Directed Verdict On Proximate Cause Cannot Be Granted Unless All Reasonable Causes Are Excluded

In the case of Rolando P. Ruiz v. Tenet Hialeah Healthsystem, Inc., Case Number SC17-1562 (Fla. December 20, 2018), a directed verdict in favor of a defendant doctor was reversed by the Florida Supreme Court because a directed verdict is improper unless all potential malpractice has been excluded from causation. In other words, the fact that the defendant doctor’s actions could be found (within reason) to have contributed to the patient’s injury was enough to submit the question of causation to the jury for determination.

Outline Of Facts

Ruiz’s wife (Maria Elena Espinoza) died after suffering a loss of blood pressure during surgery for a large mass that had developed on the back of her head. The alleged malpractice was that the mass was multiple myeloma (instead of an osteosarcoma as pre-operatively diagnosed) and that surgery was the wrong treatment for multiple myeloma. Therefore the argument goes that had the cancer been properly diagnosed then the surgery would never have occurred and Ms. Espinoza would never have died.

The type of cancer that Ms. Espinoza had was not discovered until the autopsy.

With that being said, the cause of Ms. Espinoza’s death was not cancer-it was the surgery itself. Ms. Espinoza had an abnormal EKG in the pre-anesthesia workup with slightly abnormal lab results. The case states that Ms. Espinoza lost a large amount of blood and suffered the fatal drop in blood pressure but does not directly state that anything shown on the EKG or the lab results was a cause of death.

Analysis Required To Grant A Directed Verdict On Causation In Florida Malpractice Cases

Florida’s Third DCA upheld a directed verdict for the physician who allegedly improperly performed the pre-anesthesia workup (Dr. Lorenzo). In Florida, a directed verdict takes the issue away from the jury and is intended to be reserved for cases where there is no reasonable interpretation of the facts that could support a legal result (sort of like when no one believes you when you say that your “dog ate your homework”).

So here’s what the Court said:

To obtain a directed verdict on [causation], [the defendant] must show there is no competent, substantial evidence in the record which would permit a reasonable factfinder to reach such a conclusion at all.

Dr. Lorenzo’s defense was that even if he were negligent in missing something in the pre-anesthesia workup, the patient would have died anyway because it was improper to perform surgery on the type of cancer that Ms. Espinoza had. Therefore, according to Dr. Lorenzo, his conduct was not the “primary cause” of the injury. As indicated by the Florida Supreme Court, this is not the standard.

Instead, the Court stated:

Our medical malpractice jurisprudence makes clear that a physician may be the proximate cause of a patient’s injury even if that physician is not the primary cause of that injury.

The moral of this story is that a directed verdict cannot be granted on causation if there is any reasonable way that the defendant doctor’s negligence contributed or caused (to any degree) the result.

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