Opinion ID: 2447946
Heading Depth: 2
Heading Rank: 3

Heading: Did the Defense Conclusively rebut the Statutory Presumption?

Text: Dr. Ryan's final contention addresses the degree to which a defendant must rebut the statutory inference of negligence. Specifically, Dr. Ryan contends that even if 18 Del. C. § 6853(e)(3) applies and Freeman did not need an expert to establish a prima facie case of negligence, his own evidence conclusively demolishes or rebuts the statutory presumption. Responding to Dr. Ryan's claims and relying on res ipsa loquitur precedent, [23] Freeman asserts that the jury alone determines if the defense successfully rebutted the presumption. Dr. Ryan counters Freeman's assertion by citing authority that he believes stands for the proposition that res ipsa loquitur no longer applies to medical malpractice litigation because the Healthcare Medical Negligence Insurance and Litigation statute exclusively occupies that field. [24] Lacy v. G.D. Searle & Co ., [25] the case on which Dr. Ryan mistakenly relies, does not stand for the proposition that res ipsa loquitur no longer applies to medical malpractice litigation. Rather, the trial judge stated, [t]he last sentence of § 6853, which bars drawing an inference or presumption of negligence on the part of a health care provider based upon facts which do not satisfy § 6853, makes res ipsa loquitur no longer applicable to cases involving health care providers if the facts do not fall within § 6853.  [26] In Lacy, a patient attempted to invoke § 6853(e)(1) and asserted that her physician unintentionally left a foreign object in her body after surgery. The trial judge found that the physician tried to remove Lacy's intrauterine device but failed on two occasions. The trial judge concluded that the physician's awareness of and intent to remove the foreign object removed Lacy's situation from the language in § 6853(e)(1). Unlike Lacy, Freeman does not attempt to invoke § 6853(e)(1); rather, she seeks protection under § 6853(e)(3) and the facts presented fall squarely within the confines of that subsection. Dr. Ryan inserted a surgical instrument into Freeman's body and retrieved tissue samples from Freeman's kidney instead of from her liver; therefore, he performed a surgical procedure on the wrong organ or part of the body. Moreover, we have held that res ipsa loquitur does not apply in medical malpractice actions where the [o]nly proof is the fact that treatment of a patient terminated with poor results. [27] On the other hand, before the legislature enacted 18 Del. C. § 6853, res ipsa loquitur applied when the resulting injury was [o]f a kind which ordinarily does not occur in the absence of negligence. [28] Here, the defense medical expert testified that it is extremely uncommon to conduct a biopsy and only retrieve non-target tissue. Therefore, we find the doctrine of res ipsa loquitur as now limited by 18 Del. C. § 6853 applies because Freeman's injurythe retrieval of kidney tissue onlyappears to be inconsistent with the normal and usual result of liver biopsies. [29] Dr. Ryan further contends that even if we analogized Freeman's incident to a common law res ipsa loquitur claim, then Delaware Rule of Evidence 304(c)(2) controls. Dr. Ryan's contention is not without merit. This rule permits a judgment for the defendant if he produces evidence that rebuts the inference of negligence or contradicts it such that the jury could not reasonably accept the inference of negligence. Dr. Ryan asserts that his medical expert's opinion, pictures of the biopsy, and testimony about the common occurrence of migration unquestionably rebutted and demolished the statutory inference of negligence. While Dr. Ryan correctly compels us to address D.R.E. 304(c)(2), he fails to consider the entire rule. Although 304(c)(2) allows a judgment to be entered for the defendant where the defendant conclusively rebuts the presumption of negligence, the rule also provides that [t]he defendant shall not be entitled to a directed verdict merely because he has introduced evidence in explanation and such evidence has not been rebutted. Although Dr. Ryan's medical expert explained how a needle might migrate during a biopsy, he also opined on the rare occurrence of conducting a biopsy and only retrieving non-target tissue. Allowing a directed verdict given this conflicting testimony is at odds with 304(c)(2) and overwhelming common law res ipsa loquitur precedent that requires a jury to resolve any inconsistency. [30] Because a reasonable jury could conclude that Dr. Ryan's expert inconsistently opined an appropriate standard of care given the extreme rarity of only retrieving non-target tissue, Freeman was entitled to a jury determination of the credibility and persuasiveness of Dr. Ryan's rebuttal evidence. For that reason, we hold that whether Dr. Ryan conclusively rebutted the presumption is a decision for the jury and not the court. [31]