California Civil Jury Instructions (CACI) (2017)

501. Standard of Care for Health Care Professionals

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501.Standard of Care for Health Care Professionals
[A/An] [insert type of medical practitioner] is negligent if [he/she] fails to
use the level of skill, knowledge, and care in diagnosis and treatment
that other reasonably careful [insert type of medical practitioners] would
use in the same or similar circumstances. This level of skill, knowledge,
and care is sometimes referred to as “the standard of care.”
[You must determine the level of skill, knowledge, and care that other
reasonably careful [insert type of medical practitioners] would use in the
same or similar circumstances, based only on the testimony of the
expert witnesses [including [name of defendant]] who have testified in
this case.]
New September 2003; Revised October 2004, December 2005, December 2010
Directions for Use
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.
Sources and Authority
• “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
• “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.)
• “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].)
Secondary Sources
6 Witkin, Summary of California Law (10th ed. 2005) Torts, §§ 933, 934, 971, 975
California Tort Guide (Cont.Ed.Bar 3d ed.) § 9.1
3 Levy et al., California Torts, Ch. 30, General Principles of Liability of
Professionals, § 30.12, Ch. 31, Liability of Physicians and Other Medical
Practitioners, § 31.11 (Matthew Bender)
17 California Forms of Pleading and Practice, Ch. 209, Dentists, § 209.42
(Matthew Bender)
25 California Forms of Pleading and Practice, Ch. 295, Hospitals, §§ 295.13,
295.43, 295.45 (Matthew Bender)
36 California Forms of Pleading and Practice, Ch. 415, Physicians: Medical
Malpractice, § 415.11 (Matthew Bender)
17 California Points and Authorities, Ch. 175, Physicians and Surgeons: Medical
Malpractice, § 175.20 et. seq. (Matthew Bender)