The bare minimum required to prove a medical malpractice claim requires a patient to establish:
- The healthcare provider undertook and had a duty to care for the patient;
- The healthcare provider violated that duty i.e. deviated from the standard of care and was negligence;
- The healthcare provider’s negligence was an actual cause of harm to the patient; and
- Harm in the form of injury or death.
Was there a Duty of Care?
To make out a viable medical malpractice claim the patient must prove that a doctor-patient relationship existed at the time of the events in question. Generally, any time a doctor or nurse or in the course of their business treats or provides medical care or advice to a patient the duty to provide reasonable care exists. In most instances, the patient’s medical records prove which healthcare providers rendered care and in turn owed a duty of reasonable care to the patient.
A patient will not be able to establish a claim of medical malpractice if the doctor or nurse can show that the doctor-patient relationship had terminated before the events in question or never existed in the first place.
Was it Medical Negligence?
Once you have proven duty of care, the next step is to determine whether there was a breach of the standard of care i.e. whether the healthcare provider not as careful or skillful as they should have been under the circumstances. In Pennsylvania, A doctor must have the same knowledge and skill and use the same care normally used in the medical profession. A doctor whose care falls below this standard of care is negligent.
Additionally, Pennsylvania requires doctors to use current skills and knowledge in their care of patients. In other words, a doctor must have up-to-date medical skills and knowledge, and if he or she fails to keep current or fails to use current knowledge in the medical treatment of the patient, the physician is negligent. An example would be the development of a new surgical technique which provides greater safety and better outcomes for patients. If a doctor performed a surgery on a patient using an out-of-date technique and not the current, best technique and injured that patient, the doctor would be negligent.
Did the Negligence Cause Harm?
In order to succeed in a medical malpractice claim, the patient must prove that the negligence caused actual harm to the patient. If there was negligence but it had nothing to do with the patient’s injury, then the claim fails.
In Pennsylvania, there are two ways in which causation can be established: Factual Causation and Increased Risk of Harm.
Negligence is a factual cause of the patient’s harm when the harm would not have occurred “but for” the conduct. To be a factual cause, the conduct must have been an actual, real factor in causing the harm, even if the result is unusual or unexpected.
One interesting point is that to be a factual cause, the defendant’s actions do not have to be the only factual cause. The fact that some other causes combine with the negligence of the defendant in producing an injury does not relieve the defendant from liability as long as his or her own negligence is a factual cause of the injury.
An example would be where a patient slipped and broke their leg and developed a dangerous condition called compartment syndrome (when pressure within the muscles builds to dangerous levels). If left untreated this condition will lead to the death of the patient’s muscle and nerves and potentially require amputation.
If a doctor cares for this patient but fails to recognize in time that compartment syndrome is present and the patient suffers injury from the delay as a result, the doctor can be said to have been a cause of the harm but not the only cause of the harm. Although the original injury and the compartment syndrome combined to cause the injury, the doctor’s negligence is a legal cause and damages may be awarded.
Increased Risk of Harm
When a healthcare provider acts negligently but it is impossible to state with 100% certainty what injury was caused thereby, the increased risk of harm standard may apply for Pennsylvania medical malpractice claims.
One of the great Court holdings on this point states, “When a defendant’s negligent action or inaction has effectively terminated a person’s chance of survival, it does not lie in the defendant’s mouth to raise conjectures as to the measure of the chances that he has put beyond the possibility of realization. If there was any substantial possibility of survival and the defendant has destroyed it, he is answerable. It is rarely possible to demonstrate to an absolute certainty what would have happened in circumstances that the wrongdoer did not allow to come to pass.” In short, Pennsylvania recognizes that it is often
impossible to demonstrate to an absolute certainty what would have happened under circumstances that the doctor did not allow to happen due to their negligence.
Pennsylvania law holds that when a healthcare provider negligently fails to act or negligently delays necessary care, and his or her negligence is a factual cause of injuries to the plaintiff, that negligent defendant physician is responsible for the injuries caused.
In order to establish this type of causation, the patient must present expert testimony that the failure to act or delay on the part of the doctor increased the risk to the patient of the harm the patient experienced. This type of testimony provides a sufficient basis to find that negligence was a factual cause of the injuries sustained.
Was there Harm?
Finally, the healthcare provider’s failure to meet the standard of care must have caused actual harm. Practically speaking because of how expensive and difficult medical malpractice lawsuits are to undertake, the harm needs to be substantial. A discussion of the types of damages applicable and recoverable from medical malpractice actions will be discussed in more detail in the following article titled “What Damages Are Available For Medical Malpractice?”