Sides v. St. Anthony's Medical Center
258 S.W.3d 811, 2008 Mo. LEXIS 146, 2008 WL 2971771 (2008)
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Rule of Law:
In a medical malpractice action, a plaintiff may use expert testimony to establish that an injury would not have occurred in the absence of negligence, thereby supporting a claim brought under the doctrine of res ipsa loquitur.
Facts:
- Janice Sides underwent a lumbar laminectomy with spinal fusion on June 17, 2003.
- The surgery was performed by Dr. Thomas K. Lee at St. Anthony’s Medical Center.
- Dr. Lee was an employee of Tesson Heights Orthopedic and Arthroscopic Associates, P.C.
- During the procedure, Sides was unconscious under anesthesia, and Dr. Lee was assisted by employees of St. Anthony's Medical Center.
- All surgical equipment and materials were prepared by and under the control of St. Anthony's.
- Following the surgery, Janice Sides developed an Escherichia coli (E. coli) infection at the precise surgical site.
- Sides was discharged from the hospital three days after her operation.
Procedural Posture:
- Janice and Clyde Sides (plaintiffs) sued Dr. Lee, Tesson Heights, and St. Anthony’s Medical Center (defendants) in a Missouri state trial court.
- After filing several amended petitions, the plaintiffs' final petition asserted a claim based on the theory of res ipsa loquitur.
- The defendants filed motions to dismiss, arguing that Missouri law barred the use of expert testimony to support a res ipsa loquitur claim in a medical malpractice action.
- The trial court granted the defendants' motions and dismissed the plaintiffs' suit with prejudice.
- The Sides (appellants) appealed to the Missouri Court of Appeals, Eastern District.
- The Supreme Court of Missouri granted transfer after the court of appeals issued an opinion.
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Issue:
May a plaintiff in a medical malpractice case use expert testimony to support a claim brought under the theory of res ipsa loquitur?
Opinions:
Majority - Laura Denvir Stith
Yes. A plaintiff in a medical malpractice case may use expert testimony to establish the elements of a res ipsa loquitur claim. The court's prior decision in Hasemeier v. Smith did not prohibit the use of expert testimony in a res ipsa loquitur case; rather, it held that a plaintiff could not merely substitute the doctrine for the required expert testimony on negligence when the matter is beyond a layperson's common knowledge. By aligning with the Restatement (Second) of Torts § 328D and the vast majority of other jurisdictions, this Court holds that expert testimony can be used to 'bridge the gap' and help a jury infer negligence from a particular outcome in complex medical situations. Furthermore, a res ipsa loquitur claim may proceed against multiple defendants if the plaintiff can show they had joint control or a joint right of control over the instrumentalities that caused the injury.
Concurring - Don E. Burrell, Jr.
The majority reaches the right result to reverse the dismissal, but it addresses a question that is not yet before the court. The only issue at this stage is whether the plaintiff's petition, on its face, states a claim for which relief can be granted. The question of whether expert testimony is admissible to prove that claim is a matter of evidence, which is premature to decide at the motion-to-dismiss stage. Under existing precedent from Hasemeier, the Sides' petition adequately pleaded a claim of general negligence because they could not be expected to know the specific cause of the negligence, which was a matter peculiarly within the defendants' knowledge. Therefore, the case should be reversed and remanded on that narrower ground, without rendering a broad holding on the use of expert testimony.
Analysis:
This decision significantly modernizes Missouri's medical malpractice jurisprudence by explicitly permitting expert testimony to support res ipsa loquitur claims. It resolves ambiguity created by lower court interpretations of Hasemeier and aligns Missouri with the overwhelming majority of other states and the Restatement (Second) of Torts. The ruling provides a viable path for plaintiffs who suffer injuries that strongly imply negligence but cannot identify the specific negligent act, which is common in complex surgical settings where the patient is unconscious. This will likely allow more such cases to reach a jury, shifting the focus from the plaintiff's inability to pinpoint a specific error to whether an expert can establish that the outcome itself is evidence of a breach of the standard of care.
