SMITH, CHIEF JUSTICE, FOR THE COURT.
¶ 1. Regina Powell and her husband, Thomas, filed suit against Methodist Health Care-Jackson Hospitals (Methodist), alleging that Powell had suffered an injury to her leg and foot during surgery to remove her gall bladder. The Hinds County Circuit Court granted Methodist's motion for summary judgment. Powell appealed, and the appeal was assigned to the Mississippi Court of Appeals which unanimously affirmed. We subsequently granted certiorari.
¶ 2. The Court of Appeals' opinion, Powell v. Methodist Health Care-Jackson Hosps., 856 So.2d 353, 355-56 (Miss. Ct. App. 2003), adequately sets out the facts in this case. Therefore, they will not be repeated here.
ANALYSIS
¶ 3. Because we conclude that summary judgment was appropriate and the Mississippi Court of Appeals did not err, we affirm the judgment in this case.
¶ 4. As the Court of Appeals correctly noted, where the matter at issue is not within the scope of a layperson's common knowledge, negligence can be proven in a medical malpractice action only where the plaintiff presents medical testimony establishing that the defendant physician failed to use ordinary skill and care. Gatlin v. Methodist Med. Ctr., Inc., 772 So.2d 1023, 1026 (Miss. 2000). See also Coleman v. Rice, 706 So.2d 696, 698 (Miss. 1997); Palmer v. Biloxi Reg'l Med. Ctr., Inc., 564 So.2d 1346, 1354 (Miss. 1990). Moreover, as in any negligence action, a plaintiff claiming medical malpractice must show that there is a causal connection between the injury and the defendant's conduct or acts. See Palmer, 564 So.2d at 1355.
¶ 5. Here, Powell presented medical testimony through her expert, Dr. Alexander. Powell, 856 So.2d at 357. Dr. Alexander plainly stated that the operating table strap probably did not cause Powell's injury. Id. As the Court of Appeals concluded, Dr. Alexander's testimony made no mention of any deviation from Methodist's standard of care. Id. As such, it escapes us how we could conclude that Powell established Methodist's standard of care in this case.
¶ 6. Moreover, we agree with the Court of Appeals that Powell also failed to make a showing of proximate cause. That is, Powell failed to show a causal connection between her injuries and Methodist's acts or conduct. Powell's other expert witness testified in her deposition that the operating table strap appeared to be placed on Powell's leg in a "perfectly normal" manner. Powell, 856 So.2d at 357. Powell alleged that "either medical negligence or some sort of pressure was inflicted on her left leg." Id. at 356. However, the same expert stated that according to the medical records, there was no evidence of external pressure to Powell's leg during the procedure. Id. at 357.
¶ 7. Finally, as to Powell's assertions regarding res ipsa loquitur, we conclude that doctrine is inapplicable under the facts presented here. Under the doctrine of res ipsa loquitur, negligence can be inferred in certain factual situations. Winters v. Wright, 869 So.2d 357, 363 (Miss. 2003). This Court has held that this doctrine should be cautiously applied. Id. Explaining the use of this doctrine, we have stated that
[t]he real question, generally, is whether or not in the process of the operation any extraordinary incident or unusual event, outside of the routine of the action of its performance, occurred, and beyond the regular scope of its customary professional activity in such operations, which, if unexplained, would themselves reasonably speak to the average man as the negligent cause or causes of the untoward consequence.
Id. Res ipsa loquitur may be applied only when three elements
are present. First, the defendant must have control and management of the instrumentality causing the plaintiff's injury.
Id. Moreover, "the injury must be such that in the ordinary course of things it would not occur if those in control of the instrumentality used proper care."
Id. Third and finally, res ipsa loquitur only applies where the injury is not a result of the plaintiff's voluntary act.
Id.
We note that the Court of Appeals, citing Brown v. Baptist Mem'l Hosp.-DeSoto, Inc., 806 So.2d 1131, 1135 (Miss. 2002), concluded that four elements must be satisfied in order for this doctrine to be applicable. It is true that Brown states this proposition, but that language is a mere aberration. We clarified in Winters that the doctrine is made up of three elements. We reiterate that holding today.
¶ 8. Powell's own expert witness confirmed that the cause of Powell's injury could be from negligent or non-negligent causes. Specifically, Dr. Alexander stated, "I would have to speculate as to the possible cause, and only after said speculation could I label it negligent or not. I could not tell you now that I am certain negligence occurred in the operating room this day." Id. at 359. Additionally, there was no evidence that the result of the injury was not a result of some voluntary act on Powell's part. Therefore, we hold that the doctrine of res ipsa loquitur does not apply in this case.
CONCLUSION
¶ 9. In sum, Powell failed to establish Methodist's standard of care; she made no showing of a causal connection between her injuries and Methodist's acts or conduct, and; she did not satisfy the elements of res ipsa loquitur in this case. Accordingly, under our case law, we hold that the Court of Appeals and the trial court did not err and that Methodist Health Care — Jackson Hospitals was entitled to summary judgment. Therefore, we affirm the judgments of the Court of Appeals and the trial court.
¶ 10. AFFIRMED.
WALLER AND COBB, P. JJ., CARLSON, DICKINSON AND RANDOLPH, JJ., CONCUR. GRAVES, J., DISSENTS WITHOUT SEPARATE WRITTEN OPINION. EASLEY, J., DISSENTS WITH SEPARATE WRITTEN OPINION. DIAZ, J., NOT PARTICIPATING.