Res Ipsa in Medical Malpractice Case in Missouri: A New Rule

The Missouri Supreme Court ruled in Sides v. St. Anthony’s Medical Center, that plaintiffs in a medical malpractice case in Missouri may rely on an expert’s opinion that the injury would not have happened in the absence of the defendant’s negligence even without a specific proof of a negligent act.

Facts of Sides v. St. Anthony’s

The patient underwent a lumbar laminectomy with spinal fusion and was discharged three days later. Later on, she filed a lawsuit against both the surgeon and the hospital, alleging that she contracted an E. coli infection during the surgery.

Her medical malpractice lawsuit invoked a res ipsa loquitor theory against the defendants, asserting that infection at the surgical site, like the one she experienced, just does not happen in the absence of negligence.

The defendants sought dismissal, arguing that a medical malpractice claim cannot proceed solely under res ipsa loquitor and that the plaintiff needed to specify a particular negligence theory against the medical malpractice defendants.

Although the plaintiff acknowledged her inability to prove specific negligence, she contended that she should be allowed to rely on expert testimony to demonstrate the defendants’ negligence under res ipsa loquitor. The trial court dismissed the case and the plaintiff appealed.

Court’s Ruling

The court adopted the Restatement of Torts rule that if a medical malpractice plaintiff cannot demonstrate which specific act of negligence caused the injury but can demonstrate the potential causes are within the control of the doctor, and the injury would not occur in the absence of negligence, then a medical malpractice plaintiff has jumped over the motion to dismiss/summary judgment hurdle.

The defendant’s medical malpractice lawyer argued that Hasemeier v. Smith, 361 S.W.2d 697 (Mo. banc 1962), an OB/GYN medical malpractice case, was controlling. In that case, the court found that generally res ipsa loquitur is not applicable in medical malpractice cases. The Missouri Supreme Court did not overrule Hasemeier but it may as well have.

The Missouri high court’s ruling, in this case, is consistent with common sense and, as the court noted, the trend in many other states including Kentucky, Nebraska, and New York.

Res Ipsa in Missouri

In Missouri, the legal doctrine of “res ipsa loquitur” is recognized and can be applied in certain negligence cases. “Res ipsa loquitur” is a Latin phrase that translates to “the thing speaks for itself.” It is a legal doctrine that allows a plaintiff to establish a prima facie case of negligence based on circumstantial evidence when direct evidence of the defendant’s negligence is lacking.

So res ipsa is not a cause of action in itself. It is a legal principle primarily pertaining to evidence. This principle specifically enables a fact-finder to draw an inference of a defendant’s negligence, or more precisely, a defendant’s violation of a legally assigned duty of care, based on their circumstances and context.

In Missouri, for the doctrine of res ipsa loquitur to apply, the following elements must typically be met:

  1. The event causing the injury is of a type that does not ordinarily occur in the absence of negligence.
  2. The injury is caused by an instrumentality or condition that is within the defendant’s exclusive control.
  3. The injury did not result from any voluntary action or contribution by the plaintiff.

If these elements are satisfied, the doctrine allows the judge or jury to infer that the defendant was negligent based on the circumstances of the case. However, it’s important to note that the application of res ipsa loquitur does not guarantee a finding of negligence; it merely shifts the burden of proof to the defendant to provide an explanation for the injury.

Res ipsa loquitur is not limited to medical malpractice cases but can be applied in various types of negligence cases where the elements are met. Its application depends on the specific facts and circumstances of each case, and the court will determine whether the doctrine is applicable based on those facts.

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