Opinion ID: 1656717
Heading Depth: 2
Heading Rank: 1

Heading: Instrumentality

Text: ¶ 12. The Powells cite Palmer v. Clarksdale Hospital, 206 Miss. 680, 40 So.2d 582 (1949), where Palmer suffered injuries to her feet during a non-specified surgery, allegedly due to improper use of straps used to fasten Palmer's feet to the operating table. The trial court granted a directed verdict in favor of Clarksdale Hospital at trial. Palmer called as a witness Miss Francis, who was the circulating nurse during the surgery. Francis had no independent recollection of the surgery. She did agree that she did not loosen the straps during the forty-five minutes they were on Palmer's feet, but she did not believe that the straps were capable of being tightened enough to cut off the circulation to the feet. This Court reversed, stating: There was no defect in appellant's feet when she went into the operating room. She was there placed under an anaesthetic[anesthetic] and rendered unconscious, so that she was unable to take care of herself or make complaint of anything that was done to her. The straps were placed upon her feet and were kept there, suspending the weight of her feet and legs, without release or loosening to restore circulation, for about forty-five minutes. Nothing touched appellant's feet that could have caused this injury except these straps. The demonstration made before the jury, coupled with the testimony of appellant's physician, was such that the jury could have found, as reasonable men, that the straps continued to tighten upon appellant's feet to the extent of obstructing the circulation of blood therein, and that reasonable care on the part of appellees required a temporary loosening of these straps, and that a failure therein proximately caused the injuries to appellant. In fact, the evidence excluded every causal connection except the straps, and we are of the opinion that the lower court erred in excluding the evidence and refusing to submit the case to the jury for decision. Palmer, 206 Miss. at 693-94, 40 So.2d at 584 (emphasis added). ¶ 13. This Court in Palmer v. Clarksdale Hospital relied on Ybarra v. Spangard, 25 Cal.2d 486, 154 P.2d 687 (1944), where Ybarra had his appendix removed. Ybarra remembered that when he was placed on the operating table two hard objects were pressing into his neck and shoulder area. After surgery Ybarra felt pain and numbness in his right shoulder. The trial court dismissed Ybarra's suit. The California Supreme Court reversed, finding that the fact that Ybarra could not identify any definite instrumentality as causing his injury was not fatal to his cause of action. It further found that a strict interpretation of res ipsa loquitor would result in few if any patients able to recover for injuries received while unconscious. The court finally held that where a plaintiff receives unusual injuries while unconscious and in the course of medical treatment, all those defendants who had any control over his body or the instrumentalities which might have caused the injuries may properly be called upon to meet the inference of negligence by giving an explanation of their conduct. Ybarra, 154 P.2d at 691. ¶ 14. Here, the Court of Appeals found that there was no showing of an instrumentality under the exclusive control of Methodist Hospital that caused damage to Powell. The operating room circulating nurse in Powell's gall bladder surgery was Carolyn Rowe, but there is no deposition testimony or account from her concerning the surgery in this record. There is an excerpt from the deposition of Barbara Bregande, identified as the Powells' nursing expert, in Powell's petition for certiorari. In her deposition, she testified: Q: Do you have any information or knowledge that they [operating room staff] weren't careful in placing that strap? A. I have no way of knowing that, because I see nothing in the records to indicate how the strap was placed or the second time the strap was placed on the patient. I only know how is was placed the first time which looked perfectly normal. Q. And do you have any information or information that there was any external pressure placed on Mrs. Powell leg during the course of that procedure? A. I cannot find in the records any other area where we might conceive that the patient had pressure other than in the operating room. Q. That is not my question. My question was, do you have any information or knowledge that there was external pressure placed on her leg during the course of that procedure? A. According to the record, no. (emphasis added). However, there was some mention of a body strap by Powell's experts, but there is no deposition testimony on how the strap was applied. Powell testified that she was unconscious and did not recall anything from the point that the anesthesiologist gave her a sedative. She testified in her deposition as follows: Q. When they took you to surgery, then what happened? What do you recall? A. I recall going to another area where a anesthesiologist came in and asked some questions.... Q. Let me back up a second. Before you went in to speak with the anesthesiologist, had you been given any medication  A. I don't recall.... Q. Okay. At the next stage, were you given any medication by the anesthesiologist at that point? A. I think I was givena  after I talked to the anesthesiologist, on of those  I guess, like a sedative shot to relax me. Q. Okay. How did that affect you? A. I don't remember anything past that point. Q. Were you conscious? A. Not after the sedative. Q. Okay. Prior to receiving the sedative, what else do you remember as far as preparations for surgery? A. That's about all I remember.... Q. Prior to be given the sedative, do you recall bumping your left knee on any piece of hospital equipment? A. No. Q. You were just positioned in the bed  how were you positioned in the bed? Were you laying on your back? A. Yes. Q. Legs straight out in front? A. On my back, elevated a little bit. Kind of a sitting position. Q. How were your legs positioned? A. Straight.... Q. Do you recall being uncomfortable at all in the way you were positioned prior to going into the operating room  A. No. Q.  at any point? Prior to being given the sedative, do you recall a safety strap across you at any location on your body? A. Prior to the sedative? Q. Yeah. A. No. Q. Okay. Do you recall seeing any kind of safety strap laying across your body at any point prior to or after the surgery? A. No. Q. Do you know what type of anesthetic you were given? Were you given a general anesthesia or a local? I understand you had gallbladder surgery. A. Yes. Q. Did they knock you out completely? A. Yes Q. When you transferred yourself from the stretcher to the bed, were you able to pick your legs up and move them over yourself? A. Yes. Q. So you could pick them up and put them down? A. Yes. Q. Okay. Did you tell me you recalled feeling the sensation of your left foot being asleep as soon as you woke up? A. As soon as I woke up. Q. Did you report that to anybody? A. Everyone in the room. Q. Who do you recall being in the room? A. There were two staff personnel that brought me to the room. I think it was two males. There was a nurse already in the room. I'm assuming that was my assigned nurse. My husband and my mother-in-law. ¶ 15. Dr. Fisher, the doctor who performed the gallbladder surgery, testified in his deposition that straps are always used on patients in surgery but did not recall specifically if straps were used on Powell. He stated: Q. Do you recall a safety strap being used on Mrs. Powell? A. I don't recall in particular for Mrs. Powell, but I will tell you the safety strap is always used on patients  so that number one, they don't fall off the table. Q. Certainly. A. They fall off the table and bust their head open and all like that, then we got a real problem. Q. Yes, sir. So you don't recall specifically a safety strap on Mrs. Powell; is that right? A. I wasn't  probably wasn't there when she was being place on the table and everything being put on the table, so I can't tell you one way or the other. ¶ 16. Dr. Alexander, the neurosurgeon who treated Powell for compressed nerve damage testified that he could state what cause Powell's nerve compression. However, he stated in his deposition as follows: Q. I hearing you to say that you're not prepared to testify to a reasonable degree of medical probability as to what caused her compression? A. I am prepared to give the opinion that I think it was a compression. I do not know what the compressive agent would be or could be not, A, having been there and, B, being ultimately familiar beyonda  just a rudimentary level as to what could have caused the compression. I know there is a black strap used, but I think the people that were there on that case that day might better give opinions. Q. I just want to make sure I understand so I don't waste all of our  everybody's time. With regard to the causation, at this point, you're limiting your testimony to the fact that she had a compressed peroneal nerve, but as to what caused, to a reasonable degree of medical probability, that compressed nerve, that's not what you're prepared to testify to, correct? A. That's been my opinion all along. He further testified: Q. Now, I apologize for asking you this again, but we're on the subject: Based on everything that we've talked about, and based on your knowledge, education, training and experience, I believe you've testified that you can't say to a reasonable degree of medical probability what the compressive agent was; is that correct? A. Yes, sir, I think we've hit it three or four different times. I cannot say. Q. Okay. A. All I can say is that Mrs. Powell told me she went into the operating room without this complaint and she came out with it. ¶ 17. Based on this Court's holding in Palmer and this evidence, the element of instrumentality could be met at trial. Therefore, I would reverse the judgements of the Court of Appeals and the trial court and remand this case for trial.