## Facts

- Anna Salinetro sought personal-injury benefits after an automobile accident and was required by her insurer to submit to a medical examination by Dr. Nystrom, an orthopedist.
- During the examination, Dr. Nystrom ordered x-rays of Salinetro’s lower back and pelvic/abdominal area.
- Neither Dr. Nystrom nor his staff asked Salinetro whether she was pregnant or the date of her last menstrual period.
- At the time of the x-rays, Salinetro was approximately four to six weeks pregnant, though she did not know it.
- Two days later, Salinetro consulted her gynecologist, who confirmed the pregnancy.
- After learning of the pelvic x-rays, the gynecologist advised termination due to possible fetal injury from radiation exposure.
- Salinetro underwent a therapeutic abortion; pathology reported the fetus was dead at the time of the procedure.
- At trial, Salinetro testified that if asked whether she was pregnant at the time of the x-rays, she would have answered “no” because she was unaware of the pregnancy.
- The trial court granted a directed verdict for Dr. Nystrom at the close of the plaintiff’s case for failure to establish a prima facie malpractice claim, particularly causation.

## Issues

1. Whether the plaintiff presented sufficient evidence of causation to avoid a directed verdict where the alleged negligence was failure to ask about pregnancy before ordering pelvic x-rays.
2. Whether the trial court erred by excluding the plaintiff’s gynecologist from testifying as an expert on the standard of care applicable to an orthopedic physician ordering x-rays.

## Decision

- The appellate court affirmed the directed verdict and final judgment for Dr. Nystrom.
- Assuming the failure to inquire about pregnancy could constitute negligence, the evidence showed no causal relationship between that omission and the claimed injury.
- Because causation was dispositive, any alleged error regarding expert qualification did not alter the outcome.

## Legal Principles

- Negligence liability requires proof that the defendant’s act or omission caused the plaintiff’s injury; causation is an essential element of a prima facie case.
- Under a cause-in-fact (but-for) analysis, there is no liability when the injury would have occurred even if the defendant had acted as alleged to be required.
- A directed verdict is proper when the plaintiff’s evidence, including the plaintiff’s own testimony, forecloses a reasonable jury finding on causation.

## Conclusion

The court held that the plaintiff failed to prove causation as a matter of law because she would have denied being pregnant if asked, so the x-rays would have been taken regardless; without but-for causation, the malpractice claim could not reach the jury.


Salinetro v. Nystrom, 341 So. 2d 1059 (Fla. Dist. Ct. App. 3d Dist. 1977)