Sacramento Medical Malpractice Lawyer Blog

(Please note: the names and locations of all parties have been changed to protect the confidentiality of this medical malpractice case and its proceedings.)

The following four blog entries follow-up the previous two entries from July. These entries address the same issues, but do so from the defense side. By comparing the entries readers should get a good perspective as to how the parties present such issues to the court.

The court then proceeded to apply the substantial factor test to medical malpractice actions. Espinosa determined that causation is satisfied when the plaintiff produces evidence that to a reasonable medical probability, the plaintiff would have obtained a better result absent the defendant's negligence. The court then decided the plaintiff's expert had met that burden. Based upon Espinosa reliance on reasonable medical probability to establish causation in a medical malpractice case, it seem perfectly reasonable, if not necessary, to advise our jury of the specific requirement for medical causation.

Further, Espinosa cites Jones v. Ortho Pharmaceutical Corp. to establish that mere possibility [of causation] alone is insufficient to establish a prima facie case. Id. at 1316, citing Jones, (1985) 163 Cal.App.3d 396. The Espinosa court relied on Jones for the proposition that a possible cause only becomes a probable cause when, in the absence of other reasonable causal explanations, it becomes more likely than no that the injury was a result of a defendant's action. Espinosa, Cal.App.4th 1304, 1316. However, Espinosa distinguished Jones only as to the extent that the Jones court proceeded to apply the 50% factor rule , which is not applicable in general medical malpractice cases. Id. at 1319. As the so-called 50% factor rule is completely irrelevant to the Special Instruction #1 being requested in this matter, the Espinosa court's distinction of Jones is clearly inconsequential, and plaintiffs' mention of it is made purely to distract the court from the issue of a proper jury instruction on medical causation.

Continue reading " Expert Testimony Required In Sacramento Medical Malpractice Case,Part 3 of 4 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of this medical malpractice case and its proceedings.)

The following four blog entries follow-up the previous two entries from July. These entries address the same issues, but do so from the defense side. By comparing the entries readers should get a good perspective as to how the parties present such issues to the court.

ESPINOSA v. LITTLE COMPANY OF MARY HOSPITAL AFFIRMS THE REQUIREMENT THAT CAUSATION BE ESTABLISHED TO A REASONABLE DEGREE OF MEDICAL PROBABILITY IN A MEDICAL MALPRACTICE ACTION

Espinosa specifically applies the substantial factor test to medical malpractice actions, to determine that the element of causation is satisfied when a plaintiff produces evidence to allow the jury to infer that in the absence of the defendant's negligence, there was a reasonable medical probability that the plaintiff would have obtained a better result. Espinosa v. Little Company of Mary Hospital (1995) 31 Cal.App.4th 1304, 1314-5. (Quoting, Alef v. Alta Bates Hospital (1992) 5 Cal.App.4th 208, 216.)

Plaintiff's understanding of Espinosa is entirely misguided. The Espinosa court did not address the issue of how the jury should be instructed regarding causation in a medical malpractice action. Rather, the issue before the court was whether the plaintiff actually presented expert testimony that could satisfy the plaintiff's burden to prove causation to a reasonable medical certainty. In conducting its analysis on that issue, the Espinosa court began its evaluation by expressing support for the language of BAJI 3.76, as used in general negligence cases.

Indeed, only through careful and creative excerpts can the plaintiff manage to imply that Espinosa rejected the use of reasonable medical probability as a jury instruction.

Continue reading " Man From West Sacramento Files Medical Malpractice Action, Part 2 of 4 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of this medical malpractice case and its proceedings.)

The following blog entries follow-up the previous two entries from July. These entries address the same issues, but do so from the defense side. By comparing the entries readers should get a good perspective as to how the parties present such issues to the court.

Defendant's Trial Brief Re: Special Jury Instruction #1

IT IS UNDISPUTED THAT DEFENDANT'S SPECIAL INSTRUCTION #1 IS AN ACCURATE STATEMENT OF THE LAW FOR CAUSATION IN MEDICAL MALPRACTICE

Causation Must Be Proven Within A Reasonable Degree of Medical Probability

The law is well settled that in a personal injury action, causation must be proven within a reasonable medical probability based on competent expert testimony. Jennings v. Palomar (2003) 114 Cal.App.4th 1108, 1118. Defendant's Special Instruction #1 states precisely the test for the jury to evaluate causation: Causation must be proven within a reasonable medical probability based upon competent expert testimony. Defendant's Special Instruction #1 is thus well suited to advise the jury of the requisite standard, since it is a proper and accurate statement of controlling law.

CACI 430 Fails to Apprise the Jury of The Standard of Causation For Medical Malpractice

CACI 430 states in full that:
A substantial factor in causing harm is a factor that a reasonable person would consider to have contributed to the harm. It must be more than a remote or trivial fact. It does not have to be the only cause of harm.

Continue reading " Sacramento Doctors Sued For Malpractice, Part 1 of 4 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of this medical malpractice case and its proceedings.)

IN ESPINOSA v. LITTLE COMPANY OF MARY HOSPITAL, THE SECOND DISTRICT REJECTED ARGUMENTS IDENTICAL TO DEFENDANTS' ARGUMENTS HERE
Included in the Sources and Authorities supporting CACI 430, is a Court of Appeal case from the Second District, Espinosa, which applies the substantial factor standard specifically to a medical malpractice case. As the Honorable Justice Croskey stated in Espinosa, in cases alleging negligence, the proper test for proving causation is the one set out in BAJI no. 3.76 (8th ed. 1994 bound vol.): The law defines cause in its own particular way. A cause of injury, damage, loss of harm is something that is a substantial factor in bringing about an injury, damage, loss or harm. (31 Cal.App.4th at 1313.) CACI 430 restates the substance of BAJI 3.76, in somewhat more plain and understandable language. Defendants ignore this controlling Second District case.

Also in Espinosa, as here, the Defendants relied primarily on Jones v. Ortho Pharmaceutical Corp (1985) 163 Cal.App.3d 396. (Compare, 31 Cal.App.4 th at 1320-1321, with Defendants' Special Instruction # 1.) As the Second District noted, Jones is not a medical malpractice case. (31 Cal.App.4 th at 1320.) Perhaps more importantly, as the Second District also noted, Jones is distinguishable because it concerns causes of cancer which are yet unproven, which causation had to be proven by testimony about the statistical risk or likelihood of brain damage. (31 Cal.App.4th at 1320.) In Jones, as in the present case, causation does not depend on statistical probabilities. As Espinosa, here it also would be error to fail to apply the substantial factor standard of causation.

3. CACI INSTRUCTIONS OTHER THAN CACI 430 INSTRUCT THE JURY ON THE BURDEN OF PROOF AND THE DEGREE OF PROOF
Defendants seek to supplement CACI 430 apparently because it does not require that Plaintiffs establish causation to a reasonable degree of medical probability. To the contrary, reasonable medical probability means more likely than not. (See, Espinosa v. Little Company of Mary Hospital, supra, 31 Cal.App.4th at 1316.)

CACI instruction no. 400, with medical added before negligence as required by CACI Instruction no. 500, instructs the jury that the Plaintiff must prove the elements of medical negligence, including causation. CACI instruction no. 200 instructs the jury on the requisite degree of proof to establish the elements of the negligence cause of action. Therefore, together CACI nos. 200 and 400 [as modified by 500] instruct the jury that Plaintiff must prove the elements of his case, including causation, by the more likely than not standard. An additional instruction on this same issue, stated in legalese ( reasonable medical probability ) rather than plain language ( more likely to be true than not true ), would place undue emphasis on Plaintiffs burden and confuse the jury.

4. CONCLUSION
For the foregoing reasons, Plaintiff respectfully requests that the court refuse Defendants' special instruction # 1.

Continue reading " Sacramento-Area Hospital Sued For Medical Malpractice, Part 2 of 2 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of this medical malpractice case and its proceedings.)

Plaintiff's Trial Brief Re: CACI 430
MEMORANDUM OF POINTS AND AUTHORITIES

SUMMARY OF ARGUMENT
Defendants propose Special Jury Instruction # 1 based on the argument that CACI 430 is incomplete because it does not instruct on reasonable medical probability. To the contrary, in the Sources and Authority listed under CACI Instruction No. 430 ( CACI 430 ), the authors of the jury instruction list Espinosa v. Little Company of Mary Hospital (1995) 31 Cal.App.4th 1304, 1313-1314 ( Espinosa ), a medical malpractice case. In Espinosa, the Second District Court of Appeal ( Second District ) considered, and rejected, arguments identical to those made now by Defendants. This court should reject those arguments as well under the authority and reasoning of Espinosa, particularly as they apply to this personal injury matter.

Further, other CACI jury instructions cover the burden of proof and the degree of proof. Reasonable medical probability means more likely than not. (See, Espinosa, supra, 31 Cal.App.4th at 1316.) CACI instruction no. 400, modified by adding medical under CACI Instruction no. 500, already instructs the jury that the Plaintiff must prove the elements of medical negligence, including causation. CACI instruction no. 200 already instructs the jury on the requisite degree of proof.

Continue reading " Medical Malpractice Claim Filed By Sacramento Family, Part 1 of 2 " »