No. 13404
I N T E SUPREME C U T O T E STATE O MONTANA
H OR F H F
1976
A A LLERA,
LN
P l a i n t i f f and Appellant,
...
BYRON R. WISNER, D.D.S. ; J O N A.
J O U R D O N N ~ S, D D s ; ROBERT R
HYLTON, MID.; J. MCGARITY, c.R.N.A.;
.
M.D. ANESTHESIA SERVICES; M. KEMP,R.N.;
D. DRAKE, R.N.; and SAINT VINCENT'S HOSPITAL,
Defendants and Respondents.
Appeal from: D i s t r i c t Court of t h e T h i r t e e n t h J u d i c i a l D i s t r i c t ,
Honorable C. B. Sande, Judge p r e s i d i n g ,
Counsel of Record:
For Appellant :
Lewis E m Brueggemann argued, B i l l i n g s , Montana
For Respondents:
Anderson, Symmes, Forbes, P e e t e and Brown, B i l l i n g s ,
Montana
Richard F. Cebull argued, B i l l i n g s , Montana
Weymouth Symmes argued, B i l l i n g s , Montana
Keef e r and Roybal, B i l l i n g s , Montana
J. Dwaine Roybal argued, B i l l i n g s , Montana
N e i l Keefer appeared, B i l l i n g s , Montana
Crowley, Haughey, Hanson,, Ghllagher and Toole,
B i l l i n g s , Montana
Jack Ramirez argued, B i l l i n g s , Montana
Submitted: October 19, 1976
Decided: DEC 2 0 1B
9
DEC 2 0 1976
M r . J u s t i c e John Conway H a r r i s o n d e l i v e r e d t h e Opinion of
t h e Court.
T h i s i s a n a p p e a l from summary judgment e n t e r e d i n
f a v o r of a l l d e f e n d a n t s i n a d e n t a l m a l p r a c t i c e a c t i o n i n
t h e d i s t r i c t c o u r t , Yellowstone County.
P l a i n t i f f Alan L l e r a brought a c t i o n a l l e g i n g m a l p r a c t i c e
r e s u l t i n g from an o r a l s u r g i c a l procedure known a s a p a r t i a l
glossectomy. P l a i n t i f f a l l e g e s t h e malpractice occurred i n
t h e d i a g n o s i s of h i s problem and i n t h e r e s u l t a n t o p e r a t i o n .
He a l l e g e s no informed consent was o b t a i n e d nor were t h e r i s k s
and t h e a l t e r n a t i v e s t o h i s tongue problem e v e r e x p l a i n e d or
discussed.
P l a i n t i f f a l l e g e s D r . Joh A . J o u r d o n n a i s , t h e r e f e r r i n g
d e n t i s t , gave D r . Byron Wisner no r e f e r r a l i n f o r m a t i o n a t t h e
time; t h a t D r . Hurly, the admitting doctor a t S t . Vincent's
H o s p i t a l found n o t h i n g wrong w i t h h i s tongue b u t d i d f i n d en-
l a r g e d t o n s i l s ; t h a t D r . Hylton, t h e a n e s t h e s i o l o g i s t and h i s
a g e n t s were n e g l i g e n t i n a l l o w i n g t h e o p e r a t i o n ; t h a t two n u r s e s ,
D . Drake and M. Kemp, d i d n o t p r o v i d e t h e proper c a r e ; and
f i n a l l y t h a t S t . V i n c e n t ' s h o s p i t a l f a i l e d t o e x e r c i s e t h e proper
degree of c a r e f o r p l a i n t i f f .
P l a i n t i f f , a 20 y e a r o l d man, went t o s e e D r . J o u r d o n n a i s ,
a G r e a t F a l l s o r t h o d o n t i s t , f o r t r e a t m e n t t o reduce t h e gaps
between h i s t e e t h . D r . Jourdonnais, a f t e r t r e a t i n g p l a i n t i f f
through t h e use of o r t h o d o n t i c appliances suspected t h a t t h e
space problem might be caused by what i s known i n t h e p r o f e s s i o n
a s "tongue t h r u s t " which i s an i n v o l u n t a r y f o r w a r d - t h r u s t i n g
movement of t h e tongue upon swallowing which f o r c e s t h e upper
teeth apart. He discussed h i s conclusions with p l a i n t i f f and
informed him of an operation t h a t might h e l p t h e problem. The
doctor a l s o informed p l a i n t i f f of a doctor i n B i l l i n g s , Montana
who had s p e c i a l board c e r t i f i c a t i o n a s an o r a l surgeon, one D r .
Byron R. Wisner, who might perform t h e operation necessary t o
c o r r e c t t h e tongue problem. D r . Jourdonnais d i d not know D r .
Wisner p e r s o n a l l y , he had heard about him from another d e n t i s t .
P l a i n t i f f request an appointment with D r . Wisner i n B i l l i n g s .
D r . Jourdonnais denied ever recommending an o p e r a t i o n t o
p l a i n t i f f , but stated i n h i s deposition t h a t a f t e r discussing
h i s diagnosis with p l a i n t i f f he merely made t h e appointment f o r
him with D r . Wisner. He s e n t D r . Wisner h i s X-rays and a p l a s t i c
mold of p l a i n t i f f ' s t e e t h b u t d i d n o t send h i s w r i t t e n diagnosis.
Neither d i d he t e l l D r . Wisner of h i s diagnosis a s "tongue
thrust" .
P l a i n t i f f ' s appointment with D r . Wisner was February 23,
1973, i n B i l l i n g s . D r . Wisner's diagnosis was "congential
macroglassia" which i n common terms i s an oversized tongue.
D r . Wisner recommended surgery known a s a p a r t i a l glossectomy,
which he performed on June 5, 1973 a t S t . inc cent's H o s p i t a l i n
Billings. This operation c o n s i s t e d of removal of a wedged shaped
p i e c e of t h e tongue t o reduce i t s s i z e . P r i o r t o t h e surgery
and upon entrance i n t o t h e h o s p i t a l , p l a i n t i f f was examined by
D r . John Hurly, a s required by t h e r u l e s of t h e h o s p i t a l for any
p a t i e n t who was t o undergo surgery.
During surgery D r . Wisner was a s s i s t e d by a n u r s e , M. Kemp,
who was t r a i n e d and employed by D r . Wisner f o r o r a l surgery. The
a n e s t h e s i o l o g i s t and t h e a n e s t h e t i s t , D r . Robert R. Hylton and
J . McGarity, r e s p e c t i v e l y , members of M.D. Anesthesia S e r v i c e s ,
a s s i s t e d i n the aperation. One defendant, D . Drake was t h e
c i r c u l a t i n g n u r s e and was an employee of S t . inc cent's. Plain-
t i f f remained i n t h e h o s p i t a l f i v e days b e f o r e r e t u r n i n g home
t o Great F a l l s . Although a schedule was s e t up f o r p l a i n t i f f
t o s e e D r . Wisner a f t e r l e a v i n g t h e h o s p i t a l , he r e t u r n e d only
once, on J u l y 20, 1973. I n h i s d e p o s i t i o n , D r . Wisner t e s t i f i e d
t h a t on t h a t c a l l p l a i n t i f f had no complaints. He a l s o t e s t i -
f i e d he d i d t e l l p l a i n t i f f t h e r e was a chance of some l o s s of
tongue m o b i l i t y , speech impairment, l o s s of t a s t e , and p o s s i b l y
i t might n o t c u r e h i s tongue t h r u s t when he was informed by
p l a i n t i f f t h a t D r . Jourdonnais had d i s c u s s e d t h e o p e r a t i o n w i t h
him and he wanted t h e o p e r a t i o n . However, D r . Wisner d i d s a y
he t o l d p l a i n t i f f t h a t i t was a d i f f i c u l t procedure t h a t should
be done i n t h e h o s p i t a l . Plaintiff said h i s reason f o r wanting
t h e o p e r a t i o n was because of t h e spacing and f l a r i n g of h i s t e e t h
and t h e o p e r a t i o n might h e l p remove t h e p r e s s u r e on t h o s e t e e t h .
While denied by p l a i n t i f f and h i s mother, D r . Wisner s t a t e d i n
h i s d e p o s i t i o n t h a t she was i n f a v o r of h e r son having t h e
operation.
During t h e one r e t u r n v i s i t t o D r . Wisner, no i n f e c t i o n
was noted i n t h e tongue. On examination p l a i n t i f f a l s o showed
no t a s t e nor sensory d e f i c i e n c y ; t h e tongue had normal m o b i l i t y
and p l a i n t i f f could l i c k h i s l i p s .
The h o s p i t a l r e c o r d s and d e p o s i t i o n s i n d i c a t e t h a t p l a i n -
t i f f l o s t from 1100 t o 1500 c c of blood and t h a t two blood
t r a n s f u s i o n s were r e q u i r e d . P l a i n t i f f alleges t h a t expert t e s t i -
mony would i n d i c a t e t h a t 200 t o 300 c c i s a normal l o s s i n t h i s
type of o p e r a t i o n and t h e l o s s of such a l a r g e amount i s a n
e v i d e n t i a r y f a c t tending t o prove t h e u l t i m a t e f a c t t h e operation
was not performed properly.
Following t h e operation p l a i n t i f f returned t o Great
F a l l s and continued t o have D r . Jourdonnais do orthodontic
work f o r him f o r some s i x months u n t i l p l a i n t i f f moved t o Bozeman.
P l a i n t i f f s t a t e d i n h i s deposition t h a t when he went t o s e e
D r . Wisner some s i x weeks a f t e r t h e operation h i s tongue was
inflamed and t h a t D r . Wisner gave him some p i l l s f o r t h e inflam-
mation. D r . Jourdonnais s t a t e d he had d i f f i c u l t y with p l a i n t i f f
before and a f t e r the operation with p l a i n t i f f n o t keeping
appointment d a t e s , which i n t e r f e r e d with h i s giving p l a i n t i f f
constant c a r e .
Some s i x months a f t e r t h e operation i n B i l l i n g s ,
p l a i n t i f f had h i s t o n s i l s and adenoids removed i n Great F a l l s
by D r . W. J . Roberts. I n h i s d e p o s i t i o n , D r . Roberts s t a t e d
t h a t a t t h e time of h i s removing t h e t o n s i l s they were enlarged
and i n f e c t e d and i n h i s opinion t h i s i n f e c t i o n was chronic.
However, he s t a t e d when he f i r s t examined p l a i n t i f f i n October
1973, he found no a c u t e i n f e c t i o n . He f u r t h e r s t a t e d t h a t while
he doubted t h e t o n s i l s would have i n t e r f e r e d with t h e movement
of p l a i n t i f f ' s tongue, t h e r e c u r r i n g inflammation could cause
the tongue t o be s o r e .
Five i s s u e s a r e presented a l l d i r e c t e d t o t h e g r a n t i n g
of summary judgment t o defendants. These i s s u e s can be summarized
thus -- Was summary judgment proper:
1 ) I f t h e r e were genuine i s s u e s of f a c t a s t o any one o r
more of defendants?
2) Where p l a i n t i f f moved f o r a continuance t o l o c a t e
a d d i t i o n a l expert testimony?
3 ) Where t h e r e was expert testimony already before t h e
c o u r t , o r i t s equivalent?
4) A s t o any one o r more, o r a l l of defendants, a s a
matter of law a s p e r t a i n i n g t o any one o r more of t h e t h r e e
causes of a c t i o n ?
5) When defendants f a i l e d t o comply with t h e n o t i c e
requirements of Rule 5 6 ( c ) , M.R.Civ.P.?
W n o t e here t h a t p l a i n t i f f ' s complaint a g a i n s t t h e
e
defendants s e t s f o r t h t h r e e causes of a c t i o n , t h e f i r s t f o r
lack of informed consent, t h e second f o r f a i l u r e t o use due
c a r e , (both sounding i n t o r t ) ; and t h e t h i r d a g a i n s t only
defendant Wisner f o r breach of express warranty t o o b t a i n a
specific result. Extensive discovery procedures followed t h e
f i l i n g of t h e complaint, including seven d e p o s i t i o n s , s e v e r a l
s e t s of i n t e r r o g a t o r i e s , numerous e x h i b i t s , and including a r t i c l e s
from d e n t a l p u b l i c a t i o n s t h a t considered t h e treatment of an
"open b i t e " and " tongue t h r u s t " condition.
W have c a r e f u l l y reviewed t h e posture of t h e cause
e
a t t h e time a l l defendants f i l e d motions f o r summary judgment
and a t t h e time such motions were heard. W a f f i r m such summary
e
judgments a s t o s i x defendants without f u r t h e r d i s c u s s i o n o t h e r
than t o n o t e we f i n d t h e record concerning t h e s e s i x t o t a l l y
f a i l s t o d i s c l o s e genuine i s s u e s of m a t e r i a l f a c t on any theory
of pleading advanced by p l a i n t i f f . These s i x defendants a r e :
Robert R. Hylton, M.D.; J. McGarity, C.R.N.A.; M.D. Anesthesia
S e r v i c e s ; M. Kemp, R.N.; D. Drake, R.N.; and S a i n t Vincent's
Hospital. See: Montana Deaconess Hospital v. Gratton, -
Mont . , 545 P.2d 670, 33 St.Rep. 128; C o l l i n s v. I t o h , 160
Mont.461, 503 P.2d 36; Maki v. Murray H o s p i t a l , 91 Mont. 251,
7 P.2d 228; Davis v. Trobough, 139 Mont. 322, 363 P.2d 727.
The summary judgments granted Dr. Jourdonnais and Dr.
Wisner, will be discussed individually.
As to Dr. Jourdonnais, the summary judgment resulted
after no facts were developed that revealed any deviation from
the established standards of treatment by orthodontists and
after it was shown that no harm came to plaintiff resulting from
the treatment by Dr. Jourdonnais. It is of import to note that
the court did not grant this defendant's motion for summary
judgment until after plaintiff's attorney told the court he could
not produce any additional expert witness testimony against
Jourdonnais other than that before the court.
The record is bare of any testimony of another orthodontist,
dentist, medical doctor, or other expert that the professional
service rendered plaintiff by this defendant was in any manner
improper or negligent. In truth, plaintiff has no complaint as
to the orthodontic work, but directs his complaints as to
Jourdonnais' diagnosis and his failure to warn plaintiff of the
seriousness of the operation called a "partial glossectomy".
Before the district court was the deposition of Dr. Morgan
Allison, Ohio State University, an internationally recognized
oral surgeon. His testimony shows clearly that there was no
error in diagnosis by Dr. Jourdonnais and his treatment of
plaintiff is a recognized and acceptable method of treatment.
Here we have a referring doctor being faulted on the
referral, because plaintiff is dissatisfied. We find no case
law cited by plaintiff or by our research of the question, that
holds a recommendation of a physician to another will subject
the latter to liability for the recommendation, absent a showing
of partnership or employment or agency. The recommended physician
i s t r e a t e d a s an independent c o n t r a c t o r , l i a b l e f o r h i s own
torts. Graddy v. N w Y ~ r k
e Medical College, 243 N.Y.S.2d 940;
Oldis v. La S o c i e t e Francaise de Bienfaisance Mutuelle, 130
C.A.2d 461, 279 P.2d 184; Huber v. P r o t e s t a n t Deaconess Hospital
Ass'n, 127 Ind.App. 565, 133 N.E.2d 864; Myers v. Holborn,
58 N.J.L. 193, 33 A. 389; 70 C.J.S. Physicians and Surgeons,
$ 5 4 ( d ) , p. 978.
W do n o t f i n d p l a i n t i f f ' s a l l e g a t i o n t h a t defendant
e
Jourdonnais was n e g l i g e n t due t o t h e l a c k of informed consent
supported by any evidence. Again we can f i n d no c a s e where
l i a b i l i t y f o r f a i l u r e t o inform i s found a g a i n s t one o t h e r
than t h e physician who undertakes t h e operation. Here, de-
fendant Jourdonnais d i d n o t advise p l a i n t i f f on t h e s u r g i c a l
procedure because he d i d n o t have knowledge of i t o t h e r than
reading. He s t a t e d he explained t o p l a i n t i f f t h a t he knew of
t h e procedure having been performed; he knew nothing about i t ;
he d i d not recommend i t ; b u t i f p l a i n t i f f f e l t h i s s i t u a t i o n
was s e r i o u s enough i n h i s own mind, and he wanted f u r t h e r i n -
formation on t h e procedure, then he would put him i n touch with
him
D r . Wisner. He t o l d p l a i n t i f f he would p u t / i n touch w i t h D r .
Wisner f o r information only. On t h i s b a s i s he contacted D r .
Wisner, made an appointment f o r p l a i n t i f f , and s e n t a l l h i s
records t o D r . Wisner, The r u l e i s t h a t t h e physician who pre-
pares t o perform a medical o r s u r g i c a l procedure has t h e obliga-
t i o n t o explain t h a t procedure t o t h e p a t i e n t -- n o t the r e f e r r a l
doctor. Watson v. C l u t t s , 262 N.C. 153, 136 S.E.2d 617;
M i t c h e l l v. Robinson, (Mo. 1960), 334 S.W.2d 11; Harwick v.
/I
H a r r i s , (El&;!
@p
1964), 166 S. 2d 912.
The accepted view i s t h a t t h e s u f f i c i e n c y of t h e physi-
c i a n ' s d i s c l o s u r e i s a matter t o be measured a g a i n s t acceptable
medical p r a c t i c e . P l a i n t i f f i s required t o produce expert
testimony t o e s t a b l i s h a standard of medical p r a c t i c e and show
defendant's d e v i a t i o n from t h a t standard. Zebarth v. Swedish
Hospital Medical Center, 81 Wash.2d 12, 499 P.2d 1. The record
presented t o t h e d i s t r i c t court i n t h e i n s t a n t c a s e l a c k s any
evidence of a standard f o r an o r t h o d o n t i s t , o r of one t h a t
r e f e r s p a t i e n t s t o another s p e c i a l i s t . The testimony of D r .
Schultz, an o r a l surgeon of Great F a l l s , does not supply t h e
standard necessary t o s u s t a i n p l a i n t i f f ' s p o s i t i o n here.
W f i n d summary judgment proper a s t o defendant
e
Jourdonnais.
The general f a c t s i t u a t i o n a s i t r e l a t e s t o D r . Wisner
has been h e r e t o f o r e s e t out. He i s a board c e r t i f i e d o r a l
surgeon who before p r a c t i c i n g i n B i l l i n g s , served a t h r e e year
residency under D r . Morgan ~ l l i s o n Ohio S t a t e University.
of
D r . A l l i s o n i n h i s d e p o s i t i o n s t a t e d D r . Wisner was f u l l y q u a l i -
f i e d t o perform t h e " p a r t i a l glossectomy" and a f t e r reviewing
a l l t h e d e p o s i t i o n s i n t h i s case, along with t h e records of t h e
s u r g i c a l procedure, he found no i n d i c a t i o n of any improper pro-
cedure on t h e p a r t of D r . Wisner i n performing t h e operation.
With t h i s background i n mind, we review t h e background
of t h i s complaint. The operation was performed i n June 1973.
The complaint was f i l e d March 5, 1975. Extensive discovery
followed and t h e t r i a l d a t e of February 2 , 1976 was continued
t o May 17, 1976 t o complete such discovery. Motion f o r
summary judgment was f i l e d and served by defendant Wisner on
May 7 , 1976. A f t e r reviewing t h e d e p o s i t i o n s of D r . Schultz and
and Dr.~Jourdonnais, which showed t h a t a f t e r examining p l a i n t i f f
a f t e r h i s operation they found no r e s i d u a l damage o r evidence
t o s u s t a i n t h e problems he complained o f , t h e c o u r t granted t h e
motion f o r summary judgment on May 17, 1976.
W note here t h a t a t t h e time of t h e hearing on summary
e
judgment, t h e a t t o r n e y f o r p l a i n t i f f d i d n o t o b j e c t t o n o t i c e
on t h e hearing of l e s s than t h e t e n days allowed by s t a t u t e ,
and admitted t h a t "he had no q u a l i f i e d e x p e r t testimony o t h e r
than t h e d e p o s i t i o n s which t h i s Court has read", a l l of which
appears i n t h e t r i a l c o u r t ' s judgment.
A l l p a r t i e s t o t h i s a c t i o n agree t h a t four c a s e s c o n t r o l
t h e i s s u e s before us. Donathan v. McConnell, 121 Mont. 230,
193 P.2d 819; Negaard v. Feda, 152 Mont. 47, 446 P.2d 436;
Montana Deaconess Hospital v. Gratton, - .
Mont , 545 P. 2d
670, 33 St.Rep. 128, 130, 132; C o l l i n s v. I t o h , 160 Mont. 461,
503 P.2d 36.
Donathan - e s t a b l i s h e d t h a t i n Montana a d e n t i s t , . owes
t h e same duty a s a physician t o h i s p a t i e n t .
I n Gratton t h i s Court held summary judgment i s proper:
"I* ** i f t h e pleadings, d e p o s i t i o n s , answers
t o i n t e r r o g a t o r i e s , and admissions on f i l e show
t h a t t h e r e i s no genuine i s s u e a s t o any m a t e r i a l
f a c t and t h a t t h e moving p a r t y i s e n t i t l e d t o
judgment a s a matter of law. ** *' Rule 5 6 ( c ) ,
M.R.Civ.P."
Also Gratton held t h a t where no genuine i s s u e of f a c t has been
r a i s e d t h a t t h e opposing p a r t y has t h e burden of presenting
evidence of m a t e r i a l and s u b s t a n t i a l n a t u r e r a i s i n g such i s s u e ,
noting t h a t when p l a i n t i f f f a i l s t o do s o , summary judgment
must i s s u e . The question of t h e establishment of a standard
of c a r e a g a i n s t which t h e a c t s o r omissions could be measured
t o e s t a b l i s h negligence i s quoted from Evans v. Bernhard, 23
Ariz.App. 413, 533 P.2d 721,723:
I"* ** F i r s t , evidence must be presented t o e s t a b -
l i s h : t h e a p p l i c a b l e standard of medical p r a c t i c e
i n t h e p a r t i c u l a r type of c a s e involved and second,
i t must a l s o be shown t h a t t h e doctor n e g l i g e n t l y
departed from t h i s recognized standard i n h i s t r e a t -
ment of t h e p l a i n t i f f . I n order t o make t h i s threshold
breach of duty a c t i o n a b l e , i t must then be shown t h a t
t h e breach of duty was t h e l e g a l cause of t h e p l a i n t i f f ' s
injuries. *** The medical standard of c a r e must be
e s t a b l i s h e d by expert medical testimony u n l e s s t h e con-
duct complained of i s r e a d i l y a s c e r t a i n a b l e by a l a y -
man. *** However, t h i r d p a r t y expert testimony i s
n o t always necessary a s t h i s standard can be e s t a b l i s h e d
by t h e defendant d o c t o r ' s own testimony.'"
P l a i n t i f f i n r e l y i n g upon Donathan acknowledges t h a t
t h e r u l e e s t a b l i s h e d t h e r e c o n t r o l s t h i s case. I n a l a t e r case,
Negaard t h e d u t i e s owed by a d e n t i s t were f u l l y set f o r t h , and
those p r i n c i p l e s apply t o t h e i n s t a n t case.
A t t h e time of t h e hearing on summary judgment, p l a i n t i f f
h e r e was i n t h e same p o s i t i o n a s were t h e G r a t t o n s , a p p e l l a n t s
i n Montana Deaconess Hospital i n t h e i r appeal t o t h i s Court.
P l a i n t i f f complains of numerous f a c t u a l i s s u e s p r i n c i p a l l y r e l a t i n g
t o t h e diagnosis of h i s condition, t h e procedure used t o c o r r e c t
i t , and t h e treatment given him. I f a l l t h e questions were
resolved i n h i s favor, he s t i l l , could not p r e v a i l f o r he
had no q u a l i f i e d expert testimony f i v e days before t r i a l d a t e t o
show t h a t defendant Wisner departed from t h e recognized standard
of c a r e i n h i s treatment of p l a i n t i f f . The doctors he a l l e g e d
a s h i s e x p e r t s were not "deposed" and s e v e r a l i n d i c a t e d no
i n t e n t t o t r a v e l t o B i l l i n g s t o t e s t i f y on May 1 7 , 1976.
P l a i n t i f f s t a t e d he intended t o c a l l , a s e x p e r t s , D r s .
Baldwin and Roberts of Great F a l l s , however he previously
admitted t h a t D r . Baldwin would n o t t e s t i f y a t t r i a l o r by
deposition. Sa a t t h e time of t h e summary judgment r u l i n g , he
was down t o one p o s s i b l e witness D r . W. J. Roberts, a physician
whose testimony was t o provide t h e standard of c a r e f o r an
o r a l surgeon. D r . Roberts, a board c e r t i f i e d e a r , nose and
t h r o a t s p e c i a l i s t , under t h e standard s e t by t h i s Court i n
C o l l i n s , could not q u a l i f y a s an e x p e r t a g a i n s t D r . Wisner a s
t o t h e standard of c a r e t h a t i s u s u a l l y exercised by an o r a l
surgeon. This i s t r u e too a s t o h i s testimony about t h e f a c t
t h e t o n s i l s c r e a t e d an i n f e c t e d a r e a i n t h e o r a l c a v i t y t h a t
could have caused an i n f e c t i o n t o t h e tongue. This Court
i n Gratton noted:
"The presence of an i n f e c t i o n following an o p e r a t i o n
o r open reduction of a f r a c t u r e does not e s t a b l i s h
negligence. [ C i t i n g c a s e s ] . I 1
According t o h i s d e p o s i t i o n , D r . Roberts knew nothing about
a p a r t i a l glossectomy u n t i l a f t e r he examined p l a i n t i f f before
removing h i s t o n s i l s and t h e only knowledge he had was gained
t h e r e a f t e r a f t e r discussing t h e procedure w i t h o r a l surgeons
i n Great F a l l s .
P l a i n t i f f claims " l a c k of informed consent1'. There was
nothing before t h e t r i a l c o u r t i n way of d e p o s i t i o n o r o t h e r
documents which s e t f o r t h t h e standard of d e n t a l c a r e required
of d e n t i s t s i n informing t h e i r p a t i e n t s with r e s p e c t t o r i s k s
t h a t might r e s u l t from t h e performance of an operation such a s
performed on p l a i n t i f f . N showing was made with r e s p e c t t o
o
d i s c l o s u r e required of a d e n t a l p r a c t i t i o n e r p r i o r t o t h e per-
formance of a p a r t i a l glossectomy. I n so f a r a s could be d e t e r -
mined, t h i s may have been t h e f i r s t such operation i n t h i s a r e a .
P l a i n t i f f recognizes t h a t under Negaard e x p e r t testimony i s
required t o e s t a b l i s h t h e "informed consent" d o c t r i n e , b u t argues
he has c a r r i e d t h a t burden of proof i n t h e depositions of
Jourdonnais, Wisner, Schultz, Roberts and A l l i s o n . A s previously
noted, these depositions do not present t h e necessary testimony
from any q u a l i f i e d e x p e r t t h a t e s t a b l i s h e s such standard.
W next consider t h e blood l o s s i s s u e .
e W f i n d no t e s t i -
e
mony showing t h e l o s s of blood during t h e operation could
r e s u l t i n p l a i n t i f f ' s a l l e g e d r e s i d u a l complications. Dr.
Morgan A l l i s o n , defendant's e x p e r t , t e s t i f i e d i n h i s d e p o s i t i o n
t h a t t h i s was unusual bleeding f o r t h e p a r t i a l glossectomy
on
but wentlto s t a t e t h a t p l a i n t i f f d i d n o t s u f f e r any complications
from t h i s l o s s because of t h e t r a n s f u s i o n s he received. We
f i n d no testimony of any of those deposed a l l e g i n g p l a i n t i f f
s u f f e r e d an* compensable damage o r complication r e s u l t i n g from
an abnormal l o s s of blood.
Next we consider p l a i n t i f f ' s a l l e g a t i o n s t h e operation
was unnecessary and unwarranted. The record i s devoid of any
testimony supporting t h e s e a l l e g a t i o n s . Some doctors might
have proceeded with a d i f f e r e n t treatment before r e s o r t i n g t o
t h e surgery, b u t none t e s t i f i e d t h a t i t was unnecessary o r
unwarranted. The choice was one of medical o r d e n t a l judgment.
P l a i n t i f f argues t h i s Court's holding i n Baylor v.
<-.- ..
',.
- ,>.b..A-
Jacobson, Mont . , W2P.2d 55, 33 St.Rep. 662, i s au-
t h o r i t y t o allow -him t o go t o t h e jury. He a l l e g e s t h e r e was
expert testimony o r i t s equivalent i n t h e record i n d i c a t i n g
t h e operation should be performed only a f t e r "everything e l s e
f a i l s " and t h a t t h e operation should n o t have been performed a t
a l l i n t h i s case. W do n o t agree.
e I n Baylor t h e majority
found an o f f e r of proof of t h e required standard of c a r e
and t h e defendant's breach thereof i n t h e medical testimony
of a D r . Robert Tuby whose i d e n t i t y t h e p l a i n t i f f revealed
i n an amended answer, f i l e d a day a f t e r t h e summary judgment.
Here, no expert medical testimony i s a v a i l a b l e t o e s t a b l i s h
any g e n e r a l i s s u e of m a t e r i a l f a c t concerning t h e required
standard of c a r e D r . Wisner a l l e g e d l y deviated from.
I n p l a i n t i f f ' s complaint, a s a t h i r d cause of a c t i o n ,
he a l l e g e d he agreed t o pay defendant D r . Wisner $283.20, a s
c o n s i d e r a t i o n f o r h i s promise, warranty and performance of t h e
operation. He a l l e g e s defendant breached t h i s warranty, b u t
p l a i n t i f f shows no r e l i a n c e on same. The record i n d i c a t e s t h e
amount p l a i n t i f f paid f o r t h e s u r g i c a l procedure ( t h e operation)
b u t shows no warranty, While i t i s t h e law of Montana t h a t i f
t h e c o n t r a c t was merely t h a t defendant was t o perform a s u r g i c a l
operation, then t h e law r e q u i r e s t h a t t h e defendant possess
t h e s k i l l and l e a r n i n g possessed by t h e average member of h i s
profession i n t h e community and t o use those s k i l l s and l e a r n i n g
i n a reasonable and prudent manner. He does not become a
guarantor of t h e r e s u l t s of such operation.
W f i n d summary judgment proper a s t o defendant Wisner.
e
P l a i n t i f f r a i s e s f o r t h e f i r s t t i m e on appeal t h e f a i l u r e
t o g i v e a t l e a s t t e n days n o t i c e of time fixed f o r hearing t h e
motions on summary judgments a s required by Rule 5 6 ( c ) , M.R.
Civ.P. However, p l a i n t i f f f a i l s t o recognize t h a t he must timely
o b j e c t t o t h e r u l e requirement. F a i l u r e t o do s o waives t h e
defect. 10 Wright & M i l l e r , Federal P r a c t i c e and Procedure:
C i v i l 3 2719, p. 451; 6 Moore's Federal P r a c t i c e V56,14[1], p.
56-357. Also, p l a i n t i f f f a i l e d t o r a i s e h i s o b j e c t i o n b e f o r e
t h e t r i a l court. An o b j e c t i o n r a i s e d f o r t h e f i r s t time on
appeal i s not timely and w i l l n o t be considered by t h i s Court.
Berdine v. Sanders County, 164 Mont. 206, 520 P.2d 650;
Carpenter v. F r e e , 138 Mont. 552, 357 P.2d 882. See a l s o :
Rule 61, M.R.Civ.P.
The o r d e r s of t h e d i s t r i c t c o u r t g r a n t i n g summary
judgments a r e a f f i r m e d ,
Justices
Y
QdkL
IJbn. J a c k L. Green, D i s t r i c t Judge,
sitting for ~ u s t i c e
Wesley C a s t l e s .