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How to Prove Causation in a Medical Malpractice Lawsuit

Medical malpractice cases can be complicated. This is why it is important to have an experienced legal team on your side that understands how to prove medical malpractice so you can recover damages. One of the elements of a medical malpractice claim is causation. The injury victim has to show the doctor’s error caused the injury and harm. This is often one of the most difficult parts of a medical malpractice case. 

Causation may involve cause-in-fact and proximate cause. Cause-in-fact means that the patient’s injuries were caused by the doctor’s negligent actions. Proximate causation or “foreseeability,” may not be the most immediate cause of the injury but it could have been negligence that eventually led to the injury.  

This page will help you understand how to prove causation in a medical malpractice case and why it is so important to recover damages. If you were injured because of a surgical error or diagnostic error, you may suspect your injuries were caused by medical malpractice. Contact our experienced medical malpractice law firm for a free consultation. Contact our office today online or by phone at 800-529-6162.  

Causation in a Medical Malpractice Claim

There are several elements the plaintiff has to prove in a medical malpractice claim. The elements the plaintiff needs to prove are: 

  • Duty of care
  • Breach of duty
  • Causation
  • Harm

If the plaintiff cannot prove each element “by a preponderance of the evidence,” then the defendant may not be found liable for damages. A preponderance of the evidence means more than a 50% chance the evidence supported the claim. A jury can still find the elements are met when it is “more likely than not.” 

Doctors owe their patients a duty of care, to act as a reasonable doctor would in a similar position, given their training, experience, education, and community. If a doctor deviates from medical standards in treating the patient, the doctor breaches their duty of care. If the breach caused the injury and the patient suffered harm, the doctor may be found liable for medical malpractice. 

Actual Cause and Proximate Cause of the Injury

The actual cause of the injury means that the doctor’s actions in fact caused the injury. For example, in a cosmetic surgery procedure, the plastic surgeon may operate directly on the patient. During a liposuction procedure, if the surgeon improperly uses the liposuction device and it perforates the patient’s bowels, it could result in serious infection or death. In this type of example, the surgeon’s negligence is the cause-in-fact of the injury. 

However, not all medical injuries are caused by the direct negligence of the patient. For example, if a patient has heart disease, the heart disease may have been caused by a number of factors, including diet, activity level, and family history of the disease. However, if the patient goes for an evaluation and diagnostic tests show evidence of heart problems but the doctor does not notice the results, then the patient may go on as being misdiagnosed or have a delayed diagnosis. 

In this case, if the patient suffers a heart attack, the heart attack was caused by heart problems but the doctor may be responsible because the failure to diagnose the patient left the patient untreated, which may have been a foreseeable risk of making a misdiagnosis. 

Who Can Prove Causation in a Medical Malpractice Case?

There are many types of records, statements, and reports that are used to prove causation in a medical malpractice case. However, one aspect that is more common in medical malpractice cases is the need for expert witnesses. An expert witness is generally a doctor or other healthcare professional that understands the standards of care and can speak with authority about how the doctor involved in this case was negligent. 

Affidavit of Merit From an Expert

A medical expert is generally needed early on in a medical malpractice case. The medical lobby is strong and they have an interest in limiting the number of lawsuits filed against doctors. As a result, many states require a certificate of merit or an affidavit of merit from a doctor or expert that shows the plaintiff has a valid claim. 

For example, in a Maryland medical malpractice lawsuit, the plaintiff must file a certificate of merit within 90 days of filing a Health Care Alternative Dispute Resolution Office claim. A medical malpractice claim can be dismissed if the plaintiff fails to file a certificate of a qualified expert within 90 days from the date of the complaint. The certificate attests that both: 

  • There was a departure from standards of care; and 
  • The departure was the proximate cause of the injury. 

Qualifications for a Medical Expert 

Each party in a medical malpractice case may have their own medical expert. For example, the plaintiff’s medical expert may find that the doctor deviated from the standards of care which caused the injury. The defendant’s medical experts would likely find the opposite, that the doctor did not cause the injury, there was another intervening cause, or another party was responsible for the injury. It is up to the jury to determine which expert they believe most. 

To qualify as a medical expert, the judge makes the decision whether the expert is qualified based on the court rules. For example, under the Pennsylvania Rules of Evidence 702, “A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

  1. The expert’s scientific, technical, or other specialized knowledge is beyond that possessed by the average layperson;
  2. The expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; and
  3. The expert’s methodology is generally accepted in the relevant field.”

The average layperson does not have the scientific, technical, or specialized knowledge of medical care. A juror who works as a nurse may have a lot of medical knowledge but may still not know the standards of care for a neurosurgeon. Having another qualified neurosurgeon to act as an expert witness could help the jury explain the evidence and determine the cause of the injury. 

There are medical experts in just about every practice area. Depending on the case, your medical malpractice attorney may seek out a medical expert in the same area of practice as the alleged negligent doctor. For example, if your injury was caused by a cancer misdiagnosis, the expert in your case may be an oncologist, which is a doctor that specializes in the diagnosis and treatment of cancers. 

Medical Expert Reports Showing Causation

A medical expert may prepare an expert report on the case, showing their findings of causation for the medical injury. This report is based on a review of the medical records, testimony, and other evidence that was produced in discovery. The expert doctor would review all the records and relevant information, identify any breaches of care, and explain how the breach was a cause of the patient’s injuries. The expert report also generally contains the CV or qualifications of the expert. 

As part of discovery, medical expert reports that are going to be used in the malpractice case are exchanged with the other parties. The plaintiffs will get a copy of the defendants’ medical expert reports and the defendants will get a copy of the plaintiff’s expert report. In general, the other experts can review the reports and provide an additional statement on the other expert’s findings, if necessary.  

Depositions for Medical Experts on Causation

Oral depositions are another part of the discovery process. A deposition is out-of-court sworn testimony to gather information. Most parties in a medical malpractice case will have to go through deposition, where the other parties ask them questions about the case. Your attorney will be there to represent you during deposition and can object to any improper questions on the record. 

An expert may also be deposed in a medical malpractice case. If your expert witness is deposed, they will be questioned by the defense attorneys on their findings in the expert report, try and clarify any questions, and may try to challenge them on their findings. This is a common part of the medical malpractice process and the experts and your attorneys are very familiar with depositions. 

Expert Witnesses at Trial

If your case goes to trial, your expert witness may testify in front of the jury. Expert testimony generally involves summarizing the expert’s findings and explaining them to the jury. The expert may testify about their training, experience, and education, then explain their review of the case. The expert could then testify that they found there was a departure from standards of care, and the departure was the proximate cause of the injury. 

The defense will get a chance to “cross-examine” the medical expert, asking their own questions to try and challenge the expert’s findings. Your attorney will get a similar opportunity to challenge the defense experts’ findings. Ultimately, it is up to the jury to decide whether the plaintiff has demonstrated, by a preponderance of the evidence and testimony, all the elements of a medical malpractice lawsuit, including duty, breach, causation, and harm. 

Multiple Causes of a Medical Injury

Medical malpractice cases often involve claims that there is more than one party that was responsible for the medical injury. There may be a number of health care providers who all failed to properly care for the patient, or a hospital that failed to properly monitor employees and equipment. There may be more than one party that caused the injury. 

Where there is more than one party that caused the injury, it may be up to the jury to allocate the amount of liability for each party, adding up to 100%. For example, if a patient was injured during a heart surgery, the jury may have found that a radiologist, cardiologist, and the anesthesiologist all shared some responsibility for causing the injury. The jury would have to allocate liability based on who was a cause of the injury, such as: 

Collecting Damages After Injuries With Multiple Causes

In the example above, if the injury victim suffered $1 million in damages, how would they collect from multiple parties. Each state has different laws involving joint liability claims. Under several liability, each defendant is only responsible for their share of the damages. This may seem fair to the defendants but it can cause an unjust result for the injury victim. 

In the example above, if the cardiologist is deeply in debt and has no resources to pay for the damages, the plaintiff may only be able to collect $250,000 from each the radiologist and anesthesiologist. The injury victim would still have suffered $500,000 in additional damages without compensation. Joint and several liability laws help to protect the injury victims where one party may be insolvent. 

Under joint and several liability, each defendant is liable for the total amount of damages, even if they were only partially at fault. The defendants can then collect contributions from the other defendants, placing the burden of collection on the defendants and not the injury victim. There are several variations to joint and several liability laws, depending on the state. 

Pure Joint and Several Liability States Like Maryland and D.C.

Washington, D.C. and Maryland are examples of pure joint and several liability states. In these jurisdictions, the injury victim can sue one defendant for the full amount of the damages. The injury victim could collect from any of the defendants and may try to collect everything from the defendant that is the most solvent or financially able to pay. The paying defendant then has to seek contributions from the other defendants.

Modified Joint and Several Liability States Including Illinois and Pennsylvania

Pennsylvania and Illinois are modified joint and several liability states. For an injury victim in Philadelphia, where the defendant is more than 60% at fault for the injury, the injury victim can recover joint and several liability. If no defendant is more than 60% at fault, the injury victim has to recover the damages based on each defendant’s level of fault. 

However, for injury victims in Chicago, there is joint and several liability for any defendant that is 25% or more liable for the damages. However, if a defendant is less than 25% liable, there is joint liability for medical expenses only and several liability for other damages. 

Medical Malpractice Attorneys Who Understand Causation

At Gilman & Bedigian, our experienced trial lawyers have helped our clients and their loved ones recover millions of dollars in compensation after medical errors and diagnostic errors. We have years of medical malpractice experience serving injury victims and their families. Contact us online or call our law office at (800) 529-6162 for a free consultation.

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