Arizona Supreme Court Limits When Juries Are Allowed to Infer Causation in Medical Malpractice Claims

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It is now a little easier for healthcare providers to defend against medical malpractice claims. Last month, in Sampson v. Surgery Ctr. of Peoria, LLC, the Arizona Supreme Court held:

If the cause of a patient’s death is (1) “disputed” and (2) “not obvious to an ordinary person” . . .

Then a “jury in a medical malpractice case may not be left to ‘infer’ causation without the guidance of expert testimony.”

At least, this is how the Court stated its holding in the first paragraph of its opinion. In the discussion that followed, the Court arguably held even more.

Whether the plaintiff needed to present expert causation testimony was not actually at issue—the plaintiff had presented expert causation testimony. The issue was whether the expert causation testimony that the plaintiff presented was sufficient. The plaintiff’s expert had opined that the defendant’s surgery center did not observe the decedent long enough after he came out of surgery and that a longer observation “could have” allowed the surgery center to resuscitate him.

The Court held that this was an insufficient basis from which a jury could infer, as required, that a longer observation “probably” would have allowed the surgery center to resuscitate the decedent because it was not even clear what caused the decedent to stop breathing in the first place. An autopsy report stated the underlying cause of death was a “‘disseminated Strep Group A infection,” but the plaintiff’s expert testified that it was a “‘swollen and obstructed upper airway’ combined with his inability ‘to breath from the after-effects of surgery and anesthesia.’” Under these circumstances, the Court reasoned, a jury is not competent to infer that the defendant’s failure to observe the decedent longer “caused his death by starting a natural and continuous sequence of events, unbroken by any intervening causes.”

In sum, the Court’s case-dispositive holding can be restated as follows:

If (1) the underlying cause of a patient’s death is disputed by experts and (2) the plaintiff’s expert can only say that a non-negligent intervention “could have” prevented the death

Then (1) a jury should not be allowed to speculate whether a non-negligent intervention “probably” would have prevented the death, and (2) the plaintiff’s medical malpractice claim must fail.

What Is Next

 Not only did the Supreme Court hold more than its preliminary statement said it held, the Court also provided ample dicta indicating that the Court’s intolerance for equivocal expert testimony extends to the standard-of-care element and to other injuries short of death.  When those facts inevitably come at issue in future cases, lower courts are unlikely to find a principled reason not to extend the Sampson holding to them.

What is less clear, however, is what this case means for the Arizona Supreme Court’s 1984 decision in Thompson v. Sun City Community Hosp. Inc., which held that “even if the evidence permits only a finding that the defendant’s negligence increased the risk of harm or deprived plaintiff of some significant chance of survival or better recovery, it is left for the jury to decide whether there is a probability that defendant’s negligence was a cause in fact of the injury.”  The Court in Sampson did not so much as mention Thompson, let alone explain how it intended to reconcile the two holdings.

This will likely be the issue of a future appeal.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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