Medical Malpractice Legal Update -- Third Edition

"Causation Defense Prevails"

To prevail in a medical malpractice action the plaintiff must establish the following as to each defendant: the standard of care owed by the defendant, the defendant’s breach of the standard of care, and that said breach proximately caused the damages claimedCiting Gooding v. Univ. Hosp. Bldg., Inc., 445 So.2d 1015, 1018 (Fla. 1984).  The holding in Hollywood Medical Center, Inc. v. Alfred, Nos. 4D09-4878 and 4D10-1003 (Fla. 4th DCA 2012) highlights the importance of the third element. Hollywood Medical Center (hereinafter “HMC”) appealed a final judgment in favor of the plaintiff and argued the trial court erred in denying their motion for directed verdict, as the plaintiff failed to prove that any negligence on the part of HMC’s nursing staff affected Ursuline Alfred’s outcome, or that had the negligence not occurred, Alfred more likely than not would have survived.

Alfred presented to HMC after having suffered a mal seizure.  HMC nursing personnel evaluated Alfred 8 minutes after she arrived to the emergency room.  They recorded her vital signs and described her as a level 2 patient; however, her vital signs corresponded to a level one patient, meaning she required the most intensive care.  The emergency room physician simultaneously presented at bedside and ordered medication to prevent another seizure.  Thereafter, Alfred went into full cardiac arrest and was pronounced dead 38 minutes after arriving at the hospital.

Plaintiff’s experts opined Alfred suffered a pulmonary embolism, which she could have survived had the physician intubated Alfred upon his initial evaluation.  With respect to the nursing care, Plaintiff’s expert opined nursing personnel fell below the standard of care when they failed to take Alfred’s vital signs immediately upon presentation to the hospital, characterizing her as a level 2 patient, and failing to question the physician’s choice of drug treatment.

HMC moved for directed verdict as to its vicarious liability for the physician and its nursing staff.  HMC argued the plaintiff failed to prove that the nursing staff’s breach in the standard of care caused Alfred’s death.  Plaintiff only proved the physician’s failure to intubate contributed to Alfred’s death.  No one testified the nurses’ failure to act adversely affected Alfred’s outcome.  Without such testimony as to causation, the defendant is entitled to a directed verdict.  A plaintiff in a medical malpractice action must show more than a decreased chance of survival because of the defendant’s conduct.  Rather, the evidence must show the acts or omissions adversely affected the patient’s outcome.

Practice Note:

If there are several possible causes of injury to the plaintiff, and the evidence does not eliminate the non-negligent causes, the plaintiff has not met his burden of proof.

For further assistance or questions, please contact:

·         Paula Parisi (email to:; 813-864-9311)

Partner in Cole, Scott & Kissane, P.A.’s Medical Malpractice Group.

Our team is available to discuss the topics written here and ready to provide additional information contained in this article. Contact us for more information.

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