Facts
- In 1927, Nannie E. Boyce suffered an ankle fracture and was treated by Dr. Edgar H. Brown, who surgically reduced the fracture and fixed it with a metal screw.
- After the fracture healed, Dr. Brown ended treatment; plaintiffs alleged they were not told a screw remained in the ankle.
- In November 1934, Mrs. Boyce returned to Dr. Brown with significant ankle pain.
- Dr. Brown did not order an X-ray; he taped the ankle and adjusted a prior arch support.
- Mrs. Boyce’s pain persisted and worsened.
- In January 1936, Mrs. Boyce consulted Dr. Kent, who ordered an X-ray showing a screw and necrosis around it.
- Dr. Kent removed the screw, after which Mrs. Boyce’s ankle substantially recovered.
- Plaintiffs sued for malpractice based on Dr. Brown’s 1934 failure to order an X-ray and diagnose and remove the screw.
Issues
- Whether plaintiffs presented sufficient evidence, including expert medical testimony, to establish the applicable community standard of care and that Dr. Brown deviated from it by not ordering an X-ray and further treating the ankle in 1934.
- Whether the asserted negligence was so obvious that a jury could find malpractice without expert testimony.
Decision
- The Arizona Supreme Court affirmed the directed verdict for Dr. Brown.
- The court held plaintiffs failed to present competent evidence establishing the community standard of care and a departure from that standard.
- The court rejected reliance on a physician’s testimony that he would have ordered an X-ray as proof that the standard required it.
- The court held the decision whether to order an X-ray was not within common lay knowledge, so expert testimony on standard of care was required.
- Because plaintiffs’ proof did not permit a reasonable finding of malpractice, the case was properly withheld from the jury.
Legal Principles
- A licensed physician is presumed to possess and apply the skill and learning of the average practitioner in good standing in the same community, using ordinary and reasonable care.
- A physician is liable for malpractice only if the physician does what accepted community medical practice forbids, or fails to do what that standard requires.
- The community standard of care must be shown by affirmative evidence; absent such evidence, the jury may not speculate about the standard or deviation.
- Negligence is not presumed from an unsuccessful result; it must be affirmatively proven.
- Deviation from the professional standard of care ordinarily must be established by expert medical testimony, except where negligence is so grossly apparent that laypersons can recognize it.
- A difference of medical opinion about preferred treatment does not establish malpractice unless the defendant’s approach departs from accepted methods approved in the community.
Conclusion
The court upheld judgment for the physician because the malpractice claim lacked expert proof of the applicable community standard of care and a deviation from it, and the alleged failure to order an X-ray was not an obvious form of negligence within lay competence to assess without expert testimony.