that the physician and the nurses acting under his direction were guilty of malpractice.
Briefly stated, the evidence is that on the morning of September 9th, between 8:00 and 9:00 o'clock, Dr. Kelly gave Brown an electro-shock treatment producing a grand mal reaction. After the shock, he slept, ate, bathed, read, and at about 3:00 o'clock P.M., walked upstairs to the second floor for a massage. About twenty minutes later, he was permitted to return unattended to the first floor. He fell down a flight of stairs, eighteen in number. The fall was unobserved. He immediately complained that his neck was broken and that he was dying. He could not explain what caused his fall. Dr. Kelly was summoned.
There was testimony that persons who have experienced grand mal reactions from shock treatments are mentally confused and their muscles are not co-ordinated for varying periods of time, and that they should be carefully watched. Apparently Dr. Kelly did not consider it necessary to have an attendant accompany Mr. Brown as he walked about the Sanitarium approximately seven hours after the treatment. The fact that after the fall he was conscious and complaining, but could not account for the cause of his fall, is a strong circumstance that he was still in a confused and inco-ordinated state. Thus the jury might have inferred from the circumstances that it was not only negligence on the part of the doctor to permit him to walk downstairs unaccompanied but also that that negligence was the proximate cause of his fall.
Legal causal connection between the negligence and the fall may be shown by either direct or circumstantial evidence, and when a finding is a reasonable inference from the facts and conditions directly proved, it must be classed as legal evidence and not as a mere conjecture. Hodgson v. Bigelow, 335 Pa. 497, 519, 7 A.2d 338, 348-349 (1939); Schulz v. Pennsylvania Railroad Co., 1956, 350 U.S. 523, 76 S. Ct. 608.
After the fall, nurses, at least one of whom was registered, carried Brown to a bed in a nearby treatment room. There was testimony that it was malpractice to carry a person by his extremities when a spinal injury is suspected, but that a board-like stretcher should be used and the head put in traction.
However, no specific injury was shown to have been caused by this act of negligence.
From the records, testimony and circumstances, the jury could have found that no neurological tests were made, no spinal tap was taken, and no X-ray pictures were taken. The defendants did not call as witnesses Dr. Kelly or the doctor who consulted with him, nor take their depositions. Brown not only complained that his neck was broken but he had an abrasion on the top of his head, a cut cheek, bloody nose and paralysis of his extremities. From these facts and circumstances, the jury was fully warranted in finding that the doctor disregarded the likelihood of an injury to the spine and failed to use the approved tests to determine whether or not the patient sustained a fracture or dislocation of his vertebrae. Instead he diagnosed his condition as hysterical paralysis and treated him accordingly.
That treatment which he prescribed was completely at variance with the treatment required by the patient's true condition. He was moved about without head support. His head was never put in traction. He was permitted to move about in bed. Massage was administered. Respiratory depressants were prescribed.
During the next day or two further symptoms indicating an organic lesion rather than hysteria appeared. The patient exhibited a distended abdomen, paralysis of the legs and sometimes one or both arms, elevated temperature ranging to 104 degrees, inability to defecate, projectile vomiting, respiratory embarrassment and continued complaints of neck pains. But, notwithstanding, it does not appear that any of the ordinary tests were ever made which would have led to a correct diagnosis and proper treatment. Brown died in the early morning of September 13th.
Post-mortem X-rays disclosed a dislocation of the fourth cervical vertebra on cervical vertebra number five, the extent being 8 mm.; also a fracture of the posterior spinous process of the fifth vertebra with 1 c.m. hiatus between the fragments with the body of this vertebra being depressed. No indication of hemorrhage in the spinal cord was found in the limited autopsy ordered by the Sanitarium.
From this evidence the jury was justified in finding that malpractice was the proximate cause of the decedent's death.
The owners complain that the verdicts were based on speculation and conjecture. There was testimony that if the injury had been properly diagnosed and the proper treatment administered, the patient would have lived and recovered from the effects of the broken neck as well as from the neurosis. Thus, we think there was a sufficient evidentiary basis to support a finding of loss of earning power; the fact that some speculation and conjecture concerning the extent of the recovery was involved does not invalidate the determination of the jury. Indeed, from the size of the verdicts one suspects that the jury did not find that malpractice caused the fall because if it had the evidence would have supported verdicts in a much larger total amount.
Loss of future earning power less cost of future maintenance is inherently subject to considerable conjecture in a death case; mathematical certainty cannot be attained and is not required. The same is true of problems pertaining to life expectancy and the division of the loss of earning power between the verdict under the Wrongful Death Act, 12 P.S. 1601 et seq. and the verdict under the Survival Act, 20 P.S. 320.601 et seq. Those questions are ones peculiarly adapted for resolution in the sound judgment and discretion of the jury.
Under the evidence, pain and suffering may well have been a substantial item in arriving at the verdict under the Survival Act.
There are no indications of caprice, passion or prejudice on the part of the jury. In our opinion the verdicts are not excessive.
An appropriate order will be entered.