Grubb v. Jurgens

Citations: 58 Ill. App. 3d 163; 373 N.E.2d 1082; 15 Ill. Dec. 610; 1978 Ill. App. LEXIS 2271Docket: No. 14332

Court: Appellate Court of Illinois; March 17, 1978; Illinois; State Appellate Court

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Plaintiff John R. Grubb filed a negligence lawsuit against oral surgeon Emmett H. Jurgens, seeking damages for injuries from a tooth extraction. The trial court granted a directed verdict for Jurgens on the failure-to-warn claim, and the jury found in favor of Jurgens on the res ipsa loquitur claim. Grubb appealed, arguing that the directed verdict was incorrect and that the jury received improper instructions.

During trial, Grubb testified that after his dentist recommended the extraction of his lower left wisdom tooth, he scheduled the procedure with Jurgens on May 16, 1973. Initially requesting local anesthesia, he opted for general anesthesia based on Jurgens' advice. Five days post-extraction, Grubb returned with severe jaw pain and was treated for a dry socket. He later reported persistent pain and numbness in his lip, face, and tongue to Jurgens' brother, Dr. Paul Jurgens, who suggested the sensation might return or might not.

Grubb sought help from multiple medical professionals, including his dentist, personal physician, psychiatrist, neurologist, and another oral surgeon, but found no relief. He experienced episodes of tongue-biting, corroborated by family members, and suffered from chronic depressive neurosis, for which he received psychiatric treatment. In November 1974, Dr. James C. Wellman, an oral surgery specialist, found that Grubb had no sensation on the left side of his tongue, attributing the numbness and burning pain to potential injury to the lingual nerve, though he could not determine the cause related to the extraction's execution.

Wellman's critical testimony indicated that a surgeon would typically not warn a patient of nerve injury risks for an erupted tooth unless there was significant twisting of the roots. He stated that while lingual nerve injury is uncommon with careful extraction, it could occur regardless of care; however, negligence would increase the likelihood. Jurgens' defense included testimonies from an oral surgeon and a neurologist who found no objective abnormalities in Grubb's condition.

Defendant described the tooth extraction procedure, stating he first attempted to use forceps, which resulted in a fractured crown. He then made an incision to remove the tooth fragments, noting that the roots were bifurcated, with one curving backward. He indicated that the procedure was routine and performed carefully, and clinical records showed he informed plaintiff of the risk of a numb lip. Plaintiff's complaint alleged that defendant caused damage to the left lingual nerve during the extraction, arguing that such injury was not a typical risk of the procedure. Alternatively, if it was a typical risk, plaintiff claimed defendant negligently failed to warn about it. At the close of plaintiff's case, the defendant sought a directed verdict, and plaintiff's attorney conceded that there was insufficient evidence to support the failure-to-warn claim, leading the court to grant the directed verdict for that count. However, the court did not grant a directed verdict on the res ipsa loquitur count, and the jury ultimately found in favor of the defendant. Plaintiff appealed, claiming the trial court erred in directing a verdict on the failure-to-warn issue, but the court noted that the attorney's admission of insufficient evidence bound the plaintiff to that position. Additionally, plaintiff challenged the inclusion of defendant’s instruction No. 3, which defined the standard of care for dentists, arguing it was inconsistent with the instruction on res ipsa loquitur, which allowed for an inference of negligence if certain conditions were met.

Determining whether the defendant met the legal standard of knowledge, skill, and care must rely solely on evidence from expert witnesses in the trial, specifically dentists. Personal knowledge should not be used to make this determination. Although a specific instruction from the defendant was inconsistent with the doctrine of res ipsa loquitur, any error was considered harmless because the plaintiff did not provide evidence that the injury would not have occurred with ordinary care. Dr. Wellman, the sole witness on this crucial element, confirmed that such injuries can happen even with proper care.

The doctrine of res ipsa loquitur allows for the inference of negligence through circumstantial evidence when direct evidence is primarily under the control of the defendant. This was established in Metz v. Central Illinois Electric, Gas Co., which states that if an injury-causing object was under the defendant's control and the injury would not ordinarily occur without negligence, the accident suggests negligence unless the defendant provides an explanation. 

In medical malpractice cases, as outlined in Edgar County Bank, Trust Co. v. Paris Hospital, Inc., the plaintiff must show proximate cause through direct evidence, while expert testimony is generally required to prove negligence unless the physician's negligence is grossly apparent. Walski v. Tiesenga reinforces that expert testimony is necessary unless the negligence is so obvious that a layperson could recognize it. The Walker v. Rumer case further clarifies that res ipsa loquitur can apply in any medical malpractice situation where it is shown that an injury would not occur with proper care, protecting defendants from liability in cases of mere poor outcomes that do not imply negligence. Defendants may seek summary judgment or directed verdicts based on this doctrine to avoid being held liable for unfavorable results alone.

A jury must rely on concrete evidence to establish causation and cannot speculate on the matter. Liability requires the plaintiff to prove that the defendant's actions caused the harm. Expert testimony that merely suggests a probable connection between conduct and harm does not satisfy this requirement. In the case discussed, Dr. Wellman's assertion that an injury was more likely due to negligence was inadequate as evidence of proximate cause, particularly in light of other trial evidence. Dr. Wellman acknowledged multiple possible causes for the injury and indicated that it could occur even with careful surgical practices. Consequently, the motion for directed verdict regarding the res ipsa loquitur claim should have been granted, and the erroneous jury instruction does not warrant reversal. The judgment of the circuit court of Macon County is affirmed, with concurrence from P.J. Alloy and J. Stouder.