Narducci v. Tedrow
2000 WL 1612225, 736 N.E.2d 1288, 2000 Ind. App. LEXIS 1764 (2000)
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Rule of Law:
In a medical malpractice claim involving complex procedures, a plaintiff cannot rely on the doctrines of 'res ipsa loquitur' or 'common knowledge' to infer negligence and must present expert testimony to establish that the physician breached the applicable standard of care.
Facts:
- Dr. Audrey Narducci diagnosed Dale Tedrow with a cancerous colon tumor and scheduled him for a sigmoidectomy (colon surgery).
- Prior to the surgery on February 5, 1996, Tedrow signed a consent form authorizing the procedure and any others deemed necessary.
- During the colon surgery, Dr. Narducci discovered a tear in Tedrow's spleen, which was the source of unexpected bleeding.
- After efforts to stop the bleeding were unsuccessful, Dr. Narducci removed Tedrow's spleen.
- Following the surgery, Dr. Narducci informed Tedrow that his spleen had been 'accidentally nicked' during the procedure.
Procedural Posture:
- Dale Tedrow filed a medical malpractice lawsuit against Dr. Narducci and Memorial Hospital in an Indiana trial court.
- Tedrow filed an amended complaint to limit damages to $15,000, thereby avoiding the mandatory pre-filing review by a medical panel.
- Dr. Narducci and the hospital filed motions for summary judgment, arguing Tedrow had failed to produce required expert testimony on the standard of care.
- The defendants supported their motion with an expert affidavit stating that the injury could occur without negligence.
- The trial court denied the defendants' motions, finding that the 'res ipsa loquitur' and 'common knowledge' doctrines applied, thus making expert testimony from the plaintiff unnecessary.
- Dr. Narducci and the hospital (appellants) appealed the trial court's denial of their motions for summary judgment to the Court of Appeals of Indiana.
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Issue:
Do the doctrines of res ipsa loquitur and 'common knowledge' apply to a medical malpractice claim for a spleen injury sustained during colon surgery, thereby excusing the plaintiff from the requirement to present expert testimony on the standard of care?
Opinions:
Majority - Baker, Judge
No. The doctrines of res ipsa loquitur and 'common knowledge' do not apply because determining whether the surgeon's conduct fell below the standard of care in this context requires specialized medical knowledge beyond the understanding of a layperson. Res ipsa loquitur requires a showing that the injury is one that would not ordinarily occur absent negligence. The defendants provided uncontradicted expert testimony from Dr. Hoover that a spleen injury can occur during colon surgery 'because of unavoidable trauma or even for no apparent reason' despite a surgeon's skill and care. Understanding the procedures of colon surgery, the anatomical location of the organs, and the nature of the spleen is beyond the common knowledge of a jury. Therefore, the plaintiff was required to present expert testimony to establish a breach of the standard of care, and his failure to do so is fatal to his claim.
Analysis:
This decision reinforces the significant evidentiary burden on plaintiffs in most medical malpractice cases, affirming that expert testimony is the default requirement. It narrowly construes the 'common knowledge' and 'res ipsa loquitur' exceptions, limiting their application to cases where negligence is blatantly obvious to a layperson, such as leaving a surgical instrument in a patient. The ruling protects medical professionals from liability based on bad outcomes alone, preventing juries from speculating on complex medical issues where expert guidance is necessary to determine the appropriate standard of care.
