Who May Assist a Surgeon?

By any standard, drilling holes in a man's skull, sawing a trap door out of it, or sewing up the parchmentlike covering of his brain is a drastic opera tion. But does it constitute practicing medicine? This was the question that confronted a Justice Court jury in Redding, Calif., last week as Roger Whittaker, 26, went on trial, charged with the practice of medicine without a license. At the same time, Neurosurgeon George C. Stevenson was charged with having aided and abetted Whittaker by letting him do these things.

The basic facts were scarcely in dispute. After Dr. Stevenson, 31, finished his residency at the University of California Medical Center in San Francisco and settled in Redding, he performed many operations inside patients' skulls. Some of the operations were emergency procedures on accident victims, but all were serious enough to require the attendance of two neurosurgeons. Dr. Stevenson, however, was the only neurosurgeon between Sacramento and Medford, Ore., a span of 275 miles.

Control of the Drill. Instead of relying on any one of 75 local physicians --general practitioners, obstetricians, ophthalmologists, pediatricians and the like--Dr. Stevenson called on Whittaker, a highly skilled former Navy medical corpsman, to assist him on three occasions from October 1965 to July 1966. At those times he was called upon to operate a cranial drill and a flexible saw used to remove patches of skull. What were Whittaker's qualifications to do such work? After attending hospital corps school and a naval operating-room technicians' school, Whittaker testified, he had served not only as a "circulating corpsman" in operating rooms but also as "first assistant" during at least 125 operations. Then he spent 2 1/2 years as a surgical technician at the University of California Medical Center.

District Attorney Robert Baker insisted that Whittaker had "complete physical control" of the drill with which he had bored burr holes in patients' skulls. Whittaker maintained just as stoutly that Dr. Stevenson had always put the drill in place. After the holes were drilled, a fine wire saw was passed through them to cut out the flap of bone. Toward the end of an operation, the surgeon or his assistant took a needle and suture thread and sewed up the dura mater, the brain's tough encasing membrane. A nurse testified that in some cases Whittaker had placed these stitches, but he denied it.

Loss of the Test. Attorney Frederick Cone, a partner of famed Tort Lawyer Melvin Belli, sought to prove that the kind of help rendered by Whittaker was standard. The defense involved the showing of models and color slides of gory operations, and the calling of big-name medical witnesses. A key issue was whether Dr. Stevenson had tried to get a licensed physician to assist him, at least in cases other than crash emergencies. Of the three cases before the jury, one was such an emergency. On this and one other count, the jury found both defendants not guilty. But on one, involving a case in which Dr. Stevenson had time to call another physician but did not try, it found both defendants guilty.

The penalties were nominal: suspended sentences of 30 days in jail, plus fines of $200 for Stevenson and $50 for Whittaker. More significant was the loss of a test case: Stevenson had hoped to help ease the doctor shortage by establishing the right of a well-trained technician to assist in surgery.

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