Koehler v. Schwartz, 48 N.Y.2d 807 (1979)

In medical malpractice cases, a plaintiff must establish that the defendant’s deviation from accepted medical practice was a cause-in-fact of the plaintiff’s injuries; mere deviation from a physician’s routine practice, without proof that the deviation caused or enhanced the possibility of the unsuccessful outcome, is insufficient to establish liability.

Summary

Mary Koehler sued Dr. Schwartz for malpractice after he unsuccessfully attempted to abort her pregnancy. Koehler argued that Dr. Schwartz deviated from standard practice by failing to use a sharp curette after applying a suction device, or by delaying informing her that the abortion was unsuccessful. The Court of Appeals reversed the jury verdict for the plaintiffs, holding that the plaintiffs failed to demonstrate that the defendant’s actions were the cause-in-fact of the unsuccessful abortion or of any claimed emotional injuries. The court emphasized that expert testimony was needed to establish causation, and that evidence presented did not show the alleged deviations contributed to the failed abortion.

Facts

Defendant, Dr. Schwartz, attempted to perform an abortion on plaintiff, Mary Koehler. The abortion was unsuccessful. Plaintiff claimed Dr. Schwartz was negligent in two ways: (1) by not using a sharp curette following the suction device and (2) by delaying notification that the abortion had failed. Plaintiff alleged that this negligence caused her extensive emotional and psychic injuries. Defense experts testified that either the suction method or the sharp curette were acceptable and customary practices, and that both procedures were not required.

Procedural History

The case was tried before a jury, which returned a verdict for the plaintiffs. The Appellate Division reversed the jury’s verdict, finding insufficient evidence to support the claim of medical malpractice. The plaintiffs appealed to the New York Court of Appeals.

Issue(s)

1. Whether the defendant’s failure to use a sharp curette following a suction device, in attempting to perform an abortion, can be considered medical malpractice when there is no expert testimony demonstrating that this omission caused the unsuccessful abortion.

2. Whether the defendant’s delay in notifying the plaintiff of the unsuccessful abortion was an independent cause of the plaintiff’s emotional and psychic injuries.

Holding

1. No, because there was no evidence establishing that the omission of the sharp curette caused or enhanced the possibility of an unsuccessful abortion; expert testimony was required to establish the causal link, which was absent in this case.

2. No, because the delay in notification was not shown to be an independent cause of any of the plaintiff’s injuries or damages, including emotional and psychic damages; a conclusion that earlier notification would have changed the outcome would be based on speculation.

Court’s Reasoning

The court reasoned that while the defendant may have routinely followed procedures exceeding customary practice, the failure to adhere to these added precautions only amounts to negligence if it caused or enhanced the possibility of the unsuccessful abortion. The court emphasized that expert testimony was needed to establish causation, stating, “Whether and to what extent use of a sharp curette might contribute to the success of the procedure is not a matter of common knowledge which a lay jury could decide in the absence of expert testimony.” The court noted that the defendant’s own testimony indicated the curette was used to minimize post-operative complications, not to facilitate the procedure itself. Therefore, the plaintiffs failed to demonstrate that the failure to use a sharp curette was a cause-in-fact of the unsuccessful abortion.

Regarding the delayed notification, the court found that while it might have exacerbated damages, it was not an independent cause of injury. The court reasoned that finding the delay as the cause of emotional distress would be speculative, especially given the plaintiff’s testimony that she could not have endured a second abortion. The court concludes, “plaintiff simply has not established that her injuries resulted from anything other than the failure of the abortion, regardless of when she received notification.”