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Law School Case Brief

Brune v. Belinkoff - 354 Mass. 102, 235 N.E.2d 793 (1968)

Rule:

The proper standard of care is whether the physician, if a general practitioner, exercises the degree of care and skill of the average qualified practitioner, taking into account the advances in the profession. In applying this standard it is permissible to consider the medical resources available to the physician as one circumstance in determining the skill and care required. Under this standard some allowance is thus made for the type of community in which the physician carries on his practice. One holding himself out as a specialist should be held to the standard of care and skill of the average member of the profession practicing the specialty, taking into account the advances in the profession. And, as in the case of the general practitioner, it is permissible to consider the medical resources available to him.

Facts:

Plaintiffs, patient and her husband, filed a malpractice action against defendant doctor for alleged negligence in the administration of a spinal anesthetic. The trial evidence indicated that the patient's numbness in her left leg resulted from an excessive drug dosage given by the doctor anesthesiologist. The major issue on appeal was the standard of care to applied. The trial court also refused to give the requested instruction as to the manufacturer's recommended dosages because there was a difference of opinion between the anesthesiologists.

Issue:

Was the defendant anesthesiologist to be judged by the standard of doctors practicing in New Bedford, MA.?

Did the trial judge err in refusing the request for a jury instruction on the drug manufacturer's recommended dosage?

Answer:

No; No

Conclusion:

The appellate court concluded that the "locality" rule to existing condition was inappropriate.  Defendant anesthesiologist was a specialist practicing in New Bedford, a city of 100,000, which is slightly more than 50 miles from Boston, one of the medical centers of the nation, if not the world. The court noted that this situation was far different from the country doctor in Small v. Howard, who 90 years ago was called upon to perform difficult surgery.  Yet the trial judge told the jury that if the skill and ability of New Bedford physicians were "fifty percent inferior" to those obtaining in Boston the defendant should be judged by New Bedford standards, "having regard to the current state of advance of the profession." This may well be carrying the rule of Small v. Howard to its logical conclusion, but it is, we submit, a reductio ad absurdum of the rule.

There was evidence that in a brochure published by the manufacturers of pontocaine the use of two to five milligrams in dextrose was recommended for a vaginal (saddle block) delivery, and the defendant testified that he was familiar with the contents of this brochure. There was medical evidence that it was good medical practice to follow the recommendations of the manufacturer with respect to dosages for spinal anesthetics. There was, however, testimony by an anesthesiologist that the recommendations contained in the brochure were "intended as a guide to physicians, not to anesthesiologists." The statement concerning dosages in the brochure was quite different from the rule adopted for the safety of third persons in the Stevens case. It was no more than a recommendation, and there was a difference of opinion among the anesthesiologists as to whether the failure to follow it was improper practice.

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