Legal Elements of Medical Malpractice: In the United States, the
patient alleging medical malpractice must generally prove four
elements or legal requirements to make out a successful claim of
medical malpractice [6]. These
elements include: (1) the existence of a legal duty on the part
of the doctor to provide care or treatment to the patient; (2) a
breach of this duty by a failure of the treating doctor to
adhere to the standards of the profession; (3) a causal
relationship between such breach of duty and injury to the
patient; and (4) the existence of damages that flow from the
injury such that the legal system can provide redress. (Bold
added)
The first
element is that a legal duty existed toward the patient; this
duty comes into play whenever a professional relationship is
established between the patient and health care provider. The
general idea of a legal duty is that in civilized society, each
person owes a duty of reasonable care to others. Extending this
concept to the professional setting, where a doctor provides
service to a patient, the doctor is said to owe a duty of
reasonable professional care to the patient. In practical terms,
this is the easiest element for the patient to establish, since
such a duty is essentially assumed whenever a physician
undertakes the care of a patient. A duty does not exist where no
relationship is established between the doctor and patient; but
when a relationship is established, such as covering patients
for a colleague, covering a clinic where indigent patients are
treated, or providing emergency services to an accident victim
by the roadside, a duty of reasonable care follows. In some
situations, for policy reasons related to promoting medical care
for indigent patients, or encouraging intervention by medical
bystanders in case of an accident, the law may limit the
liability of the treating physician, even though a reasonable
duty of care was established. An exception to the duty of care
is when the physician sees the patient as a nonprofessional,
such as outside the hospital or clinic, or in some social
setting. In such cases, usually no doctor-physician relationship
is established, and then there is no duty of reasonable medical
care owed.
To show that a
breach of professional duty occurred, the patient must invoke
the concept of standard of care. While the precise definition of
“standard of care” can differ among jurisdictions and the
concept can prove elusive in its application, the standard of
care generally refers to that care which a reasonable, similarly
situated professional would have provided to the patient. To
establish breach of a standard of professional care, expert
witness testimony becomes essential since a jury of lay persons
cannot understand the nuances of medical care. Some breaches of
the standard of care are so egregious that expert testimony is
not needed; thus an operation on the wrong limb is an obvious
breach of duty that speaks for itself. This concept is captured
in the legal term called res
ipsa loquitur (Latin for “the thing itself speaks” but
more often translated as “the thing speaks for itself”); in such
cases, the legal proceeding is abbreviated and the jury can
proceed to determining damages since the breach of duty is
plainly obvious. There are variations in the applicable standard
of care in some states, depending upon the patient care scenario
(such as care given in the Emergency Room in Florida).
A breach of
the standard of care in itself, aside from being a potential
quality of care concern for the medical practitioner or
institution, is legally meaningless unless it causes an injury
to the patient. This “so what?” question frames the third
element of medical malpractice, which is causation. To prove
this element, the injured plaintiff must show a direct
relationship between the alleged misconduct and a subsequent
injury. Alternatively, the patient can show a legally sufficient
relationship between the breach of duty and the injury; this
concept is referred to as proximate causation.
The fourth and
final element of medical malpractice lawsuits is called damages.
A medical malpractice claim generally concludes with a
calculation of damages. Since monetary damages are easy to
calculate and administer, courts hearing medical malpractice
cases will determine money damages to compensate the injured
patient. Punitive damages are more rare in medical malpractice
cases, and are reserved by courts for especially egregious
conduct that society has a particular interest in deterring;
examples can include altering or deliberate destruction of
medical records or sexual misconduct towards a patient. Absent a
showing of damages, a plaintiff cannot maintain a cause of
action for medical negligence. Thus if a fractured tibia was
treated using closed reduction and cast application when the
fracture pattern clearly called for open fixation, it may
constitute negligence if the fracture went on to nonunion or
malunion, requiring multiple operations and increased expenses.
But if the fracture went on to uneventful healing despite the
wrong treatment and the patient pleaded injury from this
treatment but with no showing of actual damages, there would be
nothing for the court to award. However, certain states have
limitations on the amount and types of damage awards by statute
(such as for non-economic damages).
Reproduced, in
part, as amended, from Public Domain website, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/
Our
Note: Although the
term "Medical Malpractice" is often interchanged with "Medical
Negligence" the standard of care does vary, for example in
Florida under Florida Statutes 768.13, for an Emergency Services
health care provider, "reckless disregard" as defined within
that Statute, replaces the usual standard of care of
"negligence." Under that same act, there is also a different
standard of care for a "Good Samaritan" who was not working, at
the time and place where they provided assistance, as an
Emergency Services provider.
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decision that should not be based solely upon advertisements.
Before you decide, ask us to send you free written information
about our qualifications and experience.
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