin and vicinity. In connection with the subsequent developments we shall consider the testimony favorable to plaintiff, there being some conflicts of more or less materiality. According to plaintiff's testimony she was attended by the defendant on April 8, 10, 13 and 15, and three times on Saturday, April 17; on all of these occasions but the last one she went to defendant's office. She stated that on the first visit defendant did not cut her hair, remove any skin, or 'clean out' the wound, but that he separated or parted her hair, put some salve on a pad which he applied to the wound, and then bandaged the wound and head; that he might have used a piece of gauze to swab the wound; and that he also gave her a 'shot' at that time. It was further shown without contradiction that the 'shot' was an injection of 1,500 units of tetanus antitoxin. On Saturday, the 10th, defendant re-dressed the wound, but plaintiff did not recall whether she got any more 'shots.' On the 13th defendant again re-dressed the wound, but did nothing else. She testified that on April 15th her face seemed to be somewhat swollen under the bandage, and it seemed to be a little 'difficult' to open her mouth; she located the area of difficulty as her right jaw and ear; she testified at the trial that she then told defendant that her neck was stiff and that her jaw hurt, but that he told her that it 'was a nerve' and to go home and rest. She continued to work up until Saturday, April 17th, but stated that on that day she was unable to work, and that there was an odor about the wound; defendant then removed the bandage, stated that there was a little inflammation, had her get the hair clipped around the wound, and gave her two blue pills with which to have her hair washed in boiled water. After her hair was thus cut and washed, and on the same afternoon, defendant redressed the wound; on this same day defendant gave her some 'shots,' but she could not recall just how many; she testified that her neck and jaw were 'uncomfortable,' that her face was swollen 'in here,' that she could not tell whether her neck was swollen, and that her 'jaw' was 'difficult.' We are unable to tell what complaints she may have then made to defendant, but she testified that she did tell him that her face was hurting. When she returned home she lost her power of speech for a brief time, and defendant was called to her home; when he arrived she had regained her speech, but she was 'beginning to get stiff,' mostly in her face and jaw, but she did not remember whether she then told the doctor about the stiffness; defendant then gave her another 'shot,' and told her she was nervous and that she was having too much company. On Sunday, April 18th, she was up and down, at home; her brother had come from Illinois, and she became so stiff and sore that evening that she and her brother decided that she should go to a hospital. The brother testified that he talked to defendant on Sunday about hospitalization (which defendant denied), and that the latter said he didn't think 'she was too bad,' but that he would have a bed ready if they wanted to go. Plaintiff was taken in an ambulance to St. Joseph's Hospital in Boonville at about 2:00 a. m. on Monday, April 19th, and a nurse then notified defendant by phone. He inquired as to her complaints and prescribed a sedative; he first saw her there at about 7:00 a. m. By that time plaintiff was very ill; the nurses' notes show that at 5:15 a. m. she stated that she could not open her mouth. Various laboratory tests were made and medications given, beginning immediately, including a spinal tap to eliminate the existence of meningitis, a skull X-ray, and repeated administrations of pencillin, sedatives and glucose. Two other physicians were called in consultation. Defendant became suspicious of tetanus about 8:00-8:30 a. m., and a diagnosis was made of probable tetanus at about 11:00 a. m. As soon as sufficient tetanus antitoxin could be procured for a large dosage, its administration was begun, actually about 1:30 p. m. This had to be collected at first in many small prophylactic doses from various drug stores in Boonville and Columbia until larger amounts could be procured elsewhere. About 6:00 p. m. defendant attempted to inject antitoxin into plaintiff's spinal canal; she was placed in an 'arched' position to separate the vertebrae; when the needle had been partially inserted, plaintiff gave a 'sudden, unexpected jerk,' causing the needle to break before it had actually gone into the spinal canal, and leaving the proximal end of the broken portion about a quarter of an inch beneath the surface of the skin. Such accidents are by no means unknown in the medical profession. No effort was made at that time to remove the broken portion of the needle, a piece perhaps six centimeters in length. Plaintiff remained acutely and seriously ill with tetanus for several weeks, receiving repeated large dosages of the antitoxin intravenously and much other medication; she was unable at the trial to recall much concerning the first weeks of her hospitalization. She received very frequent doses of sodium amytal for pain. The 'History and Physical Examination' on the hospital record showed: 'onset of neck and mouth complaint, about 24 hours before admission * * * head and neck arched back as in meaningitis.' Defendant was the attending physician throughout plaintiff's hospitalization and for about four months thereafter. Plaintiff did not go subsequently to any other doctor for treatment. She stated that she first learned of the breaking of the needle from one of her attorneys.

On May 16th Dr. Chamberlain had X rays taken of the lumbar spine and the broken portion of the needle was located, marked and removed. The X-ray report and the X-ray films became and are parts of the hospital records. No separate notation was made on the hospital chart of the breaking or of the removal of the needle. On this date, May 16th, the nurses' notes showed the existence of a spot on plaintiff's 'spine' about the size of a half dollar which was painful to touch, and that defendant was notified. However, there was no evidence to show that this spot was actually the site where the broken needle was located, or from which it was removed.

The defendant was placed on the stand by plaintiff's counsel. In considering the sufficiency of the evidence we may look also at his testimony, in so far as it is not in conflict, factually, with the testimony of plaintiff or her lay witnesses. Thus, defendant's testimony showed the following facts: that a 1,500 unit prophylactic injection of anti-tetanus serum was administered to plaintiff on her first visit, and that this was the usual and ordinary dosage; that he gave plaintiff various injections of penicillin, which is not only a general preventative, and cure, of infections, but is specifically effective as a preventative of tetanus; that plaintiff's wound was a clean cut, almost as if made by a knife; that plaintiff did not come back as often as directed for penicillin injections; that pus is no indication whatever of the existence of tetanus, and pus usually develops in a 'raw incision'; that pus consists merely of white blood cells combating an abnormal condition; that defendant at no time noted any odor from the wound; that some swelling in the cheek and jaw could normally result from plaintiff's injury and was of no particular significance, although defendant personally noted no increase in swelling; that he did not recall whether plaintiff complained that her jaw or neck were stiff; that he made no particular inquiries about 'stiffness' because he did not want to suggest anything to one of a nervous nature; that tetanus can flare up 'overnight,' and that at no time when he saw plaintiff prior to her hospitalization did her symptoms or appearance indicate to him that she had tetanus or that she was otherwise seriously ill.

In addition to the defendant's own testimony, there was medical testimony from Dr. W. A. Bloom of Fayette, a physician of 34 years' practice; he had been appointed, during the trial, to examine plaintiff as the court's witness. When plaintiff's counsel put him on the stand his testimony became a part of plaintiff's case. The expert evidence as a whole fairly showed: that tetanus is a rather rare disease in this locality, defendant having had two cases and Dr. Bloom three in their long periods of practice;...

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