Brannon v. Wood
251 Or. 349, 1968 Ore. LEXIS 463, 444 P.2d 558 (1968)
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Rule of Law:
The doctrine of res ipsa loquitur may apply in medical malpractice cases, even when specific negligence is alleged, but its application is limited to establishing those specifically alleged acts. For the doctrine to apply to rare injuries or those involving inherent risks in medical procedures, especially in an emergency, expert testimony is required to establish that such an occurrence is more likely due to negligence than some other cause for which the defendant is not responsible.
Facts:
- In 1964, Brannon was admitted to St. Vincent Hospital for Dr. James A. Wood, a thoracic surgeon, to remove a posterior mediastinal tumor from his chest.
- During the operation, the tumor was identified as a meningocele, which protruded through an opening in Brannon’s spinal column into his chest cavity, and was subsequently excised.
- Several hours later, Brannon began hemorrhaging severely and was returned to surgery, where Dr. Wood determined the bleeding was coming up through the foramen from which the meningocele had been removed.
- Dr. Wood attempted to stop the life-threatening bleeding using silver clips, Gelfoam, and a sponge, but these measures were ineffectual as Brannon suffered critical blood loss.
- Facing an urgent situation, Dr. Wood packed Surgicel into the foramen until the bleeding stopped, acknowledging a risk of cord damage but believing it would not likely cause injury.
- Upon returning to the recovery room, Brannon was discovered to have paralysis in the lower portion of his body.
- A neurosurgeon performed a laminectomy to remove the Surgicel from Brannon’s back, but the paralysis was not relieved, leaving Brannon a paraplegic with complete loss of feeling and motion from the umbilicus downward.
- It was undisputed that Brannon’s permanent paralysis was caused by the compression of his spinal cord by the Surgicel packed within the spinal canal.
Procedural Posture:
- Brannon filed a personal injury action against Dr. Wood and other defendants (partners and an associate in The Portland Clinic).
- Before the case was submitted to the jury, Brannon withdrew all specifications of negligence except for (1) placing and leaving packing against his spinal cord in a position likely to impinge upon it, and (2) failing to warn him of known risks.
- The trial court submitted the case to the jury upon the two remaining specifications of negligence.
- The jury returned a verdict for the defendants.
- Brannon appealed from the adverse judgment to the Supreme Court of Oregon, assigning as error the trial court's failure to give a requested instruction on res ipsa loquitur and its giving of a general instruction that the mere fact of injury is not evidence of negligence.
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Issue:
Does the doctrine of res ipsa loquitur apply in a medical malpractice case where the plaintiff alleges specific acts of negligence, when the injury (paralysis from Surgicel packing) occurred during an emergency procedure to stop life-threatening hemorrhaging, and expert testimony does not establish that such an injury is more likely than not the result of negligence?
Opinions:
Majority - Rodman, J.
No, the doctrine of res ipsa loquitur does not apply in this medical malpractice case because, while the plaintiff alleged specific acts of negligence, the injury (paralysis from Surgicel packing during an emergency to stop severe hemorrhaging) is not of a kind that ordinarily does not occur in the absence of negligence, particularly given the specific facts and lack of expert testimony establishing that such an outcome is more likely than not due to negligence. The court first acknowledged that res ipsa loquitur can be applied in medical malpractice cases, subject to limitations. Specifically, when a plaintiff pleads specific allegations of negligence, the doctrine's application is limited to establishing those specific acts, not as a general inference of negligence. The court then considered the three elements for res ipsa loquitur: (1) the accident ordinarily does not occur absent negligence, (2) exclusive control by the defendant, and (3) no voluntary action by the plaintiff. Elements (2) and (3) were clearly met. The central dispute was whether the accident was of a kind that ordinarily does not occur in the absence of someone's negligence. The court clarified that the relevant question is not merely whether a particular injury rarely occurs, but rather whether, when it occurs, it is ordinarily the result of negligence. In this context, the question became whether paralysis resulting from packing Surgicel against the spinal cord in an emergency to halt extensive hemorrhaging ordinarily occurs in the absence of negligence. The court held that this is not common knowledge for laypersons. While expert testimony indicated the result was very rare and that tightly packing Surgicel against the spinal cord was generally bad practice, no expert testified that under the specific emergency circumstances presented (life-threatening hemorrhage necessitating a risky procedure), the injury was more likely than not the result of negligence. Dr. Wood and his assistant acknowledged the risk of cord damage but used Surgicel as an emergency technique to save Brannon's life. Citing `Siverson v. Weber`, the court reiterated that for res ipsa loquitur to apply to inherent risks or rare injuries, expert witnesses must establish that the injury is more likely the result of negligence than some other cause. Absent such specific expert testimony, the trial court correctly refused the res ipsa loquitur instruction.
Analysis:
This case provides crucial clarification on the application of `res ipsa loquitur` in medical malpractice, especially when specific negligence is alleged and when an injury occurs during an emergency. It reinforces that pleading specific acts of negligence limits the scope of `res ipsa loquitur` to those specific acts, preventing its use as a general inference of negligence. Furthermore, it emphasizes that for rare or inherent risks in medical procedures, particularly in emergency contexts, `res ipsa loquitur` cannot apply without expert testimony to establish that the injury is more likely than not due to negligence, rather than an unavoidable complication. This ruling places a significant burden on plaintiffs to produce expert medical opinions tailored to the specific facts of an emergency procedure, rather than relying on a general rarity of the outcome.
