On appeal from Superior Court of New Jersey, Law Division, Monmouth County.
J.h. Coleman, Ashbey and Landau. The opinion of the court was delivered by J.h. Coleman, P.J.A.D. Landau, J.A.D., concurring.
This is a medical malpractice case based on an alleged misdiagnosis or failure to diagnose and treat an ectopic pregnancy. A jury found defendant Edward McCartin, M.D., (defendant) committed malpractice and returned a verdict for plaintiff in the sum of $28,000. Defendant filed a motion for judgment n.o.v. At the conclusion of a hearing on the motion, the trial judge determined that plaintiff's expert witness lacked the minimum qualifications to render an opinion respecting the appropriate standard of care and defendant's deviation therefrom. Consequently, judgment n.o.v. was entered in favor of defendant. Plaintiff has appealed, and we affirm the judgment n.o.v.
Our careful study of the record satisfies us the following facts are not in serious dispute. Plaintiff, the mother of two daughters, had an IUD inserted in 1981 by Dr. Shangold when she was 26 years old. Following her menstruation period in April 1983, she continued to experience vaginal bleeding and discomfort. Dr. Shangold examined plaintiff on June 2, 1983; he gave her an intravenous injection to stop the bleeding and a prescription for the pain.
Plaintiff next sought medical assistance on June 10, 1983 when she went to the emergency room of Point Pleasant Hospital. There, she complained of vaginal bleeding and abdominal pain. She was examined by defendant, a staff obstetrician and gynecologist. Plaintiff told defendant that she had been examined a few days earlier by Dr. Shangold. Defendant's examination revealed tenderness in the upper right quadrant and in the area of the cervix. Defendant ordered a number of tests, removed the IUD and admitted plaintiff to the hospital. He made a working diagnosis of pelvic inflammatory disease and started to administer an antibiotic while plaintiff was in the emergency room before a series of sophisticated
tests were performed. Blood and urine tests results later confirmed defendant's suspicion of urinary tract infection.
On June 10 a quantitative Beta Subunit Human Chorionic Gonadotropin (HCG) test was performed. This procedure utilizes a highly sensitive blood or urine test that detects early pregnancy. The HCG test score was 9027; that suggested a pregnancy of one to three months duration.
The first of three sonograms was performed the same day. This procedure utilizes ultrasound to depict internal organs. The sonogram revealed a small sonolucency within the uterus suggestive of an early gestational sac. The right adnexa, which includes the right ovary and right fallopian tube, was normal. The roentgenologist who interpreted the sonogram stated:
The left tubo-ovarian complex is prominent with the findings suggesting a complex mass having both cystic and solid components. The mass measures about 3 cm in diameter and is nonspecific consistent with either a dilated tube, abscess or even tumor. The right adnexa is well visualized and is normal.
The uterus was lightly dilated although it was normal in contour. A small sonolucency was persistently seen within the uterus. It was poorly visualized although it overall appearance suggests an early gestational sac. The uterus is otherwise normal.
Left adnexal density as described. Possible early intra-uterine gestational sac. A follow-up study in one t two weeks time is recommended for further evaluation.
Based on the examination, the sonogram, the history, the HCG as well as the other blood tests, defendant modified his working diagnosis to include: uterine pregnancy, urinary tract infection, ovarian cyst on the left side and ectopic pregnancy. The ectopic pregnancy was not ranked high on the list.
A second sonogram was performed at the hospital on June 14. The only change visualized was that the left adnexa was less prominent. Defendant explained to plaintiff the adverse effects the antibiotics administered could have on the fetus. Included was the risk that the fetus would be aborted. Because defendant did not perform abortions, he gave plaintiff the
name of the Red Bank Surgicenter in the event she decided to have an abortion.
Defendant testified that he did not perform a laparoscopy because that would have been tantamount to an abortion and the procedure would have involved great risks to the plaintiff. This procedure is performed under general anesthesia. Its purpose would have been to enable defendant to visualize the ovaries, fallopian tubes and to see if fluid had accumulated behind the uterus. The final diagnosis at the hospital was probable uterine gestation (pregnancy) and urinary tract infection. When plaintiff was discharged from the hospital on June 15, an appointment was made for her to see defendant on June 20. Plaintiff, however, failed to keep the appointment.
On June 16, 1983, plaintiff went to the Red Bank Surgicenter where Dr. Smith performed an abortion. After completing the abortion procedure, Dr. Smith informed plaintiff there was no fetus to abort. Plaintiff next saw defendant on June 24, 1983. She informed him what happened at the Surgicenter. Defendant sent plaintiff back to the hospital for a third sonogram that was performed on June 28. This sonogram was interpreted as revealing an "enlarged uterus extending to the right. The echo free area which may have represented gestational sac on the prior study is not seen on this examination. The adnexal mass on the left is again seen and unchanged. No other features are seen."
Significantly, the last sonogram disclosed that the gestational sac had disappeared since the June 14 sonogram. Both the June 10 and 14 sonograms reported that the right adnexa was normal -- meaning ...