Brune v. Belinkoff
235 N.E.2d 793 (1968)
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Rule of Law:
The standard of care for a physician is that of the average qualified practitioner in their field, taking into account the advances in the profession and the medical resources available; the standard is not limited to the practices of the specific locality where the physician practices.
Facts:
- On October 4, 1958, Theresa Brune was a patient at St. Luke's Hospital in New Bedford for the delivery of her child.
- Dr. Belinkoff, a practicing specialist in anesthesiology in New Bedford, administered a spinal anesthetic to Brune during the delivery.
- The anesthetic contained eight milligrams of pontocaine in a glucose solution.
- Eleven hours later, when Brune attempted to get out of bed, she fell to the floor.
- Following the incident, Brune suffered from persistent numbness and weakness in her left leg.
- Expert medical testimony indicated that an eight-milligram dose of pontocaine was excessive and that proper medical practice would have been a dose of five milligrams or less.
- Conflicting medical testimony, including from Belinkoff, stated that an eight-milligram dose was proper and was the customary dosage in New Bedford for a vaginal delivery.
Procedural Posture:
- Theresa Brune and her husband (plaintiffs) filed a tort action for medical malpractice against Dr. Belinkoff (defendant) in a Massachusetts trial court.
- A jury returned verdicts in favor of the defendant on all counts.
- The plaintiffs appealed to the Supreme Judicial Court of Massachusetts, taking exception to the trial judge's jury instructions, the judge's refusal to give certain requested instructions, and the denial of their motion for a new trial.
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Issue:
Does the standard of care for a medical specialist in a malpractice action depend on the customary practices of physicians in the specific locality where they practice?
Opinions:
Majority - Spalding, J.
No. The standard of care for a physician is not limited to the practices of their specific local community. A specialist must be held to the standard of care and skill of the average member of the profession practicing that specialty, taking into account the advances in the profession and the medical resources available. The court overruled the longstanding 'locality rule' established in Small v. Howard, finding it unsuited for modern conditions. The court reasoned that advances in transportation, communication, and medical education have diminished the justifications for holding a physician in a smaller community to a lower standard of care than one in a major medical center. The trial court's instruction, which suggested the defendant should be judged by the potentially 'fifty percent inferior' standards of New Bedford compared to Boston, was deemed a 'reductio ad absurdum' of the old rule. The new standard holds that all practitioners, and especially specialists, must adhere to a broader standard consistent with the profession as a whole, while allowing the fact-finder to consider the medical resources available to the physician as a relevant circumstance.
Analysis:
This landmark decision effectively abolished the 'locality rule' in Massachusetts, a significant shift in medical malpractice law that influenced other jurisdictions to follow suit. By establishing a national standard of care, the court recognized the increasing standardization of medical education and practice. This ruling raises the required standard of care for physicians in smaller communities, making it more difficult for them to defend against malpractice claims by arguing they complied with local, but substandard, practices. It also simplifies the process for plaintiffs to find qualified expert witnesses, as they are no longer restricted to finding experts only from a 'similar locality'.
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