Medicine and the Law – Part 3: Causation




Health and Healthcare CategoryOur series on Medicine and the Law continues. Previously, I wrote about what is necessary for a physician-patient relationship to exist — contract and consent. Then I went on to discuss medical malpractice and that a legitimate grievance from a patient must show that the physician has a duty to the patient, violated that duty by departing from the standard of care, and that the violation caused harm to the patient. Causation is not a simple cut and dry thing to show.

In general, most common people understand the concept of cause. In legalese, there are two types of cause — proximate and cause-in-fact. Cause in fact means that the act must have been necessary for the outcome, even if the act is not the only cause of the outcome. An example would be when a surgeon operates on a patient who has other co-morbidities such as severe clotting disorder. During the surgery on another part of her body, she suffers a clot. In this case, the surgeon may be liable for the clot even though it was partly the result of her pre-existing condition.

Courtroom GavelOn the other hand, proximate cause is when even though the physician’s act was the factual cause of a patient’s injury, the type of injury is so unlikely and unforeseeable that liability for the physician would be in conflict with general public policy. An example would be when a patient has a very rare disease that causes a poor reaction to a physician’s treatment. In that case although the treatment was the cause, it was so unforeseeable that there should be no liability. In other words, nothing could have prevented it and it could have happened to any other physician providing that patient treatment.

One thing a physician has in his/her defense is called contributory negligence. A physician can always claim the defense of contributory negligence — that the patient’s negligence contributed to the injury. An example of this would be when a patient does not tell his doctor of an allergy to medicine and the doctor prescribes the medicine and the patient has a bad reaction. Another example would be when a patient does not tell her plastic surgeon that she previously had surgery before on that same body part. The surgeon encounters difficult scar tissue during the surgery and must resect tissue that affects the cosmetic outcome of the patient.

In these situations the physician’s liability can often be reduced to partial liability or no liability.

Thus as you can see, it is not a simple cause and effect relationship when it comes to medical liability. All parties are usually involved and thus there is the need by doctors and patients to be upfront about history, expectations, and desired outcomes when it comes to medical care.

  • Ida

    True, the anesthetists comes and asks the patient to sign a form which warns them about any possible consequence of their surgery. What the doctor doesn’t realize(why I have no idea, but some practitioners do not seem to understand the way humans think) is the patient has just had their IV put in, been given pain medication and some sort of relaxant, and most likely does not have the energy to read the long document they get to sign. That’s one part of it.

    The other part is when a doctor purposely puts a patient through needless tests, because he/she happens to be getting free research out of it. (This has happened to me) The doctor is putting the patient through much pain and agony all for nothing! It can get quite ridiculous! There is another opportunity for a patient to sue.

    The next would be a surgeon cutting a body part “by accident” and damaging the patient indefinitely.

    I have been through each of these situations, and more, but I have never sued. It wasn’t because I am rich and didn’t need the money, it was because I was a nice person and therefore did not want my neurosurgeon’s premium to go up. I do think in certain situations, the doctor should pay, and sometimes I look back and wish I made my doctor pay–he has since injured a few other patients. Maybe I could have prevented that.

    You are only looking at one side of the argument because you are a physician of some sort, but next time you have to see a patient think of how you screwing things up affects their entire lives.

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  • gluck7104

    Thank you for expressing well ,my sentiments Exactly !!! It’s been my experience that many of the doctors in positions of power, abuse thier patients mentally. It’s as though they aren’t treating a ill/medicated person at all. I cannot believe that when a ‘dr’ makes an error,he and the media tell the public to be informed consumers, that we the patient must take responsibility for our own health outcomes. If I paid my mechanic to fix my car, I’d expect that he knew what he was doing and beyond bringing my car to him(because I know only basics) It is HE tha better know HOW TO FIX MY CAR and not my fault as a consumer that HE doesn’t . If my car doesn’t get fived. I sue for my money back. Why do doctors foist thier lack of skill on the ILL patient???

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JC, MD

Dr. JC is a medical doctor who has a passion for health promotion and education.
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