Opinion ID: 1359764
Heading Depth: 1
Heading Rank: 5

Heading: applicability of the doctrine of res ipsa loquitur

Text: [5a] Defendants contend that the heretofore quoted testimony elicited from defendant doctors is not sufficient, without applying the doctrine of res ipsa loquitur, to permit plaintiffs to go to the jury. We are of the opinion that the evidence is sufficient, but we are also of the opinion that the jury, under appropriate instructions, should have been permitted to determine whether each of the conditions necessary to bring into play the rule of res ipsa loquitur were present ( Roberts v. Bank of America, 97 Cal. App.2d 133, 137 [217 P.2d 129]). [6] Plaintiffs and defendants agree that the conditions to be met before the doctrine may be applied are that the accident, or injury, must be of a kind which ordinarily does not occur in the absence of someone's negligence; that it must be caused by an agency or instrumentality in the control of the defendant; and that it must not have been due to any voluntary action or contribution on the part of plaintiff. ( Ybarra v. Spangard, 25 Cal.2d 486, 489 [154 P.2d 687, 162 A.L.R. 1258]; Baker v. B.F. Goodrich Co., 115 Cal. App.2d 221, 226 [252 P.2d 24]; Burr v. Sherwin Williams Co., 42 Cal.2d 682, 687 [268 P.2d 1041].) Plaintiffs argue that it is a matter of common knowledge that a woman does not ordinarily become permanently paralyzed following childbirth after having had a spinal anesthetic administered as an incident thereto; that Dr. Haas testified that ordinarily where due care [was] used and proper practice followed, permanent paralysis [did] not follow; that Dr. West testified that he had never had a case of permanent paralysis due to sensitivity to a spinal anesthetic; that he had made four or five thousand spinal punctures; that Dr. Carl's written report shows that it was his opinion that plaintiff's injuries were due to spinal cord damage; that spinal cord damage could be caused by a spinal anesthetic needle being inserted above the first lumbar vertebra; that it was most important that the spinal anesthetic be administered in a location below the conus medullaris, or the end of the spinal cord; that Dr. West had completed the administration of the spinal anesthetic within two minutes of the time of his arrival in the delivery room; that the anesthetic was administered by him without having scrubbed. Defendant West argues that paralysis may result from a number of causes other than negligence in giving a spinal anesthetic; that in a certain percentage of cases paralysis will result from spinal anesthesia without any negligence; that plaintiffs introduced no proof that the practice used by him in administering the anesthetic was not the desirable or standard practice; that it is of no importance that he did not scrub since he used sterile gloves; that plaintiffs introduced no proof that the spinal anesthetic fluid was ever injected in Mrs. Seneris' spinal canal. [7] We said in Zentz v. Coca Cola Bottling Co., 39 Cal.2d 436, 442 [247 P.2d 344], so far as the first requirement is concerned  that the accident, or injury, must be of a kind which ordinarily or probably does not happen in the absence of negligence and that In the LaPorte case, 33 Cal.2d at page 169 [199 P.2d 665], we said, after assuming that defendants were in control at the time of the accident, that `the applicability of the doctrine of res ipsa loquitur depends on whether it can be said, in the light of common experience, that the accident was more likely than not the result of their [defendants'] negligence. [Citations.] Where no such balance of probabilities in favor of negligence can be found, res ipsa loquitur does not apply.' In determining whether such a probability exists with regard to a particular occurrence, the courts have relied both upon common knowledge and the testimony of expert witnesses. (See for example, Cavero v. Franklin etc. Benev. Soc., 36 Cal.2d 301, 309 [223 P.2d 471]; Escola v. Coca Cola Bottling Co., 24 Cal.2d 453, 459, 460 [150 P.2d 436]; Juchert v. California Water Service Co., 16 Cal.2d 500, 515 [106 P.2d 886]; Judson v. Giant Powder Co., 107 Cal. 549, 561 [40 P. 1020, 48 Am.St. Rep. 146, 29 L.R.A. 718].) [8] We also said in Zentz v. Coca Cola Bottling Co., supra, 39 Cal.2d 436, 445, that Another factor which some of the cases have considered in applying the doctrine is that the defendant may have superior knowledge of what occurred and that the chief evidence of the cause of the accident may be accessible to the defendant but inaccessible to the plaintiff. (See Ybarra v. Spangard, 25 Cal.2d 486, 490 [154 P.2d 687, 162 A.L.R. 1258]; Mudrick v. Market Street Ry. Co., 11 Cal.2d 724, 731-732 [81 P.2d 950, 118 A.L.R. 533]; Anderson v. I.M. Jameson Corp., 7 Cal.2d 60, 64 [59 P.2d 962]; Smith v. O'Donnell, 215 Cal. 714, 722 [12 P.2d 933]; Kenney v. Antonetti, 211 Cal. 336, 339 [295 P. 341]; Connor v. Atchison, etc. Ry. Co., 189 Cal. 1, 5 [207 P. 378, 22 A.L.R. 1462]; O'Connor v. Mennie, 169 Cal. 217, 225-226 [146 P. 674]; Steele v. Pacific Elec. Ry. Co., 168 Cal. 375, 378-379 [143 P. 718]; Housel v. Pacific Elec. Ry. Co., 167 Cal. 245, 249-250 [139 P. 73, Ann.Cas. 1915C 665, 51 L.R.A.N.S. 1105]; Wyatt v. Pacific Elec. Ry. Co., 156 Cal. 170, 174 [103 P. 892]....) This factor is peculiarly applicable, as well as necessary, in the type of situation we have here  where a patient suffers injury while unconscious and in the care and custody of the defendant, or defendants. It would appear that plaintiffs have made out a prima facie case by both medical testimony and common knowledge that the injuries suffered by Mrs. Seneris are not such as usually occur in the circumstances without negligence on the part of someone. Defendant West's assertions to the contrary are matters for the finders of the facts. Apparently Mrs. Seneris was unconscious at the time the spinal anesthetic was administered. Defendant West contends that her condition could have been caused by a number of causes other than negligence in giving the anesthetic. There is no doubt that when Mrs. Seneris went to the delivery room she was in good health. [9] We said in Ybarra v. Spangard, 25 Cal.2d 486 [154 P.2d 687, 162 A.L.R. 1058], that Every defendant in whose custody the plaintiff was placed for any period was bound to exercise ordinary care to see that no unnecessary harm came to him and each would be liable for failure in this regard. [10] We also said that where a plaintiff receives unusual injuries while unconscious and in the course of medical treatment, all those defendants who had any control over his body or the instrumentalities which might have caused the injuries may properly be called upon to meet the inference of negligence by giving an explanation of their conduct. [11] We also said in Summers v. Tice, 33 Cal.2d 80, 86-87 [199 P.2d 1, 5 A.L.R.2d 91], that ... a patient injured while unconscious on an operating table in a hospital could hold all or any of the persons who had any connection with the operation even though he could not select the particular acts by the particular person which led to his disability. We said too that the effect of the decision in the Ybarra case was that plaintiff had made out a case when he had produced evidence which gave rise to an inference of negligence which was the proximate cause of the injury; that it was then up to the defendants to explain the cause of the injury. [12] In order that a plaintiff be entitled to the benefit of the doctrine of res ipsa loquitur, he need not exclude every other possibility that the injury was caused other than by defendant's negligence (Prosser, Res Ipsa Loquitur in California, 37 Cal.L.Rev. 183, 197-198). Defendant West argues that Mrs. Seneris has not met the third condition  that the injury must not have been due to any voluntary action or contribution on her part. This argument stems from the testimony of one of plaintiff wife's doctors that she suffered from a psychic overlay factor (a type of hysteria induced by emotional disturbance); and from Dr. West's assertion that Mrs. Seneris may have had a sensitivity to the anesthetic solution of which it was said the paralysis might have been a result. Plaintiffs proved that Mrs. Seneris had previously had an uneventful spinal anesthetic; and by expert testimony of Dr. Haas that she was presumed, medically speaking, nonallergic to spinal anesthesia. Plaintiffs also proved that Mrs. Seneris, at the time of her admission to the hospital, was a strong and healthy woman; that she suffered from no disease in which a spinal anesthetic would be contra-indicated. [5b] In Baker v. B.F. Goodrich Co., 115 Cal. App.2d 221, 229 [252 P.2d 24], it was said: Where the evidence is conflicting or subject to different inferences, it is for the jury, under proper instructions, to determine whether each of the conditions necessary to bring into play the rule of res ipsa loquitur are present. ( Roberts v. Bank of America, 97 Cal. App.2d 133, 137 [217 P.2d 129].) ( Barham v. Widing, 210 Cal. 206 [291 P. 173]; Moore v. Belt, 34 Cal.2d 525 [212 P.2d 509].) [13] The conclusion that negligence is the most likely explanation of the accident, or injury, is not for the trial court to draw, or to refuse to draw so long as plaintiff has produced sufficient evidence to permit the jury to draw the inference of negligence even though the court itself would not draw that inference; the court must still leave the question to the jury where reasonable men may differ as to the balance of probabilities (Res Ipsa Loquitur in California, Prosser, 37 Cal.L.Rev. 183, 194-195). [14] The inference of negligence is not required to be an exclusive or compelling one. It is enough that the court cannot say that reasonable men could not draw it. ( Bauer v. Otis, 133 Cal. App.2d 439, 443 [284 P.2d 133].) [5c] The existence of the conditions upon which the operation of the doctrine is to be predicated is a question of fact and the right of the jury to find those facts must be carefully preserved ( Black v. Partridge, 115 Cal. App.2d 639, 646 [252 P.2d 760]; Rose v. Melody Lane, 39 Cal.2d 481 [247 P.2d 335]; Knell v. Morris, 39 Cal.2d 450 [247 P.2d 352]; Milias v. Wheeler Hospital, 109 Cal. App.2d 759 [241 P.2d 684].) We conclude, therefore, that plaintiffs' evidence is sufficient to submit to the jury, under proper instructions, the applicability of the rule of res ipsa loquitur. Defendants contend that the case of Engelking v. Carlson, 13 Cal.2d 216 [88 P.2d 695], is controlling concerning the application of the doctrine of res ipsa loquitur to the case at bar. While the two cases may be distinguished on their facts, we do not deem it necessary to do so here as we have concluded that the doctrine is applicable to the factual situation disclosed by the record in this case and any expression in the Engelking case which may be contrary to this conclusion is hereby disapproved. Defendants' reliance upon the rule set forth in the case of Ayers v. Parry (New Jersey), 192 F.2d 181, is misplaced. There, plaintiff suffered injuries following a spinal anesthetic administered between the second and third lumbar vertebrae. Plaintiff had been brought into the hospital acutely ill with an infection and with a temperature of 103.6°. An emergency operation was found necessary to alleviate an obstruction to the common bile duct. Expert testimony showed there that plaintiff's condition was known as a cauda equinal neuritis produced by the spinal anesthesia; that certain nerve roots had been injured; that the anesthesia had produced an inflammation about the spinal cord that constricts and damages the nerves, ... and which occurs due to some unusual reaction on the part of the patient to that solution. The court held that the doctrine of res ipsa loquitur was not available to the plaintiff under the circumstances. Whether or not we agree with the holding in the New Jersey case, it is apparent from further language of that court that the case is easily distinguishable from the one under consideration. The court said: When the expert testimony offered by the plaintiff ascribes the cause to the toxic quality of the injected drug as distinguished from the negligence of the anesthetist, that evidence is binding upon the court and the jury would not be permitted to speculate to the contrary. The court also said: Nor is the doctrine available in a case based upon want of skill in diagnosis, method or manner of treatment. Here, the process of treating the nerve roots by a drug to produce anesthesia in an operation to remove an obstruction to the common duct certainly requires technical knowledge and skill. Because the unfortunate consequences suffered by plaintiff in themselves do not as a matter of common knowledge and experience reveal lack of skill in the anesthetist, scientific opinion is clearly necessary to throw light on the subject. (Emphasis added.) In the case under consideration, plaintiffs proved, through the testimony of defendant doctors, that Mrs. Seneris' injuries were not such as usually happened when due care and proper practice were observed. [15] In a malpractice case, plaintiff may make out a prima facie case through the testimony of the defendant ( Lawless v. Calaway, 24 Cal.2d 81, 90 [147 P.2d 604]; Anderson v. Stump, 42 Cal. App.2d 761, 765 [109 P.2d 1027]).