New York Law Review

Tag: Foreign Object

  • James v. Wormuth, 24 N.Y.3d 530 (2014): Applicability of Res Ipsa Loquitur When a Doctor Intentionally Leaves a Foreign Object

    James v. Wormuth, 24 N.Y.3d 530 (2014)

    Res ipsa loquitur is inapplicable in a medical malpractice case where a doctor intentionally leaves a foreign object inside a patient, requiring the plaintiff to demonstrate a deviation from accepted medical standards through expert testimony.

    Summary

    Marguerite James sued Dr. David Wormuth for medical malpractice after he intentionally left a localization guide wire in her lung during a biopsy. After an initial unsuccessful search, the doctor determined it was safer to leave the wire than prolong the surgery. James later experienced pain and underwent a second surgery to remove the wire. At trial, James argued res ipsa loquitur applied, negating the need for expert testimony. The trial court granted a directed verdict for the defendant, which the Appellate Division affirmed. The New York Court of Appeals affirmed, holding that because the doctor’s action was intentional, the plaintiff needed to prove the doctor’s decision deviated from accepted medical practice, which required expert testimony that she did not provide. Res ipsa loquitur applies only when the object is unintentionally left.

    Facts

    In October 2004, during a lung biopsy performed by Dr. Wormuth, a guide wire dislodged. The doctor performed a 20-minute manual search, but could not locate the wire. Dr. Wormuth decided it was better to leave the wire to avoid extending the surgery time. He informed James post-surgery that he had left the wire. James returned complaining of pain that she attributed to the wire. About two months later, Dr. Wormuth performed a second operation using a C-arm X-ray machine and successfully removed the wire.

    Procedural History

    James filed a medical malpractice suit. At the close of the plaintiff’s case, the defendant moved for a directed verdict. The trial court granted the motion. The Appellate Division affirmed. James appealed to the New York Court of Appeals.

    Issue(s)

    Whether res ipsa loquitur applies when a doctor intentionally leaves a foreign object inside a patient’s body during surgery, thereby relieving the plaintiff of the burden to provide expert testimony demonstrating a deviation from the accepted standard of medical care.

    Holding

    No, because res ipsa loquitur is only applicable when a foreign object is unintentionally left in a patient; here, the doctor made an intentional decision, requiring the plaintiff to demonstrate that the decision deviated from accepted medical standards through expert testimony.

    Court’s Reasoning

    The Court of Appeals stated that normally, a medical malpractice claim requires proof that the doctor deviated from acceptable medical practice and that the deviation proximately caused the injury. The Court explained that res ipsa loquitur applies when the specific cause of an accident is unknown. To invoke res ipsa loquitur, a plaintiff must show that the event does not ordinarily occur without negligence, that the instrumentality was in the defendant’s exclusive control, and that the plaintiff did not contribute to the event. In foreign object cases, res ipsa loquitur applies only when the object is “unintentionally left in a patient following an operative procedure.” Here, the plaintiff’s case was based on the doctor’s intentional choice to leave the wire, as confirmed by her counsel. Because the doctor intentionally left the wire, the plaintiff was required to establish that the doctor’s judgment deviated from accepted community standards of practice, and that such deviation was a proximate cause of the plaintiffs injury. Dr. Wormuth claimed his decision was based on his professional judgment, testifying that it was riskier to continue the search. The Court stated that determining whether the doctor’s professional judgment was appropriate requires expert testimony. Since the plaintiff did not provide expert testimony, her complaint was properly dismissed. The court also found that plaintiff failed to establish exclusive control, as other medical personnel were involved in the process. The Court distinguished this case from those involving objects left unintentionally, where there is no decision to leave the object that must be measured against a standard of care. The Court concluded that the plaintiff failed to demonstrate a prima facie case of medical malpractice based on res ipsa loquitur or traditional negligence principles, noting, “As advantageous as the res ipsa loquitur inference is for a plaintiff unable to adduce direct evidence of negligence, application of the [evidentiary] doctrine does not relieve a plaintiff of the burden of proof.”

  • Flanagan v. Mount Eden General Hospital, 24 N.Y.2d 427 (1969): Statute of Limitations in Foreign Object Medical Malpractice

    Flanagan v. Mount Eden General Hospital, 24 N.Y.2d 427 (1969)

    In cases of medical malpractice involving a foreign object negligently left in a patient’s body, the statute of limitations begins to run when the patient could have reasonably discovered the malpractice.

    Summary

    Josephine Flanagan underwent gall bladder surgery at Mount Eden General Hospital in 1958. During the procedure, surgical clamps were left in her body. She experienced severe pain in 1966, and X-rays revealed the clamps. She sued the hospital and the surgeon’s estate for negligence. The defendants argued the statute of limitations had expired. The New York Court of Appeals reversed the lower courts, holding that in foreign object medical malpractice cases, the statute of limitations begins to run when the patient could reasonably discover the malpractice, not from the date of the negligent act.

    Facts

    In June 1958, Josephine Flanagan was treated by Dr. Max Eisenstat for a gall bladder ailment.

    Dr. Eisenstat determined surgery was necessary, and Flanagan entered Mount Eden General Hospital.

    On July 14, 1958, the surgery was performed, and surgical clamps were negligently left inside Flanagan’s body.

    In the spring of 1966, Flanagan experienced severe abdominal pain and consulted a doctor.

    On June 3, 1966, X-rays revealed the presence of surgical clamps in her abdomen.

    On June 10, 1966, another surgery was performed to remove the clamps.

    Procedural History

    Flanagan sued Mount Eden General Hospital and Dr. Eisenstat’s estate on October 20, 1966 and November 2, 1966, respectively, alleging negligence.

    Both defendants moved to dismiss, arguing the statute of limitations had expired.

    Special Term granted the motions to dismiss.

    The Appellate Division affirmed.

    The New York Court of Appeals granted leave to appeal.

    Issue(s)

    Whether, in a foreign object medical malpractice case, the statute of limitations begins to run from the date of the negligent act or when the patient could have reasonably discovered the malpractice.

    Holding

    Yes, in cases where a foreign object has been negligently left in a patient’s body, the statute of limitations does not begin to run until the patient could have reasonably discovered the malpractice because the traditional rule places an undue strain upon common sense, logic, and simple justice when an object is unknowingly left in the patient’s body.

    Court’s Reasoning

    The Court reasoned that the purpose of statutes of limitations is to protect defendants from defending stale claims after a reasonable time has elapsed, embodying a policy of repose.

    The Court distinguished this case from previous rulings, such as Schwartz v. Hayden Newport Chem. Co., noting a fundamental difference between negligent medical treatment/medication cases and those involving foreign objects left in a patient’s body.

    The Court stated that in foreign object cases, the risk of fraudulent claims is minimal, and there is a direct causal link between the negligence and the injury.

    The Court emphasized that a clamp retains its identity even after a long period, meaning a defendant’s ability to defend a “stale” claim is not unduly impaired. As the court quoted, “It simply places an undue strain upon common sense, reality, logic and simple justice to say that a cause of action had `accrued’ to the plaintiff until the X-ray examination disclosed a foreign object within her abdomen and until she had reasonable basis for believing or reasonable means of ascertaining that the foreign object was within her abdomen as a consequence of the [operation]” (Morgan v. Grace Hosp., 149 W. Va. 783, 792).

    The Court acknowledged the division among jurisdictions but found the discovery rule more equitable and consistent with the purpose of the statute of limitations.

    The Court dismissed the argument that the legislature’s failure to pass bills amending the statute indicated a legislative intent to freeze the existing interpretation, stating that legislative inaction is a weak reed upon which to lean.

    The Court asserted its authority to adjust court-made rules when justice demands it, citing precedents like Woods v. Lancet and Greenberg v. Lorenz.

    The dissenting opinion argued that the court was overstepping its bounds by altering a statutory rule, especially given the legislature’s repeated consideration of the issue. The dissent argued that the statute of limitations should run from the commission of the wrong, noting that while a discovery rule might be preferable, it is a matter for the legislature to decide. The dissent also emphasized the importance of stare decisis and the court’s recent adherence to the existing rule in Schwartz v. Heyden Chem. Corp.. The dissent noted that the existence of express statutory provisions for a discovery rule in fraud actions indicates a deliberate legislative choice not to extend such exceptions to malpractice cases.