## Facts

- Marguerite James underwent a lung biopsy in October 2004 for a suspicious lesion.
- Before surgery, a radiologist inserted a localization guide wire to help identify the lung area to be resected.
- During the procedure, the guide wire dislodged and could not be located.
- The surgeon, Dr. David Wormuth, removed the targeted lung tissue and then conducted an unsuccessful manual search for approximately 20 minutes.
- Dr. Wormuth ended the procedure and left the wire in place, reasoning that extending surgery to continue searching would increase risks (prolonged anesthesia, enlarging the incision, and additional dissection near lung structures).
- After the operation, Dr. Wormuth informed James the wire remained, explained his decision, and indicated it could be removed later if needed.
- James later reported pain she attributed to the wire and underwent a second operation about two months later to remove it.
- James alleged physical and emotional injuries from the retained wire and the second surgery.

## Issues

1. Whether James presented sufficient evidence that the surgeon’s decision to leave the guide wire in place deviated from accepted medical practice and proximately caused injury.
2. Whether res ipsa loquitur permitted an inference of negligence based solely on the presence of the wire after surgery when the wire was left intentionally as a medical decision.

## Decision

- The Court of Appeals affirmed the order upholding a directed verdict for defendants and dismissal of the amended complaint.
- The court held plaintiff failed to make a prima facie showing that the surgeon’s intraoperative decision fell outside accepted medical practice or that it proximately caused the claimed injuries.
- The court held res ipsa loquitur did not apply because the retained wire resulted from an intentional treatment decision, not inadvertent oversight.

## Legal Principles

- A medical malpractice plaintiff must prove (1) a deviation from accepted medical practice and (2) that the deviation was a proximate cause of injury.
- When physicians choose among medically acceptable options, liability requires proof that the choice was outside the range of accepted practice; a poor outcome alone is insufficient.
- Res ipsa loquitur applies only when the event is of a kind that ordinarily does not occur absent negligence, the instrumentality was within defendant’s exclusive control, and the event was not due to plaintiff’s voluntary action.
- The inference of negligence commonly associated with inadvertent “foreign object” retention does not extend to objects left in the body as an affirmative, risk-based medical judgment.
- Causation in malpractice requires competent proof linking the alleged departure to specific injuries, not merely the occurrence of additional treatment or surgery.

## Conclusion

The court sustained dismissal because plaintiff did not prove that leaving a dislodged guide wire in place after a limited search was outside accepted medical practice or that the timing of removal caused compensable injury, and res ipsa loquitur could not be used to infer negligence from an intentional, judgment-based intraoperative decision.


James v. Wormuth, 21 N.Y.3d 540 (N.Y. 2013)