Larsen v. Yelle
Can I rely on this case?
Yes — no negative treatment found
- —
- —
Analysis generated from citing opinions in this archive. Not legal advice.
Larsen v. Yelle
Opinion of the Court
Plaintiff, Irl G. Larsen, sued defendant, Dr. Matthew D. Yelle, alleging that defendant was negligent in his medical treatment of a fracture of plaintiff’s right wrist. At the close of plaintiff’s case in chief before a jury, the district court directed a verdict for Dr. Yelle, and Larsen appealed to this court. We reverse and remand for a new trial.
Larsen fell from a stack stool at his home in Anoka on Saturday, April 22, 1972, and sustained a severely comminuted Colles fracture of the right wrist (a fracture in which the bone was splintered). He was treated by Dr. Yelle, a physician engaged in the general practice of medicine, who after viewing X rays reduced the fracture and applied a conventional circular cast
Dr. David W. Florence, an orthopedic specialist, testified that because the treatment of a severely comminuted Colles fracture is totally different from the treatment of other types of Colles fractures, it is the ordinary custom and practice of a general practitioner to refer the patient to an orthopedic surgeon for treatment. He explained that this type of fracture is usually treated by a special technique called pins and plaster, in which pins are placed for traction purposes through the hand and through the elbow, then incorporated into a plaster cast. Dr. Florence testified that the purpose of the pins and plaster technique is to prevent residual deformity, and that if pins are not used the bone fragments in the communited area will settle back causing it to “clam up like an egg shell.” In Dr. Florence’s opinion, if the pins and plaster technique had been used in this case, deformity would have been minimized or eliminated.
Dr. Florence implied that some general practitioners might competently treat the type of fracture which Larsen sustained, even though most refer such cases to specialists. (Dr. Yelle had already testified that he himself would not be competent to employ a pinning technique without 2 weeks of special training for that purpose.) Dr. Florence agreed that some orthopedists might not have used the pins and plaster technique but might have used some other accepted orthopedic technique instead, such as hanging the arm in pin traction for a number of days to get swelling out before even reducing the fracture or applying a cast. Dr. Florence did testify, however, that orthopedic surgeons do not apply a circular cast in the initial treatment of this type of injury because tremendous swelling is to be expected, and this swelling cannot be handled with a circular cast.
Dr. Yelle agreed that if pins had been employed prior to the onset of Sudeck’s atrophy the shortening of the bone would have been prevented. Dr. Florence testified that Sudeck’s atrophy can occur anywhere from 8 to 16 weeks after an injury, but admitted that it might in an extremely rare case occur as early as 2 weeks following injury. In the case at bar Dr. Yelle reduced the fracture and applied the circular cast on the date of injury. The swelling that did occur came early, and the cast was loosened 1 day after injury and split completely in two on the third day after injury. It will be for the jury to resolve the factual question to what extent the swelling resulted from normally anticipated causes or from Sudeck’s atrophy. From the evidence admitted, however, the jury could have concluded that on the date of injury Dr. Yelle should have anticipated the entire extent of the swelling which occurred shortly thereafter and necessitated the loosening of the cast.
A motion for a directed verdict should not be granted if the evidence is sufficient to sustain a verdict for the opponent. Rule 50.01, Rules of Civil Procedure. In order to sustain a verdict for the plaintiff, the evidence must be sufficient for the jury to ascertain what is the requisite standard of care and to determine that defendant’s conduct was a deviation from that standard.
In a negligence action the defendant is held to that standard of care which a reasonably prudent man would have exercised under the same circumstances, although in a medical malpractice
In the case at bar the evidence was sufficient for the jury to conclude that a reasonably prudent man having and exercising the skill, care, knowledge, and attention ordinarily possessed and exercised by physicians in good standing would have recognized, first, that plaintiff’s fracture was of such a nature that tremendous swelling would soon occur and, second, that if a circular plaster cast were applied, this swelling would require the loosening of the cast to such an extent that the bone fragments could not be held in a stable position, thereby resulting in deformity of the wrist. The evidence was also sufficient for the jury to conclude that in light of those facts a reasonably prudent physician would not have applied a circular cast but would have caused some superior method of treatment to be employed, that Dr. Yelle did apply a circular cast instead of causing the plaintiff to receive a different form of treatment, and that Dr. Yelle’s conduct was the cause of the deformity of plaintiff’s wrist.
Plaintiff’s primary theory of the case was as follows: (1)
It is important to note, however, that the mere breach of duty to refer a patient to a specialist for treatment will not of itself make out a prima facie case of negligence against the general practitioner. This is so because the treatment which the general practitioner administers may in fact be the exact treatment which a specialist in good standing would have employed had the case been referred to him, and in that circumstance the general practitioner would be no more liable for injury resulting from the treatment than would be the specialist had he administered the treatment. It must appear that the breach of the duty to
Dr. Florence testified it was the “custom and practice” of general practitioners to refer the treatment of a fracture such as was sustained by plaintiff to an orthopedic surgeon. He also testified that the type of fracture which plaintiff sustained is usually treated by the pins and plaster technique, and Dr. Yelle himself testified that he would not have been competent to employ a pinning technique without an additional 2 weeks of training. While the phrasing of Dr. Florence’s testimony in terms of the “custom and practice” of general practitioners was perhaps not as helpful as if the crucial questions had been worded in the exact terms of the requisite standard itself, the jury could have concluded, based on the testimony it had, that Dr. Yelle’s failure to refer the treatment of plaintiff’s wrist fracture to an orthopedic surgeon was a deviation from that degree of skill, care, knowledge, and attention ordinarily possessed and exercised by other physicians in good standing under like circumstances.
Had the jury so concluded, it would then have proceeded to determine whether the treatment which Dr. Yelle administered instead of referring plaintiff to an orthopedic surgeon for treatment was a deviation from the standard of care required of a orthopedic surgeon.
Dr. Florence’s testimoy did not elucidate with great clarity the exact nature of those forms of treatment which he believed an orthopedic surgeon would have employed in the treatment
Reversed.
Concurring Opinion
(concurring specially).
I concur in the result, being persuaded that the trial court on this record should not have directed a verdict at the close of plaintiff's case in chief. At that point in the trial, had defendant offered no evidence, expert medical testimony viewed most favorably to plaintiff’s theory of liability would have permitted a jury finding that the treatment of plaintiff’s fracture did not conform to the required standard of medical care, proximately causing a deformity to plaintiff’s right wrist.
Reference
- Full Case Name
- Irl G. Larsen v. Dr. Matthew D. Yelle
- Cited By
- 11 cases
- Status
- Published