Patients commonly have multiple medical practitioners that have some responsibility for their care. During a given period of time, a patient may interact with their primary care physician, a diagnostic practitioner such as a radiologist, a specialist, a pharmacist, and a therapist. As the patient moves along this healthcare continuum the opportunity for errors or mistakes that could lead to actions of medical malpractice may arise. Determining causation or fault when there are subsequent medical professionals involved can be challenging. For example, one doctor may fail to diagnose a patient's condition and then a second doctor may demonstrate negligence subsequently.
The Basis for a Claim of Medical Negligence
Defendants in a medical malpractice claim may use a superseding causation defense that raises doubt about liability creating a sort of “hot potato” scenario. To prove a medical negligence case, several key elements must be satisfied including duty, breach, causation, and harm. The practitioner must have had a duty to provide patient care. This care must be provided at a level that meets the current standards for the profession. The plaintiff must show that this duty was breached, which caused an injury that entitles them to damages. Establishing this link definitively among multiple or subsequent providers clearly may be difficult.
The surviving family of Lance Copsey brought a medical malpractice claim against Dr. John S. Park in a Maryland court. Park allegedly misinterpreted an MRI report several days before Copsey had a stroke and died. A jury heard the case and was given instructions regarding the concept of superseding cause. The jury found that Park's reading of the MRI report was not negligent because it could not be determined to be the actual or proximate cause of the fatality. An appeals court later affirmed this ruling based on superseding causation. The negligent actions were deemed as independent from one another and the subsequent provider was determined to be the liable party.
Intervening or Supervening Cause
Superseding cause is often referred to as “intervening” or “supervening” cause. This involves an initial potential act of negligence followed by potentially negligent treatment by another practitioner. Often the original practitioner's potential liability relates to some failure to diagnose or an untimely diagnosis. The question is whether the liability (responsibility) for a patient's injury that occurs is shifted to the next provider or remains with the original one.
Maryland Establishes Test for Superseding Cause
The Maryland courts use a set of considerations that must be applied when determining a superseding cause. These points are outlined in the Restatement of Torts Section 442 and are as follows:
- If the intervening action resulted in a different form of harm beyond that of the original provider's negligence
- Were the results or consequences that occurred after the initial practitioner's care considered normal or expected?
- If the intervening provider was acting independently from the original provider or not
- Whether the “intervening force” was attributed to a “third-party's” actions or inactions
- The “degree of culpability of a wrongful act” of a third-party that established a supervening force