Court: Massachusetts Appeals Court; March 9, 2007; Massachusetts; State Appellate Court
Jennifer Saunders, a 37-year-old patient of orthopedic surgeon John Ready, underwent a total hip replacement on May 16, 2001, and subsequently experienced acute sciatic pain and numbness in her right leg. She filed a medical malpractice lawsuit against Ready, his practice group, and the hospital, which was referred to a malpractice tribunal under G. L. c. 231. 60B. The tribunal concluded that her injury was merely an unfortunate medical result. Saunders did not post the required bonds, leading to a judgment of dismissal, though she appealed the decision.
To prevail in a malpractice tribunal, a plaintiff must establish that the defendant is a healthcare provider, failed to conform to good medical practice, and caused resultant damage. The key issues are whether Ready deviated from the standard of care and the causation of Saunders' injury. Saunders presented four letters from Dr. Richard S. Goodman, an unchallenged orthopedic expert, asserting that the sciatic nerve was undamaged prior to surgery, was visibly damaged post-operation, and that such damage is not an unavoidable risk in hip replacement procedures, indicating a deviation from standard care.
The defendants contended that Goodman's opinion lacked specificity regarding how Ready deviated from the standard of care and failed to directly link any action of Ready to Saunders' injury, rendering the claims speculative. The absence of any mention of sciatic nerve damage in the postoperative report further complicated Saunders' ability to prove negligence and causation. The tribunal noted that proving necessary elements in such cases often relies on reasonable inferences from the evidence presented.
Additionally, a res ipsa loquitur instruction can be warranted if a jury could reasonably conclude that the injury would not have occurred without the defendant's negligence, supported by expert testimony. However, evidence suggesting that the injury could have occurred through non-negligent means may justify a directed verdict for the defendants. The distinction between permissible inferences and impermissible speculation is nuanced and relies on the reasonableness of the inferences drawn.
Dr. Goodman's analysis suggests that negligence in the surgical operation cannot be dismissed as unreasonable. While his perspective may oversimplify the situation, it is deemed sufficient to advance past the tribunal stage. The dismissal of Saunders' claims against the defendants, dated December 13, 2004, is vacated, and the case is remanded to Superior Court to recognize that Saunders' proof raises valid questions of liability warranting judicial examination.
Dr. Goodman notes that a preoperative examination by Ready indicated no neurological vascular disorder prior to surgery. The total hip replacement procedure necessitates careful handling of the sciatic nerve, emphasizing that the surgeon must avoid stretching, cutting, or otherwise damaging it during the operation. Instruments used must not impact the nerve significantly, and the prosthesis should not cause secondary injury. Although Ready's operative report does not mention sciatic nerve damage, postoperative symptoms indicated complications such as sciatic neuropathy and complex regional pain syndrome. A follow-up report from Dr. Karli approximately fourteen months post-surgery confirmed persistent pain due to sciatic nerve injury. This evidence illustrates that the postoperative neuropathy was significant and likely permanent, thus indicating a deviation from the acceptable standard of care for orthopedic surgeons performing total hip replacements in the U.S. in 2001.
