Anderson v. Somberg
Anderson v. Somberg
Dissenting Opinion
dissenting. This Court has reached an extraordinary result in a very remarkable way. As I shall hope to make clear, the structure of argument as presented
During the course of the Court’s opinion there appear statements to the effect that all those who might have been in any way responsible for plaintiff’s injury are before the court.
And yet we know — and everyone who has been associated with this case has always known — that this assumption is not in fact true. The only four defendants in the case are: the surgeon, Dr. Harold Somberg, who performed the operation; St. James Hospital, the medical facility in which the operation took place; Lawton Instrument Co., which manufactured the rongeur; and Rheinhold-Schumann, Inc., the distributor which sold it to the hospital. There is no other defendant in the case. And yet the record is replete with testimony that other surgeons — perhaps as many as twenty — have used the rongeur during the four years that it has formed part of the surgical equipment of the hospital, and that any one or more of them may perfectly well have been responsible for so injuring the instrument that it came apart while being manipulated in plain
I of course agree with the Court that it is most unfortunate that this plaintiff should go uncompensated. Every humanitarian instinct impels the hope that when an unconscious patient is injured in some unforeseen and unforeseeable way, due reparation will be forthcoming. It is to the manner in which the Court would seek to fulfill this hope that I object.
As the opinion of the Court has been careful to point out, (P. 305), plaintiff’s claims against the surgeon, Dr. Somberg, and against the hospital sound in negligence;
The opinion takes the view that at this point the burden
But certainly no farther. At this point the effect to be given a shift in the burden of proof becomes the crucial issue. The authorities which have adopted or espoused the view that res ipsa, shifts the burden of proof have, as far as I can discover, understood this to mean that upon such a shift taking place, a defendant becomes obliged to offer evidence explaining his own conduct or throwing light upon the circumstances attending plaintiff’s injury, which will be of sufficient probative force to establish his lack of fault by a preponderance of the evidence. The fact finder will then be called upon to decide whether the defendant’s proofs have met this test or whether they have fallen short.
Note, first, the role the jury is being called upon to play. The judge will give to the jury two potentially contradictory instructions. Eirst the jurors will be told to arrive at a verdict by a preponderance of the evidence, each defendant having the burden of exculpating himself. Then a further direction will be given that they must bring in a verdict against some one or more of the defendants. But suppose the members of the jury cannot agree that the evidence will sustain a verdict against any defendant. What then! Each juror has taken an oath — no small matter — to reach a verdict only “according to the evidence.”
What is to be the posture of the judge if he is thereafter called upon to rule upon a motion for judgment notwith
Consider further the hypothesis last suggested, that a jury does undertake, despite a failure of adequate proof, to carry out the mandate of this instruction. How is a verdict to be reached? The absence of sufficient evidence upon which a verdict might justly rest, coupled with the compulsion to reach a verdict against someone, removes from the case any semblance of rationality. It then becomes a mere game of chance. There being no rational guide, each jury may proceed as the whimsy of the moment dictates. Thus we have trial by lot, or by chance — no more a rational process than were trial by ordeal or trial by combat. And yet it is the very essence of the judicial process that a determination reached by a court shall be the result of a rational study and analysis of applicable fact and law.
It is, of course, generally accepted as axiomatic in a society dedicated to tbe values of individualism, that no person shall be made to answer for an event, unless his responsibility for it has been convincingly proved by due process of law. [Fleming, Developments in the English Law of Medical Liability, 12 Vand. L. Rev. 633, 646 (1959)]
Finally it may be asked whether a trial such as is here projected may in any true sense be termed either a trial by jury or an exercise of the judicial process, as those concepts are generally understood.
I would vote to reverse the judgment of the Appellate Division and to reinstate the judgment of the trial court.
Clifford, J., and Judge Collester join in this dissenting opinion.
For affirmance — Chief Justice Hughes, and Justices Jacobs, Sullivan and Pashman — 4.
For reversal — Justices Mountain and Clifford, and Judge Collester — 3.
“. . . plaintiff sued all who might have been liable for his injury . . .” (P. 295). “Since all parties had been joined who could reasonably have been connected with that negligence or defect, it was clear that one of those parties was liable . . .” (P. 303).
There was uncontradicted testimony that the rongeur had been purchased by the hospital about four years before the date of plaintiff’s operation, [T 2.70], and that during that span of time it had been used about twenty times in the performance of operations. [T 2.65-66; p. 296]
On the cross-examination of Dr. David J. Graubard, plaintiff’s medical expert, the following occurred:
Q Well, Doctor, suppose — assume, if you would, that on a prior occasion the rongeur had been used improperly, exerting too much force and the cup had been bent by a surgeon who just happened to have — who just happened to be on the hospital staff, had privileges at the hospital and the doctor straightened it, would that weaken the instrument?
A Yes.
Q And that could at a later date cause it to break, isn’t that correct?
A Yes, sir. [T 2.139]
During the interrogation of John Carroll, an expert in metallurgy called by defendant, Lawton Instrument Co., the following colloquies took place:
Q Do you think it [the rongeur] was overstrained, though, in its use?
A. At some point during its use. I couldn’t say specifically when. [T 4.34]
Q Now, you said, I believe, that at some point in the use it [the rongeur] was over-strained?
A Yes, sir.
Q Now, what did you mean by that?
A I meant that, to use a technical term, it was loaded beyond the yield point. And the yield point of a material is a load at which it loses elasticity, does not return to the original shape.
Q But you can handle over-straining without simultaneous fracture, can’t you?
A Any time you bend anything you strain it.
Q And if you bend it sufficiently enough during the course of its use at some point in time it’s going to break because it’s far over-strained above the point of its ability to take a pressure or load?
A In the sense that over-straining means weakening.
Q Bight. So that it is possible for an instrument such as a pituitary rongeur to be weakened through use over a period of time and at a final point in time break?
A Yes, sir. [T 4.43]
*308 Q So then you found, Mr. Carroll, that it had been stressed?
A Yes, sir.
Q Beyond it’s ability to tolerate, is that correct?
A That’s correct, sir.
Q Stressed over a period of time perhaps, probably?
A I couldn’t answer that as to time, sir. It could have happened during the course of one operation or many operations.
Q You know it was stressed beyond its ability to tolerate that stress?
A Yes, sir.
Q In its use? A. Yes.
Q The point of time you can’t pinpoint?
A I cannot. [T 4.50]
Not presented for consideration under the pleadings and not touched upon by the parties or any of the courts before which this case has come is the issue of whether a hospital at its peril puts into the hands of a surgeon a defective instrument, such as everyone seems to agree was the condition of the rongeur here, no matter how that defect came about. The state of the law in New Jersey thus remains open as to whether strict liability in tort might be available against the hospital here, see generally Johnson v. Sears, Roebuck & Co., 355 F. Supp. 1065 (E. D. Wis. 1973) ; Note, Torts — Strict Liability — Hospitals May. be Strictly Liable for Administrative Services, 41 Tenn. L. Rev. 392 (1974) ; cf. Magrine v. Spector, 100
It has hitherto been the generally accepted rule that the doctrine of res ipsa loquitur has no application to cases involving alleged breach of warranty. “The doctrine of res ipsa loquitur relates to cases involving negligence and has no application to an alleged breach of warranty.” Trust v. Arden Farms Co., 50 Cal. 2d 217, 324 P. 2d 583, 586 (1958). Nevertheless the manner in which inferences of defective manufacture may be drawn from factual circumstances in breach of warranty or strict tort liability cases is not very different from the way in which inferences of negligence may be drawn where res ipsa loquitur properly applies. “The doctrine of res ipsa loquitur, frequently resorted to in negligence cases, is not applicable as such in the field of warranty, although the usual resort to circumstantial evidence in attempting to establish a breach of warranty indicates some of the same thinking found in res ipsa loquitur cases.” State Farm Mut. Auto Ins. Co. v. Anderson-Weber Inc., 252 Iowa 1289, 110 N. W. 2d 449, 452 (1961). This similarity was noted by this Court in Corbin v. Camden Coca-Cola Bottling Co., 60 N. J. 425, 436 (1972), holding that a res ipsa charge in a products liability case resting upon strict tort liability would not, at least in that case, be deemed reversible error.
Apparently, as to a shift in burden of proof, no distinction is to be drawn between those defendants charged with negligence and those against whom breach of warranty is asserted. While, as I concede immediately below, a rule shifting the burden of proof may perhaps he justified here as to the negligence charges, it certainly should never, either here or elsewhere, pertain to products liability claims.
To petit jurors in New Jersey there is administered the following oath:
You do swear in the presence of Almighty God that you will well and truly try the matter in dispute between ............, plaintiff and ............. defendant, and a true verdict give according to the evidence. [N. J. S. A. 2A:74-6; emphasis supplied]
Justice (now Chief Judge) Breitel has expressed the point well:
The primary internal characteristic of the judicial process is that it is a rational one. The judicial process is based on reasoning and presupposes — all antirationalists to the contrary notwithstanding — that its determinations are justified only when explained or explainable in reason. No poll, no majority vote of the affected, no rule of expediency, and certainly no confessedly subjective or idiosyncratic view justifies a judicial determination.
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The rational judicial process is not permitted to rove generally over the scene of human affairs. Instead, it must be used, on pain of violating the proprieties, within the framework of a highly disciplined special system of legal rules characteristic of the legal order. No principle of the moral order or any other by itself may demand recognition in the judicial process of dispute determination except as it is incorporated or can be incorporated into the system of legal rules. [Breitel, The Lawmakers, 65 Colum. L. Rev. 749, 772-3 (1965)]
Opinion of the Court
The opinion of the Court was delivered by
These negligence-products liability actions had their inception in a surgery performed in 1967 on the premises of defendant St. James Hospital (Hospital). Plaintiff was undergoing a laminectomy, a back operation, performed by defendant Dr. Somberg. During the course of the procedure, the tip or cup of an angulated pituitary rongeur, a forceps-like instrument, broke off while the tool was being manipulated in plaintiff’s spinal canal. The surgeon attempted to retrieve the metal but was unable to do so. After repeated failure in that attempt, he terminated the operation. The imbedded fragment caused medical complications and further surgical interventions were required. Plaintiff
Plaintiff sued: (1) Dr. Somberg for medical malpractice, alleging that the doctor’s negligent action caused the rongeur to break: (2) St. James Hospital, alleging that-it negligently furnished Dr. Somberg with a defective surgical instrument; (3) Reinhold-Schumann, Inc. (Reinhold), the medical supply distributor which furnished the defective rongeur to the hospital, on a warranty theory, and (4) Lawton Instrument Company (Lawton), the manufacturer of the rongeur, on a strict liability in tort claim, alleging that the rongeur was a defective product. In short, plaintiff sued all who might have been liable for his injury, absent some alternative explanation such as contributory negligence.
Dr. Somberg testified that he had not examined the rongeur prior to the day of surgery. He inspected it visually when the nurse handed it to him during the operation, and manipulated its handles to make certain it was functional. The doctor stated that he did not twist the instrument, and claimed that the manner in which the instrument was inserted in plaintiff’s body precluded the possibility of twisting. He noted the absence of one of the rongeur’s cups when he withdrew the instrument from plaintiff’s spinal canal, but his efforts to retrieve the fragment proved of no avail.
Dr. Graubard, a general surgeon, testified as an expert witness for plaintiff. He stated that the rongeur was a delicate instrument, a tool not to be “used incorrectly or with excessive force or to be used against hard substances.” He claimed that a twisting of the instrument might cause it to break at the cups. Dr. Graubard stated that a “rongeur used properly and not defective would not break.”
The deposition of the operating room supervisor of defendant hospital, Sister Carmen Joseph, was read into the record. She was responsible for visually examining and
The hospital’s purchasing agent testified that the rongeur had been purchased from the distributor, Reinhold, about four years prior to plaintiff’s surgery and was received in a box bearing the name of the manufacturer, Law-ton. The owner of Reinhold testified that the rongeur was not a stock item and had to be specially ordered from Law-ton upon receipt of the hospital purchase order. The box was opened at Reinhold’s warehouse, to verify that it was a rongeur and it was then forwarded to the hospital.
Defendant Lawton called a metallurgist, a Mr. John Carroll, as an expert witness. He testified that an examination of the broken rongeur revealed neither structural defect nor faulty workmanship. He said that the examination (conducted at an optical magnification 500 times normal size) revealed a secondary crack near the main crack but he could not suggest how or when that crack formed. Mr. Carroll offered an opinion as to the cause of the instrument’s breaking: the instrument had been strained, he said, probably because of an improper "twisting” of the tool. The strain, however, could have been cumulative, over the course of several operations, and the instrument could conceivably have been cracked when handed to Dr. Somberg and broken in its normal use.
In short, when all the evidence had been presented, no theory for the cause of the rongeur’s breaking was within reasonable contemplation save for the possible negligence of Dr. Somberg in using the instrument, or the possibility that the surgeon had been given a defective instrument, which defect would be attributable to a dereliction of duty by the manufacturer, the distributor, the hospital or all of them.
First, we note that the suggestion in the concurring opinion that the case be sent back on “strengthened” instructions is little more than a pretext for giving plaintiff a second chance before a jury. FTeither in the Appellate Division nor before this Court has it been alleged, let alone demonstrated, that the charge did not comport with the standard charge for a “strong” prima facie case made out by res ipsa loquitur (thought to be appropriate here). Indeed, the trial judge very adequately explained to the jury that plaintiff, given all favorable inferences, could be said to have proved his case.
In the ordinary case, the law will not assist an innocent plaintiff at the expense of an innocent defendant. However, in the type of case we consider here, where an unconscious or helpless patient suffers an admitted mishap not reasonably foreseeable and unrelated to the scope of the surgery (such as eases where foreign objects are left in the body of the patient), those who had custody of the patient, and who owed him a duty of care as to medical treatment, or not to furnish a defective instrument for use in such treatment can be called to account for their default. They must prove their nonculpability, or else risk liability for the injuries suffered.
This case resembles the ordinary medical malpractice foreign-objects case, where the patient is sewn up with a surgical tool or sponge inside him. In those cases, res ipsa loquitur is used to make out a prima facie case. Martin v. Perth Amboy General Hospital, 104 N. J. Super. 335, 342 (App. Div. 1969); Gould v. Winokur, 98 N. J. Super. 554 (Law Div. 1968), aff’d 104 N. J. Super. 329 (App. Div.
The rule of evidence we set forth does not represent the doctrine of res ipsa loquitur as it has been traditionally understood. Bes ipsa loquitur is ordinarily impressed only where the injury more probably than not has resulted from negligence of the defendant, Germann v. Matriss, 55 N. J. 193 (1970), and defendant was in exclusive control of the instrument. Magner v. Beth Israel Hospital, 120 N. J. Super. 529 (App. Div. 1972), certif. den. 62 N. J. 199 (1973); Rose v. Port of New York Authority, 61 N. J. 129 (1972). The doctrine has been expanded to include, as in the instant matter, multiple defendants, Jackson v. Magnavox Corp., 116 N. J. Super. 1, 17 (App. Div. 1971) ; Ybarra v. Spangard, 25 Cal. 2d 486, 154 P. 2d 687 (Sup. Ct. 1948), although even this expansion has been criticized, see Adamson, “Medical Malpractice: Misuse of Ees Ipsa Loquitur,” 46 Minn. L. Rev. 1043 (1962); Seavey, “Ees Ipsa Loquitur: Tabula in Naufragio,” 63 Harv. L. Rev. 643 (1950). It has also been expanded to embrace cases where the negligence cause was not the only or most probable theory in the case, but where the alternate theories of liability accounted for the only possible causes of injury. Dierman v. Providence Hospital, 31 Cal. 2d 290, 188 P. 2d 12 (Sup. Ct. 1947); Burr v. Sherwin Williams Co., 258 P. 2d 58 (Cal. Dist. App. 1953), rev’d 42 Cal. 2d 682, 268 P. 2d 1041 (Sup. Ct. 1954). That is the situation in this ease, where we find negligence, strict liability in tort and breach of warranty all advanced as possible theories of liability. In such cases, defendants are required to come forward and give their evidence. The latter development represents a substantial deviation from earlier conceptions
In NOPCO Chem. Div. v. Blaw-Knox Co., supra, the liability for damages to a delivered product could be attributed with great probability either to the negligence of any one in a series of bailees or the breach of warranty of the seller. The Court stated that when several defendants individually owe plaintiff a duty, and all might have caused his loss and have superior knowledge of the occurrence, they all are bound to come forward and give an account of what happened. In that case, the application of res ipsa loquitur was thought to call for an explanatory rather than an exculpatory account, which would be sufficient to meet defendant’s burden, according to the traditional rule. Kahalili v. Rosecliff Realty, Inc., 26 N. J. 595, 66 A. L. R. 2d 680 (1958). See generally, Kimball, “Res Ipsa Loquitur in Suits Against Multiple Defendants,” 34 Alb. L. Rev. 106 (1969); Dierman v. Providence Hospital, supra, 188 P. 2d at 15 (dissenting opinion).
In NOPCO, however, plaintiff is still made to bear the burden of proof vis-a-vis each defendant, and, it was upon such instruction that the present case was submitted to the jury. We now hold that a mere shift in the burden of going-forward, as adopted in NOPCO, is insufficient. Por this particular type of case, an equitable alignment of duties owed plaintiff requires that not only the burden of going forward shift to defendants, but the actual burden of proof as well. Since at least one primary or third-party defendant must inevitably fail to meet his burden, a verdict must be returned for the plaintiff.
We hold that in a situation like this, the burden of proof in fact does shift to defendants. All those in custody of that patient or who owed him a duty, as here, the manufacturer and the distributor, should be called forward and should be made to prove their freedom from liability.
In cases of this type, no defendant will be entitled to prevail on a motion for judgment until all the proofs have been presented to the court and jury. The judge may grant any motion bearing in mind that the plaintiff must recover a verdict against at least one defendant. Inferences and doubts at this stage are resolved in favor of the plaintiff. If only one defendant remains by reason of the court’s action, then, in fact, the judge is directing a verdict of liability against that defendant.
The holding of the Court in this matter will, according to the dissenters, remove from the judicial process “any semblance of rationality” and reduce it to “trial by lot, or by chance.” The objections which they raise, however, hardly justify this resplendently apocalyptic rhetoric.
The dissenters are concerned with the possibility that there will be cases in which a foreign object is left in the
Once stated in simple language, free of the epithets with which the dissenters have clothed it, the objection largely evaporates. Almost by definition, one or more of the defendants are liable. Identifying the responsible party is merely a matter of elimination. To instruct the jury that it must return a verdict against one or more of the defendants is simply requiring it to determine upon the evidence which defendants, if any, have exculpated themselves. For the jury under these circumstances to conclude that no defendant is liable would be a contradiction in logic. Certainly this procedure neither compels jurors to violate their oaths nor leads to random and haphazard imposition of liability as alleged by the dissent.
The dissenters also accuse the Court of deliberately and perversely ignoring the fact — known, they assert, by everyone associated with the case — that not all conceivable defendants are before the trial court. The accusation is, of course, true. Anyone with a moderately fertile imagination could conceive of other persons whose conduct might have caused the injury. Indeed, as the dissenters are at pains to note, two witnesses did speculate that another doctor might have damaged the rongeur within the preceding four years, and, while none of the witnesses or parties have thus far suggested the possibility, the Court on its own motion might note that it is also conceivable that some unknown- enemy
Nevertheless, the fact remains that involvement by any person other than the defendants actually before the court below has never been asserted as anything other than pure and undisguised speculation. None of the defendants introduced any evidence to actually support the claim of responsibility by other persons; they made no effort to join additional parties.
A wholly faultless plaintiff should not fail in his cause of action by reason of defendants who have it within their power to prove nonculpability but do not do so. See Broder, “Res Ipsa Loquitur in Medical Mal-Practice Cases,” 18 De Paul L. Rev. 431, 422—33 (1969). In this case, the balance of equities requires no less.
The judgment of the Appellate Division is hereby affirmed, and the cause remanded for trial upon instructions consonant with this opinion.
Jacobs, J., concurs in the result but votes to affirm on the majority opinion rendered in the Appellate Division.
The charge included the following:
The right of the defendants to have the plaintiff bear the required burden is a substantial one and not a mere matter of form. This burden may be sustained, however, on the basis of all of the evidence in this case and the legitimate inference to be drawn from it. And in this connection you may consider that the defendants were the only one shown to have any relationship with the pituitary rongeur which broke during the course of the operation. And you may infer*298 that the breaking was attributable to dereliction on the part of one or other of the defendants in this case.
The dissent concedes the justification of a rule shifting the burden of proof as to negligence charges. Post. p. 310, fn. 5. But the dissenters in a footnote are critical of, among other things, the provision in this decision for a shift in burden where plaintiff has sued on counts of strict liability in tort and breach of warranty. This shift is applicable only in the particular factual situation involved in this type of case. In this factual pattern where such a shift is appropriate, it does not depend upon the specific theory of liability advanced by the plaintiff; in a factual situation where such a shift is not appropriate, the plaintiff cannot obtain its benefits by choosing one legal theory or another.
We note that a res ipsa charge has been denied where there are other equally probable multiple causes, but the ag'ents of those other causes were not joined; for example, where a wire in plaintiff’s body shattered, res ipsa was not available against the doctor when neither the manufacturer nor the hospital that supplied it was joined. Inouye v. Black, 238 Cal. App. 2d 31, 47 Cal. Rptr. 313, 14 A. L. R. 3d 961 (D. Ct. App. 1965) ; Crawford v. County of Sacramento, 239 Cal. App. 2d 791, 49 Cal. Rptr. 115 (D. Ct. App. 1966) ; cf. Talbot v. Dr. W. H. Groves’ Latter Day Saints Hospital, 21 Utah 2d 73, 440 P. 2d 872 (1968).
We do not consider here the special case of medical procedures which are foreseeably hazardous by the very reason of an exceptional risk that foreign objects might be left in the patient’s body.
On remand, defendants will have the opportunity to engage in discovery so as to identify possible additional defendants and will have the benefit of our liberal joinder rules. R. 4:8-1, R. 4:29-1(a), R. 4:30.
Reference
- Full Case Name
- Henry Anderson, Plaintiff-Respondent, v. Harold Somberg, Reinhold-Schumann, Inc., a Corporation, St. James Hospital, and Lawton Instrument Company, a Corporation, Defendants-Appellants
- Cited By
- 71 cases
- Status
- Published