Sanchez v. Tucson Orthopaedic Institute, P.C.
202 P.3d 502, 220 Ariz. 37, 537 Ariz. Adv. Rep. 11 (2008)
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Rule of Law:
To invoke the doctrine of res ipsa loquitur against one of multiple potential defendants, a plaintiff must present evidence showing it was more probable than not that the specific defendant being sued had exclusive control over the instrumentality causing the injury. It is insufficient to merely show that the injury was caused by the negligence of one of two or more independent actors.
Facts:
- Dr. James Levi, an orthopedic surgeon, performed knee surgery on Lorenzo Sanchez on April 28, 2004.
- Dr. Daniel Hughes, a board-certified anesthesiologist from a separate practice group, administered anesthesia for the surgery.
- Following the surgery, Lorenzo Sanchez suffered severe and permanent nerve damage to his leg.
- The Sanchezes alleged that the damage would not have occurred unless Dr. Levi or Dr. Hughes, or both, had been negligent, but they were unable to prove the specific conduct that caused the injury.
- An orthopedic surgeon, serving as the Sanchezes' expert, stated in an affidavit that such nerve damage would not occur during this type of procedure without negligence by either the surgeon or the anesthesiologist.
- The expert's affidavit suggested two potential causes: negligence by Dr. Levi during the procedure, or negligence by Dr. Hughes in administering a popliteal block instead of a femoral nerve block.
Procedural Posture:
- Lorenzo and Bertha Sanchez filed a medical malpractice complaint in an Arizona trial court against Dr. James Levi, Tucson Orthopaedic Institute, Dr. Daniel Hughes, and Old Pueblo Anesthesia, P.C.
- The trial court dismissed the complaint against Old Pueblo Anesthesia and Dr. Hughes for failure to provide a qualified expert affidavit against an anesthesiologist.
- Tucson Orthopaedic and Dr. Levi subsequently moved for summary judgment, arguing the Sanchezes had failed to establish a prima facie case of medical malpractice and that res ipsa loquitur was inapplicable.
- The trial court granted the motion for summary judgment in favor of Dr. Levi and Tucson Orthopaedic.
- The Sanchezes (appellants) appealed the trial court's grant of summary judgment to the Arizona Court of Appeals, with Dr. Levi and Tucson Orthopaedic as appellees.
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Issue:
Does the doctrine of res ipsa loquitur apply against a surgeon in a medical malpractice case when the plaintiff cannot show that it was more probable than not that the surgeon, rather than an independent anesthesiologist, had exclusive control of the instrumentality that caused the plaintiff's injury?
Opinions:
Majority - Eckerstrom, Presiding Judge
No. The doctrine of res ipsa loquitur does not apply against a single defendant where the plaintiff fails to show that it was more probable than not that this defendant, rather than another independent actor, had exclusive control over the cause of the injury. The court reasoned that a plaintiff must establish three elements for res ipsa loquitur: (1) an injury that does not ordinarily occur without negligence, (2) the injury was caused by an instrumentality within the defendant's exclusive control, and (3) the plaintiff cannot show the specific circumstances of the negligence. The Sanchezes failed to establish the second element, exclusive control, as to Dr. Levi. Their own arguments and expert testimony presented the anesthesiologist, Dr. Hughes, as an equally plausible cause of the injury. By alleging that either the surgeon or the anesthesiologist could have been negligent, the Sanchezes failed to present evidence that there was a greater probability the injury resulted from Dr. Levi's negligence than from any other cause. The court distinguished this from cases where multiple defendants might have shared control, as the Sanchezes argued for alternative, not joint, responsibility. Therefore, the doctrine could not be invoked to defeat the motion for summary judgment.
Analysis:
This decision reinforces a strict application of the 'exclusive control' element of res ipsa loquitur in Arizona, particularly in medical malpractice cases involving multiple independent healthcare providers. It clarifies that the doctrine cannot be used as a tool to shift the burden of proof to defendants when a plaintiff can only show that one of several parties must have been negligent. The ruling places a significant burden on plaintiffs to use discovery to pinpoint which defendant was more probably responsible for their injury, rather than relying on res ipsa to proceed against a single defendant in an 'either/or' scenario. This distinguishes Arizona's approach from the more lenient 'unconscious patient' doctrine established in cases like California's Ybarra v. Spangard.
