(dissenting) :
I respectfully dissent.
*194The majority opinion is directed toward establishing whether there was any evidence to support the reasonable inference that Dr. Lilliewood’s failure to remove the IUD from Mrs. Green’s uterus in July 1970 constituted negligence. However, that is not at issue. Dr. Lilliewood’s negligence in failing to remove the IUD is admitted. Likewise, the existence of Mrs. Green’s pain and suffering from July 1969 until September 1977 and the fact that she received subsequent medical treatment are not disputed.
The only issue presented by this appeal is whether there was any evidence to support the reasonable inference that Dr. Lilliewood’s negligence was the proximate cause of Mrs. Green’s injuries.
In a medical malpractice action it is incumbent on the plaintiff to establish proximate cause as well as the negligence of the physician. Armstrong v. Weiland, 267 S. C. 12, 225 S. E. (2d) 851 (1976). Negligence is not actionable unless it is a proximate cause of the injury complained of, and negligence may be deemed a proximate cause only when without such negligence the injury would not have occurred or could have been avoided. Hughes v. Childrens Clinic, P.A., 269 S. C. 389, 237 S. E. (2d) 753 (1977); Gunnells v. Roach, 243 S. C. 248, 133 S. E. (2d) 757 (1963).
Dr. Lilliewood’s failure to remove the IUD when requested resulted in the IUD remaining in Mrs. Green’s uterus for thirteen (13) months longer than it would have remained there had he removed it. Mrs. Green claims that the presence of the IUD in her uterus for thirteen (13) additional months was the proximate cause of all her injuries. Stated another way, Mrs. Green claims that “but for” the presence of the IUD in her uterus for an additional thirteen (13) months she would have suffered no pain, and would have required no medical treatment.
The IUD was removed in September 1971 after three attempts on three separate days. The difficulty in removing *195the IUD was caused by the IUD becoming implanted in the wall of Mrs. Green’s uterus. Dr. Lilliewood’s failure to remove the IUD when requested could be the proximate cause of the September 1971 treatment only if the IUD became implanted during the thirteen (13) month period following July 1970). If the IUD was already implanted in July 1970, Dr. Lilliewood’s negligence would have been harmless. Mrs. Green offered no evidence on this point.
Mrs. Green also claims that the presence of the IUD in her uterus for the additional thirteen (13) months proximately caused the loss of uterus and right ovary. Even if we assume these injuries were caused by Mrs. Green’s reaction to the IUD, there is no evidence that these injuries would not have occurred “but for” the presence of the IUD in Mrs. Green’s uterus for the thirteen (13) additional months.
Finally, Mrs. Green claims that the presence of the IUD in her uterus for thirteen. (13) additional months proximately caused her to suffer continuous pain. She testified, however, that she began to experience pain shortly after the IUD was inserted in July 1969, and that she continued to experience pain after the IUD was removed in September 1971. In fact, Mrs. Green’ pain continued up to and including the time of her trial in September 1977, six years after the IUD was removed. Assuming this pain and suffering was caused by Mrs. Green’s reaction to the IUD, there is no evidence that the pain and suffering would not have occurred “but for” the presence of the IUD in Mrs. Green’s uterus for the thirteen (13) additional months.
The majority opinion recognizes that Dr. Lilliewood’s affirmative nod of the head does not meet the “most probably” test for expert testimony set forth in Armstrong v. Weiland, supra; and its reliance on Gambrell v. Burleson, 252 S. C. 98, 165 S. E. (2d) 622 (1969) to overcome this defect is misplaced. The rule in Gambrell, supra, that medical testimony offered to show proximate cause need not meet *196the “most probably” test where there is other evidence from which proximate cause can be inferred is inapplicable here since there is no other evidence in the record from which proximate cause can be inferred.
Dr. Dennis’ testimony was directed to whether Dr. Lillie-wood was negligent, not to whether Dr. Lilliewood’s negligence was the proximate cause of Mrs. Green’s injuries.
Neither may an inference of proximate cause arise from the temporal relation of negligente to injuries. The simple fact that Mrs. Green received medical treatment sometime after Dr. Lilliewood’s negligence will not support a reasonable inference of proximate cause.
It should be noted again, although stated earlier, that Mrs: Green’s pain and suffering began in July 1969, one year before Dr. Lilliewood’s negligence in July 1970, existed during the thirteen (13) month period from July 1970 until September 1971 and continued thereafter up to and including the date of trial in September 1977.
I agree with the majority opinion that the only evidence introduced by Mrs. Green to establish proximate cause is her testimony regarding Dr. Lilliewood’s affirmative nod of the head. Since the majority opinion concedes this testimony does not comply with the “most probably” rule, a jury could find proximate-cause only through surmise, conjecture and speculation. Under established principles, this is impermissible.
As there was no evidence that would support the reasonable inference that Dr. Lilliewood’s negligence was the proximate cause of Mrs. Green’s injuries, the matter became one of law for the court and the trial judge correctly granted Dr. Lilliewood’s motion for a directed verdict.
I would affirm.