Cangelosi v. OUR LADY OF LAKE REG. MED. CTR.
564 So. 2d 654, 1989 WL 205621 (1990)
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Rule of Law:
A trial judge determines the applicability of res ipsa loquitur in medical malpractice cases under La.R.S. 9:2794 C by deciding if the evidence reasonably permits the jury to infer negligence, applying the same standard as for a directed verdict; however, an appellate court with a complete record may perform an independent factual review to determine if the plaintiff proved negligence by a preponderance of the evidence.
Facts:
- On November 26, 1982, Marion Cangelosi, Sr., a 68-year-old man with numerous health problems including congestive heart failure and chronic pulmonary disease, was admitted to Our Lady of the Lake Regional Medical Center for gallbladder surgery.
- On December 3, Nurse Ann Ashbaugh, a certified registered anesthetist, observed by Dr. Martin Peuler, intubated Mr. Cangelosi without a stylet for his surgery, a procedure described by medical personnel as uneventful.
- Mr. Cangelosi remained intubated for 53 hours, during which time the endotracheal tube's cuff pressure was routinely checked and the tube suctioned, until Dr. Osterberger removed it without difficulty on December 5.
- On December 7, Dr. Radzikowski noted Mr. Cangelosi's labored breathing and congestion, and Dr. Charles Mitchell, an ENT physician, diagnosed laryngeal swelling secondary to intubation, which appeared to improve with prescribed medication.
- On January 4, 1983, Mr. Cangelosi presented to Dr. Osterberger with severe hoarseness and shortness of breath, leading to a diagnosis of tracheal stenosis (narrowing) and stridor (a respiratory sound caused by airway constriction).
- The next day, Dr. Daniel Mouney, an ENT specialist, performed a tracheotomy on Mr. Cangelosi, finding scar tissue covering collapsed and apparently fractured tracheal cartilage rings, which subsequently required sixteen surgical procedures and resulted in a permanent tracheostomy.
- Plaintiffs' expert witnesses, Dr. Mouney and Dr. Joseph Stirt, opined that the tracheal injury occurred during the 53 hours of intubation and was more likely than not due to substandard care, although Dr. Mouney conceded that tracheal stenosis can occur in the absence of substandard care and perichondritis was a credible explanation.
- Defendants' experts, including Drs. Booth, Cowick, Osterberger, Radzikowski, and LaNasa, consistently testified that Mr. Cangelosi's symptoms and medical history were consistent with perichondritis, a non-negligent cause, and that a tracheal fracture from intubation without a stylet was highly improbable.
Procedural Posture:
- Marion L. Cangelosi, Sr. and his wife brought a medical malpractice action against Our Lady of the Lake Hospital, Inc., Dr. Ronald A. Radzikowski, Dr. James S. Osterberger, Jr., Dr. William Booth, Dr. Donald Cowick, Dr. Marshall Sommers, Dr. Martin Peuler, Anesthesiology Group Associates, and Ms. A.L. Ashbaugh.
- A medical review panel unanimously ruled in favor of all defendants, as required by law before a lawsuit can proceed.
- Plaintiffs then filed suit in state trial court, but later voluntarily dismissed Drs. Cowick, Booth, and Sommers.
- At the close of the plaintiffs' case, the remaining defendants moved for a directed verdict.
- At the close of all the evidence, the trial judge granted directed verdicts in favor of Drs. Radzikowski and Osterberger, but denied motions from Our Lady of the Lake, Ms. Ashbaugh, Dr. Peuler, and Anesthesiology Group Associates.
- The trial judge then refused to instruct the jury on the doctrine of res ipsa loquitur, concluding that no evidence showed the injury would not have occurred without negligence.
- The remaining defendants made new motions for a directed verdict, which the trial judge granted, dismissing the case against them.
- Plaintiffs appealed this decision to the Louisiana First Circuit Court of Appeal (appellant: Cangelosi; appellee: defendants), which affirmed the trial court's rulings, including the interpretation of La.Rev.Stat.Ann. 9:2794 C.
- Plaintiffs then applied to the Supreme Court of Louisiana, which granted certiorari. The Supreme Court of Louisiana initially affirmed the judgments of the lower courts in an original hearing (October 23, 1989), then granted a rehearing (December 7, 1989) on plaintiffs' application to reconsider the interpretation of La.Rev.Stat.Ann. 9:2794 C and the doctrine of res ipsa loquitur.
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Issue:
Does La.R.S. 9:2794 C require a trial judge to make a preponderance determination for res ipsa loquitur applicability, or merely assess if a reasonable jury could infer negligence, and if the latter, does an appellate court's independent factual review of the record negate the need for a new trial following a trial court's erroneous res ipsa loquitur ruling?
Opinions:
Majority - Justice Lemmon
No, La.R.S. 9:2794 C does not require a trial judge to find res ipsa loquitur applicable by a preponderance of the evidence, but rather to determine if the evidence reasonably permits the jury to infer negligence; and yes, an appellate court can conduct an independent factual review of a complete record. The court clarified that res ipsa loquitur is a rule of circumstantial evidence allowing a permissive inference of negligence when the injury ordinarily does not occur without negligence, other probable causes are eliminated, and the negligence is within the defendant's duty. The trial judge's role under 9:2794 C is to determine if reasonable minds could reach different conclusions regarding negligence based on the evidence, applying the same standard as for a directed verdict. If so, the judge must instruct the jury on res ipsa loquitur. The lower courts erred in interpreting 9:2794 C as requiring the plaintiff to prove res ipsa loquitur by a preponderance to the judge. However, exercising its constitutional authority to review facts in civil cases, the Supreme Court conducted its own independent review of the complete record. It concluded that the evidence indicating a non-negligent cause (perichondritis) was at least as equally plausible as the evidence suggesting defendants' negligence. Therefore, the plaintiffs failed to prove by a preponderance that their injury was more probably than not caused by defendants' negligence, thus affirming the ultimate result of the directed verdict.
Concurring - Justice Marcus
Justice Marcus concurred with the ultimate result of affirming the lower courts but disagreed with the majority's interpretation of La.R.S. 9:2794(C). He maintained that the statute intends for the trial judge to find res ipsa loquitur applicable before instructing the jury, arguing that the majority's standard makes the exception the rule. He contended that the facts of this case did not suggest defendants' negligence as the probable cause; rather, perichondritis was the most probable non-negligent explanation. Therefore, he believed the trial judge was correct in finding res ipsa loquitur inapplicable and in granting the directed verdicts because the evidence overwhelmingly favored the defendants, and reasonable minds could not reach a contrary verdict. He specifically disagreed with the majority's assertion that the trial judge originally concluded the evidence reasonably permitted an inference of negligence.
Concurring - Justice Watson
Justice Watson concurred with the result of the majority, aligning with the original opinion's outcome and largely agreeing with the scholarly discussion on res ipsa loquitur. He, however, expressed disagreement with the majority's 'unnecessary confection' of a 'directed verdict' standard for determining whether a trial court should give a res ipsa loquitur instruction. He argued that La.R.S. 9:2794(C) simply requires the judge to determine if there is evidence justifying a charge, similar to how a judge selects appropriate jury instructions in criminal procedure, rather than applying a stringent 'reasonable minds could not differ' test. He believed the process should be less about a directed verdict standard and more about assessing the permissible inferences from the evidence.
Analysis:
This case significantly clarifies the application of res ipsa loquitur in Louisiana medical malpractice actions under La.R.S. 9:2794 C, shifting the trial judge's role from weighing evidence for preponderance to merely determining if a reasonable jury could infer negligence. By affirming the appellate court's independent factual review and ultimate decision on the merits despite the trial court's instructional error, the ruling reinforces the appellate court's broad constitutional authority to avoid remands when a complete record exists. This precedent streamlines the appellate process, potentially reducing new trials due to legal errors, but also means that a plaintiff denied a proper jury instruction may still lose if a higher court finds the evidence of non-negligent causation equally plausible.
