Opinion ID: 1865512
Heading Depth: 1
Heading Rank: 2

Heading: Withdrawal of Certain Negligence Claims from the Jury.

Text: We next consider plaintiff's assignment of error based on the trial court's withdrawal of two of the following three specifications of negligence from the jury's consideration: [t]hat [d]efendants ... were negligent in the following respects: .... B. In administering, prescribing and combining the drugs neomycin and kanamycin for Plaintiff ... for a period from the 18th day of June, 1981 to the 23rd day of November, 1981 when the method of administering, prescribing, combining and the mixing of said drugs was not the accepted and recommended method of administration and combination by similar medical specialists and doctors in this locale. C. In administering and prescribing the drugs kanamycin and neomycin for Plaintiff ... from a period of June, 1981 through November 23, 1981 without providing close clinical observation including audio metric testing before and during the extended therapy.... .... F. In continuing to prescribe the drugs kanamycin and neomycin for Plaintiff... after Plaintiff commenced complaining of ringing in his ears and in failing to perform audio metric testing at said time, despite said ringing being a primary diagnostic system indicating a toxic reaction in a patient.... Although the trial court submitted specification of negligence B for the jury's consideration, it refused to submit specifications C and F on the basis that there had been an insufficient showing of causation with respect to these claims. In medical malpractice cases we have consistently held that, where common knowledge or everyday experience will not permit a lay jury to form an opinion as to causal connection between alleged acts of negligence and injury to the plaintiff, causal connection is essentially a matter which must be foundationed upon expert evidence. McCleeary v. Wirtz, 222 N.W.2d 409, 413 (Iowa 1974); accord Cronin v. Hagan, 221 N.W.2d 748, 755 (Iowa 1974); Barnes v. Bovenmyer, 255 Iowa 220, 228-29, 122 N.W.2d 312, 317 (1963). The issue in the present case is not whether there was sufficient expert medical evidence establishing a causal connection between plaintiff's hearing loss and the administration of the drugs Neomycin and Kanamycin. Defendant Van Bramer conceded in his testimony that one or both of these drugs most likely caused that condition. A broad claim of negligence with respect to the selection and utilization of these drugs was submitted to the jury under negligence specification B, previously quoted. We must decide whether there was sufficient expert testimony to support the additional claims of negligence embraced in specifications C and F. The district court determined that there was not and we agree. With regard to negligence specification F, there is no evidence indicating that if the drugs had been discontinued when the ringing in plaintiff's ears first occurred in late October the amount of permanent hearing loss ultimately sustained would have been less. Any claim of negligence under specification F is fully subsumed within the broad claim submitted to the jury under specification B. With regard to specification C, plaintiff's expert witness testified that audiometric testing should have been performed on the plaintiff before either Neomycin or Kanamycin was administered and should have been repeated at regular intervals during the time the drug therapy was ongoing in order to provide early warning of hearing loss. This claim, we believe, is also fully subsumed under specification B relating to the manner in which the drugs were administered. It was not error to fail to submit specification C as an independent ground of negligence. The record does not indicate that it was more likely than not that the proposed audiometric testing would have alerted plaintiff's doctors to the necessity of discontinuing application of the drugs before hearing loss became irreversible. Such a standard of probability is necessary in establishing the required causal relationship between negligence and injury. Plaintiff also asserts that specification C should have been given to the jury based upon expert testimony concerning the necessity of periodically monitoring the levels of Neomycin and Kanamycin in the blood. The showing of causal connection between this omission and plaintiff's hearing loss is substantially weaker than the showing made with regard to audiometric testing and does not afford a basis for establishing a claim of error with respect to the withdrawal of specification C from the jury's consideration. Plaintiff contends that in medical malpractice cases the rule stated in Restatement (Second) of Torts § 323 (1965) requires only a showing that a negligent act or omission increases the risk of ... harm to the plaintiff in order to generate a jury issue on the element of causation. We have examined the language of the Restatement section upon which plaintiff relies and the comments which accompany that section. The rule, as stated, provides liability for physical harm resulting from [the] failure to exercise reasonable care to perform [the defendant's] undertaking. (Emphasis added.) The language utilized in this section does not suggest that traditional standards of causal relationship do not apply in determining whether harm has resulted from a defendant's act or omission. Indeed, illustration 1 under comment c of section 323 suggests the contrary. The district court did not err in failing to submit negligence specifications C and F for the consideration of the jury.