## Facts

- Harriet Walski had a longstanding thyroid condition, including prior thyroid surgery and later treatment with radioactive iodine and medication.
- By mid-1971, her thyroid enlarged and compressed her trachea, causing breathing interference.
- Dr. James Walsh arranged for Dr. Marvin Tiesenga, a general surgeon, to perform a subtotal thyroidectomy on November 30, 1971; Walsh assisted.
- During surgery, Walski’s left recurrent laryngeal nerve was severed, leading to postoperative speaking and breathing problems.
- The recurrent laryngeal nerves run near the thyroid and are a known risk in thyroid surgery.
- Plaintiff’s experts testified that good practice required identifying and isolating the recurrent laryngeal nerves during thyroidectomy to avoid injury, but also acknowledged surgeons use different methods.
- Defense testimony stated that, given prior surgery and scarring, dissecting to identify the nerves was unwise and that estimating nerve location without isolating them was an accepted method under such circumstances.
- Walski alleged defendants deviated from accepted medical standards by failing to locate and protect the nerve, causing permanent injury.

## Issues

1. Whether the plaintiff presented sufficient expert testimony to establish a definite, generally accepted professional standard of care and a deviation from that standard to survive a directed verdict in a medical malpractice action.
2. Whether conflicting expert opinions about alternative surgical methods, without proof that one method is required by the profession, can create a jury question on negligence.

## Decision

- The Illinois Supreme Court affirmed the directed verdict for defendants.
- The court held the plaintiff failed to establish, through expert testimony, a clear and well-defined professional standard of care applicable to the circumstances.
- The court held that testimony showing another physician would have used a different method, without showing the profession required that method, was insufficient to prove negligence.
- The court concluded that the layperson exception to the expert-testimony requirement did not apply to thyroid surgery and recurrent laryngeal nerve protection.
- Applying the directed-verdict standard, the court found no reasonable jury could find for plaintiff on the evidence presented.

## Legal Principles

- In medical malpractice, the plaintiff must prove the applicable standard of care and breach, ordinarily through expert testimony.
- A physician must exercise the degree of care, skill, and proficiency used by reasonably careful practitioners in the same class under similar circumstances.
- Expert testimony must identify an objective, community-based standard; a witness’s personal preference or statement that they would have acted differently does not, by itself, establish the standard or breach.
- Conflicting expert opinions do not automatically require submission to a jury when the plaintiff’s proof does not define a single, generally accepted standard and a departure from it.
- Expert testimony may be unnecessary only where negligence is so apparent, or treatment so common, that lay jurors can evaluate it without specialized knowledge.

## Conclusion

The court affirmed judgment for the surgeons because the plaintiff’s expert evidence did not establish a definite, generally accepted standard of care requiring nerve identification in the specific surgical circumstances, and thus did not support a finding that defendants acted negligently.


Walski v. Tiesenga, 72 Ill. 2d 249, 381 N.E.2d 279 (Ill. 1978)