Boyce v. Brown

Arizona Supreme Court · Torts

TortsMedical Malpracticemedical malpracticestandard of careexpert testimonycommunity standarddirected verdictgrossly apparent negligence

Facts

In 1927, defendant operated on Mrs. Boyce's fractured ankle and inserted a metal screw; the opinion states there was no serious contention that this treatment up to the termination of services a few weeks later failed to meet approved medical standards. In November 1934, after no professional contact for about seven years, Mrs. Boyce returned complaining of ankle pain, and defendant examined the ankle, wrapped it with adhesive tape, and filed the edge of an old arch support; about a week later he removed the bandage. Her condition did not improve, and in January 1936 another doctor, Dr. Kent, had an X-ray taken, found necrosis around the screw, removed the screw, and the ankle recovered. Plaintiffs' appellate claim focused solely on alleged malpractice in November 1934, especially defendant's failure then to take an X-ray or otherwise provide proper treatment.

Issue

Was there sufficient evidence, taking the evidence as strongly as reasonably possible in plaintiffs' favor, to permit a jury to find that defendant committed malpractice in November 1934? More specifically, did plaintiffs present evidence of the applicable medical standard of care and a deviation from that standard, or was the alleged negligence so obvious that expert testimony was unnecessary?

Rule

A physician is liable for malpractice only if he does something the recognized standard of good medical practice in the community forbids, or omits something that standard requires. The applicable community standard must be shown by affirmative evidence, and negligence from departure from that standard ordinarily must be established by expert medical testimony; only when the negligence is so grossly apparent that a layman would have no difficulty recognizing it may expert testimony be unnecessary. Testimony that another physician would have chosen a different treatment is insufficient unless it also shows that defendant's course deviated from a method approved by the community standard.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Tucson, Dr. Lena Morris examined Carla Ruiz, who complained of recurring wrist pain two years after a fracture repair. Dr. Morris prescribed a brace and rest. Months later, another physician ordered a scan, found a hardware-related complication, and corrected it. At trial, Carla's only expert testified, "I would have ordered imaging at the first visit," but gave no testimony about the standard of practice in Tucson.

If Dr. Morris moves for a directed verdict after Carla rests, how should the court rule?

Explanation. A malpractice plaintiff must affirmatively prove the recognized standard of good medical practice in the community and show that the defendant did something that standard forbids or omitted something it requires. Testimony that the expert personally would have chosen a different diagnostic step is insufficient unless tied to the approved community standard. A worse outcome or later discovery of the true problem does not itself prove negligence. (Derived from Boyce v. Brown (n.d.).)