Dalley v. Utah Valley Regional Medical Center

• Decision Date: 19 April 1990
• Docket Number: No. 880360,880360
• Citation: 791 P.2d 193
• Parties: Jeanna M. DALLEY, Plaintiff and Appellant, v. UTAH VALLEY REGIONAL MEDICAL CENTER; IHC Hospitals, Inc., d/b/a Utah Valley Regional Medical Center; Howard R. Francis, M.D.; Kent R. Gamette, M.D.; Provo Obstetrics and Gynecology Clinic; and James P. Southwick, M.D., Defendants and Appellees.
• Court: Utah Supreme Court

Page 193

791 P.2d 193

Jeanna M. DALLEY, Plaintiff and Appellant, v. UTAH VALLEY REGIONAL MEDICAL CENTER; IHC Hospitals, Inc. d/b/a Utah Valley Regional Medical Center; Howard R Francis, M.D.; Kent R. Gamette, M.D.; Provo Obstetrics and Gynecology Clinic; and James P. Southwick, M.D., Defendants and Appellees.

No. 880360.

Supreme Court of Utah.

April 19, 1990.

S. Rex Lewis, Leslie W. Slaugh, Provo, for plaintiff and appellant.

Norman J. Younker, Charles W. Dahlquist, M. Karlynn Hinnman, Sherene T. Dillon, for Utah Valley and IHC.

William W. Barrett, Heinz J. Mahler, Salt Lake City, for Dr. Francis, Dr. Gamette, and Provo Obstetrics.

Elizabeth Brennen, Elliott J. Williams, Salt Lake City, for Dr. Southwick.

HALL, Chief Justice:

This case is on appeal from a grant of defendants' motions for summary judgment in the Fourth Judicial District Court of Utah County. Plaintiff filed a complaint asserting a medical malpractice cause of action and based her complaint upon the doctrine of res ipsa loquitur. Because she did not produce any expert witnesses with regard to causation, the trial court ruled that she had failed to show sufficient foundation for the application of res ipsa loquitur. We reverse.

FACTS

On February 5, 1985, plaintiff Jeanna M. Dalley underwent an elective caesarean section operation at Utah Valley Regional On February 6, 1985, the day after the operation, Dr. Francis observed a burn on the calf of plaintiff's right leg about the size of a half-dollar. Dr. Francis made the following notation in the hospital chart: "Does have what appears to be a 4-5 day old burn rt. calf--pt. did not know about it. It is asymptomatic."

Medical Center. Her attending physician was Howard R. Francis, M.D., who was assisted by Kent R. Gamette, M.D., and various other nurses. Her anesthesiologist was James P. Southwick, M.D.

Plaintiff alleges that the burn was not present immediately before the surgery and that it was inflicted in the operating room. The record reflects that a nurse noticed the burn while transporting plaintiff from the operating room following the operation. Skin grafts were eventually required to repair the burn, and plaintiff states that she suffered physical and emotional damages as a result of the incident.

On January 28, 1987, plaintiff filed her complaint. Between April 13, 1988, and June 10, 1988, all named defendants filed motions for summary judgment. On June 14, 1988, plaintiff filed a motion in limine seeking the trial court's determination that the injury was of a type that does not occur in the absence of negligence and that expert testimony was therefore unnecessary.

All of the motions were argued before the trial court on July 22, 1988, and on August 1, 1988, the trial court issued a ruling granting all of defendants' motions for summary judgment. The trial court based its granting of defendants' motions on plaintiff's failure to produce expert medical testimony to establish sufficient foundation for the application of the doctrine of res ipsa loquitur and to establish what instrumentality caused the burn. The court's order granting defendants' motions and denying plaintiff's motion in limine was entered on August 18, 1988.

A motion for summary judgment is granted when no genuine issues of material fact exist and the moving party is entitled to judgment as a matter of law. ¹ Because summary judgment is a conclusion of law, we give no deference to the trial court's conclusions of law but review those conclusions for correctness. ²

The issues presented on appeal are as follows: (1) Is it within the common knowledge of laypersons that a woman who goes into an operating room for a caesarean section with no burn on her leg and emerges with a burn would not have received the burn in the absence of negligence? (2) Where several persons are involved in an operation and the patient is burned by an unknown instrumentality, may all of the persons involved in the operation be held liable? (3) May a person suffer a negligently inflicted physical injury and be compensated for the resulting mental trauma?

I. NEED FOR AN EXPERT WITNESS

The first issue presented in this appeal is whether it is necessary for a medical malpractice plaintiff who is asserting the doctrine of res ipsa loquitur to obtain an expert witness to establish negligence and causation. The general rule is that a person asserting a medical malpractice claim must prove (1) the standard of care required of physicians under similar circumstances practicing in the same field or specialty, ³ (2) that the applicable standard of care was breached, (3) that the injury to the plaintiff was proximately caused by the defendant's negligence, and (4) that damages occurred as a result of defendant's breach of duty. ⁴ To establish the standard of care required of a physician in a particular field, breach of that standard, and proximate cause, the plaintiff is generally required to produce an expert witness who is acquainted with the The doctrine of res ipsa loquitur is an evidentiary doctrine created to help a plaintiff establish a prima facie case of negligence using circumstancial evidence. ⁶ Res ipsa loquitur requires the plaintiff to establish an evidentiary foundation which includes the following:

                standards of care in the same or a similar field as the defendant doctor. 5  Res ipsa loquitur is an exception to the general rule
                

(1) ... [T]he accident was of a kind which in the ordinary course of events, would not have happened had the defendant(s) used due care, (2) the instrument or thing causing the injury was at the time of the accident under the management and control of the defendant, and (3) the accident happened irrespective of any participation at the time by the plaintiff. ⁷

The first requirement to establish negligence under the doctrine of res ipsa loquitur is to show that the injury was of a kind which in the ordinary course of events would not have happened had the defendants used due care. On an appeal from a granting of a motion for summary judgment, we look at the facts most favorable to the party opposing the motion, in this case, plaintiff. ⁸ We thus presume that the burn on plaintiff's leg was not present when she went into the operating room but was present when she emerged.

It would appear that it is within the knowledge and experience of laypersons that a woman with a healthy leg does not usually go into an operating room for a caesarean section operation and emerge with a burn on her leg without some occurrence of negligence. This type of inference does not require expert testimony concerning the standard of care and breach of that standard.

Another requirement to establish the evidentiary foundation of res ipsa loquitur is that plaintiff prove that she did not contribute to the injury suffered. Again, it would appear that it is within the general experience and knowledge of laypersons that a woman who is under an epidural anesthetic rendering her essentially paralyzed from the waist down during the caesarean section delivery of a child generally is not in a position to negligently or intentionally burn herself on the back of her right calf. We conclude that laypersons are capable of discerning whether the injury occurred irrespective of any participation by the plaintiff.

The final element of res ipsa loquitur that must be proved by plaintiff is that the instrument or thing that caused the injury was under the management and control of defendants. Thus, causation becomes the crucial issue.

In Anderton, this Court stated:

[R]es ipsa loquitur is an evidentiary doctrine aiding in the proof of negligence; it has no bearing on the issue of causation, which must be separately and independently established.... Res ipsa loquitur does not relieve plaintiff of [the obligation of proving causation]; rather, it permits him, in lieu of linking his injury to a specific act on defendant's part, to causally connect it with an agency or instrumentality, under the exclusive control of the defendant, functioning in a manner which, under the circumstances, would produce no injury absent negligence. ⁹

Defendants rely on Talbot v. Dr. W.H. Groves' Latter-Day Saints Hospital,

Inc. ¹⁰ to claim that in order for plaintiff to maintain the causation aspect of her negligence In holding that Talbot did not establish a sufficient foundation to assert the res ipsa loquitur doctrine, this court stated:

claim against any defendant, she must show the precise instrumentality that caused her injury and the specific individuals who controlled the instrumentality. In Talbot, the plaintiff entered the hospital for a back operation. When Talbot was recovering in his room, he experienced numbness in his right arm. The record revealed that before Talbot had regained consciousness after the operation, he was lying on his right side with his arm under him and apparently there was a period when his forearm and hand were hanging over the bed. Expert testimony in the case could not identify what the cause of the injury was and left open the possibility of non-negligence causes.

The plaintiff does not attempt to show that the injury to his arm occurred while he was in the care of a particular defendant or defendants. The testimony produced by the plaintiff fails to show the thing, instrument or occurrence which caused the plaintiff's disability.... In this case the plaintiff asks the court to extend the doctrine of res ipsa loquitur to a situation where a number of people had control or partial control of the plaintiff during surgery and thereafter, and where his injury may have occurred by the act or omission of any one of them, and outside the observation of the others. ¹¹

The present case is distinguishable from Talbot in a number of ways. First, the plaintiff in this case alleges that her injury took place in a very confined place--the operating room--while she was under the control of a defined number of persons--the doctors and...