Overview & Standards of Care in Medical Malpractice Cases
A lawsuit for medical malpractice is an action for negligently rendered health care. Since medical malpractice suits are based in negligence, a lawsuit must meet all of the traditional elements of a negligence claim. However, within the framework of negligence actions, malpractice claims have their own special standards and problems. This article will address special problems related to the standard of care required of doctors and other health professionals.
A medical malpractice suit must meet all of the standard elements negligence. To prevail on a claim of negligence, a plaintiff must show that the defendant had a duty, breached the duty, the breach was the factual and direct cause of the injury, and that the injury caused damages. Each of these elements has various sub-elements. In many medical malpractice cases, a major issue is the duty the doctor owed to their patients. A duty is the standard of care that one person owes to another, and in most contexts ordinary people owe a duty of reasonable care to others (i.e. to act as a reasonable person under the circumstances).
Physicians and other health care professionals stand in a different position from that of an ordinary person. As a result of the unique relationship that exists between a doctor and patient, the law recognizes an implied or explicit commitment on the part of the doctor to provide a level of care provided by others in the same field. A patient can expect their doctor to have and exercise all of the skill, knowledge, and care normally possessed and exercised by other physicians. This expectation is limited to physicians practicing in the same field. In other words, a cardiologist is held to have and exercise all the skills of a cardiologist, but will not be held to have the knowledge of a neurologist.
The standard of care required of physicians is different from the standards required of ordinary persons. In a claim for negligence, the court must determine whether the conduct of the ordinary person was reasonable. To determine this, the court weighs and balances the risks and utility of the defendant’s conduct. The standard for physicians is whether they acted in conformity with the accepted customs of the relevant medical community. This standard narrows the scope of reasonable conduct, but cuts off liability for harm if custom is followed. So long as the physician was using an accepted or customary practice, method, or treatment, then they will not be liable in negligence for using them even if they are risky or unnecessary. Even if the results of treatment are less than ideal, or even bad, physicians are generally not held liable if they acted according to custom.
Customs and standards in the field of medicine are not wholly uniform. There may be multiple accepted treatments or methods for treating any given health issue. A doctor is operating within customary practice if he or she uses any of the accepted methods or treatments. In other words, if there are multiple customary practices, a physician is not negligent for choosing one over the other– they are free from liability for making such a choice. Under such circumstances, a patient may still have recourse in a legal concept call informed consent. In any event, medical customs are established by expert witness testimony.
It is also important to note that medical custom does not follow geographic boundaries. A doctor in Philadelphia, Pennsylvania is held to the same standard as a doctor in Sacramento, California or Wichita, Kansas. If a doctor in town A undertakes to provide care, he or she does so with an implicit or explicit understanding that they are capable of doing so. If a physician lacks the physical facilities to undertake treatment, or lacks expertise in a field, it is generally the case that a doctor has a duty to refer a patient to a more appropriate physician or facility– though in an emergency this duty may be lessened.
While there are no geographic boundaries on custom, there are boundaries on specialties. A specialist is held to have all the knowledge of all such specialists. In some instances, this can lead to different doctors having quite different duties. A general practitioner is held to the standard of a general practitioner, and chiropractors to another standard altogether. An important point is that a specialist is held to know the limits of their knowledge and to refer patients to other doctors when the treatment required is outside their specialty. This issue can crop up in instances of failures to diagnose. An orthopedist is not required to actually diagnose lung cancer, but may have a duty to refer you to a pulmonologist if he spots abnormalities around your lungs on an x-ray.
There are some exceptions to the medical custom standards. Physicians can be held liable for a failure to follow the instructions provided with pharmaceuticals. Such instructions can be used as evidence of the standard of care required, but it is not always dispositive of the issue. Physicians may sometimes also be held to certain judicial standards. In these cases, judges have assessed the risks and utilities of medical practices and made a determination under the reasonability standard. Where the damages from a lack of treatment can be high and the costs and risks of a test are very low, a court may find failure to perform the test to be negligent. This finding could even be in spite of the prevailing custom to not perform such tests.