Appeal from a judgment of the United States District Court for the Northern District of New York, Howard G. Munson, Chief Judge, summarily dismissing medical malpractice suit on account of plaintiff's failure to produce expert witness on issues of negligence and causation. Affirmed.
Before KAUFMAN, KEARSE, and ALTIMARI, Circuit Judges.
Plaintiff Kenneth E. Sitts appeals from a final judgment entered in the United States District Court for the Northern District of New York, Howard G. Munson, Chief Judge, summarily dismissing his medical malpractice claim against defendant United States of America, brought under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b), 2671 et seq. (1982), for damages allegedly resulting from a spinal operation he underwent at a Veterans Administration ("VA") Hospital in 1978. The district court granted defendant's motion for summary judgment on the ground that under New York law, which the parties agree is the applicable substantive law, Sitts would be required to introduce at trial expert medical testimony on the issues of negligence and causation and that Sitts had failed to identify any such expert who would testify for him at trial. On appeal, Sitts argues principally that expert testimony was not required in his case because the questions to be decided are within the ordinary experience and knowledge of lay persons and that, in any event, defendant's motion for summary judgment was not adequately supported and revealed the existence of issues of fact to be tried. Finding no merit in these contentions, we affirm.
Most of the pertinent historical facts, relating to spinal surgery undergone by Sitts at a VA Hospital in Syracuse, New York ("Hospital") in 1978, are not in dispute and may be summarized briefly. For some time prior to 1978, Sitts had experienced pain in his lower back and left leg, and had consulted doctors at the Hospital. After bed rest and medication failed to alleviate his symptoms, X-rays and a myelogram were taken and Sitts was diagnosed as having a bulging or herniated disk between the last lumber vertebra (called "L5" in medical terminology) and the first sacral vertebra (called "S1").
The VA physicians advised a laminectomy to remove the bulging material from the "L5-S1 interspace," and Sitts underwent surgery in November 1978. As performed, however, the surgery removed material from between the first two sacral vertebrae (S1 and S2), and not between L5 and S1. Following the operation, when Sitts' pre-operation symptoms persisted, X-rays and a second myelogram disclosed that the laminectomy had been performed at the wrong site. In October 1979, Sitts underwent a second operation which resulted in the removal of the bulging material and the L5-S1 interspace.
In August 1980, having first pursued his administrative remedies as required by 28 U.S.C. § 2675, Sitts commenced the present action, alleging that the first operation was negligently performed, caused a worsening of his back problems, and caused him great pain and suffering. After a period of apparent inaction, there followed pretrial discovery which included document production by both sides, interrogatories to Sitts, and depositions of VA doctors.
Dr. Wayne Eckhart, the orthopedic resident who performed the 1978 operation, testified at his deposition that he had followed the procedure normally used by members of his profession to locate the site of the prescribed laminectomy, i.e., the L5-S1 interspace. As described by Dr. Eckhardt and other orthopedic surgeons whose depositions were taken, the upper end of the human spine normally has five lumbar vertebrae, with adjacent vertebrae separated by cartilage, or disk material, and space; these vertebrae can be manipulated up and down individually in relation to one another in a pistoning-type movement. Below the lumbar vertebrae are the sacral vertebrae; the sacral vertebrae are normally fused together into one bone called the sacrum and cannot be individually pistoned. It is rare that there is movability between the sacral vertebrae--a condition called "lumbarization."
The procedure normally used in locating the operative site for a laminectomy was to make incisions exposing the spine, then to grasp vertebrae and use pistoning motions to find the sacrum, ordinarily the place where no further movement is possible; from that place, the surgeon would simply count vertebrae either up (through the lumbar area) of down (through the sacral area) until he reached the desired level. In the 1978 operation on Sitts, Dr. Eckhardt used this procedure to search for the L5-S1 interspace. Finding bulging and soft disk material between the lowest movable vertebra and the highest immobile vertebra, he concluded that he had located the L5-S1 interspaces; he removed that material and concluded the operation.
In fact, the X-rays and myelogram taken after the 1978 operation revealed that Sitts's spine had lumbarization between S1 and S2, and the material removed by Dr. Eckhardt came from that level; the bulging disk material at L5-S1 was not removed until the October 1979 operation.
As part of its discovery of Sitts, the United States served interrogatories in 1983 which asked, inter alia, whether Sitts had employed an expert to act on his behalf in any matter pertaining to the present suit. Sitts responded in the negative, "reserving the right to amend his response to this interrogatory in the event that an expert witness who is expected to testify ...