## Facts

- Judith Spidle underwent a supracervical hysterectomy performed by Dr. Lee A. Steward after recurrent pelvic inflammatory disease.
- Postoperatively, she developed a vaginal fecal fistula and a drainage sinus at the surgical incision, indicating a communication among the vagina, colon, and abdominal wall, with fecal drainage from the incision and vagina.
- The abdominal incision closed relatively soon, but the fistula persisted for about two years before being corrected by another physician; Spidle continued to experience medical problems.
- Plaintiffs presented evidence linking the fistula to the hysterectomy.
- Plaintiffs’ expert (Dr. Thomas Wilson) testified that fecal vaginal fistulas are a rare and unusual complication of hysterectomy and not normally expected after a properly performed procedure.
- Evidence suggested the hysterectomy may have been performed during an acute stage of pelvic inflammatory disease, when both parties’ experts agreed it should not be performed.

## Issues

1. Whether plaintiffs presented sufficient evidence to submit medical malpractice claims under res ipsa loquitur to the jury, rather than having those counts resolved by a directed verdict for the defendant.
2. Whether the trial court erred by refusing plaintiffs’ modified version of the pattern jury instruction on a physician’s standard of care.

## Decision

- The Illinois Supreme Court reversed the directed verdict for the defendant on the res ipsa loquitur counts and remanded for further proceedings.
- The court held plaintiffs’ evidence, including expert testimony that the injury was rare and not normally expected, was sufficient to permit an inference of negligence without requiring specific “magic words.”
- The court affirmed the trial court’s refusal to give plaintiffs’ modified standard-of-care instruction, concluding the instructions given adequately stated the governing law and the refusal was not reversible error.

## Legal Principles

- Res ipsa loquitur permits (but does not compel) an inference of negligence when the plaintiff shows: (1) an occurrence that ordinarily does not happen absent negligence, (2) an instrumentality within the defendant’s exclusive control, and (3) no voluntary act or contribution by the plaintiff.
- In medical malpractice cases involving complex treatment or surgery, expert testimony is commonly required to establish whether the occurrence is of a type that ordinarily does not happen without negligence.
- Expert testimony describing a complication as rare, unusual, and not normally expected can satisfy the “ordinarily does not occur absent negligence” element when considered with other evidence linking the injury to the defendant’s procedure.
- If the plaintiff introduces evidence supporting the res ipsa inference, the claim should go to the jury even if the defendant offers competing non-negligent explanations.
- A trial court’s refusal of a proposed jury instruction is not reversible error where the instructions as a whole correctly state the law and the refusal does not prejudice the requesting party.

## Conclusion

The court held that plaintiffs presented enough expert and circumstantial evidence to let a jury infer negligence under res ipsa loquitur from a rare, unexpected surgical complication, while also holding that refusal to give a modified physician standard-of-care instruction was not error because the instructions given adequately stated the law.


Spidle v. Steward, 402 N.E.2d 216 (Ill. 1980)