## Facts

- Theresa Brune delivered a baby at a New Bedford hospital in 1958; Dr. Stanton Belinkoff, an anesthesiology specialist, administered a spinal anesthetic containing 8 mg of pontocaine in glucose solution.
- About eleven hours later, Brune fell while attempting to get out of bed and thereafter experienced persistent numbness and weakness in her left leg.
- Medical testimony conflicted: some physicians opined the 8 mg dose was excessive and proper practice required 5 mg or less; other testimony (including the defendant’s) stated 8 mg was proper and customary for vaginal deliveries in New Bedford.

## Issues

1. In a malpractice action against a specialist, whether the standard of care is limited to the customary practice of physicians in the defendant’s locality or instead measured by the care and skill commonly possessed and used by similar specialists in like circumstances.
2. Whether a jury instruction allowing the standard of care to be reduced based on inferior local practice misstates the law and requires a new trial.

## Decision

- The Supreme Judicial Court sustained the plaintiffs’ exceptions and ordered a new trial.
- The trial court erred by instructing the jury to apply a New Bedford “community” standard that could be materially lower than the standard in other Massachusetts communities.
- The court rejected the strict locality rule as outdated under modern conditions and held the applicable standard is that of the average qualified practitioner, considering professional advances and available medical resources.

## Legal Principles

- A physician’s duty is to exercise the degree of care and skill of the average qualified practitioner in the relevant field, accounting for advances in the profession.
- For specialists, the relevant comparison is to similar specialists acting in like circumstances; geographic locality is not a controlling boundary on competence.
- The type of community and the medical resources available to the physician are relevant circumstances, but local custom cannot define legality if it reflects a lower-than-acceptable level of professional care.
- A jury instruction that permits the standard of care to be discounted solely because the defendant practices in a particular locality is erroneous and warrants a new trial when it may affect the verdict.

## Conclusion

The court replaced the strict locality-based malpractice standard with an average qualified practitioner standard (including for specialists) and required a new trial because the jury was instructed that local practice could set a substantially lower legal standard of care.


Brune v. Belinkoff, 354 Mass. 102, 235 N.E.2d 793 (Mass. 1968)