Court Opinion

ID: 9856682
Source: CourtListenerOpinion
Date Created: 2023-09-24 06:55:22.596914+00
Date Added: 2024-06-11T09:40:21.110910
License: Public Domain

SULLIVAN, J.
I dissent.
“Since the res ipsa loquitur instruction permits the jury to infer negligence from the happening of the accident alone, there must be a basis either *326in common experience or expert testimony that when such an accident occurs, it is more probably than not the result of negligence. [Citations.]” (Tomei v. Henning (1967) 67 Cal.2d 319, 322 [62 Cal.Rptr. 9, 431 P.2d 633].) (Italics added.)
It must be emphasized at the outset that the majority make absolutely no claim that there is expert testimony in this record upon the basis of which the jury could have drawn an inference of negligence from the mere happening of the accident. They proffer instead the astounding thesis that plaintiff was “entitled to a res ipsa loquitur instruction on the basis of common knowledge among laymen . . . .” (Italics added.) I agree that there is no expert testimony to support the required inference of negligence. I emphatically disagree with the majority’s conclusion that it can here be based on common experience.
The majority’s analysis is in two parts: first, the operation performed by defendant, including his decision not to provide internal or external fixation to plaintiff’s leg; and second, defendant’s instructions to plaintiff concerning the post-operative use of her leg. As to the first, the majority concede that the medical determinations involved are too complex and too far removed from the knowledge of laymen to' be resolved without the aid of expert testimony. In the absence of such testimony in the record, they recognize, as they must, that on this aspect of defendant’s treatment, common experience cannot possibly be the basis of the necessary inference of negligence.
In their consideration of the second part, however, the majority strive to reach a different result. Apparently conceding, as I have pointed out, that there is no expert testimony upon which to base the necessary inference and thus to justify a res ipsa instruction, the majority nevertheless hold that the common experience of laymen is sufficient basis for such an instruction. I cannot agree with this conclusion, which lacks any foundation in legal precedent or reality.
The crux of the majority opinion is expressed in a single sentence: “It is just common sense that after removing a substantial portion of a patient’s leg bone, a doctor should warn his patient that there is considerable risk to the patient in lifting the leg horizontally until after the healing process has been completed.” Essentially this means that, as a matter of law, laymen have the “common sense” to know that a leg from which part of the bone has been removed is likely to break simply by being lifted horizontally. I cannot find any basis for ascribing such knowledge to persons who have no medical training. The characteristics and treatment of bones is-a com*327plex and specialized field which requires considerable study beyond that needed to obain a medical degree. Lay persons simply lack the competence to make an intelligent judgment about whether plaintiff faced an appreciable risk of fracture from lifting her weakened leg. “To give a res ipsa instruction under such circumstances invites a purely speculative leap and entrusts the jury with unreviewable power to impose or withhold liability as it sees fit.” (Clark v. Gibbons (1967) 66 Cal.2d 399, 415-416 [58 Cal.Rptr. 125, 426 P.2d 525].) (Tobriner, J., concurring.)
The only support for the majority’s conclusion is their statement that “Neither such a warning nor the breaking of the leg is so uncommon or so complicated that expert testimony would be required in order to render a res ipsa loquitur instruction appropriate.” This explanation is meaningless. The complexity or simplicity of a warning is irrelevant. The crucial issue is whether a layman has the “common sense” to know if a warning was needed. Nor does the fact that a fracture of the leg is not a rare occurrence establish the result reached by the majority. There are many diseases or conditions of whose existence a layman would be aware but of whose causes he would be wholly ignorant.1 The question here is whether a lay person has sufficient common knowledge to conclude that lifting a leg whose bone has been partially removed is likely to cause it to fracture. It is manifest that this information is not within the common experience of the average person.
Prior medical malpractice cases in which this court has held that common experience is sufficient to warrant a res ipsa instruction are easily distinguishable. Several have involved routine medical procedures with which most laymen would be personally familiar. Bardessono v. Michels (1970) 3 Cal.3d 780 [91 Cal.Rptr. 760, 478 P.2d 480] and Wolfsmith v. Marsh (1959) 51 Cal.2d 832 [337 P.2d 70, 83 A.L.R.2d 1257], both cited by the majority, concerned injuries resulting from injections. In Wolfsmith the court remarked: “It is a matter of common knowledge among laymen that injections in the arm, as well as other portions of the body, do not ordinarily cause trouble unless unskillfully done or there is something wrong with the serum.” (51 Cal.2d at p. 835.) In Davis v. Memorial Hospital (1962) 58 Cal.2d 815 [26 Cal.Rptr. 633, 376 P.2d 561], where a rectal abcess developed after a routine presurgical enema was given, we declared: “Although there was no expert testimony as to the probability of negligence in such a situation, it is a matter of common knowledge among laymen that the giving of an enema is not ordinarily harmful unless negli*328gently done.” (Id. at p. 817.) Certainly, the majority cannot contend that the instant procedure was as routine and commonplace as an injection or an enema.
Other cases where the knowledge of laymen has been held sufficient have involved injuries unrelated to the medical treatment being administered. Where a clamp or sponge was left in a patient’s abdomen after surgery, this court has recognized that no medical expertise is necessary in order to infer negligence. (Leonard v. Watsonville Community Hosp. (1956) 47 Cal.2d 509 [305 P.2d 36]; Ales v. Ryan (1936) 8 Cal.2d 82 [64 P.2d 409].) The same result has been reached where the patient receives an injury to a portion of the body different from the part being treated. In Ybarra v. Spangard (1944) 25 Cal.2d 486 [154 P.2d 687, 162 A.L.R. 1258], a patient after undergoing an appendectomy found his shoulder paralyzed. In Meyer v. McNutt Hospital (1916) 173 Cal. 156 [159 P. 436], plaintiff’s legs were badly burned by a hot-water bottle while she was unconscious from the effects of anesthesia. By contrast, in the instant case, the fracture of plaintiff’s leg was intimately related to her course of treatment.
The majority treat defendant’s statement that “the amount of bone left remaining had sufficient strength to permit her a reasonable amount of activity, with precaution” (italics added) as evidence of his recognition of the danger of fracture. Plaintiff also testified that defendant told her to place only a little weight on her leg. Such testimony sheds no light on whether defendant knew or should have known that the mere lifting of the leg was likely to cause it to break. The fact that defendant warned plaintiff not to walk on her leg by no means indicates that he realized or should have realized the risk inherent in raising it slightly while lying down. To suggest that a layman could make an intelligent assessment of this danger from his common experience is to endow him with a medical sophistication acquired by physicians only after many years of training.2
*329I would affirm the judgment.
Wright, C. J., concurred.

 As the majority point out, “Although cancer has become a relatively common condition, laymen have no basis for understanding the treatment or symptoms of that disease.”

 The majority cite Meier v. Ross General Hospital (1968) 69 Cal.2d 420 [71 Cal.Rptr. 903, 445 P.2d 519] for the proposition that Dr. Bock had a duty to give plaintiff adequate instructions on how to care for her weakened leg. We there said, “If those charged with the care and treatment of a mentally disturbed patient know of facts from which they could reasonably conclude that the patient would be likely to harm himself in the absence of preclusive measures, then they must use reasonable care under the circumstances to prevent such harm. [Citations.]” (Id. at p. 424.)
Meier involved wholly different facts from the instant case and provides no support for the majority’s conclusion here. The decedent in Meier had previously attempted to kill himself and subsequently was hospitalized in the psychiatric wing of defendant hospital. His room on the second floor of the hospital had a fully openable window without any protective bars. When he committed suicide by jumping from the hospital window, his family brought an action to recover damages for wrongful death. We held that a' res ipsa instruction was proper, even absent expert testimony, since “the evi*329dence supports a conclusion that the cause of the accident (the openable window) was not inextricably bound up in a course of treatment involving the exercise of medical judgment beyond the common knowledge of laymen.” (Fn. omitted.) {Id. at p. 431.) In the instant case, by contrast, the medical judgment involved was wholly beyond a layman’s ken. Consequently, the rationale of Meier is inapplicable.