Brune v. Belinkoff

Supreme Judicial Court of Massachusetts · Torts

TortsMedical MalpracticeStandard of CareLocality RuleSpecialistsmedical malpracticelocality rulecommunity rule

Facts

The plaintiff alleged that the defendant anesthesiologist negligently administered a spinal anesthetic during childbirth by giving eight milligrams of pontocaine in one cubic centimeter of ten per cent glucose. There was evidence that her later numbness and weakness in her left leg resulted from an excessive dosage, although other medical evidence, including the defendant's testimony, stated that the dosage was proper and customary in New Bedford for a vaginal delivery. The trial judge instructed the jury to measure the defendant by the professional standard ordinarily possessed by physicians in New Bedford and its environs, even if that standard were inferior to Boston's. There was also evidence that a manufacturer's brochure recommended two to five milligrams for a vaginal delivery, but testimony indicated that the brochure was intended as a guide and that anesthesiologists differed on whether departure from it was improper practice.

Issue

Should a physician, and particularly a specialist, be judged in a malpractice case by the standard of doctors practicing in the same or similar locality, or by a broader professional standard that takes account of advances in the profession? Also, was the jury entitled to be instructed that failure to follow the manufacturer's dosage recommendation was evidence of negligence?

Rule

The locality rule is no longer the governing standard in Massachusetts medical malpractice cases. A general practitioner must exercise the degree of care and skill of the average qualified practitioner, taking into account advances in the profession, and a specialist must meet the standard of care and skill of the average member of the profession practicing that specialty, also taking into account advances in the profession; in both instances, the medical resources available to the physician may be considered as one circumstance in determining the care and skill required. A manufacturer's recommendation that is merely advisory and disputed within the profession is not, by itself, a basis for instructing the jury that noncompliance is evidence of negligence.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Tacoma, Dr. Nina Sethi, a board-certified neurologist, treated Omar Lewis for a seizure disorder using a monitoring practice commonly followed by neurologists in her city. Omar's expert testifies that average neurologists practicing that specialty, in light of current professional advances, ordinarily use a more careful monitoring approach, and that Tacoma's local custom has lagged behind.

If the case is tried under the majority rule from this case, which standard should the jury use to evaluate Dr. Sethi's conduct?

Explanation. The majority rejected the locality rule as the governing test. A specialist is judged by the care and skill of the average member of the profession practicing that specialty, taking into account advances in the profession. Local medical resources may be considered, but locality does not itself set the standard. (Derived from Brune v. Belinkoff (n.d.).)