Kambat v. St. Francis Hosp.
89 N.Y.2d 489, 678 N.E.2d 456, 655 N.Y.S.2d 844 (1997)
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Rule of Law:
In a medical malpractice case where a foreign object is left inside a patient's body, the plaintiff is entitled to a jury instruction on the doctrine of res ipsa loquitur because a lay jury can infer negligence from common knowledge without the need for expert testimony. A defendant's evidence of due care or an alternative theory of causation does not defeat the plaintiff's right to this instruction but instead creates a question of fact for the jury.
Facts:
- In August 1986, Dr. Ralph Sperrazza performed an abdominal hysterectomy on Florence Fenzel at St. Francis Hospital.
- During the surgery, Dr. Sperrazza placed several 18-by-18-inch laparotomy pads inside Fenzel's peritoneal cavity while she was unconscious.
- Months after the operation, Fenzel began complaining of stomach pain.
- On November 30, 1986, X-rays revealed a foreign object in her abdomen.
- On December 5, 1986, an 18-by-18-inch laparotomy pad, similar to those used during the hysterectomy, was discovered fully or partially inside Fenzel's bowel and was surgically removed.
- Fenzel's condition continued to deteriorate, and she died on December 29, 1986, from infection-related illnesses.
Procedural Posture:
- Plaintiffs, the decedent's family, commenced a medical malpractice action against Dr. Sperrazza and St. Francis Hospital in the New York Supreme Court (the trial court).
- At the conclusion of the trial, the plaintiffs requested a jury instruction on the doctrine of res ipsa loquitur, which the trial court denied.
- The jury returned a verdict in favor of the defendants.
- Plaintiffs moved to set aside the verdict, but the trial court denied the motion.
- Plaintiffs, as appellants, appealed to the Appellate Division, which affirmed the trial court's dismissal of the complaint, with two justices dissenting.
- Plaintiffs, as appellants, then appealed to the Court of Appeals of New York, the state's highest court.
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Issue:
In a medical malpractice action, is a plaintiff entitled to a jury instruction on the doctrine of res ipsa loquitur when a surgical pad is discovered in the patient's abdomen post-operation, even if the defendants present evidence of due care and an alternative cause for the injury?
Opinions:
Majority - Chief Judge Kaye
Yes. A plaintiff is entitled to have the case submitted to the jury on a theory of res ipsa loquitur when a foreign object, such as a large surgical pad, is discovered in a patient's body following a medical procedure. The discovery of an 18-by-18-inch laparotomy pad inside a patient’s abdomen after a hysterectomy is an event that a lay jury, relying on common knowledge, can reasonably conclude would not ordinarily occur in the absence of negligence. This satisfies the first condition of the res ipsa loquitur doctrine without the need for expert testimony. The plaintiff's evidence that the patient was unconscious during the procedure and that it was anatomically impossible to swallow the pad sufficiently established the elements of exclusive control and lack of patient contribution. Defendants’ evidence of due care and their alternative theory that the patient swallowed the pad does not disqualify the case from a res ipsa loquitur instruction; rather, it creates a factual dispute and a choice of conflicting inferences for the jury to resolve.
Analysis:
This decision reaffirms the classic application of res ipsa loquitur in "foreign object" medical malpractice cases, establishing that such scenarios do not require expert testimony for a jury to infer negligence. The ruling clarifies that the doctrine creates a permissible inference of negligence, not a legal presumption, and that the defendant's introduction of rebuttal evidence does not remove the doctrine from the case. Instead, it frames the issue as a credibility contest for the jury, reinforcing the jury's role as the ultimate fact-finder in weighing competing explanations for an injury. This strengthens the position of plaintiffs in factually straightforward malpractice cases where the negligence is apparent to a layperson.
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