201 F. 2d 423 - Graham v. Alcoa Ss Co

This is a seaman's action at law for damages for the consequences of the alleged negligent failure of defendant to provide maintenance and cure or, more specifically, to provide an operation to correct a ventral hernia.¹ After his evidence was in, plaintiff's case was dismissed, and this appeal requires that we decide whether the question of defendant's negligence should have been left for decision by the jury. We think the result reached by the district court was correct.

Considering the evidence in the light most favorable to plaintiff, the facts are as follows:

Plaintiff, DeLey R. Graham, was a member of the crew of the 'Arthur M. Hulbert,' a vessel operated by defendant. On May 4, 1948, while on shore leave in Las Piedras, Venezuela, he was shot and robbed by two natives. He was hospitalized in Venezuela and underwent major surgery to repair the damage to his colon and abdominal wall. Defendant paid the hospital and medical expenses. Upon his discharge from the hospital on July 15, he was returned to the United States by plane at defendant's expense. Upon his arrival in New York city, he went to defendant's offices to get his pay and, while there, exhibited to defendant's paymaster the medical report given him by the doctor in Venezuela.2 On July 19, 1948, he was admitted to the United States Marine Hospital at Baltimore, where he was operated upon for the repair of a hernia which had resulted from the wound and the operation in Venezuela. He was discharged from the hospital at Baltimore in October of 1948 as fit for light duty and, shortly thereafter, began soliciting magazine subscriptions, an employment he had arranged for before his discharge. When he left the Baltimore hospital, his incision was still draining and he administered to himself, and, as he traveled about, he stopped at various United States Public Health Service installations to have the incision dressed. In November of 1948, he first noticed a bulging in his abdomen. In December, at the Public Health Service clinic in Jacksonville, Florida, he was told that he had better take it easy. Following that advice, he quit the magazine job and went to stay at his brother's home. On January 19, 1949, at the behest of defendant's counsel, he was examined by a Dr. Parker who 'found there is a definite bulging and protruding area as shown between the original midline incision and the general colostomy location * * *.'³ Dr. Parker reported these findings to defendant. In February of 1949, plaintiff returned to sea as an able bodied seaman and served in that capacity on two vessels but was forced to ship on the third and fourth as an ordinary seaman because the pain and weakness in his abdomen prevented him from performing the more rigorous duties of an able bodied seaman. He has suffered from pain in his abdomen and an 'empty feeling' ever since the injury. In January of 1950, he left the sea and a few months later obtained work ashore. The complaint was filed in August of 1948 while plaintiff was still a patient at the hospital in Baltimore.

At the trial, plaintiff's medical witness testified that, in his opinion, based on an examination of May of 1951, two days before trial, plaintiff was then suffering from a ventral hernia, and that the language of Dr. Parker's report indicated that plaintiff was suffering from the same hernia when Dr. Parker examined him, and that plaintiff should then have been advised to have it repaired by surgery.

Plaintiff grounds his claim for damages on the following theory of negligence. He is suffering, and has suffered for some time in the past, from a traumatic ventral hernia which is the direct result of the gun shot, the operation in Venezuela, and the operation in Baltimore and which requires correction by surgery; defendant had notice of plaintiff's medical history, as shown by defendant's knowledge of his original injury and the consequent surgery in Venezuela and Baltimore and the prognosis by the doctor in Venezuela;4 defendant, being aware of that medical background, should have known, when Dr. Parker found a bulging in plaintiff's abdomen, that that bulge indicated that he had a hernia and that surgery should then have been advised and offered; under defendant's duty to provide maintenance and cure, it was obliged to provide surgical care; defendant negligently failed to fulfill that obligation thus subjecting plaintiff to unnecessary pain and suffering, the danger of a strangulated hernia, and preventing him from working as an able bodied seaman; therefore, defendant must pay.

Plaintiff relies on The Iroquois, 1904, 194 U.S. 240, 24 S.Ct. 640, 48 L.Ed. 955; Cortes v. Baltimore Insular Line, 1932, 287 U.S. 367, 53 S.Ct. 173, 77 L.Ed. 368, and particularly on this court's decision in Sims v. United States, 3 Cir., 186 F.2d 972, certiorari denied, 1951, 342 U.S. 816, 72 S.Ct. 31. This is not an action for failure to give proper medical care aboard ship, however, so that the Iroquois and Cortes cases are not precisely apposite. Plaintiff must sink or swim with the Sims case.⁵ In Sims, a suit in admiralty, we held the defendant liable for its failure to supply maintenance and cure, but we limited liability to damages for those consequences occurring after notice of defendant for libellant's need of care and of his inability to procure it because of indigence.

As the trial unfolded in the district court, it became evident that the crucial issue was whether there was evidence sufficient to sustain the conclusion that defendant was negligent as of January 19, 1949,6 when its doctor, with plaintiff's medical history in mind, examined him and failed to recognize the bulge in his abdomen as a hernia and recommend corrective surgery. It is not contended that an express demand was made that defendant provide further surgery. Such a demand was made in the Sims case and was the basis of our decision there. Thus, plaintiff is reduced to the contention that, although he never asked defendant to furnish surgical care, defendant was aware of sufficient facts concerning his physical condition that it had a duty to search him out, inform him of the need for surgery, and offer it to him.

To sustain that contention, plaintiff relies on the testimony of his medical witness⁷ to the effect that plaintiff had a ventral hernia on January 19, 1949, and that he should have then been advised to have it repaired by surgery. Thus, plaintiff's charge narrows down to one of vicarious liability for malpractice or negligent diagnosis. It is not said that Dr. Parker found that plaintiff had a hernia and that surgery was then necessary and advisable for its correction. The claim is that the language of Dr. Parker's report means that the condition which he did find was in fact a hernia and that he should have recognized it as such and advised corrective surgery then. This is the heart of plaintiff's case; without the testimony of his doctor there would be nothing upon which to predicate negligence. But we think even with that testimony there was not enough to go to the jury. The doctor did not say that Dr. Parker was wrong in not recommending surgery in January of 1949. He said that, in his opinion, Dr. Parker should have so advised. But he also stated that competent surgical men could reasonably differ on the advisability of a third operation under the circumstances existent here; that is, a third incision in the same spot where one incision has been made to repair the bullet wound and a second has been made, and failed, to correct a ventral hernia. This is not evidence of negligence. It is simply a difference of opinion on a question on which plaintiff's own doctor admits there is room for difference. As far as we know from this record, in January of 1949, Dr. Parker was of the opinion that a third operation was not advisable.8 In May of 1951, plaintiff's doctor was of a different opinion. This shows only a failure to agree, not that he who disagreed was negligent. To allow the lay jury to resolve this disagreement would be to let it decide a medical question upon which the doctors are divided. Plaintiff had the burden of establishing that Dr. Parker was negligent in some phase of his examination or recommendation. This he failed to do. It is conclusively established that a physician is not liable for errors of judgment⁹ if he brings to his treatment that skill and care ordinarily exercised by his professional brethren.10 If competent medical men can reasonably differ as to the best of several courses, the doctor is not negligent in pursuing one of them though a part of the profession may believe that another course might have produced better results. That is the situation here.

The judgment of the district court will be affirmed.