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SKODJE v. HARDY
Factual and Procedural Background
Obert Skodje sought diagnosis and treatment from Dr. Frederick A. Hardy for abdominal pain. Hardy diagnosed bowel infection, prescribed medication and rest, and later directed an enema and application of a heat pad. Skodje's condition worsened, and his wife contacted another physician, who diagnosed acute appendicitis. Skodje underwent an appendectomy that night, during which a perforated appendix was removed. [1][2][3][4][5]
Skodje brought a malpractice action alleging negligence in diagnosis, treatment, failure to advise an operation, and abandonment. The superior court dismissed the action at the close of the plaintiffs' case, and the Washington Supreme Court affirmed. [6][7][8][9][10][11][12]
Legal Issues Presented
- Whether the plaintiffs produced substantial evidence of actionable negligence. [7]
- Whether the evidence presented a jury question regarding the competence and care of Dr. Hardy's diagnosis. [9][13]
- Whether substantial medical evidence supported claims based on the prescribed treatment, failure to advise an operation, or alleged abandonment. [10][14][11][15]
Arguments of the Parties
Appellants' Arguments
- Dr. Hardy's primary insurance-examination practice and lack of abdominal-surgery experience could show that he lacked the knowledge and skill necessary to diagnose Skodje. [16]
- Hardy's failure to take certain vital measurements and perform X-ray or rectal examinations could show that his diagnostic methods were careless. [17]
- Medical texts recommending a more thorough examination supported the negligence claim. [18]
- The case should have gone to the jury because Hardy allegedly abandoned Skodje while he was in danger and pain. [11]
Respondents' Position
- Respondents relied on medical texts tending to support a less thorough examination, although the court treated both sets of texts as insufficient substitutes for medical testimony. [18]
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| Woods v. Pommerening, 44 Wn.2d 867, 271 P.2d 705 | A physician is negligent only for failing to exercise the care, diligence, and skill ordinarily exercised by medical professionals in the same or similar locality; generally, medical testimony is required. | The court applied this standard because the plaintiffs lacked medical testimony showing that Hardy's conduct departed from local professional practice. [19] |
| Peddicord v. Lieser, 5 Wn.2d 190, 105 P.2d 5 | A wrong diagnosis is actionable only if caused by negligence and followed by improper treatment that injured the patient. | The court recognized that Hardy's diagnosis was wrong but held that the additional requirements could not be established by the evidence presented. [20] |
| Fritz v. Horsfall, 24 Wn.2d 14, 163 P.2d 148 | Different treatment preferences or disagreement among physicians do not, by themselves, establish negligence. | The court extended that principle to diagnostic methods and rejected reliance on differing medical approaches without testimony establishing negligence. [18] |
Court's Reasoning and Analysis
The governing standard required proof that Hardy failed to exercise the degree of care, diligence, and skill ordinarily possessed and exercised by physicians in the same or similar locality. Except in circumstances not present here, that showing had to be based on medical testimony. [19]
The court acknowledged that Hardy made an incorrect diagnosis, but explained that an incorrect diagnosis alone is not actionable. The plaintiffs also had to show negligent diagnosis and improper treatment causing injury. [8][20]
The evidence that Hardy lacked abdominal-surgery experience did not establish inadequate diagnostic skill, particularly because no medical testimony said that he lacked the requisite knowledge or skill and many diagnosticians perform no surgery. [16][21]
Although Hardy did not take certain measurements or perform certain examinations, Dr. Norine did not testify that Hardy's methods were inadequate or inconsistent with community practice. The evidence also did not establish that the omitted procedures were necessary, and the available medical testimony did not show that the treatment caused the appendix to rupture or otherwise harmed Skodje. [17][22][23][24]
The court held that differing medical opinions and medical texts could not substitute for testimony establishing the applicable local standard of care and a breach of that standard. [18]
Dr. Norine's correct diagnosis the following day did not establish negligence because the appendix was unusually difficult to diagnose, the intervening day and enema may have made diagnosis easier, and Norine had the benefit of knowing that Hardy's treatment had failed. [25][26]
The failure to advise surgery was consistent with Hardy's diagnosis of bowel infection. No medical expert testified that the pills, enema, heat pad, or delay caused injury, and the court therefore found no substantial medical evidence supporting that claim. [10][27][24][14]
Finally, the alleged abandonment was not actionable because it caused no delay or detrimental result. Skodje was promptly referred, hospitalized, examined, and operated upon that night, and Norine testified that the operation occurred as soon as it should have. [15]
Holding and Implications
AFFIRMED. The court held that the plaintiffs failed to present substantial evidence of actionable medical negligence, so dismissal at the close of their case was proper. [7][13][14][15][12]
The direct effect was affirmance of the dismissal of Skodje's malpractice action. The opinion establishes no broader implication beyond applying the stated medical-malpractice evidentiary standards to these allegations. [6][19][12]
PHYSICIANS AND SURGEONS — LIABILITY FOR MALPRACTICE — DEGREE OF CARE AND SKILL REQUIRED. A physician or surgeon is negligent only if he fails to exercise that degree of care, diligence, and skill which is ordinarily possessed and exercised by members of the medical profession in the same or a similar locality.
SAME — ACTIONS FOR MALPRACTICE — EVIDENCE REQUIRED. With certain exceptions, the evidence tending to establish that a physician has been negligent in failing to exercise the requisite degree of care must be based upon medical testimony.
SAME — ACTIONS FOR MALPRACTICE — WRONG DIAGNOSIS. A wrong diagnosis is not actionable unless it was the result of negligence and was followed by improper treatment to the injury of the patient.
SAME — ACTIONS FOR MALPRACTICE — EVIDENCE — SUFFICIENCY. In an action for malpractice, a jury question as to whether the physician lacked the requisite knowledge and skill to diagnose the condition of his patient, who was suffering from acute appendicitis, is not presented by the facts that the physician's principal practice consisted of the examination of applicants for insurance policies and that, while he had performed some surgery, he had no experience in abdominal surgery; it being common knowledge that many diagnosticians perform no surgery.
SAME. The testimony of other physicians that they would have followed a different course of treatment, or a disagreement between doctors as to what the treatment should have been, does not establish negligence; and the same holds true with regard to diagnostic methods.
SAME — EVIDENCE — MEDICAL TEXT BOOKS. In an action for malpractice, medical text books are not a substitute for medical testimony, nor do they provide information as to the medical practice in the locality in question.
SAME — EVIDENCE — SUFFICIENCY. In such an action, held that the evidence was insufficient to submit to the jury the question of whether the physician's diagnosis of his patient's condition was incompetently and carelessly performed.
SAME. In such an action, held that there was no substantial evidence supporting the allegation of negligence that the physician was careless in prescribing treatment and in failing to advise an operation.
SAME — ACTS OR OMISSIONS CONSTITUTING MALPRACTICE — ABANDONMENT OF PATIENT. A physician's asserted abandonment of his patient is not actionable, where it led to no delay or other detrimental result; it appearing that the patient's wife immediately telephoned another doctor and her husband was hospitalized, examined, and operated upon later that night, and the doctor who performed the operation testified that the patient was operated upon as soon as he should have been.
See 141 A.L.R. 19; 41 Am. Jur. 240.
HAMLEY, C.J.
This malpractice case was tried to a jury and dismissed at the close of plaintiffs' case. The sole question presented on appeal is whether plaintiffs produced substantial evidence of actionable negligence.
Obert Skodje, suffering from abdominal pains, went to Dr. Hardy on July 1, 1953, for diagnosis and treatment. He told Dr. Hardy that he believed he had appendicitis. The doctor spent twenty or twenty-five minutes examining the patient, including palpation of the abdomen. A urine specimen was taken, but Dr. Hardy did not take the patient's pulse, temperature, blood count, or blood pressure. There was no X-ray or rectal examination.
Dr. Hardy diagnosed the case as bacteria colitis, or bowel infection. He gave Skodje a prescription for pills, and advised rest. Skodje followed these directions, but his condition grew worse. The next morning, Mrs. Skodje telephoned Dr. Hardy and told of her husband's increased pain, and that he was "cold and clammy and yellow." Dr. Hardy then prescribed an enema of soap and water, and asked that a heat pad be applied to the abdomen. He told Mrs. Skodje to call him back at six o'clock p.m.
The doctor's directions were followed, but Skodje continued to grow worse. His pain increased, and his stomach became bloated. Mrs. Skodje reported this information to Dr. Hardy at the appointed time, and insisted that "something had to be done." Mrs. Skodje testified that Dr. Hardy then stated that he was not sure what the difficulty was, but that he was going on his vacation in the morning and did not want to get too involved. He suggested that Mrs. Skodje call another doctor who, unlike Dr. Hardy, performs abdominal surgery.
Mrs. Skodje then telephoned Dr. Vernal C. Norine, and described her husband's symptoms. Dr. Norine ordered immediate hospitalization for purposes of examination. A complete urinalysis and a blood count were ordered, and X rays were taken. The patient's temperature, pulse, and blood pressure were also taken. Dr. Norine made a physical examination and diagnosed the case as acute appendicitis with possible abscesses.
An appendectomy was done on Skodje late that night, and a perforated appendix was removed. Skodje was discharged from the hospital ten days later, after what the doctor called a "stormy" convalescence. There was convalescence at home for a further period of six weeks. Skodje was directed not to do any heavy lifting for a period of six months.
[1, 2] A physician or surgeon is negligent only if he fails to exercise that degree of care, diligence, and skill which is ordinarily possessed and exercised by members of the medical profession in the same or a similar locality. Except under certain circumstances (not here present), the evidence tending to establish such negligence must be based upon medical testimony. Woods v. Pommerening, 44 Wn.2d 867, 271 P.2d 705.
Negligence was charged in four particulars, the first being that Dr. Hardy made a wrong diagnosis.
[3] The appendectomy showed that Dr. Hardy made a wrong diagnosis. But a wrong diagnosis is not actionable, unless (1) it was the result of negligence, and (2) it was followed by improper treatment, to the injury of the patient. Peddicord v. Lieser, 5 Wn.2d 190, 105 P.2d 5. These matters are dealt with below, in connection with the discussion of other allegations of negligence.
The second specification of negligence is that Dr. Hardy's diagnosis was incompetently and carelessly performed.
In pressing this point, appellants call attention to the fact that Dr. Hardy's principal practice consisted of the examination of applicants for policies of insurance. While he performed some surgery, he had no experience in abdominal surgery. Appellants contend that these facts presented a jury question as to whether Dr. Hardy lacked the requisite knowledge and skill to diagnose Skodje's condition.
[4] We do not agree. There was no medical testimony to the effect that Dr. Hardy, who was a licensed physician and surgeon, lacked the requisite knowledge and skill. It is common knowledge that many diagnosticians perform no surgery.
Appellants further contend that the testimony to the effect that Dr. Hardy did not take Skodje's temperature, blood pressure, blood count, or pulse, and conducted no X-ray or rectal examination, presented a jury question as to whether the diagnosis was carelessly performed.
Dr. Norine testified that he takes these steps in making a diagnosis of this kind. Neither he nor any other medical expert, however, testified that the methods followed by Dr. Hardy were inadequate, or that they were not in accordance with the practice followed by the medical community.
There was no medical testimony as to the necessity or value of taking a blood count, blood pressure, pulse, or temperature. The undisputed testimony is that Skodje's temperature, pulse, and blood pressure were normal when he was examined by Dr. Norine. While Skodje's blood count was high when he was examined by Dr. Norine, the medical testimony was to the effect that this would be indicative of colitis as well as appendicitis.
[5] The testimony of other physicians that they would have followed a different course of treatment, or a disagreement between doctors as to what the treatment should have been, does not establish negligence. Fritz v. Horsfall, 24 Wn.2d 14, 163 P.2d 148. In our opinion, the same holds true with regard to diagnostic methods. [6] Appellants refer to some medical texts which recommend a more thorough examination than Dr. Hardy made, while respondents counter with other medical texts which tend to the contrary. These text materials are not a substitute for medical testimony, nor do they provide information as to the medical practice in the locality in question.
[7] From what has been said, it follows that there was here a lack of medical testimony to present a jury question as to negligence based upon the manner in which Dr. Hardy made his diagnosis.
A final contention as to negligence in performing the diagnosis is based on the fact that Dr. Norine correctly diagnosed the case on the following day. Dr. Norine testified, however, that this was a so-called "silent" appendix, with the abscess behind, which is one of the "bug-abears" of all doctors — being very difficult to diagnose. Dr. Norine further testified that the lapse of a day and the giving of the enema could have made his diagnosis easier. He also had the advantage of knowing that Dr. Hardy's diagnosis and prescribed treatment had not produced favorable results.
There was no medical testimony that Dr. Hardy's failure to correctly diagnose the case was due to the fact that he failed to use care, skill, and diligence ordinarily possessed and exercised by members of the medical community.
We conclude that there was insufficient evidence to submit to the jury on the question of whether Dr. Hardy's diagnosis was incompetently and carelessly performed.
The third specification of negligence is that Dr. Hardy was careless in prescribing treatment, and in failing to advise an operation.
The failure to advise an operation was consistent with Dr. Hardy's diagnosis of bowel infection rather than appendicitis. Dr. Norine testified that it is a common practice for doctors in Seattle to prescribe, over the telephone, the giving of an enema. There is no evidence that Mrs. Skodje failed to follow the directions of Dr. Hardy, or gave him an incorrect description of her husband's symptoms. Hence, there was no showing of negligence in the fact that Dr. Hardy relied upon Mrs. Skodje in these particulars.
Neither Dr. Norine nor any other medical expert testified that the prescribed pills, enema, heat pad, or thirty-six-hour delay contributed to the rupture of the appendix, or in any other way proved detrimental.
[8] In our opinion, there was no substantial medical testimony supporting this third allegation of negligence.
[9] Finally, appellants argue that the case should have gone to the jury, because Dr. Hardy "abandoned" Skodje while the latter was in danger and in great pain.
The asserted abandonment of his patient by Dr. Hardy is not actionable, because it led to no delay or other detrimental result. Mrs. Skodje immediately telephoned another doctor, and her husband was hospitalized, examined, and operated upon later that night. Dr. Norine testified that Skodje was operated upon as soon as he should have been.
Affirmed.
SCHWELLENBACH, DONWORTH, OTT, and FINLEY, JJ., concur.
November 1, 1955. Petition for rehearing denied.
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