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Medscape Report And “Causation Defense” In Medical Malpractice Cases

A causation defense is a strategy that can potentially be used to defend against a medical malpractice claim. It is commonly used when the basis for the claim is a failure to diagnose a condition, or a failure to do so in a timely manner. The defense may acknowledge that a patient’s medical condition could have been detected sooner; however, that the delay did not ultimately change the outcome. An example would be that a terminal disease had already developed to a stage where the fate of the patient was already determined. As with most medical malpractice defenses, having detailed medical records throughout the course of treatment is critical.

Example Scenario

A 75-year-old patient sees a new primary care physician because his existing doctor recently retired. The doctor orders the patient to have some blood testing. After looking at these results, the patient is referred to a cardiologist for further testing and told to then return for a visit in three weeks. The patient reschedules this appointment and an additional month passes before the cardiology report will be fully reviewed.

When the patient returns he complains of urinary problems and the doctor refers him to a urology specialist. At this visit, it is determined that he has prostate cancer that has progressed. The family of the patient feels that the doctor should have made this diagnosis sooner. The defense acknowledges that it was possible that the disease could have been detected sooner. The defense states that the disease was very aggressive. They have an expert who testifies that an earlier diagnosis would not have led to a different result. One reason is that there are very limited treatment options for a man of his age.

Fundamentals of Medical Negligence

To understand causation it is important to view it as a component or element within a claim of medical negligence as follows:

  • Duty: The medical professional has a duty to provide a level of care using knowledge and skill that meets the standards of the profession
  • Breach: The plaintiff must prove that this duty was breached, often using an expert
  • Causation: The plaintiff must show that the injury incurred was caused by the breach
  • Harm: A clear link must be established between the injury and that the plaintiff is entitled to damages to compensate for the harm

Understanding Causation

The majority of personal injury cases are heavily focused on the damages. The damages are a critical aspect that must be clearly assessed and understood. When using a causation defense you are not focusing on the damages, but instead challenging the jury to question whether the medical professional was actually liable. If liability is not clearly established, then the damages lack any relevance. To be successful, a claim of medical malpractice must prove that the injury was preventable. If causation cannot be clearly proven, this claim will not succeed.

Comparing Causation in Medical vs Legal Terms

A medical malpractice claim must be fact-based and have a timeline. Typically it will be necessary to have an expert cite specifically how the standards of care were breached and how injury or death could have been prevented. Many medical experts tend to approach causation from a medical perspective. More specifically, this means that the causation is proven with nearly complete confidence and clearly supported by facts. Medical experts often mistakenly take this approach to prove causation, when actually they only need to establish that causation is probable.

About the Author

Briggs Bedigian
Briggs Bedigian

H. Briggs Bedigian (“Briggs”) is a founding partner of Gilman & Bedigian, LLC.  Prior to forming Gilman & Bedigian, LLC, Briggs was a partner at Wais, Vogelstein and Bedigian, LLC, where he was the head of the firm’s litigation practice.  Briggs’ legal practice is focused on representing clients involved in medical malpractice and catastrophic personal injury cases. 


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