Opinion ID: 1434951
Heading Depth: 1
Heading Rank: 3

Heading: The trial court properly rendered an instruction which permitted the jury to apply the doctrine of res ipsa loquitur to the present case.

Text: (1) The courts require only that physicians and surgeons exercise in diagnosis and treatment that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of the medical profession under similar circumstances. ( Sinz v. Owens (1949) 33 Cal.2d 749, 753 [205 P.2d 3, 8 A.L.R.2d 757]; Lawless v. Calaway (1944) 24 Cal.2d 81, 86 [147 P.2d 604]; see Comment, 14 Stan.L.Rev. 884, 891-892.) (2) In deciding whether physicians and surgeons have met this standard the trier of fact may infer failure of the practitioner to have done so in cases in which the happening of the accident does not normally occur in the absence of negligence. (3) This doctrine of res ipsa loquitur [4] applies in cases in which (1) the accident is of a kind which ordinarily does not occur in the absence of someone's negligence ( Ybarra v. Spangard (1944) 25 Cal.2d 486, 489 [154 P.2d 687, 162 A.L.R. 1258]) and (2) defendant is probably the person who is responsible. ( Tomei v. Henning (1967) 67 Cal.2d 319, 322 [62 Cal. Rptr. 9, 431 P.2d 633].) [5] The increasing use of res ipsa loquitur exemplifies the growing recognition of the courts of the special obligations which arise from particular relationships. ( Cho v. Kempler (1960) 177 Cal. App.2d 342, 348 [2 Cal. Rptr. 167, 76 A.L.R.2d 774], hg. den.; see Rintala, Foreword: Status Concepts in the Law of Torts (1970) 58 Cal.L.Rev. 80.) In cases in which the particular defendant is in a position of some special responsibility toward the plaintiff or the public (Prosser, Res Ipsa Loquitur in California (1949) 37 Cal.L.Rev. 183, 224), the doctrine protects the dependent party from unexplained injury at the hands of one in whom he has reposed trust. In an integrated society where individuals become inevitably dependent upon others for the exercise of due care, where these relationships are closely interwoven with our daily living, the requirement for explanation is not too great a burden to impose upon those who wield the instruments of injury and whose due care is vital to life itself. ( Cho v. Kempler, supra, 177 Cal. App.2d 342, 349; Salgo v. Leland Stanford etc. Bd. Trustees (1957) 154 Cal. App.2d 560, 568-569 [317 P.2d 170], hg. den.; 1 Louisell & Williams, Medical Malpractice, supra, §§ 15.01-15.02, at pp. 461-466; see Clark v. Gibbons, supra, 66 Cal.2d 399, 414 (concurring opn. of Tobriner, J.); 2 Harper & James, Law of Torts (1956) § 19.5, at pp. 1079-1081.) Illustrative of the growing application of the res ipsa loquitur doctrine is the wide variety of cases in which courts have found sufficient common knowledge and observation among laymen, regardless of expert testimony, to indicate that the consequences of the professional treatment were not such as ordinarily would have followed if due care had been exercised so as to raise an inference of negligence. ( Cavero v. Franklin etc. Benevolent Soc. (1950) 36 Cal.2d 301, 309 [223 P.2d 471].) [6] In other medical malpractice cases, usually involving complex or rare medical procedures, courts have found insufficient common knowledge among laymen to apply the doctrine of res ipsa loquitur, but have required expert testimony in order to establish the requisites of the doctrine. [7] (4) In cases in which the physician or surgeon has injected a substance into the body, the courts have followed the test that if the routine medical procedure is relatively commonplace and simple, rather than special, unusual and complex, the jury may properly rely upon its common knowledge in determining whether the accident is of a kind that would ordinarily not have occurred in the absence of someone's negligence. ( Berkey v. Anderson (1969) 1 Cal. App.3d 790, 799 [82 Cal. Rptr. 67] (hg. den.).) [8] (5) Whether the case falls into the category of the commonplace or the unusual must necessarily turn upon a conglomerate of medical facts; only if the facts clearly show that the procedure is so unusual and complex that the jury could not rest their understanding of it upon their common knowledge should the court refuse a tendered res ipsa loquitur instruction, based on common knowledge. We proceed to an analysis of some principal injection cases to illustrate the use of the test. In Bauer v. Otis (1955) 133 Cal. App.2d 439, 440-442 [284 P.2d 133] (hg. den.), a nurse injected Thex, a vitamin B complex, into the deltoid muscle of plaintiff's right arm. When the needle was inserted, plaintiff felt a terrific pain that engulfed his entire arm. Never before had injections caused such a severe, sharp pain. In addition, plaintiff immediately suffered wrist drop  a condition that impaired the movement of his right hand. In an operation to cure the wrist drop plaintiff's doctor discovered a lesion on the right radial nerve that had occurred at the time of the injection and had caused the wrist drop. The court observed, Needle injections of cold shots, penicillin, and many other serums have become commonplace today. Hardly a man, woman or child (even those of tender age) exists in this country who has not had injections of one kind or another.... So the giving and receiving of injections and the lack of nerve injury therefrom ordinarily has become a matter of common knowledge. If something does go wrong it is a matter for explanation by the person causing the injury. (133 Cal. App.2d at p. 444.) Hence, the court concluded that a res ipsa loquitur instruction was proper because the medical procedure was commonplace. In Wolfsmith v. Marsh (1959) 51 Cal.2d 832, 833-834 [337 P.2d 70, 82 A.L.R.2d 1257], the plaintiff received at least four injections of sodium pentathol without suffering any allergic reaction or other harm. On the fifth occasion, however, the doctor injected sodium pentathol into the inner aspect of plaintiff's right knee; the patient suffered extreme pain for 63 days thereafter, developed blood clotting, and finally a slough ulcer appeared at the site of the injection. This court found that the medical procedure used was sufficiently commonplace to support a res ipsa loquitur instruction. (51 Cal.2d at p. 835.) [9] We now turn to two cases in which the medical procedures were far from routine: In Salgo v. Leland Stanford etc. Bd. Trustees, supra, 154 Cal. App.2d 560, 565-568, the defendant doctor performed a translumbar aortography in which the aorta was punctured and radio-opaque substance injected to determine the location of a suspected block in plaintiff's circulatory system. The next morning plaintiff awoke and found that his lower extremities were permanently paralyzed. The court observed, There can be little question but that aortography and its results, because it is a relatively new diagnostic procedure, is not a matter of common knowledge among laymen.... Very few laymen have ever heard of it.... It is a matter outside the realm of the laymen's experience.... (154 Cal. App.2d at pp. 570-571.) Hence, the court concluded that the aortography was sufficiently complex and unusual to render inappropriate a res ipsa loquitur instruction based on common knowledge. In LeMere v. Goren (1965) 233 Cal. App.2d 799, 801-802 [43 Cal. Rptr. 898] (hg. den.), the plaintiff complained of pains at the base of his neck with associated headaches. In order to relieve this condition defendant doctor attempted to give plaintiff an injection of novocain in the brachial plexus nerves at the base of his neck. Plaintiff suffered severe pain and paralysis of his right arm and hand. The court noted expert testimony that it was contrary to the standards among doctors in good standing in the community to inject novocain, for the purpose of relieving pain and muscle spasm, into any nerve; that an injury to a nerve as a result of an injection was not acceptable under such standards.... (233 Cal. App.2d 799, 803.) Hence, the court, holding that a res ipsa loquitur instruction based upon expert testimony should have been rendered, reversed a jury verdict in favor of the defendant. In dictum, however, the court rejected a res ipsa instruction based upon common knowledge. The court explained: In the present case there is medical testimony that a novocain injection into the brachial plexus area, properly done, may by chance result in injury to the nerve. With respect to this particular type of injection, common knowledge of laymen is `not a reliable foundation.' (233 Cal. App.2d at p. 808.) (6) The record in this case contains substantial evidence [10] that plaintiff's tendonitis condition was most commonplace; that injections of cortisone and a local anesthetic were the normal, common treatment for this condition, and that untoward results were extremely rare. [11] This case, therefore, involves a relatively simple, rather than complex, procedure in which the physician injected a fluid into the body. The jury could accordingly rely upon its common knowledge in determining whether the accident was of a kind that would ordinarily not have occurred in the absence of someone's negligence. Thus, the trial court properly instructed the jury that if it found from expert testimony, common knowledge, and all the circumstances that the injury was more probably than not the result of negligence, it could infer negligence from the happening of the accident alone.