Question

A 75-year-old man is recovering in the hospital from a left-sided below-the-knee amputation. Three days after the surgery, the patient suddenly develops chest pain and shortness of breath that last for 20 minutes. His pain medication is increased, which improves the pain but not the shortness of breath. X-ray of the chest is negative for a pulmonary embolus, so the medical team decides to monitor him expectantly. The next day, a similar episode of shortness of breath and chest pain occurs. The patient then sustains cardiac arrest and dies. Autopsy reveals multiple pulmonary emboli. The family threatens to sue for malpractice for mismanaged postoperative care. Which of the following is necessary to prove malpractice?

(A) A patient directly suffers harm

(B) A physician’s presence at the time of injury

(C) Intent to harm

(D) Proof beyond reasonable doubt

(E) Use of standard procedures

Answer 1

The correct answer is A. Malpractice suits require that the patient prove dereliction, damage, and direct harm by a physician with whom there was an established relationship. Direct harm is a concept that the injury is causally related to the actions of the physician. This is also known as proximal cause, and in many cases is the most difficult aspect to prove, as a temporal relationship does not necessarily imply a causal relationship.

Answer B is incorrect. It is not necessary for the doctor to have been present at the time of injury, but there must be an established relationship between the physician and patient.

Answer C is incorrect. Intent is not a factor in malpractice proceedings. These proceedings are civil lawsuits, not criminal. As such,when intent or gross misconduct is proven, additional punitive damages may be assessed against the physician.

Answer D is incorrect. As malpractice suits are civil rather than criminal proceedings, the plaintiff is required only to prove “more likely than not” that the actions of the defendant led to damages.

Answer E is incorrect. Proof of malpractice requires dereliction, or deviation from standard procedure, that leads to the injury in question.