Litigation Education: The Four Elements of Proof

Foreword by Kristi Wright 
For physicians and attorneys in a medical negligence claim or lawsuit, it’s essential to understand the key elements that need to be proven for a case to be successful. These elements—Duty, Breach, Causation, and Damages—are the foundation of any medical malpractice case. Kelley Marsh, a Claims Consultant with Curi, will break down what these terms mean and why they’re so important in both defending and evaluating a claim.

To understand the four essential elements of proof, let’s start with a simple example from our everyday world of driving to help illustrate how these elements work:

An Everyday Example: Car Accident 

Dan is driving to work when he gets distracted by a roadside sign. By the time he looks up, traffic has slowed, and he rear-ends Stacy’s car, causing damage to her vehicle and a minor injury to her neck. In this situation, Stacy could likely win a negligence claim against Dan. Here’s how she would be able to prove all four elements of negligence:

1. Duty: Every driver on the road has a responsibility to drive safely and avoid causing harm to others. This is the duty Dan owed to Stacy.
   
   
2. Breach: Dan didn’t live up to that duty when he rear-ended Stacy’s car.
   
   
3. Causation: The collision caused damage to Stacy’s car and her neck, directly linking Dan’s actions to the results of the accident.
   
   
4. Damages: Stacy’s damages include the cost to repair her car and the medical bills to treat her neck injury. 

Now consider how these elements apply to a medical malpractice claim or suit. 

In a medical malpractice case, the same four elements apply, but they’re specific to the relationship between the patient and the healthcare provider. Let’s break them down one by one:

1. Duty Owed 

The duty that is created between a patient and medical provider can be viewed through several lenses. The Hippocratic Oath discusses using your best judgment and ability to treat patients while doing no harm. The term that you will most frequently hear during a claim or lawsuit relating to the duty owed will be the standard of care. The standard of care can best be described as what a reasonable and prudent medical provider would do under the same, or similar, circumstances. The standard of care is established through expert testimony, and experts may disagree on what the standard of care is. Medical providers owe a duty to their patients to follow the applicable standard of care.

2. Breach of Duty

Once the standard of care is determined, the next element is to show that the healthcare provider breached that duty. This might happen if the provider made a mistake, failed to act when they should have, or performed an inappropriate action. Again, experts will play a big role in this part of the case, offering their opinions on if medical provider deviated from the standard of care.

3. Causation 

There must be a direct link between the breach of the standard of care and the alleged harm to the patient. In other words, just because a medical provider made an error, it doesn’t necessarily mean harm was done. The saying “if it isn’t charted, then it didn’t happen” comes to mind. For instance, an expert may testify that the standard of care is to thoroughly document every physical exam, and a medical provider failed to meet the standard of care by not properly documenting a physical exam in the chart note. In this example, the provider and patient both remember and agree that the physical exam took place, and the information obtained was used to reach a correct diagnosis. Even though there is a breach of the standard of care, the failure to chart the physical exam did not cause harm to the patient.

4. Damages

Damages are the final element of a medical negligence claim. The patient must prove they suffered actual damages because of the breach. Damages can be medical bills, physical injuries, emotional distress, or lost wages. These damages typically fall into two categories: 

• Economic Damages: These are tangible amounts that can be calculated such as medical bills and lost wages.
• Non-Economic Damages: These are more subjective and include things like pain and suffering, emotional distress, or loss of companionship (also called “loss of consortium”).

If any of these four elements are not proven, the plaintiff (the person bringing the claim) most likely will not receive compensation. That’s why it’s so important to carefully evaluate each element when a medical negligence claim is made. 

In our next blog, we’ll take a closer look at the legal vocabulary involved in these cases. Much like medical terms can be confusing, legal jargon can be just as tricky for medical providers involved in litigation. Alex Hall, a Senior Claims Consultant with a background as a defense attorney, will help break down some of these terms. 

For even more information about the litigation process, you might want to check out Dr. Gita Pensa’s podcast at this link.  

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