explaining that, “[b]ecause the negligence of a physician encompasses matters not within the ordinary knowledge and experience of laypersons a medical malpractice plaintiff must present expert testimony to establish the applicable standard of care, the deviation from that standard, causation and the extent of the injury” (citation omitted)
How later courts described this case
- explaining that, “[b]ecause the negligence of a physician encompasses matters not within the ordinary knowledge and experience of laypersons a medical malpractice plaintiff must present expert testimony to establish the applicable standard of care, the deviation from that standard, causation and the extent of the injury” (citation omitted)
- stating that “[b]ecause the negligence of a physician encompasses matters not within the ordinary knowledge and experience, of laypersons a medical malpractice plaintiff must present expert testimony to establish the applicable standard of care, the deviation from that standard, causation and the extent of the injury.”
- stating that a plaintiff in a medical malpractice action must present expert testimony to establish the standard of care, breach of the standard, causation, and harm “[b]ecause the negligence of a physician encompasses matters not within the ordinary knowledge and experience of laypersons”
- finding, to prevail on medical malpractice claims, Plaintiffs must “establish a duty owed by the physician to the patient, a breach of that duty by the physician, that the breach was the proximate cause of the harm suffered, and the damages suffered were a direct result of the harm”
Written by the judges who cited it.
The opinion
Justice NIGRO
dissenting.
Under the doctrine of res ipsa loquitur as adopted by this Court, a medical malpractice plaintiff can proceed on a theory of negligence without expert testimony as to the standard of care or causation where:
(a) the event is of the kind which ordinarily does not occur in the absence of negligence;
(b) other responsible causes, including conduct of the plaintiff and third persons, are sufficiently eliminated by the evidence; and
(c) the indicated negligence is within the scope of the defendant’s duty to the plaintiff.
Hightower-Warren v. Silk, 548 Pa. 459 , 698 A.2d 52, 54 (1997) (citing Restatement (Second) of Torts § 328(D)(1965)). As I believe that these three requirements are satisfied in the instant case, I disagree with the majority’s conclusion that Toogood could not proceed in the absence of expert testimony regarding the standard of care.
*266 At trial, Toogood presented evidence that Dr. Stone had punctured his lung with a needle while giving him a routine nerve block injection in his back and that the puncture caused his lung to collapse. These facts, in my view, clearly satisfy the first prong of the res ipsa test because it is generally understood that in the absence of negligence, such an injection does not ordinarily puncture a lung and cause it to collapse. 1 See Killingsworth v. Poon, 167 Ga.App. 653 , 307 S.E.2d 123, 126 (1983) (“it is widely. known ... that a subcutaneous injection ostensibly given only for the relief of muscular pain should not, if administered correctly, result in the puncture of internal organs.”); see also Bardessono v. Michels, 3 Cal.3d 780 , 91 Cal.Rptr. 760 , 478 P.2d 480, 486-87 (1971) (“Needle injections of cold shots, penicillin, and many other serums have become commonplace today. Hardly a man, woman or child (even those of tender age) exists in this country who has not had injections of one kind or another. * * * So the giving and receiving of injections and the lack of nerve injury therefrom ordinarily has become a matter of common knowledge”) (alteration in original) (citation omitted). Moreover, I believe that the second prong of the res ipsa test is satisfied not only because there was no genuine dispute in this case that Dr. Stone was the individual who gave the injection, but also because Toogood presented specific expert testimony that the injection caused the collapsed lung. Finally, the third prong of the res ipsa test was plainly satisfied because, as this Court recognized in Hightower-Warren , it is “within the scope of [a physician’s] duty of care to protect his patient against preventable injuries which could reasonably occur during the performance of surgery,” and the same holds true for the medical procedure at issue here. 698 A.2d at 55 n. 7 (alterations in original) (citation omitted).
The majority nevertheless concludes that Toogood cannot proceed on a res ipsa loquitur theory, reasoning that laypersons cannot draw on their common knowledge to conclude that such events do not ordinarily occur .in the absence of negligence, because the injection “involved complex issues of anato *267 my, medical science, invasive procedures, and precision performance.” Op. at 263, 824 A.2d at 1150. Whether or not any such complexities actually exist, I do not agree that the fact that special skill and training may be required to perform a nerve block injection precludes the application of res ipsa loquitur on the facts of this case, where the needle punctured Toogood’s lung. Surely, a jury can draw on its common general knowledge to infer that a nerve block injection needle should never puncture the patient’s lung absent the doctor’s negligence. See Restatement (Second) of Torts § 328D cmt. e (“[I]t is enough that the facts proved reasonably permit the conclusion that negligence is the more probable explanation.”). Of course, the defendant remains free under the res ipsa loquitur doctrine to rebut the inference of negligence with its own evidence that such injections pose a greater risk of organ puncture than common perception suggests.
For the foregoing reasons, I dissent and would affirm the order of the Superior Court insofar as it permitted Toogood to proceed on a theory of res ipsa loquitur.
. The injection at issue in this case was the fourth such injection that Toogood had received in Dr. Stone’s office that very day.