17 Cal.3d 399, 551 P.2d 389, 131 Cal.Rptr. 69 (1976)
Gita Landeros was born on May 14, 1970.1 During the first year of her life she was repeatedly and severely beaten by her mother and the mother's common law husband Reyes.2
On April 26, 1971, when Landeros was eleven months old, her mother brought her to the San Jose Hospital for examination, diagnosis, and treatment.3 Defendant physician A.J. Flood, acting on his own behalf and as agent of defendant San Jose Hospitals & Health Center, Inc., examined her.4 She presented with a comminuted spiral fracture of the right tibia and fibula that appeared caused by twisting force, bruises over her entire back, superficial abrasions on other parts of her body, a healing nondepressed linear fracture of the skull, and demonstrated fear and apprehension when approached.5 Her mother offered no explanation for the injuries.6
Defendants did not order X-rays of her entire skeletal structure, did not diagnose the battered child syndrome, and did not report the injuries to local law enforcement authorities or the juvenile probation department.7 Landeros was released from the hospital and returned to the custody of her mother and Reyes, who resumed physically abusing her until she sustained traumatic blows to her right eye and back, puncture wounds over her left lower leg and across her back, severe bites on her face, and second and third degree burns on her left hand.8
On July 1, 1971 she was brought to a different doctor and hospital where the battered child syndrome was immediately diagnosed and reported to police and juvenile authorities.9 She was taken into protective custody, placed with foster parents who later adopted her, and her mother and Reyes were convicted of child abuse under Penal Code section 273a.10 Landeros filed suit through her guardian ad litem alleging negligence in diagnosis and treatment together with failure to report.11 She sought compensatory damages for permanent physical injuries and mental distress including probable loss of use or amputation of her left hand.12 The trial court sustained general demurrers to the amended complaint and entered a judgment of dismissal from which she appealed.13
Whether the amended complaint states a cause of action in medical malpractice against the physician and hospital?14
A general demurrer admits the truth of all material factual allegations in the complaint.15 The question of plaintiff's ability to prove these allegations does not concern the reviewing court.16 Plaintiff need only plead facts showing that he may be entitled to some relief.17 In this state negligence may be pleaded in general terms, and that is as true of malpractice cases as it is of other types of negligence cases.18
Yes. The amended complaint alleges that defendants negligently failed to take X-rays of the entire skeletal structure and thereby failed to diagnose the battered child syndrome.19 The amended complaint alleges that defendants negligently failed to report the injuries to authorities as required for proper treatment.20 These allegations, admitted as true on demurrer, show that plaintiff may be entitled to relief for personal injuries caused by the negligence in failing to properly diagnose and treat the condition from which plaintiff was suffering.21
The trial court therefore erred in sustaining the demurrers and entering judgment of dismissal.22
The judgment of dismissal must be reversed because the complaint states a cause of action.23
Whether the standard of care in 1971 required a physician to diagnose the battered child syndrome by ordering full skeletal X-rays and to report suspected nonaccidental injuries to authorities?24
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.25 The standard of care against which the acts of a physician are to be measured is a matter peculiarly within the knowledge of experts.26 It can only be proved by their testimony unless the conduct required by the particular circumstances is within the common knowledge of the layman.27
Yes. The complaint alleges that plaintiff presented with injuries giving the appearance of having been intentionally inflicted by other persons and exhibited the medical condition known as the battered child syndrome.28 Proper diagnosis would have included taking X-rays of the entire skeletal structure, which would have revealed the skull fracture.29 Proper treatment would have included reporting the injuries to authorities so that plaintiff could be placed in protective custody.30
Although the battered child syndrome had been identified in medical literature by 1971 and accepted as a diagnosis in California courts, whether a reasonably prudent physician examining this plaintiff in 1971 would have been led to suspect the syndrome, order full skeletal X-rays, and report the findings remains a question of fact to be decided on the basis of expert testimony.31 The common knowledge exception does not apply on these facts.32 Plaintiff is therefore entitled to the opportunity to prove by way of expert testimony that in the circumstances of this case a reasonably prudent physician would have followed those procedures.33
The standard of care presents a triable issue of fact and the demurrer cannot be sustained on this ground.34
Whether the defendants' alleged failure to diagnose and report the plaintiff's condition proximately caused her subsequent injuries at the hands of her caretakers?35
An intervening act does not amount to a superseding cause relieving the negligent defendant of liability if it was reasonably foreseeable at the time of his negligent conduct.36 If the likelihood that a third person may act in a particular manner is the hazard or one of the hazards which makes the actor negligent, such an act whether innocent, negligent, intentionally tortious, or criminal does not prevent the actor from being liable for harm caused thereby.37 Foreseeability is a question of fact for the jury.38
Yes. The continued beating inflicted on plaintiff by her mother and Reyes after she was released from the San Jose Hospital constituted an intervening act that was the immediate cause in fact of the subsequent injuries.39 One of the distinguishing characteristics of the battered child syndrome is that the assault on the victim is not an isolated event but part of a pattern of repeated beatings that will continue and become more severe unless there is appropriate intervention.40 The risk of a resumption of physical abuse is thus a principal reason why a doctor's failure to diagnose and treat the syndrome constitutes negligence.41
The trial court could not properly rule as a matter of law that the defendants' negligence was not the proximate cause of plaintiff's injuries.42 Plaintiff is entitled to prove by expert testimony that defendants should reasonably have foreseen that her caretakers were likely to resume their physical abuse and inflict further injuries on her if she were returned directly to their custody.43
The issue of proximate cause presents a triable question of fact and the demurrer cannot be sustained on this ground.44
Whether violations of the Penal Code reporting statutes can be pleaded as an alternative theory supporting a presumption of negligence?45
The failure of a person to exercise due care is presumed if he violated a statute. The violation proximately caused injury.46 The injury resulted from an occurrence of the nature which the statute was designed to prevent.47 The person suffering the injury was one of the class of persons for whose protection the statute was adopted.48 Alternative theories of common law negligence and statutory liability may be pleaded in a single count or in separate counts.49
Yes. The complaint alleges facts showing compliance with the first, third, and fourth conditions specified in Evidence Code section 669 subdivision (a) for invoking the presumption of lack of due care based on violations of Penal Code sections 11160, 11161, and 11161.5.50 The charged statutory violations constitute simply an alternative legal theory in support of plaintiff's single cause of action for personal injuries.51 Plaintiff is entitled to prove compliance with each of the four statutory conditions for invoking the presumption of lack of due care, shifting to defendants the burden of rebutting that presumption.52
Sections 11160 and 11161.5 are directed to different classes of persons and are complementary rather than inconsistent.53 Sections 11161 and 11161.5 are not in irreconcilable conflict.54
Violations of the reporting statutes may be pleaded as an alternative theory supporting a presumption of negligence.55