Sides v. St. Anthony's Medical Center

Supreme Court of Missouri, En Banc · 2008 · Torts

TortsMedical malpracticeRes ipsa loquiturExpert testimonymedical malpracticeres ipsa loquiturexpert testimonyjoint control

Facts

Janice Sides underwent a lumbar laminectomy with spinal fusion at St. Anthony's Medical Center, performed by Dr. Lee, and later alleged that she suffered an E. coli infection at the surgical site. In earlier petitions, plaintiffs alleged specific possible causes such as failures to take standard infection precautions or perforation of the bowel. In their third amended petition, they alleged under res ipsa loquitur that a surgical-site infection of this kind does not occur absent negligence, that Mrs. Sides was unconscious during surgery, and that her body, the surgical site, and the instrumentalities involved were under the exclusive and joint control of defendants, who had superior knowledge of the cause. Plaintiffs conceded they could not prove the specific negligent act but argued they should be allowed to use expert testimony to support the res ipsa theory.

Issue

Whether, in a medical malpractice case brought under res ipsa loquitur, the plaintiff may use expert medical testimony to establish that the injury ordinarily does not occur in the absence of negligence. Also, whether section 538.225 bars use of a res ipsa loquitur theory in such a case.

Rule

A plaintiff in a medical malpractice case may proceed on a res ipsa loquitur theory when the plaintiff shows that the injury is of a kind that does not ordinarily occur absent negligence, that the instrumentalities involved were under the defendants' control or right to control, and that defendants have superior knowledge of the cause; in such a case, expert medical testimony may be used to establish the negligence inference. Where a plaintiff cannot show which specific act caused the injury but can show that all potential causes were within defendants' control or right to control, that defendants had greater access to the cause, and that a medical expert testifies the injury does not occur absent defendants' negligence, the plaintiff has made a prima facie medical-malpractice case.

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

At a surgical center in Columbus, Ohio, Lena Ortiz underwent a complicated abdominal procedure while under general anesthesia. Weeks later, she developed a rare internal contamination near the operative field; her expert cannot identify the precise misstep but will testify that this type of contamination ordinarily does not occur absent negligence by those managing the procedure, and that the surgeon, the hospital staff, and the surgeon's practice all had control or a right to control the relevant instrumentalities.

If the defendants move to dismiss on the ground that a medical-malpractice plaintiff proceeding under res ipsa loquitur may not rely on expert testimony, how should the court rule?

Explanation. The majority held that expert medical testimony may be used to support a res ipsa loquitur theory in a medical-malpractice case. Where the plaintiff cannot identify the specific negligent act but shows that the injury is of a kind that does not ordinarily occur absent negligence, that the potential causes were within defendants' control or right to control, and that defendants have superior access to the cause, the plaintiff has made a prima facie case sufficient to proceed. (Derived from Sides v. St. Anthony's Medical Center (n.d.).)