$15 million verdict in medical negligence lawsuit demonstrates challenge of proving causation

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On July 12, 2013, a judge awarded $15 million verdict to the family of a young child with permanent brain damage after she suffered cardiac arrest caused by using a decongestant suggested by a University of Washington physician. This case is tragic from a human standpoint yet fascinating from a legal one, as it contains some of the most challenging components that can occur not only in a medical malpractice suit but any case involving catastrophic injuries such as this.

First, the doctor’s conduct at issue here appears at first to be relatively harmless.  The mother of a young child with a heart condition calls and asks if she can give her child an over-the-counter decongestant.  The doctor consults with a cardiologist, who tells the doctor that the medication is not safe, but the wires get crossed somehow and the doctor tells the girl’s mother that it is ok to give her the medication.  While the doctor did make a mistake, this medication is not a powerful prescription drug but rather a cold remedy available at any store.  This small mistake, one that could have been avoided with just a few moments of additional reflection, led to the tragic injuries to this young girl.

Another issue raised by this case relates to the girl’s heart condition.  Typically, an over-the counter decongestant does not lead to heart failure in healthy young people.  The young girl here had undergone a heart transplant as an infant, and thus suffered from compromised cardiac function.  However, the law requires that when someone makes a mistake, they must acknowledge the plaintiff’s health condition as it is.  This is often referred to as the “eggshell plaintiff” doctrine.  Even if the injured party is particularly susceptible to injury, the defendant is responsible for the entire injury that resulted from their conduct.

However, the crux of the issue in this case was not the girl’s cardiac condition, nor the doctor’s mistakes.  Nearly every serious injury case involves issues of causation, that is to say, whether the negligent conduct was the cause of the injury.  Likely neither side argued that the girl had an existing heart condition, or that the doctor made an error in giving her a decongestant with known cardiac side effects.  The issue was instead was causation, whether the decongestant caused the heart attack leading to the girl’s coma, or if she would have suffered heart failure in any event.

Unsurprisingly, both sides hired doctors to generate expert opinions regarding causation.  As one might imagine, these opinions often track the opinions of the party hiring them.  In this case, it was likely as simple as the proximity of the girl’s ingestion of the drug with the cardiac event, which tipped the scales and led the judge to award damages to this young child for the care and medical support she will need her entire life. The case will also likely prompt new procedures that improve communications between medical personnel, in the hopes of preventing a preventable tragedy such as this one.