In any medical malpractice case, there are four elements that a person claiming malpractice must prove in order to win. First, there must be a duty of care: this is created by the medical provider-patient relationship; doctors are obligated to abide by a certain standard of care in treating patients. There must be a breach of the duty: the doctor did something that did not comply with the applicable standard of care. The breach must have caused injury to the patient, which resulted in damages.
Causation of an injury is often one of the most challenging elements to prove in a medical malpractice case. After all, the patient was already ill or injured, and it can be hard to show in some cases that a problem they experienced after consulting a doctor was the result of the doctor’s breach of duty, rather than an unfortunate complication of the patient’s existing condition.
In some cases, causation of a patient’s injury is direct and obvious. An example would be a surgeon who failed to consult a chart and amputated a patient’s healthy left leg instead of the damaged right one. But often, harm to a patient doesn’t spring directly from a doctor’s breach of the standard of care. Instead, the doctor’s breach creates a circumstance which makes it possible for the injury to occur. That is indirect causation, and it can be especially challenging to prove.
Let’s say a middle-aged woman comes into the emergency room complaining of lower back pain, weakness in her legs, and numbness in her inner thighs and buttocks. She’s had back pain for a while, but it has worsened significantly. The other symptoms came on suddenly, as did some urinary incontinence, which the woman has never experienced before.
These are all classic red flags for cauda equina syndrome, a compression of the bundle of nerves at the base of the spine. Cauda equina syndrome is a surgical emergency. The ER doctor makes the correct call of ordering magnetic resonance imaging (MRI) for the patient. The MRI clearly shows herniation of a disc and compression of the nerves, but the ER doctor fails to call a neurosurgeon for a consult, and misreads the radiology report. Instead of consulting with a neurosurgeon and admitting the patient for the urgent surgery she requires, the ER doctor discharges her with recommendations to follow up with a physical therapist.
Desperate for relief, the woman consults a physical therapist as instructed. The physical therapist does not review the woman’s medical record, and places her on a program of high-impact physical therapy. Not only does the therapy not help the patient, it places severe strain on her lower back, immediately worsening the nerve compression, causing excruciating pain, and rendering her unable to walk.
The patient is rushed back to the emergency room. This time, her cauda equina syndrome is recognized and she is rushed to the operating room for surgery. Unfortunately, the delay in treatment, coupled with the physical therapist’s actions, significantly worsened the patient’s injury. She suffers permanent paralysis of her legs, as well as urinary and fecal incontinence and sexual dysfunction.
In the scenario above, the direct cause of the patient’s injury was the physical therapy exercises initiated by the physical therapist who failed to read her medical history. But that encounter would never have occurred had the ER doctor correctly read the radiology report and consulted with a neurosurgeon who would have recognized the need for immediate surgery. So while the physical therapist’s actions directly caused the injury, the ER doctor’s breach of duty was an indirect cause.
Let’s imagine that we can “rewind the tape” and help things play out differently. If, during the patient’s initial visit to the ER, her doctor had consulted a neurosurgeon regarding the MRI results, there might have been a completely different outcome. The neurosurgeon would likely have immediately recognized the signs of cauda equina syndrome and rushed the patient to surgery. She would never have had the harmful physical therapy that further compressed the nerve root, leading to severe and permanent dysfunction.
An experienced medical malpractice attorney is skilled at “connecting the dots” that help a jury understand not only when a doctor directly causes an injury, but when their action (or inaction) is the indirect cause. A medical malpractice attorney typically enlists the services of knowledgeable, respected medical experts to help make causation clear to the jury.
Direct causation is often the result of an action: nicking an artery or a nerve during surgery, ordering the wrong dose of a medication, or amputating the wrong limb. Indirect causation is often the result of a failure to do something: failure to run tests that are indicated, failure to properly interpret test results, failure to diagnose an illness, failure to timely treat a patient.
These failures can create a situation in which another medical professional directly causes an injury. They can also allow a condition to advance unchecked, when the patient would have had a better outcome or chance had the doctor not failed to test, diagnose, or treat the condition.
If you have suffered a medical injury, it’s possible that more than one party may be at fault. There may be a provider who indirectly caused your injury, as well as one who directly caused it. To learn more, and hold all responsible parties accountable, contact the Fraser Law Firm to schedule a consultation.
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