## Facts

- Ilene Perin underwent an anterior-approach cervical fusion by Dr. Robert A. Hayne to treat two protruded cervical discs causing pain, weakness, and numbness.
- The procedure required retracting neck structures to access the cervical spine; the recurrent laryngeal nerve lies between the trachea and esophagus within the retracted area.
- The surgery relieved Perin’s preoperative symptoms, but shortly afterward she developed right vocal cord paralysis, reducing her voice to a hoarse whisper.
- Perin alleged Dr. Hayne negligently injured her right recurrent laryngeal nerve during the operation, causing permanent impairment.
- Expert testimony indicated recurrent laryngeal nerve injury is a known but infrequent complication of this procedure and can occur even when performed with due care.
- Perin sued on theories of specific negligence, res ipsa loquitur, breach of express warranty, and battery/trespass based on lack of consent.
- After both parties rested, the trial court directed a verdict for Dr. Hayne on all theories; Perin appealed.

## Issues

1. Whether Perin presented sufficient expert evidence that Dr. Hayne breached the applicable standard of care and thereby caused her recurrent laryngeal nerve injury.
2. Whether vocal cord paralysis following anterior cervical fusion permits an inference of negligence under res ipsa loquitur.
3. Whether the evidence showed an express, definite promise of a particular surgical result sufficient to support liability for breach of express warranty.
4. Whether the operation exceeded the scope of Perin’s consent so as to constitute battery or trespass.

## Decision

- The Supreme Court of Iowa affirmed the directed verdict for Dr. Hayne.
- On specific negligence, the court held Perin failed to produce substantial expert evidence of a deviation from the standard of care or a negligent act causing the nerve injury.
- On res ipsa loquitur, the court held the doctrine did not apply because the injury was shown to be a recognized complication that can occur without negligence.
- On express warranty, the court found no substantial evidence of a clear and definite guarantee of a particular outcome.
- On battery/trespass, the court found the procedure performed fell within the scope of consent; the complained-of injury was a risk of the authorized operation, not an unauthorized touching.

## Legal Principles

- In complex medical malpractice cases, the plaintiff generally must present expert testimony to establish the standard of care, breach, and causal connection; an adverse outcome alone does not prove negligence.
- Res ipsa loquitur requires proof that the event is the type that ordinarily does not occur absent negligence; it is unavailable where competent evidence shows the injury can occur despite due care.
- Liability for an express warranty in the medical context requires a definite, affirmative promise of a particular result; optimistic statements or general expectations are insufficient.
- A battery claim in medical treatment requires proof the physician performed a substantially different procedure or exceeded the scope of consent; complications arising from an authorized procedure are addressed, if at all, under negligence principles.

## Conclusion

The court upheld judgment for the surgeon because the plaintiff’s proof did not create a jury question on any theory: expert testimony did not support a breach of medical standards, the injury could occur without negligence so res ipsa was unavailable, no definite guarantee was shown, and the operation remained within the patient’s consent.


Perin v. Hayne, 210 N.W.2d 609 (Iowa 1973)