In 2017, Laura Francke underwent a double mastectomy with reconstructive surgery after doctors diagnosed her with breast cancer. Francke had revision surgery in September 2018 to address implant failure and excess tissue. During the procedure, Desano assisted Lumley, and Wood, Beaudoin, and Sarsozo provided anesthesia to Francke. The anesthesia providers noted that Francke was placed in the “supine” position throughout the surgery, which lasted an hour and 45 minutes.
Following the surgery, Francke felt severe pain in her neck, left shoulder, arm, and hand that she did not have before the surgery. Postoperatively, Franke also had numbness, tingling, and weakness in her left arm radiating to her fingers, and she could not use her left arm. Francke’s pain level between her surgery and her postoperative visit remained constant and severe. Lumley’s notes from the first postoperative visit stated that Franke’s pain was “likely positional from the operating room table.” After multiple return visits, during which Francke continued to report persistent and worsening pain, loss of functionality, numbness, and range of motion limitations, Lumley recommended an electromyography (EMG), and that Francke see an orthopedic specialist for further evaluation.
Francke’s EMG showed evidence of “a severe, left pan-sensory, posterior cord, and lateral trunk/medial cord brachial plexopathy with acute/chronic denervation and early reinnervation.” A month later, a neurologist diagnosed Francke with brachial plexopathy likely cause by “a stretch injury to the nerve.” Francke claims that the injury resulted in permanent pain, numbness, and limited motion in her left arm.
Francke filed her Michigan medical malpractice complaint in March 2021, alleging claims of negligence against Lumley,
Desano, Wood, Beaudoin, Sarsozo, and the corresponding defendant entities with which they practiced. Specifically, Francke alleged that defendants breached the standard of care during her surgery by improperly positioning her and failing to properly pad or protect her upper extremity from a pressure or position injury. According to Francke, because of this negligence, she suffered a permanent injury to her rotator cuff, ulnar nerve, radial nerve, and brachial plexus.
Francke’s experts, nurse anesthetist, Garalynn Tomas; anesthesiologist, Ruchir Gupta; plastic surgeon, John Perrotti; and neurologist, David Preston, testified that the surgical record did not provide enough information to know the position of Francke’s arms, or if defendants moved Francke during the surgery. The experts agreed that any movement of Francke’s body while she was unconscious, particularly the placement of her arms at an angle greater than 90 degrees, would have presented a risk of nerve injuries like the injuries Francke suffered.
Defendants, Botsford General, Hajjar-Lumley, Botsford Anesthesiologists, Lumley, Wood, Beaudoin, and Sarsozo, moved for summary disposition under MCR 2.116(C)(10). The trial court granted defendants’ motion and ruled that Francke’s expert testimony that her injuries were caused by positioning during surgery were “assumptions . . . not in accord with the established facts.” The trial court also ruled that Francke’s experts formed their opinions because
they did not believe the notes in Francke’s chart, but that this did not establish any breach of the standard of care. The trial court also ruled that Francke’s evidence did not support an inference of negligence under the doctrine of res ipsa loquitur. Francke appealed.
The State of Michigan Court of Appeals stated in its unpublsihed Per Curiam opinion filed on September 19, 2024: “In this case, to show a breach of the standard of care, Francke presented expert testimony that defendants did not properly monitor, safeguard, and document Francke’s positioning during surgery. Part of this claim of breach centers on the meaning of the word “supine” as a one-word description of plaintiff’s position in the chart of her surgery. All four of Francke’s experts, Tomas, Gupta, Perrotti, and Preston, testified that “supine” means being positioned on one’s back, and does not include any indication of the position of Francke’s arms. Tomas, Gupta, and Perrotti also testified that they understood that, in some cases, “supine” may suggest that the patient’s arms were at her sides, or at least not abducted more than 90 degrees, but they did not testify that Francke’s surgical chart was one of those cases. Contrary to the trial court’s reasoning, these expert opinions are not “based on assumptions that are not in accord with established facts.” Badalamenti, 237 Mich App at 286. The only established facts related to their opinions are that the surgical chart included the word “supine” as a position description, and nothing else. The parties express a difference of opinion about what the use of the word “supine” indicates about Francke’s position, and Francke’s argument of a breach in the standard of care is predicated on this one-word descriptor showing insufficient attention to her positioning during surgery. Francke’s experts did not state opinions that conflict with objective measurement, Taylor, 329 Mich App at 285, but instead used their knowledge and experience to testify regarding the meaning of a medical term. Because the weight to be given to expert testimony is for the jury to decide, Guerrero, 280 Mich App at 669, the experts’ testimony that they find the word “supine” too vague to satisfy defendants’ duty in monitoring Francke’s position is enough to establish a question of fact whether there was a breach of the standard of care.”
Res Ipsa Loquitur Doctrine
The doctrine of res ipsa loquitur applies in the following circumstances: (1) the event must be of a kind which ordinarily does not occur in the absence of someone’s negligence; (2) it must be caused by an agency or instrumentality within the exclusive control of the defendant; (3) it must not have been due to any voluntary action or contribution on the part of the plaintiff; and (4) evidence of the true explanation of the event must be more readily accessible to the defendant than to the plaintiff.
The Michigan appellate court stated: “The testimony of Francke’s experts provide some support for the foreseeability of harm when positioning is not diligently monitored, and so is the basis for Francke’s prima facie burden of proximate causation … However, this testimony fails to establish but-for causation, Weymers, 454 Mich at 647-648, because there is no evidence that defendants mispositioned Francke, only speculation, Wiley, 257 Mich App at 496. But, under the doctrine of res ipsa loquitur, a plaintiff is entitled to an inference of negligence from circumstantial evidence when they are otherwise unable to prove the actual occurrence of a negligent act.”
The Michigan appellate court held: “On the basis of the evidence submitted, Francke presented evidence to establish a genuine issue of material fact about whether defendants breached the standard of care and caused her injury under the doctrine of res ipsa loquitor.”
Source Francke v. Botsford General Hospital, COA No. 365734.
If you or a loved one may have been injured as a result of improper surgical positioning in Michigan or in another U.S. state, you should find a Michigan medical malpractice lawyer, or a medical malpractice lawyer in your U.S. state, who may investigate your surgical positioning malpractice claim for you and represent you or your loved one in a surgical positioning medical malpractice case, if appropriate.
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