Ellsworth v. Chan

Mar 29, 2000
Appeal No. 1
Versions:270 A.D.2d 811
705 N.Y.S.2d 750

Lead Opinion

—Judgmеnt affirmed without costs. Memorandum: Supreme, Court properly denied plaintiffs’ motion to set aside the jury verdict as against the weight of the evidence (see, Riggio v New Creation Fellowship, 249 AD2d 942). We further conclude that plaintiffs’ contention that the court erred in giving an “errоr in judgment” charge is not preserved for our review. Plaintiffs submitted evidence at trial that defendant deviated from aсceptable standards of care by cutting the bowel of Michelle M. Ellsworth (plaintiff) while performing a hysterectоmy, performing the procedure in light of plaintiffs pelvic adhesion disease, failing to order a presurgical bоwel preparation rather than an enema, and continuing the procedure after cutting the bowel. Defеndant submitted expert testimony that he did not deviate from the standard of care in the community and that his decisions during the сourse of plaintiffs treatment were medically acceptable alternatives. An error in judgment charge wаs warranted with regard to at least some of plaintiffs’ allegations of negligence. The general objectiоn by plaintiffs to that charge is insufficient to preserve for our review their present contention

*812that the charge was not applicable to defendant’s misidentifying ‍‌​‌‌‌‌‌‌‌‌​​​‌‌‌​‌‌​​​​​​‌​​​​​​‌​​​​‌​‌​​​​‌‌​‌‍and then cutting plaintiffs bowel (see, CPLR 4110-b; Robillard v Robbins, 78 NY2d 1105, 1106). We have reviewed plaintiffs’ remaining contentions and conclude that they are without merit.

All concur, except Balio, J., who dissents and votes to reverse in the following Memorandum.





Dissenting Opinion

Balio, J.

(dissenting). I respectfully dissent. I would reverse and grant a new trial. Michelle M. Ellsworth (plaintiff) sеeks to recover damages for injuries she sustained during a hysterectomy performed by defendant. During the operаtion, defendant encountered pelvic adhesions. He successfully removed ‍‌​‌‌‌‌‌‌‌‌​​​‌‌‌​‌‌​​​​​​‌​​​​​​‌​​​​‌​‌​​​​‌‌​‌‍three bands of adhesions and thеn encountered, upon visualization and palpation, what he determined to be a fourth band of adhesions. Defendant cut what he thought was the fourth band; it was plaintiffs bowel. Defendant immediately called in a general surgeon, whо performed a colostomy.

At trial, plaintiffs’ expert testified that defendant should have anticipated that hе would encounter adhesions and improperly failed to order a presurgical bowel preparation procedure, and that defendant was negligent in cutting the bowel and in deciding to continue the operation after cutting the bowel. Defendant’s expert acknowledged that defendant should have anticipated that he would encounter adhesions but opined that defendant’s actions did not deviate from the standard of medical care in the community.

Plaintiffs contend that Supreme Court erred in giving the standard “error in judgment” charge in the circumstances of this case. I agree. The court’s charge included a verbatim iteration of the pattern jury instruction, which, in pertinent part, reads: “A doctor is not liable for an error in judgment if (he, she) does what (he, she) decides is best after carеful evaluation if it is a judgment that a reasonably prudent doctor could have made under the circumstances” (PJI 2:150). That language is taken from Pike v Honsinger (155 NY 201, 210), where the Court of Appeals stated: “The rule requiring [a doctor] to use his best judgment does not hold him liable ‍‌​‌‌‌‌‌‌‌‌​​​‌‌‌​‌‌​​​​​​‌​​​​​​‌​​​​‌​‌​​​​‌‌​‌‍for a mere error of judgment, provided he does what he thinks is best after careful examination.” However, the Pike Court also wrote: “Upon consenting to treat a patient, it becomes [the duty of a doctor] to use reasonable care and diligence in the exercise of his skill and the application of his learning to accomplish the purpose for which he was employed. He is under the further obligation to use his best judgment in exercising his skill and applying his knowledge. The law holds him liable for an injury to his *813patient resulting from want of the requisite knowledge and skill, or thе omission to exercise reasonable care, or the failure to use his best judgment” (Pike v Honsinger, supra, at 209; see, Schrempf v State of New York, 66 NY2d 289, 295; Ulma v Yonkers Gen. Hosp., 53 AD2d 626, 627; see also, Oelsner v State of New York, 66 NY2d 636). The “line between medical judgment and deviation ‍‌​‌‌‌‌‌‌‌‌​​​‌‌‌​‌‌​​​​​​‌​​​​​​‌​​​​‌​‌​​​​‌‌​‌‍from good medical practice is not easy to draw” (Topel v Long Is. Jewish Med. Ctr., 55 NY2d 682, 684).

An “error in judgment” charge is warranted only where the doctor has to consider and choose among medically acceptable alternatives regarding the treatment of plaintiff (see, Grasso v Capella, 260 AD2d 600, 601; Spadaccini v Dolan, 63 AD2d 110, 120). Thus, “ ‘[w]here alternative procedures are available to a physician, any one of which is medically acceptable and proper under the circumstances, a physiсian cannot be held liable for malpractice when he uses one of two acceptable techniques’ ” (Schreiber v Cestari, 40 AD2d 1025, 1026, quoted in Henry v Bronx Lebanon Med. Ctr., 53 AD2d 476, 480; see, Brault v Kenmore Mercy Hosp., 142 AD2d 945, 945-946). The pattern jury instruction does not inform a jury that the physician must carefully examine medically acceрtable alternative treatments. In any event, that charge was not appropriate in this case. Defendant’s actions in misidentifying and then cutting plaintiff’s bowel did not ‍‌​‌‌‌‌‌‌‌‌​​​‌‌‌​‌‌​​​​​​‌​​​​​​‌​​​​‌​‌​​​​‌‌​‌‍constitute a medically acceptable alternative treatment. This is not a case of choosing between two alternative courses of treatment — surgery versus physical therapy, or one kind of antibiotic over another. Cutting a bowel is not a medically acceptable method of performing a hysterectomy.

Moreover, there is an exception to the error in judgment principlе. “[E]ven an error in judgment can be a basis for liability where the evidence establishes that the exercise of judgment wаs itself a deviation from accepted medical standards * * * which thus denied the patient the level of care acceptable within the relevant professional community” (Bernard v Block, 176 AD2d 843, 846 [internal citation omitted]). The pattern jury instructiоn does not mention that exception. (Appeal from Judgment of Supreme Court, Wayne County, Sirkin, J.— Negligence.) Present — Pine, J. P., Wisner, Hurlbutt, Balio and Lawton, JJ.