Opinion ID: 2185314
Heading Depth: 1
Heading Rank: 3

Heading: General NegligenceDr. Bello.

Text: The district court granted partial summary judgment to Dr. Bello prior to trial upon the general negligence claim. If there is no genuine issue as to any material fact and the moving party is entitled to a judgment as a matter of law, the court should grant summary judgment. Iowa R.Civ.P. 237(c). The issue in this case is whether there is evidence in the summary judgment record upon which liability could be found. Cox v. Jones, 470 N.W.2d 23, 26 (Iowa 1991). If there is sufficient competent evidence of the existence of the foundation of facts to generate an inference of negligence under res ipsa loquitur doctrine, then summary judgment is not appropriate and the issue of general negligence should be submitted to the jury. If expert testimony is required to establish general negligence or the foundational facts and expert testimony is unavailable, then summary judgment is appropriate. Farley v. Ginther, 450 N.W.2d 853, 857 (Iowa 1991). The court concluded the res ipsa loquitur doctrine would not apply because it was not within common knowledge whether such an occurrence would not have happened if reasonable care had been used. The court held, without expert testimony on this issue, Welte failed to provide sufficient evidence to create the inference of negligence. We have long recognized in most cases a layman can have no knowledge whether the proper medicine administered or the proper surgical treatment was given. Evans v. Roberts, 172 Iowa 653, 660-61, 154 N.W. 923, 925 (1915). However, If a surgeon ... undertakes to stich a wound on the patient's cheek and, by an awkward move, thrusts his needle into the patient's eye ... the charitable presumptions which ordinarily protect the practitioner against legal blame where his treatment is unsuccessful are not here available. It is a matter of common knowledge and observation that such things do not ordinarily attend the service of one possessing ordinary skill and experience in the delicate work of surgery. It does not need scientific knowledge or training to understand that, ordinarily speaking, such results are unnecessary and are not to be anticipated, if reasonable care be exercised by the operator. Id. at 658-59, 154 N.W. 923. In the following medical malpractice cases we have found the occurrence or event was so obvious as to be within the comprehension of laypersons and required only common knowledge and experience: Wiles v. Myerly, 210 N.W.2d 619 (Iowa 1973) (vascular operationburned buttocks; Knowledge and experience teaches us that in the ordinary course of events one undergoing surgery does not sustain an unusual injury to a healthy part of his body not within the area of the operation in the absence of negligence.); Frost v. Des Moines Still College, 248 Iowa 294, 79 N.W.2d 306 (1957) (back surgeryether burn to abdomen; It is a simple understandable rule of circumstantial evidence with a sound background of common sense and human experience, and difficulty comes only when we attempt to transform it into a rigid legal formula, which arbitrarily precludes its application in many cases where it is most important that it be applied. This is such a case. We should, in applying the rule, not forget the particular force and justice of the rule.); Stickleman v. Synhorst, 243 Iowa 872, 52 N.W.2d 504 (1952) (insertion of needle into tracheapuncture to blood vessel in throat; We are aware of no rule that the nature of an injury must be shown by medical testimony if the injury is such that it may satisfactorily be shown by other evidence. We think the nature of plaintiff's injury is sufficiently shown here.); Whetstine v. Moravec, 228 Iowa 352, 291 N.W. 425 (1940) (removal of six teethroot of tooth found in patient's lung; It was a mechanical job. It is common knowledge that in extracting a tooth or its roots, neither ordinarily passes into the trachea and thus into the lungs. In fact such an occurrence is most rare. In the words of the authorities it is a matter of such rare occurrence and unusual character, that its very happening carries with it a strong inherent probability of negligence.). In contrast, in the following cases we have required expert testimony to establish a general negligence claim or the applicable standard of care: Tappe v. Iowa Methodist Medical Ctr., 477 N.W.2d 396 (Iowa 1991) (heart bypass resulting in brain damage; [B]ecause all the experts testified that stroke is an inherent risk of bypass surgery, the plaintiff was not entitled to the benefit of the res ipsa inference of negligence.); Cox, 470 N.W.2d at 23 (cataract removal and follow-up care resulting in detached retina; Plaintiff's claim of inadequate follow-up care would also ultimately require expert testimony regarding (1) whether a retinal detachment was occurring at the time of the follow-up visits; and (2) the appropriate standard of follow-up care for a cataract extraction.); Thomas v. Fellows, 456 N.W.2d 170 (Iowa 1990) ([T]he alleged malpractice was of a highly technical nature, and the case could therefore not be pursued without expert evidence.); Donovan v. State, 445 N.W.2d 763 (Iowa 1989) (replacement of heart valve resulting in staph infection damaging replacement valve; If a doctor operates on the wrong limb or amputates the wrong limb, a plaintiff would not have to introduce expert testimony to establish that the doctor was negligent. On the other hand, highly technical questions of diagnoses and causation which lie beyond the understanding of a layperson require introduction of expert testimony.); Forsmark v. State, 349 N.W.2d 763 (Iowa 1984) (back surgery resulting in paralysis; A layperson unaided by expert testimony could not say that in the ordinary course of events the injury would not have occurred if reasonable care had been used.). The chemical burn to Welte's arm was caused by sodium pentothal that Dr. Bello injected into her vein which then infiltrated or escaped from the vein into the surrounding tissues. We believe it is within the common experience of laypersons that such an occurrence in the ordinary course of things would not have happened if reasonable care had been used. The insertion of a needle into a vein is a common medical procedure that laypersons understand. It is a procedure that has become so common that laypersons know certain occurrences would not take place if ordinary care is used. See Wolfsmith v. Marsh, 51 Cal.2d 832, 337 P.2d 70 (1959) (misinsertion of IV needle resulting in sodium pentothal burn gives rise to res ipsa loquitur instruction). See also Horner v. Northern Pac. Ben. Ass'n Hosp., 62 Wash.2d 351, 382 P.2d 518 (1963); Annotation, Medical Malpractice: Res Ipsa Loquitur in Negligent Anesthesia Cases, 49 A.L.R.4th 63 (1986). We conclude the court erred in granting partial summary judgment on the general negligence claim against Dr. Bello. The record establishes circumstances of the occurrence sufficient to defeat summary judgment without the necessity of expert medical evidence. However, even if expert evidence were required, the record was sufficient to defeat the summary judgment motion. Dr. Bello, in his answer to the petition, admitted he administered sodium pentothal by intravenous injection into Welte's arm and that while under anesthesia, she suffered burns. He admitted sodium pentothal has a caustic and burning effect if not properly injected into the vein and that if the catheter is not properly inserted into the vein that injury can occur in the surrounding area. Dr. Bello's retained medical expert, Dr. Edwin A. Maxwell, testified in his deposition that in the usual course of events, an IV instituted for purpose of anesthesia does not infiltrate the surrounding tissue.