States v. Lourdes Hospital
792 N.E.2d 151, 100 N.Y.2d 208 (2003)
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Rule of Law:
In a medical malpractice action, a plaintiff may use expert medical testimony to establish the first element of the doctrine of res ipsa loquitur, that an injury is of a kind that does not ordinarily occur in the absence of someone's negligence, when the matter is outside the common knowledge of a lay jury.
Facts:
- On July 25, 1995, Kathleen States underwent surgery at Our Lady of Lourdes Hospital for the removal of an ovarian cyst.
- An anesthesiologist and his practice group (defendant) were responsible for administering anesthesia.
- Prior to the surgery, States's right arm was extended outward on a board, and an IV tube was inserted into her right hand.
- States complained of pain and a burning sensation upon the insertion of the IV tube.
- The surgery to remove the cyst was successful, and there was no record of any unusual event involving her arm during the procedure.
- Upon waking from the anesthesia, States complained of significant pain in her right arm and shoulder.
- States was subsequently diagnosed with right thoracic outlet syndrome and reflex sympathetic dystrophy.
- States alleged her injury was caused by the negligent hyperabduction (stretching beyond 90 degrees) of her arm for an extended period during the surgery.
Procedural Posture:
- Plaintiff Kathleen States sued her anesthesiologist and his practice group in New York Supreme Court, a trial-level court.
- At the close of discovery, defendants moved for summary judgment, arguing there was no direct evidence of negligence.
- The Supreme Court denied the defendants' motion for summary judgment.
- Defendants, as appellants, appealed to the Appellate Division, an intermediate appellate court.
- A divided Appellate Division reversed the trial court's order and granted summary judgment to the defendants.
- Plaintiff, as appellant, appealed to the New York Court of Appeals, the state's highest court, based on the two-justice dissent at the Appellate Division.
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Issue:
In a medical malpractice case, may a plaintiff rely on expert testimony to establish the first element of res ipsa loquitur—that the injury-causing event would not ordinarily occur in the absence of negligence—where a jury's common knowledge is insufficient to make that determination?
Opinions:
Majority - Ciparick, J.
Yes, a plaintiff may rely on expert testimony to establish the first element of res ipsa loquitur. The court held that expert medical testimony may be used to help a jury understand that an injury would not normally occur without negligence, especially in complex medical situations that fall outside a layperson's common knowledge. The court adopted the view of the Restatement (Second) of Torts and a majority of other jurisdictions, reasoning that in an increasingly specialized society, experts are necessary to 'bridge the gap' between the jury's understanding and the specialized knowledge of physicians. This expert testimony serves to educate the jury, which remains the ultimate finder of fact and is free to accept or reject the expert's conclusion. A plaintiff must still prove the other two elements of res ipsa loquitur: exclusive control by the defendant and the plaintiff's lack of contributory negligence.
Analysis:
This decision significantly broadens the application of the res ipsa loquitur doctrine in New York medical malpractice litigation. Prior to this case, the doctrine was generally restricted to cases where a layperson could infer negligence from common experience, such as a foreign object being left in a patient. By allowing expert testimony to establish the foundational element of the doctrine, the court enabled plaintiffs to pursue claims for more complex injuries occurring during medical procedures where they were unconscious and unable to provide direct evidence of negligence. This shifts the evidentiary burden, often compelling defendants to come forward with an explanation for an unusual injury that occurred while the patient was under their exclusive control.
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