Inouye v. Black

California Court of Appeal · Torts

TortsMedical MalpracticeRes Ipsa Loquiturmedical malpracticeres ipsa loquiturnonsuitexpert testimonyprobability of negligence

Facts

Plaintiff underwent neck surgery performed by defendant neurosurgeon to stabilize cervical vertebrae using two pieces of No. 18 stainless steel wire. Two years later X-rays showed that the wire had broken into several fragments, including one fragment that migrated downward and lodged near the spinal cord, making later surgery necessary. Plaintiff's expert, Dr. Holland, testified that the wire was the proper kind, was tied in accordance with good neurosurgical practice, and that standard practice was to inspect the wire visually and manually before use. Both Dr. Holland and defendant testified that fragmentation of properly selected and properly inspected wire into migrating fragments was unexpected and that neither had encountered or heard of such an occurrence.

Issue

Did plaintiff's evidence require submission to the jury under res ipsa loquitur, or otherwise establish a prima facie case of negligence against the surgeon, where implanted surgical wire unexpectedly fragmented and migrated but the evidence did not specifically indicate negligent conduct by the surgeon?

Rule

Res ipsa loquitur creates an inference of negligence only when, in light of past experience, the accident was probably the result of someone's negligence and the defendant is probably the responsible person. In a medical malpractice action, when the matter is beyond common knowledge, the plaintiff must use expert testimony to show that the defendant's conduct fell below the professional standard of care; proof that negligence was merely possible, or that someone was negligent, is not enough when it is at least equally probable that another actor caused the harm.

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

In Sacramento, Nina Flores underwent spinal stabilization surgery performed by Dr. Owen Park, who implanted a standard metal clamp supplied by the hospital. Three years later, imaging showed the clamp had shattered into multiple pieces, one of which had migrated near a nerve root; Nina's expert testified the clamp type was appropriate, Dr. Park's inspection matched standard practice, and the implantation technique was proper.

If Nina sues only Dr. Park and relies on res ipsa loquitur, which is the most likely result?

Explanation. The majority rule requires two conditions for res ipsa loquitur: the event must probably have resulted from someone's negligence, and the defendant must probably be the responsible person. Here, the unusual fragmentation may suggest negligence by someone, but Nina's own expert affirmatively supports Dr. Park's compliance with professional standards, while hidden defects in the device or hospital storage remain at least equally probable causes. Under the case, that is insufficient to infer negligence against the surgeon alone. (Derived from Inouye v. Black (n.d.).)