CACI 501 Standard of Care for Health Care Professionals

New September 2003; Revised October 2004, December 2005, December 2010

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This instruction is intended to apply to nonspecialist physicians, surgeons, and dentists. The standards of care for nurses, specialists, and hospitals are addressed in separate instructions. (See CACI No. 502, Standard of Care for Medical Specialists, CACI No. 504, Standard of Care for Nurses, and CACI No. 514, Duty of Hospital.)

The second paragraph should be used if the court determines that expert testimony is necessary to establish the standard of care, which is usually the case. (See Scott v. Rayhrer (2010) 185 Cal.App.4th 1535, 1542–1543 [111 Cal.Rptr.3d 36].)

If the standard of care is set by statute or regulation, refer to instructions on negligence per se (CACI Nos. 418–421). (See Galvez v. Frields (2001) 88 Cal.App.4th 1410 [107 Cal.Rptr.2d 50].)

See CACI Nos. 219–221 on evaluating the credibility of expert witnesses.

•“With unimportant variations in phrasing, we have consistently held that a physician is required to possess and exercise, in both diagnosis and treatment, that reasonable degree of knowledge and skill which is ordinarily possessed and exercised by other members of his profession in similar circumstances.” (Landeros v. Flood (1976) 17 Cal.3d 399, 408 [131 Cal.Rptr. 69, 551 P.2d 389].)

•“The courts require only that physicians and surgeons exercise in diagnosis and treatment that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of the medical profession under similar circumstances.” (Mann v. Cracchiolo (1985) 38 Cal.3d 18, 36 [210 Cal.Rptr. 762, 694 P.2d 1134].)

•“[T]he law imposes on individuals a duty to have medical education, training and skill before practicing medicine and that practicing medicine without this education, training and skill is negligent. … [A] breach of that portion of the standard of care does not, in and of itself, establish actionable malpractice (i.e., one cannot recover from a person merely for lacking medical knowledge unless that lack of medical knowledge caused injury to the plaintiff).” (Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110, 1119 [267 Cal.Rptr. 503], disapproved on other grounds in Alexander v. Superior Court (1993) 5 Cal.4th 1218, 1228 [23 Cal.Rptr.2d 397, 859 P.2d 96].)

•“[T]he standard of care for physicians is the reasonable degree of skill, knowledge and care ordinarily possessed and exercised by members of the medical profession under similar circumstances. The test for determining familiarity with the standard of care is knowledge of similar conditions. Geographical location may be a factor considered in making that determination, but, by itself, does not provide a practical basis for measuring similar circumstances. Over 30 years ago, our Supreme Court observed that ‘[t]he unmistakable general trend … has been toward liberalizing the rules relating to the testimonial qualifications of medical experts.’ ” (Avivi v. Centro Medico Urgente Medical Center (2008) 159 Cal.App.4th 463, 470–471 [71 Cal.Rptr.3d 707], original italics, internal citations omitted.)

•“Today, ‘neither the Evidence Code nor Supreme Court precedent requires an expert witness to have practiced in a particular locality before he or she can render an opinion in an ordinary medical malpractice case.’ ” (Borrayo v. Avery (2016) 2 Cal.App.5th 304, 310–311 [205 Cal.Rptr.3d 825], original italics.)

•“As a general rule, the testimony of an expert witness is required in every professional negligence case to establish the applicable standard of care, whether that standard was met or breached by the defendant, and whether any negligence by the defendant caused the plaintiff’s damages. A narrow exception to this rule exists where’ ” ‘… the conduct required by the particular circumstances is within the common knowledge of the layman.’ … [Citations.]” ’ This exception is, however, a limited one. It arises when a foreign object such as a sponge or surgical instrument, is left in a patient following surgery and applies only when the plaintiff can invoke the doctrine of res ipsa loquitur. ‘The “common knowledge” exception is generally limited to situations in which … a layperson “… [can] say as a matter of common knowledge … that the consequences of professional treatment were not such as ordinarily would have followed if due care had been exercised.” …’ ” (Scott, supra, 185 Cal.App.4th at pp. 1542–1543, footnote and internal citations omitted.)

•“We have already held upon authority that the failure to remove a sponge from the abdomen of a patient is negligence of the ordinary type and that it does not involve knowledge of materia medica or surgery but that it belongs to that class of mental lapses which frequently occur in the usual routine of business and commerce, and in the multitude of commonplace affairs which come within the group of ordinary actionable negligence. The layman needs no scientific enlightenment to see at once that the omission can be accounted for on no other theory than that someone has committed actionable negligence.” (Ales v. Ryan (1936) 8 Cal.2d 82, 93 [64 P.2d 409].)

•The medical malpractice standard of care applies to veterinarians. (Williamson v. Prida (1999) 75 Cal.App.4th 1417, 1425 [89 Cal.Rptr.2d 868].)