## Facts

- Shirley M. Locke underwent a vaginal hysterectomy with entocele and rectocele repair at a university hospital on August 5, 1981.
- Dr. Judith A. Pachtman, a fourth-year gynecology resident, performed the procedure; Dr. James A. Roberts was the attending physician and was present for most of the surgery.
- During rectocele repair, a surgical needle broke during insertion into the levator ani muscle; a 1.5 cm fragment lodged in the muscle.
- Pachtman searched for 15–20 minutes; Roberts returned and assisted; they used radiographic localization and searched through a new incision for an additional 45–60 minutes.
- The physicians ended the search and closed the incisions without retrieving the fragment, concluding termination was in the patient’s best interest.
- Pachtman informed Locke the fragment remained but would likely not cause problems; Locke later experienced significant pain.
- A different physician later surgically removed the needle fragment.
- The Lockes sued for malpractice, alleging negligent needle choice/handling and negligent failure to retrieve the fragment; they also challenged Roberts’ absence when the needle broke.
- At the close of plaintiffs’ proofs, the trial court directed a verdict for defendants for failure to make a prima facie showing of the standard of care; the appellate court affirmed.

## Issues

1. Whether plaintiffs presented sufficient evidence of the applicable medical standard of care and its breach to survive a directed verdict on claims involving needle selection, needle breakage, and failure to retrieve a needle fragment.
2. Whether a physician’s extrajudicial statements suggesting fault can, without competent proof of the community standard of care, establish the standard of care or a breach.
3. Whether res ipsa loquitur permits an inference of negligence from needle breakage and retention of a fragment when the event may occur absent negligence.

## Decision

- The Michigan Supreme Court affirmed the directed verdict for defendants.
- Plaintiffs failed to establish a prima facie case because they did not adequately prove the applicable standard of care or a breach as to either physician.
- Plaintiffs’ expert testimony did not clearly define the professional standard tied to plaintiffs’ theories and left the jury to speculation on acceptable surgical choices and technique.
- Alleged extrajudicial admissions of fault were insufficient, standing alone, to prove the community standard of care or nonconformity with it.
- Res ipsa loquitur did not apply because the evidence (including plaintiffs’ expert concessions) showed needle breakage can occur without negligence and was not shown to be an event that ordinarily does not happen absent negligence.

## Legal Principles

- A medical malpractice plaintiff must prove: (1) the applicable standard of care, (2) breach, (3) injury, and (4) proximate causation; failure to make a prima facie showing warrants a directed verdict.
- Expert testimony is generally required to establish the standard of care and breach when the subject is not within common knowledge of lay jurors.
- A physician’s out-of-court statements indicating mistake or fault do not, by themselves, establish the legally operative professional standard of care or prove breach of that standard.
- Res ipsa loquitur requires a showing that the event is of a kind that ordinarily does not occur in the absence of negligence, established by expert testimony or common knowledge; a bad result alone is insufficient.

## Conclusion

The court held that alleged surgical error and an adverse outcome were not enough to reach a jury where plaintiffs failed to present competent evidence of the governing professional standard of care and its breach; neither physician admissions nor res ipsa loquitur supplied the missing proof.


Locke v. Pachtman, 446 Mich. 216, 521 N.W.2d 786 (Mich. 1994)