Court Opinion

ID: 9657794
Source: CourtListenerOpinion
Date Created: 2023-08-23 20:38:17.805823+00
Date Added: 2024-06-11T18:13:48.519083
License: Public Domain

*651HARRIS, Justice
(dissenting).
Because I disagree with both majority holdings, I respectfully dissent. I believe the trial court acted within its broad discretion in striking Dr. Socarras’ testimony. I also think the res ipsa loquitur claim was correctly dismissed because defendants were not shown to be in exclusive control.
I. Socarras testimony. Before acting on the motion to dismiss the claims against Henderson and MAA, the trial court considered defendants’ motion to strike the testimony of Dr. Socarras that nurse anesthetists and anesthesiologists have a duty to monitor the position of a patient’s arm while the patient is under anesthesia. This testimony was of course crucial to plaintiff’s specific negligence claim against Henderson and MAA. According to Socar-ras this duty includes making sure no improper pressure is placed on a patient’s arm. This opinion was struck because the trial court concluded Socarras was not qualified to offer it.
I think the ruling should be affirmed under common law standards for admitting expert testimony. Under a de novo review, perhaps even under a review on error, I might agree with the majority in favoring admission. But we should pay more than lip service to the stated scope of review.
Our cases are legion that hold the standard for admissibility of expert testimony is discretionary; we have said we do not reverse in the absence of “manifest abuse of that discretion.” Among cases reciting this familiar principle is the one cited by the majority, DeBurkarte v. Louvar, 393 N.W.2d 131, 138 (Iowa 1986).
Socarras gave only these qualifications for stating the standard of care to which an anesthesiologist or nurse anesthetist must adhere: (1) his training in medical school; (2) his internship; (3) his reading on how damage to the ulnar nerve occurs; and (4) some procedures involving anesthesia he observed. The trial court observed that, after the doctor’s medical education in Cuba, “the record does not reflect any substantial experience, education or training for the past thirty years in surgery or anesthesiology or the relationship between the two sufficient to qualify him to render the opinions.
I cannot find manifest abuse in the ruling. Although Socarras did show extensive training and experience in neurology, he had little training in anesthesiology, except for the exposure which occurred during medical school in Cuba, and during his internship. His experience in anesthesia in the decades since then was limited to what he observed from his own capacity in operating rooms. Although he claimed he continued to educate himself in the field of anesthesiology, his testimony revealed only that he has studied the sources of damage to nerves, including damage to nerves during surgery.
Socarras did not testify that these sources contained any reference to the standard of care owed by an anesthesiologist or anesthetist. Neither did Socar-ras testify that, after the thirty years since his internship, he had taken the time to review the current standards applicable to anesthesiologists or anesthetists. It seems clear to me that the trial court did not abuse its discretion in finding he provided no substantial basis for his claim that he knew the standard of care for anesthesiologists or anesthetists.
Without the Socarras testimony there was insufficient evidence to support a jury case against Henderson or MAA on any theory of specific negligence.
II. Res ipsa loquitur. The res ipsa loquitur claim must fall in the absence of either required element. The plaintiff must prove two foundational facts in order to invoke the doctrine of res ipsa loquitur: (1) the defendants had exclusive control and management of the instrument that caused plaintiff’s injury; and (2) it was the type of injury that ordinarily would not occur if reasonable care had been used. Welte v. Bello, 482 N.W.2d 437, 439 (Iowa 1992); Tappe v. Iowa Methodist Medical Ctr., 477 N.W.2d 396, 399 (Iowa 1991).
Because the doctrine allows an inference of negligence without specific proof, we have been cautious with the doctrine’s requirements before applying it, especially in *652medical malpractice cases. Tappe, 477 N.W.2d at 399-400 (“Because the doctrine creates an inference of negligence without specific proof, it traditionally has been applied sparingly, especially in medical malpractice cases.”).
It is apparent from our recent opinions on the subject that this stated reluctance to apply the res ipsa doctrine in medical malpractice cases does not enjoy our unanimous endorsement. But, although we encounter obvious difficulty in reaching a consensus, I think the reluctance is grounded in sound public policy. The reluctance proceeds from a recognition that fundamental physical conditions and reactions of patients, even those of tragic dimensions, are often beyond the control of any physician. Morgensen v. Hicks, 253 Iowa 139, 143, 110 N.W.2d 563, 565-66 (1961) (cited in Tappe, 477 N.W,2d at 400). To say that res ipsa should be applied with reluctance in medical malpractice cases means it should not be applied in close cases. This is a close case.
I think the directed verdicts should be affirmed because the plaintiff did not establish exclusive control on the part of any defendants. This is because of the other medical personnel present in the operating room who were not named as defendants (the surgeon and the assistants). Wick’s own expert testified it was just as likely that Wick’s injury was caused by one of these other persons as it was by any failing on the part of the nurse anesthetist, Jim Byrk. The rule has been explained:
If it appears that the [injury] was, or might have been, in part due to the act of a third person over whom the defendant had no control, the doctrine is not applicable.
57B Am.Jur.2d Negligence § 1876, at 543 (1989). See also Annotation, Medical Malpractice: Res Ipsa Loquitur in Negligent Anesthesia Cases, 49 A.L.R.4th 63, 192 § 68 (1986). The majority claims the exclusive element was met on the basis of Byrk’s duty to monitor. As previously mentioned, I would affirm the trial court ruling striking the testimony of Dr. Socar-ras that Byrk had such a duty.
The trial court correctly reasoned that, because people other than defendants might well have caused Wick’s injury, the element of exclusive control was not met.
I would affirm.