No. !.3U27
IN 'CHE iUPKh=ME ZOUKT OF THE STAlE 3F 3ONTANA
19 75
MUN'MNA MACONESS HOSPlTAL, a Non-Prof i t
Corporation,
P l a i n t i f f and Respondent,
GEORGE 3, SKATTON,
Defendant and C o u n t e r c l a i m a n t and
Appellant,
GEK'IRUDE GRATTON ,
P l a i n t i f f and C o u n t e r c l a i m a n t and
Appellant,
J U D I T H GRAHAM, M.D., and J . C . WOLGAMOT, M.D.,
A d d i t o n a l Defendants on C o u n t e r c l a i m
and Respondent.
AppeaL f r o m ; D i s t r i c t Court o f t h e Eighth J u d i c i a l D i s t r i c t ,
Honorable Truman G . B r a d f o r d , Judge p r e s i d i n g .
Counsel o f Record:
For A p p e l l a n t s :
M c K i t t r i c k and Duffy, G r e a t F a l l s , Montana
Joseph W. Duffy a r g u e d and P a t r i c k M c K i t t r i c k ,
a p p e a r e d , G r e a t F a l l s , Montana
For Respondents :
J a r d i n e , Stephenson, B l e w e t t and Weaver, G r e a t
F a l l s , Montana
John D. Stephenson, J r . a r g u e d , G r e a t F a l l s ,
Montana
Smith, Emmons and B a i l l i e , G r e a t F a l l s , Montana
W i l l i a m L. B a i l l i e a r g u e d , G r e a t F a l l s , Montana
Church, H a r r i s , Johnson and W i l l i a n ~ s , G r e a t F a l l s ,
Montana
Submitted: December 1 0 , 1975
Mr. J u s t i c e Frank I . Haswell d e l i v e r e d t h e Opinion of t h e C o u r t .
A p a t i e n t and h i s w i f e a p p e a l from a summary judgment
a g a i n s t them i n t h e i r m e d i c a l m a l p r a c t i c e c l a i m a g a i n s t two
d o c t o r s and a h o s p i t a l . The summary judgment was e n t e r e d i n
t h e d i s t r i c t c o u r t of Cascade County by Hon. Truman G . B r a d f o r d ,
d i s t r i c t judge.
A p p e l l a n t s a r e George B . G r a t t o n , t h e p a t i e n t , and
Gertrude Gratton, h i s wife. Respondents a r e two G r e a t F a l l s
d o c t o r s , J u d i t h Graham, M.D. and J . C . Wolgamot, M . D . , and t h e
Montana Deaconess H o s p i t a l , a n o n p r o f i t c o r p o r a t i o n .
On J u n e 1 4 , 1970, G r a t t o n f e l l and f r a c t u r e d h i s r i g h t
shoulder. H e was h o s p i t a l i z e d a t t h e Montana Deaconess H o s p i t a l
i n G r e a t F a l l s from J u n e 1 4 t o J u n e 30 d u r i n g which t i m e D r .
Wolgamot, a n o r t h o p e d i c s u r g e o n , performed a n open r e d u c t i o n
of t h e f r a c t u r e . During t h i s h o s p i t a l i z a t i o n D r . Graham a l s o
t r e a t e d Gratton f o r a pre-existing s e i z u r e disorder. A t the
t i m e G r a t t o n was d i s c h a r g e d from t h e h o s p i t a l on J u n e 30 h i s
s u r g i c a l wound a p p e a r e d t o be h e a l e d .
During t h e n e x t two months, G r a t t o n was s e e n p e r i o d i c a l l y
by b o t h D r . Graham and D r . Wolgamot. G r a t t o n was r e h o s p i t a l i z e d
on September 1 0 f o l l o w i n g t h e b r e a k i n g and d r a i n i n g o f what
a p p e a r e d t o be a b o i l i n t h e a r e a of t h e s u r g i c a l i n c i s i o n . Cul-
t u r e s t a k e n from t h e d r a i n a g e r e v e a l e d a s t a p h i n f e c t i o n and
l a t e r showed t h e p r e s e n c e o f a pseudomonas organism.
G r a t t o n remained h o s p i t a l i z e d u n t i l October 16 d u r i n g
which time he was t r e a t e d by D r . Wolgamot and was a l s o s e e n from
t i m e t o t i m e by D r . Graham.
Following h i s d i s c h a r g e from t h e h o s p i t a l t h e second t i m e ,
Gratton's infection persisted. G r a t t o n was h o s p i t a l i z e d a t h i r d
t i m e from November 18 t o November 2 4 . L a t e r G r a t t o n was t r e a t e d
a t t h e Mayo C l i n i c i n R o c h e s t e r , Minnesota, b u t he c l a i m s h i s
r i g h t arm i s s t i l l d i s a b l e d .
I n J u n e , 1971, t h e h o s p i t a l sued G r a t t o n f o r t h e b a l a n c e
of $546.40 a l l e g e d l y owing from G r a t t o n ' s t h i r d h o s p i t a l i z a t i o n .
G r a t t o n answered c l a i m i n g t h e h o s p i t a l o v e r c h a r g e d f o r i t s
f a c i l i t i e s and s e r v i c e s and t h a t t h e s o l e r e a s o n f o r h i s second
and t h i r d p e r i o d s o f h o s p i t a l i z a t i o n was t h e i n f e c t i o n caused
by t h e h o s p i t a l ' s n e g l i g e n c e d u r i n g h i s f i r s t h o s p i t a l i z a t i o n .
G r a t t o n a l s o c o u n t e r c l a i m e d f o r damages a g a i n s t t h e h o s p i t a l and
d o c t o r s based on m e d i c a l m a l p r a c t i c e i n a n amount e x c e e d i n g
$100,000.
G e r t r u d e G r a t t o n a l l e g e s a c l a i m a g a i n s t t h e d o c t o r s and
t h e h o s p i t a l based on m e d i c a l m a l p r a c t i c e i n a n amount i n e x c e s s
of $75,000.
E x t e n s i v e d i s c o v e r y was u n d e r t a k e n by a l l p a r t i e s con-
s i s t i n g of d e p o s i t i o n s , i n t e r r o g a t o r i e s and a n s w e r s , r e q u e s t s
f o r a d m i s s i o n s , and p r o d u c t i o n of m e d i c a l r e c o r d s f o r i n s p e c t i o n
and c o p y i n g f o r a p e r i o d of a p p r o x i m a t e l y 3-1/2 years. On March
5, 1975, t h e d i s t r i c t c o u r t g r a n t e d summary judgment t o t h e two
d o c t o r s and t h e h o s p i t a l on a p p e l l a n t ' s c l a i m of m e d i c a l m a l -
practice, leaving t h e h o s p i t a l ' s o r i g i n a l action f o r c o l l e c t i o n
of t h e b a l a n c e of t h e h o s p i t a l b i l l u n d i s t u r b e d . The G r a t t o n s
a p p e a l from t h i s summary judgment.
The i s s u e on a p p e a l i s whether t h i s summary judgment
is correct.
Summary judgment i s p r o p e r :
" * * * i f t h e p l e a d i n g s , 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 a d m i s s i o n s on f i l e show
t h a t t h e r e i s no g e n u i n e 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 m a t t e r o f l a w . * * * " Rule 5 6 ( c ) ,
M.R.Civ.P.
Here a r e v i e w of t h e r e c o r d b e f o r e t h e d i s t r i c t c o u r t
d i s c l o s e s no g e n u i n e i s s u e of m a t e r i a l f a c t . The G r a t t o n s have
p o i n t e d o u t 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
t i m e of t h e i n f e c t i o n , i t s s o u r c e , t h e d i a g n o s i s o f G r a t t o n ' s
c o n d i t i o n , and t h e t r e a t m e n t g i v e n him. I f a l l these questions
were u l t i m a t e l y r e s o l v e d i n f a v o r o f t h e G r a t t o n s , t h e y s t i l l
could n o t p r e v a i l . Hence, t h e y a r e n o t m a t e r i a l f a c t s i n t h e
c o n t e x t o f t h e case b e f o r e u s . What i s m i s s i n g h e r e i s e v i d e n c e
o f any s t a n d a r d o f c a r e a g a i n s t which t h e a c t s o r o m i s s i o n s o f
t h e d o c t o r s o r t h e h o s p i t a l s t a f f c a n be measured t o e s t a b l i s h
n e g l i g e n c e on t h e p a r t of e i t h e r .
When t h e r e c o r d d i s c l o s e s no g e n u i n e i s s u e of m a t e r i a l
f a c t , t h e p a r t y opposing summary judgment h a s t h e burden o f p r e -
s e n t i n g e v i d e n c e o f a 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
a g e n u i n e i s s u e of material f a c t . Rickard v . P a r a d i s , Mont .
, 539 P.2d 718, 32 St.Rep. 834; Roope v. The Anaconda Co.,
159 Mont. 28, 494 P.2d 922. The G r a t t o n s have f a i l e d t o c a r r y
t h i s burden and have n o t met t h e i r i n i t i a l e v i d e n t i a r y o b l i g a t i o n s .
I n Evans v . Bernhard, 23 Ariz.App. 413, 533 P.2d 721,
t h e c o u r t g r a n t e d summary judgment i n f a v o r o f a g e n e r a l p r a c t i -
t i o n e r on t h e b a s i s o f a b s e n c e of any p r o o f o f a s t a n d a r d of
m e d i c a l care, o b s e r v i n g t h a t i n a m a l p r a c t i c e c a s e t h e p l a i n t i f f ' s
t h r e s h h o l d o b l i g a t i o n i n v o l v e s two e v i d e n t i a r y s t e p s :
" F i r s t , e v i d e n c e must be p r e s e n t e d 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 t y p e o f c a s e i n v o l v e d and second,
i t must a l s o be shown t h a t t h e d o c t o r n e g l i g e n t l y
d e p a r t e d from t h i s r e c o g n i z e d s t a n d a r d i n h i s
treatment of t h e p l a i n t i f f . I n o r d e r t o make
t h i s t h r e s h h o l d b r e a c h of d u t y a c t i o n a b l e , it
must t h e n be shown t h a t t h e b r e a c h o f d u t y w a s
t h e l e g a l cause of t h e p l a i n t i f f ' s i n j u r i e s .
S t a l l c u p v . C o s c a r a r t , 79 A r i z . 4 2 , 46, 282
P.2d 791, 793 ( 1 9 5 5 ) . The m e d i c a l s t a n d a r d o f
c a r e must be e s t a b l i s h e d by e x p e r t m e d i c a l t e s t i -
mony u n l e s s t h e c o n d u c t complained o f i s r e a d i l y
a s c e r t a i n a b l e by a layman. K a l a r v . MacCollum,
17 Ariz.App. 1 7 6 , 496 P.2d 602 ( 1 9 7 2 ) . However,
t h i r d p a r t y e x p e r t t e s t i m o n y i s n o t always n e c e s -
s a r y a s t h i s s t a n d a r d c a n be e s t a b l i s h e d by t h e
d e f e n d a n t d o c t o r ' s own t e s t i m o n y . V i r g i l v . H e r -
man, 102 A r i z . 31, 424 P.2d 159 ( 1 9 6 7 ) . "
The c a u s e of an i n f e c t i o n i s n o t r e a d i l y a s c e r t a i n a b l e by a layman
and t h e G r a t t o n s have n o t p r e s e n t e d e x p e r t m e d i c a l proof es-
t a b l i s h i n g t h e required standard of medical care. The t e s t i -
mony e l i c i t e d from D r s . Wolgamot and Graham a s t o t h e i r t r e a t -
ment o f G r a t t o n a s w e l l a s t h e i r p a s t e x p e r i e n c e w i t h i n f e c t i o n s
h a s n o t e s t a b l i s h e d a s t a n d a r d of m e d i c a l care o r a d e v i a t i o n
therefrom. A defendant d o c t o r ' s testimony a s t o h i s u s u a l
p e r s o n a l p r a c t i c e i s n o t s u f f i c i e n t t o e s t a b l i s h a g e n e r a l medi-
c a l s t a n d a r d of c a r e . A l s o , t h e p e r s o n a l and i n d i v i d u a l method
of p r a c t i c e of t h e defendant doctor i s n o t s u f f i c i e n t t o estab-
l i s h a b a s i s f o r a n i n f e r e n c e t h a t he h a s n e g l i g e n t l y d e p a r t e d
from t h e g e n e r a l m e d i c a l custom and p r a c t i c e of h i s community.
Bernhard, s u p r a . Also, s e e C o l l i n s v. I t o h , 160 Mont. 461, 469,
503 P.2d 36; K a r r i g a n v . N a z a r e t h Convent & Academy, I n c . , 212
Kan. 4 4 , 50, 510 P.2d 190; Downer v . V e i l l e u x , (Me. 1 9 7 4 ) , 3 2 2 A.2d
82, 88; Davis v . V i r g i n i a n R. Co., 361 U.S. 354, 80 S.Ct. 387, 4
L ed 2d 366.
A s t h e G r a t t o n s have f a i l e d t o p r e s e n t any e v i d e n c e t h a t
would e s t a b l i s h t h e a p p l i c a b l e s t a n d a r d of m e d i c a l care; t h a t
such a s t a n d a r d was d e p a r t e d from; and t h a t a b r e a c h of d u t y w a s
t h e p r o x i m a t e c a u s e o f G r a t t o n ' s i n j u r y ; t h e h o s p i t a l and d o c t o r s
a r e e n t i t l e d t o summary judgment a s a matter o f law.
The G r a t t o n s s e e k t o e s t a b l i s h a presumption of n e g l i g e n c e
t h r o u g h a p p l i c a t i o n o f t h e d o c t r i n e o f res i p s a l o q u i t u r . This
doctrine i s inapplicable i n the ordinary malpractice action. See
Negaard v . Feda, 152 Mont. 4 7 , 446 P.2d 436; Vonault v . O'Rourke,
97 Mont. 92, 33 P.2d 535.
The e l e m e n t s n e c e s s a r y f o r t h e a p p l i c a t i o n o f r e s i p s a
l o q u i t u r a r e a s follows: (1) The i n s t r u m e n t a l i t y which c a u s e d
t h e i n j u r y must be w i t h i n t h e e x c l u s i v e c o n t r o l of t h e d e f e n d a n t ;
( 2 ) t h e i n j u r y must be one t h a t d o e s n o t o r d i n a r i l y o c c u r i f t h e
p a r t y i n c o n t r o l uses proper care; ( 3 ) t h e i n j u r y must n o t be
due t o any f a u l t on t h e p a r t of t h e i n j u r e d p e r s o n . Jackson v.
W i l l i a m Dingwall Co., 145 Mont. 1 2 7 , 399 P.2d 236; Krohrner v .
Dahl, 145 Mont. 491, 402 P.2d 979; S t o c k i n g v . Johnson F l y i n g
S e r v i c e , 143 Mont. 61, 387 P.2d 312; P r o s s e r , Law of T o r t s , 4 t h
ed., p. 214.
I n t h e i n s t a n t c a s e t h e r e i s no e v i d e n c e t o e s t a b l i s h
t h a t t h e i n s t r u m e n t a l i t y c a u s i n g t h e i n f e c t i o n was w i t h i n t h e
e x c l u s i v e c o n t r o l of t h e d e f e n d a n t s . Drs. Wolgamot and Graham
t e s t i f i e d t h a t t h e i n f e c t i o n c o u l d have o r i g i n a t e d from any
number of d i f f e r e n t s o u r c e s , e . g . blood b o r n e i n f e c t i o n , d i r e c t
c o n t a m i n a t i o n from t h e p a t i e n t ' s s k i n , o r a s a r e s u l t of a t r a u -
matic injury. Therefore, t h e instrumentality causing t h e in-
f e c t i o n was n o t n e c e s s a r i l y w i t h i n t h e e x c l u s i v e c o n t r o l of t h e
h o s p i t a l and d o c t o r s . I n Chase v . Haber, 221 C.A.2d 569, 34
Cal.Rptr. 605, it w a s h e l d t h a t s e v e r e l y i n f e c t e d a b s c e s s e s
a p p e a r i n g a t t h e s i t e o f i n j e c t i o n s f o r t h e t r e a t m e n t of pneumonia
were n o t c a u s e d by a n agency o r i n s t r u m e n t a l i t y w i t h i n t h e ex-
c l u s i v e c o n t r o l of t h e d e f e n d a n t a s t h e a b s c e s s e s c o u l d e a s i l y
have o r i g i n a t e d from a n o t h e r s o u r c e .
A bad r e s u l t a l o n e d o e s n o t c o n s t i t u t e e v i d e n c e o r r a i s e
a presumption o r i n f e r e n c e o f n e g l i g e n c e . The d o c t r i n e o f r e s
i p s a l o q u i t u r i s n o t a p p l i c a b l e i n a m a l p r a c t i c e a c t i o n from t h e
m e r e f a c t t h a t an i n f e c t i o n developed i n t h e a r e a o f t r e a t m e n t .
162 A.L.R. 1265, 1284, 82 ALR2d 1262, 1298.
The p r e s e n c e o f a n i n f e c t i o n f o l l o w i n g a n o p e r a t i o n o r
open r e d u c t i o n of a f r a c t u r e d o e s n o t e s t a b l i s h n e g l i g e n c e . ~ a r m a
v . R u s t , 420 S.W.2d 563, (Ky. 1 9 6 7 ) ; P f e i f e r v . Konat, 1 8 1 Neb.
30,146 N.W.2d 743; S t a r n e s v . T a y l o r , 272 N . C . 386, 158 S.E.2d
339; Smith v . Curran, 28 Colo.App. 358, 472 P.2d 769; S t e i n m e t z
v. Humphrey, 289 Ky. 709, 160 S.W.2d 6; H a l i b u r t o n v . G e n e r a l
Hosp. Soc. of C o n n e c t i c u t , 133 Conn. 61, 48 A.2d 261, 20 N.C.C.A.,
N.S. 505; Lorenz v . Booth, 84 Wash. 550, 147 P. 31.
G e r t r u d e G r a t t o n a d d i t i o n a l l y a s s e r t s t h a t s h e i s en-
t i t l e d t o summary judgment a g a i n s t D r s . Wolgamot and Graham
a s a m a t t e r of law based on a n a d m i s s i o n of n e g l i g e n c e c o n t a i n e d
i n t h e i r answer. W e do n o t s o c o n s t r u e t h e p l e a d i n g s . W e have
examined t h e c o u n t e r c l a i m and answer and f i n d t h a t s u c h a con-
s t r u c t i o n of t h e answer i s s t r a i n e d and a t odds w i t h t h e i r en-
t i r e defense as appearing i n t h e record.
F i n a l l y t h e G r a t t o n s s e e k t o e s t a b l i s h noncompliance by
t h e d o c t o r s and t h e h o s p i t a l w i t h o r d e r s o f t h e c o u r t c o v e r i n g
answers t o i n t e r r o g a t o r i e s and p r o d u c t i o n o f r e c o r d s . Suffice
i t t o s a y t h a t t h i s i s n o t a bona f i d e i s s u e on a p p e a l i n t h e
i n s t a n t case. I n any e v e n t a l l d i s c o v e r y must come t o a n end
sometime and 3-1/2 y e a r s seems an a d e q u a t e a l l o w a n c e of t i m e .
The d i s t r i c t c o u r t o r d e r e d a l l d i s c o v e r y completed by December
1, 1974. The G r a t t o n s s i m p l y w e r e u n a b l e t o produce any e v i d e n c e
of m a l p r a c t i c e i n 3-1/2 y e a r s and t h e i r c l a i m must f a i l .
The summary judgment of t h e d i s t r i c t c o u r t i s a f f i r m e d .
T h i s c a u s e i s remanded t o t h e d i s t r i c t c o u r t f o r f u r t h e r proceed-
i n g s on t h e c l a i m of t h e h o s p i t a l a g a i n s t t h e G r a t t o n s f o r pay-
ment o f t h e b a l a n c e o f t h e h o s p i t a l b i l l .
Justice
concur :
Chief J u s t i c e