December 24, 2018

In a brand-new opinion, Ruiz v. Tenet Hialeah Healthsystem, Inc., et al., the Supreme Court of Florida reinforced that the concept of causation in medical malpractice is broad and should be left to a jury. The fact pattern in Ruiz involved a patient who was misdiagnosed with a tumor instead of multiple myeloma. Without ordering a biopsy to confirm the diagnosis, the treating neurosurgeon recommended a surgery to remove the “tumor”. During the surgery, the patient, Ms. Espinosa, went into cardiac arrest due to undiagnosed cardiac risk factors and passed away.

Surgeon looking over an x-ray with a look of discontent and hand over their face with another doctor overseeing

Ms. Espinosa’s estate brought a wrongful death medical malpractice case against a host of doctors and the hospital. One of the defendants was an anesthesiologist, Dr. Lorenzo, who had failed to recognize abnormal test results during the pre-operative clearance. The estate contended that had the defendant anesthesiologist pronounced these abnormalities, the surgery would have been cancelled and Ms. Espinosa would not have died.

The defendant doctor sought to have the case dismissed based on a failure to prove causation, e.g., that he was the legal cause of the patient’s death. Causation is a legal concept that bridges the gap between a defendant’s wrongdoing (negligence) and the damages sought by the plaintiff. In every personal injury and medical malpractice case, the plaintiff must prove that the defendant’s negligence was the legal and proximate cause of the injuries and damages that she is claiming.

In the Ruiz case, the defendant anesthesiologist argued that he was not the proximate cause of the patient’s death. Specifically, the anesthesiologist argued that it was the fault of the surgeon in making an incorrect diagnosis and deciding to operate that caused Ms. Espinosa’s death. The trial court agreed with the defendant and granted him directed verdict. The Third District Court of Appeal affirmed the trial court’s decision, holding that there was no competent, substantial evidence to conclude that the anesthesiologist was the “primary cause” of Espinosa’s death.

On appeal, the Supreme Court of Florida reversed the lower courts and overturned the directed verdict for the defendant. The Supreme Court first pointed out the heavy burden that a party has in properly receiving a directed verdict – that no proper view of the evidence could sustain a verdict in favor of the nonmoving party. With this stringent level of scrutiny set forth, the Supreme Court offered a lengthy and informative reiteration of the law on causation in medical malpractice cases.

First, the Supreme Court reinforced that Florida follows a “more likely than not” standard of proof for causation. This means that the plaintiff only has to prove that the negligence “probably caused” the injury, unlike criminal cases where “beyond a reasonable doubt” is the standard. Next, the Supreme Court went through Florida common law on causation, holding that causation is established when the damages suffered “was a foreseeable consequence of the danger created by the defendant’s negligent act or omission”. The Supreme Court set forth that in nearly every case, it is the role of the jury, as finder of fact, to decide if a plaintiff has proven causation.

Applying the law on causation to the facts of Ruiz, the Supreme Court ruled that the plaintiff presented a colorable claim. The rationale was that but for Dr. Lorenzo’s failure to recognize and report the abnormal test results, the fatal surgery never would have occurred. While Dr. Lorenzo’s negligence was not the actual cause of Ms. Espinosa’s death, he can be held liable for his part of failing to report the abnormal test results and its contribution towards the fatal result. The Court referred to its prior holding in Saunders v. Dickens, to wit, that a treating physician, “cannot insulate himself or herself from liability for negligence by presenting a subsequent treating physician who testifies that adequate care by the defendant physician would not have altered the subsequent care.”

As you can see, the medical malpractice world is complex and you need an experienced lawyer in this field. If you or a loved one has been seriously injured or killed due to the mistake of a medical provider, call The Grife Law Firm today for a free consultation.