Harder v. F.C. Clinton, Inc.

Decision Date04 November 1997
Docket NumberNo. 86426,86426
Citation1997 OK 137,948 P.2d 298
PartiesMinnie HARDER, as Administrator of the Estate of Ethel Kayser, Plaintiff-Appellant, v. F.C. CLINTON, INC. d/b/a Heritage Care Center, Defendant-Appellee.
CourtOklahoma Supreme Court

Rick Bisher, Boettcher, Ryan & Martin, Oklahoma City, for Plaintiff-Appellant.

James M. Kaufman, Michael S. McMillin, Fenton, Fenton, Smith, Reneau & Moon, Oklahoma City, for Defendant-Appellee.

OPALA, Justice.

The dispositive question before this court is whether the trial court erred by directing a verdict for the defendant at the close of the plaintiff's evidence that followed a res ipsa loquitur pattern of proof. We answer in the affirmative.


Ethel Kayser [Kayser] was admitted on July 14, 1992 to the Heritage Care Center [Heritage, Center, or nursing home]. On the evening of September 30, 1992 she was transferred to the Clinton Regional Hospital after ingesting an overdose of Tolbutamide, a diabetic medication. There she was diagnosed as having a hypoglycemic coma caused by the lowering of her blood sugar from ingestion of the medication. An intravenous device was inserted in the dorsum area of her right foot to treat the coma. Gangrene later developed in the same foot, which eventually required an above-the-knee amputation.

Minnie Harder [Harder], Kayser's sister, brought a suit against the nursing home, as Kayser's guardian, 1 for harm caused to Kayser by an overdose of the wrong prescription administered to her while she was in the Center's care and custody. 2 At the close of Harder's case, which followed a res ipsa loquitur pattern of proof, the trial court, on Heritage's demurrer to the evidence, directed a verdict for the nursing home. The trial court ruled that Harder's evidence fell short of establishing a negligence claim because her proof failed to show all the requisite foundational elements for res ipsa loquitur. The Court of Civil Appeals affirmed.


Because the record contains some evidence adduced (without objection) by the defendant before the plaintiff had rested, and the order in the record treats the ruling as a "directed verdict," 3 we will review the dispositive ruling as a judgment on directed verdict.

The legal standard that governs motions for directed verdict and those for summary judgment is very similar, if not

                indeed identical. 4  Neither may be sustained unless there is an entire absence of proof on a material issue.  Both should be denied when there are questions of material fact or reasonable persons could differ as to the choice of inferences to be drawn from the facts in evidence. 5  In determining whether a plaintiff's evidence is sufficient to withstand a motion for directed verdict, the trial court must consider as true all evidence favorable to the plaintiff together with all reasonable inferences to be drawn from it, and disregard all conflicting evidence favorable to the movant. 6  Only if all the inferences to be drawn from the evidence are in favor of the moving party will a directed verdict withstand appellate scrutiny


Harder urges that the trial court erred when it directed a verdict for Heritage based on its ruling that she had not satisfied the requirements for a res ipsa loquitur submission. According to Harder, a directed verdict was inappropriate because she adduced reasonably supportive evidence to establish the foundation facts for application of the res ipsa loquitur pattern of proof. Heritage counters that Harder cannot invoke the res ipsa loquitur evidentiary process because she failed to establish two foundation facts 7--(a) the thing causing the injury (the Tolbutamide) was under its exclusive control and (b) but for the negligence in administering an overdose of the wrong medication, the harm of which plaintiff complains would not have occurred.

Res ipsa loquitur 8 is a pattern of proof 9 which may be followed when an injury is alleged to have been negligently inflicted and the harm is shown not to occur in the usual course of everyday conduct unless a person who controls the instrumentality likely to have produced that harm fails to exercise Whether a case is fit for the application of res ipsa loquitur presents a question of law. It is a judicial function to determine if a given inference may be drawn from a proffered set of circumstances. 15 When, at the close of the plaintiff's case the evidence does not demonstrate a sufficient balance of probabilities in favor of negligence, 16 or the issue still rests on conjecture, 17 submission on res ipsa loquitur consideration is not the plaintiff's due.

                due care to prevent its occurrence. 10  The purpose of the res ipsa loquitur evidentiary rule is to aid a plaintiff in making out a prima facie case of negligence in circumstances when direct proof of why the harm happened is beyond the power or knowledge of the plaintiff. 11  Once the foundation facts for res ipsa loquitur 12 are established, negligence may be inferred from the injurious occurrence without the aid of circumstances pointing to the responsible cause.  The burden of producing further evidence (going forward with proof), but not the ultimate burden of persuasion, 13 is then shifted to the defendant. 14

The effect of the res ipsa loquitur evidentiary rule is merely to raise a

                rebuttable inference which allows a plaintiff to take the case to the jury and thus avoid a directed verdict for the defendant. 18  Where the proof is conflicting or subject to different inferences, some of which are in favor of and others against the applicability of res ipsa loquitur, the question must be left to the jury. 19  It is only when one of the foundation facts is irrefutably negated 20 that the necessary prop may be deemed knocked out from under the sine qua non predicate for application of the res ipsa proof pattern

Application Of Res Ipsa Loquitur In The Context Of Health-Care Litigation

A hospital has the duty to provide for the care and protection of its patients, and in the performance of this duty the hospital is required to exercise such reasonable care as the patient's known condition requires. 21 Vis-a-vis its resident, a nursing home stands in a relationship similar to that which a hospital occupies opposite its patient. A resident is under the control and in the care of an entity to which his (or her) safety is entrusted. A nursing home has a duty to provide care at a reasonable standard, taking into consideration the resident's known mental and physical condition. 22 In the context of health-care litigation, res ipsa loquitur--which is applicable to actions against physicians and hospitals 23--may, upon proof of the foundation elements, also be followed in lawsuits against nursing homes. 24 Negligence can never be presumed from showing no more than the happening of the harmful event. 25

It is unnecessary to analyze this cause in terms of our medical-malpractice

                legislation, 76 O.S.1991 § 21, 26 whose provisions raise "a presumption of negligence." 27  Harder's proof clearly met the common-law parameters of the res ipsa rule.  No more is required by statute than by the common law to bring a case within the purview of res ipsa loquitur rule. 28

To establish prima facie a case for res ipsa application, Harder was required to show that (1) an overdose of the wrong prescription medication is not usually ingested in the course of administering prescription drugs to residents; (2) the nursing home has exclusive control and management of the instrumentality (prescription drugs) that caused the injury; (3) evidence shedding light on the harmful event is more accessible to the nursing home than to the plaintiff; and (4) the administration of the injurious overdose is the sort of occurrence which, in the ordinary course of events, would not have happened if one having control of the instrumentality exercised due care.

The foundation facts can be established by expert testimony or by demonstrating that the defendant's substandard conduct falls within the realm of common knowledge. 29 If the showing of any foundation fact requires a degree of knowledge or skill not possessed by the average person, expert testimony must be adduced. 30

A. Foundation Fact I--The Injury Does Not Occur In The Ordinary Course of Operations

The first foundation fact requires a showing that the injury--an overdose of the wrong prescription--does not occur in the ordinary course of operations at the nursing home. 31

Jackie Dixon, a licensed practising nurse (and a medication clerk at the Center), testified that residents' prescription drugs are stored at the nurse's station. She gave a detailed account of the method used for dispensing prescribed medication to the residents. Heritage residents have no access to prescription drugs except when they are administered to them by authorized personnel--a registered or licensed practising nurse or a certified medication aide. When medication is to be administered, the correct dosage is removed from the storage site and placed in a cart that is pushed down the halls. The nurse (or certified medication aide) removes the medication from its container, places it in a cup, and then serves it to the resident. The cart is kept locked The first res ipsa element is met by the evidence adduced because, under the applicable standard of care, the overdose of a wrong prescription drug would not occur in the ordinary course of operations at the defendant nursing home.

while the nurse or aide is administering the medication. Dr. Hays--Kayser's family physician since 1973 (as well as Heritage's medical director)--testified that the administration of the wrong prescription drug in an amount that would cause harm is below the applicable standard of care.

B. ...

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