Medical malpractice occurs when a physician fails to observe a commonly accepted "standard of care" and that failure is the "proximate cause" of a subsequent injury sustained by the patient. The question of causation is normally decided by a jury. If a plaintiff fails to provide any evidence of either element--breach of standard of care or causation--a judge will not allow a malpractice case to go to the jury. However, judges must also be careful not to cavalierly dismiss cases, as a recent decision from the Georgia Court of Appeals illustrates.
Moore v. Singh
Rosemary Moore was a diabetic who died in 2010 from renal disease. In December 2008, Moore fell in her home and injured her knee. The emergency department at Henry Medical Center diagnosed her with a knee sprain. Moore could not stand or walk, but she was released.
Unfortunately, the next day Moore was found unresponsive in her bed. She returned to Henry Medical Center, where Dr. Sonu Singh, the attending physician for renal patients, assumed control of Moore's care. Singh treated Moore in the hospital for approximately two weeks.
While Singh treated Moore for complications related to her diabetes, no further action was taken regarding Moore's knee or leg, in spite of the fact she was still in pain and could not walk. At no point did Singh order any follow-up examination of Moore's leg such as a CT scan or an MRI.
More than two months after Moore's hospital discharge, another doctor examined and discovered it had been fractured and displaced. In April 2009, an orthopedic surgeon had to operate, re-breaking and resetting the leg in its correct position.
Moore--and following her death, her estate--sued Singh for malpractice. They claimed she failed to discover and treat the leg fracture back in December 2008, and that failure led to complications that made the subsequent surgery necessary. At trial, Moore's estate presented expert testimony that Moore breached the applicable standard of care by failing to order any follow-up tests on the injured leg. The second physician who treated Moore also testified that the fracture "was at least six weeks old" when he saw it in February 2009 and that it was unlikely it occurred before Moore's first visit to the emergency room back in December 2008.
Despite this evidence, the trial judge granted Singh's motion for a directed verdict. A directed verdict means the judge believes that all of the evidence introduced requires a judgment for the defendant. Here, the judge said there was no evidence of either a breach
in the standard of care or causation.
The Court of Appeals disagreed. Presiding Judge Sara L. Doyle, writing for the appeals court, said that a directed verdict can only be justified when the evidence only leads to one conclusion. That was not the case here. Judge Doyle said the "combined expert testimony" presented by the plaintiff "presented evidence creating a jury issue as to whether Dr. Singh would have discovered the fracture if she had properly complied with the standard of care during the examination of Rosemary during her hospitalization."