Boyce v. Brown
Supreme Court of Arizona, 1938.
51 Ariz. 416, 77 P.2d 455.
Author: Juliana P.

Procedural History:  Plaintiff’s, Berlie Boyce and wife, Nannie Boyce brought suit against the defendant, Dr. Edgar Brown, to recover damages for alleged malpractice by the D upon the person of Nannie Boyce. The case was tried and the court granted a motion for an instructed verdict in favor of the defendant, finding that D was not guilt of any acts to charge him with malpractice.  Judgment was rendered on the verdict, and, after the usual motion for new trial was overruled, this appeal was taken.

Facts: In September 1927, one of the plaintiffs (Nanny Boyce) had a fractured ankle, and went to the defendant, a practicing physician and surgeon for many years, for treatment.  The D operated, making an incision at the point of fracture, bringing the broken fragments of bone into apposition, and permanently fixing them in place by means of a metal screw placed in the bone.  D attended P for 3 or 4 weeks following the operation, until a complete union of the bone had been established, and his services terminated.  No services by D for P were needed for seven years until P consulted D again, complaining that her ankle was giving her pain.  D examined the ankle, wrapped it with tape, and put it in an arch.  A week later, D removed the bandage, but P’s ankle did not improve, and was growing more painful for P.  Two years later, P returned to D, who examined her ankle.  A few days later P went to another doctor, Dr. Kent, who noticed some discoloration and swelling, and made an X-ray of the ankle.  The X-ray showed there had been some necrosis of the bone around the screw.  Dr. Kent operated upon P, removed the screw, and realized the ankle was practically normal.

Issue: Whether the examination and treatment given by defendant departed from the established standard for cases like that of the plaintiff.

Rule: Negligence on the part of a physician or surgeon, by reason of his departure from the proper standard of practice, must be established by expert medical testimony, unless the negligence is so grossly apparent that a layman would have no difficulty in recognizing it.

Analysis: Most laymen know that the X-ray usually offers the best method of diagnosing physical changes of the interior organs of the body, and particularly of the skeleton, short of an actual opening of the body for ocular examination, but laymen cannot say that in all cases where there is some trouble with the internal organs that it is a departure from standard medical practice to fail to take an X-ray.   Such things are costly and do not always give a satisfactory diagnosis, or even as good a one as other types of examination may give.  In may cases the taking of an X-ray might be of no value and put the patient to unnecessary expense, and, in view of the testimony in the present case as to the arthritis which the P had, and which Dr. Kent testified would have been his first thought as to the cause of the P’s pain, the court found that it is going too far to say that the failure to take an X-ray of the P’s ankle at that time was so far a departure from ordinary medical standards that even laymen would know it to be gross negligence.

Holding:  Since, therefore, there was insufficient evidence to show that D was guilty of malpractice, the court properly instructed a verdict in favor of the defendant.

Judgment affirmed