Court Opinion

ID: 9953515
Source: CourtListenerOpinion
Date Created: 2024-03-22 14:02:17.608728+00
Date Added: 2024-06-11T08:01:14.235559
License: Public Domain

DISTRICT COURT OF APPEAL OF FLORIDA
                       SECOND DISTRICT

                         MICHAEL R. BARBER,

                               Appellant,

                                    v.

                   MANATEE MEMORIAL HOSPITAL,
                      LIMITED PARTNERSHIP,

                                Appellee.

                             No. 2D22-3459

                             March 22, 2024

Appeal from the Circuit Court for Manatee County; Edward Nicholas,
Judge.

Michael P. Milton and A.J. Hernandez of Milton, Leach, Whitman,
D'Andrea & Eslinger, P.A., Jacksonville; and Lucreita D. Becude of
Lucreita D. Becude, P.A., Jacksonville, for Appellant.

Jeffrey L. Blostein, Alexandra Hershorn, and Jay Cohen of Cohen,
Blostein & Ayala, P.A. n/k/a Cohen & Blostein, P.A., Fort Lauderdale, for
Appellee.

SLEET, Chief Judge.

     Michael Barber challenges the trial court's final summary judgment
entered in favor of Manatee Memorial Hospital in Barber's medical
negligence action against the hospital. This appeal involves the
application of the doctrine of res ipsa loquitur to a medical negligence
action wherein Barber sustained bilateral hip fractures while
unconscious in the Manatee Memorial intensive care unit (ICU), where he
was being treated for a drug overdose. We conclude, based on the facts
of this case, that Barber was entitled to assert res ipsa loquitur below
and that the application of that doctrine creates a genuine dispute of
material fact as to whether Barber's unexplained bilateral hip fractures
were the result of Manatee Memorial's negligence. Accordingly, the trial
court erred in entering summary judgment, and we reverse and remand
for further proceedings. We further conclude that the trial court erred in
granting Manatee Memorial's motion in limine to exclude evidence of its
failure to investigate the cause of Barber's unexplained injuries once they
were discovered. If this case does proceed to trial, such evidence is
admissible.
                                  FACTS
     On September 23, 2017, Barber, who was thirty-six years old at the
time, attempted to end his life by taking four different prescription
medications while at home. Fortunately, he had a change of heart and
called 911. When emergency medical technicians (EMTs) responded,
they found Barber in his garage pacing back and forth and smoking a
cigarette. During the EMTs' assessment, Barber began to have "seizure
like activity," but according to the Manatee County Emergency Medical
Services (EMS) patient record, the seizure activity lasted less than thirty
seconds and Barber had "purposeful movement during [the] event." The
Manatee Memorial Hospital History and Physical Report prepared by Dr.
Victor Ghobrial—the physician who would later admit Barber to the
hospital—indicates the following: "EMS notes upon their arrival the
patient was walking . . . but became lethargic en route to the [emergency

                                     2
department]. EMS states the patient also had a possible seizure and
became responsive to an ammonia inhalant." The lead EMT testified at
deposition that at his home, Barber walked over to and got up on the
EMS gurney without assistance.
     Barber was taken to the emergency department at Manatee
Memorial. While there, Barber submitted to a psychiatric consultation.
The notes from that consultation indicate that "[patient] walked from
stretcher to ER stretcher." Dr. Ghobrial's Hospital History and Physical
Report repeats that fact. The emergency department notes do not
contain any indication that Barber complained of pain of any kind but do
specifically state that the results of a musculoskeletal exam showed a
normal range of motion, which a Manatee Memorial nurse testified at
deposition referred to both upper and lower extremities.
     However, within four hours of arriving, Barber's condition
deteriorated rapidly; he became nonresponsive, and medical staff sedated
him, intubated him, put him on a ventilator, sent him for CT scans, and
then transferred him to the ICU. He remained under observation in the
ICU in a low position hospital bed equipped with an alarm and soft wrist
restraints for the next fifty-five hours. Hospital records show that during
that time, Barber's vitals were continuously monitored and there were no
complications, with specific notations from September 24, 2017, stating
"[a]ppropriate body movements" and "[m]oves all extremities equally."
According to hospital records, Barber's stay in the ICU was uneventful,
and nothing in the records suggest hip problems or seizure activity while
he remained unconscious.1

     1 We do note that an entry in Barber's hospital record dated

September 24, 2017, at 5:50 p.m. indicated "mild seizure activity" while
"patient [was] returning from MRI." But the hospital declared this report

                                     3
     At 1:05 p.m. on September 25, 2017, Barber was successfully
extubated and remained in bed with suicide precautions in place, but his
wrist restraints were removed. At 5:34 p.m., he was transferred with
assistance to a bedside chair. At that time, he began to complain of pain
in his right groin and thigh that felt like a "big cramp." He was sent for
x-rays, and while in the x-ray room, he complained of extreme pain and
resisted when two assistants lifted him to place him on the x-ray board.
Barber's right leg was noted to be "turned outward," and he was
diagnosed with bilateral hip fractures.2 Barber underwent surgery at
Manatee Memorial to repair his hip fractures, but no hospital personnel
ever explained to him how his hips were injured.
                         PROCEDURAL HISTORY
     In 2018, when Barber's counsel notified the hospital of his claim,
the hospital responded that it had no record of any incident or report
concerning the cause of his hip injuries. Thereafter, Barber complied
with all statutory prerequisites for notice of intent to bring a medical
malpractice claim, and the hospital completed its presuit investigation.
In his August 20, 2019, one-count amended complaint, Barber alleged
medical negligence on the part of Manatee Memorial. Although Barber
did not reference the doctrine of res ipsa loquitur in this, the operable
complaint, he did allege the following:
     [O]n September 23, 2017, he walked into the hospital
     unassisted with no complaints of any femoral or acetabular
     problems, but when he awoke on or about September 26,
     2017, the fractures to his proximal femur and acetabulum
     were grossly evident. Neither the Defendant's agents,

to be an "Error Report-Charted Wrong Patient," and Manatee Memorial
does not dispute that this record entry was not referencing Barber.
     2 These injuries are also referred to in the record as a fracture of

the right femoral neck and a fracture of the left acetabulum.

                                      4
     servants, nor employees ever advised Plaintiff of any trauma
     suffered while he was in Defendant's custody and care or
     provided any explanation for his femoral or acetabular
     injuries despite Plaintiff's pleas for an explanation since he
     had been totally unconscious for two and one-half (2 1/2)
     days; and it was obvious that he had been injured while
     under the care of the Defendant.
     Both parties conducted extensive discovery and retained qualified
experts within the same medical fields as the medical providers who had
treated Barber at Manatee Memorial. Having no hospital records
documenting any incident or event that could have caused Barber's
injuries, all medical experts were left to rely upon their collective medical
skill, expertise, and knowledge as well as literature concerning the most
common causes of bilateral hip fractures.
     After the bulk of medical discovery was completed, Manatee
Memorial filed a motion for summary judgment as a matter of law,
arguing that Barber had "failed to meet his burden of proof and . . . to
put forth sufficient evidence in order to prove his medical negligence
claim" because his "experts could not testify within a reasonable degree
of medical probability that the healthcare providers at Manatee Memorial
caused 'trauma' to this patient resulting in his fractures." It maintained
that "[t]here has been no record evidence to date demonstrating that the
nurses, physicians, techs, etc. at the hospital somehow caused trauma
to Mr. Barber as to cause a double hip fracture while he was a patient at
the hospital" but that it had presented evidence that the fractures were
caused by an "unwitnessed seizure."
     Manatee Memorial also acknowledged that Barber may argue the
doctrine of res ipsa loquitur. However, the hospital argued that he could
not avail himself of the common law application of the doctrine because
he could not establish that his injuries were the type that could only

                                      5
have been caused by negligence where his experts "acknowledged that
these types of fractures can result from falls from multiple story
buildings, a fall out of bed, or the patient getting out of bed on his own."
      Barber opposed Manatee Memorial's summary judgment motion by
pointing out that the hospital's own experts acknowledged that his hip
fractures occurred while he was under the hospital's care. With regard
to the hospital's contention that he must have suffered an unwitnessed
seizure, Barber submitted the testimony of his expert witness, who
stated that it was his opinion Barber did not suffer a seizure and that
severe bilateral hip fractures do not ordinarily occur to a sedated,
unconscious ICU patient absent negligence. Barber maintained that
because Manatee Memorial had failed to document any specific trauma
or other cause of his hip fractures, he was entitled to argue to the jury a
res ipsa loquitur theory of negligence and that the jury, as the trier of
fact, should resolve the genuinely disputed material issue of whether his
hip fractures were caused by the negligence of Manatee Memorial.
      Following a summary judgment hearing, the trial court granted
Manatee Memorial's motion, concluding that Barber "had failed to put
forth sufficient evidence that [his] inexplicable injuries were the result of
negligence on the part of" Manatee Memorial. Noting that Barber had
alleged in his complaint that his injuries "were the result of some violent
trauma he was caused to experience by the negligence of [Manatee
Memorial's] agents, servants and/or employees," the court concluded,
"The problem, however, quite simply, is that there is no evidence of
same."
      On appeal, Barber first argues that the trial court erred in granting
summary judgment in Manatee Memorial's favor because he satisfied the
criteria necessary to argue a res ipsa loquitur theory of negligence and

                                      6
that such a theory created a disputed issue of material fact that
precluded the entry of summary judgment. We agree.
                          SUMMARY JUDGMENT
      We review a trial court's granting of summary judgement de novo.
Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126, 130
(Fla. 2000); Sanders Farm of Ocala, Inc. v. Bay Area Truck Sales, Inc., 235
So. 3d 1010, 1012 (Fla. 2d DCA 2017). Pursuant to Florida Rule of Civil
Procedure 1.510(a), the trial court should grant summary judgment only
"if the movant shows that there is no genuine dispute as to any material
fact and the movant is entitled to judgment as a matter of law."3
Accordingly, the initial burden is on the movant to establish the absence
of any genuinely disputed material fact. Id.; see also Brevard County v.
Waters Mark Dev. Enters., 350 So. 3d 395, 398 (Fla. 5th DCA 2022) ("The
moving party bears the initial burden of identifying those portions of the
record demonstrating the lack of a genuinely disputed issue of material
fact." (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986))). "If the
movant does so, then the burden shifts to the [nonmoving] party to
demonstrate that there are genuine factual disputes that preclude
judgment as a matter of law." Waters Mark Dev. Enters., 350 So. 3d at
398. Under rule 1.510(a), "the correct test for the existence of a genuine
factual dispute is whether 'the evidence is such that a reasonable jury
could return a verdict for the nonmoving party.' " Carter v. Blue House
Painting & Remodeling, LLC, 367 So. 3d 618, 619 (Fla. 2d DCA 2023)
(quoting In re Amends. to Fla. Rule of Civ. Proc. 1.510, 317 So. 3d 72, 75
(Fla. 2021)); see also Pio v. Simon Cap. GP, 366 So. 3d 1200, 1203 (Fla.

      3 The final summary judgment was entered on September 12, 2022.

Accordingly, the amended version of rule 1.510 that went into effect on
May 1, 2021, is applicable.

                                      7
2d DCA 2023) ("Courts must be particularly restrained in granting
summary judgment in negligence cases[,] and summary judgment should
not be granted 'unless the facts are so crystallized that nothing remains
but questions of law.' " (quoting Grimes v. Fam. Dollar Stores of Fla., Inc.,
194 So. 3d 424, 428 (Fla. 3d DCA 2016))).
         In the instant case, Manatee Memorial met its initial burden of
showing that the record below lacked any evidence of any specific act of
negligence on the part of the hospital, its agents, or its employees that
could have caused Barber's bilateral hip fractures. The elements of a
medical negligence cause of action are (1) duty, (2) breach of that duty,
(3) causation, and (4) damages. Ruiz v. Tenet Hialeah Healthsystem, Inc.,
260 So. 3d 977, 981 (Fla. 2018). Here, Manatee Memorial correctly
argued at summary judgment that Barber had presented no specific
evidence of the breach and causation elements of his negligence claim.
         Consequently, the burden shifted to Barber to demonstrate the
existence of a genuinely disputed fact upon which a jury could find that
one or more agents or employees of Manatee Memorial committed an act
of negligence that resulted in his injuries. To meet his burden, Barber
presented expert witness testimony and relied on the doctrine of res ipsa
loquitur, which is Latin for "the thing speaks for itself." See Marrero v.
Goldsmith, 486 So. 2d 530, 531 (Fla. 1986). The trial court, however,
ruled that Barber could not avail himself of that evidentiary doctrine and
granted summary judgment in favor of Manatee Memorial. This was
error.
                               Res Ipsa Loquitur
         Under certain circumstances, plaintiffs in negligence cases may use
the doctrine of res ispa loquitur as "a common-sense inference of
negligence where direct proof of negligence is wanting." Goodyear Tire &

                                       8
Rubber Co. v. Hughes Supply, Inc., 358 So. 2d 1339, 1341 (Fla. 1978).
The doctrine "is a rule of evidence that permits, but does not compel, an
inference of negligence . . . . 'Under it an inference may arise in aid of
the proof.' " Marrero, 486 So. 2d at 531 (quoting Yarbrough v. Ball U-
Drive Sys., Inc., 48 So. 2d 82, 83 (Fla. 1950)). The case law is clear that
the doctrine only creates an inference and that while "[n]egligence may
not be presumed, . . . where direct proof is wanting and such
circumstances are shown as to leave no conclusion except that the
defendant was at fault, a prima facie case may arise, justifying the
application of the rule of res ipsa loquitur." W. Coast Hosp. Ass'n v.
Webb, 52 So. 2d 803, 804 (Fla. 1951).
      "The hospital patient relationship is one area where the application
of the doctrine . . . has been utilized to prevent injustice." Keyes v.
Tallahassee Mem'l Reg'l Med. Ctr., 579 So. 2d 201, 203 (Fla. 1st DCA
1991). However, a plaintiff may only invoke the doctrine under very
limited circumstances. See Goodyear, 358 So. 2d at 1341 ("Res ipsa
loquitur . . . is a doctrine of extremely limited applicability." (footnote
omitted)); Marrero, 486 So. 2d at 531 (explaining that the rule permits an
inference of negligence only "under certain circumstances"). And the
burden is on the plaintiff to present sufficient evidence upon which the
jury, as the finder of fact, could find the existence of those
circumstances. See Goodyear, 358 So. 2d at 1342 (explaining that in
determining whether a plaintiff may argue res ipsa loquitur, the trial
court must ask, "Can it realistically be concluded . . . that this
'happening' does not ordinarily occur in the absence of negligence by the
[defendant]?" and that "[t]he initial burden is on the plaintiff to establish
that the circumstances attendant to the injury are such that . . .
negligence is the probable cause and the defendant is the probable

                                       9
actor"). When a plaintiff meets that burden, "the doctrine of res ipsa
loquitur is applicable, and the issue of the hospital's negligence should
be submitted to the jury" with the proper jury instruction. See Troupe v.
Evans, 366 So. 2d 139, 140-41 (Fla. 1st DCA 1979) (citing Webb, 52 So.
2d 803).
      Specific to medical negligence cases like the instant one, a plaintiff
must present evidence from which a jury could conclude "that the injury
was unrelated to the surgical procedure or other medical treatment" that
the defendant was legitimately providing the plaintiff. Borghese v.
Bartley, 402 So. 2d 475, 477 (Fla. 1st DCA 1981); cf. Webb, 52 So. 2d at
804 ("[R]es ipsa loquitur is inappropriate in a matter involving a
physician's exercise of skill."); Marshall v. Stein, 662 So. 2d 720, 722 (Fla.
4th DCA 1995) ("[P]laintiff's injury was directly related to the anesthesia,
and the anesthesia was an integral part of her operation. Accordingly,
. . . res ipsa [loquitur] is not available to plaintiff.").4 But the parties do
not dispute that Barber's bilateral hip fractures were completely
unrelated to his medical treatment for his attempted overdose.
Consequently, we need not further discuss this first criterion.

      4 In its order on summary judgment, the trial court quotes section

766.102(3)(b), Florida Statues, without explanation or analysis of how it
pertains to this case. But that statute is inapplicable to the instant case
as the statute's reference to "medical injury" limits its application to
injuries "sustained as a direct result of medical treatment or diagnosis."
Borghese, 402 So. 2d at 477. In cases such as the instant one where "a
plaintiff establishes that the injury is outside the scope of medical
treatment or diagnosis," if the plaintiff can establish that "the facts and
'circumstances attendant to the injury are such that . . . negligence is the
probable cause and the defendant is the probable actor,' the doctrine of
res ipsa loquitur is applicable" under the common law. Id. (quoting
Chenoweth v. Kemp, 396 So. 2d 1122, 1125 (Fla. 1981)).

                                       10
     Additionally, to be entitled to argue res ipsa loquitur to the jury, a
plaintiff must present sufficient evidence that "the instrumentality
causing his or her injury was under the exclusive control of the
defendant" and that the incident causing the injuries would not
ordinarily occur "without negligence on the part of the one in control."
Marrero, 486 So. 2d at 531 (quoting Goodyear, 358 So. 2d at 1341-42).
                             Exclusive Control
     In its summary judgment order, the trial court made two
observations in concluding that Barber had provided insufficient
evidence of Manatee Memorial's exclusive control. First, the court stated
that "most, if not all," of Barber's expert witnesses could not rule out that
his injuries might have occurred outside the hospital.
     The trial court seems to ignore, however, that Manatee Memorial's
own expert Dr. Edward Lassiter opined that Barber sustained his
injuries "in the hospital" while he was unconscious and in the exclusive
control of the hospital. It is true that both parties' experts had to agree
that there was some possibility that Barber sustained the injuries before
he arrived at the hospital, but that is because there is simply no
explanation for Barber's fractures. However, both parties' experts also
agreed that it was more probable that the injuries occurred while Barber
was in the hospital. This evidence was sufficient to satisfy Barber's
burden, which at this point in the proceedings is only "to establish that
the circumstances attendant to [his] injur[ies] are such that . . .
negligence is the probable cause and [Manatee Memorial] is the probable
actor." See Goodyear, 358 So. 2d at 1342 (emphasis added).
     Moreover, the record evidence established that Barber was walking
around his garage when EMS arrived, that he walked to and got on the
EMS gurney without assistance before being transported to the hospital,

                                     11
and that a musculoskeletal exam conducted in the emergency
department indicated a normal range of motion of Barber's upper and
lower extremities. All of this, coupled with the report that EMS informed
hospital personnel that he "walked from [EMS] stretcher to ER stretcher,"
amounted to competent evidence from which a jury could conclude that
Barber's injuries occurred while he was a patient at Manatee Memorial.
      Second, the trial court noted that nothing in Barber's medical
records indicated the mechanism that caused his injuries or the manner
in which the injuries occurred. Although it is true that neither party's
experts were able to offer any definitive opinions as to the mechanism
that caused Barber's injuries and that there was no evidence of a
documented fall or other incident that could have caused Barber's
injuries, the court's reasoning in this regard exhibits a fundamental
misunderstanding of the exclusive control requirement.
      To argue res ipsa loquitur, a plaintiff is "not required to establish
the identity of the instrumentality that caused [the] injury; rather the . . .
doctrine merely requires 'that the instrumentality causing [the plaintiff's]
injury was under the exclusive control of the defendant.' " Soltwisch v.
Pasco County, 33 So. 3d 85, 87 (Fla. 2d DCA 2010) (second alteration in
original) (quoting Goodyear, 358 So. 2d at 1341). "[I]t is the exclusivity of
the defendant's control that permits an inference of negligence under the
doctrine, not the identity of the instrumentality itself." Id. (concluding
that exclusive control by the county was established by evidence that a
"semi-responsive" plaintiff underwent a normal physical examination
with no hip injuries before he left a clinic in a county ambulance but
then arrived at the hospital with acute hip fractures); see also Webb, 52
So. 2d 804 (concluding that all prerequisites necessary for the inference
were met, including that "the instrument that caused [plaintiff's] injury

                                     12
was in the absolute control of the personnel of the institution," where
plaintiff was unconscious in a diabetic coma and "did not know and
could not have known what apparatus was used in injuring her" but
"there [wa]s abundant proof that [she] was injured while in the hospital").
      Accordingly, because Barber presented sufficient evidence from
which the jury could conclude that Manatee Memorial had exclusive
control over Barber while he was unconscious in the ICU for fifty-five
hours, Barber has met his burden of establishing this res ipsa loquitur
prerequisite.
         Injuries Would Not Ordinarily Occur Absent Negligence
      The trial court also misunderstood the final res ipsa loquitur
prerequisite—that the injuries would not ordinarily occur absent the
defendant's negligence. In its order, the court concluded that "in the
absence of clear evidence of negligence on the part of the healthcare
provider, no . . . inference [of negligence] is permitted." In doing so, the
court came to the illogical conclusion that to be entitled to an inference
that there was negligence on the part of the defendant, a plaintiff has to
provide evidence that there was negligence on the part of the defendant.
But if the plaintiff had evidence of the defendant's negligence, the
inference would not be necessary. And in fact, "one may not avail
himself of the doctrine if he proves specific negligence." See Webb, 52
So. 2d at 804; see also Marrero, 486 So. 2d at 532 ("[W]hen a plaintiff
can introduce enough direct evidence of negligence [it] dispel[s] the need
for the inference."). Rather, the question the trial court should have
considered is "whether that which occurred is a phenomenon which does
not ordinarily happen except in the absence of due care." See Goodyear,
358 So. 2d at 1342.

                                     13
     Here, Manatee Memorial's own experts opined that the most
common causes of bilateral hip fractures are falling from the height of a
three-story building or being involved in a severe motor vehicle accident
and that such injuries do not normally happen to an unconscious ICU
patient.
     In fact, res ipsa loquitur is often invoked out of necessity in cases
like this where a previously sedated and unconscious patient wakes up
in a hospital with a new injury that is unrelated to their treatment and
where there is little to no direct evidence of negligence proving who or
what caused the injury. See Keyes, 579 So. 2d at 203. "The
unconscious patient is entitled to an explanation concerning an injury
and is, thus, in many cases, entitled to the inference created by the
doctrine." Id. (citing Marrero, 486 So. 2d at 533; Borghese, 402 So. 2d at
477). Res ipsa loquitur opens the courthouse doors to patients who, like
Barber, submit themselves to the care of medical professionals, suffer
unexplained and unrelated injuries, and lack any direct evidence of
causation. See Marrero, 486 So. 2d at 533; cf. McDonald v. Med. Imaging
Ctr. of Boca Raton, 662 So. 2d 733, 735 (Fla. 4th DCA 1995) (rejecting
the application of res ipsa loquitur where plaintiff "was not unconscious
when her injury occurred, there was no mystery as to how the injury
occurred, and there was only one possibly culpable [individual]").
     Without the aid of the doctrine [of res ipsa loquitur,] a patient
     who received permanent injuries of a serious character,
     obviously the result of some one's [sic] negligence, would be
     entirely unable to recover unless the doctors and nurses in
     attendance voluntarily chose to disclose the identity of the
     negligent person and the facts establishing liability.
Marrero, 486 So. 2d at 533.
     In the instant case, expert testimony established that Barber's
injuries are not the type that result from lying unconscious in an ICU

                                    14
bed recovering from a drug overdose. Put another way, he presented
sufficient evidence for a jury to reasonably conclude that under the
circumstances, injuries like his would not occur absent negligence.
                         An Unwitnessed Seizure
     To refute both that the hospital was in exclusive control of the
instrumentality that caused Barber's injuries and that his injuries were
the type that could only occur as a result of negligence, Manatee
Memorial advances the theory that Barber suffered "an unwitnessed
tonic-clonic seizure" while in the hospital and that his bilateral hip
fractures were caused by that seizure. The hospital's experts pointed to
the EMS record of "seizure like activity" during the initial assessment at
Barber's home as evidence that he must have had another seizure during
the fifty-five hours he was unconscious in the ICU—a seizure that no
hospital personnel documented witnessing. The irony is that, in some
sort of inverse res ipsa loquitur argument, Manatee Memorial wants this
previous seizure-like activity—which reportedly lasted less than thirty
seconds—to be "the thing that speaks for itself" to provide an inference
that Barber later suffered a seizure of such magnitude that it caused
bilateral hip fractures in the absence of any other proof.
     Such a conclusion is based on nothing but pure speculation.
Could Barber have suffered a violent seizure that no hospital personnel
documented even though he was being constantly monitored in the ICU?
Of course, anything is possible. But "[t]he mere possibility that [the
injury] could have occurred without negligence does not defeat a party's
entitlement to a[ jury] instruction on res ipsa loquitur. The proper test is
whether the [injury] would have occurred without negligence on the part
of the defendant in the ordinary course of events." Keyes, 579 So. 2d at
204 (emphasis added).

                                     15
     Here, not only do both parties' experts agree that there is no
documented medical evidence to prove that Barber suffered a seizure
while in the hospital, but such seizures alone would not ordinarily result
in the injuries that Barber suffered. According to the medical experts,
tonic-clonic seizures are severe and violent, usually last for between
three and five minutes, and involve intense stiffening and rhythmic
jerking. Expert testimony indicated that although this form of seizure
may cause violent movements of the lower extremities, absent a fall, they
mostly cause only upper extremity injuries. And one of Manatee
Memorial's experts, Dr. Bolanle Adamolekun, specifically testified that
only "around 0.3 percent" of seizures result in bone fracture absent a fall.
     Additionally, Barber presented expert medical testimony rebutting
the unwitnessed seizure theory. His experts opined that within a
reasonable degree of medical probability, Barber either fell or was
dropped while in the exclusive care and custody of the hospital and that
injuries as severe as his bilateral hip fractures could not occur under
those conditions absent negligence on the part of Manatee Memorial.
     Further, Barber's experts asserted that if Barber had suffered a
tonic-clonic seizure, the violent convulsions would have caused
tachycardia and respiratory distress, he likely would have voided his
bowels and bladder, and alarms would have been triggered to alert the
hospital's staff as his vital signs were being constantly monitored in the
ICU. And a hospital nurse monitoring Barber testified that the nurse's
charge station is located so that the ICU nurses "can certainly hear
anything that happens pretty much from anywhere in the ICU unit." But
despite all of this, the hospital's records for the period that Barber was
unconscious in the ICU do not reveal any such changes in his vital signs
or that any alarms were triggered. There is simply no evidence that

                                     16
Barber suffered an unwitnessed seizure violent enough to result in these
injuries.
      Accordingly, Barber satisfied all the prerequisites to avail himself of
the doctrine of res ipsa loquitur, and the trial court erred in placing the
burden upon Barber to prove direct evidence of Manatee Memorial's
negligence. The lack of direct evidence of negligence is not fatal to
Barber's case; it is what makes it a res ipsa loquitur case. Requiring
Barber to introduce evidence that would prove negligence would be to
require him to defeat his own res ipsa loquitur claim.
      Because the record evidence establishes that Barber's hip fractures
were unrelated to his treatment for a drug overdose, that Manatee
Memorial was in exclusive control of the instrumentality that caused his
fractures, and that his fractures would not ordinarily occur absent
negligence, Barber is entitled to argue res ipsa loquitur to the jury and
have the jury instructed on a res ipsa loquitur inference of negligence.
This inference creates a genuine dispute as to the material fact of
whether Manatee Memorial breached a duty of care owed to Barber
causing Barber's injuries. As such, summary judgment was improper.
                            MOTION IN LIMINE
      Barber also argues on appeal that the trial court erred in granting
Manatee Memorial's motion in limine to exclude evidence of its failure to
investigate the cause of Barber's injuries once they were discovered.
Again, we must agree with Barber.
      Manatee Memorial moved in limine to exclude any reference to any
risk management review or investigation of Barber's injuries by the
hospital. Manatee Memorial argued that any suggestion that an
investigation would have determined the cause of Barber's injuries was

                                     17
speculation, that whatever it did or did not do after the fact was
irrelevant, and that this is not a res ipsa loquitur case.
     In response, Barber argued that after he inexplicably suffered
bilateral hip fractures during his stay in the hospital for an overdose,
Manatee Memorial disregarded its own policies by not investigating how
the injuries occurred. Barber told the court that he did not want to
introduce the lack of investigation as evidence of Manatee Memorial's
negligence but rather wanted to use it to establish his res ipsa loquitur
claim.
     The trial court granted the motion finding that any lack of
investigation or evidence of an insufficient investigation was not relevant
to whether Barber's injuries were caused by a breach of the standard of
care. The trial court indicated that "an after-the-fact attempt to piece
together facts and theories to that analysis is generally not admissible"
and that it was speculative that an investigation would have revealed the
mechanism that caused Barber's injuries or a more specific
determination as to how Barber was injured. The court specifically
stated at the limine hearing that it was not ruling at that time on
whether Barber could avail himself of a res ipsa loquitur theory of
negligence.
     "[T]he determination of relevancy is within the trial court's
discretion." Healthcare Underwriters Grp., Inc. v. Sanford, 337 So. 3d 32,
41 (Fla. 4th DCA 2022). Here, because the trial court reserved ruling on
whether Barber could base his negligence claim on res ipsa loquitur, its
determination that evidence of Manatee Memorial's failure to investigate
his injuries was irrelevant was an abuse of discretion.
     In order to argue res ipsa loquitur, Barber must be able to establish
a lack of available evidence surrounding the events that led to his

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injuries. See Fla. Std. Jury Instr. (Civil) 402.4(e) ("If you find that
ordinarily the [incident] [injury] would not have happened without
negligence, and that the (describe the item) causing the injury was in the
exclusive control of (defendant) at the time it caused the injury, you may
infer that (defendant) was negligent unless, taking into consideration all of
the evidence in the case, you find that the (describe event) was not due to
any negligence on the part of (defendant)."). Manatee Memorial's failure
to investigate the incident is therefore relevant. See § 90.401, Fla. Stat.
(2022) ("Relevant evidence is evidence tending to prove or disprove a
material fact."). Additionally, the lack of investigation weakens Manatee
Memorial's argument that Barber's injuries were the result of an
undocumented violent tonic-clonic seizure and establishes the limited
foundation for the hospital's expert witnesses' opinions. And the trial
court can appropriately instruct the jury that Manatee Memorial's failure
to investigate should be considered only for the purposes of
demonstrating a lack of evidence surrounding the cause of Barber's
injuries and not as evidence of the hospital's negligence.
                                CONCLUSION
      We reverse the entry of the final summary judgment and remand
this matter for further proceedings, during which Barber may introduce
evidence of Manatee Memorial's failure to investigate how he sustained
bilateral hip fractures while he was being treated for a drug overdose at
Manatee Memorial.
      Reversed and remanded for further proceedings.

ROTHSTEIN-YOUAKIM and LABRIT, JJ., Concur.

Opinion subject to revision prior to official publication.

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