## Facts

- A. M. Harrison suffered fatal injuries after being thrown from a street car and remained unconscious until death.
- Dr. F. L. Wisdom was summoned and called Dr. George C. Abel to assist.
- The physicians diagnosed a skull fracture and performed a difficult trephining operation in an effort to save Harrison’s life.
- Harrison died shortly after the operation without regaining consciousness.
- The surgeons filed a $2,000 claim against Harrison’s estate for surgical services; the probate court allowed $400.
- On appeal, a jury in circuit court awarded $650 after instructions permitting consideration of factors including Harrison’s “ability to pay,” and evidence was admitted concerning the estate’s value and likely heirs.

## Issues

1. Whether physicians who perform necessary emergency surgery on an unconscious patient may recover the reasonable value of their services from the patient’s estate under a contract implied in law.
2. Whether, in valuing such services under a contract implied in law, the factfinder may consider the patient’s financial condition or ability to pay.

## Decision

- The court held that the surgeons could recover reasonable compensation from the estate under a quasi-contract (contract implied in law) despite the absence of assent.
- The court held it was error to admit evidence and instruct the jury to consider the patient’s wealth or ability to pay in determining reasonable compensation.
- The judgment was reversed and the case remanded for a new trial consistent with the proper measure of recovery.

## Legal Principles

- When necessary medical services are rendered in good faith to an unconscious and helpless person in an emergency, the law implies an obligation to pay reasonable compensation, enforceable against the patient’s estate.
- Recovery in quasi-contract is measured by the reasonable and customary value of the services based on the physician’s time, skill, responsibility, and the character of the operation.
- Absent an express agreement, a competent physician earns the reasonable and customary fee regardless of whether the treatment succeeds.
- In a contract implied in law, the patient’s financial condition, size of the estate, and disposition to particular heirs are irrelevant to the valuation of services.

## Conclusion

The court recognized quasi-contractual liability for emergency medical services provided to an unconscious patient but limited recovery to an objective reasonable value, excluding the patient’s wealth as a basis for increasing compensation, and ordered a new trial due to improper evidence and instructions.


Cotnam v. Wisdom, 83 Ark. 601, 104 S.W. 164 (1907)