A recent post outlined challenges in proving causation, the second of the three elements of a medical malpractice case. Here, we look at a related issue: indirect causation.
Let’s examine the following hypothetical scenario.
A woman arrives at the ER with a herniated disc squeezing her nerve roots, causing severe pain in her lower back. Based on the information the ER provides during a telephone consult, a neurosurgeon decides that the patient doesn’t need surgery right away, and recommends that she instead be admitted to the hospital for pain management. But the neurosurgeon then does nothing to follow up with the patient—doesn’t read the MRI showing the disc compression, doesn’t even see the patient. In the meantime, a pain specialist injects an epidural into the patient’s back, causing permanent neurological deficits by further compressing the nerves. In this situation, who caused the injury?
The answer is probably both physicians. It’s clear that the pain specialist directly caused the injury with the injection. But what about the neurosurgeon? Although indirectly, the neurosurgeon’s failure to follow up also caused the injury.
The indirect link is easier to see if you imagine what would have happened if the neurosurgeon had followed up. In that case, he would have realized that the patient’s nerves were severely compromised, that she needed surgery soon, and that giving her an epidural injection was completely off-limits. Had the neurosurgeon done his job, he would have precluded the injection. Instead, his inaction cleared the way for the injection, indirectly causing the injury.
When the causal link between negligence and harm is indirect, lawyers will sometimes say the negligence “led to” or “contributed to” the patient’s injury. This is indirect causation.
To read more about causation, click here.
To read more about negligence, click here.
To read more about the three elements of a medical malpractice case, click here.
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