In its opinion dated March 27, 2015, the Supreme Court of the State of Kansas (“Kansas Supreme Court”) had to decide whether the Kansas medical malpractice plaintiff had provided sufficient evidence of causation to survive summary judgment in a case where it was alleged that the defendant radiologist’s negligent diagnosis caused a patient’s death. The Kansas Supreme Court affirmed the lower courts’ determination that the plaintiff had not.
The Underlying Facts
On August 23, 2007, a man went to a local Kansas hospital Emergency Department with complaints of abdominal pain and a history of nausea and dry heaving. The man had CT scans of his abdomen, pelvis, and chest, which were sent to the defendant radiologist for reading and interpretation. The defendant radiologist gave a verbal report to a physician assistant (“PA”) and later dictated a written report. The defendant radiologist’s written report, however, never was provided to the man’s subsequent treating physician.
The PA’s written notes regarding the defendant radiologist’s verbal report stated that the defendant radiologist suspected that the man had an obstructive process of the gallbladder. The PA referred the man to a surgeon at another hospital, based on the verbal report that the PA had received from the defendant radiologist. The man’s CT scans accompanied the man when he was transferred to the regional hospital.
The surgeon claimed that the only thing he was told about the defendant radiologist’s interpretation of the CT scans was that the man had an enlarged gallbladder, “funny-shaped” liver, and an absent spleen. The surgeon’s resident took the CT scans to an unidentified radiologist in the regional hospital’s radiology department, where the CT scans were allegedly read as showing a mild distention of the gallbladder, no stones, a congenital abnormally shaped liver, and no evidence of small bowel obstruction.
The surgeon alleged that he personally reviewed the CT scans himself and also reviewed the CT scans with another unidentified radiologist at the regional hospital. The surgeon’s impression from the CT scans was that they showed a “dilated gallbladder without evidence for acute inflammatory change. Abnormal shape of liver—etiology unknown. Surgical absence of spleen.”
The man died at the regional hospital shortly after arrival. An autopsy found an intrahepatic hematoma with adjacent hepatic tissue damage. The cause of death was determined to be an acute intra-abdominal bleed with associated hemodynamic and cardiac instability.
The man’s widow subsequently filed a Kansas medical malpractice case against the original radiologist, the surgeon, the regional hospital, and other physicians. With regard to the defendant radiologist, the plaintiff alleged that he had failed to describe the abnormal density of the gallbladder, failed to report a potential diagnosis of a gallbladder containing a large hematoma, and failed to report possible free extravasation of contrast.
The defendant radiologist moved for summary judgment, arguing that the plaintiff had failed to establish causation in fact based on two missing links in the causal chain: (1) the treating physicians at the regional hospital never relied on his allegedly negligent evaluation of the CT scans; and (2) but for the allegedly incorrect diagnosis by the defendant radiologist, the patient’s death would not have occurred.
The trial court entered summary judgment in favor of the defendant radiologist, and the lower appellate court affirmed that decision.
The Kansas Supreme Court Decision
The Kansas Supreme Court stated that in order to prevail in a medical malpractice claim, a plaintiff must establish: (1) The health care provider owed the patient a duty of care and was required to meet or exceed a certain standard of care to protect the patient from injury; (2) the provider breached this duty or deviated from the applicable standard of care; (3) the patient was injured; and (4) the injury proximately resulted from the breach of the standard of care. The proximate cause element is defined as a cause that in natural and continuous sequence, unbroken by an efficient intervening cause, produces the injury and without which the injury would not have occurred, the injury being the natural and probable consequence of the wrongful act.
The Kansas Supreme Court noted that there are two components of proximate cause: causation in fact and legal causation. To establish causation in fact, a plaintiff must prove a cause-and-effect relationship between a defendant’s conduct and the plaintiff’s loss by presenting sufficient evidence from which a jury can conclude that more likely than not, but for the defendant’s conduct, the plaintiff’s injuries would not have occurred. To prove legal causation, the plaintiff must show it was foreseeable that the defendant’s conduct might create a risk of harm to the victim and that the result of that conduct and contributing causes was foreseeable.
The Kansas Supreme Court stated that the plaintiff needed expert medical opinion testimony to show there was a treatment approach that would have prevented the man’s death and tie the failure to pursue that approach to the defendant radiologist’s allegedly negligent CT scan evaluation. The Kansas Supreme Court held that the plaintiff’s medical expert did not identify the life-saving interventions, and, more importantly, did not explain how those interventions would have been effective in saving the man’s life. Furthermore, the plaintiff failed to show that the treating physicians relied on the defendant radiologist’s read of the CT scans.
The Kansas Supreme Court affirmed the lower courts’ decisions, holding that the facts as set out on summary judgment demonstrate that the plaintiff failed to establish causation, an essential element of plaintiff’s medical malpractice claim, by failing to come forward with evidence that the patient would not have died but for the defendant radiologist’s alleged breach of the standard of care.
Source Drouhard-Nordhus v. Neil Rosenquist, M.D., et al., No. 108,859.
If you have suffered serious injury or other harm that may be due to medical negligence that occurred in Kansas, you should promptly find a Kansas medical malpractice lawyer who may investigate your medical malpractice claim for you and represent you in a Kansas medical malpractice case, if appropriate.
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