The Locality Rule in Young

In the case of Young v. United States, the federal District Court was required to apply California substantive law, and the California “Locality Rule” played an important role in deciding the case. The plaintiff, Kalen Young, experienced a third-degree perineal tear during delivery of her baby, “which involves either a partial or complete tear through the muscle that goes around the rectum.” (Decision, para. 49.)

After noting California law on the relevant legal duty of care (“the duty to have that degree of learning and skill ordinarily possessed by reputable members of their profession practicing in the same or similar locality and under similar circumstances”), the Court weighed the credentials and experience of the opposing expert witnesses, and found that “[t]he plaintiffs have failed to meet their burden to establish a deviation from the standard of care by physicians in the California community where the case arose.” (Decision, “Conclusions of Law,” para. 16.)

One of the plaintiffs’ allegations was that Mrs. Young’s constipation was not appropriately addressed during labor or prior to delivery, and “that identified constipation [w]as a known risk that potentially leads to postpartum breaking of stitches.” (Decision, para. 31.) Dr. Burke, the plaintiffs’ expert, “testified that the elimination of fecal material prior to delivery was standard operating procedure and was almost universal where he trained and where he practiced to avoid constipation during the postpartum period.” (Decision, para. 32.)

With respect to the medical standard of care, the Court stated:

California law holds that in performing professional services for a patient, physicians have the duty to have that degree of learning and skill ordinarily possessed by reputable members of their profession practicing in the same or similar locality and under similar circumstances. [Citing Polikoff v. United States, 776 F.Supp. 1417, 1421 (S.D.Cal. 1991), and Munro v. Regents of Univ. of Calif., 215 Cal.App.3d 977, 263 Cal.Rptr. 878 (1989).]

Young Decision, “Conclusions of Law,” para. 9.

However, the Court found: “By his own testimony and admission, [Dr. Burke’s] training and practice only encompassed communities in Georgia, Virginia, Alabama and Louisiana.” (Decision, para. 34.) Moreover, “Dr. Burke could point to no national standard of care grounded in peer review literature to support the reliability of his opinion on this matter.” (Decision, para. 34.) Finally, Dr. Burke “was neither asked nor offered any testimony as to what the local community standard of care was in California where this case arose.” (Decision, para. 34)

In contrast, Dr. Taslimi, the expert for the defendant United States, provided “the only testimony regarding what the California community standard of care would be regarding whether or not Mrs. Young’s constipation was properly addressed during this labor and delivery based on the relevant standards of care.” (Decision, para. 37.) And in Dr. Taslimi’s opinion, “if a doctor gave an enema prior to C-section or to a laboring patient, he or she would be considered old-fashioned and unacquainted with contemporary medical literature and practice.” (Decision, para. 36.) Moreover, he “tesified that administration of an enema in this situation is unnecessary.” (Decision, para. 36.)

The Court therefore concluded that “[p]laintiffs have failed to establish the necessary standard of care or to show the reliability of their expert’s opinion.” (Decision, para. 35.) With regard to the particular issue of Mrs. Young’s constipation, the Court found that “[t]he greater weight of the credible evidence suggests that Mrs. Young’s constipation was properly addressed.” (Decision, para. 30.)

When faced with two conflicting expert opinions, the Court in this case used California’s Locality Rule to tip the factfinding scales in favor of the defendant. On the relevant medical standard of care, the Court found Dr. Taslimi, who was Board Certified in Obstetrics and Gynecology and who practiced and taught this specialty at Stanford University in Palo Alto, California, more credible than Dr. Burke.

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