What Constitutes a Legitimate Medical Malpractice Claim?


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Not every doctor's mistake can be classified as malpractice. There are a variety of specific factors that must be taken into consideration if a claim of medical malpractice is to be considered valid.

Definition of Medical Malpractice

The definition of medical malpractice varies somewhat from state-to-state but, in general, it means that a doctor failed to comply with the standard of acceptable care in performing his or her duties, and this harmed a patient. When the case involves a nurse, it may be referred to as a "nursing malpractice" claim or case, and the same principle applies--i.e. the nurse failed to comply with acceptable standards, thus harming a patient. When this type of case is filed against a different healthcare provider, e.g. respiratory therapist, physician assistant, etc., it can also be referred to as a "healthcare provider malpractice" case or claim. Generically, all of these types of "malpractice" cases are often called "healthcare liability cases." There are certain principles or elements that are required for most malpractice or health care liability cases.

Fundamental Requirements of a Claim

There was a relationship between the healthcare provider and the patient

In order for the claim to be valid, the healthcare professional must have assumed or provided care for, or been hired by, the harmed patient. This means that a person cannot sue a doctor for taking advice they overheard him or her give at a party; it must be shown that the patient had some type of professional relationship with the professional they are now suing. Sometimes the relationship may occur because one healthcare provider assigns another to care for a patient, such as in a hospital setting when a hospital-based doctor like a emergency medicine physician, radiologist, or pathologist is assigned by the hospital to interpret tests for the patient. The same is true with respect to nurses who are provided by a hospital to care for the patient. In these situations, even though the patient may not have selected or chosen the physician or nurse, the relationship necessary for a claim still exists because the doctor or nurse assumed or provided care (usually because of a contract or employment with the hospital) for the harmed patient. The same is true of doctors who have agreements or arrangements to care for each other's patients, for example on weekends. These situations, often referred to as "on-call," mean that when the doctor accepting the on-call responsibility assumes and provides professional care for the patient, the relationship exists--again, even though the patient may not have selected the on-call doctor. The physician-patient, or healthcare provider-patient, relationship is what gives rise to a legal obligation or duty for the doctor or other healthcare provider to follow acceptable standards in caring for the patient.

The healthcare provider was negligent

Being unhappy with the results of treatment does not constitute medical malpractice. For a claim of malpractice, it must be shown that the doctor or other healthcare provider did not provide care at the ordinary acceptable level--meaning the actions or inactions of the healthcare provider did not meet the "standard" of care. A doctor or nurses' care is not required to be perfect, but it should reasonably skilled and cautiously provided. If it is shown that the healthcare provider acted unreasonably, carelessly, or somehow did not comply with the standard of patient care for his or her profession, then in many states this would amount to negligence. To prove negligence, invariably the testimony of an expert witness, i.e. another physician, nurse or healthcare provider (oftentimes in the same field or specialty), is required to testify that the care giver did not comply with what was the ordinary or acceptable practice in effect under the same or similar circumstances.

The negligence caused harm to the patient

This can sometimes be a difficult element to show in medical malpractice cases. Since these cases typically deal with patients who are already ill or injured in some way, it may be difficult to show that the harm resulted from a healthcare provider's negligence, as opposed to being a result of a preexisting medical condition. For example, if a person dies after lung cancer treatment, it may be difficult for his or her family to show that the death occurred due to improper treatment as opposed to the cancer itself. A delay in proper treatment however, i.e. a negligent omission, can be just as much a cause of harm as is a negligent act (commission). And the law in most states is that the the healthcare provider's negligence need not have been the only cause of the patient's harm; it is sufficient so long as it was "a" proximate cause or one of the "substantial" causes of the harm. This normally requires the testimony of a medical expert witness, who can help in pinpointing how and why the healthcare provider's negligence was a cause of the patient's harm; the expert witness usually has to testify how and/or why the standard of care violation was a cause (with reasonable certainty or probability) of the harm, and that no harm would have occurred, or lesser harm would have occurred, but for the healthcare provider's negligence.

The injury resulted in damages

Even if it can be shown that a medical professional was careless and failed to perform the duties of their profession, they are usually not responsible unless it can be shown the patient suffered harm resulting in damages. Usually this is more straightforward because harm is in the nature of a physical injury that results in impairment, disfigurement, pain or mental anguish--so called non-economic damages. Likewise, such physical injuries often result in economic damages--e.g. additional medical or healthcare bills and expenses, and lost wages, benefits or employment, etc. Some states medical malpractice laws set limits or "caps" on damages that are recoverable by the patient. In some states there are limits on non-economic damages, while other states have limits on economic damages; and, other states have limits on both of these types of damages. So, even after a trial if the verdict is in favor of the patient, the judge may still be required to reduce the victim's award to the legal limits or caps.

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