Case Title: Estate of Hall v. Akron Gen. Med. Ctr.

Citation: 2010-Ohio-1041

Docket Number: 20081980

State: ohio

Court: Ohio Supreme Court

Date: 2010-03-24T00:00:00Z

Document:
[Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as 
Estate of Hall v. Akron Gen. Med. Ctr., Slip Opinion No. 2010-Ohio-1041.] 
 
 
NOTICE 
This slip opinion is subject to formal revision before it is published in 
an advance sheet of the Ohio Official Reports.  Readers are requested 
to promptly notify the Reporter of Decisions, Supreme Court of Ohio, 
65 South Front Street, Columbus, Ohio 43215, of any typographical or 
other formal errors in the opinion, in order that corrections may be 
made before the opinion is published. 
 
SLIP OPINION NO. 2010-OHIO-1041 
ESTATE OF HALL, APPELLEE, v. AKRON GENERAL MEDICAL CENTER ET AL.; 
PATTERSON ET AL., APPELLANTS. 
[Until this opinion appears in the Ohio Official Reports advance sheets, it 
may be cited as Estate of Hall v. Akron Gen. Med. Ctr.,  
Slip Opinion No. 2010-Ohio-1041.] 
Plaintiff was not entitled to a jury instruction on doctrine of res ipsa loquitur in 
medical-malpractice case. 
(No. 2008-1980 — Submitted September 2, 2009 — Decided March 24, 2010.) 
APPEAL from the Court of Appeals for Summit County, 
No. 24066, 2008-Ohio-4332. 
__________________ 
 
LUNDBERG STRATTON, J. 
{¶ 1} The issue before us is whether the plaintiff in this medical 
malpractice case was entitled to a jury instruction on the doctrine of res ipsa 
loquitur.  The defendants-appellants argue that the plaintiff was not entitled to the 
instruction for two reasons:  (1) the plaintiff presented testimony of expert 
witnesses who offered opinions on the specific act of negligence that they believe 
SUPREME COURT OF OHIO 
2 
 
caused the injury and (2) evidence was presented on two equally efficient causes 
of the injury, one of which is not attributable to negligence. 
{¶ 2} For the reasons that follow, we hold that the trial court properly 
declined to instruct the jury on the doctrine of res ipsa loquitur.  Therefore, we 
reverse the judgment of the court of appeals and remand for further consideration 
of the assignments of error that the appellate court considered moot. 
{¶ 3} Lurene N. Hall died on September 10, 2003, at Akron General 
Medical Center following a procedure performed by defendant-appellant Richard 
Patterson Jr., M.D., to place a dialysis catheter into her jugular vein.  Prior to the 
procedure, Hall had a number of medical problems including high blood pressure 
and chronic kidney disease.  She began kidney dialysis in June of 2003.  
Treatments were administered into her jugular vein through a dialysis catheter in 
the right side of her neck.  Three months later, the catheter became infected and 
Hall was referred to Dr. Patterson, an interventional radiologist, who removed the 
catheter on September 8, 2003, without incident.1    
{¶ 4} Two days later, on September 10, 2003, Patterson was scheduled 
to insert a new dialysis catheter.  He chose to use the vein in the left side of her 
neck to avoid the infection that had been present in the vein on the right side.  
Using an ultrasound image to locate the vein, Patterson inserted a needle just 
above the collarbone.  Patterson then inserted a microwire through the needle into 
the jugular vein toward the superior vena cava. 2   He monitored this procedure 
                                          
 
1.  An interventional radiologist performs procedures on patients that involve inserting wires and 
other devices into the body while monitoring the device’s movement through the body with the 
use of x-ray images.     
2.  The superior vena cava is a large vein that receives blood from the head, neck, upper 
extremities, and thorax and delivers it to the right atrium of the heart.  Stedman’s Medical 
Dictionary (26th Ed.1995) 1926.  
 
January Term, 2010 
3 
 
with a fluoroscope that produces real-time images of what is happening inside the 
patient. 
{¶ 5} Patterson removed the needle, leaving the microwire in the vein.  
He fitted a coaxial introducer over the microwire and then removed the 
microwire.  Next, Patterson slid a guidewire through the introducer, monitoring 
this process with a fluoroscope.  Once the guidewire was in place, he successively 
inserted three dilators of increasingly larger size over the guidewire in order to 
increase the size of the puncture hole created by the needle.  Patterson pushed 
each dilator through the skin, muscle, and vein until the hole was large enough for 
him to implant the catheter. 
{¶ 6} Shortly after the procedure was concluded, Hall complained of 
pain at the incision site.  Patterson prescribed medication and checked her 
condition 15 minutes later.  She was lethargic and her skin was cool and clammy.  
He checked her vital signs and instructed a nurse to call Hall’s treating physician. 
{¶ 7} Soon thereafter, Hall lost consciousness, and efforts to resuscitate 
her were unsuccessful.  An autopsy revealed a laceration in the superior vena 
cava.  As a result of the laceration, blood had leaked into the sac that surrounds 
the heart, which led to cardiac arrest, resulting in her death. 
{¶ 8} The plaintiff-appellee, April E. Couch, administrator of the estate 
of Lurene N. Hall, filed this action on behalf of her mother’s estate and next of 
kin.  The complaint alleged that Patterson had negligently performed the dialysis-
catheterization procedure, causing Hall’s death. 
{¶ 9} At trial, the plaintiff presented two expert witnesses who testified 
that Patterson’s negligence proximately caused Hall’s death.  Dr. Michael Foley, 
an interventional radiology expert, testified that Patterson’s actions fell below the 
standard of care as he inserted a very sharp dilator over a guidewire.  According 
to Dr. Foley, Patterson most likely pulled the guidewire back somewhat as he 
advanced the dilator over it, exposing the dilator’s sharp edge, which lacerated the 
SUPREME COURT OF OHIO 
4 
 
superior vena cava.  Foley testified that, in his opinion, Patterson failed to notice 
the laceration as he was inserting the dilators, something that should not occur 
with careful monitoring of the patient.  Dr. Jeffrey Kremen, a vascular surgeon, 
also testified that the dilator veered off course during the procedure and caused 
the laceration. 
{¶ 10} Two expert witnesses testified on behalf of Patterson.  Dr. Matt 
Leavitt, an interventional nephrologist, testified that a laceration was a rare 
complication of this procedure.  He testified that an abnormality or weakness in 
Hall’s vessel may have made it susceptible to laceration and that in his opinion, 
the laceration was most likely caused by friction from an instrument rubbing 
along the wall of the superior vena cava.  He further testified that a physician can 
cause a tear while performing this procedure even if his performance complies 
with the standard of care and that such injury is a known possible complication of 
the procedure. 
{¶ 11} Dr. Mark Dean, an interventional radiologist, testified that Hall’s 
blood vessels were likely weakened by the infection from the prior catheter or by 
her overall compromised medical condition and that the weak vessel was 
lacerated in the regular course of the procedure. 
{¶ 12} At the close of all evidence, the plaintiff asked for a jury 
instruction on the doctrine of res ipsa loquitur.  The court denied the request.  The 
court stated that because there were multiple potential causative factors, it was 
“up to the trier of fact to determine which version they believe.”  The jury 
returned a defense verdict. 
{¶ 13} The plaintiff moved for a new trial on the basis that the trial court 
erred as a matter of law when it refused to instruct the jury on the doctrine of res 
ipsa loquitur.  The trial court denied the motion, and the plaintiff appealed. 
{¶ 14} The Ninth District Court of Appeals reversed and remanded the 
case for a new trial.  The court concluded that the plaintiff’s evidence met the 
January Term, 2010 
5 
 
requirements for an instruction on the doctrine of res ipsa loquitur and that the 
lower court erred by refusing to instruct the jury. 
{¶ 15} The cause is before this court upon the acceptance of a 
discretionary appeal.  120 Ohio St.3d 1504, 2009-Ohio-361, 900 N.E.2d 622. 
Evolution of Res Ipsa Loquitur 
{¶ 16} Res ipsa loquitur is an evidentiary rule that permits, but does not 
require, a jury to draw an inference of negligence from circumstantial evidence.  
Fink v. New York Cent. RR. Co. (1944), 144 Ohio St. 1,  28 O.O. 550, 56 N.E.2d 
456, paragraph two of the syllabus.  Fink examined the historical underpinnings 
of the rule of res ipsa loquitur, which originated by necessity when the true cause 
of an occurrence was known by or could be determined by the defendant but not 
by the plaintiff.  Id. at 5.  Fink noted that the term first appeared in Byrne v. 
Boadle (Ex. 1863), 2 H. & C. 722, 159 Eng.Rep.R. 299, a case in England in 
which a barrel of flour had rolled from a shop window and struck a passerby 
below.  Id.  In that case, the plaintiff was unable to produce evidence to explain 
how or why the barrel had fallen.  Id.  The court in Byrne determined that the 
falling barrel itself was sufficient evidence of negligence, or “res ipsa loquitur,” 
which, literally translated, means “the thing speaks for itself.” 
{¶ 17} Seven years later, an English court applied the rule in a case where 
a brick had fallen upon the plaintiff from the wall of a bridge that was exclusively 
controlled by the defendant.  Fink at 5-6, citing Kearney v. London B. & S. C. Ry. 
Co., L. R. (1870), 5 Q.B. 411.  The use of the phrase spread through England and 
into the United States.  The rule allows a common sense appraisal of the 
circumstances surrounding an unusual accident, permitting a jury to draw the 
obvious conclusion that the accident was the defendant’s fault and requiring the 
defendant to explain why the accident was not his fault.  Wampler, Fly in the 
Buttermilk:  Tennessee’s Desire to Dispense with Layperson Common Sense and 
the Medical Malpractice Locality Rule (2002), 69 Tenn.L.Rev. 385, 391. 
SUPREME COURT OF OHIO 
6 
 
{¶ 18} The term was first mentioned in an Ohio Supreme Court opinion in 
Cincinnati Traction Co. v. Holzenkamp (1906), 74 Ohio St. 379, 78 N.E.529, a 
case in which a trolley pole fell on a person who was about to step onto the car.  
The court held that the trial court “was warranted in taking judicial notice of the 
fact” that a trolley pole does not break and fall in the ordinary course of events 
unless there was negligence in the construction or management of it and therefore 
the court had properly charged the jury on the maxim of res ipsa loquitur.  Id. at 
389. 
{¶ 19} In Soltz v. Colony Recreation Ctr. (1949), 151 Ohio St. 503, 39 
O.O. 322, 87 N.E.2d 167, this court reviewed some of its past decisions that 
applied the rule of res ipsa loquitur.  The rule was applied most often in cases 
involving falling objects, passenger common carriers, or other situations that 
presented a dangerous threat of serious injury or death.  Id. at 508; Worland v. 
Rothstein (1943), 141 Ohio St. 501, 26 O.O. 80, 49 N.E.2d 165 (window cleaner 
dropping a wet sponge);  Walters v. Baltimore & O. S. W. Ry. Co. (1924), 111 
Ohio St. 575, 146 N.E.75 (high voltage electric wires fell on a highway).  See also 
Scrabic v. Cincinnati, N.O. & T.P. Ry. Co. (1932), 42 Ohio App. 473, 182 N.E. 
528 (train derailment);  Baltimore & Ohio Ry. Co. v. Norcross Marble Co. 
(Cuyahoga App.1923), 2 Ohio Law Abs. 104 (train derailment). 
{¶ 20} In Loomis v. Toledo Rys. & Light Co. (1923), 107 Ohio St. 161, 
140 N.E. 639, this court held that res ipsa loquitur did not apply, because the 
defendant had produced evidence that the accident was the result of natural 
causes.  In Loomis, electric poles and wires fell onto the plaintiff’s automobile at 
an intersection.  The plaintiff alleged that the defendant had negligently 
maintained the poles; however, the defendant presented evidence that the poles 
fell during an unusually strong wind storm.  Loomis held that res ipsa loquitur did 
not apply under these circumstances and that the jury was properly instructed to 
consider both asserted possible causes of the occurrence.  Id. at 172-173. 
January Term, 2010 
7 
 
{¶ 21} Historically, res ipsa loquitur was not applied in medical 
malpractice cases, which require a plaintiff to demonstrate by a preponderance of 
the evidence that the injury was the direct and proximate result of the physician’s 
failure to use ordinary skill, care, or diligence, Bruni v. Tatsumi (1976), 46 Ohio 
St.2d 127, 75 O.O.2d 184, 346 N.E.2d 673, at paragraph one of the syllabus.  
Generally, to make that demonstration, a plaintiff must introduce evidence of the 
applicable standard of the medical community and evidence that the physician 
negligently departed from that standard.  Id.  Malpractice cases often require 
background information on medical treatment and possible causes of injury not 
known to the average juror.  Thus, res ipsa loquitur is usually not applicable in 
medical malpractice cases because a layperson cannot determine by common 
knowledge whether negligence occurred. 
{¶ 22} In addition, courts recognize that there may be a variety of causes 
for an injury in a medical malpractice case, and some procedures are so inherently 
risky that injuries may occur even when physicians are careful.  “A physician is 
not a warrantor of cures.  If the maxim, ‘Res ipsa loquitur,’ were applicable to a 
case like this, and a failure to cure were held to be evidence, however slight, of 
negligence on the part of the physician or surgeon causing the bad result, few 
would be courageous enough to practice the healing art, for they would have to 
assume financial liability for nearly all the ‘ills that flesh is heir to.’ ”  Ewing v. 
Goode (Cir.Ct., S.D.Ohio 1897), 78 F. 442, 443. Thus, a jury in a medical 
malpractice action would rarely be able to conclude, based on common 
experience alone, that the injury was one that did not ordinarily occur in the 
absence of negligence. 
{¶ 23} Nevertheless, courts gradually began to allow plaintiffs to use the 
doctrine of res ipsa loquitur in medical malpractice cases.  Initially, it was used 
only in the cases where expert medical testimony was not necessary because the 
negligence was so obvious that jurors could determine from their own knowledge 
SUPREME COURT OF OHIO 
8 
 
and common sense that the physician had been negligent — for example, when a 
physician failed to remove a sponge or other foreign object from the patient’s 
body during surgery.  See, e.g., Ault v. Hall (1928), 119 Ohio St. 422, 164 N.E. 
518 (failure to remove surgical sponges before the incision was closed); 
Bradshaw v. Wilson (1950), 87 Ohio App. 319, 43 O.O. 47, 94 N.E.2d 706 (bone 
fragment left in fracture site).  But courts would not apply the rule if a specific act 
of negligence was alleged.  Sieling v. Mahrer (8th Dist.1953), 113 N.E.2d 373. 
{¶ 24} Later, courts expanded the use of res ipsa loquitur to cases in 
which a plaintiff alleged and presented evidence to prove a specific act of 
negligence.  See Oberlin v. Friedman (1965), 5 Ohio St.2d 1, 34 O.O.2d 1, 213 
N.E.2d 168, paragraph two of the syllabus (“If the allegations of the petition and 
the proof in support thereof call for its application, the doctrine of res ipsa 
loquitur may be applied even though the petition also alleges and evidence is 
offered to prove specific acts of negligence”);  Morgan v. Children’s Hosp. 
(1985), 18 Ohio St.3d 185, 189, 18 OBR 253, 480 N.E.2d 464 (the use of expert 
testimony to establish possible specific acts of negligence does not preclude an 
instruction of res ipsa loquitur if otherwise justified by the circumstantial 
evidence adduced at trial).  However, a plaintiff may not use the doctrine if its 
applicability is “based solely upon the fact that the treatment was unsuccessful or 
terminated with poor or unfortunate results.  Oberlin, paragraph three of the 
syllabus. 
Application of Res Ipsa Loquitur 
{¶ 25} In this case, the court of appeals concluded that the plaintiff was 
entitled to a jury instruction on res ipsa loquitur having produced sufficient 
evidence to show that in the ordinary course of events, this type of injury does not 
occur without negligence.  2008-Ohio-4332, ¶ 30, 31.  The appellate court 
discounted the defense experts’ opinions of alternative, nonnegligent causes, 
January Term, 2010 
9 
 
holding that such testimony has no effect on a court’s determination whether to 
give an instruction on res ipsa loquitur.  Id. at ¶ 30. 
{¶ 26} A court must determine on a case-by-case basis whether the 
doctrine of res ipsa loquitur applies.  Jennings Buick, Inc. v. Cincinnati (1980), 63 
Ohio St.2d 167, 171, 17 O.O.3d 102, 406 N.E.2d 1385.  We review de novo 
whether the evidence supported a jury instruction on the doctrine of res ipsa 
loquitur. 
{¶ 27} A plaintiff must establish two elements for the doctrine of res ipsa 
loquitur to apply:  “(1) [t]hat the instrumentality causing the injury was, at the 
time of the injury, or at the time of the creation of the condition causing the 
injury, under the exclusive management and control of the defendant; and (2) that 
the injury occurred under such circumstances that in the ordinary course of events 
it would not have occurred if ordinary care had been observed.”  Hake v. George 
Wiedemann Brewing Co. (1970), 23 Ohio St.2d 65, 66-67, 52 O.O.2d 366, 262 
N.E.2d 703;  Fink, 144 Ohio St. 1, 28 O.O. 550, 56 N.E.2d 456. 
{¶ 28} The parties do not dispute the first requirement that Patterson was 
in control of the instruments inserted into the decedent’s body.  The defendants-
appellants, Patterson and his employer, Radiology & Imaging Services, Inc., 
contend that the plaintiff failed to establish the second requirement.  First, they 
contend that because the plaintiff presented “direct evidence” of specific acts of 
negligence from two medical expert witnesses, res ipsa loquitur, which permits 
jurors to draw an inference of negligence from circumstantial evidence, did not 
apply.  Second, the defendants contend that defense experts testified that the 
laceration could have occurred in the absence of negligence and that res ipsa 
loquitur does not apply when the record contains evidence of two equally efficient 
causes of the injury, one of which is not attributed to negligence. 
{¶ 29} In this case, there was no direct evidence of negligence, i.e., 
evidence based upon personal knowledge or observation.  The plaintiff’s evidence 
SUPREME COURT OF OHIO 
10 
 
to establish medical malpractice consisted of opinions of expert medical witnesses 
on the appropriate standard of care and the specific cause of Hall’s injury:  that 
Patterson negligently withdrew the guidewire, allowing a sharp dilator to lacerate 
the superior vena cava.  We have held that a plaintiff’s introducing expert 
testimony regarding possible specific acts of negligence does not preclude an 
instruction on res ipsa loquitur “if otherwise justified by the circumstantial 
evidence adduced at trial.”  Morgan v. Children’s Hosp., 18 Ohio St.3d at 189, 
480 N.E.2d 464.  Consequently, the fact that the plaintiff presented evidence from 
expert witnesses on what they believed specifically caused Hall’s injury does not 
prevent the plaintiff from also relying on the rule of res ipsa loquitur if otherwise 
justified by circumstantial evidence. 
{¶ 30} In this case, the plaintiff relied solely upon her expert witnesses to 
establish the second requirement of res ipsa loquitur.  In addition to testifying 
about a specific negligent act, both witnesses testified that a laceration of the 
superior vena cava would not occur in the ordinary course of this procedure 
without negligence.  The use of expert testimony in a medical malpractice case to 
establish that an injury occurred under such circumstances that in the ordinary 
course of events it would not have occurred if ordinary care had been observed 
does not disqualify such a case for application of the doctrine of res ipsa loquitur.  
Morgan v. Children’s Hosp. at syllabus. However, defense expert witnesses 
testified that there could be non-negligent causes of the injury.  They testified that 
a tear in a blood vessel is a known complication of this procedure, and the poor 
condition of Hall’s blood vessels may have made it susceptible to a laceration.  
They also testified that the injury may have occurred even if Patterson’s actions 
complied with the standard of care.  Thus, the defendants argue, the record 
contains evidence of two equally efficient causes of the injury, so res ipsa does 
not apply, citing Jennings Buick, Inc. v. Cincinnati, 63 Ohio St.2d 167, 17 O.O.3d 
102, 406 N.E.2d 1385. 
January Term, 2010 
11 
 
{¶ 31} In Jennings Buick, the plaintiff’s expert witness attributed a water-
main break to the city’s negligence while the defense theory attributed the break 
to natural causes.  This court concluded that both were equally probable causes 
and thus the trial court did not err in refusing to give the instruction on res ipsa 
loquitur.  Jennings Buick held that “[w]here it has been shown by the evidence 
adduced that there are two equally efficient and probable causes of the injury, one 
of which is not attributable to the negligence of the defendant, the rule of res ipsa 
loquitur does not apply.” 
{¶ 32} The court of appeals attempted to distinguish this case from 
Jennings Buick, reasoning that the plaintiff’s expert in Jennings agreed that the 
defense theory was equally probable, whereas, in this case, the plaintiff’s experts 
testified that the injury was more likely caused by negligence and rejected the 
defense theories. 
{¶ 33} The appellate court’s interpretation of Jennings Buick is mistaken.  
In that case, the court stated that “the evidence tended to show that there were 
equally probable causes of the break which were not attributable to the negligence 
of the city.”  Id., 63 Ohio St.2d at 173, 17 O.O.3d 102, 406 N.E.2d 1385.  
“[T]here was evidence presented to the trier of the facts which would have 
allowed the jury to find that one or another potential cause of the injury not 
attributable to the negligence of the city was equally as probable as was a cause 
attributable to the negligence of the city.”  Id. at 174.  Thus, because there were 
opposing opinions on causation — at least one of which was not attributable to 
negligence — the rule of res ipsa loquitur did not apply. 
{¶ 34} We hold that the reasoning of Jennings Buick applies here.  This 
case involved a complicated medical procedure, and the expert witnesses 
presented opposing opinions regarding the cause of Hall’s injury, one not 
attributable to negligence.  The experts agreed that perforation of a blood vessel is 
a known risk and complication of this procedure even when performed in 
SUPREME COURT OF OHIO 
12 
 
compliance with the standard of care.  Thus, it is not a clear case of negligence.  
Instead, the trial court was presented with equally probable causes of the injury, 
which meant that the cause of the injury was a question for the jury to determine.  
Although the plaintiff discounted the defense theory as a “far-fetched alternative,” 
the plaintiff acknowledges that the credibility of the witnesses is a question for the 
jury to assess.  Thus, under the circumstances of this case, the trial court properly 
refused to instruct the jury on res ipsa loquitur. 
{¶ 35} This holding is consistent with the doctrine of res ipsa loquitur, 
which was “founded upon an absence of specific proof concerning acts or 
omissions which would constitute negligence.”  Morgan v. Children’s Hosp., 18 
Ohio St.3d at 192, 480 N.E.2d 464 (Holmes, J., dissenting).  Under the evidence 
presented in this case, there are two equally efficient and probable causes of the 
injury; thus, it would have been improper to instruct the jury that it could infer 
negligence.  Based on the evidence produced, this is not a situation where it can 
be said that “the thing speaks for itself.”  Rather, this case represents the classic 
battle between expert witnesses.  As the court of appeals stated, “The trier of fact 
must weigh the evidence and decide which experts to believe.”  2008-Ohio-4332, 
¶ 30.  Consequently, the trial court properly declined to instruct the jury on the 
doctrine of res ipsa loquitur. 
Conclusion 
{¶ 36} For the foregoing reasons, we reverse the judgment of the court of 
appeals and remand the cause for consideration of the assignments of error that 
were considered moot. 
Judgment reversed. 
 
O’CONNOR and O’DONNELL, JJ., concur. 
 
LANZINGER, J., concurs in judgment only. 
 
MOYER, C.J., and PFEIFER and CUPP, JJ., dissent. 
__________________ 
January Term, 2010 
13 
 
 
LANZINGER, J., concurring in judgment only. 
{¶ 37} Although I concur in the judgment in this case, I would also 
overrule Morgan v. Children’s Hosp. (1985), 18 Ohio St.3d 185, 18 OBR 253, 
480 N.E.2d 464, as an unwarranted expansion of the scope of res ipsa loquitur to 
permit a jury to infer that negligence caused an injury during a complicated 
medical procedure, even when expert testimony is necessary to explain the 
procedure and the injury.3   
{¶ 38} The two prerequisites that a plaintiff must show to allow a jury 
instruction on res ipsa loquitur to be given are “(1) [t]hat the instrumentality 
causing the injury was, at the time of the injury, or at the time of the creation of 
the condition causing the injury, under the exclusive management and control of 
the defendant; and (2) that the injury occurred under such circumstances that in 
the ordinary course of events it would not have occurred if ordinary care had been 
observed.” Hake v. George Wiedemann Brewing Co. (1970), 23 Ohio St.2d 65, 
66-67, 52 O.O.2d 366, 262 N.E.2d 703. 
{¶ 39} But because injuries in medical-malpractice cases may result from 
many reasons other than the physician’s negligence, application of res ipsa 
loquitur in such cases is limited.  Many medical procedures are inherently risky, 
so injuries may occur even when physicians’ actions meet the standard of care.  
Finally, most medical procedures are beyond the common understanding of lay 
jurors, requiring an expert to explain them.  See Hubach v. Cole (1938), 133 Ohio 
St. 137, 142, 10 O.O. 187, 12 N.E.2d 283.  The need for an expert is contrary to 
the fundamental premise behind the doctrine of res ipsa loquitur.  See Prosser & 
Keeton on Torts, (5th Ed.1984) 243, Section 39. 
                                          
 
3.  Unlike Justice Cupp, I do not believe that this court must wait for an invitation to overrule a 
case before we can do so.  I would also not wait for the parties to do an analysis pursuant to 
Westfield Ins. Co. v. Galatis, 100 Ohio St.3d 216, 2003-Ohio-5849, 797 N.E.2d 1256, before 
overturning precedent that was wrongly decided.  See, e.g., Groch v. Gen. Motors Corp., 117 Ohio 
St.3d 192, 2008-Ohio-546, 883 N.E.2d 377 (Lanzinger, J., concurring in part). 
SUPREME COURT OF OHIO 
14 
 
{¶ 40} I believe that the reasoning of the dissent in Morgan also applies in 
this case: 
{¶ 41} “The doctrine is founded upon an absence of specific proof 
concerning acts or omissions which would constitute negligence.  It also has been 
stated that the doctrine can only be applied when the ‘thing speaks for itself.’  
Here, as noted, there was evidence adduced by the plaintiff relating to the 
defendant's negligence.  Also, [the plaintiff’s] injury cannot be deemed to speak 
for itself where complex technical and medical testimony was required to explain 
the result, and which evidence produced conflicting opinions as to the more 
probable cause of the injury. 
{¶ 42} “It became a jury question to choose the more probable cause of 
the injury and, after considering all of such evidence, the jury did just that * * *.”  
Morgan, 18 Ohio St.3d at 192, 18 OBR 253, 480 N.E.2d 464 (Holmes, J., 
dissenting). 
{¶ 43} Hall’s injury and eventual death occurred during a complicated 
medical procedure, and expert witnesses presented opposing opinions regarding 
whether her injury could have occurred if ordinary care had been observed.  
Although the plaintiff discounts the defense theory as a “far-fetched alternative,” 
the defense experts characterized plaintiff experts’ explanation as “unlikely as can 
be.”  This case represents a classic battle between expert witnesses, making a jury 
instruction on res ipsa loquitur inappropriate.  Our holding, rather than usurping 
the jury’s role, relies on the jury as the trier of fact to “weigh the evidence and 
decide which experts to believe.”  Estate of Hall v. Akron Gen. Med. Ctr., Ninth 
Dist. No. 24066, 2008-Ohio-4332, ¶ 30. 
{¶ 44} “Where it has been shown by the evidence adduced that there are 
two equally efficient and probable causes of the injury, one of which is not 
attributable to the negligence of the defendant, the rule of res ipsa loquitur does 
not apply. In other words, where the trier of the facts could not reasonably find 
January Term, 2010 
15 
 
one of the probable causes more likely than the other, the instruction on the 
inference of negligence may not be given.” Jennings Buick, Inc. v. Cincinnati 
(1980), 63 Ohio St.2d 167, 171-172, 17 O.O.3d 102, 406 N.E.2d 1385, citing 
Huggins v. John Morrell & Co. (1964), 176 Ohio St. 171, 27 O.O.2d 50, 198 
N.E.2d 448; Schafer v. Wells (1961), 171 Ohio St. 506, 14 O.O.2d 439, 172 
N.E.2d 708; Krupar v. Procter & Gamble Co. (1954), 160 Ohio St. 489, 52 O.O. 
363, 117 N.E.2d 7; Soltz v. Colony Recreation Ctr. (1949), 151 Ohio St. 503, 39 
O.O. 322, 87 N.E.2d 167; Glowacki v. N. W. Ohio Ry. & Power Co. (1927), 116 
Ohio St. 451, 5 Ohio L. Abs. 316, 157 N.E. 21. 
{¶ 45} Under the circumstances of this case, the trial court properly 
refused to instruct the jury on res ipsa loquitur.  I concur in judgment only. 
__________________ 
 
MOYER, C.J., dissenting. 
{¶ 46} Because the majority refuses to apply our precedent that directly 
resolves the issue before us, I respectfully dissent.  This court has held that “[i]t is 
a well-established principle that a court may not refuse as a matter of law to 
instruct on the doctrine of res ipsa loquitur merely upon the basis that the 
defendant’s evidence sufficiently rebuts the making of such an inference.”  
Morgan v. Children’s Hosp. (1985), 18 Ohio St.3d 185, 189, 18 OBR 253, 480 
N.E.2d 464.  Application of that well-established principle to the facts presented 
would compel us to find that the jury in this case should have been instructed on 
the doctrine of res ipsa loquitur. 
{¶ 47} The plaintiff in Morgan entered a comatose state following 
complications from surgery to remove his thymus gland.  Id. at 186.  A medical-
malpractice action was brought against the anesthesiologist on his behalf.  Id.  
The plaintiff’s expert testified that the plaintiff’s oxygen deprivation resulted from 
the defendant’s agent, a nurse, failing to adequately ventilate the plaintiff.  Id.  
The defendant’s expert concluded that the oxygen deprivation was caused by 
SUPREME COURT OF OHIO 
16 
 
bubbles of air blocking the blood vessels.  Id.  The trial court refused the 
plaintiff’s request to instruct the jury on res ipsa loquitur, and the jury returned a 
verdict for the defendant.  Id. at 186-187. 
{¶ 48} We held on appeal that the instruction was warranted despite the 
competing expert theories on causation.  Id. at 190.  Relying on precedent from 
1944, we underscored the role of the jury as the finder of fact.  Id.  It would be 
“an invasion of the province of the jury” for the trial court to declare as a matter 
of law that the jury is not permitted to draw a reasonable inference of negligence 
because the defendant has offered his own competing explanation.  Id. 
{¶ 49} Ignoring the import of Morgan, the majority instead relies on 
Jennings Buick, Inc. v. Cincinnati (1980), 63 Ohio St.2d 167, 171, 17 O.O.3d 102, 
406 N.E.2d 1385, and its holding: “Where it has been shown by the evidence 
adduced that there are two equally efficient and probable causes of the injury, one 
of which is not attributable to the negligence of the defendant, the rule of res ipsa 
loquitur does not apply.”  The majority, however, overlooks the very next 
sentence in Jennings Buick, which clarifies that “where the trier of facts could not 
reasonably find one of the probable causes more likely than the other, the 
instruction on the inference of negligence may not be given.”  (Emphasis added.)  
Id.  It is therefore only when the jury has no basis upon which to favor the 
plaintiff’s explanation over the defendant’s that the res ipsa loquitur instruction is 
impermissible.  As the majority observes, determining the credibility of witnesses 
is left to the jury, and such determinations could be a basis for favoring a 
plaintiff’s theory.  As the court of appeals here properly noted, the plaintiff’s own 
expert in Jennings Buick admitted that it was equally likely that the damage to the 
plaintiff’s property resulted from a cause other than the defendant’s negligence.  
Estate of Hall v. Akron Gen. Med. Ctr., Summit App. No. 24066, 2008-Ohio-
4332, ¶ 23.  The jury could not, thus, reasonably infer that the damage would not 
have occurred absent the defendant’s negligence. 
January Term, 2010 
17 
 
{¶ 50} The new rule adopted by the majority runs a substantial risk of 
largely foreclosing the use of res ipsa loquitur in medical-malpractice cases.  The 
defendant must now only posit a realistic alternative explanation for the cause of 
injury, which seems very likely given the abundant availability of experts in 
medical-malpractice cases, and the plaintiff will be deprived of the benefit of the 
long-standing negligence doctrine.  The majority may envision the trial judge 
making a probability determination for each theory presented, but that is exactly 
the usurpation of the jury’s role that this court sought to avoid in Morgan. 
{¶ 51} Until today, there was no indication that Morgan did not remain 
viable precedent.  The majority overrules it without saying so.  Because Morgan 
authorizes the jury, as the ultimate finder of fact, to determine the likely cause of 
injury, I would affirm the judgment of the court of appeals and hold that the trial 
court should have instructed the jury on the doctrine of res ipsa loquitur.  I note 
that such an instruction does not permit a jury to infer negligence if it merely 
decides that the plaintiff’s causation theory is more likely than the defendant’s.  
Instead, res ipsa loquitur can be used to find liability only if “ ‘the injury occurred 
under such circumstances that in the ordinary course of events it would not have 
occurred if ordinary care had been observed.’ ”  Morgan, 18 Ohio St.3d at 188, 18 
OBR 253, 480 N.E.2d 464, quoting Hake v. George Wiedemann Brewing Co. 
(1970), 23 Ohio St.2d 65, 66-67, 52 O.O.2d 366, 262 N.E.2d 703.  That 
requirement must be included in any jury instruction given on the doctrine. 
 
PFEIFER, J., concurs in the foregoing opinion. 
__________________ 
 
CUPP, J., dissenting. 
{¶ 52} I agree with Chief Justice Moyer’s dissent in that both the issue in 
this case and the factual context in which it arises are virtually indistinguishable 
from those in Morgan v. Children’s Hosp. (1985), 18 Ohio St.3d 185, 18 OBR 
SUPREME COURT OF OHIO 
18 
 
253, 480 N.E.2d 464, and that as a consequence, our decision should be controlled 
by Morgan. 
{¶ 53} In both cases, an injured patient (or injured patient’s estate) 
brought a medical-malpractice action against the treating physician.  In both 
cases, the patient and the physician each presented expert testimony as to the 
cause of the patient’s injuries, and in each case the opinion testimony of the 
patient’s experts and the physician’s experts directly conflicted.  In each case, the 
trial court denied the patient’s request to instruct the jury on res ipsa loquitur.  
Both trial courts reasoned that the res ipsa loquitur inference was inapplicable 
because there were competing expert opinions as to the cause of the injury. 
{¶ 54} In Morgan, this court held that the trial court erred in denying the 
requested res ipsa loquitur instruction and remanded the case for a new trial.  In 
light of the close similarity of the present case to Morgan, our decision in the 
present case should be governed by our decision in Morgan under the principle of 
stare decisis.  This would result in the affirmance of the court of appeals’ 
judgment reversing the trial court for failure to instruct the jury on the doctrine of 
res ipsa loquitur. 
{¶ 55} I am not convinced, however, that Morgan was correctly decided.  
I have reservations about the application of the res ipsa loquitur doctrine in 
medical-malpractice cases when conflicting expert testimony is the basis on 
which the issue must be decided.  The use of res ipsa loquitur in such 
circumstances seems to extend the doctrine beyond the scope of its justification. 
{¶ 56} As a general rule, medical-malpractice cases require expert 
testimony because the determination whether a physician’s treatment of a patient 
fell within the appropriate standard of care is beyond the jury’s common 
knowledge and experience.  Hubach v. Cole (1938), 133 Ohio St. 137, 142, 10 
O.O. 187, 12 N.E.2d 283.  Res ipsa loquitur, however, is an evidentiary rule that 
“permits, but does not require, the jury to draw an inference of negligence when 
January Term, 2010 
19 
 
the logical premises for the inference are demonstrated.”  Jennings Buick, Inc. v. 
Cincinnati (1980), 63 Ohio St.2d 167, 169, 17 O.O.3d 102, 406 N.E.2d 1385.  In 
other words, a res ipsa loquitur case is a type of circumstantial-evidence case.  Id. 
at 170.  See also Restatement of the Law 2d, Torts, Section 328D, comment b.  
The doctrine applies when the injury complained of would not have occurred in 
the absence of negligence.  Id. at comment c.  A key factor in the application of 
res ipsa loquitur is that a sufficient base of knowledge exists with the jury to 
justify allowing the inference.  Prosser & Keeton on Torts, (5th Ed. 1984) 243, 
Section 39 (the inference is “based upon the evidence given, together with a 
sufficient background of human experience to justify the conclusion”); 
Restatement of the Law 2d, Torts, Section 328D, comment d.  Since the inference 
permitted by the res ipsa loquitur doctrine is drawn from applying common 
knowledge and experience to the facts, res ipsa loquitur seems incompatible with 
situations in which expert assistance is required to determine the standard of care.  
See, e.g., Orkin v. Holy Cross Hosp. of Silver Springs, Inc. (1990), 318 Md. 429, 
433, 569 A.2d 207. 
{¶ 57} As noted in the majority opinion, res ipsa loquitur originally was 
not applied in medical-malpractice cases, because many medical procedures are 
so inherently risky that injuries can occur even when no physician has been 
negligent.  Prosser & Keeton on Torts, 243, Section 39.  In this regard, Ohio has 
long recognized that the doctrine of res ipsa loquitur is inapplicable in medical-
malpractice actions when the claim is based solely on unsuccessful treatment or 
unfortunate results.  Oberlin v. Friedman (1965), 5 Ohio St.2d 1, 8, 34 O.O.2d 1, 
213 N.E.2d 168. 
{¶ 58} Still, res ipsa loquitur has been used in medical-malpractice cases.  
The doctrine was first applied to medical-malpractice actions when “the lack of 
skill or care of the physician or surgeon is so apparent as to be within the 
comprehension of laymen and requires only common knowledge and experience 
SUPREME COURT OF OHIO 
20 
 
to understand and judge it, and in such case expert testimony is not necessary.”  
Bruni v. Tatsumi (1976), 46 Ohio St.2d 127, 130, 75 O.O.2d 184, 346 N.E.2d 673.  
The classic example of such a circumstance is when a foreign object is left in the 
body of a patient after surgery.  Oberlin, 5 Ohio St.2d at 9, 34 O.O.2d 1, 213 
N.E.2d 168.  See also Ault v. Hall (1928), 119 Ohio St. 422, 164 N.E.2d 518, 
paragraph eight of the syllabus.  In such a case, it is within a juror’s common 
knowledge and experience that the injury was one that would not ordinarily occur 
without negligence. 
{¶ 59} The res ipsa loquitur doctrine, however, has been extended to cases 
like the one before us in which opinion testimony of medical experts provides the 
only basis for a jury’s determination whether the injury was one that would 
ordinarily not occur in the absence of negligence.  Thus, instead of relying on 
common knowledge and experience to draw an inference from the facts, the jury 
is relying on expert testimony.  Under these circumstances can it any longer be 
said that the physician’s lack of care is so apparent that it is obvious from the 
jury’s common knowledge and experience?  The common-knowledge component 
of res ipsa loquitur should mean that an injury’s cause must be discernable 
without expert testimony, as, for example, in the cases where a foreign object is 
left in the patient’s body after surgery.  Thus, applying the res ipsa loquitur 
doctrine in circumstances in which conflicting medical-expert testimony is needed 
to determine whether negligence was involved and, more particularly, that the 
injury is one which would not occur in the absence of negligence  appears to be 
extending the doctrine beyond the purpose and rationale that justify its use. 
{¶ 60} In this case, however, we have not been asked to overrule Morgan.  
Nor has any analysis or argument been offered in the briefs or at oral argument 
which might meet the test adopted in Westfield Ins. Co. v. Galatis, 100 Ohio St.3d 
216, 2003-Ohio-5849, 797 N.E.2d 1256, to demonstrate a justified break with 
existing precedent.  Thus, despite my reservations with the continued use of the 
January Term, 2010 
21 
 
res ipsa loquitur doctrine in cases where jurors must rely on conflicting medical-
expert testimony to determine whether negligence caused the injury, I am 
constrained here to adhere to this court’s established precedent in the absence of 
briefing and argument on the justification for abandoning such precedent. 
{¶ 61} I, therefore, dissent. 
 
MOYER, C.J., concurs in the foregoing opinion. 
__________________ 
 
Paul W. Flowers Co., L.P.A., and Paul W. Flowers; Stan B. 
Schneiderman; and Gary T. Mantkowski, for appellee. 
 
Roetzel & Andress, L.P.A., Douglas G. Leak, and Stacy Ragon, for 
appellants. 
_____________________