Opinion ID: 1652339
Heading Depth: 1
Heading Rank: 1

Heading: Dr. Nazar's Individual Liability

Text: In defense of the Court of Appeals' decision, Branham argues that under Laws v. Harter, 534 S.W.2d 449 (Ky.1975), Dr. Nazar was negligent as a matter of law for permitting the Durahook to remain in his scalp after surgery. In Laws , a surgical sponge was left in the plaintiff following thoracic surgery performed by the defendant surgeon. Id. at 450. Before the incision in the plaintiffs body was closed, a nurse's count revealed that one of the sponges was missing. Id. After searching the operating room for an extended period of time, the sponge still could not be located. Id. The surgeon decided that under the circumstances it would be best to close the patient despite the fact that the sponge was missing. Id. Following the surgery, X-rays revealed that the missing sponge remained in the plaintiffs body. Id. Upon discovering the sponge, the plaintiff sued the surgeon, alleging that he was negligent as a matter of law. Id. The surgeon argued that he had satisfied the standard of care of a reasonably prudent doctor by deciding to close the patient, despite the missing sponge. Id. The former Court of Appeals, however, was not convinced, and held that the reasonableness of the doctor's decision was not relevant. Id. at 450-51. Instead, the Court held that the surgeon was negligent per se because [h]owever exemplary the care given to appellant after discovering that a sponge was missing, the fact remains that when the incision through the diaphragm was closed a sponge was left in the abdomen. Id. at 450. Accordingly, the Court remanded to the trial court for a new trial addressing only the issue of plaintiffs damages. Id. at 451-52. Dr. Nazar argues that despite Laws , retained foreign object cases are generally resolved under a res ipsa loquitur standard under Kentucky law. Under this standard, juries maybut are not required toinfer negligence from the fact that a surgical item was left in a patient's body. While the retained foreign object is evidence of negligence, the jury is free to determine the ultimate issue of the surgeon's liability from the evidence presented at trial. In support of his argument, Dr. Nazar relies upon Chalothorn v. Meade, 15 S.W.3d 391 (Ky.App.1999), where the Court of Appeals reversed a trial court order holding a doctor negligent as a matter of law. In Chalothorn, the plaintiff required a cesarean section to deliver her baby. Id. at 392. After the baby was delivered, the nurse informed the doctor that one surgical sponge was missing. Id. When a search revealed that a sponge was located on the baby's body in the nursery, a nurse told the doctor that the count was correct and the doctor closed the incision in the plaintiffs body. Id. Later, it was discovered that what was believed to be a sponge on the baby's body was not a sponge at all and that in fact one sponge was still missing. Id. The missing sponge was eventually discovered in the plaintiffs abdomen and was removed without complications. Id. After the sponge was discovered, the plaintiff sued the doctor, arguing that he was negligent as a matter of law for having left the sponge in her body. Id. at 393. Relying on Laws , the trial court granted summary judgment to the plaintiff and the doctor appealed. Id. The Court of Appeals reversed, ruling that because the doctor had presented evidence of his compliance with the standard of care summary judgment was inappropriate. Id. The appellate court distinguished Laws because in that case the doctor was aware that a sponge was missing when he decided to close the patient. Id. The doctor in Chalothom, on the other hand, relied on a nurse's sponge count which informed him that all the sponges had been located. Id. As such, the appellate court remanded with instructions for the jury to determine the doctor's liability. Id. In the present case, the Court of Appeals held that Laws mandates the application of a negligence per se standard in all retained object cases, and overruled Chalothorn. Branham v. Nazar, No.2003-CA-001110-MR, 2004 WL 2367143 at  (October 22, 2004). In doing so, the court was influenced more by the binding authority of Laws than by the reasonableness and wisdom of its holding. See id. Indeed, the court acknowledged that it was troubled by many aspects of the negligence per se rule, but noted that it lacked the authority to formally adopt the res ipsa loquitur approach in Kentucky. Id. Because we are similarly troubled by the impact that the negligence per se approach would have on Kentucky medical malpractice jurisprudence, we adopt the res ipsa loquitur approach and hold that juries should generally be permitted to determine a healthcare professional's liability in a retained foreign object case. Our decision to adopt this approach was influenced by a number of reasons. First, the negligence per se standard is inconsistent with Kentucky's pure comparative fault system. Nine years after Laws applied the negligence per se rule, the Supreme Court in Hilen v. Hays joined the majority of American jurisdictions in adopting comparative fault. See 673 S.W.2d 713, 720 (Ky.1984). Under comparative fault, a jury is permitted to allocate fault to each party to the action, considering both the nature and conduct of each party at fault and the extent of the causal relationship between the conduct and the damages claimed. Id. at 719. The negligence per se rule announced in Laws takes the issue of individual accountability away from the jury and inexplicably ascribes fault to the surgeon, regardless of whether the evidence suggests otherwise. As the Court of Appeals noted,  Laws assumes that negligence had to have occurred so, therefore the surgeon must have been negligent. Branham v. Nazar, No.2003-CA-001110-MR. This conflict is significant because comparative fault analysis will inevitably arise in the vast majority of retained foreign object cases. Usually, retained foreign object cases originate from medical operations in which multiple medical care professionals perform a variety of tasks. As illustrated by the present case, any number of people including the surgeon, anesthesiologist, nursing staff, and other hospital staff may be at fault for having left an offending item in a plaintiffs body. The varied business relationships which exist at modern hospitals further complicate the issue. Because of these various types of relationships, no two surgical procedures are exactly alike, and the duties and responsibilities of the medical care professionals will likely depend on the specific facts of each case. A per se rule cannot account for these differences and would unfairly ascribe fault to surgeons, regardless of their responsibility for the plaintiffs injury. The res ipsa loquitur approach avoids this unfairness by permitting juries to infer negligence from the fact of the retained foreign object, while granting them the latitude to analyze other facts and evidence relevant to liability. As such, juries are free to analyze the reliability and veracity of the defendant's expert witnesses and weigh it against the likelihood that the surgeon was negligent in failing to remove an object from the plaintiffs body during surgery. The res ipsa loquitur standard simply provides a more equitable method for resolving retained foreign object cases. In addition, the res ipsa loquitur approach is more consistent with most of our caselaw. Of all the retained foreign object cases in Kentucky, only Laws applied the negligence per se rule. Before Laws , Kentucky courts repeatedly held that a jury should decide whether a surgeon is liable for permitting a surgical item to remain in a patient after surgery. See Samuels v. Willis, 133 Ky. 459, 118 S.W. 339, 342 (1909); Barnett's Adm'r v. Brand, 165 Ky. 616, 177 S.W. 461, 464 (1915); Carter v. Harlan Hospital, 278 Ky. 84, 128 S.W.2d 174, 176 (1939). Unfortunately, the Court in Laws made no effort to distinguish these decisions or to question the significance of this line of contrary precedent. Further, the court cited no legal authority, from Kentucky or any other jurisdiction, to support its per se rule. The lack of analysis and supporting authority in Laws does little to instill confidence in the wisdom of its approach. The lukewarm reception of Laws by subsequent Kentucky courts further undermines our faith in the negligence per se rule. Just two years after Laws , this Court noted that a res ipsa loquitur standard should apply in a case where a surgical blade was left in a patient's body during an operation to remove a kidney stone. See City of Somerset v. Hart, 549 S.W.2d 814, 817 (Ky.1977). This theme continued in Chalothom, where the Court of Appeals refused to apply the negligence per se rule and distinguished Laws on its facts. See 15 S.W.3d at 393. Even in the process of applying the negligence per se rule in the present case, the Court of Appeals expressed disapproval of Laws and argued for its hasty demise. Branham v. Nazar, No.2003-CA-001110-MR. As such, to promote a negligence per se rule now would require us to adopt a rule that has never been well-received by Kentucky courts. Instead, we reaffirm the caselaw which leaves the issue of a surgeon's liability to the jury and adopt the res ipsa loquitur approach for Kentucky retained foreign object cases. Our adoption of the res ipsa loquitur standard renders the continued viability of Laws questionable. Though stare decisis inspires in this Court both humility and respect for established precedent, it does not commit us to the sanctification of ancient fallacy. Hilen, 673 S.W.2d at 717. As Justice Leibson noted, [t]he common law is not a stagnant pool, but a moving stream. Id. (citing City of Louisville v. Chapman, Ky., 413 S.W.2d 74, 77 (1967)). When rules, as the one announced in Laws , prove unworkable or inconsistent with other law, it is the duty of this Court to clarify the common law and direct its development. Because the negligence per se rule announced in Laws is inconsistent with the res ipsa loquitur approach we adopt today, it is now overruled. Because we have rejected the per se rule in retained foreign object cases, the trial court was correct in refusing to hold Dr. Nazar negligent as a matter of law for failing to remove the Durahook from Branham's scalp. Branham, however, still argues that trial court should have granted his motion for summary judgment or his motion for directed verdict. Summary judgment is only appropriate where the moving party establishes that there is no genuine issue of material fact warranting resolution by a jury. See Ky. R. Civ. P. 56.03; see also Steelvest Inc. v. Scansteel Service Center, Inc., 807 S.W.2d 476, 482 (Ky.1991). Similarly, motions for directed verdict are appropriate if the moving party can establish that based on the evidence presented at trial, reasonable minds could not differ on the proper resolution of the case. See Ky. R. Civ. P. 50.01; Spivey v. Sheeler, 514 S.W.2d 667, 673 (Ky.1974). Both standards require, however, the reviewing court to construe the facts in favor of the non-moving party. Dr. Nazar presented adequate evidence both before and during trial which created fact issues sufficient to defeat Branham's motions. Before trial, Dr. Nazar submitted expert affidavits stating that he complied with the standard of care, despite the failure to remove the Durahook after surgery. At trial, Dr. Nazar presented one expert who testified that it was common practice for doctors to rely on nurses to account for all sharps used during surgery and another expert who testified that it was the nursing staffs obligation to count the Durahooks even though these items were not listed specifically in the Norton protocol. Even though the presence of the Durahook in Branham's scalp constituted prima facie evidence of negligence, the expert testimony created a question of fact regarding Dr. Nazar's liability for Branham's injuries. Accordingly, the trial court did not err in denying Branham's motions for summary judgment and directed verdict.