The Court of Appeals of Indiana (“Indiana Appellate Court”) held in its September 14, 2018 opinion that the res ipsa loquitur doctrine does not apply in a medical malpractice case when the injury that occurs is a known complication of surgery or a medical procedure that can occur even if a physician exercises due care.
Res Ipsa Loquitur
The doctrine of res ipsa loquitur is a rule of evidence which allows an inference of negligence to be drawn from certain surrounding facts. The plaintiff’s evidence must include the underlying elements of res ipsa loquitur, showing that: (1) the injuring instrumentality is under the management or exclusive control of the defendant or his servants and (2) the accident is such as in the ordinary course of things does not happen if those who have management of the injuring instrumentality use proper care.
In the case the Indiana Appellate Court was deciding, the plaintiff underwent a cementless total hip replacement of her right hip at the defendant hospital. The hospital administered a spinal epidural to the plaintiff during the surgery, and she had no feeling or sensation from the waist down. After her surgery, the plaintiff was moved to her hospital room where a nurse and patient care assistant rolled the plaintiff onto her side to give them access to remove the epidural. As they did so, the plaintiff heard three audible pops near her right knee.
Because the plaintiff’s lower body was still numb from the effects of the epidural, she did not experience any pain at the time she heard the popping sounds. After the effects of the epidural wore off, the plaintiff was in severe pain that would not subside. A subsequent x-ray revealed that the plaintiff had a three-part displaced fracture of her right femur. There had been no visible fracture on the x-rays taken immediately after the plaintiff’s surgery. Therefore, the plaintiff’s surgeon later opined that the fracture occurred at some point after she was transferred to her hospital room for recovery.
The plaintiff alleged in her Indiana medical malpractice claim that her injuries were a result of negligent care rendered by the defendant hospital, and that but for this negligence, she would not have suffered the fracture to her femur. The plaintiff relied on the doctrine of res ipsa loquitur to support her claim.
The Indiana Appellate Court stated that to determine if the res ipsa loquitur doctrine applies, the question is whether the incident more probably resulted from the defendant’s negligence than from another cause (the plaintiff may show, by common knowledge or expert testimony, that the injury is one that would not ordinarily occur in the absence of due care on the part of those controlling the instrumentality).
However, the res ipsa loquitur doctrine does not apply when the injury that occurs is a known complication of surgery or a medical procedure that can occur even if a physician exercises due care.
The Indiana Appellate Court stated that risks and complications associated with cementless hip replacement surgery are not commonly known to lay people and that expert testimony is required to establish the applicable standard of care, breach of that standard and proximate cause. The Indiana Appellate Court held that because the defendant hospital presented expert testimony that the fracture was a known complication of cementless hip replacement surgery which can occur even if the hospital exercised due care, “we conclude that the doctrine of res ipsa loquitur cannot be applied in this case.”
Source Glon v. Memorial Hospital of West Bend, Inc., Opinion 18A-CT-49.
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